Are the most common food allergens in an Iranian atopic population compatible with worldwide reports? A systemic review and meta-analysis with molecular classification of frequent allergens

Background: Undesirable immunological responses to alimentary allergens are one of the hallmarks of atopic diseases. The prevalence of common food allergens is dissimilar among different communities with distinct nutritional habits and genetic characteristics. Aim: To assess the prevalence of the most common food allergens in Iran, using different reliable studies. Methods: All studies determining sensitization to common food allergens that were indexed in PubMed, Web of Science, Google Scholar, ProQuest, Scopus, Iran Medex, and Magiran were included in this review. To perform a meta-analysis, STATA 14 and metaprop command was applied. A logistic-normal random-effects model with Freeman-Tukey double arcsin transformation was applied to combine the findings of different studies and evaluate their heterogeneity. Random pooled estimate (ES) (pooled prevalence), 95% confidence interval (95% CI) and p-value were determined. Results: A total of 23 studies with data from a total of 6126 children and adults met the inclusion criteria for entering this meta-analysis. The respective pooled prevalence of a positive family history of allergy and positive specific IgE to at least one food allergen was 72% (95% CI: 66-77%) and 41% (95% CI: 33-49%), respectively. Our results in the total population revealed that allergic sensitization to egg yolk, cow’s milk (CM), egg white, and wheat were 25% (95% CI: 16%-35%), 24% (95% CI: 19-29%), 23% (95% CI: 18%-28%), and 9% (95% CI: 6%-14%), respectively. Walnut, peanut, and soybean sensitization was detected in 23% (95% CI: 17%-31%), 23% (95% CI: 13%-33%), and 20% (95% CI: 12%-28%) of patients, respectively. Random pooled ES for sensitization to shrimp and fish was 32% (95% CI: 21-45%) and 12% (95% CI: 6-20%), respectively. The result of analysis in different age groups revealed that allergic sensitization to milk, egg white, and egg yolk declines in higher age groups; while shrimp sensitization increases in older patients. In patients with atopic dermatitis, egg white was the most frequent food allergen 29% (95% CI = 18-42%); while wheat was the least frequent 8% (95% CI = 4-14%). Conclusions: Considering the prevalence of different food allergens, the results of the current meta-analysis revealed that egg yolk and cow’s milk had the second and third rate after shrimp, respectively. The high prevalence of sensitization to shrimp may be attributed to its high consumption in coastal areas and/or cross-reactivity of shrimp with some aeroallergens such as mites

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Are the most common food allergens in an Iranian atopic population compatible with worldwide reports? A systemic review and meta-analysis with molecular classification of frequent allergens.

BACKGROUND: Undesirable immunological responses to alimentary allergens are one of the hallmarks of atopic diseases. The prevalence of common food allergens is dissimilar among different communities with distinct nutritional habits and genetic characteristics. AIM: To assess the prevalence of the most common food allergens in Iran, using different reliable studies. METHODS: All studies determining sensitization to common food allergens that were indexed in PubMed, Web of Science, Google Scholar, ProQuest, Scopus, Iran Medex, and Magiran were included in this review. To perform a meta-analysis, STATA 14 and metaprop command was applied. A logistic-normal random-effects model with Freeman-Tukey double arcsin transformation was applied to combine the findings of different studies and evaluate their heterogeneity. Random pooled estimate (ES) (pooled prevalence), 95% confidence interval (95% CI) and p-value were determined. RESULTS: A total of 23 studies with data from a total of 6126 children and adults met the inclusion criteria for entering this meta-analysis. The respective pooled prevalence of a positive family history of allergy and positive specific IgE to at least one food allergen was 72% (95% CI: 66-77%) and 41% (95% CI: 33-49%), respectively. Our results in the total population revealed that allergic sensitization to egg yolk, cow's milk (CM), egg white, and wheat were 25% (95% CI: 16%-35%), 24% (95% CI: 19-29%), 23% (95% CI: 18%-28%), and 9% (95% CI: 6%-14%), respectively. Walnut, peanut, and soybean sensitization was detected in 23% (95% CI: 17%-31%), 23% (95% CI: 13%-33%), and 20% (95% CI: 12%-28%) of patients, respectively. Random pooled ES for sensitization to shrimp and fish was 32% (95% CI: 21-45%) and 12% (95% CI: 6-20%), respectively. The result of analysis in different age groups revealed that allergic sensitization to milk, egg white, and egg yolk declines in higher age groups; while shrimp sensitization increases in older patients. In patients with atopic dermatitis, egg white was the most frequent food allergen 29% (95% CI = 18-42%); while wheat was the least frequent 8% (95% CI = 4-14%). CONCLUSIONS: Considering the prevalence of different food allergens, the results of the current meta-analysis revealed that egg yolk and cow's milk had the second and third rate after shrimp, respectively. The high prevalence of sensitization to shrimp may be attributed to its high consumption in coastal areas and/or cross-reactivity of shrimp with some aeroallergens such as mites.

Iranian nursing students' perspectives on transition to professional identity: a qualitative study.

AIM: To explore Iranian nursing students' transition to professional identity. BACKGROUND: Professional identity is an important outcome of nursing education that has not been fully explored in the Iranian nursing education system. INTRODUCTION: Professional identity is a significant factor influencing the development of nursing education and practice. The transition of nursing students to professional identity is the main concern of nursing education and fundamental prerequisite for policymaking and planning in the field of nursing education. METHODS: This was a qualitative content analysis study. In-depth unstructured interviews were held with 35 Iranian bachelor's degree nursing students recruited through purposive sampling. The interviews were transcribed verbatim and analysed using content analysis. FINDINGS: The data analysis led to the development of four themes and 15 categories: 'satisfaction with professional practice (attending clinical settings and communicating with patients, the feeling of being beneficial)'; 'personal development (growing interest in nursing, feeling competent in helping others, changing character and attitude shift towards patients)'; 'professional development (realizing the importance of nursing knowledge, appreciating professional roles, a changing their understanding of nursing and the meaning it)'; and 'attaining professional commitment (a tendency to present oneself as a nurse, attempting to change oneself, other students and the public image of nursing)'. DISCUSSION: Development of professional identity is a continual process of transition. The greatest transition occurred in the last year of the programme. CONCLUSION: Nursing students experienced transition to PI through gaining satisfaction with professional practice, undergoing personal and professional development and developing a professional commitment. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Educational policymakers can use our findings for developing strategies that facilitate and support nursing students' transition to professional identity.

Evaluation of sexual function and quality of life in Iranian women with tubal ligation: a historical cohort study.

Tubal ligation (TL) is an option for contraception for women who have completed their family. The existence of sexual dysfunction and impaired quality of life (QOL) following this procedure has been the subject of debate for decades. The aim of this study was to evaluate the sexual function, QOL and other factors affecting Iranian women who underwent TL. A historical cohort study was carried out on 150 women who had undergone TL and on 150 women who had used a condom (as the control group). The sexual function of participants was evaluated and compared using Female Sexual Function Index (FSFI) questionnaire. They were also asked to fill out the Short Form Health Survey (SF-12) for evaluating their QOL. Furthermore, the effects of educational level and poststerilization regret in the women of TL group were evaluated. With regard to FSFI, all mean values were found to be lower in the TL women and the differences between the two groups were statistically significant in all domains. A significant difference was found in sexual dysfunction in orgasm (P = 0.02), satisfaction (P = 0.01), pain (P = 0.006) and total FSFI scores (P = 0.006) between the women regretting vs those not regretting their sterilization. In evaluating the relationship between FSFI and educational level, with the increase of educational level all domain scores increased significantly only in the TL group. There was a significant difference between the two groups in SF-12 scores (69.18 ± 14.05 vs 78.41 ± 12.50; P < 0.0001). Our findings reveal the adverse effects of TL on the sexual life and QOL of women. It is recommended that the awareness and knowledge of health-care professionals regarding the sexual function and QOL in women undergoing TL should be increased.

Effect of Pilates exercises on postpartum maternal fatigue.

INTRODUCTION: Postpartum fatigue is a pervasive phenomenon and often affects mothers immediately after delivery. The present study aimed to assess the effect Pilates home exercises had on postpartum maternal fatigue. METHODS: A total of 80 women participated in our clinical trial study. The women were randomly divided into two groups - the intervention group (n = 40) and the control group (n = 40). In the intervention group, the women performed Pilates exercises five times a week (30 min per session) for eight consecutive weeks. The first session was conducted 72 hours after delivery. The control group did not receive any intervention. Each woman's level of fatigue was evaluated at hospital discharge (as a baseline), and at four and eight weeks after delivery, using the standard Multidimensional Fatigue Inventory (MFI-20) questionnaire and repeated measures analysis. RESULTS: During the eight weeks of follow-up, we found that the intervention group had lower mean MFI-20 scores than the control group with regard to general fatigue (7.80 ± 2.07 vs. 12.72 ± 1.79; p < 0.001), physical fatigue (7.12 ± 1.41 vs. 10.42 ± 2.02; p < 0.001), reduced activity (6.95 ± 1.35 vs. 11.27 ± 1.70; p < 0.001), reduced motivation (6.20 ± 1.01 vs. 9.80 ± 2.04; p < 0.001) and mental fatigue (6.85 ± 1.45 vs. 10.72 ± 1.98; p < 0.001). CONCLUSION: The present study's findings show that physical exercise can significantly reduce postpartum maternal fatigue in all subscales.

Spiritual care in nursing: a concept analysis.

BACKGROUND: Around the world, spiritual care in nursing is a critical part of providing holistic care, but within our profession, there is a lack of certainty over the meaning of spirituality and delivery of spiritual care, including nurses thinking of spirituality as religion. METHODS: We adopted the eight-step Walker and Avant's concept analysis approach to provide a definition of the concept, searching and analysing international and national online databases. Inclusion criterion included that articles were published between 1950 and 2012 in English or Persian language. Finally, 151 articles and 7 books were included in the analysis. FINDINGS: The attributes of spiritual care are healing presence, therapeutic use of self, intuitive sense, exploration of the spiritual perspective, patient-centredness, meaning-centred therapeutic intervention and creation of a spiritually nurturing environment. Spiritual care is a subjective and dynamic concept, a unique aspect of care that integrates all the other aspects. It emerges in the context of nurses' awareness of the transcendent dimension of life and reflects a patient's reality. The provision of spiritual care leads to positive consequences such as healing for patients and promotion of spiritual awareness for nurses. IMPLICATIONS FOR NURSING AND HEALTH POLICY: The conceptual definition of spiritual care provided in this study can help clinical nurses, educators and nurse managers to develop and implement evidence-based health policies, comprehensive staff training programmes and practical quality assessment guidelines to try to ensure that all nurses are competent to include relevant spiritual care in practice. CONCLUSION: A comprehensive definition of the concept of spiritual care ensued. The findings can facilitate further development of nursing knowledge and practice in spiritual care and facilitate correction of common misconceptions about the provision of spiritual care.

Historical cohort study of shift work and blood pressure.

BACKGROUND: It has been suggested that shift work (SW) is associated with changes in blood pressure (BP). However, studies have reported contradictory results. AIMS: To prospectively examine the association between SW and BP among male workers. METHODS: A historical cohort study, involving workers of Esfahan's Mobarakeh Steel Company, in Iran, was conducted over 14 years. The association between SW, systolic BP (SBP) and diastolic BP (DBP) was investigated after adjusting for body mass index, age, work experience, marriage, smoking and education based on the Bayesian multilevel modelling approach. RESULTS: The study sample included 5331 male workers. The mean age (standard deviation, SD) was 34.8 (6.6) years and mean work (SD) experience was 9.4 (6.1) years. Among these subjects, 2348 (44%), 340 (6%) and 2643 (50%) were day workers, weekly rotating shift workers and routinely rotating shift workers, respectively. The mean SBP (SD) and DBP (SD) of these workers were 118.7 (8.1) and 73.1 (6.7) mmHg, respectively. After controlling for several confounding variables, there was no significant relationship between SBP and DBP and SW. CONCLUSIONS: No significant association between SW and BP was observed among these three groups (day workers, weekly rotating shift workers and routinely rotating shift workers). Prospective studies, which control for confounding factors, such as the healthy worker effect, occupational history, family history and psychological factors (e.g. occupational stress and job satisfaction), are required to evaluate this further.

Users of withdrawal method in the Islamic Republic of Iran: are they intending to use oral contraceptives? Applying the theory of planned behaviour.

Many couples in the Islamic Republic of Iran rely on coital withdrawal for contraception. The purpose of this cross-sectional study was to use the theory of planned behaviour to explore factors that influence withdrawal users' intent to switch to oral contraception (OC). Participants were 336 sexually active, married women, who were current users of withdrawal and were recruited from 5 public family planning clinics in Tehran. A questionnair included measures of the theory of planned behaviour: attitude (behavioural beliefs, outcome evaluations), subjective norms (normative beliefs, motivation to comply), perceived behaviour control, past behaviour and behavioural intention. Linear regression analyses showed that past behaviour, perceived behaviour control, attitude and subjective norms accounted for the highest percentage of total variance observed for intention to use OC (36%). Beliefs-based family planning education and counsellingshould to be designed for users of the withdrawal method.

Application of artificial neural network in predicting the survival rate of gastric cancer patients.

BACKGROUND: The aim of this study was to predict the survival rate of Iranian gastric cancer patients using the Cox proportional hazard and artificial neural network models as well as comparing the ability of these approaches in predicting the survival of these patients. METHODS: In this historical cohort study, the data gathered from 436 registered gastric cancer patients who have had surgery between 2002 and 2007 at the Taleghani Hospital (a referral center for gastrointestinal cancers), Tehran, Iran, to predict the survival time using Cox proportional hazard and artificial neural network techniques. RESULTS: The estimated one-year, two-year, three-year, four-year and five-year survival rates of the patients were 77.9%, 53.1%, 40.8%, 32.0%, and 17.4%, respectively. The Cox regression analysis revealed that the age at diagnosis, high-risk behaviors, extent of wall penetration, distant metastasis and tumor stage were significantly associated with the survival rate of the patients. The true prediction of neural network was 83.1%, and for Cox regression model, 75.0%. CONCLUSION: The present study shows that neural network model is a more powerful statistical tool in predicting the survival rate of the gastric cancer patients compared to Cox proportional hazard regression model. Therefore, this model recommended for the predicting the survival rate of these patients.

The Relationship between Obesity and Quality Of Life in School Children.

BACKGROUND: To determine relationships between healths related quality of life and body mass index in children aged 9-11 years old. METHODS: This cross sectional study was conducted on 240 children 9-11 year olds who were selected via multi stage cluster sampling design from primary schools in the Shahre Qods of the Tehran, Iran in 2007. Pediatric Quality of Life inventory was completed by child self report with measured height and weight used to determine body mass index percentile/weight classification. Obesity was defined as body mass index (BMI) ≥95(th) percentile for age and gender and one way analyses of variance (ANOVA) was used for data analyses. RESULTS: Physical, social and school functioning was significantly lowered for obese when compared to normal weight children (P<.05). The impairment in QOL in the community-based sample of elementary school children was less marked than clinical sample of obese. Obese children maintain emotional health. CONCLUSION: These results highlight the importance in considering dimensions of quality of life at further understanding obesity in children.

Comparison of artificial neural network and binary logistic regression for determination of impaired glucose tolerance/diabetes.

Models based on an artificial neural network (the multilayer perceptron) and binary logistic regression were compared in their ability to differentiate between disease-free subjects and those with impaired glucose tolerance or diabetes mellitus diagnosed by fasting plasma glucose. Demographic, anthropometric and clinical data were collected from 7222 participants aged 30-88 years in the Tehran Lipid and Glucose Study. The kappa statistics were 0.229 and 0.218 and the area under the ROC curves were 0.760 and 0.770 for the logistic regression and perceptron respectively. There was no performance difference between models based on logistic regression and an artificial neural network for differentiating impaired glucose tolerance/diabetes patients from disease-free patients.

Changing pattern of mortality trends in iran, South, South-west Asia and world, 1970-2010.

BACKGROUND: Mortality refers to the death that occurs within a population. It is linked to many factors such as age, sex, race, occupation and social class. The incidence and prevalence of mortality could affect the population's standard of living and health care. The aim of this study was to explore the pattern of mortality trends in Iran, south-south west Asia and the world in 1970-2010. METHODS: A descriptive study was conducted on the registered data in the Statistical Center of Iran and National Organization of Civil Registration. The data were analyzed using statistical methods and graphs. Finally, the analyzed data were compared with the world and south-south west Asia data. RESULTS: In Iran, 61.1% of all the registered deaths were in male and 60.4% were in urban areas. Crude death rate, infant mortality rate and under five mortality rate decreased from 13, 164 and 281 per 1000 in 1970-75 to the estimated values of 5, 25 and 35 per 1000 in 2005-2010, respectively. CONCLUSION: The results showed that similar to other countries, the trends of all mortality indicators in Iran have been changed and decreased, which is related to many factors such as improvement health situation and medical interventions.

Comparison of artificial neural network and binary logistic regression for determination of impaired glucose tolerance/diabetes

Models based on an artificial neural network [the multilayer perceptron] and binary logistic regression were compared in their ability to differentiate between disease-free subjects and those with impaired glucose tolerance or diabetes mellitus diagnosed by fasting plasma glucose. Demographic, anthropometric and clinical data were collected from 7222 participants aged 30-88 years in the Tehran Lipid and Glucose Study. The kappa statistics were 0.229 and 0.218 and the area under the ROC curves were 0.760 and 0.770 for the logistic regression and perceptron respectively. There was no performance difference between models based on logistic regression and an artificial neural network for differentiating impaired glucose tolerance/diabetes patients from disease-free patients

The effect of severe zinc deficiency and zinc supplement on spatial learning and memory.

Zinc deficiency during pregnancy and during lactation has been shown to impair cognitive function and motor activity in offspring rats. In the present study, the effect of zinc deficiency and zinc supplement on spatial learning and memory in Morris Water Maze (MWM) and motor activity in open field were investigated. Pregnant rats after mating were divided to three groups. Control group fed a standard diet and a zinc deficient (ZnD) group fed a diet deficient in zinc (0.5-1.5 ppm) and a zinc supplement (ZnS) group fed a standard diet and enhanced zinc in the drinking water (10 ppm). All the diets were exposed during the last trisemester of pregnancy and during lactation. Rat's offspring in these groups were tested for spatial learning and memory in MWM at post natal day (PND) 56 and were tested for motor activity in open field at PND 66.The Escape Latency (EL) and Traveled Distance (TD) in the ZnD group were increased but Percentage of Time Spent in the target quadrant (PTS) was decreased compared to the control group. In addition, these were no significant differences in EL and TD, but PTS had significant increase in ZnS compared to the control group. In the open field, Total Distance Moved (TDM) and Time of Motor Activity (TMA) for the ZnD were decreased compared to the control group, but there were no significant differences in TDM and TMA between control and ZnS groups. These findings suggest that zinc deficiency during the last trimester of pregnancy and during lactation impaired spatial learning and memory in their offsprings and has also negative effect on motor activity. In addition, ZnS has a significant effect on spatial learning and memory but no effect on motor activity in their offsprings.

The effect of iron and zinc dietary restriction of pregnant rats on physical growth of litters.

Evidence suggests that micronutrient deficiencies may be associated with problems in early growth. Iron (Fe) and Zinc (Zn) deficiency (D) are prevalent during gestation in low-income countries. For pregnant dams, adequate amount of these micronutrients are needed in the diet to ensure the capacity for increased physical growth. In this study, the role of Fe and Zn dietary restriction of pregnant rats on physical growth of litters was investigated. Pregnant rats after to mating were divided to three groups. Control group fed a standard diet and a FeD group fed a diet deficient in Fe and a ZnD group fed a diet deficient in Zn. All the diets were exposed during the last third of pregnancy. The results showed serum Fe and Zn concentration after to exert dietary compared to before to exert dietary in FeD and ZnD groups was significant. There was a significant difference in the physical growth indexes (body weight, body length, tail length, and head length) between FeD and ZnD groups compared to the Control group, but a significant difference in head width and brain weight between FeD and ZnD groups compared to the Control group was not seen. The results of this study suggest that adequate Fe and Zn affect the physical growth of litters.

Application of the health promotion model to predict stages of exercise behaviour in Iranian adolescents.

A cluster random sample of 1073 students in the Islamic Republic of Iran (mean age 14.37 years) completed a self-report questionnaire consisting of an exercise measure, selected constructs of Pender's health promotion model and an assessment of stages of behaviour change in exercise. In multivariate discriminant analysis, exercise self-efficacy, perceived barriers to exercise, perceived benefits of exercise and exercise behaviour were significant predictors of the stage of exercise behaviour change for both female and male adolescents. The findings support the importance of self-efficacy for engaging in physical activity for both sexes of Iranian adolescents. The barriers faced by Iranian girls should be considered in interventions to increase physical activity rates.

Site-specific evaluation of prognostic factors on survival in Iranian colorectal cancer patients: a competing risks survival analysis.

BACKGROUND: Colorectal cancer (CRC) is one of the most malignant cancers, but prognosis varies in different parts of the world. Knowing the prognostic factors of the cancer is clinically important for prognosis and treatment application objectives. However, evaluation of these factors overall does not provide thorough understanding of the cancer. Therefore, this study aimed to evaluate prognostic factors of colon and rectal cancers site-specifically, via a competing risks survival analysis with colon and rectum as competing causes of death. METHODS: A total of 1,219 patients with CRC diagnosis according to the pathology reports of our cancer registry, from 1 January 2002 to 1 October 2007, were entered into the study. Demographic and clinicopathological factors with regard to survival of patients were analyzed using univariate and multivariate competing risks survival analysis, utilizing STATA statistical software. RESULTS: The results of univariate analysis showed that gender, body mass index (BMI), alcohol history, inflammatory bowel disease (IBD), tumor size, tumor grade and pathologic stage were significantly associated with colon cancer and BMI, personal history of cancer, pathologic stage and the kind of first treatment used were significantly related to rectal cancer. In the multivariate analysis, BMI, IBD, tumor grade and pathologic stage of the cancer were significant prognostic factors for colon cancer and BMI and the kind of first treatment used were significant prognostic factors of rectal cancer. Also 1, 2, 3, 4 and 5 year and overall adjusted survival of patients with rectal cancer was better than those of colon cancer. CONCLUSION: Based on our findings, CRC is not a single entity and its sub-sites should be evaluated separately to reveal hidden associations which may not be revealed under general modeling.

Application of the health promotion model to predict stages of exercise behaviour in Iranian adolescents

A cluster random sample of 1073 students in the Islamic Republic of Iran [mean age 14.37 years] completed a self-report questionnaire consisting of an exercise measure, selected constructs of Pender's health promotion model and an assessment of stages of behaviour change in exercise. In multivariate discriminant analysis, exercise self-efficacy, perceived barriers to exercise, perceived benefits of exercise and exercise behaviour were significant predictors of the stage of exercise behaviour change for both female and male adolescents. The findings support the importance of self-efficacy for engaging in physical activity for both sexes of Iranian adolescents. The barriers faced by Iranian girls should be considered in interventions to increase physical activity rates