Islamic fasting and weight loss: a systematic review and meta-analysis.

OBJECTIVE: Studies on the effects of Ramadan fasting on weight changes have been contradictory. We brought together all published data to comprehensively examine the effects in a systematic review and meta-analysis. DESIGN: Relevant studies were obtained through searches of PubMed and CINAHL and by independent screening of reference lists and citations without any time restriction. All searches were completed between October and November 2011. SETTING: Changes in body weight during and after Ramadan were extracted from thirty-five English-language studies and were meta-analysed. Most of the studies were conducted in West Asia (n 19); the remainder were conducted in Africa (n 7), East Asia (n 3) and North America/Europe (n 4). SUBJECTS: Healthy adults. RESULTS: Fasting during Ramadan resulted in significant weight loss (-1·24 kg; 95% CI -1·60, -0·88 kg). However, most of the weight lost was regained within a few weeks and only a slight decrease in body weight was observed in the following weeks after Ramadan compared with that at the beginning of Ramadan. Weight loss at the end of Ramadan was significant in both genders (-1·51 kg for men and -0·92 kg for women); but again the weight loss lasted no longer than 2 weeks after Ramadan. Weight loss during Ramadan was greater among Asian populations compared with Africans and Europeans. CONCLUSIONS: Weight changes during Ramadan were relatively small and mostly reversed after Ramadan, gradually returning to pre-Ramadan status. Ramadan provides an opportunity to lose weight, but structured and consistent lifestyle modifications are necessary to achieve lasting weight loss.

A data set for the design and implementation of the upper limb disability registry.

BACKGROUND: If the data elements needed for patient registries are not identified, designing and implementing them can be very challenging. Identifying and introducing a Data Set (DS) can help solve this challenge. The aim of this study was to identify and present a DS for the design and implementation of the upper limb disability registry. MATERIALS AND METHODS: This cross-sectional study was conducted in two phases. In the first phase, to identify the administrative and clinical data elements required for registry, a comprehensive study was conducted in PubMed, Web of Science, and Scopus databases. Then, the necessary data elements were extracted from the studies and a questionnaire was designed based on them. In the second phase, in order to confirm the DS, the questionnaire was distributed to 20 orthopedic, physical medicine and rehabilitation physicians and physiotherapists during a two-round Delphi. In order to analyze the data, the frequency and mean score of each data element were calculated. Data elements that received an agreement more than 75% in the first or two-round Delphi were considered for the final DS. RESULTS: A total of 81 data elements in five categories of "demographic data", "clinical presentation", "past medical history", "psychological issues", and "pharmacological and non-pharmacological treatments" were extracted from the studies. Finally, 78 data elements were approved by experts as essential data elements for designing a patient registry for upper limb disabilities. CONCLUSION: In this study, the data elements necessary for the design and implementation of the upper limb disability registry were suggested. This DS can help registry designers and health data administrators know what data needs to be included in the registry system in order to have a successful design and implementation. Moreover, this standardized DS can be effective for integrating and improving the information management of people with upper limb disabilities and used to accurately gather the upper limb disabilities data for research and policymaking purposes.

Survey for asymptomatic malaria cases in low transmission settings of Iran under elimination programme.

BACKGROUND: In malaria endemic areas, continuous exposure to Plasmodium parasites leads to asymptomatic carriers that provide a fundamental reservoir of parasites, contributing to the persistence of malaria transmission. Therefore, in the present investigation, the presence and prevalence of malaria asymptomatic cases were determined to evaluate the reservoir of infection in two malaria endemic areas with a previous history of malaria transmission in the south of Iran, Bashagard and Ghale-Ganj districts of Hormozgan and Kerman provinces, respectively, where malaria transmission has been drastically reduced in the recent years. METHODS: The population samples (n = 500 from each of the studied areas) were randomly collected from non-febrile, long-term residing, aged two to over 60 years, during 20092010. Three identical surveys were carried out in both study areas and in each phase all the consent participants were interviewed and clinically examined. In all, three surveys to detect hidden parasite reservoirs (both Plasmodium falciparum and Plasmodium vivax), thick and thin blood smears and a highly sensitive nested-PCR were applied. In addition, the sero-prevalence survey for detecting malaria exposure was done by using a serological marker. RESULTS: In this study, P. vivax and P. falciparum parasites were not detected by light microscopy and nested-PCR assay in all three surveys of samples. Antibody responses against P. vivax and P. falciparum were detected in 1% and 0.2% of the total examined individuals, respectively, in Bashagard district. Regarding to Ghale-Ganj district, about 0.9% of the individuals had IgG -specific antibody to P. vivax at the first and second surveys, but at the third survey 0.45% of the participants had positive antibody to P. vivax parasite. IgG -specific antibody to P. falciparum was detected in 0.2% of the participants at the first and follow-up surveys. The overall regional differences were not statistically significant (P > 0.05). CONCLUSION: Taken together, the lack of asymptomatic carrier with the evidence of extremely low sero-positive to both P. vivax and P. falciparum among examined individuals supported the limited recent transmission in the studied areas and, therefore, these parts of Iran have potential to eliminate the disease in the next few years. However, continued follow up and action are still needed in both studied areas and also in their neighbouring province, Sistan and Baluchistan, which has the highest reported cases of malaria in Iran and also, has the largest border line with Afghanistan and Pakistan, with no elimination activities. This data will provide useful information for managing elimination activities in Iran.

Related factors to disparity of diabetes care in Iran.

BACKGROUND: We determined, in Iranian patients with diabetes mellitus, the prevalence of inadequate glycemic control and its predictors. MATERIAL/METHODS: The data from a national population-based survey that included a random sample of 89 404 Iranian individuals in 2005 were analyzed. In that sample, 2923 diabetic subjects (age range, 25-64 years) were identified. We linked the results of their fasting plasma glucose levels with demographic and behavioral variables to determine predictors of poor glycemic control. RESULTS: About 57% of the subjects had a fasting plasma glucose level of > or =130 mg/dL. That percentage was comparable in male and female subjects and in literate and illiterate subjects. However, inhabitants in rural areas controlled their fasting plasma glucose level about 11% better than did subjects who lived in an urban area. We also found that control of the fasting plasma glucose level was much better in relatively younger diabetic patients. Diabetic subjects with a family history of type 2 diabetes mellitus exhibited a higher uncontrolled fasting plasma glucose level than those without positive family history of diabetes. CONCLUSIONS: The percentage of uncontrolled type 2 diabetes found in our study suggests that the Iranian healthcare system should devote more attention to that disorder, particularly in elderly individuals, who are more vulnerable to the complications of diabetes and control their disorder less well than do younger diabetic patients. The recent integration of diabetic care in primary healthcare systems in Iranian rural areas was found to have a promising effect on community health.

Temporal variations of health indicators in Iran comparing with other Eastern Mediterranean Region countries in the last two decades.

BACKGROUND: The recent significant improvement in most health indicators in Iran has not been explored deeply particularly in comparison with other countries in Eastern Mediterranean Region (EMR). We aimed to explore the temporal variations of five main indicators in Iran and compare their variations in EMR countries. METHODS: Data on DPT vaccination and birth weight were obtained from EMR office reports, and total fertility rate, under 5 mortality rate (U5MR) and adult literacy rate (ALR) were obtained from WHO sources for the time period 1995-2005. Using linear regression, we modeled the temporal variations in Iran and other EMR countries classified by their human development index (HDI) levels. RESULTS: The estimated annual decline rate of U5MR in Iran as a middle HDI country was 2.5 per 1000 live birth which was much greater than the corresponding number in countries with medium HDI (1.85) and very close to countries with high HDI (2.67). The WHO data showed that Iran was very successful in increasing ALR. CONCLUSION: It seems that most health indicators in Iran have improved more rapidly compared with countries with low and medium HDI in EMR. The improvement rates were also very close to countries with high HDI in the region.

Role of environmental, climatic risk factors and livestock animals on the occurrence of cutaneous leishmaniasis in newly emerging focus in Iran.

INTRODUCTION: Occurrence of leishmaniasis is affected by various biological and environmental factors. Kohgiluye and Boyerahmad (K-B) province is an emerging focus of cutaneous leishmaniasis (CL) in Southwest Iran. SUBJECTS AND METHODS: To elucidate some angles of occurrence of CL in this province, climatic and environmental factors and close proximity to livestock were studied by univariate and two multivariate logistic regression models. The dwelling addresses of 275 CL patients were obtained from Health Centers records for a 5 years period. The effect of mean annual temperature, minimum mean annual temperature, maximum mean annual temperature, mean annual rainfall, slope, elevation, land covers and close proximity to cattle and sheep/goat sheds on the occurrence of CL were analysed using geographical information systems (GIS) approach. RESULTS: CL occurred in all counties with the most cases in Northwest, West and South semi-arid and warm regions. Land cover, slope, elevation and close proximity to cattle sheds, were the most effective factors. Urban, dry farm and thin rangeland were found as the most important land covers. Slope and elevation decreased the probability of disease. Close proximity to cattle sheds notably increased the chance of CL. The importance of other factors such as rainfall, temperature and close proximity to sheep/goat sheds only were shown when their effects were evaluated independently from other factors. So regions with urban, dry farm and thin rangeland covers with lower slope and altitude where in close proximity of cattle sheds seems to be potentially most high risk areas. CONCLUSION: Distribution of CL cases is influenced by combination of environmental, ecological factors and close proximity to livestock sheds but control programs should be focused on cities and villages in the above-mentioned most high risk regions.

Maternal malaria during pregnancy and infant mortality rate: critical literature review and a new analytical approach.

BACKGROUND & OBJECTIVES: Malaria during pregnancy is a recognised risk factor for low birth weight and probably decreases the survival of offspring, particularly during their first month of life. On the other hand, acquired maternal immunity may protect infants against malaria infection or disease. This study assesses these two opposite effects simultaneously. METHODS: We used the data of a large epidemiological study on malaria (Garki project) to analyse the impact of malaria during pregnancy on survival of offspring in their first year of life. The dataset contains 138,197 survey records, representing 12,849 subjects. Of 663 reported deliveries, 417 could be linked to survival data for the newborn. RESULTS: The mortality rate during the first year of life was independent of maternal malaria infection during pregnancy (crude rate ratio 1.0). After adjustment for malaria in infancy, the rate ratio was 1.2. The corresponding rate ratios for maternal malaria during the second half of pregnancy were 1.46 and 1.73. None of these rate ratios was statistically significant. This may be due to the small number of deaths in the first year of life with a complete record of maternal malaria (27 deaths). The infants during the first four months of life had the lowest risk for Plasmodium falciparum, R malariae and P. ovale infections which may be partly due to acquired maternal immunity. There was a positive association between malaria during pregnancy and malaria during first year of life which might be due to similarity in exposure risks within a family, or confounding effects of socioeconomic status. However, this association was weaker in the first four months of life, and in those women who contracted infection during the second half of pregnancy. This may indicate that acquired immunity is stronger in this group and partially protects babies for a few months. INTERPRETATION & CONCLUSION: It seems that on the whole, malaria during pregnancy was not a major risk factor for infant mortality in the Garki project. These results suggest that ignoring acquired maternal immunity may overestimate the hazard of malaria during pregnancy on infant survival.

Injection drug use among female sex workers in Iran: Findings from a nationwide bio-behavioural survey.

BACKGROUND: Globally, one in three women who inject drugs is involved in sex work which increases their vulnerability to sexually transmitted infections including HIV. This study was conducted to improve our understanding of injection drug use practices among Iranian female sex workers (FSWs) and shed light on the high-risk profile of FSWs who inject drugs (FSW-IDUs). METHODS: This survey was conducted in 2010, by recruiting 872 FSWs through facility-based sampling from 21 sites in 13 cities in Iran. Data were collected through face-to-face interviews and lifetime injection drug use was assessed through the responses to the question "Have you ever injected any illicit drugs?". Independent variables included a range of socio-demographic and risk characteristics. Logistic regression models were applied to investigate the correlates of lifetime history of injection drug use. RESULTS: Median (Q1, Q3) age of the participants was 30 (25, 37) and a total of 127 (14.6%, 95% confidence interval (CI): 12.3-17.1) had ever injected drugs. In the multivariable logistic regression model, older age (adjusted odds ratio (AOR)=AOR25-34 vs. <18=3.37, 95% CI: 1.64, 7.70; AOR≥35 vs. <18=2.80, 95% CI: 1.11, 7.10), longer duration (>5 years) of involvement in sex work (AOR=1.06, 95% CI: 1.02, 1.10), and history of drinking alcohol (AOR=4.42, 95% CI: 2.67, 7.32) were positively associated with lifetime history of drug injection and younger age at sex work debut (AOR=0.52, 95% CI: 0.28, 0.96) was negatively associated with lifetime history of illicit drug injection among FSWs. CONCLUSION: The prevalence of injection drug use among FSWs in Iran is concerning. Given the potential of this sub-population in bridging HIV into the general population, gender-sensitive and peer-led harm reduction programs should be further scaled up to meet the special needs of this vulnerable population.

Medical student and academic staff perceptions of role models: an analytical cross-sectional study.

BACKGROUND: This study explored the associations between the perceptions of students and the perceptions of academic staff about the characteristics of clinical lecturers at the Department of Internal Medicine at Kerman University of Medical Sciences (KUMS). It also assessed what characteristics constitute a 'role model' from the point of view of students and staff. METHODS: Staff and students were questioned about the characteristics of their colleagues and lecturers, respectively. They were asked about 15 characteristics under four headings: personality, teaching skill, group working and overall performance as a role model. Associations between lecturers' characteristics were explored using Pearson correlation and characteristics were allocated into groups by partition cluster method. In addition, predictors of being a valuable lecturer were assessed using logistic regression analysis. RESULTS: Based on staff responses, the strongest association observed was between honesty and being respectful (r = 0.93, p < 0.0001). Based on student responses, the strongest association observed was between being professional and honesty (r = 0.98, p < 0.0001). None of the correlations between student and staff perceptions were significant for any characteristic. Two groups were recognized among the characteristics. group one contained those characteristics which were related to the lecturer's activity; while the second group contained characteristics that were related to the personality or teaching performance of the lecturer. The predictors of lecturer as 'role model' (i.e., perceptions of students) consisted mostly of characteristics from the first group, while the predictors of a 'role model' by fellow academic staff consisted of characteristics that were in both groups. CONCLUSION: These findings showed considerable differences between the perceptions of students about their lecturers when compared with perceptions of staff about their colleagues. Students were more concerned with the personality of their lecturers, while staff also considered their ideas and behaviors. This suggests that a more comprehensive assessment of a lecturer's performance could be obtained by taking into account feedback from both students and colleagues.

Social disparities in prevalence, treatment and control of hypertension in Iran: second National Surveillance of Risk Factors of Noncommunicable Diseases, 2006.

OBJECTIVE: Assessing hypertension prevalence, treatment and control by sociodemographic factors in Iran. METHODS: We analyzed data from the 2006 National Surveillance of Risk Factors for Noncommunicable Diseases of Iran with a population-based sample of almost 30,000 people aged 15-64 years. Multiple logistic regression models were used to explore differences in hypertension prevalence, treatment and control, adjusting for sociodemographic factors, comorbidities and behavioral factors. RESULTS: Hypertension prevalence was 17.37%. Among hypertensive patients, 33.35% were under treatment, and, among treated people, 35.10% had hypertension controlled. In multiple-regression analysis, age, male sex, low level of education, Kurd ethnicity, overweight and obesity, diabetes mellitus, lower level of physical activity and high-Human Development Index provinces were independently associated with higher prevalence of hypertension. Income and living in rural or urban area were not related to hypertension prevalence. Treatment rates were lower in men, younger people and people of low education and low income, but there were no treatment rate disparities connected to living area, ethnicity and provinces (by Human Development Index). In addition, diabetic patients, obese people and past daily smokers had higher treatment rates. Lower control rates were independently associated with male sex, higher age and lower education, but not with other variables. CONCLUSION: In Iran, there is comparatively higher prevalence of hypertension among people of Kurdish ethnicity, people of low education and in high-Human Development Index provinces; a lower treatment rate among men, younger people, people of low education and low income; and a lower control rate among men and people of low education. These disparities should be addressed by researchers and health policy makers.

Evaluation of the wash resistance of three types of manufactured insecticidal nets in comparison to conventionally treated nets.

The present study evaluated the efficacy and wash resistance of several commercial deltamethrin-treated nets (PermaNet, from factory (PN-F) and market (PN-M), Yorkool (Y) and AZ net) that were claimed by the manufacturers to be Long-Lasting Insecticide Treated Nets (LLITNs), compared to ITNs conventionally treated with deltamethrin (23-27 mg/m(2), using one K-O Tab tablet (KO) per net). Montpellier washing technique was used for washing the pieces of the nets. Insecticidal activity was assessed on dried pieces of nets after 0, 2, 5, 8, 11, 15, 18 and 21 washes, using two types of bioassay (mean median knock down times and mortality 24 h after a 3-min exposure) and reared female Anopheles stephensi. To evaluate the effect of heat on diffusion of insecticide from inside of the nets to the surface of them, some Permanet nets were heated. For all the types of nets tested the median knock down time (MKDT) increased approximately linearly with number of washes. The slopes of the lines (increase of MKDT per wash) were low with the PN-F and PN-M, intermediate with Y and equally high with KO and AZ. No significant differences can be claimed with the 3-min exposure tests. The slopes of the regression lines did not differ significantly between the heated and unheated samples. It is concluded that diffusion at ambient temperature is fast enough to rapidly compensate for the loss of insecticide on the surface with no need to artificially stimulate diffusion by heating.

Effect of phosphate buffer saline on coronal leakage of mineral trioxide aggregate.

This study was carried out to compare the bacterial leakage of MTA used as a root-end filling material when it was kept in phosphate buffer saline (PBS) or normal saline. In this study, 72 freshly extracted teeth were used. The roots were randomly divided into four experimental groups of 15 each (groups I and II gutta-percha obturation + MTA, groups III and IV only MTA) and two positive and negative control groups of six each. The samples in groups I and III were kept in normal saline for 1 month while the samples in groups II and IV were kept in PBS. Enterococcus faecalis was used for determination of the bacterial penetration. Kaplan-Meier survival curve and chi(2) test were employed for data analysis. The obturated samples with root-end filling showed significantly longer duration of resistance to bacterial penetration than canals without obturation (P < 0.05). The roots that were placed in PBS (groups II and IV) showed significantly less bacterial penetration in comparison with the roots that were stored in normal saline (P < 0.05). In conclusion, MTA, which acts as a bioactive material, should be placed in a synthetic tissue fluid before any leakage evaluation.