Ali Delpisheh

Trends of fatal road traffic injuries in Iran (2004-2011).

Road traffic injuries (RTIs) leading to death need the most essential concern for low, middle and high income societies. Mortality rate due to traffic injuries is considerable in Iran particularly during the last decade along with the industrialization process. The present study considered the trend of traffic injuries leading to death in Iran for a period of seven-years which started from March 2004 to March 2011. The formal merged Iranian database provided by the Ministry of Roads, the Legal Medicine Organization, the Traffic Police (NAJA), and the Ministry of Health covering 146, 269 deaths due to traffic injuries between 2004 and 2011 was analyzed. The time series method was carried out to determine the death trends of RTIs in the whole country. The Poisson regression model was used to estimate the changes in the frequency of events over time adjusting for associated known risk factors. The SARIMA (0, 1, 1)×(0, 1, 1)12 model was used for fitting to the time series of death rate. The death rate due to RTIs in Iran has statistically declined from 38 in 2004 to 31 per 100,000 populations in 2011. Based on the number of vehicles, the mortality rate has also declined from 38 to 12 cases per 10,000 vehicles from 2004 to 2011 respectively. However, the mortality rate was increased from 51 to 65 cases per 1000 accidents from 2004 to March 2011 respectively. Despite minor variations in mortality trends of RTIs in Iran according to different criteria, an annual average of 21,000 deaths is considerable and needs serious attentions. Modification of traffic laws, enhancement of police controls, improving transport infrastructure, holding education courses for drivers and providing optimal healthcare services are recommended.

Dose response association of pregnancy cigarette smoke exposure, childhood stature, overweight and obesity

BACKGROUND The combined dose response effects of pregnancy cigarette smoke exposure on childhood overweight, obesity and short stature have not been reported. METHOD A community based cross-sectional survey of 3038 children aged 5-11 years from 15 primary schools in Merseyside, UK. Self-completed parental questionnaires were used for family characteristics, socio-economic status and parental smoking practices. Children were measured for height and weight and z-scores calculated for parental smoking categories. RESULTS Of 689 (34.0%) mothers who smoked during pregnancy 50.5% smoked ten or more cigarettes daily (heavy smokers). Children of maternal non-smokers had prevalence estimates for overweight, obesity and short stature of 25, 9.6 and 3.2%, respectively. Prevalence estimates were higher in children of mothers who were heavy smokers during pregnancy, 31.5% (P = 0.001), 15.6% (P < 0.001) and 5.5% (P = 0.001), respectively. Mean height for age z-scores was lower among heavy maternal (P < 0.001) and paternal smokers (P < 0.01) compared to non-smokers. Childhood overweight, obesity or short stature were all associated with heavy maternal smoking during pregnancy (all P < 0.001). Mean body mass index (BMI) z-scores were higher in boys of mothers who smoked (P = 0.043). The adjusted odds ratio for short stature in children of heavy maternal smokers was 2.76 (95% CI 1.21-6.33) and 4.28 (1.37-13.37) if both parents were heavy smokers. The adjusted OR for obesity in children of maternal smokers was 1.61(1.19-2.18). The population attributable risk for short stature was 8.8% (1.1-22.7) for heavy maternal smokers. CONCLUSION A dose-response association was observed between pregnancy smoking exposure, short stature and obesity.

Socio-economic status, smoking during pregnancy and birth outcomes: an analysis of cross-sectional community studies in Liverpool (1993–2001)

Objective: To assess the influence of socio-economic status on pregnancy outcomes in smoking mothers. Study design: Retrospective analysis. Methods: Parent-completed questionnaires addressing pregnancy smoking patterns and birth outcomes. Were distributed via children aged 5–11 years attending 10 primary schools in Merseyside. Data from three communitybased cross-sectional surveys undertaken in 1993, 1998 and 2001 were analysed. Townsend score was used as an indicator of household socioeconomic status. Results: 82.2 percent (n = 3730) of respondents were classified as low (disadvantaged) socio-economic status. One-third of mothers smoked during pregnancy and this proportion was significantly higher among disadvantaged than advantaged categories (37.7% versus 14.6%; p < 0.001). The logistic regression analysis showed that only maternal smoking during preg-nancy was a significant risk factor for adverse birth outcomes when socioeconomic variables were controlled. Conclusion: Birth outcomes were worse in babies of smoking mothers during pregnancy independent of households socio-economic status.

Prevalence of Depression among University Students: A Systematic Review and Meta-Analysis Study

Introduction. Depression is one of the four major diseases in the world and is the most common cause of disability from diseases. The aim of this study is to estimate the prevalence of depression among Iranian university students using meta-analysis method. Materials and Methods. Keyword depression was searched in electronic databases such as PubMed, Scopus, MAGIran, Medlib, and SID. Data was analyzed using meta-analysis (random-effects model). Heterogeneity of studies was assessed using the I 2 index. Data was analyzed using STATA software Ver.10. Results. In 35 studies conducted in Iran from 1995 to 2012 with sample size of 9743, prevalence of depression in the university students was estimated to be 33% (95% CI: 32–34). The prevalence of depression among boys was estimated to be 28% (95% CI: 26–30), among girls 23% (95% CI: 22–24), single students 39% (95% CI: 37–41), and married students 20% (95% CI: 17–24). Metaregression model showed that the trend of depression among Iranian students was flat. Conclusions. On the whole, depression is common in university students with no preponderance between males and females and in single students is higher than married ones.

Pregnancy smoking and birth outcomes.

This review summarizes the epidemiology and consequences of maternal smoking in pregnancy, with emphasis on the adverse effects on birth outcomes. In developed countries, approximately 15%, and in developing countries, approximately 8% of women smoke cigarettes, and adolescents and women from lower socioeconomic groups are more likely than other women to smoke while pregnant. Maternal smoking during pregnancy is the largest modifiable risk factor for intrauterine growth restriction. A meta-analysis of recent studies showed that the pooled estimate for reduction of mean birthweight was 174 g (95% confidence limits 132–220 g). Other studies confirm a weaker association between maternal smoking and preterm birth. The population attributable risk of low birthweight due to maternal smoking in the UK is estimated to be 29–39%. Tobacco smoke toxins damage the placenta and may lead to placental abruption, abortion or placenta praevia. Infants of mothers who smoke in pregnancy are at an increased risk of respiratory complications including asthma, obesity and, possibly, behavioral disorders. These effects may be dose-related, as there is good evidence that mean birthweight decrements are greater with increased numbers of cigarettes smoked during pregnancy. Cotinine is a useful indicator of tobacco smoke exposure in pregnant women and higher levels in body fluids have been related to lower birthweights. Maternal genetic polymorphisms of the cytochrome P (CYP)450 and glutathione-S-transferase (GST) subfamilies of metabolic genes influence the magnitude of the effect of nicotine exposure on birth outcomes through their influence on nicotine metabolism. Greatly increased risk of cigarette smoke-induced diseases, including low birthweight, has been found in individuals with susceptible genotypes. Interventions to control maternal smoking are also considered.

Smoking status in Iranian male adolescents: A cross-sectional study and a meta-analysis

The present study aimed to estimate the prevalence of smoking status and its associated factors in Iranian adolescents and a meta-analysis of recent cross-sectional studies in order to estimate the corresponding prevalence for all Iranian adolescents. In a cross-sectional study, 1064 male high school students in Zanjan city (northwest of Iran) were recruited. A self-administered questionnaire was used for smoking status and associated factors. Through the meta-analysis, all relevant published studies were reviewed. Almost one-third of adolescents (34.2%, n=354) have experienced smoking either experimentally (23.4%, n=242), or regularly (10.8%, n=112). Multivariate analysis showed that older age (OR=1.20; 95% CI: 1.05-1.37), risky behaviors (OR=1.83; 1.25-2.68), Tramadol medication (OR=2.19; 1.54-3.11), low self-esteem (OR=1.07; 1.03-1.11), positive attitude toward smoking (OR=1.15; 1.09-1.21), positive thinking about smoking (OR=1.07; 1.01-1.14) and having smoker friends (OR=1.94; 1.36-2.77) were significantly associated with cigarette smoking in adolescents. Meta-analysis results showed that 7% of Iranian adolescents are regular smokers and 27% are experimenters. Increasing prevalence of smoking in Iranian adolescents is a major concern for public health. Controlling risky behaviors and increasing health education are recommended.

Anxiety as a consequence of modern dietary pattern in adults in Tehran—Iran

Food intake patterns in relation to mental health have already been revealed. To investigate the relationship between processed food consumption behavior and anxiety disorder, a cross sectional study was conducted. Overall, 1782 young adults aged 18-35 years were randomly selected using cluster sampling method from 22 districts of Tehran-Iran in 2011. Diet assessment was done using a 24 hour recall questionnaire in two times with a week interval. Anxiety level was determined using the validated Speilburger test (Persian version). A proportional odds regression model was used to assess the effect of processed food consumption on anxiety variables. A significant statistical difference was found between men and women in terms of processed food consumption (p<0.001). Adjusting for age, total calorie intake, gender, body mass index, socioeconomic status, and history of sedative drug consumption as well as mental health disorders, the proportional odds regression model showed a significant relationship between increased consumption of processed foods and anxiety (OR=4.73, 95% CI: 2.89-12.54 for state and OR=4.91, 95% CI: 2.88-13.99 for trait). Identification, modification and adjusting incorrect food patterns in the community could be considered as valuable steps to turn down nutritional-based health difficulties.

Prenatal smoking exposure and asymmetric fetal growth restriction.

Background: Prenatal smoking exposure causes intrauterine fetal growth restriction (IUGR), although its effects on fetal proportionality are less clearly defined. Aim: The present study assessed fetal proportionality in babies with IUGR using maternal salivary cotinine to indicate maternal smoking exposure. Subjects and methods: A case-control study at the Liverpool Womens Hospital, UK of babies with asymmetric and symmetric IUGR and non-growth restricted babies was carried out. Results: 270 white women including 90 IUGR cases and 180 controls were enrolled. Asymmetry presented in 52.2% of IUGR cases. Geometric mean maternal cotinine concentration was higher with asymmetric (p=0.002) than symmetric IUGR (p=0.07), when compared to controls. Maternal smoking exposure was independently associated with asymmetric IUGR (OR 2.4, 95% CI, 1.5–4.4, p≤0.001). Maternal anaemia was more frequent in babies with symmetric IUGR (OR 1.9, 1.3–3.4, p=0.002), but not in asymmetric babies. Rohrers index ranged between 1.64 and 2.25 for asymmetric infants and significantly decreased with increasing maternal cotinine concentration in IUGR babies. Increased cotinine was not associated with shortened gestational age in IUGR babies. Conclusions: Asymmetric IUGR occurred more frequently in heavy smokers. Stopping smoking even late in pregnancymay be beneficial for improved fetal outcomes. Symmetric IUGR was associated with maternal anaemia, highlighting the importance of prenatal nutritional status.

Trends of Postpartum Depression in Iran: A Systematic Review and Meta-Analysis

Background. Postpartum depression (PPD) is a serious mental health disorder affecting 13% of women in developed communities. The present study reviews available epidemiological publications on PPD-related aspects in Iranian women to help policy makers and health workers to design preventative strategies and further researches. Materials and Methods. A systematic review was constructed based on the computerized literature valid database. The 95% confidence intervals were calculated by random effects models. Metaregression was introduced to explore and explain heterogeneity between studies. Data manipulation and statistical analyses were performed using Stata 11. Results. Overall, 41 studies met the inclusion criteria. The pooled prevalence of PPD in Iran was 25.3% (95% CI: 22.7%–27.9%). Amongst subgroups of unwanted delivery, illiterate, housewives, and having history of depression the prevalence was 43.4% (35.6–51.1), 31.6% (18.1–45.0), 30.7% (25.2–36.3), and 45.2% (35.4–53.1), respectively. Conclusions. Interventions that would specifically target women with a prior history of depression, illiterates, housewives, or women with unwanted pregnancies could be helpful to decrease the prevalence of postpartum depression in Iran.

Anti-fungal resistance in candida isolated from oral and diaper rash candidiasis in neonates.

The purpose of the present study is to evaluate the sensitivity of Candida species isolated from oral candidiasis and diaper dermatitis infections in children. The children referring to private and public clinics in Ilam, Iran were exmined for oral candidiasis and diaper dermatitis. In this study, 248 oral candidiasis and diaper dermatitis samples were collected and cultured.Candida species were identified by using standard methods. Resistance and sensitivity to amphotericin B, nystatin, ketoconazole, fluconazole, itraconazole, clotrimazole, and posaconazole were determined using the CLSI M44-A standard disk diffusion method. From the 248 studied samples, 149 were positive for Candida, among which the Candida albicans was the most prevalent (64.4%). The resistance of different Candida species to nystatin, itraconazole, fluconazole, ketoconazole, clotrimazole, voriconazole, and posaconazole were 4, 43, 34.2, 34.9, 21.5, 6, and 6.7%, respectively. No resistance to amphotericin B was observed. Considering rather low resistance to nystatin, this drug is the best choice for oral candidiasis and diaper dermatitis.