Prevalence of Induced Abortion in Iran: A Comparison of Two Indirect Estimation Techniques.

CONTEXT: Surveys that use direct questions to ascertain women's history of induced abortion tend to underestimate abortion prevalence, especially in such contexts as Iran where the procedure is legally restricted and highly stigmatized. No previous study has compared two indirect techniques for estimating abortion prevalence. METHODS: A sample of 708 married women were recruited from one public hospital in Tehran between August and December 2013. Participants completed a survey, which included induced abortion estimation using the randomized response technique (RRT) and the unmatched count technique (UCT), as well as questions about demographic characteristics, trust in direct questions about abortion, and comprehensibility of and trust in RRT and UCT. Prevalence of induced abortion was calculated for each technique. Spearman correlation was used to evaluate whether comprehensibility of and trust in estimation methods were associated with women's age and education. RESULTS: The prevalence of induced abortion was estimated to be 14% using RRT and 12% using UCT; the estimates were not significantly different. Ninety-one percent of women reported that UCT was very easy to comprehend; the proportion for RRT was 78%. Sixty-three percent of women reported completely trusting in the confidentiality of UCT; the proportion for RRT was 50%. Age was inversely associated with comprehensibility for UCT (correlation coefficient, -0.13), and with trust for both RRT and UCT (-0.12 and -0.08, respectively); education was directly associated with trust for both methods (0.24 and 0.22). CONCLUSIONS: Of the two indirect methods, UCT may be simpler and more dependable for the estimation of induced abortion prevalence in low-literacy, abortion-restricted settings.

RESUMEN Contexto: Las encuestas que utilizan preguntas directas para determinar el historial de abortos inducidos de las mujeres tienden a subestimar la prevalencia del aborto, especialmente en contextos como Irán, donde el procedimiento está legalmente restringido y está altamente estigmatizado. Ningún estudio previo ha comparado dos técnicas indirectas para estimar la prevalencia del aborto. Métodos: Entre agosto y diciembre de 2013, en un hospital público en Teherán, se reclutó una muestra de 708 mujeres casadas. Las participantes completaron una encuesta, que incluyó la estimación del aborto inducido mediante la técnica de respuesta aleatoria (RRT) y la técnica de conteo no pareado (UCT), así como preguntas sobre características demográficas, nivel de confianza en preguntas directas sobre el aborto, así como comprensión y confianza en la RRT y la UCT. Se calculó la prevalencia del aborto inducido para cada técnica. Se usó la correlación de Spearman para evaluar si la comprensión y la confianza en los métodos de estimación estaban asociadas con la edad y escolaridad de las mujeres. Resultados: Se estimó que la prevalencia de aborto inducido era del 14% con la RRT y del 12% con la UCT. Las estimaciones no fueron significativamente diferentes. El noventa y uno por ciento de las mujeres informaron que la UCT era muy fácil de comprender; la proporción para la RRT fue del 78%. El sesenta y tres por ciento de las mujeres reportaron confiar completamente en la confidencialidad de la UCT. La proporción para la RRT fue del 50%. La edad se asoció inversamente con la comprensibilidad para la UCT (coeficiente de correlación, −0.13) y con la confianza tanto para la RRT como para la UCT (­0.12 y −0.08, respectivamente); la escolaridad se asoció directamente con la confianza en ambos métodos (0.24 y 0.22). Conclusiones: De los dos métodos indirectos, la UCT puede ser más simple y más confiable para la estimación de la prevalencia del aborto inducido en entornos de baja alfabetización y de aborto restringido.

RÉSUMÉ Contexte: Les enquêtes faisant appel aux questions directes pour évaluer les antécédents d'avortement provoqué des femmes tendent à sous-estimer la prévalence de la pratique, en particulier dans les contextes tels que l'Iran où la procédure est limitée par la loi et fortement stigmatisée. Aucune étude antérieure n'a comparé deux techniques indirectes d'estimation de la prévalence de l'avortement. Méthodes: Un échantillon de 708 femmes mariées a été recruté dans un hôpital public de Téhéran entre août et décembre 2013. Les participantes ont été invitées à répondre à un questionnaire, avec estimation de l'avortement provoqué selon la technique de la réponse aléatoire (RRT) et celle du dénombrement d'items (UCT). Le questionnaire couvrait aussi les caractéristiques démographiques, la confiance à l'égard des questions directes relatives à l'avortement, la compréhensibilité des méthodes RRT et UCT et la confiance à leur égard. La prévalence de l'avortement provoqué a été calculée pour chaque technique. La question de savoir si la compréhensibilité et la confiance relatives aux méthodes d'estimation étaient associées à l'âge et à l'éducation des femmes a été évaluée par corrélation de Spearman. Résultats: La prévalence de l'avortement provoqué a été estimée à 14% selon la technique RRT et à 12% selon la méthode UCT, soit une différence non significative. Quatre-vingt-onze pour cent des femmes ont déclaré la technique UCT très facile à comprendre; la proportion correspondante était de 78% pour la technique RRT. Soixante-trois pour cent des femmes ont indiqué avoir pleine confiance en la confidentialité de la méthode UCT; cette proportion était de 50% pour la technique RRT. L'âge s'est avéré inversement associé à la compréhensibilité pour la technique UCT (coefficient de corrélation, −0,13) et à la confiance pour les deux techniques (­0,12 pour RRT et −0,08 pour UTC); l'éducation s'est révélée directement associée à la confiance pour les deux méthodes (0,24 et 0,22). Conclusions: Des deux méthodes indirectes, la technique UCT peut être plus simple et plus fiable pour l'estimation de la prévalence de l'avortement provoqué dans les contextes à faible niveau d'alphabétisation sujets à restriction de l'avortement.

Evaluation of Mental Workload among ICU Ward's Nurses.

BACKGROUND: High level of workload has been identified among stressors of nurses in intensive care units (ICUs). The present study investigated nursing workload and identified its influencing perfor-mance obstacles in ICUs. METHODS: This cross-sectional study was conducted, in 2013, on 81 nurses working in ICUs in Imam Khomeini Hospital in Tehran, Iran. NASA-TLX was applied for assessment of workload. Moreover, ICUs Performance Obstacles Questionnaire was used to identify performance obstacles associated with ICU nursing. RESULTS: Physical demand (mean=84.17) was perceived as the most important dimensions of workload by nurses. The most critical performance obstacles affecting workload included: difficulty in finding a place to sit down, hectic workplace, disorganized workplace, poor-conditioned equipment, waiting for using a piece of equipment, spending much time seeking for supplies in the central stock, poor quality of medical materials, delay in getting medications, unpredicted problems, disorganized central stock, outpatient surgery, spending much time dealing with family needs, late, inadequate, and useless help from nurse assistants, and ineffective morning rounds (P-value<0.05). CONCLUSION: Various performance obstacles are correlated with nurses' workload, affirms the significance of nursing work system characteristics. Interventions are recommended based on the results of this study in the work settings of nurses in ICUs.

RNA-mediated gene silencing in Candida albicans: inhibition of hyphae formation by use of RNAi technology.

The introduction of RNA silencing machinery in fungi has led to the promising application of RNAi methodology to knock down essential vital factor or virulence factor genes in the microorganisms. Efg1p is required for development of a true hyphal growth form which is known to be essential for interactions with human host cells and for the yeast's pathogenesis. In this paper, we describe the development of a system for presenting and studying the RNAi function on the EFG1 gene in C. albicans. The 19-nucleotide siRNA was designed on the basis of the cDNA sequence of the EFG1 gene in C. albicans and transfection was performed by use of a modified-PEG/LiAc method. To investigate EFG1 gene silencing in siRNA-treated cells, the yeasts were grown in human serum; to induce germ tubes a solid medium was used with the serum. Quantitative changes in expression of the EFG1 gene were analyzed by measuring the cognate EFG1 mRNA level by use of a quantitative real-time RT-PCR assay. Compared with the positive control, true hyphae formation was significantly reduced by siRNA at concentrations of 1 µM, 500 nM, and 100 nM (P < 0.05). In addition, siRNA at a concentration of 1 µM was revealed to inhibit expression of the EFG1 gene effectively (P < 0.05). On the basis of the potential of post-transcriptional gene silencing to control the expression of specific genes, these techniques may be regarded as promising means of drug discovery, with applications in biomedicine and functional genomics analysis.

The positive association between number of children and obesity in Iranian women and men: results from the National Health Survey.

BACKGROUND: To date, few studies have assessed the association between the number of children and obesity in couples. We aimed to investigate this association in men and women aged 20-75 years. METHODS: Data from the National Health Survey were considered in this investigation. It included 2728 women and men (1364 couples) aged 20-75 years. Height and weight were actually measured rather than self-reported. A generalized estimating equation model was used to estimate the odds of obesity (body mass index (BMI > or = 30)) as a function of the number of children adjusted for age, sex, education, economic index, workforce, smoking and place of residence. RESULTS: We infer that each additional child has at least 5% and at most 34% increase in the odds of obesity in men and at least 4% and at most 29% increase in the odds of obesity in women. Our test of interaction by sex showed that the association between the number of children and obesity was not different among men and women. Among women, factors that increased obesity included age, low education, having more children, being inactive workforce and being nonsmoker. Among men, these factors included high economic index, low education, having more children, and being nonsmoker. CONCLUSION: Our results show an association between the number of children and obesity among men. We would recommend interventions to reduce the number of children to prevent obesity in men.

Sociodemographic and smoking associated with obesity in adult women in Iran: results from the National Health Survey.

BACKGROUND: There is no study that had a sample size sufficient to study the association between sociodemographic and smoking with obesity in Iran. The goal was to investigate these associations in the Iranian women. METHODS: Multivariate statistical techniques included 14 176 women between 20 and 69 years of age. Height and weight were measured rather than self-reported. RESULTS: In Iranian adult women, obesity OR(S) for the moderate and high education were 0.78 and 0.41, respectively, compared with basic level. Using low economy index as the reference, Obesity OR(S) for the urban women were 1.29, 1.25 and 1.28 for the lower-middle, upper-middle and high groups, respectively. Obesity OR(S) for the rural women were 1.71, 1.71 and 2.02 for the lower-middle, upper-middle and high groups, respectively. Obesity OR was 0.48 for active workforce compared with inactive group. Obesity OR was 0.70 for smokers women compared with nonsmokers. Using non-married as the reference group, Obesity OR(S) were 1.23 and 2.34 for married urban and rural women, respectively. CONCLUSIONS: Our results on the associations between age, smoking, education level, workforce and obesity are consistent with most studies, but between economic level and obesity are consistent with some study in developing countries.

dupA as a risk determinant in Helicobacter pylori infection.

The Helicobacter pylori duodenal ulcer promoting (dupA) gene has been previously described as a risk marker for duodenal ulcer (DU) development and a protective factor against gastric cancer (GC). Recent studies which have assessed the application of dupA in the prediction of clinical outcomes have been controversial. In the current study, the association of dupA with the clinical outcomes and histopathological changes following H. pylori infection was evaluated in Iranian patients. A total of 157 H. pylori-infected patients with DU (n=30), gastric ulcer (n=23), gastritis (n=68) or GC (n=36) were assessed. The presence of jhp0917 and jhp0918 genes was determined by gene specific PCR. Gastric histopathological changes were recorded according to the updated Sydney system. Seventy-eight (49.7 %) and 71 (45.2 %) of the 157 tested strains, respectively, were positive and negative for both genes. The remaining 8 (5.09 %) of the 157 strains were jhp0917-positive/jhp0918-negative. Univariate analysis showed inverse associations between dupA and histological features including dysplasia as the penultimate stage of GC and lymphoid follicles as a consequence of relatively long-standing H. pylori-associated gastritis. The degrees of nucleotide sequence identity of Iranian strains to Colombian, Brazilian and Indian strains ranged from 86.1 to 100 % for the aligned regions of jhp0917, from 88 to 98.8 % for jhp0918 and from 93.4 to 99.5 % for the partial sequences of the dupA gene. Despite the fact that possession of the dupA gene showed no association with any disease category in our population as reported in several other countries, association of dupA-negative strains of H. pylori with pre-malignant lesions calls for additional studies to evaluate the role of this gene as a protective marker against GC.

Determination of gelatinase A using a modified indirect hemagglutination assay in human prostate cancer screening and assessment of its correlation with prostate-specific antigen parameters.

BACKGROUND: Prostate cancer is the most common malignancy affecting men and is a major cause of cancer death. There are increasing data on novel tumor markers, such as gelatinase A, which play a key role in tissue invasion and metastasis. OBJECTIVES: We designed a study to evaluate total gelatinase A content using a simple and applicable Indirect hemagglutination (IHA) test in harmony with gelatinase A activity in serum samples as compared with prostate-specifc antigen (PSA) parameters. METHODS: In this study, we analysed the circulating form of gelatinase A (MMP-2) in patients suffering from either benign prostate hyperplasia (n=54) or prostate cancer (n=26) versus normal individuals as control (n=26). The gelatinolytic activity was determined by zymography and total MMP-2 content was measured by a novel IHA method. Total PSA and free PSA were quantified using a standard ELISA technique. RESULTS: Correlation of densitometric analysis of gelatinase A activity and IHA titer is significant at the 0.01 level (P<0.01, rho=0.916). Correlation of PSA and IHA titer is significant at the 0.01 level (P<0.01, rho=0.746). Correlation of free PSA and IHA titer is significant at the 0.01 level (P<0.01, rho=0.749). Borderline of IHA titer in patients with prostate cancer was 512+/-1 tube titer, in benign prostate hyperplasia patients was 128+/-1 tube titer and the titer in normal individuals was 8+/-1 tube titer. CONCLUSIONS: These results demonstrate that assessment of gelatinase A might be a promising procedure for monitoring and screening patients with prostate cancer.