The use of metformin, sulfonylurea compounds and insulin and the risk of hip fractures in diabetic patients: a systematic review and meta-analysis of observational studies.

BACKGROUND: Hip fracture is a major health problem that occurs more often in the elderly, especially in diabetic patients. Some studies have been conducted regarding the effect of anti- diabetic drugs on fractures. But so far, no meta-analysis study has been conducted to investigate the effect of diabetic drugs on hip fractures. Therefore, this study investigated the relationship between anti-diabetic drugs (Metformin, Sulfonylurea, and insulin) with hip fractures. METHODS: In this systematic review and meta analysis study, PubMed, Scopus, Google Scholar, and Web of Science databases were searched with specific keywords to find relevant studies. Two researchers included related studies after screening based on the title and full text. Cochran's Q and I2 tests were used to assess heterogeneity between studies. Publication bias between studies was evaluated for each drug using Egger's test. A 95% confidence interval was used for effect size significance. Overall, 49 studies, including 6,631,297 participants, were reviewed. RESULTS: The results showed that metformin significantly reduced the risk of hip fracture (HR: 0.833, 95% CI: 0.759, 0.914, P:0.001). Consumption of sulfonylurea compounds was significantly associated with an increased risk of hip fracture. (HR: 1.175, 95% CI:1.068,1.293, P:0.001), The risk of hip fracture in patients receiving insulin was significantly higher than in diabetic patients who did not receive insulin. (HR:1.366, 95% CI:1.226,1.522, P:0.001). CONCLUSION: The results of this study showed that taking metformin reduces the risk of hip fracture, and insulin and Sulfonylurea increase the risk of hip fracture.

Using Health in All Policies Approach for the Management of Non-Communicable Disease Risk Factors: A Developing Country Experience.

Background: Controlling and preventing non-communicable diseases and their risk factors through multisector collaboration and participation of other stakeholders requires structures that provide the necessary basis for sustainable interaction between stakeholders with legal support. The purpose of this study is to express the experience of the Islamic Republic of Iran in advancing the goals of the National Plan on Control and Prevention of Non-Communicable Diseases (NCD) through Health in All Policies (HiAP) approach and multisector collaboration. Methods: In this qualitative study, all documents related to the control and prevention of non-communicable diseases in the Secretariat of the Supreme Council for Health and Food Security(SCHFS) in the period 2013-2020 were reviewed. Data were thematically analyzed with the qualitative content analysis method; coding has done manually. Results: Multisector work group, which is one of work groups in the National Committee for control and prevention of NCD, applies its effect through SCHFS that proposed a four-level policy formulation and decision-making units for multisector collaboration based on political and administrative structure and HiAP approach at the national and provincial level. The Memorandum of Understanding (MOU) and health secretariats are used as tools for a multisector approach in non-communicable disease management. Conclusion: To draw up an appropriate structure for multisector collaboration for health, it is necessary to have a whole government-policy approach, through which all relevant organizations are appointed to engage and work together in a coherent framework since a sustainable framework based on shared trust and understanding for multisector decision-making and health action is a prerequisite for achieving health goals in NCD management.

Prevalence, correlates and comorbidities of feeding and eating disorders in a nationally representative sample of Iranian children and adolescents.

OBJECTIVE: This study investigated the prevalence of feeding and eating disorders, and identified their correlates and comorbidities among children and adolescents. METHOD: We used the nationally representative sample of the Iranian Children and Adolescents' Psychiatric disorders (IRCAP) survey, with 30,532 participants randomly selected by a multistage cluster sampling method. We employed the kiddie schedule for affective disorders and schizophrenia-present and lifetime version (K-SADS-PL) semi-structured face-to-face interview to screen for any psychiatric disorders, including feeding and eating disorders, and associated factors. We used multivariate binary logistic regression to analyze the data. RESULTS: Valid data from 27,111 participants were analyzed. The total prevalence of feeding and eating disorders among children and adolescents was 0.89 (0.81-1.10). In all types of feeding and eating disorders, the adjusted odds ratio was higher among girls (except binge-eating disorder) and older adolescents but was lower among rural residents. The most common psychiatric comorbidities observed in children and adolescents with feeding and eating disorders were obsessive-compulsive disorder (20.2%), agoraphobia (20.2%), depressive disorder (16.4%), social phobia (10.1%), oppositional defiant disorder (10.1%), generalized anxiety disorder (9.4%), attention deficit hyperactivity disorder (7.5%), and conduct disorder (5.7%), which were significantly more common compared to their peers without feeding and eating disorders. DISCUSSION: Older age, female gender and living in an urban area are predisposing factors in feeding and eating disorders (in binge-eating disorder, the male gender is a positive correlate). We suggest that future works pay attention to the role of gender, comorbidities and predisposing factors.

Prevalence, comorbidities, and sociodemographic predictors of conduct disorder: the national epidemiology of Iranian children and adolescents psychiatric disorders (IRCAP).

The aim was to evaluate the lifetime prevalence of conduct disorder according to sociodemographic characteristics, determine the sociodemographic predictors of conduct disorder, and estimate the rates of comorbidities of psychiatric disorders in children and adolescents with conduct disorder by age and gender. The National Epidemiology of Iranian Children and Adolescents Psychiatric Disorders was a cross-sectional, general population-based study on 30,532 children and adolescents aged 6-18 years from all provinces of Iran, which was done using multistage cluster sampling. Iranian citizens aged 6-18 years who resided at least 1 year in each province were included, and children and adolescents with severe physical illnesses that prevented them to participate in the study were excluded. The sample weighting adjustment was used, since we had randomly selected the equal number of 1000 participants of each province from the urban and rural areas. Trained psychologists conducted diagnostic interviews with the adolescents and the children's parents using the Persian version of the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL). In this study, 54 children aged 6-9 years (0.58%, CI 0.47-0.77), 64 adolescents aged 10-14 years (0.57%, CI 0.47-0.77), and 117 adolescents aged 15-18 years (1.22%, CI 0.96-1.44) met the criteria of the lifetime conduct disorder. Conduct disorder was significantly more common in boys than in girls, and was significantly less prevalent among those participants whose fathers had no history of psychiatric hospitalization. Of the participants with conduct disorder, 83.4% met the criteria for at least one other psychiatric disorder. Conduct disorder had a high rate of comorbidity with oppositional defiant disorder (54.89%, CI 48.50-61.12), attention-deficit/hyperactivity disorder (32.34%, CI 26.68-38.56), tobacco use (20.43%, CI 15.77-26.04), and depressive disorders (18.30%, CI 13.88-23.74). Because of using the diagnostic instrument, we found a low total rate of prevalence for conduct disorder; however, higher rates of it were observed among boys and adolescents. Further studies are needed to explore the nature of comorbidities of conduct disorder and to consider them in a large clinical population.

Risk factors of knee osteoarthritis: A case-control study.

BACKGROUND AND OBJECTIVE: Knee osteoarthritis is one of the most common rheumatologic problems. To investigate risk factors related to the knee osteoarthritis a case-control study was performed using cases diagnosed in the Community Oriented Program for Control of Rheumatic Diseases (COPCORD) study, stage I. METHODS: Using data from the 2012 COPCORD study, stage-I that was conducted in Sanandaj, northwestern of Iran, we runned a case-control study in 2014-2015. Cases were 700 knee osteoarthritis using American College of Rheumatology (ACR) criteria, frequency matched with 700 healthy controls that were randomly selected from the general population. RESULTS: In multivariate analysis, statistical significant relation was observed between knee OA and some studied factors such as body mass index (P <0.001), lodging (living in highland vs. plain) (P <0.001), type of used toilet (regular vs. toilet) (P <0.001), history of using high-heeled shoes (>3 cm) (P = 0.005), history of knee Injury (P = 0.04), history of lower limb fracture (P = 0.02), Number of pregnancies (P <0.001) and history of pain and swelling (lasting for one months) (P = 0.04). CONCLUSIONS: Living in highland area, using regular toilet, having knee injury and lower limb fracture in the past were most significant associated factors with occurrence of knee osteoarthritis.

Effect of childhood BMI on asthma: a systematic review and meta-analysis of case-control studies.

BACKGROUND: Asthma is a multifactorial syndrome that threatens the health of children. Body mass index (BMI) might be one of the potential factors but the evidence is controversial. The aim of this study is to perform a comprehensive meta-analysis to investigate the association between asthma and BMI. METHODS: Electronic databases including, Web of Science, Pubmed, Scopus, Science Direct, ProQuest, up to April 2017, were searched by two researchers independently. The keywords "asthma, body mass index, obesity, overweight, childhood and adolescence" were used. Random and fixed effects models were applied to obtain the overall odds ratios (ORs) and standardized mean difference (SMD). Heterogeneity between the studies was examined using I2 and Cochrane Q statistics. RESULTS: After reviewing 2511 articles, 16 studies were eligible for meta-analysis according to inclusion/exclusion criteria. A meta-analysis from 11 case-control studies revealed OR of asthma and overweight as OR = 1.64; (95% Confidence Interval (CI): 1.13-2.38) and from 14 case-control studies, OR for asthma and obesity was OR = 1.92 (95% CI: 1.39-2.65), which indicated that risk of asthma in overweight and obese children and adolescence was significantly higher (1.64 and 1.92 times) than that of individuals with (p-value < 0.01 for underweight/normal weight in both cases). Furthermore, there was a significant relationship between asthma and BMI > 85 percentile according to SMD SMD = 0.21; (95%CI: 0.03-0.38; p-value = 0.021). CONCLUSIONS: The results showed a significant relationship between BMI (obesity/overweight) and asthma among children and adolescents. It is important to study the confounding factors that affect the relationship between asthma and BMI in future epidemiological researches.

Prevalence of low back pain in Iranian nurses: a systematic review and meta-analysis.

BACKGROUND: Low back pain (LBP) as a musculoskeletal disorder is one of the most common occupational injuries in nurses but there isn't any valid measure of the prevalence of LBP in Iranian nursing. In order to increase the power and improve the estimates of the prevalence of LBP in Iranian nurses, a comprehensive meta-analysis was carried out. A summary measure of all studies conducted in this field was found and distributions of LBP were evaluated based on different variables. METHODS: Inclusion criteria included articles with prevalence of LBP in Iranian nurses, who had at least six months of work experience without any trauma, injuries to spine, or any underlying disease. The keywords"prevalence, low back pain, nurses", and "Iran" were used as part of this search. Databases such as Pubmed, Web of Science, Science direct, Scopus, IranMedex, Irandoc, Magiran, SID, CIVILICA, IMEMR and Google scholar were searched up to and including 15 June 2016. For data extraction a form was designed that included the following variables: Author names, province, sample size, age, gender, marital status, work experience, body mass index, job type, smoking status, work schedule, year of publication, type of standard questionnaire, prevalence of LBP, studies' quality score and climate classifications. Data analysis was carried out using fixed and random effects model. Heterogeneity between studies was assessed by using the I2 and Q tests. RESULTS: In all 1250 articles were identified and 22 articles with 9347 participants met the inclusion criteria for meta-analyses after filtering. The prevalence of low back pain during their working life and during the last year, was estimated at 63% (95% Confidence Interval (CI): 57.4-68.5) and 61.2% (95% CI: 55.7-66.7) respectively. The prevalence rate of this disorder was 58.7% (95% CI: 35.8-81.7) and 60.4% (95% CI: 52.2-68.6) among men and women respectively. Furthermore, prevalence's of LBP were 59.5% in wards nurses, 50.3% in operating room technicians, and 39.4% in aid nurses. CONCLUSIONS: The results showed the high prevalence of LBP injury in nurses, especially female nurses. The effect of musculoskeletal disorders such as LBP may be reduced by considering proper observation of the principles of ergonomics in the workplace, performing physical examinations on a regular basis, identifying risk factors in the advancement of musculoskeletal disorders and then trying to fix them.

Seasonality and time patterns in attempted suicide in Ilam province of Iran: An appraisal of current data of 2010 -2014.

Background: Seasonality in suicide has been investigated from the early 19th century to explore the productive environmental variables. Seasonality studies can provide information on prevention and interventions in suicide. In this study, we examined seasonality in suicide and aimed to explore the differences in seasonality between rural and urban areas, mental disorders, and genders. Methods: In this cross-sectional study, overall identified suicide cases in Ilam province from 21 March 2010 and 11 December 2014 were identified, using systematic registration suicide data (SRSD). Two methods were used separately to analyze seasonality (Chisquare, Edwards' T). Seasonal effect (peak/ trough seasons) and (deaths/ attempts suicide) was explored by ratio statistics. The null hypothesis was that the completed suicides in each method group were evenly distributed over a year. Results: Significant seasonality was observed in suicide during the study period, with one peak in the spring and one in the winter. Our results showed that suicide seasonality following mental disorders was statistically significant with a peak in the spring, regardless of other factors such as gender and age. When all non- mental suicides are taken into account, the seasonality remains statistically significant, but the peak season is shifted to autumn. Conclusion: Investigating suicide in Ilam revealed a significant seasonality for both rural and urban areas, which was greater in the urban part. A significant seasonality in suicide was observed in attempters with mental disorders. In suicide attempters with mental disorders, findings showed two peaks in the spring and the autumn.

An application of a theory of planned behaviour to determine the association between behavioural intentions and safe road-crossing in college students: perspective from Isfahan, Iran.

OBJECTIVE: To identify the determinants of behavioural intention towards safe road-crossing among college students. METHODS: The cross-sectional study was conducted in 2013-14 and comprised students of Isfahan University of Medical Sciences, Isfahan, Iran. A self-administrated questionnaire was distributed among the subjects related to road-crossing based on the theory of planned behaviour. Data was analysed using SPSS 21. RESULTS: Of the 300 questionnaires distributed, 278(92.66%) were returned completed. The mean age of the subjects was 23.16±3.66 years. There were 149(53.6%) females and 129(46.4%) males, with females crossing the street more safely than the males. There was a significant difference between the genders for subjective norms (p=0.001), perceived behavioural control (p=0.002) and behavioural intention (p=0.001), but no differences were traced with respect to attitude towards safe crossing (p=0.597). Results showed a direct and positive correlation between attitude towards safe crossing (r=0.276; p=0.001), subjective norms (r=0.368; p=0.001) and perceived behavioural control (r=0.419; p=0.000) with behavioural intention to safe crossing. CONCLUSIONS: The attitude towards safe crossing and perceived behavioural control had significant effect on behavioural intention among college students.

Association of rs7903146, rs12255372, and rs290487 polymorphisms in TCF7L2 gene with type 2 diabetes in an Iranian Kurdish ethnic group.

BACKGROUND: Single nucleotide polymorphisms (SNPs) within the transcription factor 7-like 2 (TCF7L2) gene are well known risk variants for type 2 diabetes mellitus (T2DM). The association between TCF7L2 SNPs and T2DM has been investigated in several studies, but the results are controversial. In this study, we investigated whether the rs7903146, rs12255372, and rs290487 polymorphisms of TCF7L2 are associated with T2DM per se or metabolic traits related to this disease in a Kurdish ethnic group of Iran. METHODS: In all, 173 patients with T2DM and 173 normoglycemic subjects were included in this study. All subjects were genotyped using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Genotypic and allelic frequencies were then analyzed in each group. Serum lipids, fasting glucose, fasting serum insulin, HOMA-IR, and HbA1c levels were determined by conventional methods. RESULTS: T-allele and genotype frequencies of rs7903146, rs12255372, and rs290487 were significantly different between T2DM and control subjects. The CT genotype (OR = 1.98, p = 0.008), TT genotype (OR = 3.54, p = 0.024), and the dominant model (OR = 2.16, p = 0.002) of rs7903146 were associated with T2DM. The GT genotype (OR = 2.23, p = 0.005), TT genotype (OR = 4.25, p = 0.046), and the dominant model (OR = 2.2, p = 0.001) of rs12255372 gave a higher risk for T2DM. The carriers of CT genotype of rs290487 showed a significantly increased risk for T2DM (OR = 2.24, p = 0.003). Similarly, the dominant model of this SNP was found to be significantly associated with T2DM (OR = 2.25, p = 0.002). The control subjects carrying the T-allele of rs7903146 had higher levels of total cholesterol (CC; 4.52 +/- 1.03 vs. CT + TT; 5.00 +/- 1.2 mmol/L, p = 0.009) than those with CC genotype. Normoglycemic subjects carrying GT + TT genotypes of rs12255372 had a significantly higher WHR (GG; 0.90 +/- 0.059 vs. GT + TT; 0.93 +/- 0.07, p = 0.038) as compared with those with the GG genotype. CONCLUSIONS: The T-allele of rs12255372, rs7903146, and rs290487 polymorphisms of TCF7L2 confer susceptibility to T2DM in the Kurdish population of Iran.

Attribution of lifestyle risk factors in subjects with and without impaired fasting glucose.

OBJECTIVE: To investigate the association between lifestyle risk factors and impaired fasting glucose level. METHODS: The large-scale, community-based, cross-sectional study was conducted in 2012 in Ilam province, Iran, and comprised 150 impaired fasting glucose cases and 450 controls. Face-to-face interviews were conducted using a standard lifestyle questionnaire, and subjects were checked for fasting plasma glucose. Chi-square test and multivariate logistic regression were used for statistical analysis. RESULTS: Of the 600 participants, 172 (28.7%) were males and 428 (71.3%) were females. Their ages ranged from 20 to 83 years with a mean of 48.9 +/- 14.2 years for the cases and 45.5 +/- 13.4 years for the controls (p < 0.008). There was no statistically significant difference in terms of age, gender, marital status, location, family history of diabetes and body mass index in the two groups (p > 0.05). Using multivariate logistic regression, ghee consumption increased the risk of impaired fasting glucose up to 2.2 folds (Odds Ratio = 1.28, 95% Confidence Interval: 0.75-2.2); inactivity up to 2.33 folds (Odds Ratio = 1.33, 95% Confidence Interval: 0.75-2.33) and smoking up to 3.13 folds (Odds Ratio = 1.46, 95% Confidence Interval: 0.68-3.13). The differences were not statistically significant. CONCLUSION: Risk of impaired fasting glucose increases with lifestyle risk factors that need to be considered seriously by policy makers.

Enhancing Public Health Surveillance: Outbreak Detection Algorithms Deployed for Syndromic Surveillance During Arbaeenia Mass Gatherings in Iraq.

BACKGROUND: Large gatherings often involve extended and intimate contact among individuals, creating environments conducive to the spread of infectious diseases. Despite this, there is limited research utilizing outbreak detection algorithms to analyze real syndrome data from such events. This study sought to address this gap by examining the implementation and efficacy of outbreak detection algorithms for syndromic surveillance during mass gatherings in Iraq. METHODS: For the study, 10 data collectors conducted field data collection over 10 days from August 25, 2023, to September 3, 2023. Data were gathered from 10 healthcare clinics situated along Ya Hussein Road, a major route from Najaf to Karbala in Iraq. Various outbreak detection algorithms, such as moving average, cumulative sum, and exponentially weighted moving average, were applied to analyze the reported syndromes. RESULTS: During the 10 days from August 25, 2023, to September 3, 2023, 12202 pilgrims visited 10 health clinics along a route in Iraq. Most pilgrims were between 20 and 59 years old (77.4%, n=9444), with more than half being foreigners (58.1%, n=7092). Among the pilgrims, 40.5% (n=4938) exhibited syndromes, with influenza-like illness (ILI) being the most common (48.8%, n=2411). Other prevalent syndromes included food poisoning (21.2%, n=1048), heatstroke (17.7%, n=875), febrile rash (9.0%, n=446), and gastroenteritis (3.2%, n=158). The cumulative sum (CUSUM) algorithm was more effective than exponentially weighted moving average (EWMA) and moving average (MA) algorithms for detecting small shifts. CONCLUSION: Effective public health surveillance systems are crucial during mass gatherings to swiftly identify and address emerging health risks. Utilizing advanced algorithms and real-time data analysis can empower authorities to improve their readiness and response capacity, thereby ensuring the protection of public health during these gatherings.

Effect of metformin (vs. placebo or sulfonylurea) on all-cause and cardiovascular mortality and incident cardiovascular events in patients with diabetes: an umbrella review of systematic reviews with meta-analysis.

Purpose: The current umbrella review aimed to evaluate the effect of metformin on all-cause mortality (ACM), cardiovascular mortality, and cardiovascular disease (CVD) incidence in DM patients. Methods: PubMed, Scopus, Cochrane, Google Scholar, and Web of Science databases were searched with special keywords. Related studies were included after screening by two independent investigators based on title and full texts. The AMSTAR2 checklist was used to assess the quality of studies, and Cochran tests were used to assess the heterogeneity between studies. Overall, seventeen systematic reviews and meta-analysis studies were included. The results revealed that the risk of ACM in patients who received metformin was lower than in patients who did not receive metformin. (OR: 0.80, 95% CI:0.744,0.855); also, the risk of CVD mortality in metformin patients was lower than in the other two groups (placebo and other anti-diabetic drugs) (OR: 0.771, 95% CI:0.688,0.853, P:0.001). The risk of CVD in metformin users was also lower than in the other two groups (OR: 0.828, 95% CI:0.781,0.785). Summary: This comprehensive review showed that the risk of ACM, death due to CVD, and incidents of CVD in DM who use metformin was lower than the patients who received a placebo only or other diabetic drugs, which can guide clinicians in medical decision-making. Supplementary Information: The online version contains supplementary material available at 10.1007/s40200-023-01309-y.

Epidemiologic Features and Risk Factors for Crimean-Congo Hemorrhagic Fever in Dhi Qar Province, Iraq.

BACKGROUND: Crimean-Congo hemorrhagic fever virus (CCHFV) is endemic in Iraq, where recurrent epidemics have been constantly observed during the last five years. The present study aimed to determine the factors associated with Crimean-Congo hemorrhagic fever (CCHF) cases in Dhi Qar province during the year 2022. METHODS: A test-negative case-control design was used to analyze 621 CCHF patients, of which 162 were confirmed and 459 were suspected cases. To identify the confirmed and suspected cases, reverse transcriptase polymerase chain reaction (RT-PCR) was used. Suspected patients whose PCR test results were negative were selected as the control group. Data on potential risk factors for CCHF were collected as existing data for previous years for the same geographical locations in Dhi Qar province. Logistic regression analyses were used to determine the correlation between probable risk factors and confirmed CCHF cases. RESULTS: The incidence rate of CCHF was 6.8% per 100,000 people. The total number of deaths was 48 for patients with a case fatality rate of 7.7%. The patients' ages ranged from one year to 65 years, with an overall mean ± SD of 36.08 ± 18.29 years. A total of 98.2% of the patients were between 15 and 65 years of age; 58% of the reported patients were male, and the male-to-female ratio was 1.4:1. Additionally, contact with raw meat, animal contact, and tick bite had the highest percentages for CCHF positivity cases. CONCLUSIONS: Male gender, high-risk jobs like housewives, health staff, shepherds, butchers, animal dealers, slaughterhouse workers, veterinary staff, and farmers, tick bites, and contact with raw meat were statistically significant predictors for increasing CCHF incidence in Dhi Qar province during the year 2022.

Asthma in children in relation to pre-term birth and fetal growth restriction.

To assess the impact of parental asthma on risk of pre-term birth (PTB) and intrauterine growth restriction, and their subsequent association with childhood asthma. Three sequential cross-sectional surveys were conducted in 1993 (3,746), 1998 (1,964) and 2006 (1,074) in the same 15 schools among 5-11 year old children in Merseyside using the same respiratory health questionnaire completed by parents (sample size in brackets). Between 1993 and 2006, prevalence of PTB varied between 12.4 and 15.2 %, and of small for gestational age (SGA or growth restricted) babies between 2.1 and 4.6 %, and maternal asthma prevalence between 8.1 and 13.4 %. For the combined surveys mothers with asthma were more likely to have a PTB than non-asthmatic mothers (OR 1.39, 95 % CI 1.10-1.95, p < 0.001), and in the 2006 survey were more likely to have an SGA baby. 40.9 % of PTBs of asthmatic mothers developed doctor diagnosed asthma compared to 34.3 % for term babies (adjusted OR 1.65, 1.34-2.04, p < 0.001). The corresponding estimates for the symptom triad of cough, wheeze and breathlessness were 19.4 and 17.6 % (adjusted OR 1.78, 0.79-3.98). Conversely SGA babies were less likely to develop doctor diagnosed asthma (adjusted OR 0.49, 0.27-0.90, p < 0.021), or the symptom triad of cough, wheeze and breathlessness (adjusted OR 0.22, 0.05-0.97, p < 0.043), whether or not the mother was asthmatic. Maternal asthma is an independent risk factor for PTB which predisposes to childhood asthma. Intrauterine growth restriction was protective against childhood asthma.

Risk factors for acquisition of ventilator-associated pneumonia in adult intensive care units.

OBJECTIVE: Ventilator Associated Pneumonia (VAP) has an imperative place amongst nosocomial infections leading to increase morbidity and mortality rates. The present study aimed to determine risk factors for acquisition of ventilator- associated pneumonia in an intensive care unit (ICU). METHODS: A nested case-control study was carried out from September 2007 to June 2008. All 183 patients hospitalized at the adult ICU ward in Be'sat Hospital, Sanandaj city western Iran over a 48 hour period were included. Bacteriologic diagnosis and antibiotic susceptibility patterns were performed based on Edward & Ewing's methods and CLSI system guidelines. Results : Of the 149 samples which were taken from endotracheal tubes of 183 patients, 48 cases were diagnosed for VAP with an incidence rate of 26.2%. Mean duration of hospitalization was 23.4±10.2 days. The maximum and minimum antibiotic resistance for the gram negative bacteria was 93.3% for Cefalotin and 50% for Amikacin. The main risk factors for acquisition of ventilator- associated pneumonia were mechanical ventilation (Adjusted OR: 1.55, 95% CI: 1.37-1.74), history of antibiotic consumption (AOR: 8.92, CI: 1.16- 66.66) and fever (AOR: 3.11, CI: 1.22- 7.93). CONCLUSIONS: VAP is significantly related to ICU hospitalization, mechanical ventilation and history of antibiotics consumption. Cefalotin and Amikacin showed the highest and lowest antibiotic resistance against gram negative bacteria respectively.

Nurses and midwives' sleep quality and its associated factors during the early COVID-19 pandemic in Iran.

Objectives: Good sleep quality is crucial for medical staff especially nurses and midwives to prevent possible errors and injuries during the providing care. The aim here is to investigate the sleep quality of nurses and midwives during the early corona pandemic and its related factors. Methods: An online observational and cross-sectional study included 340 medical staff who engaged in the treatment of patients with COVID-19 infection in 2020. Participants completed questionnaires about working characteristics, Pittsburgh Sleep Quality Index (PSQI), and Social Support Indexes (SSI). Pearson's correlation analysis and Multivariate logistic regression identified the interactions between these factors. Results: The mean PSQI and SSI were 8.4 ± 4.46 and 28.6 ± 13.29, respectively, indicating poor sleep quality and moderate social support. The condition of the participants was serious in terms of sleep efficiency, and sleep disturbance. More than half of the participants reported severe and very serious daytime dysfunction. Poor sleep quality was more common, in nurses than in midwives (OR:0.074, CI; 0.032-0.098, P < 0.001), nurses working in intensive care units than in other wards (OR:1.082, CI; 1.003-4.023, P = 0.005), in people who had long shifts (OR:1.757, CI; 1.123-4.323, P = 0.003), and in people working more than 5 years (OR:4.949, CI; 1.673-6.023, P = 0.028). Social support has a statistically significant relationship with the quality of sleep (OR:0.013, CI; 0.001-0.244, P = 0.004). Conclusion: The sleep quality of the medical staff has been impaired during the epidemic period, especially among nurses. Targeting staff who are more prone to sleep disturbance, such as nurses with longer work experience, helps us design an optimal strategy to support them through sleep hygiene education.

Comparison of machine learning algorithms to predict intentional and unintentional poisoning risk factors.

Introduction: A major share of poisoning cases are perpetrated intentionally, but this varies depending on different geographical regions, age spectrums, and gender distribution. The present study was conducted to determine the most important factors affecting intentional and unintentional poisonings using machine learning algorithms. Materials and methods: The current cross-sectional study was conducted on 658 people hospitalized due to poisoning. The enrollment and follow-up of patients were carried out during 2020-2021. The data obtained from patients' files and during follow-up were recorded by a physician and entered into SPSS software by the registration expert. Different machine learning algorithms were used to analyze the data. Fit models of the training data were assessed by determining accuracy, sensitivity, specificity, F-measure, and the area under the rock curve (AUC). Finally, after analyzing the models, the data of the Gradient boosted trees (GBT) model were finalized. Results: The GBT model rendered the highest accuracy (91.5 ± 3.4) among other models tested. Also, the GBT model had significantly higher sensitivity (94.7 ± 1.7) and specificity (93.2 ± 4.1) compared to other models (P < 0.001). The most prominent predictors based on the GBT model were the route of poison entry (weight = 0.583), place of residence (weight = 0.137), history of psychiatric diseases (weight = 0.087), and age (weight = 0.085). Conclusion: The present study suggests the GBT model as a reliable predictor model for identifying the factors affecting intentional and unintentional poisoning. According to our results, the determinants of intentional poisoning included the route of poison entry into the body, place of residence, and the heart rate. The most important predictors of unintentional poisoning were age, exposure to benzodiazepine, creatinine levels, and occupation.

The effect of high-intensity interval training on serum and adipose tissues vaspin levels in rats fed a high-fat high-sucrose diet.

BACKGROUND: Vaspin is an adipocytokine with insulin-sensitizing and anti-inflammatory traits. OBJECTIVES: The purpose of this study was to evaluate the effect of high-intensity interval training (HIIT) on serum, visceral and subcutaneous adipose tissue vaspin levels in rats exposed to a diet high in fat and sugar (HFS). MATERIALS AND METHODS: Thirty-two male Wistar rats were randomly divided into HFS and standard diet (SD) groups. After 12 weeks, each group was divided into sedentary and HIIT groups. HIIT program was performed 3 times/week for 8 weeks. Retroperitoneal adipose tissue, inguinal adipose tissue and serum were collected to analyze vaspin levels. Also, serum glucose and insulin levels, insulin resistance index (HOMA-IR) and retroperitoneal and inguinal fat weights were measured. RESULTS: HFS significantly increased weight gain, weight of inguinal (p=0.001) and retroperitoneal fat depots (p<0.001), serum glucose levels (p<0.001) and HOMA-IR (p<0.001). The HIIT was able to decline weight gain and fat mass (p<0.05) but did not affect inguinal and retroperitoneal fat depots' vaspin levels. Eight weeks' HIIT significantly increased serum vaspin (p=0.002) and decreased insulin (p=0.001) levels only in rats fed with SD. CONCLUSIONS: Although the HIIT program can cause significantly reducing effects on weight gain and fat depots' weights, it does not effect on circulating and fat depots' vaspin levels in rats fed an HFS.

Dose response association of pregnancy cigarette smoke exposure, childhood stature, overweight and obesity.

BACKGROUND: The combined dose response effects of pregnancy cigarette smoke exposure on childhood overweight, obesity and short stature have not been reported. METHOD: A community based cross-sectional survey of 3038 children aged 5-11 years from 15 primary schools in Merseyside, UK. Self-completed parental questionnaires were used for family characteristics, socio-economic status and parental smoking practices. Children were measured for height and weight and z-scores calculated for parental smoking categories. RESULTS: Of 689 (34.0%) mothers who smoked during pregnancy 50.5% smoked ten or more cigarettes daily (heavy smokers). Children of maternal non-smokers had prevalence estimates for overweight, obesity and short stature of 25, 9.6 and 3.2%, respectively. Prevalence estimates were higher in children of mothers who were heavy smokers during pregnancy, 31.5% (P = 0.001), 15.6% (P < 0.001) and 5.5% (P = 0.001), respectively. Mean height for age z-scores was lower among heavy maternal (P < 0.001) and paternal smokers (P < 0.01) compared to non-smokers. Childhood overweight, obesity or short stature were all associated with heavy maternal smoking during pregnancy (all P < 0.001). Mean body mass index (BMI) z-scores were higher in boys of mothers who smoked (P = 0.043). The adjusted odds ratio for short stature in children of heavy maternal smokers was 2.76 (95% CI 1.21-6.33) and 4.28 (1.37-13.37) if both parents were heavy smokers. The adjusted OR for obesity in children of maternal smokers was 1.61(1.19-2.18). The population attributable risk for short stature was 8.8% (1.1-22.7) for heavy maternal smokers. CONCLUSION: A dose-response association was observed between pregnancy smoking exposure, short stature and obesity.