The Effect of Lactofem Oral Probiotic Capsule on Lactobacilli Colonization and Some Vaginal Health Parameters.

BACKGROUND AND OBJECTIVE: Healthy vaginal ecosystem is conserved with the connection of vaginal epithelium and flora in which lactobacilli play a significant role. The present study aimed to examine the effect of lactofem oral probiotic capsule on Lactobacillus colonization and some other vaginal health indices in women aged 18-55 years. MATERIALS AND METHODS: This interventional, double-blind controlled clinical trial was conducted on 70 women with Nugent score = 4-6 and vaginal pH >4.5. The participants were divided into an oral probiotic group and a control group. The oral probiotic group was required to take one 500 mg lactofem capsule daily for 2 months, while placebo was prescribed for the control group. Samples from 6 visits were examined during the period of prescription. The data were analyzed using the SPSS statistical software, version 18. RESULTS: The results showed no significant difference in the average colonization of vaginal Lactobacillus in the 2 groups before and during the intervention (p = 0.26). Also, no significant difference was observed in the 2 groups' Nugent mean scores before and after the intervention up to the 60th day. However, a statistically significant difference was found in this regard on the 70th day (p = 0.032). Moreover, the results indicated no significant difference in the 2 groups' mean vaginal pH before and after the intervention (p = 0.101). CONCLUSION: Lactofem oral capsule could improve the participants' Nugent scores, but caused no change in Lactobacillus colonization or vaginal pH.

Hospitalized adolescents' perception of dignity: A qualitative study.

BACKGROUND: Adolescents can be vulnerable to diminished dignity in the hospital because young people have significantly different healthcare needs than children and adults. They like to cooperate with caregivers only when they get respectful and dignified care. Care without considering dignity can adversely influence the adolescents' recovery. However, many studies have been conducted on exploring the concept of the patients' dignity from the adult patients and fewer studies still have explored the dignity of young people. OBJECTIVE: This study explores the hospitalized adolescents' perception about dignity. RESEARCH DESIGN: A conventional qualitative content analysis method was used to explore the meaning of hospitalized adolescents' dignity. PARTICIPANTS AND RESEARCH CONTEXT: Hospitalized adolescents in general medical and surgical pediatric units were eligible to participate. Data were obtained through unstructured interviews. Purposive sampling was used and adolescents were recruited until data saturation was reached (n = 13). ETHICAL CONSIDERATIONS: Ethical approval for the study was granted by the Ethics Committee of Shiraz University of Medical Sciences. Participants were provided with information about the purpose, reasons for recording interviews, voluntary participation, and confidentiality of data and interviewees. FINDINGS: Dignity was reflected in four themes: (1) protection of personal privacy, (2) protection of autonomy, (3) respect for identity, and (4) intimate communication. DISCUSSION AND CONCLUSION: Hospitalized adolescents stated that healthcare services should protect their personal privacy and autonomy. Also, they should respect the adolescent's identity and communicate intimately with them to provide the dignity. Adolescence is a discrete developmental stage, with specific healthcare needs which must be addressed effectively by healthcare providers especially nurses.

Investigation of breastfeeding training based on BASNEF model on the intensity of postpartum blues.

Postpartum blues is a major risk factor for the incidence of postpartum depression and disruption of breastfeeding. This semi-experimental study investigated the effect of breastfeeding training based on the BASNEF model on severity of postpartum blues in 2012. Four educational sessions based on the BASNEF model were held separately for pregnant women and their mothers, mothers-in-law and spouses. The control group received routine care at the clinic. After delivery, women's knowledge of and attitude towards postpartum blues were evaluated using the Zung Self- Rating Depression Scale. There were significant differences between the groups regarding mean scores of knowledge, mothers' evaluation of behaviour outcomes, attitude, and enabling factors. Also, the mean score for postpartum blues was significantly lower in the intervention group compared to the control group. In conclusion, training based on the BASNEF model had a positive effect on maternal knowledge and attitude and, consequently, the intensity of postpartum blues. Further studies are required to determine the reliability and effectiveness of this method.

Prognostic Factors of Breast Cancer Survival in the Islamic Republic of Iran: an Additive Empirical Bayesian Approach.

Breast cancer is a public health challenge in the Islamic Republic of Iran. Relatively few studies have dealt with large dataset and advanced statistical methods. Therefore, we aimed to investigate the role of prognostic factors on breast cancer survival using Additive Empirical Bayesian model with large data set. Breast cancer data set included 1574 women diagnosed with breast cancer from 2002 to 2012 that registered from Cancer Registry in Fars Province, Islamic Republic of Iran. Overall survival rates at 2, 3, 5 and 10 years were 0.98, 0.94, 0.87 and 0.76, respectively. Five years survival at stages 1, 2 and 3 were 0.94, 0.92 and 0.74, respectively. The younger patients with characteristics such as zero involved nodes, negative progesterone receptor, free skin and good prognostic level had a higher survival chance than others. The 5-year survival probability by stage in Fars Province was nearly the same as that reported by the American Cancer Society. The Nottingham prognostic index (NPI) related to nodal status, tumour size and nuclear grade was the main indicator of breast cancer mortality.

Adjusted adaptive Lasso for covariate model-building in nonlinear mixed-effect pharmacokinetic models.

One important aim in population pharmacokinetics (PK) and pharmacodynamics is identification and quantification of the relationships between the parameters and covariates. Lasso has been suggested as a technique for simultaneous estimation and covariate selection. In linear regression, it has been shown that Lasso possesses no oracle properties, which means it asymptotically performs as though the true underlying model was given in advance. Adaptive Lasso (ALasso) with appropriate initial weights is claimed to possess oracle properties; however, it can lead to poor predictive performance when there is multicollinearity between covariates. This simulation study implemented a new version of ALasso, called adjusted ALasso (AALasso), to take into account the ratio of the standard error of the maximum likelihood (ML) estimator to the ML coefficient as the initial weight in ALasso to deal with multicollinearity in non-linear mixed-effect models. The performance of AALasso was compared with that of ALasso and Lasso. PK data was simulated in four set-ups from a one-compartment bolus input model. Covariates were created by sampling from a multivariate standard normal distribution with no, low (0.2), moderate (0.5) or high (0.7) correlation. The true covariates influenced only clearance at different magnitudes. AALasso, ALasso and Lasso were compared in terms of mean absolute prediction error and error of the estimated covariate coefficient. The results show that AALasso performed better in small data sets, even in those in which a high correlation existed between covariates. This makes AALasso a promising method for covariate selection in nonlinear mixed-effect models.

The Effect of Warm Compress Bistage Intervention on the Rate of Episiotomy, Perineal Trauma, and Postpartum Pain Intensity in Primiparous Women with Delayed Valsalva Maneuver Referring to the Selected Hospitals of Shiraz University of Medical Sciences in 2012-2013.

BACKGROUND: Genital trauma during vaginal delivery may result from episiotomy, spontaneous perineal tears (perineum, vagina), or both. In 2012, this study aimed to investigate the effect of warm compress bistage intervention on the rate of episiotomy, perineal trauma, and postpartum pain intensity in the primiparous woman with delayed Valsalva maneuver. METHODS: In this randomized clinical trial, which was performed in hospitals in Shiraz, Iran, in 2012-2013, 150 women were randomly divided into 2 groups: 1 intervention and 1 control. The intervention group received warm compress bistage intervention at 7-cm and 10-cm dilatation and zero position during the first and second stages of labor for 15 to 20 minutes, whereas the control group received the hospitals' routine care. After delivery, the prevalence of episiotomy; intact perineum; location, degree, and length of rupture; and postpartum pain intensity were assessed in the 2 groups. Following that, the data were analyzed with SPSS statistical software (version 16) using χ test, t test, and odds ratio. RESULTS: The results revealed a significant difference between the intervention and control groups regarding the frequency of intact perinea (27% vs 6.7%) and the frequency of episiotomy (45% vs 90.70%). In addition, the frequency of the location of rupture (P = .019), mean length of episiotomy incision (P = .02), and mean intensity of pain the day after delivery (P < .001) were significantly lower in the intervention group compared with the control group. However, the rate of ruptures was higher in the intervention group. CONCLUSIONS: Warm compress bistage intervention was effective in reducing episiotomies and the mean length of episiotomy incision, reducing pain after delivery, and increasing the rate of intact perinea. However, the rate of ruptures slightly increased in the intervention group compared with the control group.

Comparison of the effects of acupressure and self-care behaviors training on the intensity of primary dysmenorrhea based on McGill pain questionnaire among Shiraz University students.

BACKGROUND: Dysmenorrhea is one of the common problems during reproductive ages, with prevalence rate of 60-90%. This study aimed to compare the effects of acupressure at Guan yuan (RN-4) and Qu gu (RN-2) acupoints, self-care behaviors training, and ibuprofen on the intensity of primary dysmenorrhea based on McGill pain questionnaire. MATERIALS AND METHODS: In the randomized clinical trial, 120 females, aged between 18 and 25 years, with primary dysmenorrhea, randomly selected from five dormitories of Shiraz University, Shiraz, Iran were screened and randomized into acupressure group, in that pressure was applied for 20 min over the 1st 2 days of menstruation for two cycles. In the second group, the training group took part in four educational sessions each lasting for 60-90 min and control group received ibuprofen 400 mg. The intensity of pain before and after the intervention was measured using short-form McGill pain questionnaire. The data were entered into the SPSS statistical software (version 16) and analyzed using Kruskal-Wallis test, paired t-test, and Chi-square test. RESULTS: A significant difference was found in the mean intensity of pain before and after the intervention in all the three study groups. The mean score of pain intensity was 10.65 ± 5.71 in the training group, 19 ± 5.41 in the control group, and 14.40 ± 6.87 in the acupressure group after the intervention. The results of Kruskal-Wallis test revealed that both interventions were more effective compared to consumption of ibuprofen. CONCLUSION: Training and acupressure were more effective than ibuprofen in the reduction of dysmenorrhea. Thus, they can be considered as trainable methods without side effects in adolescent girls.

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.

Quality of life of childbearing age women and its associated factors: an application of seemingly unrelated regression (SUR) models.

PURPOSE: This article is a report of using seemingly unrelated regression (SUR) models to examine the determinants of different dimensions of quality of life (QoL) among childbearing age women. There are a limited number of studies on QoL and its associated factors among women in developing countries such as Iran. Therefore, more attention should be focused on identifying these issues. METHODS: We administered the Persian's abbreviated version of the World Health Organization Quality of Life (WHOQOL-BREF) questionnaire to 1,067 married women aged between 15 and 49 years. The women were chosen via a multistage research design from the rural region of Shiraz, the center of Fars Province in Iran in 2008. Clinical and socio-demographic characteristics as well as their reproductive health-related characteristics were investigated. To identify associated factors of QoL dimensions, ordinary least squares (OLS) regression and SUR were used and their findings were compared. RESULTS: The WHOQOL-BREF showed acceptable consistency (Cronbach's alpha range: 0.62-0.75 across domains). Lower age, absence of long-term illness, economic status satisfaction, higher level of education, lower number of pregnancies, and higher body mass index were important associated factors of different dimensions of the QoL among these women. The estimated parameters for these factors were in close agreement in both OLS and SUR estimation methods. However, the SUR estimator provided the higher precision of the estimates than the OLS estimator, as the parameters obtained by SUR are characterized by lower standard errors. Women's age, income satisfaction, and level of education were common for all domains. CONCLUSIONS: This study presents a novel approach to simultaneously predict QoL domains using the SUR estimators and the results are relevant for implementing objective QoL. SUR estimators performed consistently better than the OLS estimators, since SUR takes the correlation between error terms into account. Thus, the SUR method could be a useful methodology for predicting QoL domains.

The effect of cardiac rehabilitation on anxiety and depression in patients undergoing cardiac bypass graft surgery in Iran.

BACKGROUND: Many patients experience anxiety and depression after cardiac bypass surgery.The aim of this study was to examine the effect of cardiac rehabilitation on anxiety and depression in patients undergoing coronary artery bypass grafting in hospitals affiliated to Shiraz University of Medical Sciences in southern Iran. METHODS: For this randomized controlled trial, 80 patients who met the inclusion criteria were recruited and randomly assigned to case and control groups. Anxiety was measured with the Spielberger Anxiety Scale and depression was measured using Beck's Depression Inventory at three points in time: on discharge from the hospital, immediately after the intervention, and 2 months after cardiac rehabilitation. After measuring anxiety and depression in both groups upon discharge, the experimental group participated in 8 cardiac rehabilitation sessions over a 4-week period. The control group received only the routine follow-up care. RESULTS: There was a statistically significant difference in depression scores between groups at all three time-points (Mean score from 19.6 to 10 in the intervention group and from 19.5 to 14 in the control group, P = 0.0014). However, no significant difference was seen in anxiety scores between the groups (Mean score from 37 to 28 in the intervention group and from 38 to 32 in the control group, P = 0.079). CONCLUSIONS: Cardiac rehabilitation was effective in reducing depression 2 months after surgery in patients undergoing coronary artery bypass grafting. TRIAL REGISTRATION: IRCTN201203262812N8.

Preserving effect of Loboob (a traditional multi-herbal formulation) on sperm parameters of male rats with busulfan-induced subfertility.

OBJECTIVE: Male infertility secondary to exposure to gonadotoxic agents during reproductive age is a concerning issue. The aim of this experimental study was to determine the effect of Loboob on sperm parameters. METHODS: 55 healthy rats were selected, weighted and divided into five groups consisting of 11 rats each. The control group received no medication. Rats in Treatment Group 1 received 10mg/kg Busulfan and rats in Treatment Groups 2, 3, and 4 received 35,70 and 140 mg/kg Loboob respectively in addition to 10mg/kg Busulfan. Finally, the sperm parameters and weights of the rats were compared using the Kolmogorov-Smirnov, non-parametric Kruskal-Wallis, and Dunn-Bonferroni tests. RESULTS: All sperm parameters and weights were significantly decreased among rats receiving Busulfan. All dosages of Loboob were effective to enhance the motility of slow spermatozoa, while only in the rats given 70 and 140 mg/kg of Loboob saw improvements in progressively motile sperm percentages (0.024 and 0.01, respectively). Loboob at a dosage of 140mg/kg improved sperm viability. It did not improve normal morphology sperm or decrease immotile sperm counts. Loboob did not affect mean rat weight. CONCLUSIONS: Loboob offered a dose-dependent protective effect on several sperm parameters in rats with busulfan-induced subfertility.

A parametric method for cumulative incidence modeling with a new four-parameter log-logistic distribution.

BACKGROUND: Competing risks, which are particularly encountered in medical studies, are an important topic of concern, and appropriate analyses must be used for these data. One feature of competing risks is the cumulative incidence function, which is modeled in most studies using non- or semi-parametric methods. However, parametric models are required in some cases to ensure maximum efficiency, and to fit various shapes of hazard function. METHODS: We have used the stable distributions family of Hougaard to propose a new four-parameter distribution by extending a two-parameter log-logistic distribution, and carried out a simulation study to compare the cumulative incidence estimated with this distribution with the estimates obtained using a non-parametric method. To test our approach in a practical application, the model was applied to a set of real data on fertility history. CONCLUSIONS: The results of simulation studies showed that the estimated cumulative incidence function was more accurate than non-parametric estimates in some settings. Analyses of real data indicated that the proposed distribution showed a much better fit to the data than the other distributions tested. Therefore, the new distribution is recommended for practical applications to parameterize the cumulative incidence function in competing risk settings.

The effect of peer-led education on the life quality of mastectomy patients referred to breast cancer-clinics in Shiraz, Iran 2009.

BACKGROUND: Breast cancer among women is a relatively common with a more favorable expected survival rates than other forms of cancers. This study aimed to determine the improved quality of life for post-mastectomy women through peer education. METHODS: Using pre and post test follow up and control design approach, 99 women with stage I and II of breast cancer diagnosis were followed one year after modified radical mastectomy. To measure the quality of life an instrument designed by the European organization for research and treatment of cancer, known as the Quality of Life Question (QLQ-30) and its breast cancer supplementary measure (QLQ-BR23) at three points in time (before, immediately and two months after intervention) for both groups were used. The participant selection was a convenient sampling method and women were randomly assigned into two experimental and control groups. The experimental group was randomly assigned to five groups and peer educators conducted weekly educational programs for one month. Tabulated data were analyzed using chi square, t test, and repeated measurement multivariate to compare the quality of life differences over time. RESULTS: For the experimental group, the results showed statistically significant improvement in all performance aspects of life quality and symptom reduction (P < 0.001), while the control group had no significant differences in all aspects of life quality. CONCLUSION: The findings of this study suggest that peer led education is a useful intervention for post-mastectomy women to improve their quality of life.

A Comparative Study of Different Joint Modeling Approaches for HIV/AIDS Patients in Southern Iran.

BACKGROUND: The prevalence of HIV/AIDS has been increasing in Iran, especially amongst the young population, recently. The joint model (JM) is a statistical method that represents an effective strategy to incorporate all information of repeated measurements and survival outcomes simultaneously. In many theoretical studies, the population under the study were heterogeneous. This study aimed at comparing three approaches by considering heterogeneity in the patients. METHODS: This study was conducted on 750 archived files of patients infected with HIV in Fars Province, southern Iran, from 1994 to 2017. Proposed Approach (PA), Joint Latent Class Models (JLCM), and Separated Approach (SA) were compared to evaluate the influence covariates on the longitudinal and time-to-event outcomes in the heterogeneous HIV/AIDS patients. RESULTS: Gender (P<0.001) and HCV (P<0.01) were two significant covariates in the classification of HIV/AIDS patients. Time had a significant effect on CD4 (P<0.001) in both classes in the three approaches. In PA and SA, females had higher CD4 than males (P<0.001) in the first class. In JLCM, females had higher CD4 than males (P<0.01) in both classes. The patients with higher Hgb had also higher CD4 (P<0.001) in both classes in the three approaches. HCV reduced the CD4 significantly in both classes in PA (P<0.05) and SA (P<0.001). Within the survival sub-model, HCV reduced survival rate significantly in the second class in PA (P<0.05), JLCM (P<0.01) and SA (P<0.001). CONCLUSION: PA was an appropriate approach for joint modeling longitudinal and survival outcomes for this heterogeneous population.

A New Method for Imputing Censored Values in Crossover Designs with Time-to-Event Outcomes Using Median Residual Life.

Crossover designs are commonly applied in research due to efficiency and subject parsimony compared to parallel studies. Baseline measurements would improve the power of comparison. For time to event outcomes, the sample size is reduced due to censorship, if they are ignored; thus, applying traditional regression models will be limited. A logical solution is to impute the censored observation and apply common analytical models for analyzing the data. Nevertheless, techniques to impute censored data in time-to-event outcomes in crossover designs are not practiced as much. Accordingly, we propose a method to impute the censored observation using median residual life regression and then analyze the data using analyses of covariance (ANCOVA), considering the difference of period-specific baselines as covariate. We used simulation to show the favorable performance of our method relative to a recently proposed method, multiple imputation with model averaging and ANCOVA (MIMI). Specifically, the censored observations were multiply-imputed using prespecified parametric event time models, and then, the methods were applied to a real data example.

Improved Landmark Dynamic Prediction Model to Assess Cardiovascular Disease Risk in On-Treatment Blood Pressure Patients: A Simulation Study and Post Hoc Analysis on SPRINT Data.

Landmark model (LM) is a dynamic prediction model that uses a longitudinal biomarker in time-to-event data to make prognosis prediction. This study was designed to improve this model and to apply it to assess the cardiovascular risk in on-treatment blood pressure patients. A frailty parameter was used in LM, landmark frailty model (LFM), to account the frailty of the patients and measure the correlation between different landmarks. The proposed model was compared with LM in different scenarios respecting data missing status, sample size (100, 200, and 400), landmarks (6, 12, 24, and 48), and failure percentage (30, 50, and 100%). Bias of parameter estimation and mean square error as well as deviance statistic between models were compared. Additionally, discrimination and calibration capability as the goodness of fit of the model were evaluated using dynamic concordance index (DCI), dynamic prediction error (DPE), and dynamic relative prediction error (DRPE). The proposed model was performed on blood pressure data, obtained from systolic blood pressure intervention trial (SPRINT), in order to calculate the cardiovascular risk. Dynpred, coxme, and coxphw packages in the R.3.4.3 software were used. It was proved that our proposed model, LFM, had a better performance than LM. Parameter estimation in LFM was closer to true values in comparison to that in LM. Deviance statistic showed that there was a statistically significant difference between the two models. In the landmark numbers 6, 12, and 24, the LFM had a higher DCI over time and the three landmarks showed better performance in discrimination. Both DPE and DRPE in LFM were lower in comparison to those in LM over time. It was indicated that LFM had better calibration in comparison to its peer. Moreover, real data showed that the structure of prognostic process was predicted better in LFM than in LM. Accordingly, it is recommended to use the LFM model for assessing cardiovascular risk due to its better performance.

Prevalence of Cytomegalovirus in Semen of Male Partners of Infertile Couples and the Virus Impact on Sperm Parameters.

BACKGROUND: Genital tract infection is one of the causes of male infertility. Several studies have shown a role for human cytomegalovirus (CMV) in this context. In the present study, the prevalence of CMV in a population of male partners of infertile couples was estimated and the impact of CMV on sperm parameters was determined. METHODS: In this cross sectional study, CMV DNA and virus copy number were examined in the semen of 150 participants including 80 with normal semen analysis (SA) and 70 with abnormal SA, by quantitative Real-Time PCR. Sperm parameters were compared between CMV positive and negative groups. Comparisons with p- values under 0.05 were considered significant. Logistic regression was performed to control the effect of some variables with p<0.25 on sperm parameters. RESULTS: CMV DNA was detected in the semen of 28 (18.6%) individuals. 21 men (30%) with abnormal SA and 7 (8.8%) with normal SA were positive for CMV DNA (p=0.001). The mean virus copy number was 883.1±4662.01 for the men with abnormal SA and 2525.7±12680.9 for those with normal SA (p=0.001). Sperm count was (32.1±23.5) ×106 in CMV positive and (44.2±24.1) ×106 in CMV negative groups (p=0.022). Normal sperm morphology was 2.73±2.83% and 5.99±5.44% in CMV positive and negative groups, respectively (p<0.001). After controlling some variables, the sperm morphology remains the only statistically significant sperm parameter that was reduced by CMV. CONCLUSION: The higher CMV prevalence in the semen of males with abnormal SA compared to normal SA and significant reduction of sperm morphology in the presence of CMV, are in favor of the negative impact of CMV on male fertility.

Atrial fibrillation in patients with constrictive pericarditis: the significance of pericardial calcification.

BACKGROUND: Although atrial fibrillation (AF) is commonly encountered in patients with constrictive pericarditis (CP), little has been done to clarify its associated predisposing factors. Our aim was to evaluate the association of age, gender, disease duration, and pericardial calcification with AF in these patients. METHODS: The medical records of 44 patients with CP were reviewed. There were 13 (29.5%) with AF and 31 (70.5%) with sinus rhythm. The two groups were compared for demographic variables, disease duration, and the presence of pericardial calcification. RESULTS: The male-to-female ratio was 3.4:1. Calcification was seen in 11 (25%) of the entire group. AF was much more common in those with calcification than those with sinus rhythm (odds ratio, 7.87 [95% CI, 1.73-35.78], P=0.008). There was no association between the presence of AF and the age (P=0.156) or gender (P approximately 1.00). Logistic regression, however, showed that the chance of developing AF increased by 27% by each year of increase in disease duration (P=0.025). CONCLUSION: It seems that in patients with CP, the presence of pericardial calcification and the increasing disease duration are associated with a higher chance of developing AF.

Patent foramen ovale in patients with tension headache: is it as common as in migraineurs? An age- and sex-matched comparative study.

The association of patent foramen ovale (PFO) and atrial septal aneurysm (ASA) with migraine headache attack (MHA) has been clearly shown. The same findings have been recently demonstrated also in cluster headache. Although tension-type headaches (TTH) are the most common kind of headache, their association with these atrial septal abnormalities has never been studied before. The study was conducted to clarify whether there was a significant association between the presence of such atrial septal abnormalities and tension headache, when compared with migraineurs. One hundred consecutive patients with migraine and 100 age- and sex-matched subjects with TTH and 50 healthy volunteers with no headache were enrolled in the study and underwent a complete transesophageal echocardiographic study with contrast injections at rest and with the Valsalva maneuver. There was no significant difference between the age and the sex of the participants of the three groups. The overall prevalence of PFO was 23% in patients with TTH and that of large PFOs was only 11%. The 23% prevalence of PFO in patients with TTH was not statistically different from 16% found in our normal control group. Furthermore, we found a significantly higher prevalence of PFO in migraineurs (50%) when compared with patients with tension headache (p < 0.001). This was also true for the collective presence of large PFOs and ASAs (35%) (p < 0.001). Although atrial septal anomalies have an association with MHA, they do not have a significant association with TTH.

Bayesian Spatial Joint Model for Disease Mapping of Zero-Inflated Data with R-INLA: A Simulation Study and an Application to Male Breast Cancer in Iran.

Hierarchical Bayesian log-linear models for Poisson-distributed response data, especially Besag, York and Mollié (BYM) model, are widely used for disease mapping. In some cases, due to the high proportion of zero, Bayesian zero-inflated Poisson models are applied for disease mapping. This study proposes a Bayesian spatial joint model of Bernoulli distribution and Poisson distribution to map disease count data with excessive zeros. Here, the spatial random effect is simultaneously considered into both logistic and log-linear models in a Bayesian hierarchical framework. In addition, we focus on the BYM2 model, a re-parameterization of the common BYM model, with penalized complexity priors for the latent level modeling in the joint model and zero-inflated Poisson models with different type of zeros. To avoid model fitting and convergence issues, Bayesian inferences are implemented using the integrated nested Laplace approximation (INLA) method. The models are compared according to the deviance information criterion and the logarithmic scoring. A simulation study with different proportions of zero exhibits INLA ability in running the models and also shows slight differences between the popular BYM and BYM2 models in terms of model choice criteria. In an application, we apply the fitting models on male breast cancer data in Iran at county level in 2014.