Epidemiology of Omphalocele and Gastroschisis in Glasgow

Omphalocele and gastroschisis (O&G) are relatively common congenital anomalies. Omphalocele (or exomphalos) is defined as herniation of some intra-abdominal contents through the umbilical ring in to the cord. This defect has a membrane over it, and may contain abdominal organs. Gastroschisis is defined as a full-thickness defect in the abdominal wall without herniation or a covering membrane. The aetiology of omphalocele and gastroschisis is still in doubt. Epidemiological studies suggest that the cause of these defects might be multifactorial, but hypotheses relating to gastroschisis have focused more on environmental factors. This study reports descriptive and case-control epidemiological findings from an investigation of abdominal wall defects in Greater Glasgow Health Board, Scotland, United Kingdom between the birth years 1980 and 1993. All registered cases (live births, stillbirths and induced abortions following prenatal diagnosis) of O&G, primary and secondary were included. The aims of the study were, firstly, to establish the epidemiology of O&G in Glasgow; secondly, to determine the extent of any association between the prevalence of O&G and a number of the hypothetical risk factors, particularly maternal age, cigarette smoking, and socio-economic status; thirdly, to assess the extent and epidemiological impact of prenatal diagnosis on the prevalence of O&G. During 1980-1993, 73 cases of omphalocele (4.1 per 10,000 births) and 24 cases of gastroschisis (1.3 per 10,000 births) were registered. The pregnancy prevalence of gastroschisis (but not omphalocele) showed a significantly increasing trend over time. The prevalence rate of omphalocele in Glasgow appears to be the highest in the United Kingdom. The male to female ratio was 2.0 for gastroschisis and 0.8 for omphalocele. The risk of gastroschisis was inversely correlated maternal age (chi-square= 8.8; p<0.003). The highest rate was found for maternal age under 20. There was a greatly increased risk for young mothers of isolated gastroschisis (under 20 years) compared to those aged over 20 years; these young mothers were 7.8 times more at risk (95% CI= 3.08 to 19.79). In the case-control study, age remained a significant risk factor in the multivariate analysis. The prevalence of the two malformations showed no significant seasonal variation, nor a strong and consistent association with socio-economic status, as determined by postcode of maternal residence. Both defects were associated with early birth and low birth weight, an effect that was more pronounced for multiple malformed than for isolated cases. Isolated cases of gastroschisis had significantly lower birth weights than isolated cases of omphalocele. There was a significant association of omphalocele with other malformations (p< 0.0001). The most common abnormalities among O&G were musculoskeletal anomalies (26%), genital and urinary abnormalities (15%), neural tube defects (13%), and GI in the upper alimentary tract (13%). Omphalocele was also associated with trisomies 13, 18 and Beckwith-Wiedemann syndrome. The percentage of smokers in isolated cases of gastroschisis was significantly higher than that in associated cases (Fisher's exact test, two tailed = 0.01). In the case-control study, after logistic regression smoking remained a significant risk factor among gastroschisis cases compared to non-malformed controls (RR= 3.8, 95% CI =1.16 to 12.45) and malformed+ non-malformed controls (RR= 2, 95% CI =1.12 to 3.4). The length of survival during first week and first year was significantly longer among infants with gastroschisis than omphalocele (p=0.005 up to first week; p=0.001 up to one year). Perinatal deaths were more frequent among omphalocele cases than gastroschisis (p=0.09). While the proportion of gastroschisis prenatally diagnosed significantly increased fi-om 1980-1986 to 1987-1993 (Fisher's exact test=0.01), the proportion terminated did not. Although the proportion of omphalocele prenatally diagnosed non-significantly increased in that time, the proportion of prenatally diagnosed cases that were terminated showed a non-significant decrease. Although the numbers of cases are small, this study has highlighted several epidemiological features of O&G that could be important aetiologically. A comprehensive public health strategy, including antenatal screening, is probably required to prevent these anomalies

Challenges in the design, conduct, analysis, and reporting in randomized clinical trial studies : A systematic review

This study was funded by Iran University of Medical Sciences (grant number 97-01-27-33259).Peer reviewedPublisher PD

Premarital addiction test and its outcomes

Introduction: Although many people around the world are dealing with addiction, still no method that can detect and permanently treat it has been found. Premarital addiction test is one of the factors of great importance in this field. An erroneous detection in this test affects the psychosocial aspects and marital decisions of the individual. The purpose of this study was to determine the effectiveness of the health system in premarital addiction tests and its psychosocial effects. Method: This interpretive qualitative study was performed using content analysis. Data were collected from 6 focus group discussions and 2 semi-structured individual interviews with couples and health care personnel. All interviews were tape-recorded and transcribed verbatim, and themes were extracted using content analysis method. Results: Qualitative content analysis determined the 2 themes of lack of professional adequacy and consequence of marriage. Conclusion: Premarital addiction test is one of the health services provided by the health care system. An incorrect diagnosis not only has a considerable impact on different aspects of individuals’ life, but is also closely related to the psychosocial concept of dignity. Therefore, the professional competence of the staff in providing these services is very important and necessary. Keywords: Addiction, Marriage, Health syste

Survey of Effective Factors in the Event of Neuropathy in Type 2 Diabetic Patients

Introduction: Diabetic neuropathy is a common and sever complication of diabetes that its progression can lead to disability and even amputation in diabetic patients. The aim of this study was to determine the effective factors in the event of neuropathy and to assess the cumulative incidence of neuropathy in patients with type 2 diabetes. Methods: In this cohort study, all patients with type 2 diabetes who were registered at Fereydunshahr Diabetes Clinic, Isfahan, Iran, were selected by census method. They were followed up for diagnosis of neuropathy since 2006 until March 2016. To investigate the quantitative and qualitative effective factors in the event of neuropathy, one-sample t-test and chi-square test, respectively, were used. And for modeling of effective factors in the event of neuropathy, logistic regression was used. All statistics were analyzed by R software (version 3.2.3) and P values less than 0.05 were considered significant. Results: At the end of 10-year follow-up, cumulative incidence and prevalence of neuropathy were estimated 31% and 41.6%, respectively. After removal of confounders in the final model, variables such as age, ethnicity, family history of diabetes, duration of diabetes, FBS and HDL levels were identified as effective factors in the event of neuropathy (P<0.05). Conclusion: Low levels of HDL and poor control of FBS level are modifiable risk factors for diabetic neuropathy. But non-modifiable risk factors include Persian ethnicity, family history of diabetes, age and increase of diabetes duration. For this reason, in order to increase the HDL level and to decrease FBS level, education is recommended particularly in elderly patients with a family history of diabetes

Survey of Effective Factors in the Event of Neuropathy in Type 2 Diabetic Patients

Introduction: Diabetic neuropathy is a common and sever complication of diabetes that its progression can lead to disability and even amputation in diabetic patients. The aim of this study was to determine the effective factors in the event of neuropathy and to assess the cumulative incidence of neuropathy in patients with type 2 diabetes. Methods: In this cohort study, all patients with type 2 diabetes who were registered at Fereydunshahr Diabetes Clinic, Isfahan, Iran, were selected by census method. They were followed up for diagnosis of neuropathy since 2006 until March 2016. To investigate the quantitative and qualitative effective factors in the event of neuropathy, one-sample t-test and chi-square test, respectively, were used. And for modeling of effective factors in the event of neuropathy, logistic regression was used. All statistics were analyzed by R software (version 3.2.3) and P values less than 0.05 were considered significant. Results: At the end of 10-year follow-up, cumulative incidence and prevalence of neuropathy were estimated 31% and 41.6%, respectively. After removal of confounders in the final model, variables such as age, ethnicity, family history of diabetes, duration of diabetes, FBS and HDL levels were identified as effective factors in the event of neuropathy (P<0.05). Conclusion: Low levels of HDL and poor control of FBS level are modifiable risk factors for diabetic neuropathy. But non-modifiable risk factors include Persian ethnicity, family history of diabetes, age and increase of diabetes duration. For this reason, in order to increase the HDL level and to decrease FBS level, education is recommended particularly in elderly patients with a family history of diabetes

Sexual Risk Behaviors and Condom Use Barriers in Iranian Men with Substance Use Disorders

Background: We aimed to investigate risky sexual behaviors (RSBs) and condom use barriers in Iranian men with substance use disorders (SUDs).Methods: Of the total 1800 outpatient drug free (ODF) and methadone maintenance treatment program (MMTP) active centers in Tehran, Iran, six were selected to participate in the current study. Data were collected (n = 300 men) using three questionnaires including a demographic questionnaire, the Risky Sexual Behavior Questionnaire (RSBQ), and the Condom Barriers Scale (CBS). The statistical software R, analysis of variance post hoc and multivariate analysis of variance (MANOVA) logistic regression tests were used in data analysis.Findings: The majority, (n = 194, 64.7%) reported at least one lifetime episode of RSBs. Compared to married participants (23.1%), 88.5% of single and 87.0% of divorced men had a history of RSB. Generally, the lowest and highest subscale scores of the CBS were related to sexual experience (2.60 ± 0.71) and access/availability structure (3.77 ± 0.54), respectively. The results of MANOVA analysis showed that there was a statistically significant difference between the CSB subscales based on the participants' education and marital status (P < 0.001). Only the partner barrier subscale had a significant negative relationship (P = 0.003) with RSB.Conclusion: Sexual dynamic of Iranian men with SUDs is different. Barriers to condom use seem to be socio-culturally determined. Culturally acceptable strategies need to be utilized in Iranian clinical settings reaching beyond simply condom accessibility for this at risk population

The Relationship of Different Dimensions of Social Support with Older Adults’ Quality Of Life in the 8th District of Tehran in 2013

Background and Objectives: Older adults’ quality of life and factors affecting it such as social support are a major concern because they are among vulnerable groups and should receive different supports to ensure their quality of life. This study aimed to determine the relationship between social support and quality of life in the older adults living in the 8th district of Tehran. Materials and Methods: This cross-sectional study was conducted on 240 older adults living in the 8th district of Tehran. Participants were selected via cluster sampling method. We used LEIPAD quality of life questionnaire to measure the quality of life and Norbeck Social Support Questionnaire to evaluate social support. Data were analyzed in SPSS-20 using Mann-Whitney test, Kruskal-Wallis test and Spearman’s correlation. Results: The mean score of quality life was 68.9 of 93 in men and 97.6 of 93 in women and this difference was not statistically significant (P=0.404). Education level had a significant effect on both quality of life and social support (P<0.05). Furthermore, there was a significant relationship between social support and some dimensions of the quality of life, e.g. physical, social and cognitive function (P<0.05). Conclusion: Different dimensions of social support were higher in men than in women. Although the relationship between dimensions of social support on the overall quality of life score was not statistically significant, the significant relationship between dimensions of social support and dimensions of quality of life show that social support can impact quality of life

Mumps Meningoencephalitis In Pediatric Ward Of Rasoolakram Hospital In Tehran, Iran, 1999-2000

To determine the frequency of mumps infection in children hospitalized with aseptic meningoencephalitis (ME), as well as its correlation with parotiditis, this case-series study was conducted in the pediatric ward of Rasool Akram Hospital in Tehran, Iran, from 1999 to 2001. The blood samples of these patients were tested for specific IgM antibody for mumps by Elisa method. The results of this study showed that 62.7% of children with ME were IgM positive, and the remaining (37.3%) were IgM negative. There was a significant correlation between positive IgM and the presence of parotiditis. However, no correlation was noted between age, sex and season with IGM positivity except for CSF changes (aseptic meningitis) between the two groups. It can be concluded that the presence of neural symptoms (especially aseptic meningitis) in children less than 7 years of age with parotiditis could indicate mumps ME, especially in the spring. Due to a higher percentage of unvaccinated young persons <15yr old) in Iran, probably the incidence rate of mumps infection and its sequelae are higher compared with its incidence in developed countries before massive vaccination. Therefore with massive vaccination of Iranian young people (< 20yr old), the costs of! mumps infection and its sequelae will decrease

Sexual and reproductive health educational needs in engaged couples in Tehran in 2010

Performing needs assessment is an essential step for developing and designing sexual and reproductive health (SRH) educational programs. In Iran, there is little information about couples' SRH educational needs. This research aimed to describe engaged couples' SRH educational needs in Tehran in 2010. In a cross-sectional study, 450 engaged people participating in a premarital educational course were selected by randomized stratified sampling with two-gender strata. A questionnaire was developed as a new measurement tool to determine the need for education in the SRH field using a 5-point Likert scale. A high percentage of both men (44.8 %) and women (56.6 %) mentioned a high or very high need for education in SRH, and the mean reported need for SRH education was significantly higher in women (42.29 +/- 10.35) than men (39.74 +/- 10.84) (P = 0.02). "Healthy sexual relationships" was the most important topic for both men and women, with 51 % of men and 62 % of women reporting a high to very high need. Our findings demonstrate that engaged Iranian couples wish to receive information about SRH matters, particularly in topics related to sexuality. The results suggest a need for developing comprehensive and culturally sensitive marital education for engaged Iranian couples