Alarm of non-communicable disease in Iran: Kavar cohort profile, baseline and 18-month follow up results from a prospective population-based study in urban area

The PERSIAN Kavar cohort study (PKCS) aims to investigate the prevalence, trends, and relevant prognostic risk factors of non-communicable diseases in participants aged 35-70 years living in the urban area of Kavar County. Kavar County is located at the center of Fars province in the southwest of Iran. Overall, 5236 adults aged 35-70 years old were invited to participate in the PKCS. From whom, 4997 people comprising 2419 men and 2578 women met the inclusion criteria and were recruited in the study (participation rate: 95.4%). This study is aimed to follow participants for at least 10 years; it is designed to perform all procedures similar to the primary phase including biological sampling, laboratory tests, physical examinations, and collecting general, nutritional, and medical data at the 5th and 10th years of follow-up. In addition, participants are annually followed-up by phone to acquire data on the history of hospitalization, any major diagnosis or death. At the enrollment phase, trained interviewers were responsible for obtaining general, nutritional, and medical data utilizing a 482-item questionnaire. The results of the baseline phase of this study show that the overweight category was the most prevalent BMI category among the registered participants (n = 2005, 40.14%). Also, almost one-third of Kavar adult population suffered from metabolic syndrome at the baseline phase (n = 1664, 33.30%). The rate of eighteen-month follow-up response was 100% in the PKCS. Hypertension (n = 116, 2.32%), cardiovascular outcomes (n = 33, 0.66%), and diabetes (n = 32, 0.64%) were the most prevalent new-onset NCDs during eighteen months of follow-up in the participants.

Is Cam Morphology Found in Ancient and Medieval Populations in Addition to Modern Populations?

BACKGROUND

Cam morphology is thought to originate near puberty and reflects a response of the peripheral aspect of the proximal femoral physis to increased local load. Participation in particular sports activities has been associated with cam morphology in contemporary patient populations; however, it is unclear whether cam is a recent phenomenon. There are limited data regarding the frequency of its occurrence and the general deviations in femoral anatomy in different historical populations. Such information may help to understand the possible influence of lifestyle and diet on cam morphology.

QUESTIONS/PURPOSES

The purpose of this study was to evaluate femoral morphology in three historical populations. We asked: (1) Was cam morphology present in the three study populations, did those populations differ, and were there differences between sexes? (2) Were there differences in neck-shaft angle, version, or inclination between and among the examined populations?

METHODS

We examined 204 adult femurs from the Neolithic population from Iran (n = 37, 3000 BC to 1631 BC), medieval population from Poland (n = 135, 10th to 13th centuries), and contemporary Australian aborigines (n = 32, early 20th century), provided by the Open Research Scan Archive, Museum of the First Piasts at Lednica and the University of Wrocław, respectively. All three human populations represent different chronologic periods and lifestyles. All bones were scanned using CT and then measured on their three-dimensional (3-D) reconstructions in selected planes. Cam impingement was defined as an alpha angle > 55° measured on the inclination view. To evaluate the differences in anatomy between populations, we measured the true neck-shaft angle on the true AP view, apparent neck-shaft angle on the apparent AP view, the version angle on the version view, and the inclination angle on the inclination view. The prevalence of cam morphology and other anatomic parameters were compared among groups using chi-square test, one-way ANOVA with post hoc Tukey test, and paired t-test.

RESULTS

Cam morphology was present in 5% of the Neolithic population from Iran, in 7% of the medieval population from Poland, and 3% of the contemporary Australian aborigine femurs (OR Neolithic population from Iran/the medieval population from Poland 0.7 [95% CI 0.2 to 3.4]; p = 0.67; OR Neolithic population from Iran/contemporary Australian aborigines 1.8 [95% CI 0.2 to 20.5]; p = 0.65; OR the medieval population from Poland/contemporary Australian aborigines 2.5 [95% CI 0.3 to 20.1]; p = 0.40). There were differences in the presence of cam morphology between the sexes in the medieval population from Poland with both femurs (females: 1% [1 of 76]; males: 15% [9 of 59]; p = 0.002). There was a difference in true neck-shaft angle between the Neolithic population from Iran (121° ± 6°) and contemporary Australian aborigines (131° ± 5°; mean difference 10° [95% CI 7° to 13°]; p < 0.001) and between the medieval population from Poland (124° ± 5°) and the contemporary Australian aborigines (mean difference 7° [95% CI 5° to 9°]; p < 0.001). Apparent neck-shaft angle differed between the Neolithic population from Iran (126° ± 6°) and the contemporary Australian aborigines (134° ± 5°; mean difference 8° [95% CI 6° to 11°]; p < 0.001), and between the medieval population from Poland (126° ± 6°) and the contemporary Australian aborigines (mean difference 9° [95% CI 7° to 11°]; p < 0.001). Moreover, we observed a difference in the version angle between the Neolithic population from Iran (19° ± 7°) and the medieval population from Poland (12° ± 9°; mean difference 7° [95% CI 4° to 10°]; p < 0.001] and in the inclination angle between aforementioned groups (18° ± 7° versus 11° ± 8°; mean difference 7° [95% CI 5° to 10°]; p < 0.001).

CONCLUSION

This study found that cam morphology existed in historical populations at rates comparable with a contemporary population.

CLINICAL RELEVANCE

The presence of cam morphology in historical populations suggests that cam morphology can develop outside of the intense sports activity seen in modern adolescents. Further study will help elucidate the etiology of cam morphology, which may be useful in the development of preventive strategies.

Early and late manifestations of neuropathy due to HSPB1 mutation in the Jewish Iranian population

OBJECTIVE

Mutations in the HSPB1 gene are associated with a distal hereditary motor neuropathy type 2 (dHMN2) or Charcot-Marie-Tooth disease type 2F (CMT2F), usually with autosomal dominant inheritance. This study aimed to describe the phenotype of the HSPB1 c.407G>T (p.Arg136Leu) mutation at early and late stages of the disease course.

METHODS

We identified this mutation (previously reported in patients from Italy) in a heterozygous state, among 14 individuals from eight families of Jewish Iranian descent. The clinical, electrophysiological and ultrasonographic features were evaluated during early (less than 5 years, N = 9) or late disease course (N = 5).

RESULTS

The majority of subjects were males with a mean age at onset of 43.4 years (range 21-67). Common initial symptoms were gait imbalance, distal (often asymmetric) lower limb weakness and feet numbness. Neurological examination in early disease course showed distal lower extremity weakness in nearly all cases, and absent Achilles tendon reflex in about half. A minority had distal loss of pain, vibration or position sensation. These findings were more prevalent in late disease stage. Electrodiagnostic studies demonstrated a length-dependent axonal motor neuropathy, with typical preferential involvement of the tibial nerve. Muscle ultrasound showed a corresponding length-dependent increase of homogeneous echo-intensity, most noticeably in the gastrocnemius. One patient had a dual diagnosis of CMT2F and CMT2W.

INTERPRETATION

The HSPB1 c.407G>G (p.Arg136Leu) mutation causes an adult-onset, predominantly motor, axonal neuropathy in individuals of Jewish Iranian descent. Variable manifestations are noticed, and sensory involvement is more prominent in prolonged disease duration.

Artemisia biennis Willd.: Anti-Nociceptive effects and possible mechanisms of action

ETHNOPHARMACOLOGICAL RELEVANCE

Artemisia biennis Willd. (Dermane in Persian) has been used as an antinociceptive remedy in Iranian folkloric medicine.

OBJECTIVE

The aim of the present study was to evaluate the anti-nociceptive effects of Artemisia biennis Willd. aerial part essential oil (ABAEO) on male Swiss mice.

MATERIALS AND METHODS

Nociceptive pain techniques including acetic acid-induced writhing (AAIW), formalin-induced paw licking (FPL), glutamate-induced paw licking (GPL), and tail-flick (TF) models were applied. We assessed opioid and L-arginine-NO-cGMP-KATP pathways to detect the possible anti-nociceptive properties of ABAEO. In addition, neuropathic pain was induced by the cervical spinal cord contusion model.

RESULTS

ABAEO (120 mg/kg) had a significant anti-nociceptive activities in comparison to the control animals (p < 0.05) in the AAIW, TF, GPL, and FPL assays. The selective opioid antagonist (naloxonazine) administration in the AAIW test alleviated the anti-nociceptive effect of ABAEO (p < 0.05). L-arginine, methylene blue, and glibenclamide treatment prevented the ABAEO anti-nociceptive effects (p < 0.05); however, sodium nitroprusside could profoundly potentiate the ABAEO-associated antinociception in the FPL (phase II) test (p < 0.05). In nociceptive pain models, Cr (one of the main constituents of ABAEO) showed significant anti-nociceptive effects (p < 0.05). Moreover, the von Frey results indicated that ABAEO could attenuate mechanical allodynia in mice.

CONCLUSION

Our observation revealed the anti-nociceptive effects of ABAEO in male mice. These effects could include, at least in part, modulating glutamatergic mechanisms via opioid systems. Our data output also indicates activating the L-arginine-NO-cGMP-KATP system in ABAEO anti-nociceptive activities.

Treatment of women's sexual dysfunction using Apium graveolens L. Fruit (celery seed): A double-blind, randomized, placebo-controlled clinical trial

ETHNOPHARMACOLOGICAL RELEVANCE

Traditional manuscripts refer to plants such as Apium graveolens L. Fruit (celery seed), which could be used to improve sexual function among women. Since that time, local herbal shops in Iran continue to provide this herb as a natural aphrodisiac product.

AIM OF THE STUDY

This study aimed to evaluate the efficacy and safety of celery seed for the treatment of female sexual dysfunction.

METHODS AND MATERIALS

In this parallel, randomized, double-blinded clinical trial, 80 women were assigned to receive either 500 mg of celery seed or placebo 3 times a day for a period of 6 weeks (n = 40 per group). The female sexual function index (FSFI) questionnaire was used to evaluate women's sexual function before and after treatment.

RESULTS

At the end of the sixth week, an improvement in the total FSFI score was significantly greater in celery seed-treated women than those receiving the placebo (P < 0.001). Increased total FSFI score is mainly contributed by improvement in the sexual desire (p < 0.001), arousal (p < 0.001), lubrication (p < 0.001), and pain (p = 0.033) domains at the endpoint of study. No serious side effects were noticed in both groups during the study period.

CONCLUSION

It seems that celery seed improved sexual function in women and could be used as a safe, well-tolerated, and effective herbal medicine in women with sexual dysfunction.

Cervical Cancer Screening Participation among Women of Russian, Somali, and Kurdish Origin Compared with the General Finnish Population: A Register-Based Study

Migrant-origin women are less prone to cervical screening uptake compared with host populations. This study examined cervical cancer screening participation and factors associated with it in the Finnish mass screening program during 2008–2012 in women of Russian, Somali and Kurdish origin compared with the general Finnish population (Finns) in Finland. The study population consists of samples from the Finnish Migrant Health and Well-being Study 2010–2012 and Health 2011 Survey; aged 30–64 (n = 2579). Data from the Finnish screening register linked with other population-based registry data were utilized. For statistical analysis we employed logistic regression. Age-adjusted screening participation rates were Russians 63% (95% CI: 59.9–66.6), Somalis 19% (16.4–21.6), Kurds 69% (66.6–71.1), and Finns 67% (63.3–69.8). In the multiple-adjusted model with Finns as the reference; odds ratios for screening were among Russians 0.92 (0.74–1.16), Somalis 0.16 (0.11–0.22), and Kurds 1.37 (1.02–1.83). Among all women, the substantial factor for increased screening likelihood was hospital care related to pregnancy/birth 1.73 (1.27–2.35), gynecological 2.47 (1.65–3.68), or other reasons 1.53 (1.12–2.08). Screening participation was lower among students and retirees. In conclusion, screening among the migrant-origin women varies, being significantly lowest among Somalis compared with Finns. Efforts using culturally tailored/population-specific approaches may be beneficial in increasing screening participation among women of migrant-origin.

Pre-migration traumatic experiences, post-migration perceived discrimination and substance use among Russian and Kurdish migrants-a population-based study

BACKGROUND AND AIMS

The associations between traumatic events, substance use and perceived discrimination have been rarely studied among migrants in host countries. We examined whether pre-migration potentially traumatic experiences (PTEs) or perceived discrimination (PD) are associated with substance use among migrants with voluntary (Russians) and forced (Kurds) migration backgrounds.

DESIGN

Cross-sectional interview and health examination data from the Finnish Migrant Health and Wellbeing Study were used. The target sample (n = 1000 for each group) was drawn from the national population register using stratified random sampling by participants' country of birth and native language.

SETTING

Population-based data were collected from six cities in Finland during 2010-12.

PARTICIPANTS

The participation rates were 68% (Russians) and 59% (Kurds). The analytical sample size varied (Russians n = 442-687, Kurds n = 459-613), as some participants completed only interview, health examination or short interview. The majority of Kurds had a refugee background (75%) while Russians had mainly migrated for other reasons (99%).

MEASUREMENTS

The three main outcomes were self-reported binge drinking, daily smoking and life-time cannabis use. PTEs and PD were self-reported in the interview. Socio-demographic background, migration-related factors and current affective symptoms were adjusted for.

FINDINGS

Among Kurds, PTEs were associated with binge drinking [adjusted odds ratio (aOR) = 2.65, 95% confidence interval (CI) = 1.30-5.42] and PD was associated with life-time cannabis use (aOR = 3.89, 95% CI = 1.38-10.97) after adjusting for contextual factors. Among Russians, PTEs were associated with life-time cannabis use adjusting for contextual factors (aOR = 2.17, 95% CI = 1.12-4.18).

CONCLUSIONS

In Finland, pre-migration traumatic experiences appear to be associated with life-time cannabis use among the Russian migrant population (voluntary migration) and binge drinking among the Kurdish migrant population (forced migration). Perceived discrimination in Finland appears to be associated with life-time cannabis use among Kurdish migrants.

The personal politics of private life in the United Arab Emirates (UAE): sexualities, space, migration and identity politics in motion

Activism on sexuality and sexual politics in South and West Asia has been increasing in the last two decades, resulting in challenges and opportunities to negotiate sexual subjectivity, intimacy and politics. But some people articulate a desire to disentangle sexual politics from identity politics. Against this background, a two-pronged investigation of the intersections of sexuality and migration was conducted in the United Arab Emirates (UAE) with the aim of understanding the role of sexuality in compelling migration. Data were collected by means of qualitative interviews and participant observation. Findings identify the existence of two contrasting forms of sexual politics: the strategic deployment of sexuality to affect social and political change, and activism with the goal of rethinking ideas and norms about sexuality. Challenges to sexual subjectivities resulting from the tethering of sexual politics to LGBT identity politics act as something of a 'push' factor for some individuals, encouraging them to migrate from places such as Iran, Pakistan and Nepal to the Persian Gulf countries in search of space in which to explore their bodies and sexualities.

Engage In or Refrain From? A Qualitative Exploration of Premarital Sexual Relations Among Female College Students in Tehran

This study explored the factors that educated young Iranian women consider when they decide whether to have premarital sex. Using a purposive sampling method, 30 in-depth interviews were conducted with female college students in both government and private universities in Tehran in 2005-2006. The respondents included unmarried women who had experienced sexual relations, unmarried women who had abstained, and married women. Young women's considerations for premarital sex included (1) marriage meaning and motivations; (2) compliance with family values and expectations; (3) perceived gender and social norms of premarital sex; (4) importance of religiosity; and (5) sexual knowledge and self-efficacy. Marriage meaning and motivation seem to be the central pillar in the complex decision to engage in or refrain from premarital sex among female college students. These considerations have theoretical implications for understanding premarital relationships and sex in a conservative setting. Finally, some shifts are occurring in the meaning of marriage and sexual mores among educated young women in Iran; these changes are discussed.

An interactional perspective on sound prolongation in multilingual encounters in residential care

Elderspeak refers to adapting one's language to a  perceived language decline of an older interlocutor. Earlier studies have explored different features of elderspeak; some of these studies attribute positive outcomes to using elderspeak that facilitates communication, but other studies consider elderspeak a negative way of communicating that should be avoided. The aim of this study is to investigate a largely unexplored feature of elderspeak, namely sound prolongation in a multilingual context. There are five participants in this study: three carers and two care recipients in a residential care unit. The carers and care recipients have limited access to a shared spoken language. The data consist of video- and audio recordings of interaction between the participants. The recordings have been transcribed and analysed in accordance with Conversation Analytical methodology. The analysis shows that the carers use sound prolongation as part of their interactional repertoire in order to manage situations of distress. We conclude that in some distressful situations carers' use of sound prolongation may help mitigating the care recipient's emotional concerns since the source of agitations has been addressed properly. In other situations, the use of sound prolongation may lead to an escalation in distress, if the source of agitation is not addressed adequately. Our results bring to the fore that an interactional practice, such as the use of sound prolongation in the context of expressed distress must be interpreted in relation to the complexity of each and every situation participants find themselves in, their level of understanding, and the task/activity at hand.

Historic migration to South Asia in the last two millennia: A case of Jewish and Parsi populations

The South Asian populations have a mosaic of ancestries likely due to the interactions of long-term populations of the landmass and those of East andWest Eurasia. Apart from prehistoric dispersals, there are some known population movements to India. In this study,we focussed on the migration of Jewish and Parsi populations on temporal and spatial scales. The existence of Jewish and Parsi communities in India are recorded since ancient times. However, due to the lack of high-resolution genetic data, their origin and affiliation with other Indian and non-Indian populations remains shrouded in legends. Earlier genetic studies on populations of Indian Jews have found evidence for a minor shared ancestry of Indian Jews with Middle Eastern (Jews) populations, whereas for Parsis, the Iranian link was proposed. Recently, in our high-resolution study, we were able to quantify the admixture dynamics of these groups, which has suggested a male-biased admixture. Here, we added the newly available ancient samples and revisited the interplay of genes and cultures. Thus, in this study we reconstructed a broad genetic profile of Indian Jews and Parsis to paint a fine-grained picture of these ethnic groups.

Suicidal Thoughts, Attempts and Motives Among University Students in 12 Muslim-Majority Countries

There is a scarcity of research on suicidal phenomena in the Muslim world. Therefore, this study aimed at investigating the self-reported prevalence of suicidal thoughts, attempts and motives in 12 Muslim countries. A total of 8417 (54.4% women) university students were surveyed by means of a self-report questionnaire. Overall, 22% of the participants reported suicidal ideation and 8.6% reported attempting suicide. The odds of suicidal thoughts were elevated in Azerbaijan, Indonesia and Saudi Arabia, while reduced ORs were recorded in Egypt, Jordan, Lebanon and Malaysia. While odds of suicide attempts were high in Azerbaijan, Palestine and Saudi Arabia reduced odds ratios (OR) were detected in Indonesia, Iran, Jordan, Lebanon, Malaysia and Tunisia. Taking drugs and using a sharp instrument were the two most frequently used methods to attempt suicide. Only 32.7% of attempts required medical attention. Escape motives were endorsed more than social motives by participants who attempted suicide. Suicidal behaviors were more frequent in women than in men. Compered to men, fewer attempts by women required medical attention. Moreover, our results show that making suicide illegal does not reduce the frequency of suicidal behavior. Results from this comparative study show that suicidal thoughts and attempts are frequent events in young adults in countries where religious scripture explicitly prohibit suicide and the frequencies of nonfatal suicidal behavior show large variation in nations adhering to the same religion.

TNF receptor type 1 and TNF receptor type 2 mRNA expression was not associated with coronary artery disease in a group of Iranian Turks

OBJECTIVES

Present investigation was carried out to evaluate the mRNA level of TNF receptor type 1 (TNFR1) and TNF receptor type 2 (TNFR2) in peripheral-blood cells in patients with premature CAD over healthy controls.

BACKGROUND

TNFα as a pleiotropic cytokine could be concerned in cardiovascular pathophysiology regarding its special effects on endothelial cells. TNFα exerts its activities through its receptors, TNFR1 and TNFR2.

METHODS

Totally, 40 patients with premature CAD and 40 healthy controls were studied. The qRT-PCR technique was used to determine the mRNA level of TNFR1 and TNFR2 in tested groups.

RESULTS

The results of this study show that the relative expression was 1.32 ± 0.34 in cases and 1.11 ± 0.16 in controls for TNFR1. The relative expression was 0.96 ± 0.13 in cases and 1.49 ± 0.41 in controls for TNFR2. There is no significant difference in the level of gene expression in the studied groups regarding TNFR1 and TNFR2 genes (p > 0.05).

CONCLUSION

It can be concluded that the mRNA levels of TNFR1 and TNFR2 were not associated with CAD risk. Studies with more details, larger sample size, and new risk loci are necessary to reveal disease-causing mechanisms in the pathogenesis of CAD (Fig. 3, Ref. 21).

Investigating the Association of Orosomucoid 1-like 3 (ORMDL3) Gene Polymorphism (rs12603332) with Susceptibility to Allergic Asthma in Iranian Northwestern Azeri Population

Orosomucoid 1-like 3 (ORMDL3) gene, located on chromosome 17q21, is an asthma candidate gene that encodes ORMDL3. This molecule has been reported to play a role in airway remodeling and bronchial hyper-responsiveness. In this study, we aimed to investigate the possible association of ORMDL3 single nucleotide polymorphism (SNP) (rs12603332) with susceptibility to allergic asthma in Iranian Northwestern Azeri population. 193 asthmatic patients and 185 normal individuals were included. Genomic DNA was extracted and genotyping was performed by standard restriction fragment length polymorphism-polymerase chain reaction RFLP-PCR method using BstUI restriction enzyme. Our results showed dominant presence of TC genotype and C allele in both patients (49.2% and 59.8%, respectively) and controls (48.6% and 60%, respectively). Frequency of genotypes and alleles showed no significant difference between two groups (p=0.994 and p=1.00, respectively). None of alleles could be defined as risk allele for allergic asthma (OR=0.99, 0.88-1.12, 95% CI). We failed to show significant association between ORMDL3 rs12603332 with predisposition to allergic asthma in Iranian Northwestern Azeri population. More studies with larger number of participants should be done to find more reliable results for such association.

Racial entanglements and sociological confusions: repudiating the rehabilitation of integration

In line with the broader nationalist advances currently remaking the Western political landscape, the concept of integration has witnessed a marked rehabilitation. Whilst many influential critiques of the sociology of integration are already available, this article contests the concept's renewed purchase through addressing its own internal incoherence. Based on research in Stockholm, this critique concerns the relationship between ethnic identity and cultural integration. It will be argued that integration and the production of difference are intertwined, entangled dualities, and far from being a benign entanglement, this duality is premised on the force and reach of everyday civic racisms. Of pivotal and unique analytical significance here is the observation that racism should not only be considered an exogenous process that impedes integration, but as a multifaceted phenomenon folded into integration.

Which anthropometric measures best indicate type 2 diabetes among Russian, Somali and Kurdish origin migrants in Finland? A cross-sectional study

OBJECTIVES

To compare the performance of body mass index (BMI), waist-to-height ratio (WHtR), waist circumference (WC) and waist-to-hip ratio (WHR) in detecting type 2 diabetes among Russian, Somali and Kurdish (born in Iraq/Iran) origin migrants and Finns.

DESIGN AND PARTICIPANTS

Cross-sectional study comparing health examination survey data of Russian, Somali and Kurdish origin migrants (n=917) aged 30-64 years who took part in the Migrant Health and Wellbeing Survey with the general Finnish population in the Health 2011 Survey (n=887). Participants were randomly selected from the National Population Register.

SETTING

Six cities in Finland, where a substantial majority of migrants live.

OUTCOME MEASURES

Anthropometric measures included objectively measured BMI, WHtR, WC and WHR. Type 2 diabetes was defined based on self-report, laboratory measures of glycated haemoglobin and register data. Test performance was assessed using receiver operating characteristics curves, using area under the curve (AUC) as a measure of accuracy.

RESULTS

Among Finns, test performance was highest for WC (AUC=0.81, 95% CI 0.74 to 0.87) and WHtR (AUC=0.81, 95% CI 0.75 to 0.87). Test performance was similar for BMI (AUC=0.80, 95% CI 0.67 to 0.92), WC (AUC=0.79, 95% CI 0.67 to 0.91) and WHtR (AUC=0.70, 95% CI 0.66 to 0.93) among Russians. WC and WHtR had highest test performance also among Somali (AUC=0.74, 95% CI 0.64 to 0.84 for WC and AUC=0.75, 95% CI 0.65 to 0.85 for WHtR) and Kurds (AUC=0.71, 95% CI 0.61 to 0.81 for WC and AUC=0.70, 95% CI 0.59 to 0.80 for WHtR).Among migrants, WHR had the poorest test performance.

CONCLUSION

WC and WHtR performed overall the best across all study groups, however, accuracy of detection was lower particularly among Somali and Kurds. Currently used diabetes risk assessment tools assume a strong association between anthropometrics and diabetes. These tools need to be validated among non-Western populations.

[Black smoke lung disease – a new disease in Sweden]

Black smoke lung disease - a new disease in Sweden We describe two elderly female patients, immigrants to Sweden from Afghanistan, with intensive longtime exposure to smoke from biomass, and who presented with bronchial stenosis and severe bronchial obstruction. CT and X-ray showed bizarre perihilar infiltrates in the lungs. Bronchoscopy revealed black narrow bronchi with a middle lobe stenosis in one of the patients. These findings indicate the diagnosis bronchial anthracofibrosis (BAF). The here described findings are seen mainly in elderly never-smoking women from developing countries who have spent years cooking food in poorly ventilated kitchens. With increased immigration from these countries such cases will be seen in industrialized countries as well. Active tuberculosis must always be excluded but otherwise no more active investigations such as biopsies are warranted. We suggest that this disease should be termed »black smoke disease« to differentiate it from coal workers' pneumoconiosis, silicosis, and other classical occupational diseases which can have similar clinical and radiological pictures. This term is easily understood even by non-medical persons and illustratess both the etiology and the black bronchi.

The impact of the asylum process on mental health: a longitudinal study of unaccompanied refugee minors in Norway

OBJECTIVES

To examine the mental health of unaccompanied refugee minors prospectively during the asylum-seeking process, with a focus on specific stages in the asylum process, such as age assessment, placement in a supportive or non-supportive facility and final decision on the asylum applications.

DESIGN

This was a2½ year follow-up study of unaccompanied minors (UM) seeking asylum in Norway. Data were collected within three weeks (n=138) and at 4 months (n=101), 15 months (n=84) and 26 months (n=69) after arrival.

SETTING

Initially in an observation and orientation centre for unaccompanied asylum-seeking adolescents, and subsequently wherever the UM were located in other refugee facilities in Norway.

PARTICIPANTS

Male UM from Afghanistan, Somalia, Algeria and Iran.

MAIN OUTCOME MEASURES

Mental health symptoms assessed by Hopkins Symptom Checklist-25 and Harvard Trauma Questionnaire.

RESULTS

At the group level, the young asylum seekers reported high levels of psychological distress on arrival and symptom levels that stayed relatively unchanged over time. According to age-assessment procedures, 56% of the population were not recognised as minors. Subsequent placement in a low-support facility was associated with higher levels of psychological distress in the follow-up period. Those who were placed in a reception centre for adults had higher levels of psychological distress symptoms both after 15 months and 26 months compared with the remaining participants who were placed in reception centres for youth. Refusal of asylum was highly associated with higher levels of psychological distress.

CONCLUSION

Mental health trajectory of young asylum seekers appears to be negatively affected by low support and refusal of asylum.

Ethnopharmacological studies of indigenous medicinal plants in the south of Kerman, Iran

ETHNOPHARMACOLOGICAL RELEVANCE

The aim of this study was to collect and document information concerning the medicinal plants used by indigenous people and traditional healers in the south of Kerman Province, Iran.

MATERIALS AND METHODS

Overall, 64 informants between the ages of 30 and 89 were interviewed about the modes of application and consumption of medicinal plants in the region. Quantitative analysis was conducted that included informant consensus factor (ICF), use value (UV), relative frequency of citation (RFC) and cultural importance index (CI).

RESULTS AND DISCUSSION

In the current study, a total of 115 medicinal plants in 41 families were reported in the south of the Kerman region. Apiaceae, Asteraceae and Lamiaceae (with 14 species each) were the families with the most medicinal plants. The most frequently used plant parts were leaves at 26.17% and aerial parts (23.49%). Decoction (53%), liniment (23%) and infusion (9%) were the most common preparation methods. The highest UVs were obtained from the following medicinal plants: Amygdalus eburnea Spach, Genista tinctoria L., Calotropis procera (Aiton) Dryand., Fortuynia garcinii (Burm.f.) Shuttlew. and Cerasus mahaleb (L.) Mill. The ICF results indicated that cold-flu and fever were the most common diseases (0.67) in the south of Kerman.

CONCLUSION

Based on the current study, the south of Kerman has many potential medicinal plants, and these plants should be the focus of future research.

Sexual and Reproductive Health Knowledge Among Men and Women Aged 15 to 49 Years in Metropolitan Tehran

Sexual and reproductive health (SRH) knowledge is an important predictor of an individual's sexual behavior; however, little is known regarding this issue among Iranians. This study assessed sexual and reproductive health knowledge among men and women aged 15 to 49 years in Tehran. A total of 755 men and women aged 15 to 49 years were recruited using multistage, random cluster sampling in June 2014. An illustrative anonymous questionnaire endorsed by the World Health Organization (WHO) was used to collect the data. Bivariate and multivariate analyses were performed. The results showed that men and women were moderately knowledgeable about sexual and reproductive health (mean score of SRH knowledge = 39, range: 26 to 52); however, myths and misperceptions prevailed in different aspects of SRH. For example, only 45% of women and 38.7% of men accurately knew that a person infected with human immunodeficiency virus (HIV) can look healthy. Friends were identified as the primary or secondary source of knowledge about puberty and sex-related issues. A multivariate analysis showed that being female (coefficient = 0.139, p < 0.001) and being married (coefficient = 0.180, p < 0.001) were significant predictors of better SRH knowledge, while being young (age group 15 to 24) was a significant determinant of poor SRH knowledge (coefficient = -0.161, p < 0.001) when other influencing factors were controlled. Culturally appropriate and age-specific comprehensive education is recommended, particularly for men, the unmarried, and the younger generation in Iran.

Estimating the visibility rate of abortion: a case study of Kerman, Iran

OBJECTIVES

Abortion is a sensitive issue; many cultures disapprove of it, which leads to under-reporting. This study sought to estimate the rate of abortion visibility in the city of Kerman, Iran-that is, the percentage of acquaintances who knew about a particular abortion. For estimating the visibility rate, it is crucial to use the network scale-up method, which is a new, indirect method of estimating sensitive behaviours more accurately.

MATERIALS AND METHODS

This cross-sectional study was conducted in Kerman, Iran using various methods to ensure the cooperation of clinicians and women. A total of 222 women who had had an abortion within the previous year (74 elective, 74 medical and 74 spontaneous abortions) were recruited. Participants were asked how many of their acquaintances were aware of their abortion. Abortion visibility was estimated by abortion type. 95% CIs were calculated by a bootstrap procedure. A zero-inflated negative binomial regression analysis was conducted to assess the variables related to visibility.

RESULTS

The visibility (95% CI) of elective, medical and spontaneous abortion was 8% (6% to 10%), 60% (54% to 66%) and 50% (43% to 57%), respectively. Women and consanguineal family were more likely to be aware of the abortion than men and affinal family. Non-family members had a low probability of knowing about the abortion, except in elective cases. Abortion type, marital status, sex of the acquaintance and closeness of the relationship were the most important determinants of abortion visibility in the final multifactorial model.

CONCLUSIONS

This study shows the visibility rate to be low, but it does differ among social network members and by the type of abortion in question. This difference might be explained through social and cultural norms as well as stigma surrounding abortion. The low visibility rate might explain the low estimates of abortion rates found in other studies.

Nutrient patterns and their relationship to metabolic syndrome in Iranian adults

BACKGROUND

The prevalence of metabolic syndrome (MetS) is increasing globally. It is associated with a significant risk of developing type 2 diabetes mellitus and cardiovascular disease.

MATERIALS AND METHODS

The relationship between adherence to several different dietary patterns and the presence of MetS was explored in an Iranian population sample of 5764 subjects.

RESULTS

We observed that the prevalence of MetS was 13% and 18% in men and women, respectively. There were three main dietary patterns: the first pattern was characterized by protein, carbohydrate, starch, glucose, fructose, sucrose, maltose, dietary fibre, potassium, calcium, magnesium, phosphorus, iron, zinc, manganese, thiamine, riboflavin, carotene, vitamin c and lactose; second representative of fat, saturated fat, monounsaturated fat, polyunsaturated fat, cholesterol, sodium, calcium, zinc, phosphorus, iodine, vitamin D, chloride, betaine, niacin; third consisting of copper, selenium, vitamin A, riboflavin, vitamin B12. In this dietary pattern, individuals in first quintile had a higher consumption of total fat, saturated fatty acid, monounsaturated fatty acid, polyunsaturated fatty acid, cholesterol and vitamin A. In the second pattern, individuals in the fifth quintile ate less carbohydrate, dietary fibre, glucose, Fructose, potassium compared to first quintile. We found that individuals in the first quintile in pattern 3 had higher intakes of protein, zinc and calcium compared to other quintiles.

CONCLUSIONS

We have found that a nutrient pattern which mostly characterized by dietary protein, carbohydrate, starch, glucose, fructose, sucrose, maltose was associated with a higher risk of MetS in both genders, while a pattern which was represent of copper, selenium, Vitamin A, riboflavin, vitamin B12 was associated with greater odds of Mets, in women.

Association of Promoter Polymorphisms of Interleukin-10 and Interferon-Gamma Genes with Tuberculosis in Azeri Population of Iran

Promoter polymorphism of cytokine genes may lead to inter-individual differences in cytokine levels, therefore, polymorphisms may associate with susceptibility to infectious diseases. In this study, we investigated a possible association between interleukin-10 (IL-10) -1082A⁄G (rs1800896) and interferon (IFN)-gamma +874T/A (rs2430561) promoter polymorphisms and tuberculosis (TB) in the Azeri population of Iran. IL-10 -1082G/A and IFN-gamma +874T/A single nucleotide polymorphisms (SNPs) were genotyped by amplification refractory mutation system (ARMS)-PCR in 200 healthy controls and 124 tuberculosis patients. IL-10 -1082 A allele was more frequent in the control group than in the patient group (p=0.001, odds ratio [OR]=2.183). On the other hand, the AA genotype was significantly more frequent in the control group (p=0.0001). The frequency of IFN-gamma +874 T allele was significantly higher in the controls (p=0.013, OR=1.56). There was no significant association between IFN-gamma +874 T/A genotypes and susceptibility to tuberculosis (p=0.078), but TT genotype was more frequent in the control group. Our findings suggest that interleukin-10 -1082G/A polymorphism may play an important role in susceptibility to tuberculosis in our population. On the other hand, the +874T allele, which has been suggested to be associated with high IFN-gamma levels, was significantly higher in the controls and TT genotype was also more frequent in the control group. Thus, +874 T allele may be associated with resistance to tuberculosis in this Azeri population of Iran.

Serum Zinc and Haptoglobin in Noncirrhotic Azeri Patients with Chronic Active Hepatitis C: a Case-Control Study

The aim of present study was to compare levels of serum zinc and haptoglobin between patients with chronic active hepatitis C and controls. Two groups including Azeri patients with chronic active hepatitis C (n = 274) and their healthy family members (n = 100) were studied. Serum zinc and haptoglobin were measured using colorimetric and nephelometric methods, respectively. Patients were 156 males (56.9%) and 118 females (43.1%) with the mean age of 40.15 ± 12.24 years. Controls were 56 males (56%) and 44 females (44%) with the mean age of 39.32 ± 4.40 (p = 0.87 for sex and 0.51 for age). Both the mean levels of serum zinc (72.04 ± 19.08 vs. 106.18 ± 25.52 μg/dL) and haptoglobin (0.72 ± 0.45 vs. 1.08 ± 0.34 g/L) were significantly lower in patients than in controls (p < 0.001 for both comparisons). Serum zinc concentration was significantly higher in males and did not correlate significantly with age, serum glutamic pyruvic transaminase (SGPT), or serum glutamic oxaloacetic transaminase (SGOT). Serum haptoglobin did not differ significantly between males and females, and it correlated significantly with age (r = -0.20), serum SGPT (r = -0.22), and SGOT (r = -0.20). This study showed lower levels of serum zinc and haptoglobin in patients with chronic hepatitis C than in controls. Major confounding factors in previous studies were left out.

Women self-perception of excess hair growth, as a predictor of clinical hirsutism: a population-based study

PURPOSE

Hirsutism is the most common indicator of hyperandrogenism. Both, the sensitivity of the patients to the serum androgen levels and the responsiveness of women to the perceived excess hair growth vary among different populations. This report elaborates the relationship between the woman's discerned abnormal hair growths with the clinical diagnosis of hirsutism.

METHODS

The survey was conducted among 1160 women aged 18-45 and randomly selected from Tehran Lipid and Glucose Study for further detailed assessment of Hirsutism; using the m-FG scoring method. Data gathering was performed by interviews and physical examinations. The receiver operating characteristic curve was drawn and the new cutoff value, sensitivity, specificity and concordance percentage were calculated.

RESULTS

The results demonstrated that among 12 androgen-dependent body areas, the chin skin had the highest area under curve of 0.81 (CI; 0.78-0.84). According to the patient's evaluation, a threshold point of 4 had the optimum concordance percentage of 0.77 with the modified Ferriman-Gallwey scoring system.

CONCLUSIONS

Patient's self-identification of excess terminal hair based on the chin area has great sensitivity and reliability in predicting the clinical hirsutism.

Gene mutation analysis in Iranian children with nephronophthisis: a two-center study

INTRODUCTION

Nephronophthisis is of the most commonly inherited ciliopathies that leads to end-stage renal disease in children. The NPHP1 gene is the first identified gene responsible for nephronophthisis and related diseases. This study assessed mutations of the NPHP1 gene in 16 Iranian families with at least one member presenting features of nephronophthisis.

MATERIALS AND METHODS

Fifty-seven patients diagnosed with chronic kidney disease or end-stage renal disease were referred to Imam Hossein Children Hospital, in Isfahan, Iran. The gene analysis study was carried on 16 patients and their first-degree relatives (40 DNA samples) suspicious of having nephronophthisis. The NPHP1 deletion analysis was performed for exons 5, 7, and 20 of the NPHP1 gene.

RESULTS

The patients' median age was 15 years. The mean and median age of the first presentation was 10.06 ± 2.59 years and 10.5 years, respectively. A homozygous deletion was identified in the NPHP1 gene spanning at least from exon 5 to exon 20 in two families. High-throughput mutation analysis identified a homozygous truncating mutation (c.1504C>T, p.R502*) in the NPHP5 in 5 families.

CONCLUSIONS

By combining NPHP1 deletion analysis with multiplex-polymerase-chain-reaction-based high-throughput mutation analysis we could identify the molecular disease-cause in 7 of 15 families from Iran. In 8 families, the molecular disease cause remained unknown.

Geographical distribution of torture: An epidemiological study of torture reported by asylum applicants examined at the Department of Forensic Medicine, University of Copenhagen

Using reports from 154 examinations of alleged torture victims among asylum applicants to Denmark conducted by the Department of Forensic Medicine, University of Copenhagen, between 2001 and 2013, we have categorized the victims into four geographical regions, as well as according to the conflict that caused them to flee. The torture incidents described by the victims were divided into 12 different categories defined by the Istanbul Protocol. These data were cross referenced in order to identify any differences in the prevalence of the 12 forms of torture. The study showed that crush injuries were only reported by refugees from Asia, including Afghanistan and Pakistan, and that incidents of electrical torture were reported twice as frequently by torture victims from Middle Eastern and North African countries, though it was lower among Iraqis, Iranians and ethnic Kurds. Sexual torture was reported by 78% of females and 25% of males.

Guidelines for conducting rigorous health care psychosocial cross-cultural/language qualitative research

The purpose of this article is to synthesize and chronicle the authors' experiences as four bilingual and bicultural researchers, each experienced in conducting cross-cultural/cross-language qualitative research. Through narrative descriptions of experiences with Latinos, Iranians, and Hmong refugees, the authors discuss their rewards, challenges, and methods of enhancing rigor, trustworthiness, and transparency when conducting cross-cultural/cross-language research. The authors discuss and explore how to effectively manage cross-cultural qualitative data, how to effectively use interpreters and translators, how to identify best methods of transcribing data, and the role of creating strong community relationships. The authors provide guidelines for health care professionals to consider when engaging in cross-cultural qualitative research.

A case-control study on the association of common variants of CAPN10 gene and the risk of type 2 diabetes in an Iranian population

BACKGROUND

Calpain-10 is a ubiquitously expressed protease that serves as an intracellular calcium-dependent cysteine protease and is regarded to be one of the candidate genes for type 2 diabetes mellitus (T2DM). We aimed to identify the association of the common variants of this gene and the risk of T2DM in the Kurdish ethnic group of Iran.

METHODS

Study groups included 173 T2DM and 173 normoglycemic subjects. Genotyping was determined by PCR-RFLP. Genotypic and allelic frequencies were then evaluated. Data was analyzed using SPSS software.

RESULTS

The allelic frequency of the A-allele of SNP-43 variant was significantly different (p = 0.01) between case and control groups (18% vs. 11%). The genotype frequencies for SNP-43 did not show any significant difference between case and control individuals. However, the dominant model of SNP-43 was found to be significantly associated with T2DM (OR = 1.75, 95% CI = 1.06 - 2.89, p < 0.029). The distribution and allele frequency of other SNPs (SNP-19 and -63) did not show any significant difference between the study groups. For SNP-43, fasting serum insulin (p = 0.043) and HOMA-IR (p = 0.026) were higher in the control subjects with the GA+AA genotype when compared with the GG genotype. Among the T2DM subjects, there was no significant difference in any of the clinical or biochemical parameters between the GG and GA+AA genotypes of SNP-43. Normoglycemic subjects carrying the 2R/3R+3R/3R genotypes of SNP-19 had significantly lower HDL-C (p = 0.034) as compared with those with the 2R/2R genotype. In T2DM subjects, no significant difference was found in any of the clinical or biochemical parameters between 2R/2R and 2R/3R+3R/3R genotypes. T2DM subjects carrying the CT+TT genotypes of SNP-63 variation had significantly higher LDL-C (p = 0.015) as compared with those with the CC genotype. In normoglycemic subjects, no significant difference was found in any of the clinical or biochemical parameters between CC and CT+TT genotypes.

CONCLUSIONS

Our findings revealed that there is an association between the SNP-43, but not SNP-19 and -63, and T2DM in the Kurdish ethnic group of West Iran.

The incidence of cleft lip and palate in a Kurd population: a prospective study

AIM

To assess the incidence of cleft lip and palate and factors associated with them in the hospital births of Iran's Kurdistan province in 2010.

METHODS

Researcher-completed questionnaires captured data on gender, mother's age during pregnancy, parents' occupation, father's birthplace, family background, consanguinity, systemic diseases, mother's disease during pregnancy, drugs abuse, smoking, alcohol drinking, radiography and mother's radiotherapy during pregnancy.

RESULTS

Of 26,537 newborns, 29 (19 male and 10 females) were affected by various types of cleft lip and palate. Of newborns with cleft lip and palate: 38% had other abnormalities, consanguinity was reported in about 31% of cases and 28% of mothers used prescribed drugs during pregnancy while no mothers used cigarettes or alcohol. There was no report of radiotherapy or radiography.

CONCLUSIONS

The incidence rate of oral clefts was 1.09 in the 1,000 live births.

Association between oral and general hygiene behaviours among Iranian adolescents

PURPOSE

To assess the association between oral and general hygiene behaviours in 12-year-old Iranians and the impact of sociodemographic and educational factors on the association.

MATERIALS AND METHODS

A representative random sample of 550 12-year-old Iranian adolescents from two deprived tribes answered a 41-item questionnaire on sociodemographic background, education and oral and general hygiene behaviours. The association between tooth cleaning frequency and other study outcome variables were tested using binary logistic regression. The sex differences in the study outcome variables were investigated using chi-square and Mann-Whitney tests.

RESULTS

The frequency of tooth cleaning was significantly associated with a general hygiene behaviour: frequency of taking a bath (OR 0.5; 95% CI: 0.3, 0.7). This association remained significant when sociodemographic factors and educational factors were added to the model both separately (P < 0.001) and together (P < 0.001). Girls were significantly more likely than boys to clean their teeth once or more times a day (OR 2.4; 95% CI: 1.7, 3.4).

CONCLUSION

Oral and a general hygiene behaviour were strongly associated. Oral, general and environmental hygiene programmes should use integrated approaches.

Activity of daily living performance amongst Danish asylum seekers: a cross-sectional study

OBJECTIVE

The aim of this study was to evaluate the extent of Activities of Daily Living (ADL) ability impairment in newly arrived Danish asylum seekers. It was hypothesized that exposure to trauma and torture would negatively influence ADL performance and that measures of ADL ability would be lower in individuals exposed to torture as compared to the non-tortured.

SUBJECTS

Forty-three newly arrived asylum seekers aged 20-50 years, from Iran, Afghanistan and Syria, were consecutively included in the study.

METHOD

ADL ability was assessed with the observation-based test Assessment of Motor and Process Skills (AMPS). Interviews were based on questionnaires about torture exposure, WHO-5 Wellbeing Index, Major Depression Inventory and Pain Detect Questionnaire. All participants were interviewed and tested using a linguistic interpreter.

RESULTS

Thirty three (77%) participants reported exposure to torture. The tortured did not differ significantly from the nontortured on measures of ADL ability (two-sample t-tests: Motor, p= 0.36; Process, p= 0.82). ADL performance impairment was observed in the overall study sample. Twelve had motor and 15 process ability measures below age norms and 2 below both AMPS motor and process cut-offs for effortless and efficient ADL performance. There were statistically significant - weak to moderate - correlations between self-reported psychological distress, VAS average pain, pain distribution and the AMPS measures.

CONCLUSION

The study results supported significant ADL ability impairment in tortured as well as non-tortured newly arrived asylum seekers. Implementation of performance-based evaluation of ADL ability as part of the initial medical screening of this particular population should be considered.

Personality factors and attitudes toward euthanasia in Iran: implications for end-of-life research and practice

This article reports on the relationship of personality and euthanasia attitudes. Results from a survey of 165 Iranian students showed that religiosity, honesty-humility, agreeableness, and extraversion were related to negative attitudes toward euthanasia, whereas openness was related to acceptance of euthanasia, with the unconventionality facet driving this relationship. Moreover, openness explained additional variance when added to a multivariate model containing religiosity and HEXACO factors. This study illustrates the possibility of accounting for variation beyond the traditional group level predictors of attitudes toward euthanasia and promoting future cross-cultural studies into personality and end-of-life issues and informing end-of-life conversations at the bedside.

Cross-cultural adaptation of the Female Genital Self-Image Scale (FGSIS) in Iranian female college students

The aim of the present study was to investigate the psychometric properties of a translated and culturally adapted Iranian version of the Female Genital Self-Image Scale (FGSIS-I) in a sample of college women. Further, the relationship between women's self-image, body appreciation, sexual functioning, and gynecological exam behavior was explored. A sample of 1,877 female students from five different universities across Qazvin and Tehran completed the Female Sexual Function Index (FSFI), the Body Appreciation Scale (BAS), the Rosenberg Self-Esteem Scale (RSES), the FGSIS-I, and a gynecological exam behavior questionnaire. Good to excellent internal consistency reliability, test-retest reliability, and convergent and construct validity were found. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) both provided a two-factor structure for the FGSIS-I. The validity of the FGSIS-I in predicting gynecological exam behavior of college women was tested using structural equation modeling (SEM). The final model accounted for 33% of the variance in gynecological exam behavior (p < 0.01). In conclusion, the FGSIS-I was found to be a highly valid and reliable instrument to assess female genital self-image in Iranian women.

Constructions and experiences of sexual health among young, heterosexual, unmarried Muslim women immigrants in Australia

Minority ethnic immigrant women are frequently vulnerable to poor sexual health outcomes, due to poor use of sexual health services, lack of knowledge and social stigma associated with the discussion of sexuality. This paper explores the sexual health accounts provided by a group of young, unmarried heterosexual Muslim women immigrants residing and studying in Sydney, an under-researched group in the Australian context. Ten semi-structured interviews were conducted, focusing on sex before marriage, spouse selection and contraceptive use. Feminist discourse analysis identified 'purity versus corruption' as the primary construction of women's sexuality, where women positioned their sexual behaviour as that of purity and uninvolvement or corruption through unwedded participation. The subthemes 'maintaining ignorance and naivety', 'remaining virginal', 'sex segregation' and 'the fallen woman' capture women's personal sexuality-related experiences and values within the context of their religious and cultural communities. Additional research with this community is needed to examine the effects of negative social constructions of sex on young sexually active Muslim women, as well as further research on young women's sexual health within immigrant communities.

Assessment of patrilineal gene pool of the Iranian Azeris

The Iranian Azeris are the largest ethno-linguistic minority in Iran who live mainly in the north-west part of the country. Located in the crossroad of ancient human migrations the Iranian Azeris bear the complicated historical influence of the region in their gene pool. Despite the importance of Iranian Azeris in reconstructing the historical event of the Middle-East, their (genetic) origin still remains heavily disputed. In this study we tried to evaluate the rates of genetic contribution of possible source populations (namely, indigenous Iranian, Caucasian, and Central Asian) in the gene pool of modern Iranian Azeris through paternally inherited Y-chromosomal 6 STR markers. The assessment of genetic distances reveals that the Iranian Azeris are mixed population with substantial North Caucasian genetic contribution being genetically much closer to their immediate neighboring ethnic groups. Based on the results of admixture analysis we can conclude that there are significant Caucasian and no visible Central Asian contribution to the gene pool of modern Iranian Azeris.

Sex guilt and life satisfaction in Iranian-american women

Although the experience of sex guilt has been considered among a variety of ethnic groups, the area has not yet been empirically explored among Iranian American women. The present study investigated the relationship between sexual self-schema (i.e., beliefs about the sexual aspects of oneself), acculturation, and sex guilt, and it further examined the association between sex guilt and life satisfaction in Iranian American women. A total of 65 Iranian American women, with a mean age of 31.3 years (SD = 11.7), completed five self-administered questionnaires. Findings indicated a significant inverse correlation between sexual self-schema and sex guilt. More specifically, women who endorsed negative self-views regarding their sexual self reported higher levels sex guilt. Results revealed that acculturation was unrelated to sex guilt, when the effect of being Muslim or non-Muslim was controlled. Women with high sex guilt reported significantly lower levels of life satisfaction. Moreover, analyses for mediation effects supported sex guilt as a partially mediating variable between sexual self-schema and life satisfaction. Levels of sex guilt were higher among Muslim women when compared to women of other religious affiliations. Additionally, Muslim women appeared to be significantly less acculturated to Western ideals than other religious groups. The present findings suggest that mental health professionals who provide services to Iranian American women need to consider the negative effects of sex guilt, particularly among Muslim women.

'My culture haunts me no matter where I go': Iranian-American women discussing sexual and acculturation experiences

Iranian-American womens' perceptions of their sexual-selves and gender roles are influenced both by the cultural context of their life experience in Iran and their acculturation in the USA. In a qualitative study, using narrative as methodology and a feminist theoretical framework, individual interviews were conducted with 24 first-generation Iranian-American women in southern California. The narratives revealed that these Iranian-American women felt attached to their home culture while also having a desire to distinguish themselves from it. In so doing, they realised that their individual sexual-selves and gender roles stemmed from their life experiences, such as home culture memories and new cultural exposures. The degrees of adjustment during the acculturation process provided women with challenges in dealing with the consequences of new experiences and the shame and guilt of shedding old cultural norms. Acculturation offered these Iranian-American women a fuller understanding of their gender role and sexual-self perceptions. An understanding of cultural impact on women's life experiences may assist healthcare professionals in their efforts to assist women in determining innovative intervention where the needs of gender role and sexual-self-concept are concerned.

[Glandular tuberculosis as the cause of dysphagia]

Tuberculosis without pulmonal manifestation is uncommon, but must still be considered as differential diagnosis of lymphadenopathy. We present a case where the main symptom was dysphagia caused by a traction diverticulum due to glandular tuberculosis, which involved the lymph nodes in the neck. Based on the results of a magnetic resonance scanning and a computed tomography the primary diagnosis was a malignant oesophageal tumour, but a polymerase chain reaction on needle-aspirated pus from a lymph node revealed a Mycobacterium tuberculosis complex. No malignant cells were found in an oesophageal biopsy. After anti-tuberculous treatment, the dysphagia resolved completely.

A study of Iranian immigrants' experiences of accessing Canadian health care services: a grounded theory

BACKGROUND

Immigration is not a new phenomenon but, rather, has deep roots in human history. Documents from every era detail individuals who left their homelands and struggled to reestablish their lives in other countries. The aim of this study was to explore and understand the experience of Iranian immigrants who accessed Canadian health care services. Research with immigrants is useful for learning about strategies that newcomers develop to access health care services.

METHODS

The research question guiding this study was, "What are the processes by which Iranian immigrants learn to access health care services in Canada?" To answer the question, a constructivist grounded theory approach was applied. Initially, unstructured interviews were conducted with 17 participants (11 women and six men) who were adults (at least 18 years old) and had immigrated to Canada within the past 15 years. Eight participants took part in a second interview, and four participants took part in a third interview.

RESULTS

Using a constructivist grounded theory approach, "tackling the stumbling blocks of access" emerged as the core category. The basic social process (BSP), becoming self-sufficient, was a transitional process and had five stages: becoming a stranger; feeling helpless; navigating/seeking information; employing strategies; and becoming integrated and self-sufficient. We found that "tackling the stumbling blocks of access" was the main struggle throughout this journey. Some of the immigrants were able to overcome these challenges and became proficient in accessing health care services, but others were unable to make the necessary changes and thus stayed in earlier stages/phases of transition, and sometimes returned to their country of origin.

CONCLUSION

During the course of this journey a substantive grounded theory was developed that revealed the challenges and issues confronted by this particular group of immigrants. This process explains why some Iranian immigrants are able to access Canadian health care effectively while others cannot. Many elements, including language proficiency, cultural differences, education, previous experiences, financial status, age, knowledge of the host country's health care services, and insider and outsider resources work synergistically in helping immigrants to access health care services effectively and appropriately.

Comparison of glycated hemoglobin with fasting plasma glucose in definition of glycemic component of the metabolic syndrome in an Iranian population

AIMS

The aim of this study was to compare the utility of glycated hemoglobin (GHb) versus the fasting plasma glucose (FPG) in definition of glycemic component of the metabolic syndrome (MetS) in a non-diabetic Iranian population.

METHODS

A cross-sectional study of first-degree relatives (FDRs) of patients with type 2 diabetes was conducted from 2003 to 2005. A total of 2410 non-diabetic FDRs of consecutive patients with type 2 diabetes 30-60 years old were examined. All subjects underwent a standard 75 g 2-h oral glucose tolerance test and GHb measurement. Consensus criteria in 2009 were used to identify MetS. Glycemic component of MetS was defined as either FPG≥100 mg/dl or GHb≥5.7%. The mean (SD) age of participants was 43.6 (6.5) years.

RESULTS

The prevalence of MetS was 33.5% (95% confidence interval (CI): 31.6, 35.4) based on FPG criterion alone and 28.6% (95% CI: 26.8, 30.4) based on GHb criterion alone. Use of combination of both criteria increased the prevalence of MetS (36.7%; 95% CI: 34.8, 38.6). There was 88.7% (95% CI: 87.5, 90.0) agreement between the GHb and FPG when either was used to define MetS (κ coefficient=0.737).

CONCLUSIONS

These data indicate that using GHb may be an acceptable surrogate of FPG to define glycemic component of MetS.

Christchurch earthquakes: how did former refugees cope?

AIM

This study investigated how former refugees now living in Christchurch (Canterbury Province, New Zealand) communities coped after the 4 September 2010 and subsequent earthquakes.

METHOD

A systematic sample of one in three former refugees from five ethnic groupings (Afghanistan, Kurdistan, Ethiopia, Somalia and Bhutan) was selected from a list of 317 refugees provided by the Canterbury Refugee Council and invited to participate in the study. Seventy-two out of 105 potential participants completed a 26 item questionnaire regarding the impact of the quakes, their concerns and anxieties, coping strategies and social supports. The methodology was complicated by ongoing aftershocks, particularly that of 22 February 2011.

RESULTS

Three-quarters of participants reported that they had coped well, spirituality and religious practice being an important support for many, despite less then 20% receiving support from mainstream agencies. Most participants (72%) had not experienced a traumatic event or natural disaster before. Older participants and married couples with children were more likely to worry about the earthquakes and their impact than single individuals. There was a significant difference in the level of anxiety between males and females. Those who completed the questionnaire after the 22 February 2011 quake were more worried overall than those interviewed before this.

CONCLUSION

Overall, the former refugees reported they had coped well despite most of them not experiencing an earthquake before and few receiving support from statutory relief agencies. More engagement from local services is needed in order to build trust and cooperation between the refugee and local communities.

Exploring discrimination in american health care system: perceptions/experiences of older Iranian immigrants

The United States population is older and more diverse than ever before. Older Immigrant and minorities have been found to suffer from health care disparities. The National Institute of Health (2002) has identified discrimination as one of the factors that contributes to health disparities among immigrants and minority populations. The purpose of this qualitative phenomenological study was to explore older Iranian immigrants' perceptions/experiences of discrimination in their encounter with the American health care system. In depth interviews were conducted with 15 Iranians who had immigrated to the United States after the age of 50. The following major themes emerged from the study: 1) "American doctors don't discriminate", 2) class discrimination in American and Iranian health care system and 3) treating the illness and not the whole person. In general the participants reported that they did not perceive/experience discrimination in their encounter with the American health care system. In fact majority of the participants reported highly positive impressions of American health care providers. Some participants claimed that language barriers may have protected them from recognizing possible discriminations, while others reported that this absence of perceived discrimination may be a function of American provider's perception of a patient as an "illness" and not a whole person.

Mutual role of PGRN/TNF-α on osteopenia developing in obesity's inflammation state

AIM

The aim of the study was to investigate the concentration of PGRN and other inflammatory cytokines TNF-α, IL-1β, IL-4, IL-6, IL-10, IL-13 and IL-17 in osteopenic and non-osteopenic obese subjects. Bone mineral density in subjects with different PGRN levels were compared to the appraisal of our hypothesis.

METHODS

A total of 171 obese participants (BMI ≥30) were included in the study. Analysis of body composition was performed with use of Body Composition Analyzer. All blood samples were collected between 8:00 and 10:00 a.m. following an overnight fasting. The circulating levels of TNF-α, PGRN, IL-1β, IL-4, IL-6, IL-10, IL-13, IL-17, PTH, 25-Hydroxy Vitamin D and crosslaps were measured with the EIA method. BMD was measured by use of dual energy X-ray absorptiometery (DXA) at lumbar spine (vertebrae L2-L4) and hip level. Participants were categorized into osteopenic and healthy group according to the World Health Organization (WHO) criteria. Of 171 participants, 51 (29.82 %) were osteopenic and 120 (70.17%) were healthy.

RESULTS

We found significantly higher concentrations of crosslaps, IL-17, IL-6, TNFα and IL-4 and lower concentrations of IL-13, IL-10, PGRN and free fat mass in osteopenic group. With raising the PGRN level, the concentrations of IL-13, IL-10 and 25-(OH) vitamin D were increased and the concentration of TNFα and IL-17 were decreased. Our results demonstrated that the density of bone at both sites of lumbar spine (L2-L4) and hip region was highest in 4th quartile and lowest in first quartile of categorized PGRN concentration. The bone status was gradually improved with raising the PGRN level in parallel at lumbar spine (L2-L4) and hip regions.

CONCLUSION

Based on the pathway of effect of TNFα on bone metabolism, it appears that PGRN acts on the bone with mechanisms involving TNFR signaling, disturbance and TNFα performance, similar to the results that have been found in animal model study.

The immigration experience of Iranian Baha'is in Saskatchewan: the reconstruction of their existence, faith, and religious experience

For approximately 150 years, Baha'is in Iran have been persecuted on the basis of their religion. Limitations to aspects of their lives have compelled them to face "civic death" or migrate to other countries. This qualitative pilot study explored the experience of forced migration and how religion attenuates the disruption to the lives of Iranian Baha'is. Adaptive strategies that four participants utilised to re-establish continuity were examined. Participants who were satisfied with their lives developed a way to allow parallel cultural traditions (Iranian and Canadian) to co-exist; those who could not integrate found it difficult to maintain a balance between these traditions.

MEFV gene mutations (M694V, V726A, M680I, and A744S) in Iranian children with Henoch-Schönlein purpura

INTRODUCTION

Henoch-Schönlein purpura (HSP) is the most common systemic vasculitis in children. Several risk factors play important role in pathogenesis of HSP. We aimed to study the MEFV gene mutations (M694V, V726A, M680I, and A744S) in Iranian children with HSP.

MATERIAL AND METHODS

50 unrelated pediatric cases were studied regarding M694V, V726A, M680I, and A744S mutations using ASO-PCR method.

RESULTS

24% of cases had a mutation. 22% of cases had M694V mutations. One out of 50 (2%) patients had V726A mutation. In 76% of cases no mutation was determined. In other hand, 13 out of 100 alleles (13%) were carrier for one mutation. 12 out of 100 alleles had M694V mutations (% 12) and I out of 100 alleles had V726A mutation (%1). In 87 out of 100 alleles no mutation was detected. M680I and A744S mutations were not found in tested group. Mutation study and analysis demonstrated that the most frequent mutation was M694V (22%). Frequency of alleles were 0.12, 0.01,0,0,0.13, and 0.87 regarding M694V, V726A, M680I, A744S, total mutation, and wild type alleles, respectively. Our findings imply that M694V was dominant mutation.

CONCLUSIONS

This report as the first investigation of its kind in Iranian Azeri Turkish patients implying that M694V mutations are more frequent in tested group in comparison with general population. So it is suggested that investigation of M694V mutations should be considered as genetic test for diagnosis of HSP among Iranian Azeri Turkish patients.

The case of Iranian immigrants in the greater Toronto area: a qualitative study

INTRODUCTION

Iranians comprise an immigrant group that has a very different cultural background from that of the mainstream Canadian population and speaks a language other than English or French; in this case mainly Farsi (Persian). Although Iranian immigrants in Toronto receive a high proportion of care from Farsi-speaking family physicians and health care providers than physicians who cannot speak Farsi, they are still not satisfied with the provided services. The purpose of this study was to identify the obstacles and issues Iranian immigrants faced in accessing health care services as seen through the eyes of Iranian health care professionals/providers and social workers working in Greater Toronto Area, Canada.

METHODS

Narrative inquiry was used to capture and understand the obstacles this immigrant population faces when accessing health care services, through the lens of fifty Iranian health care professionals/providers and social workers. Thirty three health care professionals and five social workers were interviewed. To capture the essence of issues, individual interviews were followed by three focus groups consisting of three health care professionals and one social worker in each group.

RESULTS

Three major themes emerged from the study: language barrier and the lack of knowledge of Canadian health care services/systems; lack of trust in Canadian health care services due to financial limitations and fear of disclosure; and somatization and needs for psychological supports.

CONCLUSION

Iranians may not be satisfied with the Canadian health care services due to a lack of knowledge of the system, as well as cultural differences when seeking care, such as fear of disclosure, discrimination, and mistrust of primary care. To attain equitable, adequate, and effective access to health care services, immigrants need to be educated and informed about the Canadian health care system and services it provides. It would be of great benefit to this population to hold workshops on health topics, and mental health issues, build strong ties with the community by increasing their involvement, use plain language, design informative and health related websites in both Farsi and English, and provide a Farsi speaking telephone help line to answer their health related issues.

Growth pattern in 7-12 years old Arak children (central Iran) in comparison with other ethnic subgroups of Iran

BACKGROUND

growth is a remarkable index of health and can be influenced by genetic and environment conditions. The pattern of growth is unique for every nation and worldwide studies have demonstrated separate national standards. In the case of Iran, there is not enough information in this field.

METHODS

This study was undertaken on 7-12 years old children from Arak. The data for each individual such as age, height, weight and body mass index (BMI) were recorded. Differences in the data between two sexes were tested by means of the paired sample t- test and the mean BMI was compared with sex- and age-specific reference values from the National Center for Health Statistics of the Centers for Disease Control (CDC) 2000 growth chart using independent sample t-tests. Levels of P < 0.05, P < 0.01 and P < 0.001 were recorded as significant.

RESULTS

In this study, males were significantly taller and heavier than females at the same age (P < or = 0.01) except for length at age 10 and weight at age 12. The BMI curves were between 50th and 25th percentiles of CDC.

CONCLUSIONS

The present study shows the effect of socioeconomic background that had been also considered in other studies in Iran. There is a need for ethnic specific growth charts and BMI cut-off points for underweight, overweight and obesity in children of each ethnic subgroup of Iranian population.

Prospective one-year treatment outcomes of tortured refugees: a psychiatric approach

The treatment of torture survivors from diverse cultures has been a difficult task involving issues of loss, massive trauma, cultural style, and adjusting to a new country. Research on treatment outcomes has shown inconsistent results. This report presents a prospective one year treatment outcome of 22 severely tortured patients from Ethiopia, Somalia, Iran and Afghanistan. Treatment was provided by psychiatrists and counselors with interpreters from each culture involved. The specific treatment included psychiatric evaluation, medicine, education, supportive psychotherapy and assisting some social needs. All 22 were diagnosed with depression and 17 of these also had posttraumatic stress disorder (PTSD). Twenty of 22 patients showed marked significant improvement on all of the scales for depression, PTSD, disability, and quality of life. Medicine was particularly useful in treating depression and the symptoms of flashbacks, nightmares and irritability. Standard psychiatric treatment with evaluation, diagnosis, appropriate medicine, supportive psychotherapy and counseling by ethnic counselors provided good outcomes.

Breast cancer and screening information needs and preferred communication medium among Iranian immigrant women in Toronto

Few studies have investigated what information women from minority immigrant groups need about breast cancer and screening. Nor has much research been conducted about how such women would prefer to receive this information. Mere translation of breast cancer and screening information from generic materials, without considering and respecting women's unique historical, political, and cultural experiences, is insufficient. This study explored breast cancer and screening information needs and preferred methods of communication among Iranian immigrant women. A convenience sample of 50 women was recruited and interviewed over a 4-month period (June-September 2008); all resided in Toronto Canada, and had no history of breast cancer. Tape-recorded interviews were transcribed and analysed using a thematic analysis technique. While generic breast health communication focusing on physiological risk information meets some of the needs of Iranian immigrant women, results showed that the needs of this group go beyond this basic information. This group is influenced by historical, sociopolitical, and cultural experiences pre- and post-immigration. Their experiences with chemical war, unsafe physical environment (air and water pollution), and their sociopolitical situation appear to have limited their access to accurate and reliable breast cancer and screening information in their homeland. Moreover, the behavioural and psychosocial changes they face after immigration appear to have a strong influence on their breast cancer and screening information needs. Considering their limited time due to their multiple demands post-migration, multi-media methods were highly preferred as a communication means by this group. The results of this study can be used to guide the design and implementation of culturally sensitive breast health information. For instance, video presentations conducted by a trusted Iranian healthcare professional focusing on socioculturally relevant breast cancer risk factors, symptoms, and screening methods, as well as a list of available breast health resources, could improve Iranian women's knowledge and uptake of breast health practices.