A Systematic Literature Review on the Association Between Toxic and Essential Trace Elements and the Risk of Orofacial Clefts in Infants.

Orofacial clefts (OFCs) have been linked to various toxic and essential trace elements (TETEs) worldwide. However, review estimation is absent. Therefore, addressing the hypothesis that TETEs are associated with OFCs is the main area of this review. A systematic literature search was conducted using electronic databases through PubMed, Web of Science, Scopus, Science Direct, and Google Scholar between 2004 and August 2022. The "AND" and "OR" operators were used to make our search results inclusive and restrictive as follows: ("Toxic element*" OR "Heavy metal*") AND ("Toxic element*" OR "Lead OR Arsenic OR Mercury*")) AND ("Essential trace element*" OR "Zinc OR Selenium OR Copper*")) AND ("Orofacial cleft*" OR "Cleft lip*" OR "Cleft palate*") AND ("Infant*" OR "Newborn*" OR "Neonate*")). The presence of toxic elements was linked to the development of OFCs. The results showed that higher levels of toxic elements in various biological sample types were related to increased risks for OFCs. Increased concentrations of essential trace elements (ETEs) lowered the risk of OFCs. Maternal consumption of diets rich in ETEs, including zinc (Zn), selenium (Se), copper (Cu), cobalt (Co), and molybdenum (Mo), was linked to a more pronounced reduction in the risk of OFCs. Based on the findings, it is acceptable to infer that maternal exposure to toxic elements, whether through environmental contaminants or dietary sources, was associated with an elevated risk of OFCs. Furthermore, the study revealed that ETEs exhibited a potential protective role in reducing the incidence of OFCs. This observation highlights the importance of reducing exposure to toxic elements during pregnancy and suggests that optimizing maternal intake of ETEs could be an effective preventive strategy.

Determining the relationship between over-care burden and coping styles, and resilience in mothers of children with autism spectrum disorder.

BACKGROUND: Stress and over-care burden are problems for mothers of children with Autism Spectrum Disorder (ASD). Therefore, it seems necessary to evaluation of coping with stress according to the burden of care for these mothers. This study aimed to determine the relationship between care burden with coping styles and resilience of mothers of children with ASD. METHODS: The present study is a descriptive-analytical study performed on mothers of children with ASD in Kermanshah, Iran. Participants in the study were selected by convenience sampling. A Demographic questionnaire, Caregiver Burden Inventory (CBI), Connor-Davidson Resilience Scale (CD-RISC), and Coping strategies questionnaire (CSQ) were used for collecting data. Then it was analyzed through an independent t-test, ANOVA, and Pearson correlation test. RESULTS: The mean total score of the burden of care was 95.5 ± 9.1, resilience was 52.7 ± 8.7, and coping styles were 92.4 ± 8.4. Mothers of children with autism experience a severe burden of care and moderate levels of resiliency. There was also a significant negative correlation between the burden of care and resilience) p < 0.001, r = -0.536), but no significant correlation was found between burden of care and coping style) p = 0.937, r = -0.010). CONCLUSION: According to the results of this study, it is necessary to pay more attention to the factors affecting resiliency. Also, considering the significant relationship between burden of care and resiliency, teaching strategies to increase resiliency can be used in the educational program for mothers with autistic children.

A systematic literature review on the association between exposures to toxic elements and an autism spectrum disorder.

BACKGROUND AND AIM: Autism spectrum disorder (ASD) is a neurodevelopmental illness characterized by difficulties in social communication and repetitive behaviors. There have been many previous studies of toxic metals in ASD. Therefore, the priority of this study is to review the relationships between exposure to toxic metals and ASD. MATERIALS & METHODS: This study was based on a comprehensive search of international databases, such as Web of Science, Science Direct, Scopus, PubMed, and Google Scholar, for all works related to the subject under discussion from 1982 to 2022. We further summarize published data linked to this topic and discuss with clarifying evidence that agrees and conflicts with the association between exposure to toxic metals, including mercury (Hg), lead (Pb), cadmium (Cd), arsenic (As), and aluminum (Al) and ASD. RESULTS: 40 out of 63 papers met the requirements for meta-analysis. Blood Pb levels (standardized mean difference (SMD) = 0.81; 95 % confidence interval (CI): 0.36-1.25), blood Hg (SMD = 0.90; CI: 0.30-1.49), hair Pb (SMD = 1.47; CI: 0.03-2.92), urine As (SMD = 0.65; CI: 0.22-1.09), and urine Al levels (SMD = 0.85; CI: 0.40-1.29) in autistic individuals were significantly higher than those of healthy control (HC). Whereas, blood As levels (SMD = 1.33; CI: -1.32-3.97), hair As (SMD = 0.55; CI: -0.14-1.24), hair Cd (SMD = 0.60; CI: -0.31-1.51), hair Hg (SMD = 0.41; CI: -0.30-1.12), hair Al (SMD = 0.87; CI: -0.02-1.77), urine Pb (SMD = -0.68; CI: -2.55-1.20), urine Cd (SMD = -0.26; CI: -0.94-0.41), and urine Hg levels (SMD = 0.47; CI: -0.09-1.04) in autistic individuals were significantly lower than those of HC. CONCLUSION: Toxic metal content significantly differed between individuals with ASD and HC in the current meta-analysis. The results assist in clarifying the significance of toxic metals as environmental factors in the development of ASD.

Socioeconomic disparities in using rehabilitation services among Iranian adults with disabilities: a decomposition analysis.

BACKGROUND: Persons with disabilities (PWD) generally experience various barriers in using health care compared to the general population, and these problems are more worsened for those with disabilities in lower socioeconomic status. The study aimed to estimate socioeconomic inequality in using rehabilitation services (URS) in adults with disabilities in Iran. METHODS: This cross-sectional study was conducted at a national level in Iran. 786 PWD (aged 18 years and older) participated in the study between September and December 2020. Socioeconomic-related inequality in URS was estimated by the Concentration Index (C). The C was decomposed to identify factors explaining the variability within the socioeconomic inequality in URS. RESULTS: In the present study 8.10% (N = 61) of the study population used rehabilitation services during the past three months. In this study, the value of the C was estimated 0.25 (p-value = 0.025) that shows URS was unequally distributed, and concentrated among the higher SES groups. The results of decomposition analysis indicated that the wealth index was the largest contributor (94.22%) to the observed socioeconomic inequalities in URS among PWD. Following the wealth index, Age and marital status were the major contributors to the unequal distribution of URS among the study population. CONCLUSIONS: Our findings revealed that socioeconomic inequality in using rehabilitation services was concentrated among well-off PWD. Accordingly, rehabilitation financing through appropriate mechanisms for individuals with low SES is suggested.

Translation, Validity, and Reliability of the Persian Version of the Aging Voice Index.

OBJECTIVES: The Aging Voice Index (AVI) was developed to study quality of life in older adults with voice disorders. The purpose of this study was to translate the original English version of the AVI to Persian version of Aging Voice Index (P-AVI) and validate the P-AVI for the Persian-speaking older adults with voice disorders. METHODS: A cross-sectional, descriptive, and methodological study was performed to translate and validate the Persian version of the AVI. The translation was performed in accordance with recommendations from the World Health Organization. Eighty-five treatment-seeking patients with voice disorders and 20 older adults without voice complaints were recruited for this study. Psychometric properties were investigated, including: different types of validity (content validity, construct validity, and criterion-related validity), reliability (test-retest and internal consistency), and item analysis of the Persian version of AVI. The relationship between total score of P-AVI and age, sex, and voice pathology were determined using multiple linear regression. RESULTS: A panel of three speech pathologists performed the content validity of the P-AVI and reached agreement on all of the items. Construct validity was confirmed by a significant difference in the mean of total score of the P-AVI was identified between the particiapnts with voice disorders and those with no voice complaints (P < 0.001). There was high correlation between the total scores of the participants in the Persian version of the AVI and the Persian version of the voice-related quality of life (r = 0.86, P < 0.001). All reliability measures were found to be good with scores higher than 0.8. To assess the need for item reduction, a Cronbach's alpha coefficient remained constant with the elimination of each item; therefore, all no items were removed. Age and voice pathology were not predictive for the total P-AVI score, but a weak effect was identified for sex and the total score of P-AVI (F = 18.75, P < 0.001) with an R2 of 0.21. CONCLUSIONS: The Persian version of AVI is a valid and reliable questionnaire designed specifically for older adults that speech-language pathologists and otolaryngologists can use to objectively assess the impact of voice disorders in aging Persian-speaking patients.

Translation and Validation of the Voice Catastrophization Index for Persian-Speaking Patients with Dysphonia.

PURPOSE: Catastrophization refers to the cognitive distortion that is experienced by patients with several diseases who suffer from pain. There is some evidence that catastrophization may be found in patients with voice disorders. The Voice Catastrophization Index (VCI) was developed in English to measure catastrophization in patients with dysphonia. The goal of this research was to translate and validate the Persian version of the VCI (P-VCI) for use with Persian-speaking people in Iran and elsewhere. METHODS: This was a prospective and cross-sectional study. First, the questionnaire was translated, then its various psychometric properties were investigated. RESULTS: There was a significant difference in mean P-VCI score between participants with and without dysphonia (p < 0.001). Test-retest reliability for the total score of P-VCI was excellent (ICC = 0.94, p < 0.001), as was its internal consistency, as determined by Cronbach's alpha coefficient (α = 0.956). Confirmatory factor analysis revealed that some of the indices show a good fit for the 3-subscale model. There was a moderate correlation in criterion-related validity between the P-VCI and Voice Activity Participation Profile - Persian version (r = 0.644, p < 0.001). CONCLUSIONS: The translated test exhibited satisfactory psychometric properties. The P-VCI is a valid and reliable tool for the assessment of catastrophization in persons with voice disorders.

Comprehension of Complex Sentences in the Persian-Speaking Patients With Aphasia.

INTRODUCTION: To study sentence comprehension in Persian-speaking Patients with Aphasia considering the factors of complexity. METHODS: In this cross-sectional study, the performance of 6 non-fluent aphasic patients were tested and their performance was compared to 15 matched control group. Comprehension of semantically reversible sentences was assessed using a binary sentence-picture matching task. The stimuli were as follows: clefts; subject clefts and object clefts, also relative clauses; subject relatives and object relatives. All of them were types of movement-derived structures and also simple declarative sentences as the control task. RESULTS: The best performance of aphasic patients were seen in the comprehension of subject clefts, although prior to this result we assumed that simple declarative sentences (in which there is no structural factor of complexity) can be understood easily. They showed the highest difficulty in the comprehension of object relatives. Furthermore, the performance of patients in the comprehension of relative clauses was significantly weaker than understanding the clefts. CONCLUSION: The outcomes of this study suggest that the sentence comprehension deficits of aphasic patients, in contrast to the specific deficit models, may not be related to linguistic disabilities. Moreover, the problems in the comprehension of non-canonical sentences may be related to failure in the allocation of attention. Finally, our results support the claims that neural characterization of the cognitive resources (e.g. working memory) is disrupted in sentence comprehension deficits.