Participation in Cervical Screening by Older Asian and Middle Eastern Migrants in New South Wales, Australia

Background: There is little information on the detailed patterns of cervical screening uptake in older migrant women in Australia. This linkage study was performed to assess cervical screen-ing participation in older migrants.Methods: We linked year 2000-2001 records for 14,228 Middle Eastern/Asian-born women 40-64 years of age, and an age and area matched random sample of 13,939 Australian-born wom-en in the New South Wales (NSW) Admitted Patients Data Collection (APDC), which records country of birth, to screening register records. Screening behaviour after 1st July 2001 was as-sessed in women without a recorded prior cervical abnormalityResults: Compared to Australian-born women, women born in South Central Asia had a low-er screening participation rate (odds ratio for being screened at least once within a 3 year period 0.78, 95% CI 0.70-0.88). However, participation appeared relatively higher (17%-25%) in women born in the Middle East or other parts of Asia. Screening increased with increasing socioeconom-ic status (SES) in Australian-born women, but this trend was not observed in the migrant wom-en. When we broadly corrected for hysterectomy, the apparent excess of screening in women from the Middle East and other parts of Asia was substantially eliminated and in contrast, the apparent deficiency in screening in women from South Central Asia increased.Conclusions: Older women from the Middle East, and North East and South East Asian countries appeared to have similar overall screening participation to that of Australian-born women. Women from South Central Asia appeared less likely than Australian-born women to participate in cervical screening at the recommended interval

Learning Style and Academic Achievement among Students at Tabriz University of Medical Sciences, Iran

Background: Variations in learning styles among students could explain many differences in students’ acquisition of knowledge. This study examined the association between learning styles and academic achievement among students at Tabriz University of Medical Sciences in the northwest of Iran. Methods: This research is part of a longitudinal study entitled, "Health and Lifestyle of University Students" among undergraduate, medical, dentistry, and pharmacy students at Tabriz University of Medical Sciences who entered the university in October 2014. A self-administered questionnaire that consisted of general information and Kolb’s learning style was completed by these students during the first eight weeks of their first semester. Academic achievement was assessed using grade point average (GPA) in the following semesters (1 and 2) of the academic year. Results: A total of 452 students were included in this study with a mean age of 19.16 ±1.03. The most prevalent learning style was convergent and the second most common was accommodative.The average GPA of the students was 15.74 ± 1.57 out of a possible 20. The results of a multivariate regression showed that the effect of learning style on academic achievement, in the presence of other variables, was not statistically significant. Sex was able to predict academic progression (β = 0.188, P = 0.001). In addition, GPA was higher among dentistry students(β = 0.128, P = 0.012) and lower among nursing and medical students (β = =-0.211, P = 0.001;β = -0.127, P = 0.015 respectively). Conclusion: Although students’ academic achievement was correlated with their learning style, the popularity of convergent and accommodative styles should be considered in that acknowledging the prevailing learning styles of students could promote academic achievement

Prevalence of Chronic Bronchitis in the Northwest of Iran: Results of the Pilot Phase of the Azar Cohort Study

Background and aims: Although chronic bronchitis is markedly under-diagnosed in the general population, it has a significant impact on the health status and the well-being of patients as well as healthcare resource consumption. This study aimed to determine the prevalence of chronic bronchitis and its correlates in the northwest of Iran. Methods: In 2014, all residents aged 35 and over in Khameneh city, East Azerbaijan, were invited to participate in the pilot phase of the Azar cohort study. The respiratory symptoms questionnaires were filled out by two trained general practitioners. Participants with a cough and phlegm on most days during at least three successive months in the previous two years were classified as chronic bronchitis group. Chi-square test was used to compare the chronic bronchitis and smoking status between males and females. Results: A total of 1036 participants were interviewed, 1006 of whom had completed a respiratory questionnaire, from them 544 (54.1%) were females, and 462 (45.9%) were males. The mean age was 52.5 ± 10.5 years. The prevalence of smoking was 16.2%. According to the chronic bronchitis definition, 24 (2.4%) subjects were classified with chronic bronchitis, and the prevalence was higher in the males (4.1%) than that in the females (0.9%). The prevalence was higher among the active smokers and ex-smokers compared to non- smokers (8.6% and 4.1% vs. 0.8%). The prevalence of cigarette smoking was 16.2% and it was higher in the males than that in the females (33.5% vs. 1.5%). Conclusion: the prevalence of chronic bronchitis in the population of the region under study was relatively low in comparison to the other parts of Iran and its prevalence was higher in the males than that in the females

The validity of self-reported drug use with urine test: results from the pilot phase of Azar cohort study

Background: The present study aimed at assessing the validity of self-reported drug use in people aged 35 and older in a pilot phase of a population-based cohort study. Methods: A total of 1038 adults over 35 years old in Khamene city in East Azerbaijan province were recruited for the pilot phase of Azar cohort; a province-level of a nationwide PERSIAN cohort study completing a questionnaire and providing biological samples from October to December 2014. Information about the history and duration of smoking tobacco, using drug and medication were obtained by the physician. The validity of the drug use was assessed through comparing the questionnaire response with three urine strip tests for the detection of morphine, amphetamine and methamphetamine among 259 randomly selected subjects. Results: The prevalence of drug use according to self-report was 2.6% (95% CI: 1.7%-3.8%).One-step drug test as the gold standard for the use of drug self-reported demonstrated a sensitivity(95% CI) and specificity 15% (10-22) and 99.7% (98.9%-99.9%) respectively. All participants with positive self-report were male; however, in the urine analysis drug test, it was positive for 7out of 68 randomly selected women. Conclusion: The validity of self-reported drug use in this population was low; therefore, the self reported use of the drug should be used with caution in this population. It is recommended to use alternative techniques to improve the validity of data using the self-report procedure

Effect of Zinc Supplementation on Growth of Low Birth Weight Infants Aged 1–6 Mo in Ardabil, Iran

Objective To assess the effect of zinc supplementation on growth of low birth weight (LBW) infants aged 1–6 mo. Methods LBW infants were enrolled at birth and randomly assigned to receive 5 mg elemental Zn per day (n=45) or placebo (n=45) until 6 mo of age. They were followed monthly for information on compliance; anthropometric measurements were performed monthly. Results After randomization, 5 infants from zinc group and 9 from placebo group were excluded. At 6 mo of age, significantly greater weight gains were observed in the zinc than in the placebo group (4995±741g in zinc group vs. 3896±865 g in placebo group, p = 0.036). Length gain during the study period improved in zinc group (16.9±8.2 cm vs. 15.1±4.1 cm, p = 0.039); after zinc supplementation head circumference were increased (8.7±1.4 cm vs.7.4± 1.5 cm p<0.001). In male infants, total weight gain and height and head circumference gain were higher in the zinc than in the placebo group. However, only head circumference change was statistically significant. A similar trend was observed among female infants, but these differences were not statistically significant. There was no significant relation between breast-feeding status and the main outcome variables. Conclusions Infants in the present study showed improve¬ments in growth rate, but more studies are required in this field to confirm this fact

Nationwide Prevalence of Diabetes and Prediabetes and Associated Risk Factors Among Iranian Adults: Analysis of Data from PERSIAN Cohort Study

Introduction Over the past decades prevalence of diabetes has increased in Iran and other countries. This study aimed to update the prevalence of diabetes and prediabetes in Iran and to determine associated sociodemographic risk factors, as well as diabetes awareness and control. Methods This is a nationally representative cross-sectional survey that included 163,770 Iranian adults aged 35-70 years, from different ethnic backgrounds, between 2014 and 2020. Diabetes was diagnosed at fasting blood sugar of >= 6.99 mmol/L (126 mg/dL), or receiving blood glucose-lowering treatment. Multivariable logistic regression was applied to detect determinants associated with prevalence of diabetes and prediabetes, as well as predictors of diabetes awareness and glycemic control. Results Sex- and age-standardized prevalence of diabetes and prediabetes was 15.0% (95% CI 12.6-17.3) and 25.4% (18.6-32.1), respectively. Among patients with diabetes, 79.6% (76.2-82.9) were aware of their diabetes. Glycemic control was achieved in 41.2% (37.5-44.8) of patients who received treatment. Older age, obesity, high waist to hip ratio (WHR), and specific ethnic background were associated with a significant risk of diabetes and prediabetes. Higher awareness of diabetes was observed in older patients, married individuals, those with high WHR, and individuals with high wealth score. Moreover, glycemic control was significantly better in women, obese individuals, those with high physical activity, educational attainment, and specific ethnic background. Conclusions The prevalence of diabetes and prediabetes is increasing at an alarming rate in Iranian adults. High proportion of uncontrolled patients require particular initiatives to be integrated in the health care system

This is a thesis entitled:"Cervical screening in New South Wales and its relationship to country of birth and socioeconomic status

Background and objective: The National Cervical Screening Program in Australia recommends 2 yearly screening in women 18-20 to 69 years. Since the introduction of organised screening in Australia in 1991, the incidence and mortality rates of cervical cancer among women over 20 years of age have fallen remarkably. However it is not known that this decline has been uniform in all ethnic groups and whether all women have shared, or are sharing, equally in the benefits of an organised approach to cervical screening. The aim of this PhD project was to examine cervical screening and its relationship to country of birth and socioeconomic status in New South Wales. Method and materials: I examined cervical cancer screening in NSW by country of birth and socioeconomic status (SES) using three approaches. First I compared trends in incidence and mortality of cervical cancer by birthplace before and after introduction of organised screening program in 1991. Second I examined screening behaviour in women born in Middle Eastern and Asian countries, for whom cultural factors may be important in determining participation in cervical screening. Two linkage studies were done to obtain information on birthplace and cervical screening behaviour because the Pap Test Register (PTR) in NSW does not collect information on country of birth. For the first, I linked data from cohorts of women from the New South Wales (NSW) Midwives Data (MDC) to the PTR and, for the second, I linked data from cohorts of women from the Admitted Patients’ Data Collection (APDC) to the PTR. Third I undertook an analysis of the use of liquid based cytology (LBC) in cervical screening in NSW women in relation to a number of factors that may influence the use of this new technology, including SES and % of Non English Speaking Background as an indicator of country of birth. Results: Organised cervical screening, introduced from 1991, may have been effective in reducing the incidence and mortality of the cervical cancer in the whole population of women 20+ years of age in NSW, although there was only weak evidence for a fall in mortality in women 50+ years of age. Women born in Asia, the Middle East and North Africa appeared to have shared in these reductions to a similar degree to Australian-born women. Women of reproductive age (40 years of age born in Asia, but not those born in the Middle East, had lower screening rates than Australian born women of this age, and their screening rates were again largely uninfluenced by SES. In both age groups, the screening rates were least in women born in South Central Asia. The disparities were less in women selected for study following an episode of hospital care. Australia’s cervical screening program is based on the use of conventional cytology and women must pay for adjunctive LBC. LBC uptake in NSW is high (~30% of all women screened) but steady. LBC uptake varies with age in a similar way to screening participation. LBC uptake is most strongly determined by whether or not it was taken up in the preceding cervical screen and also depends on the preceding smear result, age, socioeconomic status, area of residence, proportion of non-English speaking background people in the area and the type of health practitioner who takes the smear. Conclusions: Incidence of and mortality from cervical cancer fell after the introduction of organised cervical screening in NSW. While this fall was shared by migrant women from Asia and the Middle East, their participation in cervical screening at the recommended interval is less than that in Australian women. The disparity in women from South Central Asia is particularly great. Language and cultural factors are probably the main causes of these differences; SES appears not to be important. Women’s contact with the health service for reasons other than cervical screening may reduce these barriers. Use of adjunctive LBC, while strongly determined by a range of other factors, including in particular the most recent cytology result and SES, appeared also to be less in women of non-English speaking background than in other women in NSW. The persisting disparities in cervical screening uptake by country of birth in NSW, particularly in women from South Central Asia, present a challenge to cervical screening services and for research

Impact of organised cervical screening on cervical cancer incidence and mortality in migrant women in Australia

Abstract Background Organised cervical screening, introduced in 1991, appears to have reduced rates of cervical cancer incidence and mortality in women in Australia. This study aimed to assess whether cervical cancer rates in migrant women in the state of New South Wales (NSW) showed a similar pattern of change to that in Australian-born women after 1991. Methods Data from the NSW Central Cancer Registry were obtained for females 15+ years diagnosed with invasive cervical cancer from 1973 to 2008 (N=11,485). We used joinpoint regression to assess annual percent changes (APC) in cervical cancer incidence and mortality before and after the introduction of organised cervical screening in 1991. Results APC in incidence fell more rapidly after than before 1991 (p Conclusions Like Australian-born women, most, but not all, groups of migrant women experienced an increased rate of fall in incidence of cervical cancer following introduction of organised cervical screening in 1991. An apparent rise in mortality in women in a ‘Rest of the World’ category might be explained by a recent rise in migration from countries with high cervical cancer incidence and mortality rates.</p

The association between self-care and quality of life in hypertensive patients: findings from the Azar cohort study in the North West of Iran

Background: Hypertension affects the quality of life of patients and their caregivers. The aim of this study was to assess the knowledge and self-care behaviors and health-related quality of life (HRQOL) among hypertensive people Methods: All people aged 35 years and older with hypertension were invited to participate in this study. Information on self-care behavior for hypertension (H-scale), and health-related quality of life (WHOHRQOL-BRFF) were completed by trained interviewer. Data analysis was done using SPSS 16.Results: The median age of hypertensive patients was 62.5(25th to 75th percentile: 55 to 72 years), the correlation between quality of life and overall self-care scores was not significant(r =-0.048, P =0.520). Physical activity was the only significant predictor for quality of life,showing that the quality of life of hypertensive people increased by 3.371 units per day of being physically active in the cohort study (β =0.223, P<0.01). The only significant predictor of quality of life among the elderly was medication use (β =-0.572, P<0.001). Quality of life of participants decreased 3.456 units per day as a result of medication adherence Conclusion: No association was observed between self-care and HRQOL total score in hypertensive patients in the study. Among the self-care domains, only medication adherence and physical activity had significant association with social health. There was a reverse association between smoking and HRQOL