Psychosexual counseling intervention to improve women's genital self-image: Study protocol for a randomized controlled trial based on a multistage mixed method design.

Background: Genital self-image (GSI) is a major barrier to reproductive and sexual health for women. This practical randomized trial aims to evaluate the effect of psychosexual counseling based on a cognitive-behavioral approach to promoting GSI for reproductive-age married Iranian women. Methods: Married women aged 15-49 years under the coverage of health centers will be invited to join the study. The study will be conducted using a multistage mixed method design in three phases. In the first phase, semi-structured interviews with women and key informants will be conducted to understand better the GSI concept, the factors influencing it, and the interventions promoting it. Simultaneously, a literature review will be conducted by searching electronic databases to find the factors influencing GSI and the interventions to enhance it.In the second phase, the GSI-related factors, sexual and reproductive health outcomes correlated with GSI, and intervention programs for promoting GSI in women will be extracted from the integration of qualitative study and literature review. Then, based on the expert panel's priority, a suitable program will be prepared.In the third phase, at first, a cross-sectional study will be conducted to identify women with poor GSI and the factors relating to GSI, and then psychosexual counseling intervention will be performed. For the randomized controlled trial study, participants will be randomly allocated into two groups: (1) the intervention group and (2) the control group. Data will be collected using the Female Genital Self-Image Scale and sexual and reproductive health outcomes correlated with GSI at baseline, immediate, and 2-month follow-up assessments. The impact of the intervention on the promotion of GSI will be evaluated. Discussion: This study provides a counseling program for promoting GSI. If this interventional program is successful, it has practical potential to be generalized for Iranian Women with poor GSI.

Regular Sports Participation as a Potential Predictor of Better Clinical Outcome in Adult Patients With COVID-19: A Large Cross-Sectional Study.

PURPOSE: To compare the severity outcomes of COVID-19 disease between patients with and without regular sports participation. METHODS: In a cross-sectional study, the authors investigated all patients who visited the emergency department of Imam Khomeini hospital with signs and symptoms of COVID-19 from February 20 to April 20, 2020. Then the authors assessed all patient outcomes (outpatient vs hospitalization or death). Finally, the authors compared the outcomes between athletes with regular sports participation and others, adjusting for confounding factors of age and sex. RESULTS: Of all 4694 adult patients, 249 individuals (137 males and 112 females with mean [SD] age of 36.45 [9.77] y) had regular participation in different sport disciplines. Overall, 30 (12%) athletes were hospitalized or died (30 and 0, respectively) compared with 957 (21.5%) nonathletes (878 and 79, respectively). Athletes with regular sports participation were 1.49 times less likely to be hospitalized (P = .044). CONCLUSIONS: Regular sports participation may positively affect the clinical outcome, regardless of confounding factors of age and sex. The probability of hospitalization in athletes with regular sports participation was 33% lower than nonathletes. However, more longitudinal studies are needed to determine the causal effects.

Relationship between suicide mortality and lithium in drinking water: A systematic review and meta-analysis.

BACKGROUND: Lithium at therapeutic doses has protective effects against suicide in clinical practice. This meta-analysis aimed to investigate the relationship between lithium concentration in drinking water and suicide mortality in the general population. METHODS: A systematic search was conducted in Web of Knowledge, PubMed, ScienceDirect, and Scopus to find papers reporting the crude relationship between drinking water lithium and suicide incidence in the general population until June 2019. The pooled effect measure was expressed as odds ratio (OR) and 95% confidence interval (CI) using the random-effects model. RESULTS: We retrieved 308 English original articles, of which 13 ecologic studies with a total sample size of 939 regions and one cohort study with a sample size of 3,740,113 people were eligible for the meta-analysis. A significant relationship was found between the lithium concentration in drinking water and reduced suicide mortality (OR= 0.42; 95% CI: 0.27-0.67; p-value <0.01). Ten studies reported gender-specific responses to lithium, with the pooled estimates as follows: OR= 0.54; 95% CI: 0.35-0.84; p-value <0.01 for men, OR= 0.70; 95% CI: 0.48-1.01; p-value =0.057 for women, and OR= 0.63; 95% CI: 0.47-0.83; p-value <0.01 for total. LIMITATIONS: The study was limited to the assessment of the crude relationship between lithium exposure and suicide rate without considering the role of confounders. CONCLUSIONS: Lithium in drinking water is dose-dependently associated with reduced suicide mortality at least in ecological studies. However, we need well-designed clinical trials to confirm the protective effect of drinking water lithium intake against suicide.

Bioaccessibility analysis of toxic metals in consumed rice through an in vitro human digestion model - Comparison of calculated human health risk from raw, cooked and digested rice.

The health risk assessment of exposure to toxic metals through the consumption food crops is very important. The present study was aimed to investigate the bioaccessibility of toxic metals (including arsenic, lead and cadmium) in rice through an in vitro gastrointestinal digestion model, and assess health risks associated with these metals in raw, cooked and digested rice. Total and bioaccessible concentration of metals were measured by introducing the prepared samples into the inductively coupled plasma-optical emission spectroscopy. Based on the results, the bioaccessible toxic metals in gastric phase were significantly higher than that in both oral and small intestinal phases. The estimated concentrations of these metals in the raw and cooked rice are very far from the actual exposure state. Therefore, to assess the extent of health risks associated with the subjected toxic metals through the rice consumption, the actual exposure value of the metals (bioaccessible value) should be considered.

The reduction of toxic metals of various rice types by different preparation and cooking processes - Human health risk assessment in Tehran households, Iran.

In this study, the effect of washing, soaking (1, 5 and 12 h), and cooking rice methods including Rinsed (boiling in excess water) and Kateh (conventional) cooking on the reduction of the arsenic (As), lead (Pb), and cadmium (Cd) were evaluated. The results showed that the rinsed cooking has higher efficiency for removal of toxic metals (As = 42.3%, Pb = 42.9% and = 27.6%) than Kateh method (As = 26.9%, Pb = 26.9% and = 20.9%). Additionally, by increasing of rice soaking time from 1 to 12 h, the toxic metals removal was increased up to 37.1%, 42.6% and 16.6% for As, Pb and Cd, respectively. Although the toxic metals reduction was such that the non-carcinogenic risk was regarded as acceptable level after all processes, for arsenic, these reductions did not lower the carcinogenic risk to an acceptable level. Finally, it is suggested that Tehran households, after washing and soaking to 5 h, then cook it by rinse method.

The relation between air pollution and respiratory deaths in Tehran, Iran- using generalized additive models.

BACKGROUND: Some epidemiological evidence has shown a relation between ambient air pollution and adverse health outcomes. The aim of this study was to investigate the effect of air pollution on mortality from respiratory diseases in Tehran, Iran. METHODS: In this ecological study, air pollution data was inquired from the Tehran Province Environmental Protection Agency and the Tehran Air Quality Control Company. Meteorological data was collected from the Tehran Meteorology Organization and mortality data from the Tehran Cemetery Mortality Registration. Generalized Additive Models (GAM) was used for data analysis with different lags, up to 15 days. A 10-unit increase in all pollutants except CO (1-unit) was used to compute the Relative Risk of deaths. RESULTS: During 2005 until 2014, 37,967 respiratory deaths occurred in Tehran in which 21,913 (57.7%) were male. The strongest relationship between NO2 and PM10and respiratory death was seen on the same day (lag 0), and was respectively (RR = 1.04, 95% CI: 1.02-1.07) and (RR = 1.03, 95% CI: 1.02-1.04). O3 and PM2.5 had the strongest relationship with respiratory deaths on lag 2 and 1 respectively, and the RR was equal to 1.03, 95% CI: 1.01-1.05 and 1.06, 95% CI: 1.02-1.10 respectively. NO2, O3, PM10 and PM2.5 also showed significant relations with respiratory deaths in the older age groups. CONCLUSIONS: The findings of this study showed that O3, NO2, PM10 and PM2.5 air pollutants were related to respiratory deaths in Tehran. Reducing ambient air pollution can save lives in Tehran.

Data about knowledge and tendency towards organic foods use in Tehran.

Improper use of chemical fertilizer and pesticide poses not only threats to the environmental safety but also major public health issues globally. The adverse effects of chemical fertilizers and pesticides forced agricultural scientist to look for safer methods such as organic farming. This study was aimed at assessing the knowledge and tendency towards organic foods use among people of living in a megacity, Tehran. Data was collected from "fall exhibition" and "health food exhibition" participants using pretested questionnaire. Data were entered, cleaned and analyzed by SPSS version 17. T-test, ANOVA and Regression analysis were carried out and the association was considered significant at p-value less than 0.05. A total of 400 respondents participated in the study, making a response rate of 100%. There were reverse relation between knowledge and accessibility and positive relation between trust, marriage and gender and no relation with price. Building trust in consumer, and allocation of a special label, known logos and ways to track most of the products sold as organic foods seems necessary for increasing consumption.

An optimized SPE-LC-MS/MS method for antibiotics residue analysis in ground, surface and treated water samples by response surface methodology- central composite design.

BACKGROUND: Antibiotic residues are being constantly identified in environmental waters at low concentration. Growing concern has been expressed over the adverse environmental and human health effects even at low concentration. Hence, it is crucial to develop a multi-residues analytical method for antibiotics to generate a considerable dataset which are necessary in the assessment of aquatic toxicity of environmental waters for aquatic organisms and human health. This work aimed to develop a reliable and sensitive multi-residue method based on high performance liquid chromatography coupled with quadrupole-linear ion trap tandem mass spectrometry (HPLC-MS-MS). The method was optimized and validated for simultaneous determination of four classes of antibiotics including, ß-lactam, macrolide, fluoroquinolone and nitro-imidazole in treated, ground and surface water matrices. METHODS: In order to optimize the solid phase extraction process, main parameters influencing the extraction process including, pH, the volume of elution solvent and the amount of Na4EDTA were evaluated. The optimization of extraction process was carried out by response surface methodology using central composite design. Analysis of variance was performed for nine target antibiotics using response surface methodology. RESULTS: The extraction recoveries were found to be sensitive to the independent variables of pH, the volume of elution solvent and the amount of Na4EDTA. The extraction process was pH-dependent and pH was a significant model term in the extraction process of all target antibiotics. Method validation was performed in optimum operation conditions in which the recoveries were obtained in the range of 50-117% for seven antibiotics in spiked treated and ground water samples and for six antibiotics in spiked river water samples. Method validation parameters in terms of method detection limit were obtained in the range of 1-10 ng/L in treated water, 0.8-10 ng/L in the ground water and 0.8-25 ng/L in river water, linearity varied from 0.95 to 0.99 and repeatability in term of relative standard deviation values was achieved less than 10% with the exception for metronidazole and ceftriaxone. The developed method was applied to the analysis of target antibiotics in treated, ground and surface water samples. CONCLUSIONS: Target antibiotics were analyzed in different water matrices including treated, ground and river water. Seven out of nine antibiotics were detected in Kan River and Firozabad Ditch water samples, although none of them were detected in treated water and ground water samples.

Assessing the Prevalence of Publication Misconduct among Iranian Authors Using a Double List Experiment.

BACKGROUND: This study was done to determine the prevalence of publication misconduct among Iranian authors. METHODS: Data were collected through an email survey of corresponding authors of papers published in Iranian journals indexed in Scopus during 2009-2011. Using the double list experiment, these individuals were indirectly questioned about committing one of the five misconducts including duplicate publication, falsification, guest authorship, plagiarism, and fabrication over the past year. RESULTS: The survey was sent to 2321 individuals; 100 emails bounced, and of the remaining, 813 (36.60%) people responded to the questions. The prevalence rates were 4.15% for fabrication, 4.90% for plagiarism, 18.10% for guest authorship, 12.65% for falsification of the study methods, and -5.40% for duplicate publication. Among respondent 56.50% trusted the method and confidentiality of the survey and 6.50% did not trust the method or confidentiality at all. CONCLUSION: We found that the double list experiment method is simple and reliable for use in the academic community, and it can be conducted easily in an e-survey. According to our results, the most common misconducts among Iranian authors are guest authorship and falsification of the methodology. In light of the negative and maleficent impact of publication misconduct in the scientific society, we recommend raising awareness and educating authors and investigators in this regard. To determine the accuracy of the method used in this study, further studies on publication misconduct using a control group and direct questioning, as well as other indirect methods are suggested.

The Evaluation of Multiple Sclerosis Dispersal in Iran and Its Association with Urbanization, Life Style and Industry.

BACKGROUND: Multiple Sclerosis (MS) is an autoimmune disease with unknown factor. The prevalence and incidence rate of this disease had an upward trend in many regions in the world such as Middle east and consequently in Iran over the recent years. As the risk factors of this increased trend and high-prevalence is unknown in Iran, the current study has been designed to evaluate the correlation between MS dispersal with urbanization, life style and industry, as an ecological research. METHODS: This retrospective study was designed as an ecological approach in 2011. Data were collected from three databases by high precision (CI95%) from national registry plans. The subjects of study were provinces of Iran (n=31). The linear regression was used to perform statistical analyses. RESULTS: The obtained results indicated an ascendant trend of MS during the recent years, as the incidence of this disease reached from 26.24/100000 (CI95%) people in 2006 to 44.53/100000 (CI95%) in 2011. There is a direct correlation (P<0.05) between the percentage of urbanization and the percentage of male smokers with the prevalence of MS in provinces. CONCLUSION: The role of smoking was more highlighted in this study as a probable factor in increasing risk and causing MS disease. Urbanization could be introduced as an augmentative factor, but this is a combination of several complex factors that this effect must be appraised with smaller scale in other researches.

Content Validity of National Post Marriage Educational Program Using Mixed Methods.

BACKGROUND: Although the validity of content of program is mostly conducted with qualitative methods, this study used both qualitative and quantitative methods for the validation of content of post marriage training program provided for newly married couples. Content validity is a preliminary step of obtaining authorization required to install the program in country's health care system. METHODS: This mixed methodological content validation study carried out in four steps with forming three expert panels. Altogether 24 expert panelists were involved in 3 qualitative and quantitative panels; 6 in the first item development one; 12 in the reduction kind, 4 of them were common with the first panel, and 10 executive experts in the last one organized to evaluate psychometric properties of CVR and CVI and Face validity of 57 educational objectives. RESULTS: The raw data of post marriage program had been written by professional experts of Ministry of Health, using qualitative expert panel, the content was more developed by generating 3 topics and refining one topic and its respective content. In the second panel, totally six other objectives were deleted, three for being out of agreement cut of point and three on experts' consensus. The validity of all items was above 0.8 and their content validity indices (0.8-1) were completely appropriate in quantitative assessment. CONCLUSION: This study provided a good evidence for validation and accreditation of national post marriage program planned for newly married couples in health centers of the country in the near future.

Determination of aluminum and zinc in infusion tea cultivated in north of Iran.

To determine aluminum and zinc levels in black tea cultivated in north of Iran, 105 black tea samples were collected from the tea growing regions of Guilan and Mazandaran provinces and were analyzed for Al and Zn concentration of tea infusion. Contents of all elements were analyzed three times separately by using an Inductively Coupled Plasma Atomic Emission Spectrometry (ICP - AES). The solubility of Al and Zn in infusions at 5, 15 and 60 min with boiling water showed that the mean level of Al in the third infusion was the highest (262.09 mg/kg) and in the first infusion was the lowest (169.40 mg/kg). The mean level of Zn in the third infusion was the highest (51.40 mg/kg) and in the second infusion was the lowest (48.33 mg/kg). The analysis of results also showed that the location factor influences the contents of these metals at different infusions.

Use of the extended parallel process model (EPPM) to predict Iranian women's intention for vaginal delivery.

PURPOSE: To explicate whether knowledge, perception of health threat, efficacy, and personal beliefs act as predictors for women's intention to have a normal vaginal birth. DESIGN: The study uses a mixed approach. Simultaneously, 290 pregnant women who visited prenatal clinics completed the study. Quantitative and qualitative data were collected using a structured questionnaire based on Witte's extended parallel process model and four focus groups, respectively. RESULTS: Women perceived lower risk but higher levels of efficacy. Perceived self-efficacy, severity, and response efficacy were identified as significant predictors of intention to experience vaginal birth. Participants' insufficient knowledge and misconceptions about birth methods were dominant. Two major themes were identified and divided into negative and positive beliefs about vaginal birth. DISCUSSION: The extended parallel process model provides a useful framework to assess women's intention to have a vaginal birth, especially when it is combined with a qualitative approach. Within Iranian women, self-confident mothers are more likely to intend to deliver vaginally. IMPLICATION FOR FURTHER PRACTICE: Prenatal care provides an opportunity for nurses and midwives to explore mothers' beliefs and intended childbirth method prior to offering medical intervention.

Consanguinity and neonatal death: a nested case-control study.

OBJECTIVE: Although numerous studies have found higher rates of abortion and still births following consanguinity (familial marriages), the question of whether consanguinity significantly increases the risk of neonatal death has inadequately been addressed.This study aims to evaluate familial marriage effects on neonatal death in rural areas in Iran. MATERIALS AND METHODS: In this nested case-control study, 6900 newbornswho were born in rural areas of Kohgiluyeh and Boyerahmad Province (South-West of Iran)were followed till the end of neonatal period, and neonatal death was the outcome of interest. Subsequently 97 cases and 97 controls were selected in study cohort by using risk set sampling model. Crude and adjusted odds ratios (OR) were estimated by usinga conditional logistic regression model. RESULTS: In the final model, prematurity (OR = 5.57), low birthweight (LBW) (OR = 7.68), consanguinity (first cousins) (OR = 5.23), C-section (OR = 7.27), birth rank more than 3 (OR = 6.95) and birthsinterval less than 24 months (OR = 4.65) showed significant statistical association with neonatal mortality (p < 0.05). CONCLUSION: According to our findings, after adjusting the effects of other significant risk factors, familial marriageto first cousins is considered asan important risk factor for neonatal death.

Challenges for Better thesis supervision.

BACKGROUND: Conduction of thesis by the students is one of their major academic activities. Thesis quality and acquired experiences are highly dependent on the supervision. Our study is aimed at identifing the challenges in thesis supervision from both students and faculty members point of view. METHODS: This study was conducted using individual in-depth interviews and Focus Group Discussions (FGD). The participants were 43 students and faculty members selected by purposive sampling. It was carried out in Tehran University of Medical Sciences in 2012. Data analysis was done concurrently with data gathering using content analysis method. RESULTS: Our data analysis resulted in 162 codes, 17 subcategories and 4 major categories, "supervisory knowledge and skills", "atmosphere", "bylaws and regulations relating to supervision" and "monitoring and evaluation". CONCLUSION: This study showed that more attention and planning in needed for modifying related rules and regulations, qualitative and quantitative improvement in mentorship training, research atmosphere improvement and effective monitoring and evaluation in supervisory area.

Distribution of estrogenic steroids in municipal wastewater treatment plants in Tehran, Iran.

BACKGROUND: Estrogenic steroids such as estrone (E1), 17ß-estradiol (E2), estriol (E3), and 17α-ethinylestradiol (EE2) are among the most potent endocrine disrupting compounds (EDCs). Compared with North America, Europe and Japan there is no reliable information on the concentration of steroid hormones in wastewater treatment plants (WWTPs) influents and effluents in Iran. The aim of the present study was to determine the amounts of E1, E2, E3, and EE2 influents and effluents of 7 municipal WWTPs across Tehran, the capital city of Iran, in two seasons, summer and autumn, through solid-phase extraction (SPE) gas chromatography-mass spectrometry (GC-MS). RESULTS: The results showed that the concentrations of E1, E2, and EE2 in influents ranged from 6.54-18.76 ng/L, 1.02-8 ng/L and 4.18-11.76 ng/L, respectively. Also, the concentrations of E1, E2, and EE2 in effluents ranged from 1.04-4.99 ng/L, 0.5-2.20 ng/L and 0.5-2.58 ng/L, respectively. The levels of E3 were below the detection limit (0.5 ng/L). The percentage removal rate of E1, E2 and EE2 ranged between 61.76-87.25%, 50.98-82.63%, and 66.3-90.25%, respectively. Results indicated no significant correlation between hormone concentrations and seasons. CONCLUSIONS: The study showed that WWTP number 7 had significant differences in influent hormone concentrations compared with others. Results only showed a significant relationship between hormones and TSS removal rate, but there was no significant relationship between hormones and COD removal rate. The removal rate of hormone in WWTP number 4 and 7 were significantly different from the others. There was no significant correlation between hormone concentrations and seasons.

Estimating the prevalence of illicit drug use among students using the crosswise model.

OBJECTIVE: The aim of our study is to compare the prevalence of illicit drug use estimated through a technique referred to as the "crosswise model" (CM) with the results from conventional direct questioning (DQ). METHOD: About 1,500 students from Tehran University of Medical Sciences 2009-2010 were first interviewed by DQ and, then three months later, by the CM. RESULT: The CM yielded significantly higher estimates than DQ for lifetime prevalence of use of any illicit drug (CM = 20.2%,DQ = 3.0%, p < .001) and for lifetime prevalence of use of opium or its residue (CM = 13.6%, DQ = 1.0%, p < .001). Also, for use of any illicit drug in the last month and use of opium or its residue in the last month, the CM yielded higher point estimates than DQ, although these differences were not significant (any drug: CM = 1.5%, DQ = 0.2%, p = .66; opium: CM = 3.8%, DQ = 0.0%, p = .21). CONCLUSION: Our findings suggest that the CM is a fruitful data collection method for sensitive topics such as substance abuse.

Excess mortality during heat waves, Tehran Iran: an ecological time-series study.

BACKGROUND: In the past three decades, Tehran has experienced warmer summer so we need to determine heat-related mortality to establish appropriate public health activities during hot summers. The aim of the present study was to detect heat waves during the last decades and then determine excess mortality in immediate and lagged times. METHODS: An ecological study based on time-series model was conducted in Tehran for recent decade using generalized linear lagged model (GLLM) with Poisson regression. Maximum daily temperature was heat exposure for death outcome on the same day (lag 0), 3 (lag01) and also 7 (lag02) day moving average. Relative risk with 95% confidence was reported to quantify for increasing of daily mortalities for 1°C risen exposure. Air pollutants considered as confounders in final model. RESULTS: Total excess mortality during 17 heat waves was 1069 (8.9 deaths/Heat wave days). All non-external cause of death increased significantly during heat waves (3-9%) and after adjusting for ozone and PM10, raised. Cause-specific deaths (especially circulatory disease) and death among elderly increased during heat waves (especially in the hottest wave). The largest positive lagged effect of hot temperature although seen during hottest waves for all mortalities. Three waves had the most harvest effect for all categories of mortalities. CONCLUSION: Study showed excess mortalities resulted from hot temperatures and exacerbated with air pollutants in Tehran in the context of climate change. Forward displacement mortality and lagged mortalities as well as were seen, but our results were not conclusive about the displacement pattern of mortalities.

Exposure assessment of extremely low frequency electric fields in Tehran, Iran, 2010.

Extremely Low-Frequency (ELF) electric and magnetic fields belonging to the nonionizing electromagnetic radiation spectrum have a frequency of 50 - 60 Hz. All people are exposed to a complex set of electric and magnetic fields that spread throughout the environment. The current study was carried out to assess people's exposure to an ELF electric field in the Tehran metropolitan area in 2010. The measurement of the electronic fields was performed using an HI-3604 power frequency field strength measurement device. A total number of 2,753 measurements were performed. Afterward, the data obtained were transferred to the base map using Arc View Version 3.2 and Arc Map Version 9.3. Finally, an interpolation method was applied to expand the intensity of the electric field to the entire city. Based on the results obtained, the electric field was divided into three parts with various intensities including 0-5 V m, 5-15 V m, and >15 V m. It should be noted that the status of high voltage transmission lines, electric substations, and specific points including schools and hospitals were also marked on the map. Minimum and maximum electric field intensities were measured tantamount to 0.31 V m and 19.80 V m, respectively. In all measurements, the electric field was much less than the amount provided in the ICNIRP Guide. The results revealed that 141 hospitals and 6,905 schools are situated in an area with electric field intensity equal to 0-5 V m, while 15 hospitals and 95 schools are located in zones of 5-15 V m and more than 15 V m. Examining high voltage transmission lines and electric substations in Tehran and its suburbs suggested that the impact of the lines on the background electric field of the city was low. Accordingly, 0.97 km of Tehran located on the city border adjacent to the high voltage transmission lines have an electric field in the range of 5 to 15 V m. The noted range is much lower than the available standards. In summary, it can be concluded that the public is not exposed to a risky background electric field in metropolitan Tehran. The result of comparing sensitive recipients showed that the schools have a more desirable status than the hospitals. Nonetheless, epidemiologic studies can lead to more understanding of the impact on public health.