davoud pourmarzi

Preterm birth is associated with high rates of neonatal morbidity and mortality. This study aimed to investigate the relationship between inter-pregnancy interval and the incidence of preterm birth.

In a case-control study, 185 women with preterm delivery and 185 women with term delivery were included. Data including inter-pregnancy interval, demographic characteristics, history of prenatal and neonatal complications, parity, gravidity, type of delivery, and smoking status were collected.

The mean of the inter-pregnancy interval in the case and control groups were 79.84 ± 45.55 months and 78.49 ± 41.29 months, respectively (P = 0.767). Inter-pregnancy interval 12-month or less in comparison with Inter-pregnancy interval more than 24 months significantly increased the odds of preterm delivery (OR: 4.05, 95% CI: 1.06-15.39, p = 0.040). However, inter-pregnancy interval of 13-24 months was not a risk factor when compared with more than 24-month inter-pregnancy interval (OR: 1.54, 95% CI: 0.62-3.80, p = 0.351). Having an educational level less than high school in comparison with tertiary level decreased the odds of preterm delivery (OR: 0.25, 95% CI: 0.11-0.56, P = 0.040). With each increase in number of gravidity odds of preterm delivery increased by 1.5 times (95% CI: 1.11-2.04, P = 0.009). Having a history of preterm delivery (OR: 2.57, 95% CI: 1.17-5.64, P = 0.019) and experiencing preeclampsia (OR: 1.98, 95% CI: 1.06-3.68, P = 0.032) increased the odds of preterm delivery.

Inter-pregnancy interval of 12-month or less in comparison with more than 2-year inter-pregnancy interval, experiencing preeclampsia, history of preterm delivery and increased number of gravidity increase the risk of preterm delivery. Health care providers need to be informed with the appropriate inter-pregnancy interval and counsel women to make an informed decision regarding their pregnancy.

The current treatment regimen for ovarian stimulation in Intracytoplasmic sperm injection (ICSI) patients is daily injections of Gonadotropins. Recombinant DNA technologies have produced a new recombinant molecule that is a long-acting Follicle Stimulating Hormone (FSH), named corifollitropin alfa. A single injection of long-acting FSH can replace seven daily FSH injections during the first week of controlled ovarian stimulation (COS) and can make assisted reproduction more patients-friendly. There is limited data with different results in this area. To compare the effectiveness of long-acting FSH vs. daily r-FSH in terms of  pregnancy and safety outcomes in women undergoing ICSI cycles. In this clinical trial study, 109 women who were the candidates  for ICSI at azzahra hospital were divided in two groups. The first group received 150 units of daily Gonal-f from second or third day of menstruation. The second group received a 150IU corifollitropin alfa on the second or third day of mensuration, and the treatment continued from day eighth of stimulation with Gonal-f based on the ultrasound finding. Both the groups received GnRH antagonist from fifth day of stimulation. Two groups were compared in terms of number of dominantfollicles, number of oocytes, stimulation duration, total number of embryos, number of transferred embryos, and success rate of pregnancy. No significant difference was found between the two groups in terms of stimulation duration, number of follicles, number of oocytes, total number of embryos, and number of transferred embryos. Moreover, pregnancy outcomes including chemical pregnancy rate (positive pregnancy test), clinical pregnancy rate (detection of fetal heart), the rate of ovarian hyper-stimulation syndrome, multiple-pregnancy, ectopic pregnancy, and miscarriage didn’t have a significant difference between the two groups. As corifollitropin alfa was as effective as r-FSH, it could be used as an alternative to ovulation stimulation method in patients undergoing ICSI.

This study aimed to report on perceived stigma by PLWH and factors that affect it.
A cross-sectional study was carried out on 120 PLWH in Qom, Iran from November 2015 to April 2016. Persian version of Fife and Wright's scale was used to measure perceived stigma.
The mean score of stigma was 73.19 ± 12.23 (range: 48-97). The means of external stigma and internal stigma were 43.70 ± 8.61 (range: 19-60), and 29.49 ± 5.32 (range: 17-40), respectively. Living in a rural areas (β = 10.341, p = 0.006), unemployment status (β = 6.910, p = 0.006), and poor support from family members (β = 4.772, p = 0.028) significantly increased the level of perceived stigma. PLWH experience a considerable level of stigma in their daily life. Mass media involvement to increase public awareness and reduce HIV related stigma need be more highlighted.
Working with the patient's families, interventions in the rural areas and workplaces, and providing social supports is necessary to minimize the HIV related stigma.

This study aimed to determine the relationship between vitamin E in the follicular fluid (FF) and serum with oocyte morphology and embryo quality.
A cross-sectional study was conducted on serum samples, FF samples, oocytes, and embryos collected from 50 women undergoing in vitro fertilization in the Alzahra Hospital, Rasht, Iran from March to August 2014. Vitamin E level was measured using HPLC. Oocyte morphology and embryo quality were evaluated during inverted optical microscopy.
Totally 434 oocytes and 199 embryos were examined. Most frequently the metaphase II (MII) oocytes were observed at the 0.35-1 mg/dl level of vitamin E in FF (89.2%) and the 1-5 mg/dl level of vitamin E in serum (86.1%). The odds of having MII oocytes at the level of 0.35-1 mg/dl (OR = 2.48, 95% CI = 1.24-4.94) and 1.5-2 mg/dl (OR = 2.51, 95% CI = 1.02-6.19) of vitamin E in FF was significantly higher compared to level of 2-7.4 mg/dl. The effect of vitamin E serum level on oocyte maturation was not significant. The odds of having embryo with Z1 or Z2 quality, at the 10-15 mg/dl level of vitamin E in serum (OR = 6.45, 95% CI = 1.18-35.22), compared to the 15-20 mg/dl level, was significantly higher. The effect of vitamin E levels in FF on the embryo quality was not significant.
At certain levels of vitamin E in the FF, oocytes with higher maturation and at certain levels of vitamin E in serum, embryo with higher quality can be achieved.

There are many factors that affect intrauterine insemination (IUI) success rate and identifying those factors can be helpful. This study aimed to investigate the single versus double IUI in controlled ovarian hyperstimulation cycles.
This is a randomized clinical trial with equal randomization (1:1) conducted on 580 women who underwent IUI in a private infertility clinic from May 2013 to November 2014 in Rasht, Iran. Women were randomly assigned to single (n = 290) or double (n = 290) IUI groups. Women in the single group underwent IUI performed 36 h after human chorionic gonadotropin (HCG) administration. Women in the double group underwent two IUIs performed 18 and 40 hours after HCG administration. The main outcome was clinical pregnancy confirmed by evidence of fetal cardiac activity. Data were analyzed by SPSS software. Comparisons of frequencies were done using the Fisher exact test and Chi-square test. For comparing means between the two groups, the independent t-test was used. The P-value Pregnancy rate was 11.7% (34/290) in the single IUI group and 13.4% (39/249) in the double IUI group. The difference between the two groups was not statistically significant (P = 0.617, OR = 1.17, 95% CI: 0.72 – 1.91). Also, we could not show significant difference between single and double IUI groups in different cause of infertility groups regarding the success rate.
Based on findings, double versus single IUI did not increase the pregnancy rate of IUI and further investigations are recommended.

To assess the perceived HIV/AIDS related stigma a comprehensive and well developed stigma instrument is necessary. This study aimed to assess validity and reliability of the Persian version of HIV/AIDS related stigma scale which was developed by Kang et al for people living with HIV/AIDS in Iran.
Thescale was forward translatedby two bilingual academic members then both translations were discussed by expert team. Back-translation was done by two other bilingual translators then we carried out discussion with both of them. To evaluate understandability the scale was administered to 10 Persons Living with HIV/AIDS (PLWHA). Final Persian version was administered to 80 PLWHA in Qom, Iran in 2014. Test–retest reliability was assessed in a sample of 20 PLWHA after a week by intra-class correlation coefficient (ICC).
Cronbach’s alpha coefficient for overall scale was 0.85. Also Cronbach’s alpha coefficients for the five subscales were as follows: social rejection (9 items, α = 0.84), negative self-worth (4 items, α = 0.70), perceived interpersonal insecurity (2 items, α = 0.57), financial insecurity (3 items, α = 0.70), discretionary disclosure (2 items, α = 0.83). Test–retest reliability was also approved with ICC = 0.78. Correlation between items and their hypothesized subscale is greater than 0.5. Correlation between an item and its own subscale was significantly higher than its correlation with other subscales.
This study demonstrate that the Persian version of HIV/AIDS related stigma scale is valid and reliable to assess HIV/AIDS related stigma perceived by people living whit HIV/AIDS in Iran.

Rabies is one of the most important zoonosis. Rabies vaccination after dog bite incidence is important way for prevention of this disease. This article aimed to determine awareness about necessity of rabies vaccination among dog bite victims in Rasht city. This study was a cross-sectional study. During one year, we surveyed all cases at least 16 years old of dog bite that referred to rabies vaccination centers in Rasht city. During research period we surveyed 482 cases of dog bite. For data collection we used researcher-made questionnaire. Data were analyzed by descriptive statistic, chi square test, independent samples t test, analyses of variance and logistic regression. Only 59.8% of subjects were aware of necessaries of rabies vaccination after dog bite. In comparison of illiterate individuals, having elementary and secondary education level (OR= 3.45, CI: 1.54-6.02), high school education level (OR= 4.65, CI: 2.09-10.35), university education level (OR= 7.60, CI: 2.92-19.73) increase chance of be aware about necessaries of rabies vaccination but inhabit in rural area decrease this chance (OR= 0.57, CI: 0.36-0.89). High percentage of population is unaware about necessity of rabies vaccination after dog bites occur. Designing and performing educational programs about this issue especially at rural area and people with lower educational level are necessary. Also educational level at designing and performing educational programs should be considered.

Rabies vaccination after animal bite is the most important method for prevention of rabies. Delay in rabies vaccination increases the risk of rabies after animal bites. This study aimed to determine incidence rate of rabies vaccination delay after dog bite and its related factors in Guilan province. In this cross-sectional descriptive analytical study conducted over one year period from July 2011 to June 2012 we surveyed all those with at least 16 years of age with dog bite who referred to rabies vaccination centers in Guilan province. A researcher-made questionnaire was used for data collection and data were analyzed by descriptive statistics، Chi square test، independent t test and logistic regression. During research period 1604 cases of dog bites were surveyed of whom 13. 8% of cases had at least 24 hour and 5. 5% had at least 48 hour delay for receiving rabies vaccine. Having superficial injury (OR: 2. 16، CI: 1. 34-3. 48)، incidence in rural area (OR: 1. 69، CI: 1. 05-2. 72) and lack of knowledge about necessity of rabies vaccination after dog bite (OR: 1. 45، CI: 1. 07-1. 97) significantly led to delay of rabies vaccine after dog bite. Based on this study results it is necessary to inform people on rabies and also the need of rabies vaccination after dog bite in order to reduce delay.

High level of cortisol that is concentrated due to stress expose had negative effects on health. Spiritual well-being cause positive fall and can decreases cortisol level. This study aimed to determine relationship between spiritual well-being score and cortisol level in nursing students. This was a descriptive analytical cross-sectional study that was carried out on 100 nursing students in Rasht Islamic Azad University who were training at internship in 2013. Simple random sampling based on students’ identification number was performed. We used standard spiritual well-being (SWB). Serum cortisol level was obtained at morning between 10 and 12. For statistical analysis we used independent t-test and Pearson’s coefficient of correlation. Mean of spiritual well-being and its religious and existential well-being scale were 97.8±13.4, 48.6±7.1, and 49.2±7.2, respectively. Most of students (51%) were in high level of Spiritual well-being and rests (49%) were in moderate level. Mean of plasma cortisol level was 14.08±5.08. There was no significant correlation between spiritual well-being and its subscales with serum cortisol level. Among 20 questions in Spiritual well-being scale there were significant negative correlations between cortisol level and “I believe that God is concerned about my problems” (r=-0.211, P=0.035) and “I don’t enjoy much about life” (r=-0.202, P=0.044). There was no relationship between serum cortisol level in morning and spiritual well-being scale and its subscales. However, the belief that God is a helper in problems and enjoy about life have relations with low level of serum cortisol.

Animal bites specially dog bite imposes a financial burden on country’s health system annually. This paper aimed to report imposed financial burden due to rabies and tetanus prevention after dog bite incidence. in a cross-sectional study during one year, administered treatments for prevention of rabies and tetanus on dog bite cases that referred to Rasht rabies vaccination centers were studied. Data were collected by a check list and designed based on objectives of this research. Data were analyzed by descriptive statistics, fisher’s exact test, independent t-test and one way ANOVA. Five hundred and sixty one cases of dog bite were studied. For each case the average doses of anti rabies and anti tetanus vaccine inoculated were 3.2 and 0.7 and administrated 499.5 unit rabies and 0.1 vial tetanus immunoglobulin. Mean of unit of rabies immunoglobulin administrated for men was significantly more than women. Among age groups mean of unit of rabies immunoglobulin administrated, dose of anti tetanus vaccine inoculated and vial of tetanus immunoglobulin administrated were significant. Rabies immunoglobulin that was administrated in 30-39 years old were higher than other age group.Also anti tetanus vaccine and tetanus immunoglobulin that were administrated in 50 years old or further cases were higher than other age group. Based on results each dog bite imposes heavy cost on health system for rabies and tetanus prevention. Older cases impose more costs than other. Design and perform dog bite prevention programs can reduce such costs.

Educational programs for couple's mental health promotion in marital life are a necessity. The first step in planning an educational program understands the needs of the target group. This paper reports the mental health educational needs in youth planning to marry.

In a descriptive-analytical cross sectional study, 450 individuals taking part in pre-marriage education courses in Tehran were selected by randomized stratified sampling. The data was collected using a questionnaire that measured the educational needs in the area of mental health by the 5-point Likert-type scale. Data analysis was done using the SPSS-15 software, the statistical tests being the independent T-test, one-way analysis of variance (ANOVA), and the chi-square test.

On the whole, the subject's felt need for mental health education was more than moderate (3 on the Likert scale); women expressed a higher need than men (p=0.001). The main concern of the participants - both men and women - was How to keep romance alive in married life. The extent of need expressed for mental education was not statistically different in different socio-demographic groups of women, while worker men expressed a higher need than self-employed men (P=0.018).

Based on the findings of this study, young people planning to marry have a felt need for education in the area of mental health. It is recommended to design and implement educational programs to promote their knowledge in this area with due consideration of priorities stated by them.