Sleep quality, stress and thyroid cancer: a case-control study.

BACKGROUND: Stress and sleep disturbance have been found to be associated with numerous adverse health outcomes, including cancer. Our study aimed to measure the association between quality of sleep, short-temperedness, and stress in life with the risk of thyroid cancer. METHODS: The present study is conducted on 361 newly diagnosed TC patients and 347 sex-age frequency matched controls. Control and case participants were registered with the same health centers. We used multiple logistic regression to investigate the association between TC risk and the interested factors. RESULTS: Based on the results of the multivariate analysis, stress (ORalways stressful/often calm = 3.07, 95% CI 1.42-6.63) and short-temperedness (ORnervous/calm = 2.00, 95% CI 1.28-3.11) were directly associated with the risk of TC. On the other hand having a quality sleep (ORsometimes/never = 0.36, 95% CI 0.16-0.79) and quality sleep (ORoften/no = 0.45, 95% CI 0.21-0.96, P = 0.041) seems to be a protective factor. CONCLUSIONS: Some community-based interventions, e.g., lowering stress levels and improving sleep quality, may help in preventing different types of cancer, including TC. We suggest further evaluation of these important findings in the prevention of TC cancer.

Gender difference in all-cause mortality of people living with HIV in Iran: findings from a 20-year cohort study.

OBJECTIVES: Gender differences in the efficacy of treatment and the mortality of HIV-infected patients have not yet been fully elucidated. For the first time, we used data from a 20-year cohort of people living with HIV (PLWH) in four provinces (Fars, Bushehr, Bandar Abbas, and Kohgiluyeh and Boyer-Ahmad) in the southern part of Iran to assess the gender difference in all-cause mortality in PLWH in Iran. METHODS: We analysed data for 1216 patients aged ≥ 15 years who were diagnosed with HIV/AIDS between 1997 and 2017. Three hundred and fourteen (25.8%) were women. RESULTS: The death rate from all causes among women was 13.7% vs. 43.8% among men (P < 0.001). All-cause mortality was significantly associated with gender [the adjusted hazard ratio (aHR) for men compared with women was 3.20], not being on antiretroviral therapy (ART) compared with being on ART at the last visit (aHR 5.42), older age (aHR 1.03), delayed HIV diagnosis compared with early diagnosis (aHR 1.72), history of incarceration (aHR 1.57), higher log CD4 count at diagnosis (aHR 0.54), and prophylaxis for Pneumocystis pneumonia (aHR 0.09). CONCLUSIONS: The results of this 20-year cohort study suggest that gender is an important predictor of survival among HIV-infected patients. Improving early HIV diagnosis and early ART initiation in men, as well as increased access to hepatitis C virus treatment are needed to increase the survival rate of HIV-infected patients in Iran.

Underascertainment, underreporting, representativeness and timeliness of the Iranian communicable disease surveillance system for tuberculosis.

OBJECTIVES: A well-functioning disease surveillance system is essential for effective control of diseases. Therefore, conducting evaluation studies on the performance of disease surveillance systems is necessary. This study was conducted to evaluate the performance of the Iranian syndrome-based surveillance system for tuberculosis (TB) in rural areas of Fars, the third largest province located in southern Iran. STUDY DESIGN: This was an evaluation study. METHODS: Two independent sources of information (data from a population-based survey and data from the surveillance system) were used in this evaluation. A group of trained female nurses used a specially designed interview-administered questionnaire to obtain data on the health status of family members from mothers or other adult women in rural houses. Subsequently, the nurses obtained data from individuals who reported a history of TB during a specified period and defined whether the patients presented themselves to a rural or urban health centre or clinic. RESULTS: A total of 48,771 individuals participated in this study. Of 156 cases who reported a history of TB, 137 (87.82%) presented themselves to at least one medical care provider seeking diagnosis and treatment services. Of patients who visited a health or medical centre, only 18 (13.14%) were reported to the highest level of the surveillance system. Accordingly, the rates of underascertainment and underreporting of the Iranian surveillance system for TB were 12.18% and 86.86%, respectively. Moreover, underascertainment was significantly higher for men (19.40%) than for women (6.74%). The mean time between the date at which TB was noticed and the date of diagnosis was 56.24 days, which was longer for men (79.29 days) than for women (40.10 days). The highest and lowest levels of underreporting were observed for private general practitioners (100%) and the health centres run by the government (87%), respectively. CONCLUSION: The quality of the communicable disease surveillance system for TB in Iran is facing important challenges, including underascertainment, underreporting and timeliness, in addition to different types of bias. Informing the general population and health workforce about TB and the importance of timely diagnosis is a good approach to improve the performance of Iran's national communicable disease surveillance system.

Effect of vitamin D and omega-3 on nocturnal enuresis of 7-15-year-old children.

INTRODUCTION: Nocturnal enuresis is known to be a common urinary bladder complication in children. Recent studies have associated vitamin D and omega-3 insufficiency with nocturnal enuresis. AIM: This was a 2-month randomized, placebo-controlled, double-blind trial to measure the effects of vitamin D, omega-3 supplements, and their combination on nocturnal enuresis among 7-15-year-old children. MATERIALS AND METHODS: Participants (180 children with nocturnal enuresis) were selected from children referred to the Pediatric ward of Imam Reza Clinic in Shiraz, Iran. Demographic information and anthropometric measures were taken. Fasting blood and urine samples were also collected, and serum vitamin D and urine prostaglandin E2 were measured before and after intervention. Enuretic children were randomly assigned to four groups: Group A, vitamin D (1000 IU/day); Group B, omega-3 (1000 mg/day); Group C, both omega-3 (1000 mg/day) and vitamin D (1000 IU/day); and Group D, placebo. RESULTS: The results suggested that the study groups were not significantly different regarding demographic and anthropometric measures at baseline. Comparison of different groups revealed that 44.4% of participants in Group A, 28.2% of Group B and 45% of Group C were cured from enuresis (P = 0.03). Serum 25(OH) D was significantly increased in Group A, but urine prostaglandin E2 was not significantly decreased in response to supplementation. Although supplementation with both Group A and Group B were found to be effective, the combined intervention did not increase the effect of each intervention solely. CONCLUSIONS: The results showed that supplementation with vitamin D and omega-3 could reduce the number of wet nights among 7-15-year-old children with nocturnal enuresis.

Under-ascertainment, under-reporting and timeliness of Iranian communicable disease surveillance system for zoonotic diseases.

OBJECTIVES: The important steps in controlling infectious diseases are fast detection, proper treatment and on-time reporting of cases to the appropriate authorities. This study was conducted to evaluate the quality of Iranian communicable diseases surveillance system (CDSS) for zoonotic diseases in rural areas of Fars province (Iran's third largest province). STUDY DESIGN: The three most important evaluation indices of CDSS, namely under-ascertainment, under-reporting and timeliness, for the three most common zoonotic diseases were measured using independent data source obtained from door-to-door interviews and patients' medical records. METHODS: Interviews were conducted with 48,771 households in rural areas of Fars province from April 2014 to March 2015. The medical and registration data were obtained from the CDSS and medical or health centres. RESULTS: Under-ascertainment, total under-reporting and timeliness (delay from the time of onset of symptoms to the time of visiting a medical or health centre, to the time of reporting visited cases to the highest level of CDSS) for leishmaniasis were 19.6%, 42.5% and 81.61 days (48.95 due to system delay), respectively. The corresponding indices for brucellosis were 0%, 41.8% and 56.5 days (22 due to system delay), respectively. For animal bite, the corresponding indices were 7.83%, 13.07% and less than 72 h, respectively (no system delay). CONCLUSIONS: Although the status of case reporting and timeliness of surveillance system in public sectors providing medical services are clearly better than those of the private sectors, the indices are far from the level needed by CDSS to be able to detect and handle epidemics on time. Training health personnel, especially physicians, from public and private sectors to secure their cooperation along with routine and indebt evaluation are necessary to improve CDSS in Iran.

Deaths of children aged under 5 years and related factors in the Islamic Republic of Iran: a populationbased case-control study.

The study was conducted to determine the family, social and economic factors associated with deaths of children aged under 5 years. A registry-based nested case-control study was conducted of the deaths of all children aged under 5 years in Kohgilooyeh and Boyer-Ahmad Province in the Islamic Republic of Iran. For each death, two controls were randomly selected among children of the same age, sex and place of residence (186 cases and 372 controls). Congenital abnormality (37.6%) and preterm birth (29.0%) were the two most frequent causes of death among children aged under 5 years. No vaccine-preventable disease was reported as the cause of death. The strongest associations were found with consanguinity of the parents (OR = 3.92; 95% CI = 2.27-6.85 for being first cousins in comparison with no family relation; P < 0.001) and with domestic violence to the mother during pregnancy (OR = 3.13; 95% CI = 1.60-6.17; P < 0.01). The main causes of death of children aged under 5 years in the Province were congenital abnormality and prematurity.

Deaths of children aged under 5 years and related factors in the Islamic Republic of Iran: a population-based case-control study

The study was conducted to determine the family, social and economic factors associated with deaths of children aged under 5 years. A registry-based nested case-control study was conducted of the deaths of all children aged under 5 years in Kohgilooyeh and Boyer-Ahmad Province in the Islamic Republic of Iran. For each death, two controls were randomly selected among children of the same age, sex and place of residence [186 cases and 372 controls]. Congenital abnormality [37.6%] and preterm birth [29.0%] were the two most frequent causes of death among children aged under 5 years. No vaccine-preventable disease was reported as the cause of death. The strongest associations were found with consanguinity of the parents [OR = 3.92; 95% CI = 2.27-6.85 for being first cousins in comparison with no family relation; P < 0.001] and with domestic violence to the mother during pregnancy [OR = 3.13; 95% CI = 1.60-6.17; P < 0.01]. The main causes of death of children aged under 5 years in the Province were congenital abnormality and prematurity

La présente étude a été menée pour déterminer les facteurs familiaux, sociaux et économiques associés aux décès des enfants de moins de cinq ans. Une étude cas-témoin nichée reposant sur les données de registres a été menée sur les décès de tous les enfants de moins de cinq ans dans la province de Kohgilooyeh et Boyer-Ahmad en République islamique d'Iran. Pour chaque décès, deux témoins étaient sélectionnés de façon aléatoire parmi les enfants du même âge, sexe et lieu de résidence [186 cas et 872 témoins]. Les malformations congénitales?[37,6%] et les naissances prématurées [29,0%] constituaient les deux causes de décès les plus fréquentes parmi les enfants de moins de cinq ans. Aucune maladie à prévention vaccinale n'a été rapportée comme cause de décès. Les associations les plus fortes étaient liées à la consanguinité des parents [OR = 3,92 ; IC à 95% = 2,27-6,85 pour les cousins de premier degré en comparaison avec les sujets n'ayant aucun lien de parenté ; p < 0,001] et à la violence conjugale envers les mères pendant la grossesse [OR = 3,13 ; IC à 95% = 1,60-6,17 ; p < 0,01]. Les principales causes de décès des enfants de moins de cinq ans dans la province étaient les malformations congénitales et la prématurité

Cancer incidence appears to be rising in a small province in Islamic Republic of Iran: a population-based cohort study.

In 2006 the Iranian national cancer registry reported that Kohgiluyeh and Boyer-Ahmad, a small province located in the southern part of the country, had a low incidence rate of almost all types of cancer. In a population-based cohort study, data on 660 cases of cancer in Kohgiluyeh and Boyer-Ahmad province were analysed after ICD codes had been rechecked and duplicates removed. Over the period 2007-2009 the annual average incidence rate of all cancers rose significantly by 53.0% and 115.1% in men and women respectively. Cancers of the prostate, thyroid, bladder and soft tissues decreased over the study period. Despite the recorded rise, the incidence rates for different sites of cancer (except for skin cancer) were significantly lower compared with their corresponding national rates for 2006. The results point to improvements in the cancer diagnosis and registry in the province, although real changes in cancer incidence over the period cannot be ruled out.

National guidelines for outbreak investigation: an evaluation study.

This paper reports an independent epidemiological study to evaluate the validity of the results of an official investigation into an outbreak of gastroenteritis at a university campus in Yasuj, central-south Islamic Republic of Iran. The official report of the outbreak by the Department for Disease Control at the provincial health centre found only 65 cases over a 5-day period, all females, living in the student halls of residence. This contrasts with a questionnaire survey of 963 students at the same university, which found 395 students (192 males and 203 females), living in residences and at home, who reported at least 1 gastrointestinal symptom over a 12-week period. Within this period at least 2 outbreaks occurred. Such a large discrepancy between the official report and the current study suggests that the health services and the public may have been misled about the proper response to the outbreak.

Happiness and health behaviour in Iranian adolescent girls.

This study was conducted to examine the association of happiness in adolescent females with leisure time and health related behaviours namely diet, physical activity and first or second hand smoking. Using a self-administered questionnaire, data were collected from 8159 female high school students ages 11-19 years. Multivariate linear regression analysis revealed statistically significant associations between happiness and weight, regular exercise, exposure to second-hand tobacco smoke, daily fruit or vegetable consumption and the way participants spent their leisure time. Happiness was associated with lower BMI, regular physical activity, absence of exposure to second-hand smoke, higher consumption of fruits and vegetables, and spending leisure time with family (all P < 0.005). These exploratory findings suggest that encouraging children and adolescents to adopt healthy behaviours, providing family time and a smoke-free environment may make them not only healthier but also happier.