Effectiveness of a school-based health education program to improve the symptoms of premenstrual syndrome in high school girls in Ilam.

BACKGROUND: The premenstrual syndrome happens periodically and affects both the individual and family. The aim of this study was to determine the effect of the health education program on reducing premenstrual syndrome in high school girls in Ilam. MATERIALS AND METHODS: This experimental study was conducted in girls' high schools in Ilam, in 2017-2018. In total, 120 students were enrolled in the study (intervention group = 61 and control group = 59) and selected through convenience sampling. In this study, a standard Premenstrual Symptoms Screening Tool (PSST) was used to diagnose students with premenstrual syndrome or Premenstrual Dysphoric Disorder (PMDD). The educational program for the intervention group was held in four sessions of 30 min for 4 consecutive weeks. The obtained data were analyzed by the SPSS statistical software at a significance level of less than 0.05. RESULTS: The results showed a significant difference in the proportion of cases with moderate and severe PMS and PMDD between intervention and control groups in follow-up (P < 0.001). However, these proportions were not significantly different between the two groups in the baseline. CONCLUSIONS: According to the results, the educational program can be recommended as an effective intervention for girls with moderate-to-severe premenstrual symptoms and premenstrual dysphoric disorder.

Translation and psychometric properties of the Persian version of the Audit of Diabetes Dependent Quality of Life (IR-ADDQoL).

BACKGROUND: This study aimed to undertake linguistic validation and assess the psychometric properties of the Persian version of the Audit of Diabetes-Dependent Quality of Life (IR-ADDQoL) questionnaire in Iranian patients with type 1 and type 2 diabetes. METHODS: The gold-standard linguistic-validation procedure required by the developer of the ADDQoL (see https://www.healthpsychologyresearch.com ) including cross-cultural adaptation was followed. Validity and reliability of the Persian ADDQoL were then evaluated in a cross-sectional study of a sample of 153 patients with diabetes. Exploratory and confirmatory factor analyses were applied to assess structural validity. Internal consistency reliability was assessed. RESULTS: Both forced one-factor and unforced four-factor solutions were extracted from the exploratory factor analysis that jointly accounted for 48% and 66.53% of the variance observed, respectively. Confirmatory factor analysis indicated an acceptable model fit for the Persian ADDQoL. Cronbach's alpha showed excellent internal consistency for the questionnaire (alpha = 0.931 for the single scale). CONCLUSION: The Persian ADDQoL (IR-ADDQoL) showed adequate structural validity and excellent internal consistency. Therefore, it could be efficiently used to evaluate the impact of diabetes on quality of life in outcome studies and research settings in Iran.

Alteration in serum levels of immunoglobulins in seriously eye-injured long-term following sulfur-mustard exposure.

INTRODUCTION: Sulfur mustard (SM) is a potent toxic agent that cause local and systemic changes in the human body such as dysregulation of the immunological system. This gas affects different organs such as lungs, skin, eyes and the gastrointestinal tract. METHODS: 128 veterans with SM-induced eye injuries were examined and compared to 31 gender- and age-matched healthy controls. Serum levels of IgM, IgE, IgA, IgG, and IgG subclasses were measured using ELISA method. RESULTS: There was no significant difference in IgM level between two groups with abnormal and normal ocular conditions except for those having bulbar conjunctiva-limbal ischemia and bulbar conjunctiva-hyperemia abnormalities. There were not significant difference in IgA, IgE, and IgG levels between two groups with and without ocular problem also between study groups. IgG1 level in some ocular abnormalities were significantly lower than the healthy control groups. IgG2 level in SM-exposed participants with stromal abnormality was higher in the SM-exposed groups without this problem. IgG2 levels in the exposed group with some ocular problems were significantly increased compared with control. IgG3 level in all patients did not reveal any significant changes compared with the controls except the fundus abnormality. IgG4 level was not significantly different between two groups with normal and abnormal ocular conditions. Nonetheless, IgG4 level in the exposed participants with some ocular abnormalities significantly increased compared with the controls. CONCLUSION: The results showed SM exposure could alter immunoglobulins level compared with healthy controls and the changes of IgG2 and IgG1 levels were associated with some ocular problems.

Tear and serum MMP-9 and serum TIMPs levels in the severe sulfur mustard eye injured exposed patients.

INTRODUCTION: Sulfur mustard (SM) intoxication produces local and systemic changes in the human body. In this study, the relationship between tear and serum matrix metalloproteinase (MMP)-9 and serum tissue inhibitors of metalloproteinases (TIMPs) are assessed in serious eye-injured SM-exposed casualties. METHODS: A group of 128 SM-exposed patients with serious ocular injuries in three subgroups (19 mild, 31 moderate, and 78 severe cases) is compared with 31 healthy controls. Tear and ocular status and serum MMPs and MMP-9/TIMPs complex levels were evaluated using enzyme-linked immunosorbent assay (ELISA). RESULTS: Serum level of MMP-9 was significantly higher in the SM-exposed group compared to the control group (P = 0.009). Mean serum MMP-9 level in the SM-exposed group with ocular abnormalities was significantly higher than that in the SM-exposed group without ocular abnormalities. SM-exposed people with corneal calcification had significantly higher serum MMP-9/TIMP-1 level compared to the SM-exposed ones without this problem (P = 0.045). The SM-exposed group with severe ocular injuries had significantly higher MMP-9/TIMP-1 than the controls (P = 0.046). The SM-exposed group had significantly lower levels of MMP-9/TIMP-4 complex than the controls (P < 0.001). The SM-exposed group with tear meniscus and fundus abnormality had significantly higher MMP-9/TIMP-4 levels than the SM-exposed group without these problems (P = 0.009 and P = 0.020). CONCLUSION: Serum MMP-9 level had increased in SM-exposed groups with ocular problems, while TIMP-1 and TIMP-2 levels had remained unchanged. Serum TIMP-4 drastically decreased in SM-exposed group, which clearly explains the severity of the systemic and ocular damages.

Nutritional Status and Anthropometric Indices in High School Girls in Ilam, West Iran.

Background. Adolescence is one of the most challenging periods for human growth and nutritional status. The aim of this study was to assess the nutritional status and anthropometric indices in high school girls in Ilam. Methods. This cross-sectional study was performed on 360 domestic high school girl students chosen randomly by cluster sampling. Data were gathered through interviews performed by a dietitian to fill 24-hour dietary recall and food frequency and demographic questionnaires. Then we performed the anthropometric measurements and we compared the results with CDC2000 standards. We analyzed our data by N4 food analyzer and SPSS16 software. Results. The prevalence of obesity and overweight was 5% and 10.8%, respectively. Simultaneously, the prevalence of underweight was 20.2%. The prevalence of stunting was 5.8%. We also showed that 50% of high school girls in Ilam suffered from severe food insecurity, 14.7% suffered from mild insecurity, and 4.7% get extra energy from foods. Food analysis showed that micronutrients such as zinc, iron, calcium, folate, fiber, magnesium, and vitamin B12 were less than what is recommended by the RDA. Conclusion. Undernutrition and overnutrition are completely prevalent among girls studied in Ilam. This needs further acts and investigations in the field and more nutritional and health educations.

Social Cognitive Predictors of Breakfast Consumption in Primary School's Male Students.

PURPOSE: This study aimed to test the usefulness of social cognitive theory (SCT) in explaining breakfast consumption in a sample of primary male students. METHODS: Participants in this cross-sectional study were 358 male students (3rd, 4th and 5th grades) from eight public primary schools of Ilam city. Data were collected by a self-administered questionnaire based on components of SCT. Bivariate correlations and multiple logistic regression analysis using an Enter method were used to identify social cognitive correlates and determinants of breakfast consumption. RESULTS: A total of 358 participants ranging in age from 8-12 years (M=10.06) were studied. The result of the study showed that the SCT significantly predicted breakfast consumption. SCT variables explained 41.4% of the variance in breakfast consumption behaviors, though, self-regulation was found to be the strongest predictor of breakfast consumption behaviors. There was the strongest correlation between behaviors and self-regulation, (r=0.561; P<0.001). CONCLUSION: The findings support the usefulness of SCT in explaining breakfast consumption behaviors. These results suggest an essential role for self-regulation, self-efficacy and social support in the breakfast consumption behaviors of primary male students.

Predictive Factors for Pelvic Organ Prolapse (POP) in Iranian Women's: An Ordinal Logistic Approch.

INTRODUCTION: To investigate the predictors factors of Pelvic Organ Prolapse (POP) in Iranian women by using ordinal logistic regression. MATERIALS AND METHODS: The role of risk factors of POP was evaluated among 365 patients attending in two public centres in Ilam province, Iran. Exclusion criteria were of single, pregnant and lactate women receiving hormone replacement therapy. Both the unvaried and multi-variate ordinal logistic regression were used to find the predictive factors of POP and computing sensitivity and specificity of models. RESULTS: In multi-variate ordinal logistic regression the variables of Body Mass Index (BMI) Maximum Birth Weight (MBW) and delivery mode were the most important factors for prediction of prolapse stage. The sensitivity and specificity of multi-variate ordinal logistic, as a screening test, were 95.7% and 48.7% respectively. CONCLUSION: BMI, MBW and delivery mode can use for prediction of POP stage. Stage of prolapse is an ordinal variable, therefore to show relationship between stage of prolapse and other variables ordinal logistic regression is an appropriate model.

Long-term effects of sulfur mustard on civilians' mental health 20 years after exposure (The Sardasht-Iran Cohort Study).

BACKGROUND: Sulfur mustard (SM) is an alkylating agent that induces short and long term toxicity on various organs. The aim of this study was to assess the long-term psychological symptoms among samples of exposed to sulfur mustard gas compared with unexposed civilians 20 years after exposure. METHODS: This historical cohort study was conducted on 495 civilians of Sardasht and Rabat in two age matched groups, including 367 sulfur mustard exposed participants from Sardasht and 128 unexposed subjects from Rabat. Psychological symptoms was assessed using the Symptom Check List-90 Revised (SCL-90-R) including measures of somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism providing three global distress indices namely: Global Severity Index (GSI), Positive Symptom Total (PST) and Positive Symptom Distress Index (PSDI). Comparison was made between exposed and unexposed civilians. RESULTS: There were significant differences in somatization (P = 0.002), obsessive-compulsive (P = 0.031), depression (P = 0.007), anxiety (P = 0.042), and hostility (P = 0.002), between the exposed and unexposed groups. In addition there were significant differences between two groups concerning the GSI (P = 0.045) and the PSDI (P < 0.001). The differences between two groups in other subscales were not significant. CONCLUSIONS: The findings from this study showed that civilians who exposed to sulfur mustard gas were suffering from a number of psychological symptoms even 20 years after exposure. Providing mental health services and more resource allocation for this community are highly recommended.

Association of chemokines and prolactin with cherry angioma in a sulfur mustard exposed population--Sardasht-Iran cohort study.

Exposure to SM leads to short and long term adverse effects on various organs including the skin. Cherry angioma is one of the late skin disorders in SM exposed individuals. The pathogenesis of abnormal angiogenesis in cherry angioma is not well known but the role of inflammatory mediators and certain hormones, including prolactin, in the regulation of angiogenesis in other diseases has been reported. Alterations in serum levels of prolactin and chemokines in SM-exposed victims and the impact on angiogenesis are indications of the role in SM-induced cherry angioma. As part of the SICS, this study seeks to evaluate the possible association of prolactin and chemokines in the emergence of SM-induced cherry angioma. The serum concentrations of prolactin, IL-8/CXCL8, RANTES/CCL5, MCP-1/CCL2, and fractalkine/CX3CL1 were titrated using sandwich ELISA technique. There was a significant difference in the level of prolactin between the exposed subgroups (with cherry angioma n=72; mean: 10.13) and without cherry angioma (n=268; mean: 13.13, p<0.0096). Median of the serum levels of CCL2 in the exposed patients with cherry angioma was significantly higher than exposed patients without cherry angioma (median=203.5 pg/ml and median=187.10 pg/ml respectively, p=0.035). There was no significant difference in the serum levels of IL-8, RANTES and CX3L1 between the exposed subgroups with cherry angioma and without cherry angioma. This finding serves as a basis for further research on the molecular mechanisms and pathways involved in the pathogenesis of cherry angioma and other related disorders.

Fibrinogen and inflammatory cytokines in spontaneous sputum of sulfur-mustard-exposed civilians--Sardasht-Iran Cohort Study.

Sulfur mustard (SM) causes late complications in respiratory system of exposed individuals. In this preliminary study, the levels of IL-1α and ß, TNF, IL-1Ra, IL-6 and fibrinogen in the spontaneous sputum of SM-exposed individuals were examined 20 years after exposure and the correlation with pulmonary function was tested. The participants were categorized into two major subgroups (hospitalized and non-hospitalized) based on the severity of the clinical complications immediately after exposure. Every participant was visited by a physician; the respiratory functions were checked using spirometry and were categorized as normal, mild, moderate or severe pulmonary complications. The levels of cytokines in the sputum and serum samples were measured using ELISA method. The mean values of TNF, IL-1α and IL-1ß were 524.15, 115.15, 1951.33 pg/ml respectively, and the mean levels of IL-1Ra and IL-6 were 6410.52 and 124.44 pg/ml respectively; fibrinogen was 71.59 ng/ml and index of IL-Ra/IL-1ß was 7.78. There was more TNF-α and IL-1ß and less IL-1Ra and fibrinogen in the sputum of the hospitalized subgroup. The level of TNF-α and IL-1ß also increased in moderate and severe pulmonary status comparing with the group with mild disorders, while fibrinogen was lower or decreased significantly in problematic patients. IL-1ß and TNF showed positive correlation (r=0.5, and r=0.59, respectively); fibrinogen and IL1Ra/IL-1ß have negative correlation with lung function according to the GOLD classification (r=-0.4, and r=-0.61, respectively). It is concluded that sputum cytokines and fibrinogen, reflect the degree of the severity of airway inflammation and the cytokine levels in the sputum might be completely different from the serum fluctuations.

Withdrawal users' experiences of and attitudes to contraceptive methods: a study from Eastern district of Tehran, Iran.

BACKGROUND: The aim of this study was to explore withdrawal users' experiences of and attitudes to contraceptive methods in Tehran, Iran. METHODS: This was a cross-sectional study. A sample of women attending a health care center in Tehran, Iran was entered into the study. To collect data structured interviews were conducted. RESULTS: In all 300 women who were using withdrawal took part in the study. Of these, 210 women (70%) indicated that they were used modern contraceptive methods previously. The mean duration for withdrawal use was 6.5 (SD = 4.9) and for modern contraceptive it was 2.3 (SD = 2.9) years. The most common reasons for using withdrawal were: no cost involvement, did not need medical advice, having fewer side effects and easier to use than other methods. The main obstacles to use modern contraceptives were: health concerns, fear of side effects, misinformation, lack of confidence and sexual dissatisfaction. CONCLUSION: The study results suggest that withdrawal users carry misconceptions about modern contraception and exaggerate its related health problems. Indeed these are important issues for the understanding of attitudes and experiences of women in Iran. The findings from this study might be essential for making evidence-based policy decisions, and for planning, monitoring and evaluating reproductive health programs in Iran and elsewhere.

Development and psychometric properties of a belief-based Physical Activity Questionnaire for Diabetic Patients (PAQ-DP).

BACKGROUND: This study carried out to develop a scale for assessing diabetic patients' perceptions about physical activity and to test its psychometric properties (The Physical Activity Questionnaire for Diabetic Patients-PAQ-DP). METHODS: An item pool extracted from the Theory of Planned Behavior literature was generated. Then an expert panel evaluated the items by assessing content validity index and content validity ratio. Consequently exploratory factor analysis (EFA) was performed to indicate the scale constructs. In addition reliability analyses including internal consistency and test-retest analysis were carried out. RESULTS: In all a sample of 127 women with diabetes participated in the study. Twenty-two items were initially extracted from the literature. A six-factor solution (containing 19 items) emerged as a result of an exploratory factor analysis namely: instrumental attitude, subjective norm, perceived behavioral control, affective attitude, self-identity, and intention explaining 60.30% of the variance observed. Additional analyses indicated satisfactory results for internal consistency (Cronbach's alpha ranging from 0.54 to 0.8) and intraclass correlation coefficients (ranging from 0.40 to 0.92). CONCLUSIONS: The Physical Activity Questionnaire for Diabetic Patients (PAQ-DP) is the first instrument that applies the Theory of Planned Behavior in its constructs. The findings indicated that the PAQ-DP is a reliable and valid measure for assessing physical activity perceptions and now is available and can be used in future studies.

Determinants of glycemic control in female diabetic patients: a study from Iran.

BACKGROUND: Since microvascular and macrovascular complications are reduced through strict glycemic control, this study carried out to identify the factors that affect glycemic control. METHODS: A cross-sectional design was carried out to examine the role of demographic, anthropometric, clinical and other relevant characteristics in a sample of 103 female diabetic patients in Tehran, Iran. Personal interviews were conducted to collect data. Then blood sampling collected and the patients were divided into two outcome groups (controlled and uncontrolled diabetes). The groups were compared on the basis of their characteristics using both univariate and multivariate analyses. RESULTS: In all 103 patients were entered into the study. The mean age of patients was 46.38 (SD = 11.42) years. Overall, the mean value of HbA1c for the whole sample was 7.5 (SD = 2.35) and 56.3% had HbA1c > or = 7%. The findings obtained from univariate analysis revealed that there were no significant differences between controlled and uncontrolled patients. However, in multivariate analysis the waist circumference was found to be a significant predictor of increased level of HbA1c (OR = 1.04, 95% CI = 1-1.08, P = 0.04). CONCLUSIONS: The findings suggest that increased level of HbA1c is associated with waist circumference that is a modifiable factor. It seems that physical activity might be a solution to overcome this health problem. A larger study to identify other factors also is recommended.

Association of physical activity and IL-10 levels 20 years after sulfur mustard exposure: Sardasht-Iran cohort study.

IL-10 is an anti-inflammatory cytokine that is important in the regulation of inflammatory processes in different conditions. Sulfur mustard (SM) intoxicated patients are suffering from different inflammatory diseases in their lung, skin and eyes. Physical activity (PA) is reported to control inflammation by reducing pro-inflammatory and inducing anti-inflammatory cytokines. Our previous study revealed lower PA and more sedentary lifestyle among SM exposed population. This study aimed to determine the relationship of PA with IL-10 production in SM exposed subjects. Baseline, mitogen-induced and the serum levels of IL-10 were evaluated. In a historical cohort study, Sardasht-Iran Cohort Study (SICS), 372 SM exposed participants were studied 20 years after exposure and were compared with 128 unexposed control participants. The Global Physical Activity Questionnaire (GPAQ; developed by WHO) was used to obtain a self-reported measure of physical activity. Whole blood culture supernatants and serum samples were used for IL-10 measurement by ELISA technique. In both the control and exposed groups mitogen-induced IL-10 production was significantly elevated with severity of PA intensity (p<0.05). In the control subjects with moderate PA intensity, the mitogen-induced IL-10 production was higher than the corresponding in the exposed group (p<0.05). In the exposed group, mitogen-induced IL-10 production had significant positive correlation with total PA, total transport PA, total recreational PA and total moderate intensity work (p<0.05). The positive relationship between high PA and the levels of anti-inflammatory cytokine IL-10 indicates a need to encourage a more active lifestyle among the SM exposed subjects who have various inflammatory complications.

Sardasht-Iran cohort study of chemical warfare victims: design and methods.

BACKGROUND: Insights into long-term clinical consequences of sulfur mustard have emerged from some investigations but less is known about the basic and molecular mechanisms of these complications. Sardasht-Iran Cohort Study is a comprehensive historical cohort study on Sardasht chemical victims' population which was designed to find out the long-term complications of sulfur mustard exposure and the basic mechanisms underlying clinical manifestations. This paper describes the design and methodology of Sardasht-Iran Cohort Study. METHODS: In Sardasht-Iran Cohort Study, 500 individuals including 372 subjects from Sardasht, as the exposed group, and 128 subjects from Rabat, as the unexposed age-matched control group were evaluated. The exposed group was divided into two groups based on the severity of clinical complications at the time of exposure. Different samples including blood, sputum, saliva, tear, urine, and semen were collected for immunologic, hematologic, biochemical, and other laboratory analysis. Data were gathered from medical records, clinical examinations, laboratory tests, and questionnaires for psychological and lifestyle situations. CONCLUSION: The important distinctions setting this study apart from the previous ones are discussed. The Sardasht-Iran Cohort Study provides important information on various aspects of long-term consequences of sulfur mustard exposure. This database will provide a better position to suggest guidelines for the diagnosis, treatment, and prevention of delayed complications in the patients exposed to sulfur mustard.