Assessment and management of pain in children and adolescents with bleeding disorders: a cross-sectional study from three haemophilia centres.

INTRODUCTION: Pain is a major clinical problem in patients with bleeding disorders. This study aimed to determine the level of pain and how it is managed in children and adolescents with bleeding disorders. METHODS: This cross-sectional study was performed in three haemophilia centres (one in Shiraz and two in London).The data were collected using questions about pain management and Wong-Baker Faces Pain Rating Scale at routine clinical review as well as attendance for bleed treatment in summer 2014. RESULTS: This study indicated no difference among the three haemophilia centres regarding having pain, however, a significant difference was found among them concerning the mean score of pain intensity. Among the 154 subjects, 20.8% had pain on the study day, most reporting moderate levels of pain. The study participant's most frequently described their pain as aching, dull, throbbing and stabbing. Moreover, 84.38% of pain was experienced in joints and the most common painful joints were knees, ankles, elbows, hands and hips. The most common pain relief strategies included factor administration, immobilization and rest, ice packs and analgesia. Pain was significantly associated with disease severity and age. CONCLUSION: As the intensity of pain in on-demand patients was highest, using prophylaxis treatment is suggested. Moreover, adolescent patients reported more pain; giving more self-care information to them and their parents is recommended. Since little evidence was published for pain assessment and management in children and adolescents with bleeding disorders, more research is recommended.

Parental smoking and risk of childhood cancer: hospital-based case-control study in Shiraz.

This case-control study in Shiraz aimed to determine the relationship between parental smoking and childhood cancer. A questionnaire was completed by the mothers of 98 children newly diagnosed with cancer before the age of 14 years and 100 age- and sex-matched controls. Maternal smoking (prior to and during pregnancy and after the birth), and the numbers of maternal cigarettes smoked were not associated with an increased risk of childhood cancer. However, maternal exposure to passive smoke during pregnancy increased the risk of cancer childhood (OR = 3.6, 95% CI: 1.3-5.0). Father's smoking prior to (OR = 1.8, 95% CI: 1.4-6.0) and during pregnancy (OR = 3.0, 95% CI 1.4-5.0) was significantly associated with an increased risk of cancer and this increased with heavy smoking. There were no relationship between an enhanced risk of childhood cancer and father's smoking after the child's birth.

Socioeconomic status of Iranian living unrelated kidney donors: a multicenter study.

Renal transplantation is the best treatment modality for end-stage renal disease (ESRD) patients. In Iran, a living unrelated donor (LURD) transplant program was started in 1988, because of the shortage of living related and cadaver donors. In this study, we evaluated the socioeconomic status of LURD in Iran. We enrolled 478 LURDs from 30 transplant centers between October 2005 and March 2006. The demographic data, education, employment, motivation, and satisfaction status were asked. Economic status was assessed using criteria of the statistics center of Iran. Ninety-six percent of donors were referred from the Kidney Foundation of Iran (KFI). The mean age of the donors was 27 +/- 4.8 years and 85% were men (n=408). Fifty-one percent were smokers, 82% married, and 79% the breadwinner; 29% were unemployed; 2.7%, 90.8%, and 6.5% were illiterate, school graduates, and university graduates, respectively. Coercion was documented for only one donor. Financial issues were the most frequent motive. Among them, 91% were satisfied with the donation. Finally, 53% suggested kidney donation to others. Of donors, 62% were living below the poverty line. In the Iran model, the KFI is a bridge that connects recipients and donors. As a result, there is no middle man or broker introducing donors to recipients. The transplantation team knows nothing about money transactions between recipient and donor. Most donors were satisfied with the donation. However, establishment of a government-regulated program for social support of donors, such as lifelong health insurance may be a compensation for donors.

Predicting isolated postchallenge hyperglycaemia: a new approach; Tehran Lipid and Glucose Study (TLGS).

AIMS: To determine factors predicting isolated postchallenge hyperglycaemia (IPH) defined as fasting plasma glucose (FPG) < 7.0 mmol/l and 2-h plasma glucose (2-hPG) >or= 11.1 mmol/l after an oral glucose tolerance test (OGTT) and factors influencing the value of 2-hPG in a population-based study. MATERIALS AND METHODS: From 15,005 participants in the Tehran Lipid and Glucose Study (TLGS), we analysed the results of OGTTs in 5386 individuals (2909 women and 2437 men) aged >or= 20 years, free of known diabetes and any other disorders influencing glucose metabolism. Logistic and multiple linear regression models were developed to predict IPH and the 2-hPG, respectively. RESULTS: The overall prevalence of non-diabetic subjects, IPH and undiagnosed Type 2 diabetes mellitus (FPG >or= 7.0 mmol/l) were 94.5% (n = 5088), 2.5% (n = 133) and 3.1% (n = 165), respectively. Of subjects with IPH, 29.3% (n = 39) had FPG levels < 5.6 mmol/l. Factors associated with IPH were FPG (mmol/l) [odds ratio (OR) 11.05, 95% confidence interval (CI) 7.9, 15.4], age >or= 40 years (OR 2.0, 95% CI 1.3, 3.2), abnormal waist circumference (OR 2.1, 95% CI 1.4, 3.1) and serum triglycerides >or= 1.7 mmol/l (OR 2.0, 95% CI 1.3, 3.1). In the multiple linear regression model, six explanatory factors (FPG, age, female sex, triglycerides, systolic blood pressure, waist circumference) were positively related to 2-hPG. CONCLUSIONS: The model could predict 47.7% of total variance of 2-hPG. Based on our results in this Iranian population, OGTT can be recommended in subjects with FPG < 7.0 mmol/l in the presence of abnormal waist circumference and triglycerides, age >or= 40 years and in particular when FPG is close to 7.0 mmol/l.