Risk of Stillbirth in Women with Gestational Diabetes and High Blood Pressure.

BACKGROUND: Both Gestational diabetes and hypertension almost affect 10.5% of the pregnancies. This study was conducted to investigate and compare the pregnancy outcomes in women with gestational diabetes or high blood pressure with outcomes belonging to healthy mothers. METHODS: This population-based case-control study was conducted in 8 provinces and two cities of Iran on women referred to the public health centers during 2015 to 2018. Descriptive statistics for variables presented by percentages and frequencies and logistic regression analysis was used to analyze data at a significance level of less than 0.05. RESULTS: Some variables such as ethnicity, maternal education and age, gestational diabetes, high blood pressure and previous pregnancy outcome were significantly associated with stillbirth. Maternal age greater than 35 yr (OR=1.78, CI: 1.29-2.48), maternal illiteracy (OR=3.67, CI: 2.25-5.98), a previous stillbirth (OR=9.92, CI: 4.98-19.78), gestational diabetes among women who had never had a screening test (OR =3.91, CI: 2.96-5.18) and high blood pressure (OR =1.95, CI: 1.38-2.77) were important factors associated with stillbirth. Maternal and paternal occupation, paternal education and age, place of residence, smoking and maternal BMI were significantly associated with stillbirth. CONCLUSION: Gestational diabetes, hypertension, a previous miscarriage, stillbirth, first pregnancy, low education level, advanced maternal age and ethnicity were associated with an increased risk of stillbirth. It is necessary to provide high-quality healthcare services before and during pregnancy particularly for those at heightened risk and improve knowledge of mothers on the side effects of each of the mentioned risk factors in order to control these factors more effectively and thus reducing the risk of stillbirth.

The Correlation Between Bladder Cancer and Obesity, Overweight, Physical Inactivity, and Tobacco Use: An Ecological Study in Asian Countries.

BACKGROUND: Bladder cancer is the ninth most common cancer in the world. OBJECTIVES: This study aimed to determine the correlation between age-standardized incidence rates of bladder cancer and some risk factors in Asian countries through an extensive ecological analysis. METHODS: This ecological study evaluated the correlation between age-standardized incidence rates of bladder cancer and obesity, overweight, physical inactivity, and tobacco use in 30 Asian countries. To determine the factors that were significantly related to age-standardized incidence rate of bladder cancer, a univariate analysis was performed using simple linear regression. In the next step, variables with p-values less than 0.25 were entered into a multivariate linear regression model. RESULTS: The incidence of bladder cancer was higher in countries with higher prevalence of overweight (r2 = 0.36, p < 0.001), obesity (r2 = 0.34, p = 0.001), current daily tobacco use (r2 = 0.17, p = 0.03), and physical inactivity (r2 = 0.13, p = 0.04). The results of multiple regression analysis indicated a direct correlation between the incidence of bladder cancer and overweight (ß = 0.15, p < 0.001) and current daily tobacco use (ß = 0.21, p = 0.001). CONCLUSIONS: There was a significant relationship between the incidence of bladder cancer and overweight and current daily tobacco use. Further epidemiological studies are needed to confirm this relationship.

Assessing the risk factors before pregnancy of preterm births in Iran: a population-based case-control study.

BACKGROUND: Preterm birth is a major cause of prenatal and postnatal mortality particularly in developing countries. This study investigated the maternal risk factors associated with the risk of preterm birth. METHODS: A population-based case-control study was conducted in several provinces of Iran on 2463 mothers referred to health care centers. Appropriate descriptive and analytical statistical methods were used to evaluate the association between maternal risk factors and the risk of preterm birth. All tests were two-sided, and P values < 0.05 were considered to be statistically significant. RESULTS: The mean gestational age was 31.5 ± 4.03 vs. 38.8 ± 1.06 weeks in the case and control groups, respectively. Multivariate regression analysis showed a statistically significant association between preterm birth and mother's age and ethnicity. Women of Balooch ethnicity and age ≥ 35 years were significantly more likely to develop preterm birth (OR: 1.64; 95% CI: 1.01--2.44 and OR: 9.72; 95% CI: 3.07-30.78, respectively). However, no statistically significant association was observed between preterm birth and mother's place of residence, level of education, past history of cesarean section, and BMI. CONCLUSION: Despite technological advances in the health care system, preterm birth still remains a major concern for health officials. Providing appropriate perinatal health care services as well as raising the awareness of pregnant women, especially for high-risk groups, can reduce the proportion of preventable preterm births.

Mediators in the Relationship between Internet Addiction and Body Mass Index: A Path Model Approach Using Partial Least Square.

BACKGROUND: Adolescence obesity has now become an epidemic. In recent years, Internet addiction has been identified as a risk factor for obesity. We aimed to evaluate the role of some mediators such as sleep quality, physical activity and fast food consumption in the relation between internet addiction and Body Mass Index (BMI) among adolescents. STUDY DESIGN: A cross-sectional study. METHODS: Overall, 928 students, aged between 13 and 17 yr, were randomly selected in Behbahan, southwestern Iran from Oct 2017 to Dec 2017. Data were collected using a demographic survey, Young's internet addiction, Pittsburgh sleep quality, and food frequency, questionnaires. Data analysis was performed using Partial Least Squares (PLS) path analysis. RESULTS: PLS path analysis revealed that the direct effect of Internet addiction on BMI was (Path Coefficient = 0.16, [95% CI: 0.12- 0.21]). Moreover, the indirect effect of internet addiction on BMI through sleep quality was (f2 = 0.12 (P<0.001)), physical activity (f2 =0.04 (P<0.001)), and fast food consumption ( f2 = 0.05 (P<0.001)). CONCLUSIONS: Results of this study regarding the relationship between internet addiction and BMI and the effect of this phenomenon on sleep quality, physical activity and dietary habits suggest planning prevention and treatment programs to reduce the prevalence of this phenomenon in schools.

Characteristics and health effects of BTEX in a hot spot for urban pollution.

This study reports a spatiotemporal characterization of toluene, benzene, ethylbenzene, and xylenes concentrations (BTEX) in an urban hot spot in Iran, specifically at an bus terminal region in Shiraz. Sampling was carried out according to NIOSH Compendium Method 1501. The inverse distance weighting (IDW) method was applied for spatial mapping. The Monte Carlo simulation technique was applied to evaluate carcinogenic and non-carcinogenic risk owing to BTEX exposure. The highest average BTEX concentrations were observed for benzene in the morning (at 7:00-9:00 A.M. local time) (26.15 ±â€¯17.65 µg/m3) and evening (at 6:00-8:00 P.M. local time) (34.44 ±â€¯15.63 µg/m3). The benzene to toluene ratios in the morning and evening were 2.02 and 3.07, respectively. The main sources of BTEX were gas stations and a municipal solid waste transfer station. The inhalation lifetime cancer risk (LTCR) for benzene in the morning and evening were 1.96 × 10-4 and 2.49 × 10-4, respectively, which exceeds the recommended value by US EPA and WHO. The hazard quotient (HQ) of all these pollutants was less than 1. The results of this work have implications for public health near 'hot spots' such as IKBT where large populations are exposed to carcinogenic emissions.

Cigarette smoking patterns in relation to religiosity and familial support among Iranian university students: A Latent Class Analysis.

INTRODUCTION: Entering University is an important developmental milestone that might be associated with cigarette smoking. The aim of this study was to identify the subgroups of university students on the basis of cigarette smoking patterns, and to assess the role of familial support and religious beliefs on membership in specific subgroups. METHODS: This cross-sectional study was performed in 2016 using multistage random sampling among students of Bushehr University (n=977). Anonymous, structured questionnaires were distributed to the students in each selected class. Cigarette smoking prevalence was assessed in three time intervals: lifetime, last year, and last month. All of the analyses were performed using PROC LCA in the SAS software. RESULTS: The lifetime, last-year and last-month prevalence of cigarette smoking was 13.7%, 10.0% and 7.0%, respectively. In this study, the prevalence of passive smoking was relatively high (15.3%) among students. Four latent classes were identified: 1) non-smoker 58.2%, 2) passive smoker 31.3%, 3) moderate smoker 3.4%, and 4) heavy smoker 7.1%. The prevalence of cigarette smoking of close friends was: 73% among passive smokers, 81% for heavy smokers and 63% for moderate smokers. Being male (OR=4.42, 95% CI; 2.90-6.74) and a higher score of religious beliefs (OR=0.97, p<0.001 95% CI; 0.96-0.98) were associated with the heavy smoker class. CONCLUSIONS: Among students at Bushehr University in Iran, 10.5% were either moderate or heavy smokers in 2016. These results point out the critical importance of designing specific preventive interventional programs for university students. Higher level of religiosity may serve as a preventive factor in engaging in cigarette smoking.

Study on nutritional monitoring of Persian malnourished school students: A check on reproducibility and validity of questionnaire.

AIM: To develop a nutritional screening tool and examine its reliability and validity in elementary school children with malnutrition based on PRECEDE-PROCEED model, in Shiraz, Iran. METHODS: A questionnaire was designed and its reproducibility was analysed via test-retest design among students with malnutrition. The students were in the fourth to sixth grades. Validity was assessed using face validity, content validity, construct validity, item difficulty and item discrimination. Reliability was measured by Cronbach's alpha (internal consistency), the intra-class correlation coefficient (ICC) and κ statistics (test-retest reliability). RESULTS: A total of 165 primary school students (mean age of 11.21 ± 1.08 years, 65.5% females) participated in the study. The PRECEDE-PROCEED theoretical model for health education was adapted for this questionnaire. The questionnaire was divided into four main sections: predisposing, reinforcing, enabling factors and behaviour. Coefficient α reliability estimate was above 0.9 for most scales. The ICCs for different scales of the questionnaire were within the range of 0.402-0.800. Values for κ ranged from 0.412 to 0.785 for most scales. CONCLUSIONS: The results showed reasonable validity, excellent reliability and moderate to substantial reproducibility for all scales of the questionnaire except two questions for κ statistics. The present study is of great importance, as there are no psychometrically evaluated tools (based on health behaviour models) with accepted validity and reliability for the evaluation of such factors in children with malnutrition. The questionnaire developed in the present study can be used to assess the effect of intervention among primary school students with malnutrition.

Forecasting the number of zoonotic cutaneous leishmaniasis cases in south of Fars province, Iran using seasonal ARIMA time series method.

OBJECTIVE: To predict the trend of cutaneous leishmaniasis and assess the relationship between the disease trend and weather variables in south of Fars province using Seasonal Autoregressive Integrated Moving Average (SARIMA) model. METHODS: The trend of cutaneous leishmaniasis was predicted using Mini tab software and SARIMA model. Besides, information about the disease and weather conditions was collected monthly based on time series design during January 2010 to March 2016. Moreover, various SARIMA models were assessed and the best one was selected. Then, the model's fitness was evaluated based on normality of the residuals' distribution, correspondence between the fitted and real amounts, and calculation of Akaike Information Criteria (AIC) and Bayesian Information Criteria (BIC). RESULTS: The study results indicated that SARIMA model (4,1,4)(0,1,0)(12) in general and SARIMA model (4,1,4)(0,1,1)(12) in below and above 15 years age groups could appropriately predict the disease trend in the study area. Moreover, temperature with a three-month delay (lag3) increased the disease trend, rainfall with a four-month delay (lag4) decreased the disease trend, and rainfall with a nine-month delay (lag9) increased the disease trend. CONCLUSIONS: Based on the results, leishmaniasis follows a descending trend in the study area in case drought condition continues, SARIMA models can suitably measure the disease trend, and the disease follows a seasonal trend.

Effect of Low Glycemic Index Diet Versus Metformin on Metabolic Syndrome.

BACKGROUND: Metabolic syndrome (MetS) continues to be highly prevalent and contributes to a rapidly growing problem worldwide. The most important therapeutic intervention for metabolic syndrome is diet modification, an intervention whose efficacy has been proven for metabolic syndrome. OBJECTIVES: The aim of the present study was to compare the effects of low glycemic index diet versus metformin on MetS components in adults with MetS. PATIENTS AND METHODS: Fifty-one adults with MetS participated in this randomized controlled clinical trial. Patients were randomly allocated to two groups of metformin and low glycemic index diet. The intervention period was eight weeks. The studied participants were compared at baseline and the end of the trial, regarding the following factors: weight, blood pressure, waist circumference, fasting blood sugar, hemoglobin A1c and lipid profiles (Triglyceride (TG), Total Cholesterol (TC), Low-Density Lipoprotein (LDL) cholesterol, and High-Density Lipoprotein (HDL) cholesterol). RESULTS: The anthropometric measurements, Fasting Blood Sugar (FBS), Hemoglobin A1c, serum lipid profiles (TG, TC, LDL-C, HDL-C) and lipoprotein ratio (LDL/HDL) showed a significant decrease after the intervention in both groups (P < 0.05). Comparison of the difference between the two groups was not significant, except for the mean reduction in FBS, which was more in the metformin group although this was not clinically significant. CONCLUSIONS: This study supports the assumption that low glycemic index diet as well as metformin can positively affect metabolic syndrome components.

Analysis of survival data in thalassemia patients in Shiraz, Iran.

OBJECTIVES: The survival rate of thalassemia patients has not been conclusively established, and the factors associated with survival remain unclear. This study aimed to determine the survival rate of thalassemia among patients in southern Iran and to identify the factors associated with mortality from thalassemia. METHODS: This retrospective cohort study was conducted based on a retrospective review of the medical records of 911 beta-thalassemia patients in 2014. Data analysis was conducted using the Kaplan-Meier method and Cox regression analysis. RESULTS: Overall, 212 patients (23.3%) died, and 26.8% had thalassemia intermedia. The 20-year, 40-year, and 60-year survival rates were 85%, 63%, and 54%, respectively. Both crude and adjusted analyses found that education, marital status, ferritin levels, and comorbidities were related to mortality. CONCLUSIONS: Sociodemographic and hematological factors were found to be significantly associated with the survival rate of thalassemia. Addressing these factors may help healthcare providers and physicians to provide the best possible care and to improve the survival rate.

Impact of media literacy education on knowledge and behavioral intention of adolescents in dealing with media messages according to Stages of Change.

INTRODUCTION: Mass media influence the health behaviors of adolescents. Evidence shows that traditional strategies such as censorship or limitation are no longer efficient; therefore, teaching media literacy is the best way to protect adolescents from harmful effects. The aim of this pilot study was to evaluate the effects of a media literacy training program on knowledge and behavioral intention of a sample of female students according to the stages of change in dealing with media messages. METHODS: The study was conducted based on a pre-test and post-test control group design. Some 198 female students including 101 in the intervention group and 97 in the control group participated in this study. The educational program was run using interactive teaching-learning techniques. Data collection was performed using a validated and reliable self-administered questionnaire in three phases including a pre-test, post-test, 1 and post-test, 2. The research data was analyzed through SPSS statistical software, version 14 using both descriptive and inferential statistics. RESULTS: The results of the study showed a significant increase (p=0.001) in the intervention group's knowledge mean scores after the training program. On the other hand, the difference was not significant in the control group (p=0.200). A considerable percentage of the participants, in the intervention and control groups, were in pre contemplation and contemplation stages in the pre-test (64 and 61, respectively). After the intervention, however, a significant improvement (p=0.001) was observed in the intervention group's stages of change compared to that in the control group. The distribution of the control group students regarding the stages of change was similar to that in the pre-test. CONCLUSION: The study findings revealed that the planned education programs are efficient to improve the adolescents' knowledge and behavioral intention in dealing with mass media messages.

Effect of a parenting education program on girls' life satisfaction in governmental guidance schools of Shiraz.

INTRODUCTION: One of the main determinants of adolescents' life satisfaction is parenting skills. Due to the lack of educational trials in this field, this research was done to evaluate the effect of a parenting education program on girls' life satisfaction in governmental guidance schools of Shiraz.  METHODS: This study is an educational randomized controlled trial. At first, 152 female students in 2nd grade of governmental guidance schools and 304 parents (152 mother and 152 father) were selected by multistage random cluster sampling method. Then, they were categorized into experimental and control groups. Before and after the intervention, data were collected from two groups using multidimensional students' life satisfaction scale with stability (Cronbach's alpha=0.89), test-retest and correlation coefficient (r=0.70). Educational intervention for parents was performed in the experimental group through presentations with question and answer, discussion in small groups and distribution of educational booklets in 5 volumes. Finally, the data were analyzed using SPSS 14 and through Mann-Whitney test, Chi-square test, Fisher's Exact test, Wilcoxon test. RESULTS: Before the intervention, the experimental and control groups did not show a statistically significant difference based on the demographic variables. Thetotal of life satisfaction scores and also its subscales in the experimental and controlgroup, before and six weeks afterthe educational interventiondid showstatisticallysignificant difference (p<0.001). The scores of differences (pre-test/post-test) in total life satisfaction between the experimental and control groups were statistically significant difference (p<0.001). CONCLUSION: According to low scores of the students in the pre-test, especially in the control group which didn't undergo any educational program, holding scheduled educational intervention is necessary. This study not only supports the effectiveness of educational intervention but also recommends further educational research to develop knowledge regarding patterns of parenting education.

The effects of a peer-led training program on female students' self-esteem in public secondary schools in Shiraz.

INTRODUCTION: Low self-esteem in adolescence is one of the risk factors for negative outcomes in important domains of adulthood life. Due to the lack of trials based on modern methods of teaching in the field of self-esteem, this study aimed to investigate the effects of a peer-led training program on female second graders' self-esteem in public secondary schools in Shiraz. METHODS: The present study is an educational controlled trial. 223 public school female students in the second grade were selected with the Multi-stage random cluster sampling method. The selected Schools were assigned randomly to experimental and control groups. The data were collected before, one and six weeks after an intervention in the control and experimental group, using Pope's 5-scale test of self-esteem with Cronbach's alpha reliability of 0.85. The educational intervention in the experimental group was a peer-led approach, using discussion techniques in small groups (the group work, role play and group play) and a 5-volume training manual. The data were analyzed through SPSS, version 14, using Mann-Whitney test, Chi-square test, Wilcoxon and repeated measure Analysis of Variance (ANOVA). RESULTS: The results showed that the mean of total self-esteem scores and the sub-scales (except for family self-esteem) in the experimental groups compared to that in the control groups, one and six weeks after the peer-led based approach intervention was significantly different (p<0.001). Before the intervention, the mean for self-esteem in the experimental groups was 51.80±13.91 but in the first post-test and second post-test the mean increased to 73.72±12.94, and 69.48±12.63, respectively. Before the educational intervention, the frequency distribution of females' self-esteem in the experimental and control groups did not differ significantly from each other (p=0.337). But during one and six weeks after the intervention, a significant increase was observed between the two groups (p<0.001). CONCLUSION: The results of this study suggest that peer education is an effective way to promote self-esteem in adolescents. Providing opportunities such as a peer-led approach can help adolescents to acquire practical ways to increase their self-esteem.

Effects of "vitex agnus castus" extract and magnesium supplementation, alone and in combination, on osteogenic and angiogenic factors and fracture healing in women with long bone fracture.

BACKGROUND: The purpose of this study was to investigate the effects of the combination of vitex agnus castus extract, as a source of phytoestrogens, plus magnesium supplementation on osteogenic and angiogenic factors and callus formation in women with long bone fracture. MATERIAL AND METHODS: In a double-blind randomized placebo controlled trial, 64 women with long bone fracture, 20-45 years old, were randomly allocated to receive 1) one Agnugol tablet (4 mg dried fruit extract of vitex agnus castus) plus 250 mg magnesium oxide (VAC + Mg group (n = 10)), 2) one Agnugol tablet plus placebo (VAC group (n = 15)), 3) placebo plus 250 mg magnesium oxide (Mg group (n = 12)), or 4) placebo plus placebo (placebo group (n = 14)) per day for 8 weeks. At baseline and endpoint of the trial, serum alkaline phosphatase, osteocalcin, and vascular endothelial growth factor (VEGF) were measured together with radiological bone assessment. RESULTS: There were no significant differences in the characteristic aspects of concern between the four groups at baseline. Despite the increased level of alkaline phosphatase in the VAC group (188.33 ± 16.27 to 240.40 ± 21.49, P = 0.05), administration of VAC + Mg could not increase alkaline phosphatase activity. However, treatment with VAC + Mg significantly enhanced the osteocalcin level. The serum concentration of VEGF was increased in the VAC group (269.04 ± 116.63 to 640.03 ± 240.16, P < 0.05). Callus formation in the VAC + Mg group was higher than the other groups but the differences between the four groups were not significant (P = 0.39). No relevant side effect was observed in patients in each group. CONCLUSION: Our results suggest that administration of vitex agnus castus plus magnesium may promote fracture healing. However, more studies need to further explore the roles of vitex agnus castus in fracture repair processes.

Association between Tumor Necrosis Factor- α-308 G/A Polymorphism and Multiple Sclerosis: A Systematic Review and Meta-Analysis.

Multiple sclerosis (MS) is a complex polygenic disease in which gene-environment interactions are important. A number of studies have investigated the association between tumor necrosis factor-α (TNF-α) -308 G/A polymorphism (substitution G→A, designated as TNF1 and TNF2) and MS susceptibility in different populations, but the results of individual studies have been inconsistent. Therefore, performing a systematic review and meta-analysis of the published studies is desirable. We sought to quantitatively summarize the association between TNF-α-308 G/A polymorphism and MS. The Medline and Scopus databases were searched to identify potentially relevant case-control studies published in English journals up to January 2010. A meta-analysis of these studies was performed. Summary odds ratios (ORs) and 95% confidence intervals (CIs) were calculated under fixed and random effects models. Twenty-one eligible studies, comprising 2880 patients with MS and 3579 controls, were included in the meta-analysis. The overall pooled ORs (95%CI) for TNF2 versus TNF1 and TNF2 carriers (2/2+2/1) versus non-carriers (1/1) were 1.02 (0.86-1.21) and 0.99 (0.8-1.24), respectively. In the European populations, the pooled ORs (95%CI) for TNF 2/1 versus 1/1 were 0.85 (0.73-0.98), which was statistically significant. However, the other results did not support this finding. The pooled ORs (95%CI) for TNF 2/1 versus 1/1 and TNF 2/2 versus 2/1 were not statistically significant in the overall population. In addition, the pooled ORs for TNF2/2 versus TNF2/1+1/1 and TNF2/2 versus TNF1/1 were not statistically significant. Our meta-analysis does not support the role of TNF-α -308 G/A polymorphism in developing MS.

Implementation of a protocol for integrated management of pain, agitation, and delirium can improve clinical outcomes in the intensive care unit: a randomized clinical trial.

BACKGROUND: Inappropriate diagnosis and treatment of pain, agitation, and delirium (PAD) in intensive care settings results in poor patient outcomes. We designed and used a protocol for systematic assessment and management of PAD by the nurses to improve clinical intensive care unit (ICU) outcomes. MATERIALS AND METHODS: A total of 201 patients admitted to 2 mixed medical-surgical ICUs were randomly allocated to protocol and control groups. A multidisciplinary team approved the protocol. Pain was assessed by Numerical Rating Scale and Behavioural Pain Scale, agitation by Richmond Agitation Sedation Scale, and delirium by Confusion Assessment Method in ICU. The Persian version of the scales was prepared and tested for validity, reliability, and feasibility in a preliminary study. The patients in the protocol group were managed pharmacologically according to the protocol, whereas those in the control group were managed according to the ICU routine. RESULTS: The median (interquartile range) for the duration of mechanical ventilation in the protocol and control groups was 19 (9.3-67.8) and 40 (0-217) hours, respectively (P = .038). The median (interquartile range) length of ICU stay was 97 (54.5-189) hours in the protocol group vs 170 (80-408) hours in the control group (P < .001). The mortality rate in the protocol group was significantly reduced from 23.8% to 12.5% (P = .046). CONCLUSION: The current randomized trial provided evidence for a substantial reduction in the duration of need to ventilatory support, length of ICU stay, and mortality rates in ICU-admitted patients through protocol-directed management of PAD.

The Effect of Cochlear Implantation on the Improvement of the Auditory Performance in 2-7 Years old Children, Shiraz 2004-2008.

BACKGROUND: Hearing loss is the most common sensorineural deficiency in human beings. Cochlear implantation is introduced worldwide to treat the severe to profound sensorineural hearing loss, and can result in both speech comprehension and production. OBJECTIVES: The present study aims to determine the effect of cochlear implantation on the improvement of the auditory performance in 2-7 years old children. PATIENTS AND METHODS: The present follow-up study is a kind of cohort study which was conducted on 98 children between 2-7 years old who had referred to Fars Cochlear Implantation Center. The patients' information was gathered from their profiles both before and after the operation. The auditory performance score was obtained in 3 stages; 6 months, 1 year, and 2 years after the cochlear implantation through the Cap test. The data was analyzed using the nonparametric Friedman test as well as Mann-Withney, Kruskal-Wallis, and Spearman's Ranks Correlation coefficients. RESULTS: The mean and the median of the auditory performance score of the children who had undergone the cochlear implantation revealed a significant improvement from 6 months to 1 year, and 2 years after the implantation. It showed a significant statistical association between implantation age, type of hearing loss, regular reference, and the length of being present in the rehabilitation program with the auditory performance. It showed no significant association between sex, mother's level of education, being monolingual or bilingual, and family size with the auditory performance. CONCLUSIONS: This study revealed that the type of hearing loss, Presence in the rehabilitation program, and the age of cochlear implantation can be major prognostic factors of the response to the treatment, then the country's health policy makers and health planners must executively take into account the infants' hearing screening program during the first 6 month of age.

Titering of 2009 pandemic H1N1 influenza virus hemagglutinin inhibition antibody in nonvaccinated pregnant women in Shiraz, Southern Iran.

Influenza may cause severe complications for pregnant women. In this study antibody response against 2009 H1N1 influenza virus in pregnant women was investigated. This seroprevalance cross sectional and questionnaire based study was conducted using a convenient sampling method. Blood samples of pregnant women were checked for antibodies against 2009 H1N1 influenza virus using hemagglutination inhibition assay. An antibody titer level of ≥ 1:40 dilution was considered as the protective level. 167 (43.60%) of 383 pregnant women who participated in this study had protective antibody levels against this virus. 62 (35.63%) of 3rd trimester, 79 (46.74%) of 2nd trimester, and 21(52.50%) of 1st trimester pregnant women were immune respectively (χ2(for trend) = 8.20, p < 0.004). Lack of protective antibody level was significantly seen more in pregnant women of 3rd trimester of pregnancy (OR = 2.37, CI = 1.09-5.18). Pregnant women with higher education (OR = 1.67, CI = 1.02-2.73) and those with history of anemia (OR = 2.09, CI = 1.18-3.68) had more immunity. Older women (OR = 0.95, CI = 0.91-0.99) and those with history of psychological diseases (OR = 0.19, CI = 0.05-0.70) had less immunity. Vaccination of pregnant women, especially those who are in the higher trimesters of pregnancy, older, or less educated, against the 2009 H1N1 influenza virus should be continued.

High titers of hemagglutination inhibition antibodies against 2009 H1N1 influenza virus in Southern Iran.

BACKGROUND: Pandemic flu had at least two waves in Iran. Knowing how many of the general population were already exposed to this infection has a major impact on national preventive measures. As of December 30, 2009, a total of 3672 confirmed cases of human infection with a novel Influenza A (2009 H1N1) virus had been reported in Iran with 140 deaths. OBJECTIVE: In this study we aim to measure, as a pilot study, the seroprevalence of positive antibody titer (humoral immunity) against 2009 H1N1 virus in Iranian population in Shiraz, Southern Iran. METHODS: Through cluster random sampling of families residing in Shiraz, 2553 subjects were selected and after a medical interview blood samples were taken and checked for polyclonal antibody against 2009 H1N1 antigen using hemagglutination inhibition assay. An antibody titer of more than 1:40 dilution was considered positive. Data were analyzed considering the demographic characteristics of the population and were compared among different age groups. RESULTS: 1504 (58.91%) samples were tested positive for the presence of polyclonal antibody against 2009 H1N1 virus. The prevalence of positive titers were significantly higher in 60 to 64 years old group and significantly lower in 20 to 24 years old group (p<0.05). Data did not differ based on other demographic characteristics or the history of flu like illnesses in the past 6 months. CONCLUSION: High seroprevalence of antibody against 2009 H1N1 in the sera of our subjects describes either a high level of pre-existing immunity against H1N1 in Iranian population or a high rate of asymptomatic infection in our area compared to other countries.