The Causes of Insufficient Breast Milk and Approach to it: Perspectives of Persian Medicine and Classical Medicine

زمینه و هدف: شیر مادر اولین غذای طبیعی شیرخوار تا شش ماهگی می‌باشد. شایع‌ترین عامل قطع آن، کمبود شیر است که علی‌رغم تلاش‌های صورت‌گرفته، اما همچنان در رأس موانع تغذیه انحصاری با شیر مادر می‌باشد. طب سنتی ایران برای شیردهی موفق و نیز پیشگیری و درمان مشکلات این دوران تدابیر ویژه‌ای ارائه نموده است. هدف این مطالعه بررسی علل کمبود شیر مادر و نحوه برخورد با آن در طب ایرانی و مقایسه آن با طب کلاسیک می‌باشد. مواد و روش‌ها‌: در این مطالعه مروری علل کمبود شیر مادر و نحوه درمان آن در منابع مرجع طب ایرانی در کنار مقالات مرتبط طب سنتی و طب نوین از بانک‌های اطلاعاتی پزشکی تحلیل و مقایسه گردیدند. یافته‌ها: تولید شیر فرآیندی عصبی ـ هورمونی است که تحت تأثیر شرایط جسمی و روانی متعددی قرار می‌گیرد. ارتباط تنگاتنگ پستان با رحم و مغز در هر دو مکتب طبی به اثبات رسیده است. علل کمبود شیر را می‌توان در ۲ دسته کلی عوامل مربوط به ماده مولد شیر (خون صالح) و عوامل مربوط به عضو تولیدکننده شیر (پستان) قرار داد. بنابراین درمان عمدتاً مبتنی بر ایجاد دم صالح از طریق تغذیه مناسب و سایر اصول حفظ‏الصحه، برطرف‌نمودن سوءمزاج موجود و استفاده از غذاها و داروهای شیرافزا می‌باشد. از دیدگاه طب کلاسیک مهم‌ترین علت کمبود شیر، عدم تخلیه کافی شیر از پستان‌ها که اغلب در اثر تکنیک‌های نادرست شیردهی است، می‌باشد، لذا در طب رایج آموزش شیردهی صحیح به مادر و تقویت ارتباط مادر و شیرخوار از اهمیت بیشتری در مواجهه با این مشکل برخوردار است. نتیجه‏گیری: با بهره‌گیری از تدابیر حفظ‌الصحه‌ خاص دوران شیردهی و دستورات درمانی مربوطه، در کنار آموزش تکنیک‌های صحیح شیردهی منطبق بر طب کلاسیک می‌توان گام‏های مؤثرتری در رفع مشکل کمبود شیر مادر برداشت.Background and Aim: Breast milk is the first natural food for infants up to 6 months. Insufficient Milk Supply (IMS) is the most common of its discontinuation, which despite efforts, is still at the top of the problems of exclusive breastfeeding. Iranian Traditional Medicine (ITM) proposed specific approaches for successful lactation, prevention and treatment of breastfeeding problems. This study focused on the causes and approaches to IMS based on ITM and compare it with Classical Medicine. Materials and Methods: In this review article the causes and treatments of IMS were searched from ITM references and were analyzed and compared along with studies from ITM and Classical Medicine which collected from medical databases. Findings: Lactation is a neuro-hormonal process that is affected by several psychological and physical factors. The close relationship between the breast, uterus and brain has been proven in both medical doctrines. Causes of IMS can be classified into two main categories: causes of milk-producing source (good blood) and milk-producing organ (breast). Therefor treatment is mainly based on the good blood production through proper nutrition and the other healthy lifestyle principles (Hifz-o-Sihhe), eliminating distemperament and using galactogogues foods and herbal medicines. From the Classical Medicine perspective, the most important cause of IMS is the lack of adequate milk removal often due to improper lactation techniques so the correction of breastfeeding skills and improvement of mother-infant relationship is notable in management of IMS. Conclusion: By using the ITM perspective along with teaching of breastfeeding skills based on Classical Medicine, more effective management of IMS will be approached.   Please cite this article as: Jahangir M, Emaratkar E, Nakhaie SH, Sadeghian M, Faghihzadeh S. The Causes of Insufficient Breast Milk and Approach to it: Perspectives of Persian Medicine and Classical Medicine. Med Hist J 2018; 10(34): 95-108

Comparison of the Effect Of 0.2% Chlorhexidine and Xylitol Plus 920 Ppm Fluoride Mouthwashes on Count of Salivary Streptococcus Mutants, a Pilot Study

Statement of the Problem: Dental caries is a common chronic disease. Mouthwashes and other preventive approaches play an important role in caries prevention. Finding the most efficient mouthwash in the market is always a concern for dentists and patients. Purpose: This study aimed to assess the effect of chlorhexidine (Behsa, Iran) and xylitol plus 920 ppm fluoride (FX) (Fuchs, Germany) mouthwash on salivary Streptococcus mutans (S. mutans), which is the main microorganism responsible for dental caries. Materials and Method: This single-blind randomized clinical trial was conducted on 30 dental students, divided into two groups. The salivary count of S. mutans was measured at the beginning of the study. Group 1 students used chlorhexidine mouthwash while group 2 used FX mouthwash for two weeks. Saliva samples were collected again and salivary count of S. mutans was determined. Data were analyzed using Mann Whitney and Wilcoxon signed rank tests Results: Salivary count of S.mutans significantly decreased in the two groups after using the mouthwashes (p 0.05). Conclusion: Within the limitations of this study, the results showed that both mouthwashes could decrease S. mutans count

Developing Persian Quick Speech in Noise With Words Containing High Frequency Phonemes: Determining its Validity and Equivalency

Background and Aims The quick speech in noise (Q-SIN) test shows how difficult it is to perceive speech in noise by determining signal-to-noise ratio (SNR) loss. The lists with high-frequency words have a better ability to identify SNR loss which have been created in Persian. Although a Persian version of Q-SIN with emphasis on high frequency is available، but there is no Q-SIN lists with high-frequency words; therefore,this study aims to develop new lists and the lists with high-frequency words for Q-SIN test and determine their equivalency in normal-hearing people which was condcuted in Tehran University of Medical Sciences.Methods The sentences were first developed. Then, their content validity and face validity were determined. In this regard، 36 sentences were used to make new Q-SIN lists and 36 sentences were used to make Q-SIN lists with high-frequency words. Based on the Q-SIN test development criteria، six regular lists (lists 1-6) and six lists with high-frequency words (lists 7-12) were tested on 46 people (23 males and 23 females) aged 18-35 with normal hearingResults The content validity index for new and high-frequency words lists were 0. 74 and 0. 736، respectively. The equivalency test results showed that among the first 6 lists، the lists no. 1, 2, 3, and 4 were equal. Among the six lists with high-frequency words, the lists no. 7, 8, 10, 11 were equal. There was no gender differences between six regular lists and high-frequency lists (P>0.05). Conclusion The Q-SIN word lists with equivalency can be used for normal-hearing people in clinical practice

Motor Speech Sequence Learning in Adults Who Stutter

Objective Developmental stuttering is a speech disorder characterized by repetition, prolongation, block and disruption of the smooth flow of speech. Environmental, physical, mental, and cognitive-linguistic factors were involved in the initiation and development of stuttering. There have been several theories about the development of stuttering. One of these theories suggests that stuttering is a speech motor control disorder. Based on the speech-motor skills hypothesis, speech production is a motor skill similar to any other (fine) motor skill that humans possess, and the individual motor skills develop from the lowest skill level to the highest level of motor skills. The SMS view suggests that stuttering may arise from limitations in speech motor skill in people who stutter are located more toward the lower end of a presumed normal speech motor skill continuum. Therefore, people who stutter have difficulty learning speech motor skills and have a limited ability to benefit from speech motor practice compared to normal individuals. Many of the stuttering treatment programs teach the new pattern of speech, and the success of these treatment programs depends on the learning of the new speech patterns. So if people who stutter have limited speech motor skills, also will have little success in this treatment programs. Therefore, this study aimed to investigate motor speech sequence learning in adults who stutter. Materials & Methods This was a descriptive-analytical study with participants as 15 adults who stutter and 15 adults who do not stutter. All subjects were matched for age, sex and educational level. The average age was 28.73 for the adults who stutter was 28.4 for the normal people. All of the participants had history of neurological and motor speech disorders. The convenience sampling method was used for this study. The stuttering severity of people who stutter was assessed with Wingate scale and was in moderate range. Participants were asked to repeat an eight syllable non word sequence 30 times during three practice sessions. Recorded samples were analyzed with PRAAT software, and the variables used to measure performance gains included accuracy, response preparation time and sequence duration. The data were statistically analyzed by SPSS software (version 23). Results Based on the findings of the present study, PWS showed improvement in accuracy from day 1 to day 3 (P0.05). Also, the reaction time of the PWS improved from day 1 to day 3 (P0.05). The sequence duration of the PWS improved from day 1 to day 3 (P<0.05) and there was a significant difference between the two groups (P<0.05). According to the results of this study, PWS showed slower sequence duration compare to PNS . Conclusion The results of this study showed that PWS show improvement in accuracy, reaction time and sequence duration variables from day 1 to day 3. Also, PWS show more substantial number of errors compared to PNS, but this difference was not significant between the two groups. Similar results were obtained for the reaction time. Results of this study demonstrated that PWS show slower sequence duration compared to PNS. Some studies suggested that this could be because people who stutter use a control strategy to reduce the number of errors, although many studies suggested that this may indicate motor learning. According to speech motor skills hypothesis, it can be concluded that people who stutter have limitations in motor speech learning abilities. The findings of the present study could have clinical implication for the treatment of stuttering

Socio-economic inequalities in health-related quality of life among Iranian young people in the middle stage of adolescence: application of Health Equity Assessment Toolkit

Abstract Background One of the main concerns of public health is the increasing inequality of health status, which has an adverse effect on people’s life. Purpose The current study aims to analyze the role of socioeconomic inequalities in health-related quality of life (QoL) among Iranian young people in the middle stage of adolescence. Methods A cross-sectional descriptive study was conducted on 576 young people in the middle stage of adolescence. The samples were selected using the Multi-stage sampling method. Data were collected by a demographic checklist, and KIDSCREEN-52 questionnaire and analyzed by SPSS ver.16. The Health Equity Assessment Toolkit (HEAT) Version 4.0 (beta) was used to assess adolescents’ QoL inequalities in terms of socio-economic subgroups. Results The results show that 27.2 adolescents had low quality of life. The score of physical and autonomy components of QoL was significantly more in male versus school environment in female adolescents. Also, the asset index, father’s, and mother’s education, and family income in female adolescents, and the assets and family income in male adolescents were significantly related to the quality of life (p < 0.05). The risk of lower QOL in the poorest quintile was 1.12 times more than in the richest quintile. The consideration index of Asset in terms of sex was 4.5 and the modified Gini index was more than 0.5 in females and males. Conclusion Our findings highlight the significant effects of socioeconomic inequality on the HRQL of Iranian adolescents. Requires a targeted policy approach to reach the poorest quintile for improving the quality of life of adolescents

Perceived needs in women with gestational diabetes: A qualitative study

Introduction: Diabetes is the most common medical complication of pregnancy. It can be associated with many complications for mother and fetus. Gestational diabetes is also one of the main health issues in Iran. Therefore, the present study is aimed at a deeper understanding of women’s experiences of gestational diabetes and their perceived needs to inform future lifestyle interventions. Methods: This qualitative content analysis study was carried out in 2015. Participants were pregnant women diagnosed with gestational diabetes in the 24th to 36th week of pregnancy, who were referred to the clinics affiliated with Shahid Beheshti Medical Science University in Tehran, Iran. In-depth interviews were conducted with participants, using semi-structured questions. Interviews were audio taped and transcribed verbatim. Conventional content analysis was carried out for data analysis. Interviews continued until data saturation was obtained. Data were coded in MAXQDA software (version 11). Results: Content analysis highlighted two themes; educational needs and need to support. The former was featured with five main categories: information sources, education process, unknown and known, weaknesses of public information system, and eagerness to learn. The latter was featured with two main categories: family support and social support. Conclusion: Clarifying the needs of the mothers with gestational diabetes, leads to better and proper education planning and a program toward the improvement of health, self-care, and prevention of diabetes

The effects of noise exposure and work-related fatigue on the acceptable noise level test in normal-hearing people

Background and Aim: The acceptable noise level (ANL) assesses the noise that a person can tolerate during a running speech. Although it is a strong test, it has not yet become popular in clinical practice. One of the reasons is its contradictory results. Since it is a psychoacoustic test, psychological factors can affect its output. Investigation of these factors can provide more accurate results. This study aims to investigate the effects of noise and work-related fatigue on the ANL in normal-hearing people. Methods: Participants were the male workers in the administration (n = 26) and production (n = 26) departments of an automotive manufacturing industry in Iran. They were evaluated before and after leaving the workplace in order to determine the effects of noise exposure, fatigue as well as their simultaneous effects on the ANL. Results: In both groups, the ANL showed a significant increase after work compared to its level before work, and the background noise level (BNL) was significantly decreased. There was no significant difference in the BNL between administration and production groups before work. The most comfortable level (MCL) showed no significant increase. Moreover, the MCL changes were not significantly different in the production group compared to administration group, but the BNL and ANL changes were significantly higher. Conclusion: Noise exposure and work-related fatigue affect the ANL. During the ANL test, earlier exposure to noise and the amount of fatigue should be controlled

A Survey on Mental Health Status of Adult Population Aged 15 and above in the Province of Bushehr, Iran

Introduction: This research aims to determine the mental health status of population aged 15 and over in the province of Bushehr in 2015. Methods: The statistical population of this cross-sectional field survey consisted of residents of urban and rural areas of Bushehr province in Iran. Through systematic random cluster sampling, 1200 individuals were selected from the residents of urban and rural areas of Bushehr, Deilam and Borazjan. The 28-item version of the General Health Questionnaire was applied as the screening tool. Data were analyzed using SPSS, version 18.0 for windows. Results: The results of this study showed that using the traditional scoring method, 23.4% of the subjects (29% of females and 14.7% of males) were suspected of mental disorders. The prevalence of suspected psychiatric disorders in rural areas (24.5%) was more than the prevalence of these disorders in urban areas (22.8%). The prevalence of suspected anxiety and the somatization of symptoms was higher than the prevalence of social dysfunction and depression, and the prevalence of these components was higher in women than men. The findings of this study also showed that the prevalence of suspected cases of mental disorders increased significantly with age. The prevalence of suspected cases of these disorders was higher among females, the age group of 65 and older, people living in rural areas, divorced and widowed, students and primary and secondary education than other groups. Conclusion: The results of this study show that more than one fourth of the sample were suspected of mental disorders, and the prevalence of these disorders has increased from 21.3% in 1999 to 23.4% in 2015. Therefore, it seems necessary for the provincial public health authorities to take the needed steps for providing requirements encompassing prevention and promotion of mental health in this are

Prediction of Brain Connectivity Map in Resting-State fMRI Data Using Shrinkage Estimator

Introduction: In recent years, brain functional connectivity studies are extended using the advanced statistical methods. Functional connectivity is identified by synchronous activation in a spatially distinct region of the brain in resting-state functional Magnetic Resonance Imaging (MRI) data. For this purpose there are several methods such as seed-based correlation analysis based on temporal correlation between different Regions of Interests (ROIs) or between brain’s voxels of prior seed. Methods: In the current study, test-retest Resting State functional MRI (rs-fMRI) data of 21 healthy subjects were analyzed to predict second replication connectivity map using first replication data. A potential estimator is “raw estimator” that uses the first replication data from each subject to predict the second replication connectivity map of the same subject. The second estimator, “mean estimator” uses the average of all sample subjects' connectivity to estimate the correlation map. Shrinkage estimator is made by shrinking raw estimator towards the average connectivity map of all subjects' first replicate. Prediction performance of the second replication correlation map is evaluated by Mean Squared Error (MSE) criteria. Results: By the employment of seed-based correlation analysis and choosing precentral gyrus as the ROI over 21 subjects in the study, on average MSE for raw, mean and shrinkage estimator were 0.2169, 0.1118, and 0.1103, respectively. Also, percent reduction of MSE for shrinkage and mean estimator in comparison with raw estimator is 49.14 and 48.45, respectively. Conclusion: Shrinkage approach has the positive effect on the prediction of functional connectivity. When data has a large between session variability, prediction of connectivity map can be improved by shrinking towards population mean

The prevalence of violence and its association with mental health among the Iranian population in one year after the outbreak of COVID-19 disease

Abstract Background COVID-19 spread between and across nearly every country, with considerable negative health consequences. The current study aimed to determine the prevalence of violence and its association with mental health among Iranians older than 15 years in 2020. Methods Data was collected through National Mental Health Survey on 24,584 Iranians older than 15 years in 2020. were analyzed to determine the prevalence of violence and its association with mental health. Multi-stage sampling method was used, and data on demographic characteristics and domestic-social violence and mental health (GHQ-28) were collected. Data analysis was administered using descriptive statistics and a chi-square test at a 95% level. Results The mean age of participants was 44.18 ± 16.4 years. The overall prevalence of domestic and social violence was 11.4% and 5.5%, respectively. Verbal violence was the most common type; with 61.8% and 66.8% for domestic and social violence, respectively. A suspected case of mental disorder, female gender, being younger than 25 years, living apart together, unemployment, low education, and history of COVID-19 infection presented a significant association with domestic and social violence (p > 0.05). Conclusion In comparison to the previous study in 2015, the prevalence of violence has increased. Therefore, domestic and social violence are the social concerns of Iranian society, indicating the necessity of appropriate interventions, particularly for those suspected of mental disorders and young women with low education levels