Effect of oral carbohydrate intake on labor progress: randomized controlled trial

Lack of information regarding biochemical changes in women during labor and its outcomes on maternal and neonatal health still is an unanswered question. This study aims to explore the effectiveness of oral carbohydrate intake during labor on the duration of the active phase and other maternal and neonatal outcomes. A parallel prospective randomized controlled trial, conducted at the University Affiliated Teaching Hospital in Gonabad. Totally, 190 women were randomly assigned to an intervention [N=87] or control [N=90] group. Inclusion criteria were low-risk women with singleton cephalic presentation; and cervical dilatation 3-4 cm. Randomization was used by random number generator on every day. Odd numbers was used for intervention and even numbers for control group. Intervention was based on the preferences between: 3 medium dates plus 110 ml water; 3 dates plus 110 ml light tea without sugar; or 110 ml orange juice. The protocol is only run once but women ate and drank gradually before second stage of labor. Control group were fasted as routine practice. Neither participants nor care givers or staff could be blinded to group allocation. Differences between duration of the active phase of labor were assessed as primary outcome measure. There was significant difference in the length of second stage of labor [P <.05]. The effect size for this variable was 0.48. There were no significant differences in other maternal and neonatal outcomes. Oral intake of carbohydrate was an effective method for shortening the duration of second stage of labor in low-risk women

Direct estimate of population attributable fraction of risk factors for cardiovascular diseases: tehran glucose and lipid study

Cardiovascular disease is the first cause of death and third place in disease burden in Iran. This study estimâtes population attributable fraction [PAF] of Cardiovascular risk factors in Tehran population. PAF is one of the important parameters of measuring population affect of risk factors and evaluating potentiel impact of preventive strategies in community level. In this study 5868 participants above 30 years old of Tehran lipid and glucose study [TLGS] were employed and 501 CVD events detected during 10 years follow-up. Direct estimate of adjusted PAFs using logistic regression which is one of less biased exist methods of PAF calculation were applied. Highest modifiable Cardiovascular risk factor PAFs, in sequence, was smoking [14.16%], hypertension [11.73%], diabètes [7.32%] hypercholesterolemia [6.85%] and central obesity [5.91%] for men, and hypertension [19.25%], diabètes [18.82%], central obesity [9.88%] and hypercholesterolemia [7.95%], for women. Also PAF of hazardous age and premature family history of CVD, as most important nonmodifiable CVD risk factors, were 36.09%, 1 6.61% and 3.95%, 7.56% for men and women respectively. According to the difference of risk factors PAFs ranking in men and women, it is suitable that CVD preventive interventions to be prioritized by sex separately. In this regard, besides special attention to control tobacco use in men, hypertension and diabètes in both sexes and high cholesterol in men and central obesity in women respectively, should be given in priority of preventive strategies

Human papillomavirus infection prevalence in women referred to health clinic of shahid beheshti university of medical sciences, Tehran, Iran

Human papillomavirus [HPV] infection seems to be the most common sexually transmitted infection. High-risk [HR] human papillomavirus [HPV] prevalence has been shown to correlate well with cervical cancer incidence rates. Since there is little known about the epidemiology of this infection in Tehran, we designed to estimate the prevalence of HPV in some areas in Tehran. Cervical specimens were obtained from 825 married women aged 21-59 years from the general population of Tehran, Iran according to the standardised protocol of the IARC International HPV surveys. HPV was detected using a GP5+/6+ PCR-based assay. HPV prevalence in the general population was 7.8% [5.1% of high-risk types], with no statistically significant variations by age. Cervical intraepithelial neoplasia was diagnosed in 4.1% of women, of whom 35.3% were HPV-positive. HPV1 6 was confirmed as the most common type among women with both normal [1.8%] and abnormal [8.8%] cytology. HPV positivity was significantly higher among divorced women, women in polygamous marriages and those reporting husbands' extramarital affairs. However the prevalence of HPV seems not high in comparison with other international data, more molecular and seroepidemiological survey in national level needs to hâve a better perspective

Total burden of esophageal cancer disability adjusted life years in Golestan Province during 1387

Maintenance of health and its fair and just promotion in any society is the responsibility and duty of its respective government. Appropriate financial allocations and prudent decisions in the health sector requires the definition of an index that would reveal the loss resulting from early deaths of any cause and originate from disabilities due to nonfatal outcomes. The disability adjusted life years [DALY] index has such a characteristic. Esophageal cancer is the third prevalent cancer of the gastrointestinal tract. In Golestan Province, among the variety of cancers, it is the third leading cause of death and its incidence rate in the province is the highest in the country. In this study we try to compute the burden of this cancer. In this manner, while estimating the importance of this disease in Golestan Province, we aim to pave the way for scientific and effective assessments of this disease and determine an action plan for its containment. In this cross-sectional study, we used Dismod II software that has been designed for cancer modeling in populations. With this software, we computed the burden of cancer for the year 1387 in Golestan Province. The data needed as input for Dismod II included the population of the province, mortality and incidence rates that originated from esophageal cancer, all which were obtained from the 1385 census, Mortality Registry System, Cancer Registry' System and expert panel views. Total burden of esophageal cancer according to DALY in Golestan Province during 1387 was 2992/48 years in the total population. Amongst males, it was 1533/65 years and 1408/46 years in females due to years of lost life [YLL]. As a result of years lived with disability [YLD], it was 25/54 years in males and 24/84 years in females. The burden of esophageal cancer per 1000 population of Golestan Province equaled 1 /76 years for females and 1/88 years for males. The peak age of esophageal cancer burden was in the age groups of 60 to 80 years and above 80 years. The relative high burden of esophageal cancer in Golestan Province compared to other parts of the country is justifiable due to the existence of the highest incidence rate in this province. Therefore, we believe that esophageal cancer should be one of the highest priorities of the health system of the province. However, the final and definitive judgment is contingent upon computations of the burden of other cancers and diseases at the provincial level and its respective rankings

Effect of simultaneous educational program for mothers and daughters on osteoporosis preventive behaviors among girls

Osteoporosis is a metabolic disease which results from gradual destruction of bone mass. Prevention of Osteoporosis should be started from childhood by getting adequate calcium and doing weight-bearing exercises. Participating of mothers in health education interventions is likely to promote longer-lasting health behaviors in their daughters. The aim of this study was to investigate the effect of simultaneous education of mothers and daughters on Osteoporosis preventive behavior among high school female students. In this interventional study, 400 female students were randomly selected via a two-phased sampling method. At first stage, four schools were selected randomly. At the second stage, 400 students were divided randomly into two groups. Their Osteoporosis preventive behaviors were measured using a two-sectioned questionnaire: demographic section, and Osteoporosis preventive behaviors assessment section. The first group participated in the educational programs with their mothers and the other group participated without their mothers. The educational program had two sessions, each one lasted 45 minutes. The second stage of the study was performed three months later. Data analysis was carried out using t-test and chi squared test. Results showed that in both groups, Osteoporosis preventive behaviors scores increased significantly after intervention. It was higher in case group [P<0.001]. Eating behavior was significantly different in two groups [P=0.003]. Results showed that simultaneous educational program for mothers and daughters promotes eating behavior in the girls

[Soft neurological signs in hyperactive inattentive children and comparison with normal children]

This research focused on estimating the mean of Neurological Soft Signs scores in children with Attention Deficit and Hyperactivity Disorder and comparing them with normal children. We evaluated 25 children with Attention Deficit- Hyperactivity Disorder in the age group of 7-12 years [mean age: 10.16 +/- 1.5y] using the DSM-VI Attention Deficit - Hyperactivity Disorder Questionnaire, Conner's Parents' Rating Scale, and the 28-item NES Questionnaire. There was no significant age difference between cases and controls. The mean total NES score was 11.4 +/- 4.14 in cases and 5.6 +/- 2.79 in controls [P< 0.0001]. Compared to the control group, the cases had significantly more problems with the glabellar reflex, rapid alternative movements and right-left discrimination. Soft Neurological signs are observed with greater frequency among children with ADHD compared to normal subjects and the difference is more significant in certain domains such as rapid alternative movements, right- left confusion, and glabellar reflex. Considering the relatively high frequency of soft neurological signs in children with Attention deficit- Hyperactivity Disorder, earlier diagnosis and treatment of the disease might be possible through careful neurological examination

[Causes and clinical presentations of hypoglycemia in patients with low blood glucose admitted to the emergency ward]

Hypoglycemia is a medical emergency with severe side effects and also nonspecific symptoms. This survey aims at determining the causes and symptoms of hypoglycemia in patients with low blood glucose admitted to the emergency ward, approaches for prevention in hypoglycemia and decrease of further side effects are proposes. All patients with symptoms of hypoglycemia and blood glucose less than 45 mg/dl admitted to the emergency ward, between 2002 and 2003, were included in this survey. Initially a questionnaire on demographic information, coexisting disorders and drug history was completed, physical exam was done and 10 ml venous samples were obtained for CBC, liver and renal function tests. Hormonal assay and 72 hour fasting assessment was done. 89 patients with a mean age of 66.73 +/- 14.91 were included 53% females and 47% males [P= NS]. 86.5% were diabetic and 13.5% nondiabetic [P< 0.001]. Common causes were: drugs [36.3%], renal failure [23%], sepsis [14.3%] and medical mismanagement [11%]. The most common symptoms in diabetic and nondiabetic patients were adrenergic + norglycopenic 50.6% and 58.3%, norglycopenic 46.8% and 41.7%, and adrenergic 2.6% and 0% respectively [P=NS]. Drugs were the most common cause of hypoglycemia, although medical mismanagement was also observed in 11% of patients. Education not only for patients but also for medical groups is the basis of prevention. High percentage of patients had norglycopenic symptoms due to long durations of diabetes and old age as an independent risk factor, drugs should hence be used contiously in older patients also training physicians especially for geriatric groups is recommended

Reproductive characteristics and the risk of breast cancer: a case-control study

Breast cancer is a common malignancy in women in many parts of the world. The Incidence of breast cancer in Iranian women is growing. Iranian patients are relatively younger than their western counterparts. We conducted a case-control study to determine roles of reproductive factors for breast cancer among women in Iran. A hospital based case-control study was conducted in 2004 at a teaching hospital in Tehran, Iran. A total of 303 cases of breast cancer and 303 healthy controls were interviewed. Cases were identified through the oncology department of a university hospital and controls were recruited from other wards or out-patients clinics at the same hospital. Controls were matched to cases on age. Demographic and reproductive data were ascertained by personal interview using a structured questionnaire. Informed consent was obtained from cases and controls. Odds ratios and 95% confidence intervals for breast cancer were derived using logistic regression analysis. Mean +/- SD age of cases and controls was 48.8 +/- 9.8 and 50.2 +/- 11.1 years, respectively [range 24-84]. The final model constructed after multivariate analysis indicated that factors such as never being married, menopause, older age at first live birth, parity, use of oral contraceptives, and history of chest X-ray between adolescence and the age of 30 yrs were significantly associated with breast cancer. Variables such as higher education, early age at menarche, abortion, breast feeding and its duration did not constitute significant risk factors. Marital status, history of chest X-ray between adolescence end the age of 30, number of live births, and age at first live birth, menopause, and oral contraceptive use seem to increase the risk of developing breast cancer among women in Iran

Using latent variables to eliminate multicollinearity effect in a logistic regression on risk factors for breast cancer

Logistic regression is one of the most widely used generalized linear models for analysis of the relationships between one or more explanatory variables and a categorical response. Strong correlations among explanatory variables [multicollinearity] reduce the efficiency of model to a considerable degree. In this study we used latent variables to reduce the effects of multicollinearity in the analysis of a case-control study. Our data come from a case-control study in which 300 women with breast cancer were compared to 300 controls. Five highly correlated quantitative variables were selected to assess the effect of multicollinearity. First, an ordinary logistic regression model was fitted to the data. Then, to remove the effect of multicollinearity, two latent variables were generated using factor analysis and principal components analysis methods. Parameters of logistic regression were estimated using these latent as explanatory variables. We used the estimated standard errors of the parameters to compare the efficiency of models. The logistic regression based on five primary variables produced unusual odds ratio estimates for age at first pregnancy [OR=67960, 95%CI; 10184-453503] and for total length of breast feeding [OR=0]. On the other hand the parameters estimated for logistic regression on latent variables generated by both factor analysis and principal components analysis were statistically significant [P<0.003]. The standard errors were smaller than with ordinary Logistic regression on original variables. The factors and components generated by the two methods explained at least 85% of the total variance. This research showed that the standard errors of the estimated parameters in logistic regression based on latent variables were considerably smaller than that of model for original variables. Therefore models including latent variables could be more efficient when there is multicollinearity among the risk factors for breast cancer

Estimation of the gene-environment interaction in breast cancer patients

There is growing interest in assessing gene-environment interaction in the course of case-control studies. Difficulties related to the sampling of controls have led to the development of a range of non-traditional methods that do not require controls for estimating gene-environment interaction. One of these new modalities is the case-only approach, in which the assessment of gene-environment interaction is based on information from the cases only. The present article describes the application of this approach to data from breast cancer patients and compares its efficacy with that of a traditional case-control analysis. We used age at first pregnancy, number of live birth, menopause and the total number of post-menopausal years as the [environment] factors and family history of breast cancer as the [gene] factor. We computed standard errors, 95% confidence intervals and [-2 log likelihood] to compare efficiency between case-control and case-only analyses. We observed significant interaction between menopause and family history of breast cancer by both methods [OR=4.32 CI: 1.10-16.90 for case-control analysis and OR=3.40 CI: 1.17-9.87 for case-only analysis]. There was also a significant interaction effect between total years after menopause and family history of breast cancer [OR=1.07 CI: 0.98-1.16 in case-control analysis and OR=1.07 CI: 1.01-1.12 in case-only analysis]. The case-only approach yielded narrower confidence intervals for the odds ratio, and the [-2 log likelihood] values computed by this method were correspondingly smaller. Comparison of confidence intervals and [-2 log likelihood] values shows that the estimation of gene-environment interaction in breast cancer would be more efficient with the case-only approach than with the traditional case-control analysis

[ study of clinical trend and effects of caustic ingestion based on endoscopy of children referring to Loghman Hakim hospital]

Background: One of the prevalent causes of injury to the esophagus and stomach in children is caustic ingestion. Most of the cases of alkaline or acidic ingestion in children occur accidentally. Acute and chronic complications of caustic ingestion in children are severe and occasionally life-threatening. This study was conducted on children with caustic ingestion accepted as in-patients during 2002-2004 in Loghman Hakim Hospital

Methods: All children hospitalized for caustic ingestion, aged 16 years and younger, were evaluated from demographic viewpoint as well as clinical history, endoscopies findings, method of treatment and observed complications

Finding: Out of 72 children under study, 41 had consumed acidic and 31 alkaline materials. 74.7% of patients were accidentally afflicted with food poisoning. Relevant clinical symptoms consisted of vomiting, oropharyngeal lesions, restlessness, abdominal pain, and dysphagia, in order of occurrence. In endoscopy of esophagus. 68% of patients had G1 or normal endoscopy and 32% had a burning intensity of G2a or higher. 16.7% underwent surgery and the rest were under medical treatment. 20.8% were inflicted with esophageal stricture and stenosis, 2.8% with esophageal perforation and mediastinitis, and 1.4% lost their lives

Conclusions: The role of prevention as a comprehensive strategy promoted by medical councils, the media, and radio and TV is imperative. It is recommended that dangerous caustic pharmaceutical, sanitary and industrial materials be filled in containers with safe and tight lids or caps