Journal of research in health sciences最新文献

Background: Tuberculosis (TB) remains a global health concern with high mortality despite treatment options. Understanding the underlying risk factors for TB mortality is essential for guiding effective control strategies. This study examined sociodemographic and clinical factors related to TB mortality in Hamadan province, Iran, to inform control strategies. Study Design: A cross-sectional study.

Methods: This study evaluated data (March 2011-March 2022) obtained from a provincial TB surveillance database, encompassing smear-positive pulmonary TB (SPT), smear-negative pulmonary TB (SNT), and extrapulmonary TB (EPT) patients. Demographic and clinical characteristics were investigated, and the death rate for each group was calculated by dividing the number of TB-related deaths by the total number of diagnosed TB cases for that group during the study period. Logistic regression was applied to computed unadjusted and adjusted odds ratios (ORs) with a 95% confidence interval for the death rate using Stata 17 (P<0.05).

Results: Among the 942 patients included in the study, 49%, 21%, and 30% were diagnosed with SPT, SNT, and EPT, respectively. The risk of mortality was the highest among SPT patients, with EPT cases showing significantly lower odds of death (OR: 0.38, P<0.001) compared to SPT. Among SPT patients, mortality was associated with older age (OR: 1.04, P<0.001) and positive sputum smear at month 2 (OR: 19.72, P<0.001). Human immunodeficiency virus (HIV) positivity significantly increased the death rate in SNT patients (P=0.037). In EPT patients, mortality was linked to male gender (P=0.042), referral unit (P=0.023), TB hospitalization (P=0.018), and advanced age (P<0.001).

Conclusion: Targeted interventions focusing on early diagnosis, HIV management, and care for high-risk groups (e.g., elderly) are essential to reduce TB mortality in Hamadan province. However, the findings should be interpreted with caution due to limitations, such as reliance on retrospective registry data, potential information bias, and missing data, particularly regarding HIV status.

Background: The urban poor represent a vulnerable population within society, particularly in terms of maternal health. Economic and access-related limitations often prevent this group from accessing healthcare services, especially in the institutional delivery process. This study aimed to analyze the barriers to institutional delivery among Indonesia's poor urban society. Study Design: This study employed a cross-sectional design.

Methods: Data were obtained from the 2023 Indonesian Health Survey, including 7,548 participants. Eight independent variables were analyzed, including age, education, marital status, employment, wealth, insurance, and parity, with institutional delivery used as the dependent variable. Binary logistic regression was employed for analysis.

Results: Approximately 38.1% of Indonesian pregnant women had non-institutional deliveries. All age groups showed a higher likelihood of non-institutional delivery compared to those aged≥45. Lower education levels were associated with a heightened probability of choosing non-institutional delivery. Married women were 0.704 times less likely than divorced or widowed women to give birth in non-institutional settings (AOR: 0.704; 95% CI: 0.693-0.716). Unemployed women had 1.218 times higher likelihood of engaging in non-institutional delivery compared to employed women (AOR: 1.218; 95% CI: 1.1210-1.226). The poorest women were 0.973 times less likely than the poorer group to have non-institutional delivery (AOR: 0.973; 95% CI: 0.967-0.980). Uninsured women were 2.364 times more likely than insured women to give birth outside of healthcare institutions(AOR: 2.364; 95% CI: 2.345-2.379). Women with all other parity levels were less likely than grand multiparous women to have non-institutional deliveries.

Conclusion: Seven barrier factors to institutional delivery were younger age, low education, divorced/widowed marital status, unemployment, lower wealth status, lack of insurance, and grand multiparity.

Background: The increasing prevalence of hypertension (HTN), accompanied by a decreasing quality of life (QoL), requires appropriate interventions to avoid its impacts and the occurrence of chronic conditions. The purpose of this study was to assess the effect of the intervention model education on the QoL of hypertensive patients compared to HTN self-management training and no intervention. Study Design: A quasi-experimental study.

Methods: The sample consisted of 138 hypertensive patients, divided into an HTN intervention model education group (n=46), an HTN management training group (n=46), and a group without treatment (n=46). The study used a quasi-experimental design with a control group. All groups received a pre-test, and after 6 weeks, they all received a post-test with the WHOQOL-BREF questionnaire.

Results: The HTN intervention model education group and the HTN self-management training group had a significant effect on the QoL of hypertensive patients (P=0.0001), while the control group showed no effect (P=0.310). The Kruskal-Wallis test demonstrated a significant difference in the three interventions, and the highest difference was observed in the HTN intervention model education group.

Conclusion: The HTN intervention model education was the main choice because it involved not only the patient himself but also policies, health workers, cadres, and families, as well as the presence of booklets.

Background: Cohabitation is vulnerable from a legal perspective. However, legal marriage does not exempt women from experiencing sexual abuse, while marriage is often misused as a justification. This study aimed to examine the impact of marital status on the incidence of sexual violence against women within couples. Study Design: A cross-sectional study.

Methods: The secondary analysis examined the 2022 Ghana Demographic and Health Survey, which included data from 8811 respondents. The study used sexual violence and marital status as outcome and exposure variables, respectively. Meanwhile, five control variables, including age, marital status, education, employment, wealth, and recent sexual activity, were analyzed in this study. Finally, the results were analyzed by binary logistic regression (P<0.05) using SPSS 21.

Results: Sexual violence was reported by 5.3% of women living with a partner and 2.6% of married women (P<0.001). Based on marital status, women in a cohabitation relationship were 1.57 times more likely to experience sexual violence than married ones (adjusted odds ratio [AOR]: 1.857, 95% confidence interval: 1.857-1.858). Several factors were also significantly associated with increased risk of sexual violence, including urban residence (AOR: 1.139), younger age (e.g., 20-24 years: AOR: 1.766), lower education/no education (AOR: 2.045), unemployment (AOR: 1.415), lack of pregnancy (AOR: 1.221), recent sexual activity (AOR: 1.266), and women in middle-income and richer groups (AOR: 1.175 and AOR: 1.414).

Conclusion: The evaluation revealed that marital status was related to sexual violence against women among Ghanaian couples. Women living in cohabitation with a partner were more likely to experience sexual violence than married women.

Background: The trend of human immunodeficiency virus (HIV) disease progress is different for every patient. Some patients may experience events during the course of their disease that can affect disease progression and death. The main objective of the present study was to investigate the effect of risk factors in progression of HIV disease, taking into account intermediate events, using a multistate model. Study Design: A retrospective cohort study.

Methods: The current study used information from 673 HIV-infected adult patients registered at the Hamadan Provincial Health Center in Iran, between 1997 and 2023. A multistate framework was described to investigate the progression of HIV disease over time. Three states (HIV-infected, acquired immunodeficiency syndrome [AIDS], and death) and three possible transitions (from HIV to AIDS, from HIV to death, and from AIDS to death) were considered in this framework. An illness-death multistate model was applied to determine the effect of risk factors on these transitions.

Results: The results revealed that receiving antiretroviral therapy (ART) significantly decreased the hazard of transition from HIV to AIDS, whereas older age, tuberculosis (TB) co-infection, and treatment with the final guideline intensified the hazard of the mentioned transition. Low education, older age, and unprotected sexual transmission increased the risk of transition from HIV to death, while receiving ART and treatment with the final guideline decreased the risk of this transition. Receiving ART, being employed, having a history of prison, and being treated with the final guideline could decrease the hazard of transition from AIDS to death, whereas TB co-infection increased the hazard of this transition.

Conclusion: Implementing strategies for early diagnosis, timely treatment, adherence to treatment, as well as screening and TB treatment, especially at younger ages, can be useful in reducing AIDS progression and mortality.

Background: Prematurity and neonatal hypotrophy (defined as a Z-score below -2 for weight, length, or head circumference) increase the risk of perinatal morbidity, mortality, and long-term developmental disorders. This study examines the growth trajectories of Moroccan preterm infants and investigates the factors influencing their overall growth outcomes at six months, including weight, length, and head circumference. Study Design: A retrospective longitudinal cohort study.

Methods: This study was conducted at the National Reference Center for Neonatology and Nutrition in Rabat from April to October 2023. It included 686 premature newborns (24-36 weeks) hospitalized for≥48 hours, with complete anthropometric data and follow-up of six months. Exclusion criteria were major malformations, chromosomal abnormalities, metabolic disorders, and incomplete data. ANOVA and multivariate logistic regression identified independent predictors of weight growth outcomes at six months (WAZ≥-2), adjusting for confounders (gestational age, gender, hospitalization, multiparity, phototherapy, antibiotics, and early food diversification). Results are reported as odds ratios (ORs) with 95% confidence intervals (CI). Growth curves were generated with Python. Significance was set at P<0.05.

Results: Gestational age of≥32 weeks (OR=6.66, 95% CI: 1.21, 36.72; P=0.029) and multiparity (OR=12.09, 95% CI: 2.12, 68.93; P=0.005) predicted growth outcomes, while a hospital stay of≥10 days reduced the likelihood (OR=0.05, 95% CI: 0.01, 0.27; P=0.001). Male gender and antibiotic use showed non-significant trends (P=0.053).

Conclusion: Close monitoring and targeted nutritional strategies are essential to improve postnatal growth in preterm infants.

Background: Thyroid nodules are common endocrine disorders. Most nodules are benign, with only 5% to 15% being malignant. Fine needle aspiration (FNA) is a primary diagnostic method; however, recent studies have raised concerns about its diagnostic reliability. This study aimed to evaluate performance of FNA in diagnosing thyroid nodules using pathology results as the gold standard. Study Design: A cross-sectional study.

Methods: This study analyzed patients who were referred to an endocrine clinic in Hamadan city and underwent thyroidectomy during a 10-year period. The collected data included demographics, clinical symptoms, FNA results, and pathological outcomes. Statistical analysis was conducted using Stata software, with the significance level set at 0.05.

Results: The study included 700 patients, predominantly female (86.2%), with a mean age of 42.5 years. FNA results were as follows: non-diagnostic in 4.8% (n=43), benign in 43.4% (n=304), atypia of undetermined significance or follicular lesion of undetermined significance in 6.1% (n=42), follicular neoplasm in 13.2% (n=92), suspicious for malignancy in 22.8% (n=160), and malignant nodules in 9.7% (n=68) of the cases. Pathology revealed malignant nodules in 56.9% (n=398) of the cases, predominantly papillary carcinoma. Significant factors associated with malignancy included younger age, male gender, history of thyroid cancer in a first-degree relative, and the presence of cervical adenopathy. FNA showed a sensitivity of 72.43% (95% CI 67.58%, 76.93%) and a specificity of 89.64% (95% CI 85.46%, 92.95%), with an accuracy of 79.85% (95% CI 76.55%, 82.87%).

Conclusion: While FNA is a valuable diagnostic tool for thyroid nodules, its sensitivity varies, necessitating close follow-up of patients with negative results.

Background: Fractures constitute a significant concern in low-income and middle-income countries, primarily due to road traffic crashes (RTCs), a leading cause of such injuries. This study aimed to analyze fracture patterns resulting from RTCs in Iran. Study Design: A cross-sectional study.

Methods: A registry-based study was conducted using data from the National Trauma Registry of Iran spanning 2016-2023. The study included 10,114 trauma patients involved in RTCs, encompassing car and motorcycle crashes with at least one fracture. International Classification of Diseases (ICD-10) codes were used for data analysis, considering both orthopedic and non-orthopedic admissions related to RTCs. Fracture incidence was compared among pedestrians, drivers/riders, and passengers/pillions.

Results: Males constituted a significant majority of the car (90.1% drivers, 72.1% pedestrians, and 47.0% passengers) and motorcycle (99.6% riders, 77.0% pedestrians, and 65.3% pillions) crashes (P<0.001). Patients under 18 comprised 18.4% of the motorcycle riders and 2.5% of the car drivers. Drivers showed the highest frequency of head injuries (26.9%, P<0.010), while pedestrians had the highest frequency of upper extremity injuries (73.1%, P<0.001). Drivers also demonstrated a higher frequency of vertebral fractures than passengers (C3-C7: 3.2% vs. 1.4%, P=0.006). Riders (33.5%) displayed a higher frequency of head and face fractures compared to pillions (24.8%) and pedestrians (17.4%) (Head: pedestrian vs. rider, P<0.001; pedestrian vs. pillion, P=0.018; rider vs. pillion, P=0.005; Face: pedestrian vs. rider, P<0.001; pedestrian vs. pillion, P<0.001; rider vs. pillion, P=0.033).

Conclusion: The study provided valuable information on the fracture patterns associated with RTCs among road user groups.

Background: Smoking remains a serious public health issue on a global scale and warrants increased attention. This research aimed to assess the prevalence of smoking and identify key predictors driving the adoption of smoking prevention behaviors among university students in northern Iraq. Study Design: A cross-sectional study.

Methods: An online study was conducted among 765 students at Raparin University, Sulaymaniyah, Iraq. The required data were collected using a structured questionnaire distributed through Google Forms. The questionnaire, developed from standardized instruments, assessed sociodemographic factors and determinants of smoking behaviors. Finally, the data were analyzed by SPSS-16 using linear and logistic regressions.

Results: The average age of the students was 21.04 years [95% confidence interval: 20.89, 21.20], with ages ranging from 17 to 29 years. The age group of 21-23 years old increased the chances of cigarette smoking among students (odds ratio [OR]: 2.068). In addition, male students were more likely to have cigarette smoking (OR: 11.675). Father smoking, brother smoking, and friend smoking increased the chances of cigarette smoking by 1.981, 2.687, and 10.426 times among students, respectively. Our study identified key determinants of smoking preventive behaviors, including peer pressure (B=0.507), self-image (B=0.235), belief (B=0.134), value (B=0.184), attitude (B=0.115), and the influence of friends who smoke (B=-1.110).

Conclusion: Our findings emphasize the critical roles of peer pressure and self-image in influencing smoking behaviors among students. To address this issue, targeted educational programs that foster positive self-image and resilience against peer influence are vital for effective smoking prevention strategies.

Background: Coronary artery disease (CAD) is a leading cause of death globally, with genetic and lifestyle factors contributing to its development. The first-degree relatives of CAD patients are at increased risk due to shared genetics and environments. This study aimed to perform a comparative analysis of gender-specific patterns of traditional CAD risk factors and QRISK3 scores in the first-degree relatives of CAD patients. Study Design: A cross-sectional study.

Methods: This study enrolled 4,485 participants of first-degree relatives of patients who had been admitted to the hospital for CAD. Gender-specific comparisons were conducted in the first-degree relatives of CAD to assess traditional risk factors and QRISK3 scores.

Results: The mean age of patients was 41.8 years, with males comprising 66% of participants in our study. Males exhibited more traditional risk factors, including higher systolic and diastolic blood pressure, dyslipidaemia, smoking, alcohol, junk food consumption, and oral tobacco use. Females had a higher prevalence of obesity, inadequate sleep, depression, and migraines. Males had a significantly higher 10-year CAD risk according to QRISK3 scores, reflecting an increased healthy heart age of 4.20±1.32 years compared to their chronological age (P=0.0004).

Conclusion: The prevalence of coronary risk factors was twice as high in the first-degree male relatives of individuals with known CAD compared to females. Distinct gender-based differences were found in risk factors and QRISK3 scores, highlighting the significance of specific approaches in evaluating and managing the risk of CAD within this high-risk group.