Risk of urinary tract cancers following arsenic exposure and tobacco smoking: a review.

Bladder cancer, prostate cancer, and kidney cancer, due to their high morbidity and mortality rates, result in significant economic and health care costs. Arsenic exposure affects the drinking water of millions of people worldwide. Long-term exposure to arsenic, even in low concentrations, increases the risk of developing various cancers. Smoking is also one of the leading causes of bladder, prostate and kidney cancers. Accordingly, this research reviews the relationship between arsenic exposure and smoking with three kinds of urinary tract cancers (bladder cancer, prostate cancer, and kidney cancer) due to their widespread concern for their negative impact on public health globally. In this review, we have gathered the most current information from scientific databases [PubMed, Scopus, Google Scholar, ISI web of science] regarding the relationship between arsenic exposure and tobacco smoking with the risk of bladder, prostate, and kidney cancer. In several studies, a significant relationship was determined between the incidence and mortality rate of the above-mentioned cancers in humans with arsenic exposure and tobacco smoking. The decrease or cessation of smoking and consumption of arsenic-free water significantly declined the incidence of bladder, prostate, and kidney cancers.

Anesthesia technique and serum cytokine concentrations in the elective cesarean section.

BACKGROUND: Anesthesiologists should obtain the best technique for cesarean section (CS). This study designed to compare the effect of general anesthesia (GA) and spinal anesthesia (SA) on immune system function in elective CS. MATERIALS AND METHODS: This descriptive study was performed on forty candidates for elective CS. They were randomly divided into GA and SA groups. The serum concentrations of interleukin (IL)-4, IL-6, IL-10, and IL-17 and interferon-gamma (IFN-γ) were measured using ELISA method prior to anesthesia (T0), immediately after the uterine incision (T1), 2 h post CS (T2), and 24 h post CS (T3). Data were analyzed using descriptive statistics and Chi-square, independent t-test, and repeated measures. RESULTS: No significant differences were observed between the GA and SA groups regarding the serum levels of IL-4, IL-6, IL-10, IL-17, and IFN-γ. The serum levels of transforming growth factor beta (TGF-ß) in the SA group were significantly (P = 0.003) more than that of the GA group at T3. CONCLUSION: According to the angiogenesis properties of TGF-ß, it seems that SA probably affects the rate of recovery more than that of the GA.

Opium and risk of gastrointestinal cancer: a case-control study

Background/aim: Gastrointestinal (GI) cancers are among the most common cancers in the world. Many risk factors may increase the chance of developing GI cancers. In recent years, a number of epidemiological studies have reported evidence of carcinogenic effects of opium in humans. This study aimed to investigate the relationship between opium use and GI cancer. Materials and methods: This case-control study was performed on 95 patients with GI cancer and 190 healthy individuals (matched for age, sex, place of residence, and smoking) in Rafsanjan, Iran, in 2018. Diet information, as well as history of smoking, the use of hookah, opium, and its derivatives was collected using a checklist in interview sessions. Conditional logistic regression was performed to investigate the proposed relationship and to estimate odds ratios (OR). Results: After adjusting the confounding variables, the use of opium was significantly associated with an increased risk of GI cancer development (OR = 5.95, 95% CI: 2.4­14.9). Also, a dose-response association was found between the cumulative use of opium and the risk of GI cancers. Consumption of fruit and vegetables reduced the risk of developing GI cancers in opium users (OR = 4.9 and 4.7, respectively). Conclusion: Opium, in the form used among drug users in this area, can lead to an increased risk of GI cancers. Fruit and vegetables have a protective and modifying effect on the risk of GI cancer development caused by opium consumption.

The biological functions, structure and sources of CXCL10 and its outstanding part in the pathophysiology of multiple sclerosis.

The etiology of several autoimmune diseases, including multiple sclerosis (MS), has still not been completely clarified. MS is defined as an autoimmune disease with clinical features of a chronic, inflammatory and demyelinating autoimmune disorder which affects the central nervous system. The course of the disease includes phases of remission and relapses which can be exacerbated in both severity and duration. Chemokines, which are a subfamily of the cytokines, act as chemoattractants for a wide variety of cells, including immune cells. CXCL10 is a small protein that is defined as an 'inflammatory' chemokine and binds to CXCR3 to mediate immune responses through the activation and recruitment of leukocytes such as T cells, eosinophils, monocytes and NK cells. The aim of this review is to address recent findings regarding the relationship between CXCL10 and MS.

A preliminary validation of the impact on participation and autonomy questionnaire in an Iranian sample of patients with type 2 diabetes.

BACKGROUND: This study aimed to determine the face, convergent validity, internal consistency, and stability reliability of the impact on participation and autonomy-Persian version (IPA-p) scale for using among Iranian patients with type 2 diabetes. MATERIALS AND METHODS: Trained experts interviewed 227 type 2 diabetes patients who were registered in out-patient Diabetes Clinic of Ali-Ibn Abi-Talib Hospital, (Rafsanjan, Southeast Iran from May 2018 to February 2019) and their relatives to assess the face and convergent validity, internal consistency, and stability reliability of the IPA-p scale. A checklist was used to collect demographic information and also to record expert's̛̛̛̛̛̛ points of view about the scale to assess face validity. Internal consistency was measured using Cronbach's alpha, and stability was assessed using interclass correlation coefficients (ICCs). Test-retest method was used to detect the reliability of the questionnaire. Respondents completed the IPA-p scale on the two occasions with an interval of 30-45 days. RESULTS: In relation to convergent validity, the confirmatory model showed an acceptable fit and the scale had a highly convergent validity. Exploratory factor analysis showed that the IPA-p scale has a ten-factor structure that explained 77.42% of the variance. Cronbach's alpha between the mean IPA-p scores achieved on the two occasions ranged from 0.65 to 0.92. Test-retest ICCs for the ten domains were between 0.64 and 0.81. CONCLUSIONS: The IPA-p questionnaire can be a relatively valid and reliable instrument for assessing self-reported participation among Iranian type 2 diabetes patients. However, some improvement is needed to make it fully suitable for using among Persian-language diabetic patients.

Dietary antioxidants and hypertension among menopausal women in Rafsanjan Cohort Study.

Studies on the beneficial role of dietary antioxidants in preventing or managing hypertension in postmenopausal women are infrequent. The present cross-sectional study aimed to assess the association between dietary antioxidants and hypertension among menopausal women in Rafsanjan, a city located in the southeast of Iran. This study was based on data from the Rafsanjan Cohort Study (RCS), as part of the Prospective Epidemiological Research Studies in IrAN (PERSIAN). Among 2359 postmenopausal women, finally, 1936 women were included in this study. Participants were grouped as having normal blood pressure (BP), elevated BP, stage 1 hypertension, or stage 2 hypertension as defined by the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) BP guideline. A food frequency questionnaire (FFQ), was utilized to ascertain the levels of various nutrients and dietary antioxidants in the diet. The association between dietary intakes of antioxidants and blood pressure groups was evaluated by crude and adjusted models in the multinominal logistics regression analysis. Normal BP, elevated BP, stage 1 hypertension, and stage 2 hypertension were observed in 35.69%, 3.62%, 10.59%, and 50.10% of postmenopausal women respectively. In the adjusted model, in subjects with higher consumption of ß-carotene, the odds ratios of elevated BP in the 3rd quartile was about 2 times (OR: 2.04 (1.06-3.93) higher than 1st quartile. Also, in subjects with medium quality of DAQS, the odds ratios of elevated BP and stage 1 blood pressure were about 2 times (OR: 2.09 (1.05-4.17) and 1.69 times (OR: 1.69 (1.09-2.63) higher than subjects with low quality respectively. Furthermore, we did not find any statistically significant association between increased intake of dietary antioxidants and decreased odds of hypertension. After controlling the effects of confounding variables, increased dietary intake of selenium, carotenoids, vitamin A, vitamin C, and vitamin E did not decrease the odds of hypertension in postmenopausal women. Accordingly, it is suggested that this association be further investigated in the follow-up phase of this prospective study.

Increased circulating levels of CXC chemokines is correlated with duration and complications of the disease in type-1 diabetes: a study on Iranian diabetic patients.

BACKGROUND: Type-1 diabetes (T1D) is characterized as a heterogenous autoimmune disease. Immune system factors are important in the pathogenesis of T1D. Chemokines as crucial members of the immune system are key factors in the pathogenesis of several autoimmune diseases, including T1D. They are potent chemotactic cytokines with various functions varied from maturation, trafficking of leukocytes, to angiogenesis, angiostasis, and homing of stem cells. Therefore, the current study was aimed to examine if the expression of pro-angiogenic CXC chemokines like CXCL1 and anti-angiogenic chemochines such as CXCL9 are associated with duration and complications of T1D in Iranian diabetic patients. METHODS: In this experimental study, blood samples were collected from 209 T1D patients and 189 healthy controls. The serum levels of CXCL1 and CXCL9 were measured by ELISA. Demographic data were also collected on a questionnaire which was designed specifically for this study. RESULTS: Increased plasma levels of chemokines studied (CXCL1 and CXCL9) were observed in T1D patients compared to controls. Current findings also demonstrated that there was a close association between chemokines and complications of T1D and chemokines were elevated in T1D patients suffering complications. CONCLUSIONS: Our results probably suggest that the serum levels of CXCL1 and CXCL9 play important roles in T1D pathogenesis. It is also worth noting that these factors are useful prognostic and/or diagnostic biological markers in T1D patients.

The Effect of Palm Pollen Extract on Sexual Disorders in Postmenopausal Women: A Randomized Clinical Trial.

Background: Considering the numerous nutritional and estrogenic compounds of palm pollen and their effect on sexual function, this study was performed to investigate the effect of palm pollen extract on sexual disorders in postmenopausal women. Methods: In this three-blind clinical trial, 110 postmenopausal women from December 2019 to December 2020 from Rafsanjan comprehensive health service centers were randomly assigned to two groups, using a lottery method. The intervention group received 300 mg capsule of palm pollen extract, and the control group received placebo for 4 weeks. Sexual disorders were assessed with a 6-item female sexual function index before, at the end of the intervention, and 4 weeks after the end of the intervention. Independent t-test, Chi-square and repeated measures ANOVA were used to analyze the data through SPSS software version 21. The statistically significant level was considered P value less than 0.05. Results: The mean scores of sexual disorders before the intervention in the intervention and control groups were 15.36±5.01 and 14.13±4.67 (P=0.68); at the end of the intervention, they were 15.18±4.50 and 14.22±3.91 (P=0.43) and 4 weeks after the end of the intervention we obtained 15.7±4.77 and 14.44±3.78, respectively (P=0.90). Conclusions: According to the results, daily consumption of 300 mg of date pollen extract had no effect on improving sexual disorders in postmenopausal women. Further studies in this field are suggested.Trial Registration Number: IRCT20160308026971N1.

Effect of misoprostol with and without evening primrose (Oenothera biennis) on induction of missed abortion.

Objective: To determine whether addition of evening primrose to a misoprostol-based abortion regimen can increase the success of abortion. Materials and Methods: In this randomized clinical trial., 148 women referring to Niknafas Hospital in Rafsanajn with diagnosis of missed abortion were randomly allocated into two 74-subject groups. The intervention group used 2000 mg vaginal evening primrose capsules the night before the hospitalization, while the control group did not receive any medication. Both groups received an initial dose of 800 µg of vaginal misoprostol after admission and the next dose was given three hours later if necessary. Results: The two groups had significant differences in terms of full abortion, consistency and dilatation of cervix, duration between the first dose of misoprostol until the ejection of fetus, the misoprostol dose administered, and the level of vaginal bleeding during the hospitalization. They had no significant differences regarding curettage, duration of hospitalization, or side effects. The mean pain score had no significant difference between the two groups, though the score was lower in the intervention group (p>0.05). Conclusion: Administration of vaginal evening primrose before vaginal misoprostol was found to be more effective compared to misoprostol alone in missed abortion.

Lack of association between chemokine receptor 5 (CCR5) δ32 mutation and pathogenesis of asthma in Iranian patients.

BACKGROUND: Chemokines and their receptors are clinically important mediators, as the chemokine receptors are expressed on almost all immune cells. They play pivotal roles in pathogenesis of almost all clinical situations including asthma. Correspondingly, MIP-1α (CCL3), MIP-1ß (CCL4), and RANTES (CCL5) are among the important chemokines involved in the pathogenesis of asthma. These chemokines bind to the CCR5 (their related receptor) on the cell surfaces. Attachment of related chemokine ligands to CCR5 plays an important role in the pathogenesis of asthma; hence, this study aimed to analyze δ32 mutations in CCR5 in asthmatic patients. MATERIAL AND METHODS: This experimental study was undertaken on 162 asthmatic patients and 200 healthy controls during February to June 2008 at Rafsanjan University of Medical Sciences. The Gap-PCR method was applied to analyze the δ32 mutation in the CCR5 gene, and demographic data (eg, age, sex, occupation, socio-economic status) were collected using a questionnaire. RESULTS: The findings of this study indicated that none of the asthmatic patients exhibited δ32 mutation in CCR5 chemokine receptor while only 3 (1.5%) of controls had the heterozygotic form of this mutation. DISCUSSION: Several research groups analyzed δ32 mutations in CCR5 in different diseases, including asthma. Some investigations reported a significant relation between asthma and δ32 mutations in CCR5, but there are also many reports which failed to find a relation between asthma and this mutation. Based on the results of this study and others, it seems that the δ32 mutation does not affect the pathogenesis of asthma.

General Anesthetics on Immune System Cytokines: A Narrative Review Article.

CONTEXT: According to the previous studies, general anesthesia influences the immune system. Evaluating such impacts on the immune system helps to improve the management of anesthesia. EVIDENCE ACQUISITION: The current review aimed to summarize the literature related to the effects of general anesthesia agents on the cytokines. Google Scholar, PubMed, and ISI/Web of Sciences databases were searched using the following keywords: cytokine, general anesthesia, immune response, intravenous anesthetics, volatile anesthetics, opioids, benzodiazepines, and controlled ventilation. RESULTS: Long-term administration of general anesthesia drugs, due to their effects on cytokines, can lead to disease progression in patients with immune deficiency. Due to the conflicting results of various studies and the increasing number of patients with immune deficiency, the choice of the appropriate general anesthesia agents facilitates achieving the more favorable function of the cytokines. CONCLUSIONS: It seems that the effect of general anesthesia on the immune system in healthy patients and short-term surgeries is not considerable and changes in the immune system are related to surgical trauma, particularly in major surgery.

Effect of Different Anesthetic Techniques on Cytokine Gene Expression in Patients who Underwent Elective Cesarean Section.

Cesarean section (CS) is an important challenge for a pregnant woman and her newborn. The most common anesthesia techniques used for CS are general anesthesia (GA) and spinal anesthesia (SA). This study was designed to compare the modulation of genes whose expression level is indicative of the immune system following exposure to GA and SA. The present study was performed on 40 women who were scheduled for elective CS receiving GA or SA. The expression levels of the relative mRNA of Interleukin (IL)-4, IL-6, IL-10, IL-17, Interferon (IFN)-γ, and tumor growth factor (TGF)-ß before anesthesia (T0) and 24 hours post-anesthesia (T1) were analyzed by real-time polymerase chain reaction (RT-PCR) technique.  Twenty-four hours post-anesthesia, the expression levels of IL-10, IL-17, and IFN-γ genes were decreased while the expressions of IL-4, IL-6, and TGF-ß genes were upregulated in two groups, however, the differences were not significant. The mRNA level of IL-4 was increased in the SA group significantly. The post-CS mRNA levels of IL-4 in the SA group may indicate that SA is more appropriate than GA for the initiation of tissue repair pathways.

Epidemiology of Vehicle Fire Fatalities of Road Traffic Injuries in Kerman Province, Iran: A Cross-Sectional Study.

BACKGROUND: Vehicle fires are one of the most important causes of fatalities in road traffic injuries (RTIs), but there are no accurate statistics about vehicle fire fatalities (VFFs) due to RTIs in Iran. AIM: This study aimed to investigate the Epidemiology of vehicle fire fatalities (VFFs) due to road traffic injuries (RTIs) in Iran. METHODS: In this cross-sectional study, a researcher-made checklist was used to collect the required data from the files of RTI fatalities in the Kerman Legal Medicine Organization (KLMO), or coroner's office. All reported victims of vehicle fires in the ten years from 2007 to 2017 were included in the study. The data were analysed using SPSS ver. 18, with p = 0.05 considered as the level of significance. RESULTS: The authors found 124 cases of vehicle fire fatalities in Kerman, with a mean age of 30.45 ± 12.41, of which 50% were in the 25-49 years age group. Most frequently, the victims were Iranian (91.9%), married (66.1%), self-employed (51.6%), and urban dwellers (79.8%), and had died because of burns (91.9%). In 46.8% of cases, the victims were the driver, and in the remaining 53.2%, they were the passenger of the crashed vehicle. Most frequently, vehicle fires occurred on extra-urban roads (90.3%), during spring (35.5 %) or summer (32.3%), due to a vehicle-to-vehicle collision (66.9%), between sedans (69.9%), and at night (63.7%). Most victims died at the scene of the incident (87.9%) and had been transferred to hospital by an ambulance (71%). CONCLUSION: This study indicated that car fires caused the death of young and middle-aged people. The authors suggest the implementation of preventative measures promoting car safety; establishing speed management; establishing laws governing driving, manufacturing and importation of vehicles; construction of safe roads; identifying accident-prone points; installing road warning signs; establishing more roadside stations; ensuring stricter police monitoring; and improving vehicle safety standards and public awareness about the risks of speeding.

Cesarean or Cesarean Epidemic?

Due to advances in surgical procedure, anesthesia techniques, blood transfusion and antibiotic therapy, the technique of cesarean section has been progressing over the time. However, cesarean section is still a risk-specific operation, with long-term and shortterm consequences for the mother and neonate. The rate of cesarean surgery is constantly growing due to both justifiable and nonjustifiable medical and non-medical reasons. There is evidence indicating that efforts are made in many countries to reduce the rate of cesarean delivery. In this review article, we try to assess the frequency of cesarean section in different countries, especially Iran. We searched several keywords, including cesarean section prevalence, cesarean section rate, world, delivery, Iran and health policies within the newest articles published in Google Scholar, PubMed, and ISI/Web of Sciences, as well as Iranian databases (Magiran, SID), from January 2017 to April 2019. The results show that there is still a high prevalence of C-section. In Iran, the highest rate of cesarean was in Tehran province (62.1%-72.1%) and the lowest was in Sistan and Baluchestan province (12%). It appears necessary to plan for effective interventions in terms of painless vaginal delivery, improving the quality of vaginal delivery services, proper culture and education.

Age-Related Effect of Antihypertensive Treatment on Cognitive Performance: Is it Better Preventing Dementia in Older Age?

The aim of this study is to investigate the impact of optimal antihypertensive medication on cognitive function. In this 6-month clinical trial, 248 adults were randomly selected by a registry of hypertensive-treated patients (based on a National Hypertension Treatment Program), followed health centers located in Rafsanjan County, Southeast, Iran. Blood pressure was measured 3 times in each appointment pre- and posttreatment. Mini-Mental State Examination was used for cognitive performance evaluation. Paired t test and multiple regression model showed significant correlation between "the differences of systolic and diastolic blood pressure levels" and "cognitive performance in treated patients more than 40 years old." Cognitive performance was not significantly different in patients less than 40 years old post antihypertensive treatment. Cognitive performance scores demonstrated significant increase in responders more than 40 years old post antihypertensive treatment. Antihypertensive treatment in responders with age equal or more than 40 years improves the level of cognitive performance significantly.

Ferritin concentration and pregnancy outcome: linear models for predicting birthweight and birth length.

BACKGROUND: Iron-deficiency anemia can have negative consequences for pregnant women. Previous investigations conducted to explore the association between iron-related components of mothers' serum and the outcome of pregnancy have had diverse results. OBJECTIVE: This study aimed to investigate the correlation between ferritin concentration (as the index of stored iron) of mothers' serum during the last 24 hours of pregnancy and birth outcome. METHODS: Respondents were chosen from the list of all women who had given birth between January 1 and March 30, 2006, in a Rafsanjan county maternal hospital in southeast Iran. The study checklist was completed for 600 to 900 mothers (over a period of 30 days), and about 600 were eligible to participate. Blood samples were taken from 120 eligible women who were randomly selected after they had given their second consent. Data, including birthweight and birth length, were analyzed with SPSS; parametric (t-test, correlation, logistic regression) and nonparametric (chi-square, Mann-Whitney U) tests were used where appropriate. RESULTS: No significant differences between different groups of respondents were found in birthweight, birth length, or the ferritin concentration of mothers' serum, indicating that the effect of confounder variables (e.g., baby's sex, mother' educational status, mother's age, gestational age, etc.) was controlled successfully. Significant positive correlations were found between the mother's ferritin concentration and the baby's birthweight (r = 0.434, N = 120, p < .001) and birth length (r = 0.396, N=120, p < .001). Linear models revealed that the ferritin concentration of mothers' serum during the last 24 hours of pregnancy could be suitable to predict both birthweight and birth length. CONCLUSIONS: This study confirms that provision of sufficient amounts of iron-related components to pregnant women is necessary to improve pregnancy outcome.

Life expectancy and years of life lost in HIV patients under the care of BandarAbbas Behavioral Disorders Counseling Center.

BACKGROUND: HIV epidemic is mostly targeted adults and has numerous negative health, social, economic, cultural and political consequences. In this study Life Expectancy (LE) and Average Years of Life Lost (AYLL) in HIV/AIDS patients are estimated. MATERIALS AND METHODS: In this descriptive study all the patients at the age of 18 and more under the care of BandarAbbas Behavioral Disorders Counseling Center (BBDCC) during 2005-2015 are included. The town of BandarAbbas is center of Hormozgan Province in southern Iran. LE and AYLL have been estimated based on Life Table. RESULTS: One hundred thirty four of the 426 eligible patients died during the study period. Compared to the general population LE for HIV/AIDS patients at age 20 is 46 years less in comparison with the general population of BandarAbbas. Moreover, a total of 8839 years of life lost during 2005-2015. CONCLUSION: LE in HIV/AIDS patients is less than LE among BandarAbbas general population and AYLL among them is more than general population. Most of the years of life lost are preventable if the health care system seriously will implement programs to control HIV/AIDS.

Serum CXCL10 and CXCL12 chemokine levels are associated with the severity of coronary artery disease and coronary artery occlusion.

BACKGROUND: Cardiovascular disease constitutes a major cause of death worldwide. Inflammation plays an important role in atherosclerosis formation, coronary artery disease progression, acute coronary thrombosis and occlusion. Chemokines are inflammatory mediators disposing several bio-functions, as leukocyte migration towards inflammatory signals and vascular injuries. The present study was designed to evaluate the potential correlation between serum levels of chemokines CXCL-10 and CXCL-12 and the degree of coronary artery occlusion. METHODS: Eighty eight patient candidates for coronary angiography with coronary artery disease symptoms and potentially high risk of coronary artery occlusion were recruited. Chemokine serum levels were measured with the ELISA method and patients underwent coronary angiography. All patients with coronary artery disease (CAD) were divided into four groups according to the Gensini score. Data were presented as mean±SD. All P values <0.05 were considered significant. RESULTS: Our demographic data showed that of the 88 patients, 46 were male and 42 female. The mean age of patients was 57.95±11.13. Following increased coronary artery occlusion the serum levels of chemokines were significantly increased (CXCL-10 and CXCL-12; P<0.0001 and P<0.0001, respectively). CONCLUSION: In this novel study, a significant correlation between the serum levels of CXCL-10 and CXCL-12 and the severity of coronary artery occlusion was found. This could be attributed to the role of these chemokines in the processes of angiogenesis and angiostasis, a biological phenomenon that can play key role in the development of collateral circulation.

Exposure to pistachio pesticides and stillbirth: a case-control study.

OBJECTIVES: Stillbirth is an undesirable outcome of pregnancy. In light of the increasing use of pesticides and growing concerns about the possible health effects of agricultural pesticides, we investigated the effect of exposure to pistachio pesticides on stillbirth in pregnant mothers. METHODS: This case-control study was conducted in Rafsanjan, Iran from 2011 to 2012. A total of 125 females who had a recent stillbirth were included as the case group, and 250 controls were selected from females who had a recent live birth. For each case, two controls with the nearest propensity score to the case were selected. Data were collected using a protocol developed by the researcher that involved interviewing respondents and reviewing their medical records. Conditional multivariate and univariate logistic regression analysis were performed and odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. RESULTS: The ORs of stillbirth in mothers living in pistachio gardens and those who were exposed to sprayed pesticides, in comparison to the controls, were 14.1 (95% CI, 3.3 to 63.4) and 5.0 (95% CI, 1.2 to 28.6), respectively. No significant differences were found in stillbirth rates according to the distance between the mother's residence and a pistachio garden or involvement in agricultural activities. CONCLUSIONS: The results of our study showed that exposure to pistachio pesticides during pregnancy may increase the likelihood of stillbirth in mothers.

The Persian Version of a Participation Scale: Is It Valid and Reliable Enough for Use among Iranian Patients with Multiple Sclerosis?

BACKGROUND AND PURPOSE: The aim of this study was to determine the face and criterion validity, stability reliability, and internal consistency of the Persian version of the Impact on Participation and Autonomy (IPA-p) scale among Iranian people with multiple sclerosis (MS). METHODS: Trained experts interviewed 364 MS patients and their relatives to assess the criterion validity, stability reliability, and internal consistency of the IPA-p scale. Ten specialists from different disciplines were also recruited to assess its face validity. A consent form was completed by the patients and their relatives. Internal consistency reliability was measured using Cronbach's alpha and stability reliability was assessed using interclass correlation coefficients (ICCs). The test-retest method was used to detect the reliability of the questioner. The study subjects completed the IPA-p scale on two occasions separated by an interval of 30-45 days. Study checklists were also used to assess the face validity, stability reliability, and internal consistency of the IPA-p scale. RESULTS: About 50% of the respondents reported their perceived overall participation to be "good" or "very good" and 60% of the specialists rated the ability of the IPA-p scale to measure what it was designed for as "excellent." Spearman correlation coefficients were >0.8 for all but one IPA-p domain. Cronbach's alpha between the mean IPA-p scale scores achieved on two separate occasions ranged from 0.858 to 0.913. The highest and lowest internal consistencies belonged to the "social relationships" and "education and learning" domains, respectively. The test-retest ICCs for the nine domains were between 0.789 and 0.919, and all were significant at p<0.001. CONCLUSIONS: The IPA-p questionnaire can be considered a valid and reliable instrument for assessing self-reported participation among Iranian MS patients.