Depression, Anxiety, and Stress Relative to Swallowing Impairment in Persons with Multiple Sclerosis.

Dysphagia and symptoms of depression, anxiety and stress are common in persons with multiple sclerosis (MS). We posited a relationship between dysphagia and increased frequency of psychological symptoms. Therefore, the aim of the present study was to examine associations between symptoms of psychological difficulties, use of emotional suppression and cognitive reappraisal strategies, and dysphagia status in persons with MS. One hundred persons with MS were prospectively assessed in multiple domains of functioning: cognitive, psychological, and dysphagia-related. Participants underwent cognitive screening with the Mini Mental State Examination and completed two psychological inventories: The depression, anxiety and stress scale (DASS)-21 and the Emotion Regulation Questionnaire. Further, they completed the dysphagia in Multiple Sclerosis questionnaire. A speech-language pathologist evaluated persons suspected of having dysphagia with the Mann Assessment of Swallowing Ability. Dysphagia was present in 29 persons with MS, and the sample was split accordingly. The two groups differed at baseline with respect to Expanded Disability Status Scale scores. There were significant between-group differences for mental health symptoms and for use of emotional regulation strategies. Accordingly, multivariate logistic regressions showed that increased symptoms of psychological stress, decreased use of cognitive reappraisal strategies, and increased indicators of emotional suppression independently predicted the presence of dysphagia. There was a clear pattern towards poorer psychological well-being in persons with dysphagia compared to those without. Psychological difficulties may contribute to the manifestation or worsening of dysphagia and should be addressed in treatment planning and future investigations. Therapeutic interventions that promote improvement in mental state alongside swallowing function may be highly beneficial.

Lifetime and past-month substance use and injection among street-based female sex workers in Iran.

BACKGROUND: Street-based female sex workers (FSWs) are highly at risk of HIV and other harms associated with sex work. We assessed the prevalence of non-injection and injection drug use and their associated factors among street-based FSWs in Iran. METHODS: We recruited 898 FSWs from 414 venues across 19 major cities in Iran between October 2016 and March 2017. Correlates of lifetime and past-month non-injection and injection drug use were assessed through multivariable logistic regression models. Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were reported. RESULTS: Lifetime and past-month non-injection drug use were reported by 60.3% (95% CI 51, 84) and 47.2% (95% CI 38, 67) of FSWs, respectively. The prevalence of lifetime and past-month injection drug use were 8.6% (95% CI 6.9, 10.7) and 3.7% (95% CI 2.6, 5.2), respectively. Recent non-injection drug use was associated with divorced marital status (AOR 2.00, 95% CI 1.07, 3.74), temporary marriage (AOR 4.31 [1.79, 10.40]), had > 30 clients per month (AOR 2.76 [1.29, 5.90]), ever alcohol use (AOR 3.03 [1.92, 6.79]), and history of incarceration (AOR 7.65 [3.89, 15.30]). Similarly, lifetime injection drug use was associated with ever alcohol use (AOR 2.74 [1.20-6.20]), ever incarceration (AOR 5.06 [2.48-10.28]), and ever group sex (AOR 2.44 [1.21-4.92]). CONCLUSIONS: Non-injection and injection drug use are prevalent among street-based FSWs in Iran. Further prevention programs are needed to address and reduce harms associated with drug use among this vulnerable population in Iran.

Methamphetamine use and HIV risk behavior among men who inject drugs: causal inference using coarsened exact matching.

BACKGROUND: Understanding the association between methamphetamine (MA) use and HIV risk behavior among people who inject drugs (PWID) will assist policy-makers and program managers to sharpen the focus of HIV prevention interventions. This study examines the relationship between MA use and HIV risk behavior among men who inject drugs (MWID) in Tehran, Iran, using coarsened exact matching (CEM). METHODS: Data for these analyses were derived from a cross-sectional study conducted between June and July 2016. We assessed three outcomes of interest-all treated as binary variables, including distributive and receptive needle and syringe (NS) sharing and condomless sex during the month before interview. Our primary exposure of interest was whether study participants reported any MA use in the month prior to the interview. Firstly, we report the descriptive statistics for the pooled samples and matched sub-samples using CEM. The pooled and matched estimates of the associations and their 95% CI were estimated using a logistic regression model. RESULTS: Overall, 500 MWID aged between 18 and 63 years (mean = 28.44, SD = 7.22) were recruited. Imbalances in the measured demographic characteristics and risk behaviors between MA users and non-users were attenuated using matching. In the matched samples, the regression models showed participants who reported MA use were 1.82 times more likely to report condomless sex (OR = 1.82 95% CI 1.51, 4.10; P = 0.031), and 1.35 times more likely to report distributive NS sharing in the past 30 days, as compared to MA non-users (OR = 1.35 95% CI 1.15-1.81). Finally, there was a statistically significant relationship between MA use and receptive NS sharing in the past month. People who use MA in the last month had higher odds of receptive NS sharing when compared to MA non-users (OR = 4.2 95% CI 2.7, 7.5; P = 0.013). CONCLUSIONS: Our results show a significant relationship between MA use and HIV risk behavior among MWID in Tehran, Iran. MA use was related with increased NS sharing, which is associated with higher risk for HIV exposure and transmission.

Association of wrist circumference with cardio-metabolic risk factors: a systematic review and meta-analysis.

BACKGROUND AND AIMS: The association of Wrist Circumference (WrC) with cardio-metabolic risk factors is still contradictory. We aimed to systematically review the association of WrC with cardio-metabolic diseases among the general populations. METHODS: We systematically searched electronic databases such as PubMed/Medline, Web of Sciences, and Scopus without language restriction until March 2017. Observational studies that examined the association of WrC with any cardio-metabolic risk factors were included. Pooled association of WrC with metabolic syndrome (MetS) was estimated using a random-effect model, and heterogeneity among studies was assessed by I2 index and Q test. RESULTS: A total of 14 papers including cohort study (n = 9), cross-sectional study (n = 4), and case-control study (n = 1) met the criteria and included. The eligible papers have been examined the association of WrC with any cardiovascular disorders (n = 8), metabolic syndrome (n = 4), insulin resistance (IR) (n = 5), diabetes mellitus (n = 2), impaired glucose tolerance (n = 1), cardio-metabolic risk factors (n = 2) and obesity/overweight (n = 1). In the whole population (both adults and pediatric population), high WrC increased the risk of MetS by 33% (Pooled OR = 1.33; 95% CI 1.20, 1.48; I2 = 60.2%, p = 0.04), while the pooled OR in adult populations was 1.27 (95% CI 1.15-1.41; I2: 32.8%, p = 0.21). Qualitative synthesis showed that associations of WrC with other cardio-metabolic risk factors are conflicting. CONCLUSION: High WrC increased the risk of MetS and other cardio-metabolic risk factors. However, due to limited studies, particularly in children, results should be declared with great caution. Further cohort studies are needed to clarify whether WrC is a suitable anthropometric index to predict cardio-metabolic disorders in adult and children populations in different societies. LEVEL OF EVIDENCE: Level 1, systematic review and meta-analysis.

Population Size Estimates of Street Children in Iran: Synthesis of Multiple Methods.

We used four methods (direct count, indirect count, wisdom of the crowd, and unique object multiplier) to map and estimate the population size of street children in six major cities in Iran in 2017. In aggregate for the six cities, the number of street children was estimated at 5296 (interquartile range [IQR] 4122-7071) using the median of the four methods. This corresponds to a rate of 16.3 (IQR 12.5-24.5) per 10,000 children age 5-18 years old, or 3.2 (IQR 2.4-5.3) per 10,000 total population. The total number for street children in the country is estimated at 26,000 (IQR 20,239-34,719) children. Results can help policy-makers advocate for resources, plan programs, and evaluate the reach of programs for street children. The maps created through the course of the population size estimation exercise can also guide outreach efforts to provide street children with health and social welfare services.

Needle and Syringe Programs and HIV-Related Risk Behaviors Among Men Who Inject Drugs: A Multilevel Analysis of Two Cities in Iran.

BACKGROUND: Many studies have found significant differences in HIV risk at the community and socioeconomic levels. However, few have considered variations in needle and syringe program (Jin et al., Oral Dis. 1;22(7):609-19) coverage and other community characteristics on HIV risk behaviors among people who inject drugs (PWIDs). Our objective was to study the relationship between individual factors and city-level characteristics (such as the city's coverage of harm reduction programs) on HIV risk behavior among PWID residing in two cities in Iran. METHODS: The study was conducted from March to August 2016 in Tehran and Kermanshah provinces. One thousand PWID were recruited by a convenience sampling recruitment at local NSP Drop-in Centers (DIC) and through "snowball sampling" (i.e., using peers to refer participants to the study). We first examined associations between individual-level variables and HIV risk behaviors in bivariate analysis using the chi-square or Fisher's exact tests, as appropriate. Next, multi-level models were constructed to determine the amount of variability in HIV risk behavior that could be accounted for by individual- and community-level characteristics. Variables with p value < 0.2 were included in the multiple logistic regression model. RESULTS: The results of the multilevel modeling showed that 32% of the variability in HIV risk behaviors among PWID could be explained by factors that differed between the two cities. When individual factors including higher HIV knowledge, access to NSP, higher HIV risk perception, and methamphetamine use were all included in the final model, 22% of the variability in HIV risk behaviors could be explained to city-level variables. CONCLUSION: Findings suggest that expanding the accessibility (i.e., hours and venues) and community-level coverage of NSP services by establishing programs where PWID congregate might reduce HIV risk behavior among PWID.

Clinical determinants associated with quality of life for people who live with HIV/AIDS: a Meta-analysis.

BACKGROUND: During recent years, Quality of Life (QoL) is a significant assessment factor in clinical trials and epidemiological researches due to the advent of Antiretroviral Therapy (ART), Human Immunodeficiency Virus (HIV) has become a manageable,chronic disease. With regards, more attention must be paid to the QoL of infected patients. Limited evidence exists on the impact of ART on QoL among HIV infected patients. Due to lacking of a systematic approach to summarizing the available evidence on the clinical determinants of People Who Live with HIV/AIDS (PWLHs') QoL, this study aimed to analyze the impact of clinical determinants (ART experience, CD4 count < 200, co-morbidities, time diagnosis and accessibility to cares) on QoL among PWLHs'. METHODS: This study was designed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). PubMed, Science Direct, Web of Science, and Cochrane electronic databases were searched in February 2017 to identify all past studies that discussed social and behavioral characteristics of QoL in PLWHA. To recognize effective factors on social and behavioral QoL, a meta-analysis was conducted. Polled Odds Ratios (ORs) were utilized at a 95% confidence level. Since sampling methods differed between articles in the systematic review, we evaluated pooled estimates using a random effect model. Metan, metareg, metacum, and metabias commands in STATA version 13.0 were applied to analyze the data. RESULTS: Our findings indicated that ART has a positive impact on QoL, with a pooled effect size at approximately 1.04 with a confidence interval between 0.42 to 1.66 which indicates this impact is not very considerable and may be relatively neutral. The pooled effect size for CD4 count on QoL was .29 (95%CI = .22-.35), indicating that there is a negative associate between CD4 count and QoL. The co-morbidity as a negative determinant for QoL among HIV/AIDS infected people. The pooled effect size implies on a relative neutral association, although the confidence interval is wide and ranges between 0.32 to 1.58. The pooled effect size is about 1.82 with confidence interval 1.27 to 2.37 which indicates a considerable positive association with lowest level of heterogeneity. CONCLUSIONS: The results illustrated that time diagnosing and availability to hospital services had significant relationship with a higher QoL and CD4 < 200 was associated with a lower QoL. In conclusion, policy makers should set an agenda setting to provide a suitable diagnostic and therapeutic facilities to early detecting and continues monitoring the health status of People Who Live with HIV/AIDS (PWLHs').

Comparing Injecting Risk Behaviors of Long-Term Injectors with New Injectors in Tehran, Iran.

BACKGROUND: Global estimates suggest there are 15.6 million people who inject drugs (PWID) of whom 17.8% are living with HIV.Few studies have characterized newly-onset injectors with long-term injectors and its association with injecting risk behaviors. OBJECTIVES: We examined the relationship between length of injection and risk behaviors among people who inject drugs (PWID) in Tehran, Iran. METHODS: A cross-sectional study was conducted among PWID, from March to August 2016 in Tehran, Iran. PWID were recruited by convenience and snowball sampling from five Drop-in Centers (DIC) located in the south of Tehran. Our primary independent variable was length of injecting career, defined as the number of months since injecting initiation. Those defined as new injectors (were injecting for less than 18 months), and long-term injectors (as injecting drugs for more than 18 months). We reported the adjusted odds ratio (aOR) point estimate and 95% confidence interval (CI95%) as the effect measure. The level of significance used in multiple logistic regression model was 0.05. We used STATA v. 11 for all analyzes. RESULTS: The analytical sample comprised of 500 participants (100% male). Mean (±SD) age of PWID with a length of injection history was 31.2 ± 7.2 years. Overall, 270 (54%) (CI95%: 49.6%, 58.4%) of participants were long-term injectors. The average age of drug use initiation among long-term injectors group was lower as compared to new injectors group (31.2 vs. 29.4, p < 0.001). The odds of distributive syringe sharing among new injectors were two times higher than long-term injectors (AOR = 2.1, 95% CI 1.4-4.7). The odds of receptive syringe sharing were lower among new injectors group (AOR = 0.7, CI95% 0.2-0.87), compared to long-term injectors. New injectors had higher odds of reusing their own syringes (OR = 2.8, 95% CI: 1.4-5.7; p = 0.01). CONCLUSIONS: Improvements in harm reduction service provision can occur through taregted risk reduction education for new injectors focusing on reducing distributive syringe sharing among them.

Effect of Selenium Supplementation on Lipid Profile: A Systematic Review and Meta-Analysis.

Selenium is an essential mineral that plays a key role in plenty of major metabolic processes. A growing body of literature has shown that selenium deficiency leads to an increase in plasma TC and TG levels. This study explores the effect of selenium supplementation on serum level of lipid profile [total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL), very low density lipoprotein (VLDL)]. We systematically searched PubMed/MEDLINE, ISI/WOS, and Scopus (from their commencements to Jan 2016) to identify the papers investigating the association between the intake of selenium and lipid profile. Data extracted from the relevant studies were screened. The pooled standardized mean difference was estimated using the random or fixed effects model. Heterogeneity among the studies was assessed using Q-test. Of the potentially relevant articles screened, 11 articles including 1221 participants were included in this meta-analysis. Results of meta-analysis showed that intake of selenium resulted in a statistically significant improvement in TC, [(SMD): -0.13, 95% CI: (-0.24, -0.02)], TG [(SMD): -0.19, 95% CI: (-0.38, -0.01)] and VLDL [(SMD): -0.34, 95% CI: (-0.63, -0.05)]. The selenium supplementation did not significantly improve lipid profile such as LDL [(SMD): -0.08, 95% CI: (-0.036, 0.19)], HDL [(SMD): 0.01, 95% CI: (-0.164, 0.18)], HDL/TC ratio [(SMD): 0.025, 95% CI: (-0.11, 0.16)], non-HDL-C [(SMD): 0.018, 95% CI: (-0.13, 0.16)]. This meta-analysis suggests that the effect of selenium supplementation on the serum levels of TG and VLDL is marginally significant. However, the supplementation has no effect on other serum lipids. Moreover, the study shows that the effect of selenium supplementation on lipid profile is negative.

Decomposition of Economic Inequality in Needle and Syringe Programs Utilization to its Determinants among Men Who Inject Drugs in Tehran using Blinder-Oaxaca Decomposition Method.

BACKGROUND: According to latest available data there are more of 300,000 people injects drug users (PWID) in Iran. OBJECTIVES: In this study, we used a Blinder-Oaxaca (BO) decomposition to explore the relative contributions of inequality in utilization of NSPs and to decompose it to its determinants in Teheran. METHODS: We used data from a cross-sectional survey using snowball sampling to recruit 500 PWID from June to July 2016 in Tehran. Participants were reported injecting drug use in the past month, were able to speak and comprehend Farsi enough to respond to survey questions, and were able to provide informed consent to complete the interview. We used a BO method to decompose the role of economic inequality on utilization of needle and syringe programs. RESULTS: A total 520 of clients participated in the study of which data was fully complete for 500. The selected predictor variables (age, education level, marital status, homelessness, HIV risk perception, and HIV knowledge) together explain 54% (8.5% out of 16%) of total inequality in utilization of needle and syringe programs and the remaining 46% constitute the unexplained residual. HIV risk perception status contributed about 38% (3.3% out of 8.5%) to the total health inequality, followed by HIV knowledge (26%) and education level were contributed 20% each, respectively. CONCLUSION: The results showed that contribution of economic inequalities in utilization of NSPs was primarily explained by the differential effects of HIV risk perception and HIV knowledge among PWID. Reducing HIV risk perception and increasing HIV knowledge might be essential to efforts to eliminate inequalities in access to NSPs among PWID.

HIV Risk Perception and Risky Behavior Among People Who Inject Drugs in Kermanshah, Western Iran.

PURPOSE: Understanding and increasing awareness on individual risk for HIV infection as well as HIV risk perception's effects on different behavioral outcomes for people who inject drugs (PWID) is important for policymaking and planning purposes. The objectives of the present study were to determine whether HIV risk perception was associated with greater injection and sexual risk-taking behaviors among PWIDs. METHOD: We surveyed 460 PWID in Kermanshah regarding their demographic characteristics, sexual risk behaviors, HIV risk perception, and drug-related risk behaviors in the month prior to the study. Three classes of HIV risk perception were identified using ordinal regression to determine factors associated with HIV risk perception. RESULTS: Study participants were categorized as follows: "low" (n = 100, 22%), "moderate" (n = 150, 32%), and "high" (n = 210, 46%) risk perception for becoming infected with HIV. The odds of categorizing as "high" risk for HIV was significantly greater in PWID that reported unprotected sex (adjusted odds ratio (AOR) 2.4, p value 0.02), receptive syringe sharing (AOR 1.8, p value 0.01), and multiple sex partners (AOR 1.4, p value 0.03). PWID who reported unprotected sex had 2.7 times the odds of "high" risk perception when compared to PWID with "low" risk perception. CONCLUSION: Findings show that PWID could rate their HIV risk with acceptable accuracy. Additionally, perceived HIV risk was associated with many risk factors for transmission of HIV, emphasizing the importance of developing targeted prevention and harm reduction programs for all domains of risk behaviors, both sexual and drug-related use.

Comparing Characteristics of Early-Onset Injection Drug Users to Those With Late-Onset Injection in Kermanshah, Iran.

BACKGROUND: Characteristics and behaviors of early-onset injection drug users are under studied topics in Iran. This study aimed to identify and compare the demographic characteristics as well as the drug using behaviors of early-onset and late-onset injection drug users in Kermanshah, West Iran. METHODS: In this cross-sectional study using snowball and convenience sampling, we recruited 450 people during the Fall of 2014 from two drop in centers in Kermanshah, Iran. We collected data through face-to-face interviews. Early-onset injection is defined as whether the person reported their first injection at 22 years of age or younger. Subsequently, late-onset injection is defined as 23 years of age or older. We compared the characteristics of the two groups through both univariate and multiple logistic analyses. RESULTS: Overall, 54% (CI 95%: 44.3%, 62.2%) were early injectors. After controlling for low socioeconomic status, initiation of drug use at a young age, multiple drug use and methamphetamine use were all significantly associated with a higher likelihood of early-onset injection. Additionally, early-onset injection was associated with recent syringe borrowing (OR = 2.6, p = 0.001), recent syringe lending (OR = 1.4, p = 0.01), recent cooker sharing (OR = 3.2, p = 0.01) and injecting two or more times a day (OR = 2.2, p = 0.04). CONCLUSION: Early-onset injectors were more likely to report a lower socioeconomic status, initiation of first drug use at a younger age, using methamphetamine alongside polydrug use, and engaging in higher risk taking behaviors like borrowing needles. With these associations, the study emphasizes the need for drug-prevention programs to focus on the transition to injection drug use at younger ages.

Prevalence of hepatitis C infection in Iranian hemodialysis patients: An updated systematic review and meta-analysis.

BACKGROUND: Hepatitis C virus (HCV) is a major cause of liver disease and a potential cause of substantial morbidity and mortality. This study aims to provide a comprehensive evidence on HCV Infection in Iranian hemodialysis (HD) patients we conducted a systematic review. MATERIALS AND METHODS: In this systematic review and meta-analysis, through a comprehensive search of literature until January of 2016, we estimated the pooled prevalence of hepatitis C infection in Iranian HD patients. Using Medical Subject Headings terms, Emtree, and related equal Persian key words for Iranian databases and also international databases of PubMed and NLM Gateway (for MEDLINE), and SCOPUS. Interest outcome of HCV infection prevalence was confirmed based on positive hepatitis B surface antigen of blood samples. Random effect meta-analysis was used to estimate pooled prevalence of HCV infection in Iranian HD patients, date and language, HD patients, in adult HD patients, Institute of Scientific Information, Iran-doc, irrespective of age, living in Iran. Searches run through main domestic databanks of Iran-Medex, renal transplantation, Scientific Information Database, the relevant literature-searched concentrating on HCV infection. RESULTS: Through searching steps, 305 publications were found from them following the excluding duplicates and overlapping studies 54 studies relevant to HCV prevalence in Iranian HD zcxw patients, with number of 23921 participants, remained in our analyses. The overall results of test of heterogeneity demonstrate sever heterogeneity between reported prevalence (I2 = 96.62%, Chi-square = 1566, P < 0.001). Due to sever heterogeneity results of random effect meta-analysis showed that the estimated pooled prevalence was 11% (95% confidence interval [CI] =10%-13%). The pooled prevalence base on polymerase-chain reaction, recombinant immunoblot assay, and enzyme-Linked Immunosorbant Antibody method were 11% (95% CI = 6%-15%), 9% (95% CI = 5-13) and 12% (95% CI = 10-14), respectively. In line with previous studies, the present finding shows the significant variation in the rate of HCV in dialysis units among the regions in Iran. CONCLUSION: Present paper is the comprehensive updated systematic review on HCV prevalence in the Iranian HD patients. Our findings provide the reliable evidence for promotion of policies and interventional programs.

Effect of action observation training on the oral phase of swallowing in children with cerebral palsy: a pilot randomized controlled trial.

Swallowing disorder is prevalent in children with cerebral palsy (CP), and previous studies have shown that motor-based programs benefit children with CP by facilitating motor learning. We hypothesized that action observation training (AOT) could enhance motor learning and improve the oral phase of swallowing in children. In this two-group parallel double-blind randomized controlled trial, the intervention group received AOT and sensorimotor therapy, while the control group received a sham and sensorimotor therapy. The function of the oral phase of swallowing, as the primary outcome, was measured pre-intervention, post-intervention, and at one month of follow-up. Secondary outcomes included reported symptoms of feeding problems and the impact of the child's swallowing disorder on the main caregiver, which were measured pre-intervention and post-intervention. The result of the Mann-Whitney U test showed a significant difference between the two groups in the function of the oral phase of swallowing after the intervention. Additionally, the intervention had a large effect size. However, no significant difference was found in the parent-reported scores of the feeding/swallowing impact survey and symptoms of feeding problems between the two groups. In conclusion, this pilot study provides preliminary evidence of the clinical efficacy of AOT as a safe neurorehabilitation method to improve the oral phase of swallowing in children with CP. However more studies are needed in the future.

The menopausal age and associated factors in Gorgan, Iran.

BACKGROUND: Considering the physical, emotional and psychological complications of early or delayed menopause on women's life, it is necessary to determine associated factors of menopause age. This study designed to determine menopausal age and associated factors in women of Gorgan, i.e. the capital of Golestan province in the north-east of Iran. METHODS: In this cross-sectional study, 804 menopausal women in Gorgan were selected via two-stage sampling method in 2009. The study included only women who had undergone natural menopause and had their last menstrual bleeding at least one year before. Data were gathered through structured questionnaire that included individual characteristics, socioeconomic characteristics, menstrual and fertility characteristics and climacteric complaints. Socioeconomic status was defined using principal component analysis. Data were analyzed with T-student's and ANOVA tests using SPSS version 16 (SPSS Inc, Chicago, IL, USA) for Windows. RESULTS: The mean menopause age was 47.6±4.45 years with the median age of 48 years. The mean menopause age in women with first pregnancy before 30 years (47.58±4.47years), without pregnancy (46.26±4.90years) and without delivery (46.30±4.47 years) was significantly lower than others (p<0.01). The mean menopause age was lower in single women (46.6±2.80 years), with low income level (47.7±4.39 years) and smokers (47.6±4.45 years) compared to others; but these differences were not statistically significant (p>0.05). Socioeconomic status was not associated significantly with menopause age (p>0.05). CONCLUSION: This study illustrated that menstrual and fertility factors have influence on menopausal age while socioeconomic factors were not effective.

The correlation between strength and range of motion of the neck muscles and opium smoking in Iran.

Objectives: Opium smoking is commonly practiced via traditional and novel routes in Iran. Both smoking methods are practiced in a non-ergonomic position. According to previous studies and our hypothesis, it can be potentially harmful to the cervical spine. Thus, the present study aimed to investigate the relationship between opium smoking and neck range of motion and neck muscle strength. Methods: In this cross-sectional and correlational study, the range of motion and strength of the neck muscles of 120 men with drug use disorder were measured by a CROM goniometer and a hand-held dynamometer. Other data gathering was performed using a demographic questionnaire, the Maudsley Addiction Profile, and the Persian version of Leeds Dependence Questionnaire. The obtained data were analyzed by Shapiro-Wilks test, Pearson's correlation coefficient and stepwise linear regression. Results: There was no significant correlation between the age of drug use onset and range of motion and muscle strength of the neck; however, the daily duration of opium smoking and the number of years of opium smoking were inversely and significantly correlated with the range of motion and muscle strength of the neck in some directions. Daily opium smoking time for decreasing in neck range of motion and total duration of opium smoking for reduction of neck muscles strength are stronger predictor variables. Conclusion: Opium smoking by traditional routes causes non-ergonomic positions and has a moderate significant correlation with reduced range of motion and neck muscle strength, in Iran. Highlights: - The harm of drug use disorder is not only AIDS and hepatitis, and harm reduction programs should go beyond the prevention of AIDS and hepatitis. According to more than 90% of smoking use of drug compared to other methods (oral and injectable, etc.) musculoskeletal disorders caused by the smoking use of drugs, have a greater cost burden in reducing the quality of life and the need for rehabilitation.- Drug abuse treatment and harm reduction programs should focus more seriously on replacing smoking use of drugs with oral medications assisted treatment.- Although in Iran and some countries in the region, a large number of people smoke opium for many years and sometimes all their lives, daily in a completely non-ergonomic position, but studying the deformation of the posture and musculoskeletal disorders related to the body position in them, is not a scientific concern and neither physical therapy researchers have paid attention to it nor addiction researchers.- Neck muscles strength and range of motion in opium addicts are correlated to the number of years of opium smoking and daily minutes of opium smoking, but not to its oral use.- There is no significant correlation between the onset age of continues and permanent opium smoking and substance dependence severity with neck range of motion and muscles strength.- People with drug use disorder (especially smoking users) as a large group of vulnerable people, should be the target population of musculoskeletal disorders researchers and addiction harm reduction researchers, and more experimental, comparative, cohort, etc. researches should be designed and implemented for them.

The Correlation between Neck Pain and Disability, Forward Head Posture, and Hyperkyphosis with Opium Smoking: A Cross-Sectional Study from Iran.

Opium smoking has been a common practice in Iran for many years, with people often smoking for long hours. During the COVID-19 pandemic, there was an increase in opium smoking due to false beliefs about its protective effects against COVID-19 infection. In this study, we aimed to examine the association between the non-ergonomic positions associated with traditional opium smoking in Iran and the development of neck pain and disability, forward head posture (FHP), and hyperkyphosis (HK). In this cross-sectional, correlational study, a total of 120 individuals who smoked opium were selected based on the inclusion criteria. They were interviewed about their addiction profile using the Lite version of the Addiction Severity Index and the Leeds Dependence Questionnaire. The presence of neck pain and disability was also evaluated using the Visual Analog Scale and the Neck Disability Index. The participants were examined for FHP via side-view photography and for HK using a flexible ruler. Data were analyzed using correlation coefficient tests and stepwise linear regression analysis. Based on the results, homelessness, the lifetime duration of opium smoking (in months), the duration of daily opium smoking (in minutes), and the severity of drug dependence had significant relationships with the severity of neck pain, neck disability, FHP, and HK. Homelessness was the strongest predictor of neck pain and disability (R2 = 0.367, p < 0.001), FHP (R2 = 0.457, p < 0.001), and HK (R2 = 0.476, p < 0.001), followed by the lifetime duration of opium smoking and the duration of daily opium smoking, respectively, in which R2 increased to 0.505 (p = 0.011), 0.546 (p = 0.022), and 0.570 (p = 0.004) with the addition of two other variables. Overall, an increase in the duration of sitting in non-ergonomic positions could lead to neck pain and disability, FHP, and HK due to the non-neutral posture of opium smokers.

Test of infant motor performance: Cross-cultural adaptation, validity and reliability in Persian infants.

BACKGROUND: The Test of Infant Motor Performance (TIMP) is an appropriate tool used to measure infant motor performance in many countries and due to the importance of the TIMP in the early diagnosis of infants with developmental delay, the production of a reliable translation of the TIMP in Iran is necessary. AIMS: This study was designed to evaluate the validity and reliability of the Persian version of the TIMP and cross-cultural adaptation of the TIMP to Persian. METHOD: Twenty- two experts were involved in translation, cross-cultural adaptation, validity and reliability. 170 Persian premature infants with post menstrual age (PMA) 34-42 weeks were tested to evaluate inter-rater and intra-rater reliability, test-retest and discriminative validity of the Persian version of the TIMP. RESULTS: The content validity and face validity of the items of the Persian version of the TIMP were confirmed by a 10-expert panel and 10 therapists. High intra- and inter-rater reliability (ICC = 0.98, Kappa = 0.93), test-retest reliability (ICC = 0.98) and internal consistency (α = 0.82) were detected for the Persian version of the TIMP. Discriminative validity confirmed that the TIMP could distinguish groups of infants born with a low birth weight (p ˂ 0.001) and infants born small for gestational age (p = 0.002). CONCLUSIONS: High validity and reliability are reported for the Persian version of the TIMP and this test was demonstrated to be differentiate among groups of infants who are at risk of motor delay.

Executive functions in Persian-speaking preschool children with speech sound disorders and comparison with their typically developing peers.

This study aimed to compare working memory, inhibitory control, and cognitive flexibility, the core components of executive functions, among two prevalent subtypes of preschool children with speech sound disorder, i.e., phonological delay (n = 16) and consistent phonological disorder (n = 15), and a group of typically developing children (n = 18). The correlation between executive function components and the accuracy of speech sound production were also investigated. Nonword repetition task and syllable repetition task were used to evaluate the phonological loop of working memory. Backward digit span was administered to examine the central executive of working memory. Cognitive flexibility was assessed using the second selection of the flexible item selection task and inhibitory control using Stroop-like and Go/No-Go tasks. The percentage consonants correct was applied to calculate the accuracy of speech sound production. Results of a one-way multivariate analysis of covariance revealed statistically significant differences between groups in the combined dependent variables after controlling for age (F(14, 80) = 17.289, p < .001, Pillai's trace = 1.503, partial ηƞ2 = .752). Typically developing children outperformed in all measurements of executive functions than both speech sound disorder subgroups. Moreover, children with phonological delay performed better in nonword repetition and corrected responses of Stroop-like than consistent phonological disorder group. All executive function measurements also correlated with speech sound production. The results of the present study highlight the importance of including domain-general cognitive skills in current assessment protocols for children with phonological delay and consistent phonological disorders.

Lifetime alcohol-use prevalence and correlated factors among street children in Iran.

BACKGROUND: Several studies on street children in Iran reported a high prevalence of alcohol consumption among this group. This study assessed the prevalence of lifetime alcohol use and correlated factors among street children in Iran. METHODS: We conducted a cross-sectional survey among 856 street children from six provinces of Iran. Behavioral data were collected by trained interviewers using a structured questionnaire. Our target outcome was lifetime alcohol use. We examined associations between individual variables and lifetime alcohol use using the chi-square. A multiple logistic regression model included variables with a p-value < .2. Lastly, we reported the adjusted odds ratio (an OR) point estimate and 95% confidence interval (95% CI) as the effect measure. RESULTS: Mean age and standard deviation (SD) of alcohol drinkers were 14.94 ± 2.16. Overall, 16.6% (CI95%: 14.38%, 19.55%) of participants reported lifetime alcohol use, and almost 60% of children reported alcohol use over three past months. In the final model, factors that were independently associated with alcohol use included the 15-18 age range (AOR 2.35, 95% CI 1.48-3.73), Iranian nationality (AOR 3.36, 95% CI 2.07-5.45), working longer than 5 years in the streets (AOR 2.90, 95% CI 1.72-4.88), father's drug use (AOR 1.93, 95% CI 1.22-3.01), and illiteracy (AOR 1.65, 95% CI 1.03-2.66). CONCLUSIONS: The results of the present study demonstrated that preventive plans for alcohol use among street children must be addressed using the services provided by governmental and nongovernmental organizations.