Publications by authors named "Tania Dehesh"

18 Publications

  • Page 1 of 1

Role of Urodynamics Study in the Management of Pelvic Organ Prolapse in Women.

Urol J 2021 02 24. Epub 2021 Feb 24.

Department of Biostatistics and Epidemiology, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran.

Objectives: Pelvic organ prolapse (POP) and lower urinary tract symptoms (LUTS) usually coexist and are common among women. Since the efficacy of urodynamic studies (UDS) in evaluating these conditions is subject to controversy, this study aimed to assess the accordance between urodynamic findings and LUTS and to determine the importance of UDS in women with POP.

Methods: This cross-sectional study was conducted on women over 18 years with symptomatic POP referred to the female urology clinic of Kerman University of Medical Sciences, Kerman, Iran, during 2017-2018. Patients who met the inclusion criteria were included in the study with informed consent. The Pelvic Floor Disability Index (PFDI-20) was completed for each patient. Pelvic examination was performed using the Pelvic Organ Prolapse Quantification System (POPQ). Subsequently, multi-channel UDS was performed, and the findings were analyzed in SPSS 20, using Chi-square or Fisher's test.

Results: A total of 200 women with symptomatic POP were included in the study. Stress, urge, and mixed urinary incontinence showed significant accordance with the urodynamic findings (urodynamic stress incontinence and/or detrusor overactivity). However, there was no significant relationship between urinary voiding LUTS and urodynamic findings.

Conclusion: UDS should be performed for selective patients with POP. According to the results of the present study, UDS can help us provide consultation for POP patients with voiding LUTS. However, in POP patients with urinary incontinence, this test cannot provide further information and should be performed based on the patient's condition.
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http://dx.doi.org/10.22037/uj.v18i.6408DOI Listing
February 2021

Statins in patients with COVID-19: a retrospective cohort study in Iranian COVID-19 patients.

Transl Med Commun 2021 25;6(1). Epub 2021 Jan 25.

Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has profoundly affected the lives of millions of people. To date, there is no approved vaccine or specific drug to prevent or treat COVID-19, while the infection is globally spreading at an alarming rate. Because the development of effective vaccines or novel drugs could take several months (if not years), repurposing existing drugs is considered a more efficient strategy that could save lives now. Statins constitute a class of lipid-lowering drugs with proven safety profiles and various known beneficial pleiotropic effects. Our previous investigations showed that statins have antiviral effects and are involved in the process of wound healing in the lung. This triggered us to evaluate if statin use reduces mortality in COVID-19 patients.

Results: After initial recruitment of 459 patients with COVID-19 (Shiraz province, Iran) and careful consideration of the exclusion criteria, a total of 150 patients, of which 75 received statins, were included in our retrospective study. Cox proportional-hazards regression models were used to estimate the association between statin use and rate of death. After propensity score matching, we found that statin use appeared to be associated with a lower risk of morbidity [HR = 0.85, 95% CI = (0.02, 3.93),  = 0.762] and lower risk of death [(HR = 0.76; 95% CI = (0.16, 3.72),  = 0.735)]; however, these associations did not reach statistical significance. Furthermore, statin use reduced the chance of being subjected to mechanical ventilation [OR = 0.96, 95% CI = (0.61-2.99),  = 0.942] and patients on statins showed a more normal computed tomography (CT) scan result [OR = 0.41, 95% CI = (0.07-2.33),  = 0.312].

Conclusions: Although we could not demonstrate a significant association between statin use and a reduction in mortality in patients with COVID19, we do feel that our results are promising and of clinical relevance and warrant the need for prospective randomized controlled trials and extensive retrospective studies to further evaluate and validate the potential beneficial effects of statin treatment on clinical symptoms and mortality rates associated with COVID-19.
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http://dx.doi.org/10.1186/s41231-021-00082-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7829327PMC
January 2021

Associated factors of pregnancy spacing among women of reproductive age Group in South of Iran: cross-sectional study.

BMC Pregnancy Childbirth 2020 Sep 22;20(1):554. Epub 2020 Sep 22.

Department of Biostatistics and Epidemiology, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran.

Background: Optimal pregnancy spacing is an important incidence in reproductive women's health. Short or long pregnancy spacing leads to the greatest health, social and economic problems such as increase in maternal and infant mortality and morbidity, and adverse pregnancy outcomes. The aim of this study is to assess the mean of pregnancy spacing and associated factors of pregnancy spacing among women of reproductive age group with recurrent event analysis.

Methods: The fertility history of 1350 women aged 15-49 years was collected in this cross-sectional study. The women were selected through multistage random sampling method from a list of clinics in 2018. Some predictors were collected from their records and others were collected by face-to-face interview. The recurrent event survival analysis was used to explore the effect of predictors on pregnancy spacing. The R software program was used for analysis.

Results: There were nine predictors that had significant effect on pregnancy spacing. These predictors included the age of mother at marriage, mother's BMI, contraception use, breast feeding duration of the previous child, the education level of husband, the sex preference of the mother, presence of abortion or stillbirth in the preceding pregnancies, income sufficiency, and mother's awareness of optimum pregnancy interval. The most influential predictors; contraception use (HR = 2.34, 95%CI = 1.23 to 2.76, P < 0.001) and income sufficiency (HR = 2.046, 95%CI = 1.61 to 3.02, P = 0.018) lead to longer and son preference of mother (HR = 2.231, 95%CI = 1.24 to 2.81, P = 0.023) lead to shorter pregnancy spacing.

Conclusion: The up to date contraception tool should be at hand for couples to manage their pregnancy intervals. The unfavorable economic situation of a family leads to long pregnancy spacing. Despite the relative equality of the status of girls and boys in today's societies, the desire to have a son child is still an important factor in shorter pregnancy spacing. The benefit of optimal pregnancy spacing should be more announced.
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http://dx.doi.org/10.1186/s12884-020-03250-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7510127PMC
September 2020

Relationship Between Thyroid Hormones and Left Ventricular Mass in Peritoneal Dialysis Patients.

Iran J Kidney Dis 2020 Sep;14(5):380-388

Department of Nephrology, Kerman University Of Medical Sciences, Kerman, Iran.

Introduction: Non-thyroidal illness is prevalent in patients with advanced stages of chronic kidney disease and could be considered as a risk factor for cardiovascular mortality; this relation is partially explained by malnutrition and the concomitant condition of high inflammation. This study is designed to investigate the relationship between left ventricular mass and thyroid hormone abnormalities and evaluate this relationship after adjustment of inflammatory factors and nutritional status in peritoneal dialysis patients.

Methods: A total of 71 patients undergoing maintenance peritoneal dialysis were included. Serum concentration of total and free triiodothyronine (fT3), total and free thyroxine (fT4), and TSH were measured. LV mass index and the structural properties of heart including LVEDD, LVESD, PWD, and EF were assessed by transthoracic echocardiography. The Surrogates of Inflammation, including IL-6, albumin, and hs-CRP were measured. The nutritional status of patients was assessed by one point SGA scoring and biochemical data. The relation between thyroid hormones and echocardiographic variables, inflammatory and nutritional markers was determined.

Results: LVMI was significantly higher in the group with lower fT3 levels. Linear regression analyses showed statistically significant univariate association between fT3, tT3, and tT4; and LVMI. In multiple linear regression analysis adjusted for albumin, hs-CRP, IL- 6, and ferritin; only fT3 level had a meaningful negative correlation (P < .05) with LVMI, free T3 level was positively correlated with rGFR (P < .05, c = 0.39) and KT/V (P < .05, c = 0.27).

Conclusion: Low fT3 level was negatively and significantly associated with LVML even after adjustments for known risk factors in peritoneal dialysis patients.
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September 2020

Slot blotting and flow cytometry: two efficient assays for platelet antibody screening among patients with platelet refractoriness.

Vox Sang 2021 Jan 8;116(1):106-115. Epub 2020 Aug 8.

Cell Therapy and Regenerative Medicine Comprehensive Center, Kerman University of Medical Sciences, Kerman, Iran.

Background And Objectives: Frequent platelet transfusion may lead to the formation of alloantibodies and immune-mediated platelet destruction. Currently, identifying economic and effective screening methods is necessary for the management of platelet transfusion while different tests were recommended. The present study aims to challenge the performance of slot blotting (SB) and flow cytometry (FC) assays in detecting immune platelet refractoriness.

Materials And Methods: Sera from 118 patients who received blood components and were clinically suspected of platelet refractoriness were enrolled. Platelet-reactive antibodies were explored in parallel by SB, FC and monoclonal antibody-specific immobilization of platelet antigens (MAIPA) techniques. In a further study, chloroquine-treated platelets were incubated with MAIPA-positive serum, and then, the results of the SB and FC techniques were compared.

Results: Using MAIPA as a reference, antibodies were detected in 51 sera, with specificity for human leucocyte antigens (HLA), human platelet antigens (HPA) or both HLA/HPA, in 27, 18 and 6 patients, respectively. The sensitivity and specificity of SB and FC were 86·3%, 88·1%, 82·4% and 95·5%, respectively. The Spearman correlation revealed significant (P < 0·001) correlations between FC (r = 0·763) and SB (r = 0·738) with MAIPA. In respect to HPA antibody detection, SB had 83·3% sensitivity and 92·6% specificity compared to 91·7% and 96·3% for FC while both approaches are acceptable (P < 0·001, r = 0·69; P < 0·001, r = 0·773) and can be recommended.

Conclusions: The present study acknowledges that among the used methods, the flow cytometry's performance is the most appropriate, but slot blotting, with acceptable sensitivity, can be used as an acceptable and convenient procedure for platelet antibody screening.
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http://dx.doi.org/10.1111/vox.12988DOI Listing
January 2021

The effect of cognitive behavioral counseling on sexual knowledge, motivation to avoid risky sexual relationships, and sexual depression in female university students.

Trends Psychiatry Psychother 2020 Jun 17;42(2):122-128. Epub 2020 Jul 17.

Department of Epidemiology and Biostatistics, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran.

Introduction Misunderstanding of different aspects of sex makes individuals vulnerable to sexual dysfunction, sexually transmitted diseases, mental disorders, and illegal relationships. This study aimed to determine the effect of cognitive behavioral counseling on the sexual self-concept of female students at Kerman University of Medical Sciences. Methods This study is an intervention conducted with female students living in dormitories at Kerman and Rafsanjan Universities of Medical Sciences. The sample size was estimated at 63 students from different fields of study; 31 students from Kerman University of Medical Sciences comprised the experimental group and 32 students from Rafsanjan University of Medical Sciences comprised the control group. Cognitive behavioral group counseling sessions were held every 3 days. The instrument used for collecting pre-test and post-test data was Snell's Multidimensional Sexual Self-concept Questionnaire. Data analysis was conducted using measures of central tendency, t tests and chi-square tests. Results The two groups were homogenous in terms of demographic factors. Analysis of the results of the intervention revealed significant differences in sexual self-consciousness and motivation to avoid high risk sexual relationships, but there was no significant difference in terms of sexual depression. Discussion Cognitive behavioral group counseling can improve sexual self-concept. Therefore, this type of counseling is recommended from younger ages or at enrollment at university, to help correct development of this important part of identity.
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http://dx.doi.org/10.1590/2237-6089-2019-0052DOI Listing
June 2020

Prevalence and Predictors of Post-Traumatic Stress Disorder and Depression Among Survivors Over 12 Years After the Bam Earthquake.

Neuropsychiatr Dis Treat 2020 12;16:1207-1216. Epub 2020 May 12.

Department of Biostatistics and Epidemiology, Kerman University of Medical Sciences, Kerman, Iran.

Purpose: The Bam earthquake was one of Iran's worst natural disasters. As a reason of limited sample size, prevalence and risk factors of PTSD and depression were still unclear after a huge earthquake in Bam.

Patients And Methods: A total of 1500 participants selected from the survivors by multistage sampling. Instruments included the demographic questionnaire, the PTSD Checklist-Civilian Version and the Beck Depression Inventory-2. Bivariable and multivariable logistic regressions were used to analyze the data.

Results: The prevalence rates of PTSD and depressive symptoms were 38.7% (n = 581) and 40.1% (n=597), respectively. The most commonly occurring symptoms of PTSD were distress at reminders (73.7%), fear of recurrence (70.3%) and sleep disturbance (68.4%). Age (OR=1.5, 95% CI= [1.03, 1.74], P < 0.001) and being injured (OR=1.68, 95% CI= [1.09, 2.61], P=0.02) are positive risk factors of PTSD. The risk factors for depressive symptoms were old age (OR= 1.46, 95% CI= [1.02, 1.64], P < 0.001), female gender (OR=1.42, 95% CI=[1.14, 1.77], P=0.002), and death of work colleagues (OR=4.03, 95% CI= [1.54, 6.54], P=0.005).

Conclusion: Professional and effective mental health services should design programs in order to aid the psychological wellbeing of the population focusing on older adults, females, those who lost work colleagues, and those who lost their family members.
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http://dx.doi.org/10.2147/NDT.S252730DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7231761PMC
May 2020

Prevalence and Associated Factors of Anxiety and Depression Among Patients with Type 2 Diabetes in Kerman, Southern Iran.

Diabetes Metab Syndr Obes 2020 5;13:1509-1517. Epub 2020 May 5.

College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.

Purpose: Depression and anxiety are common disorders in patients suffering from type 2 diabetes. These disorders can lead to premature morbidity, exacerbate disease complications, make patients suffer more, and increase health-care costs. As diabetes has increased worldwide recently, it is necessary to reduce the prevalence of factors that are associated with depression and anxiety in diabetes patients. This study aimed to assess the prevalence of anxiety and depression and to identify their associated factors, including metabolic components among people with type 2 diabetes.

Patients And Methods: We performed a cross-sectional study in 1500 patients with type 2 diabetes in Kerman, in the southern part of Iran. The prevalence of depression and anxiety was estimated using the Beck Depression Inventory and the Hamilton Anxiety questionnaires, respectively. After calculating the proportions of depression and anxiety, univariate logistic regression was performed. Factors whose -values were smaller than 0.2 in univariate logistic regression were included in multiple logistic regression for confounder adjustments. The analysis was performed using SPSS version 20.

Results: The rates of depression and anxiety were 59% (95% CI: 54.48-63.12) and 62% (95% CI: 59.51-66.27), respectively. Factors found to be independently associated with anxiety were high FBS, high LDL-C, high TG, hypertension, complications, low physical activity. Factors found to be independently associated with depression were female gender, older age, high BMI, high FBS, high LDL-C, low HDL-C, high TG, high HbA1c, hypertension, and low physical activity. Complications were independently associated with anxiety but not with depression. Female gender, older age, high BMI, low HDL-C, and high HbA1c were independently associated with depression but not with anxiety.

Conclusion: Current findings demonstrated that a large proportion of patients with type 2 diabetes suffer from depression and anxiety. This study also identified factors associated with these disorders. Controlling some metabolic variables will decrease the prevalence of these disorders and improves clinical remedy and quality of life in patients with type 2 diabetes.
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http://dx.doi.org/10.2147/DMSO.S249385DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7211308PMC
May 2020

Metabolic factors that affect health-related quality of life in type 2 diabetes patients: a multivariate regression analysis.

Diabetes Metab Syndr Obes 2019 19;12:1181-1188. Epub 2019 Jul 19.

Department of Endocrinology, Kerman University of Medical Sciences, Kerman, Iran.

Purpose: In the past few decades, an increase in the life span of the population has caused more people to experience chronic diseases, such as type 2 diabetes. Since chronic diseases influence the whole life of patients and do not have a specific remedy, improving their health-related quality of life (HRQoL) becomes more important. The aim of the present study was to investigate the metabolic variables that influenced HRQoL questionnaire scores most significantly among patients with type 2 diabetes.

Patients And Methods: The population of this cross-sectional study included 163 patients with type 2 diabetes and 214 healthy people who were asked to complete the HRQoL questionnaire, and their metabolic blood variables were recorded simultaneously. The effects of metabolic variables and some other demographic ones on two main scales of HRQoL, Mental Component Summary (MCS) and Physical Component Summary (PCS), were evaluated using multivariate regression.

Results: Multivariate regression analysis showed that PCS score was most negatively influenced by cigarette smoking (=0.009, β-15.761), maximum blood pressure (=0.008, β=-0.108), minimum blood pressure (=0.009, β=-0.039), low-density lipoprotein cholesterol (=0.008, β=-0.721), cholesterol (=0.006, β=-0.648), HbA1c (=0.004, β=-0.878), FBS (=0.006, β=-0.769), and body mass index (BMI) (=0.034, β=-0.287). The MCS score was influenced positively by smoking cigarettes (=0.041, β=13.032), gender (=0.018, β=15.633), and BMI (=0.048, β=-0.088). Men had a higher MCS score compared to women.

Conclusion: The HRQoL questionnaire (as a concept of health) score could be improved by controlling the variation of some metabolic variables in patients with type 2 diabetes. Some metabolic variables could be the main causes of a decrease in physical and mental HRQoL among patients with type 2 diabetes.
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http://dx.doi.org/10.2147/DMSO.S208689DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6648653PMC
July 2019

The Effects of Age and Fasting Models on Blood Pressure, Insulin/Glucose Profile, and Expression of Longevity Proteins in Male Rats.

Rejuvenation Res 2020 Jun 23;23(3):224-236. Epub 2019 Sep 23.

Department of Epidemiology and Biostatistics, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran.

Intermittent fasting can be effective in reducing metabolic disorders and age-related diseases. However, there remain questions about the effects of fasting with respect to the age in which fasting begins, the fasting models, and the mechanisms involved. We investigated the effects of age of beginning fasting and chronic mild and severe fasting models on blood pressure (BP), insulin/glucose profile, and expression of klotho, sirtuin1 (SIRT1), and sirtuin3 (SIRT3) in male Wistar rats. Young (3 months), middle-aged (12 months), and old (22 months) animals were randomly divided into three subgroups and fed as (AL), AL with fasting 1 day per week (FW), and AL with fasting every other day (EOD), respectively, for 3 months. The FW reduced the weight gain in young animals ( < 0.001 vs. AL), whereas EOD induced weight loss in all three age categories ( < 0.001). Aging was associated with high BP, high glucose, and insulin levels. Both FW and EOD feedings decreased BP and blood glucose level ( < 0.001) and EOD decreased insulin level ( < 0.05 vs. AL) in old animals. Parallel to aging, the expression of SIRT1 and klotho significantly decreased in plasma and EOD feeding recovered this defect. Both FW and EOD feedings increased the expression of SIRT3 in middle-aged and old rats. Age is a determining factor for the effectiveness of fasting and old animals respond more desirably to fasting. The effect of EOD fasting is more effective than FW fasting in improving the metabolic factors, partly through the recovery of SIRT1 and klotho.
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http://dx.doi.org/10.1089/rej.2019.2205DOI Listing
June 2020

Classifying patients with lumbar disc herniation and exploring the most effective risk factors for this disease.

J Pain Res 2019 15;12:1179-1187. Epub 2019 Apr 15.

Department of Neurology, Kerman University of Medical Sciences, Kerman, Iran.

To classify patients suffering from low back pain (LBP) into two different groups - patients with lumbar disc herniation (LDH) and patients without this disease based on simple questions and without magnetic resonance imaging (MRI) procedure - and to diagnose the most effective risk factors of LDH. Four hundred patients aged over 18 years suffering from LBP for over 6 months were randomized into two groups in this cross-sectional study. The data were gathered at Besat clinic, in Kerman, southeast of Iran. Twelve dichotomous questions from the main LDH risk factors were asked. Three statistical classification methods - K-nearest neighbors (KNN), support vector machine (SVM), and logistic regression (LR) - were performed. LR was used in order to diagnose the most important risk factors of LDH. SVM method was more efficient among the small sample sizes, while KNN method showed the best classification relative to other methods when the sample size increased. LR model had the least efficiency of all. The drug use increased the chance of LDH more than 7 times (OR=7.249), and the chance of having LDH among people who had associated illness was 4.847 times more compared with people who did not have. Using hookah increased the chance of having LDH more than twice (OR=2.401), and the chance of smokers for LDH was near four times higher than nonsmokers (OR=3.877). : The statistical classification methods had acceptable precisions for diagnosis of LDH patients. It is suggested that neurologists become more familiar with these methods and use them before MRI prescription to decrease the unnecessary burden on health services. Addiction to drugs, cigarettes, and hookah is the main factor in the creation of a lumbar disc herniation.
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http://dx.doi.org/10.2147/JPR.S189927DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6489673PMC
April 2019

Impact of Ondansetron on Withdrawal Signs, Fentanyl Requirement and Pain Relief in Opioid-addicted Patients under General Anesthesia.

Curr Clin Pharmacol 2019 ;14(3):232-241

Department of Toxicology and Pharmacology, Faculty of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran.

Background: Serotonin 5-HT3 receptor antagonists such as ondansetron have been investigated to attenuate opioid withdrawal signs in studies.

Objective: Therefore, we designed a randomized double-blinded placebo-controlled trial to evaluate this effect on opioid-addicted patients who were admitted to the orthopedic department for surgery due to bone fractures.

Methods: Male adults who were addicted to opioids, aged 18 to 79 years were enrolled (n=96) and randomized into intravenous doses (4 & 8 mg) of ondansetron (n=32) and placebo (n=32). The vital signs, withdrawal symptoms and the frequency requirement of fentanyl were recorded during anesthesia, and opioid (pethidine) analgesic was received during the recovery period. Outcome parameters were analyzed for reduction of withdrawal symptoms in addicted adults.

Results: We indicated that ondansetron demonstrated significant differences with few vital outcomes including systolic blood pressure (SBP) 20 (SBP3) and 50 min (SBP4) after injection of ondansetron during the period of surgery. Ondansetron could also significantly reduce the frequency requirement of fentanyl at 20 min (dose 3) in general anesthesia. Furthermore, requirement for further administration of opioid analgesic drugs such as pethidine was significantly reduced in the ondansetron groups. Objective opioid withdrawal scale (OOWS) results indicated that few clinical parameters including tremor, hot and cold flushes and anxiety were significantly attenuated in addicted patients who received ondansetron.

Conclusion: This study demonstrated supporting evidence for the beneficial treatment of ondansetron for the control of withdrawal symptoms and pain in addicted patients, and more clinical studies are suggested in this regard.
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http://dx.doi.org/10.2174/1574884714666190131122846DOI Listing
August 2020

Prevalence of meningococcal carriage among male university students living in dormitories in Kerman, southeast of Iran.

Pathog Glob Health 2018 09 29;112(6):329-333. Epub 2018 Aug 29.

a Department of Microbiology and Virology, School of Medicine , Kerman University of Medical Sciences , Kerman , Iran.

Neisseria meningitidis is an important causative agent of bacterial meningitis. The nasopharynx is the only known reservoir of this organism. Although the relationship between carriage and invasive disease is not completely understood, asymptomatic meningococcal carriers are considered as the most important sources for causing strains of disease. Living in closed and overcrowded places such as university dormitories can increase the carriage rate and meningococcal disease. This cross-sectional study was conducted to determine the prevalence of N. meningitidis carriers among male students living in three dormitories affiliated with Kerman University of Medical Sciences (Kerman, Iran). Nasopharyngeal swab was taken from all participants recruited in the study. Conventional microbiological tests were performed for isolation and detection of the organism. The amplification of crgA gene was used to confirm the identity of isolates. Molecular serogrouping was used to detect the six most frequent serotypes. The overall carriage rate was 6.8% (23/335). The capsular type of these isolates was in determinate (56.5%) or of serogroup C (43.5%). Multivariate logistic regression analysis revealed that cigarette smoking was significantly associated with meningococcal carriage (OR = 5.02; p = 0.01). Additionally, using univariate regression analysis, a significant association was found between water pipe smoking and carriage (p = 0.018). The rate of meningococcal carriage among male students in the studied population was lower as compared to other high-risk group (freshmen conscripts) in Iran. University students should be aware of the consequences of cigarette and water pipe smoking as risk factors in meningococcal carriage.
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http://dx.doi.org/10.1080/20477724.2018.1514138DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6381525PMC
September 2018

The Covariance Adjustment Approaches for Combining Incomparable Cox Regressions Caused by Unbalanced Covariates Adjustment: A Multivariate Meta-Analysis Study.

Comput Math Methods Med 2015 1;2015:801031. Epub 2015 Sep 1.

Department of Biostatistics, Faculty of Medicine, Shiraz University of Medical Sciences, P.O. Box 71345-1874, Shiraz, Iran.

Background: Univariate meta-analysis (UM) procedure, as a technique that provides a single overall result, has become increasingly popular. Neglecting the existence of other concomitant covariates in the models leads to loss of treatment efficiency. Our aim was proposing four new approximation approaches for the covariance matrix of the coefficients, which is not readily available for the multivariate generalized least square (MGLS) method as a multivariate meta-analysis approach.

Methods: We evaluated the efficiency of four new approaches including zero correlation (ZC), common correlation (CC), estimated correlation (EC), and multivariate multilevel correlation (MMC) on the estimation bias, mean square error (MSE), and 95% probability coverage of the confidence interval (CI) in the synthesis of Cox proportional hazard models coefficients in a simulation study.

Result: Comparing the results of the simulation study on the MSE, bias, and CI of the estimated coefficients indicated that MMC approach was the most accurate procedure compared to EC, CC, and ZC procedures. The precision ranking of the four approaches according to all above settings was MMC ≥ EC ≥ CC ≥ ZC.

Conclusion: This study highlights advantages of MGLS meta-analysis on UM approach. The results suggested the use of MMC procedure to overcome the lack of information for having a complete covariance matrix of the coefficients.
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http://dx.doi.org/10.1155/2015/801031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4568051PMC
June 2016

Testing measurement equivalence of the SF-36 questionnaire across patients on hemodialysis and healthy people.

Int Urol Nephrol 2015 Dec 2;47(12):2013-21. Epub 2015 Sep 2.

Department of Biostatistics, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Differential item functioning (DIF) occurs when members from different groups respond differently to particular items in a health-related quality of life (HRQoL) questionnaire after controlling for underlying HRQoL construct. This study aimed to assess DIF in the SF-36 questionnaire and its effect on comparing HRQoL scores across patients on HD and healthy people.

Methods: One hundred fifty patients on maintenance hemodialysis (HD) and 642 healthy individuals filled out the Persian version of the SF-36 questionnaire. Multiple-group multiple-indicator multiple-causes (MG-MIMIC) model was used to assess DIF across patients on HD and healthy population.

Results: Sixteen out of 36 (44.4 %) items were flagged with DIF. Six out of 16 items (37.5 %) were flagged with uniform DIF, nine items (56.2 %) with non-uniform DIF, and one item (6.2 %) with both uniform DIF and non-uniform DIF. DIF items were associated with all subscales with the exception of the limitation due to physical problems and bodily pain subscales. The significant lower HRQoL scores of patients on HD in comparison with healthy people in the physical functioning and vitality subscales did not change after removing the items with uniform DIF.

Conclusions: Our findings revealed that patients on HD and healthy people perceived the meaning of the items in SF-36 questionnaire differently. Although the impact of DIF is minimal, the cross-group comparison across patients on HD and healthy people should be performed with caution.
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http://dx.doi.org/10.1007/s11255-015-1092-zDOI Listing
December 2015

Health-related quality of life in southern Iranian rural women: a multivariate multilevel study.

Int J Womens Health 2015 10;7:213-8. Epub 2015 Feb 10.

Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.

Purpose: The evaluation of health-related quality of life (HRQOL) is increasingly growing to be of much significance. In an attempt to improve the agricultural conditions and to prevent the rural-urban migration, analyzing HRQOL in rural communities has gained significant governmental attention. The purpose of this study was initially to investigate rural women's HRQOL, and then to assess the influence of some specific covariates on four domains of rural women's HRQOL via multivariate analysis (MA) and multivariate multilevel analysis (MMA), and finally to compare the results.

Methods: Out of 146 active health centers in villages around Shiraz, Iran, ten health centers were selected, using a multistage random sampling process. These ten health centers covered 18 villages. In this cross-sectional study, all women over the age of 15 in a sample of 1,128 rural residents were interviewed using a brief version of the World Health Organization HRQOL (the WHOQOL-BREF) questionnaire. Assessing the influence of some specific covariates on the four domains of rural women's HRQOL was conducted by MA and MMA.

Results: The average range for all four domain scores was between 12.53 and 14.27, which indicates that HRQOL for rural women is acceptable on the whole. The social relations domain and the environmental domain received the highest (14.3±2.5 SD) and the lowest (12.5±2.3 SD) scores respectively. Marital status did not indicate any significant effects on MA, but it presented an important influence on MMA. Furthermore, age and chronic diseases showed indifferent levels of significance in the two analytical methods.

Conclusion: Rural women are in need of more heedfulness during their lives, especially about facilities and health. MMA is a more accurate procedure in exploring the important covariates in HRQOL.
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http://dx.doi.org/10.2147/IJWH.S73373DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4332292PMC
February 2015

General Health in the Elderly and Younger Adults of Rural areas in Fars Province, Iran.

Int J Community Based Nurs Midwifery 2015 Jan;3(1):60-6

Family Health Unit, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: There are critical gaps in assessment and research on health among the elderly living in rural communities. The state of aging and health in rural areas provides a snapshot of our older adults's need to necessary public health measures .The aim of this study was to determine the self-rated general health of adults residing in rural areas and compare the general health of the elderly with younger adults.

Methods: In this population based study using multistage random sampling, 2259 adults aged (≥15 years old) were selected from rural areas of Shiraz, southern Iran. The participants were divided into three age groups: young adults (15-39 years old n=1574), middle aged adults (40-59 years old, n=530), and the elderly (≥60 years of age, n-155).  Data were gathered using a translated version of the general health questionnaire (GHQ-28) and analyzed using Chi-square, one-way ANOVA, Kruskal-Wallis tests and ANCOVA analysis.  SPSS software, version 16, was used for analysis.

Results:   34.8%, 31.6%, 52.3% and 7.7% of the elderly had a probable mental disorder  in the somatization, anxiety, social dysfunction and depression categories, respectively. Moreover, 9.7, 7.1, 3.9 and 4.5% of the elderly had a  severe mental disorder  in the four mentioned subscales, respectively. Compared with younger adults, the elderly showed a significantly higher disorder in all subscales except for anxiety.

Conclusion: Our findings showed that chronic disease had a great effect on general health. Screening programs and prevention of chronic disease by the newly established family physician in rural districts can improve the overall community health.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4280558PMC
January 2015

Psychometric assessment of the Persian version of the Ferrans and Powers 3.0 index in hemodialysis patients.

Int Urol Nephrol 2014 Jun 25;46(6):1183-9. Epub 2013 Aug 25.

Department of Biostatistics, Shiraz University of Medical Sciences, Shiraz, Iran,

Background: This study aimed to assess the psychometric properties of the Persian version of the Ferrans and Powers 3.0 quality of life index (dialysis type) in patients receiving hemodialysis (HD) in order to describe their health-related quality of life (HRQOL).

Methods: The sample (n = 150) consisted of adult HD patients receiving HD for at least 6 months from the establishment of the study. A total of 88 men and 62 women, with an average age of 50.47, from Shiraz, southern Iran, were enrolled in this study. The questionnaire was translated into Persian language using back translation and bilingual techniques. Convergent, discriminant, and construct validity of the Ferrans and Powers 3.0 dialysis version was evaluated. To check the internal consistency of the data, Cronbach's alpha, which indicates the reliability of the data, was used for the entire questionnaire and for the subscales.

Results: The convergent and discriminant validity and success scaling rate for both sexes were 100 %. Cronbach's alpha was 0.95 overall, which was greater than 0.7 for all the subscales except for the family subscale. Our results suggest that HD patients in southern Iran have higher HRQOL scores when compared with those in other countries. Despite the higher mean HRQOL score for men compared with women, men had significantly higher HRQOL scores only in the health and functioning subscale. There was no significant correlation between HD patients' HRQOL and educational level.

Conclusion: The Persian version of Ferrans and Powers 3.0 has sufficient reliability and validity for measuring the quality of life of Persian-speaking HD patients. Female HD patients need more support and attention from family and society.
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Source
http://dx.doi.org/10.1007/s11255-013-0537-5DOI Listing
June 2014