The effect of yogurt fortified with Lactobacillus acidophilus and Bifidobacterium sp. probiotic in patients with lactose intolerance.

This study assessed the effect of probiotic yogurt fortified with Lactobacillus acidophilus and Bifidobacterium sp. in patients with lactose intolerance. Fifty-five patients suffering from lactose intolerance were randomly divided into control group of 28 lactose intolerance patients who received nonprobiotic yogurt (100 ml) and experimental group consisted of 27 lactose intolerance patients who received probiotic yogurt fortified (100 ml) with L. acidophilus and Bifidobacterium sp. Each individual received yogurt for one week. Lactose intolerance was confirmed when the patients received 75 g lactose and were positive after 30 min until 3 hr for lactose intolerance symptoms and by hydrogen breath test (HBT). After intervention, the hydrogen level was lower in experimental group in comparison with the control group. Lactose intolerance symptoms in experimental group were much less than the control group. Our findings revealed that probiotic yogurt fortified with L. acidophilus and Bifidobacterium sp. could safely and effectively decrease lactose intolerance symptoms and HBT, so our probiotic can be recommended as a treatment of choice in lactose intolerance patients.

Root-Cause Analysis of Maternal Mortality in Fars Province, Southern Iran 2014: Negligence Is the Prime Suspect.

Objective: we aimed to carry out an applied methodological tool, using Root-Cause Analysis (RCA), to determine the main causes of maternal mortality in Fars province, south of Iran, in 2014. Materials and methods: This is a case-series study and was conducted based on a careful examination of records and verbal autopsy with the family of the deceased person and their medical care team. Using RCA, quantitative dynamic modeling was done to display the overall impacts of different causes on maternal mortality. Finally, sensitivity analysis was done to determine the magnitude of contribution of each root-cause of maternal mortality. Results: Totally, all 10 maternal deaths with Maternal Mortality Rate (MMR) of 13.4 per 100.000 births, were recorded in the maternal surveillance system during 2014. The RCA results revealed that the root-causes of maternal mortality were ignorance and negligence (50%), delay in diagnosis (30%), delay in service provision in the first 24 hours after delivery (10%), and undesirable health care (10%). The results of sensitivity analysis in different scenarios revealed that medical negligence had the highest contribution to maternal mortality. Conclusion: Although maternal surveillance system stated some causes such as hemorrhage to be responsible for maternal deaths, the RCA showed that root-causes such as medical neglects had a fundamental role. Therefore, maternal mortality can be prevented by reforming the health care system and training all service providers, especially for high-risk mothers.

Pattern of Changes in Age-Specific Fertility Rates, Total Fertility Rate, and Cohort Fertility Rate in Rural Areas of Fars Province, Southern Iran (1988-2012).

Objective: To investigate the trend of changes in Age-Specific Fertility Rate (ASFR), Total Fertility Rate (TFR), and Cohort Fertility Rate (CFR) in rural areas of Fars province, southern Iran during 1988-2012. Materials and methods: This cross-sectional study was conducted based on analyze fluctuations in fertility. Information about the number of births and mothers aged 15-49 years was collected. By calculating the ASFR, TFR, and CFR along with analyzing their patterns the trend of changes in fertility rate would be revealed. Finally, modeling and time series forecast of ASFR based on age groups was conducted using the SPSS software. Results: The TFR was estimated to be 4.21, 2.1, 1.76, 1.65, and 1.78 per thousand in 1992, 1997, 2002, 2007, and 2012, respectively. Moreover, CFR was 2.01, 1.54, 1.05, 0.54, and 0.13 for those born during 1972-1976, 1977-1981, 1982-1986, 1987-1990, and 1991-1995, respectively. Also the time trend of ASFR based on age groups showed a negative slope. Conclusion: The fertility followed a negative slope during 1992-2012, indicating their descending trend during these years. TFR = 2.1 was a standard population replacement rate in the societies. Therefore, continual decline of this rate during 1992-2012 could be a warning factor that requires planning for reform and precise evaluation.

The study of waiting time to first pregnancy in the south of Iran: A parametric frailty model approach.

BACKGROUND: Time to first pregnancy (TTFP) has never been studied in an Iranian setting. Lifestyle, occupational and environmental factors have been suggested to affect the female reproduction. OBJECTIVE: This study was conducted to measure TTFP in the south of Iran and survey the effects of several similar factors on TTFP by frailty models. MATERIALS AND METHODS: The data on TTFP were available for 882 women who were randomly selected from the rural population (the south of Iran). Only the first and the planned pregnancies of every woman were included. The data were collected retrospectively by using self-administered questionnaires. Frailty and shared frailty models were used to determine which factors had the highest impact on TTFP. RESULTS: The median TTFP was 6.4 months and several factors were surveyed. However, only the age of marriage, height, maternal education and regularity of menstruation prior to conception were selected in the multivariable models. CONCLUSION: Among the several factors which were included in the study, the result of frailty model showed that the height, age of marriage and regular menstruation seemed more notable predictors of TTFP.

The prevalence of dyspepsia symptoms and its correlation with the quality of life among Qashqai Turkish migrating nomads in Fars Province, Southern Iran.

OBJECTIVES: To determine the prevalence of dyspepsia and its correlation with quality of life in Fars Qashqai Turkish migrating nomads from Southern Iran. METHODS: During 2010 we enrolled 397 Qashqai migrating nomads from Southern Iran who were 25 years of age or older. Participants completed a questionnaire that consisted of demographic factors, lifestyle data, gastrointestinal symptoms, and the Short-Form 36 Health Survey (SF-36) questionnaire. RESULTS: There was a 48% prevalence of dyspepsia symptoms among participants. The prevalence was higher among females, those less than 35 years of age, married participants, and those with a low body mass index (BMI). The correlation between dyspepsia and quality of life was significant. Dyspeptic patients were classified into ulcer-like (27.9%), dysmotility-like (26.2%), and unspecified (45.9%) groups. A significant correlation existed between dyspepsia symptoms and consumption of dairy products, drinking water and tea before and after meals, smoking, dysphagia, reflux, heartburn, and use of non-steroid anti-inflammatory drugs and acetaminophen. CONCLUSION: The high prevalence of dyspepsia in Qashqai nomads necessitates educational health programs for the migrating tribes in order to decrease prevalence of this disease.

General Health in the Elderly and Younger Adults of Rural areas in Fars Province, Iran.

BACKGROUND: There are critical gaps in assessment and research on health among the elderly living in rural communities. The state of aging and health in rural areas provides a snapshot of our older adults's need to necessary public health measures .The aim of this study was to determine the self-rated general health of adults residing in rural areas and compare the general health of the elderly with younger adults. METHODS: In this population based study using multistage random sampling, 2259 adults aged (≥15 years old) were selected from rural areas of Shiraz, southern Iran. The participants were divided into three age groups: young adults (15-39 years old n=1574), middle aged adults (40-59 years old, n=530), and the elderly (≥60 years of age, n-155).  Data were gathered using a translated version of the general health questionnaire (GHQ-28) and analyzed using Chi-square, one-way ANOVA, Kruskal-Wallis tests and ANCOVA analysis.  SPSS software, version 16, was used for analysis. RESULTS:   34.8%, 31.6%, 52.3% and 7.7% of the elderly had a probable mental disorder  in the somatization, anxiety, social dysfunction and depression categories, respectively. Moreover, 9.7, 7.1, 3.9 and 4.5% of the elderly had a  severe mental disorder  in the four mentioned subscales, respectively. Compared with younger adults, the elderly showed a significantly higher disorder in all subscales except for anxiety. CONCLUSION: Our findings showed that chronic disease had a great effect on general health. Screening programs and prevention of chronic disease by the newly established family physician in rural districts can improve the overall community health.

Prognostic factors of first birth interval using the parametric survival models.

BACKGROUND: In recent years, the study of birth intervals has been a main determinant of the levels of fertility in the populations, as it is associated with rates of fertility and population growth. OBJECTIVE: The purpose of this study was to firstly apply survival analysis for modeling of first birth interval and secondly to explore its determinants. MATERIALS AND METHODS: In a cross sectional study, the fertility history of 858 women was collected in rural areas of Shiraz (southern Iran) in 2008. We used the survival analysis such as cox regression and alternative parametric models to evaluate the prognostic factors of first birth interval. RESULTS: Among the explanatory variables of interest, age at marriage, level of women's education, and menstrual status had highly significant effects on the duration of birth interval after marriage (p<0.01). CONCLUSION: It is concluded that the suitable parametric models would be a useful tool for fitting to first birth interval, the fact that has been less paid attention to in researches.

The preference of Iranian women to have normal vaginal or cesarean deliveries.

BACKGROUND: The cesarean section (C-section) has higher risk compared to normal vaginal delivery (NVD). The aim of this population-based study was to evaluate the frequency of mothers' tendency toward the mode of delivery and the factors that can affect this inclination. MATERIALS AND METHODS: This cross-sectional study was conducted from August 2011 to June 2012 in Fars Province, Iran, and comprised mothers in their 20(th) to 30(th) weeks of pregnancy. A questionnaire was designed to include, sociodemographic information, maternal knowledge, main sources of knowledge, attitude of the mother, husband, parents, close friends, and gynecologist, regarding the route of delivery, convenience factors, and barriers to choosing NVD, and mother's preference for the route of delivery. RESULTS: Of 6921 participants, 2197 (31.7%) preferred C-section and 4308 (62.2%) favored NVD while 416 (6%) had no idea regarding the preferred route of delivery. Score of knowledge in 904 (13.1%) participants was zero, and 1261 women (18.2%) achieved an acceptable level of knowledge. Using binary logistic regression, positive history of previous abortion and/or infertility, higher education level of mother and husband, mother's unacceptable level of knowledge regarding complications of C-section, and mother's and husband's positive attitude toward C-section were determinant factors in choosing C-section as a preferred route of delivery. CONCLUSION: Appropriate measures should be taken to raise awareness and knowledge of mothers and all families about complications of the C-section. Establishment of clinics for painless NVD and assuring mothers of benefits and lower complications of NVD can reduce the tendency for C-sections.

Correlation of quality of life with gastroesophageal reflux disease amongst Qashqai nomads in Iran.

BACKGROUND: Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal diseases encountered in today's clinic practice. GERD symptoms are troublesome and disruptive to the physical, social and emotional well-being of many patients. This is a cross-sectional study performed on Qashqai nomads of Fars Province in southern Iran to determine the impact of GERD on quality of life. METHODS: We randomly selected 748 subjects over the age of 25 years. Subjects completed two questionnaires conducted by interviews. The first one consisted of questions on gastroesophageal reflux symptoms. The second questionnaire was the Short Form Health Survey (SF-36), a generic health-related quality of life instrument that consists of 36 items divided into eight dimensions. It has a 0- to 100-point scale where higher scores show better functioning and well-being. RESULTS: Of 748 Qashqai migrating nomads who participated in the study, 717 subjects) mean age: 43 ± 14.2 years) completed the GERD questionnaire and only 372 subjects completed the SF-36 questionnaire due to their busy lifestyles, and GERD was reported in 106 subjects (28.5%). For all dimensions of SF-36, the mean score was consistently lower in patients with GERD compared to non-GERD subjects (P < 0.001). The dimension most frequently impaired was role-physical (40.9 vs. 77.3) followed by role-emotional (44.7 vs. 77.5), physical functioning (66.9 vs. 84.6), and general health (46.8 vs. 63.8). An association existed between impairment in quality of life and frequency (P < 0.05), but not severity, of GERD symptoms.  CONCLUSION: In this group of Qashqai nomads, all dimensions of health-related quality of life as measured by the SF-36 questionnaire were meaningfully impaired in subjects with symptomatic GERD compared to non-GERD subjects. There was an association between impaired quality of life and frequency, but not severity, of GERD.

Prevalence and risk factors of gastroesophageal reflux disease in Qashqai migrating nomads, southern Iran.

AIM: To investigate the prevalence and risk factors of gastroesophageal reflux disease (GERD) symptoms in Qashqai migrating nomads with a different life style in Fars province, southern Iran. METHODS: In summer 2006, 748 Qashqai migrating nomads aged 25 years or more were enrolled using a multiple-stage stratified cluster random sampling method. A questionnaire consisting of demographic characteristics, lifestyle and GERD symptoms (heartburn, regurgitation, chest pain, dysphagia, hoarseness and cough) as completed for each subject. RESULTS: The questionnaire was completed in 717 subjects. The prevalence rate of GERD, defined as reflux occurring at least one time per week in the preceding year, was 33% (237 subjects). The prevalence was higher in older individuals (36.0% vs 28.9%, P < 0.05) and in those with other gastrointestinal complaints (51.0% vs 27.8%, P < 0.001), but not different in obese and non-obese subjects. It was also higher in those consuming fruits and vegetables more than once a week (36.2% vs 17.3%, P < 0.001). GERD had a positive correlation with smoking (42.1% vs 27.8%, P < 0.001), but a negative relation with non-alcoholic beverages. The association between GERD and non-steroidal anti-inflammatory drugs (NSAIDs) consumption was also significant (40.2% vs 25.4%, P < 0.001). CONCLUSION: The prevalence of GERD (33%) is very high in Qashqai migrating nomads which may be due to a lower socioeconomic and educational level of these people and difference in the life style. Older age, frequent consumption of fruits and vegetables, smoking and NSAIDs are risk factors for GERD in this population.