Educational difference in the prevalence of osteoporosis in postmenopausal women: a study in northern Iran.

BACKGROUND: Osteoporosis is the most common metabolic bone disease in the world and it is rapidly increasing in Iran. In this study the relationship between educational levels and osteoporosis was investigated among Iranian postmenopausal women. METHOD AND SUBJECTS: Seven hundred and six women aged 50-75 years old were randomly recruited from urban (n = 440) and rural (n = 266) areas in Guilan. Osteoporosis was diagnosed by quantitative ultrasound technique and dual X-ray absorptiometry. Serum 25(OH) D3, body weight and height were measured in all subjects. Other data including age, educational level, menopause age, medications and history of illness were also collected. RESULTS: We found that the prevalence of osteoporosis was significantly greater among women with low educational level than women with high educational status (18.0% vs 3.8% P < 0.0001). However, women with low educational level had higher mean serum level of vitamin D than women with high educational level. Osteoporosis was significantly more prevalent among women living in rural areas than women living in urban areas (19.1% v.s 13.3%, P < 0.0001). CONCLUSION: This study showed that educational level is associated with bone health in this population of postmenopausal women with significantly higher osteoporosis found in lower social groups. Therefore, we suggest that women with low social level should be carefully evaluated for signs of osteoporosis during routine physical examinations.

Randomised clinical trial of the influence of pulmonary recruitment manoeuvre on reducing shoulder pain after laparoscopy.

Shoulder pain after laparoscopy is common and its probable mechanism is residual CO(2) gas after surgery. The aim of this study was to examine the effect of pulmonary recruitment manoeuvre which means pulmonary inflation with positive pressure of 40 cm H(2)O to remove gas and reduction of shoulder pain after gynaecological laparoscopic surgery. A double-blind clinical trial on 146 patients for minor gynaecological laparoscopy was performed from May 2008 to February 2009. Patients were randomly assigned into two groups of control and intervention (cases). The intervention was five manual inflations of the lungs with positive pressure ventilation of 40 cmH(2)O at the end of surgery, while the last one was held for 5 s. In the controls, CO(2) was removed by the traditional passive deflation of abdominal cavity. Shoulder pain intensity was assessed at 4, 12, 24 and 48 h after the surgery using a visual analogue scale (VAS).The background variables; characteristics of operation and analgesic use were recorded. Statistical significance was defined as p < 0.05. A total of 131 complete sets of data were analysed. Participants in the two groups were matched for age, parity, body mass index, type of surgery and CO(2) pressure setting. The relative frequency of shoulder pain at 4 h did not show significant differences in the two groups, but was lower in the intervention group at 12, 24, and 48 h after the surgery (p = 0.001). Pain scores in the control and intervention group were 3.6 +/- 3.5 vs 1.28 +/- 1.7; 3.4 +/- 2.9 vs 1.19 +/- 1.7; 2.6 +/- 2.4 vs 0.89 +/- 1.3; 1.5 +/- 1.6 vs 0.46 +/- 0.7, at 4, 12, 24 and 48 h after operation, respectively (p < 0.001). The controls had greater usage of analgesics 1.12 +/- 5.67 compared with 0.95 + 0.31 in the cases. It was concluded that pulmonary recruitment manoeuvre seems to be a simple and safe way to reduce shoulder pain and analgesic use after laparoscopy.

Urinary tract infections in pregnant women with bacterial vaginosis.

Urinary tract infections (UTIs) and bacterial vaginosis are common problems in pregnancy and are associated with serious obstetric complications. We evaluated the risk of UTIs in pregnant women with bacterial vaginosis. A total of 322 pregnant women who presented for a prenatal visit were evaluated for bacterial vaginosis and UTIs, between March 2003 and September 2004. Bacterial vaginosis was diagnosed based on Amsel's criteria. Women using antibiotic or other vaginal cream, with specific vaginitis or vaginal bleeding were excluded. Data were analysed using chi(2), Student t-test and multiple logistic regression. A total of 76 women had bacterial vaginosis and 246 women did not; and 18 women (23.6%) with bacterial vaginosis had UTIs, compared with 24 (9.8%) of those without. Bacterial vaginosis was associated with an increased risk of UTIs (odds ratio (OR) 3.05; 95% CI: 1.47-6.33). Pregnant women with bacterial vaginosis are at increased risk for UTIs.