2021 Impact Factor: 1.479
2021 CiteScore: 2.1
Chairman & Editor-in-Chief:
Dariush D. Farhud, MD, Ph.D., MG.
Iranian Journal of Public Health has been continuously published since 1971, in two languages (English and Persian). From 2001 issue, the Journal is published only in English language.
Iran J Public Health is published by Tehran University of Medical Sciences (TUMS). It is the official Publication of the Iranian Public Health Association and the School of Public Health, TUMS, Iran.
Background: We aimed to determine the plausible role of high body mass index (BMI) in the etiopathogenesis of coronary artery disease (CAD), erosive esophagitis (EE) and gastroesophageal reflux disease (GERD) and their complex associations.
Methods: The published literature was retrieved from Cochrane, Google Scholar, Embase, PubMed and Scopus databases until August 2021 based on the inclusion and exclusion criteria. The Newcastle-Ottawa quality assessment scale was used for the risk of bias and publication bias with a funnel plot. Heterogeneity between studies underwent evaluation using the I2 statistic and Q-test, and a random and fixed-effect model analysed studies with low to moderate heterogeneity.
Results: Out of 3819 studies extracted, 20 studies were studied based on the inclusion and exclusion criteria. The study corroborated the direct association of GERD symptoms and EE among obese Odds Ratio (OR) = 4.25) and overweight subjects (OR 9.75). Separate analyses of the link between GERD symptoms and EE was conducted among the overweight (OR 4.11, OR 4.61) and obesity subjects was statistically significant (OR 12.07, OR 9.95). The corresponding adjusted OR was noted for the association of CAD with overweight and obesity amounted to 3.41 and 3.01, respectively. Separate subgroup analysis was analyzed based on different ethnic populations for the association between GERD symptoms and EE in obesity (OR of 9.38) and overweight (OR of 4.21) subjects were statistically significant (P<0.05). For population subgroup analyses the overall OR of 3.32 was noted on the association between CAD and obesity.
Conclusion: Moderate to severe BMI has bene considered as an independent risk factor for GERD symptoms, EE and CAD.
Background: Occupational noise exposure is one of the environmental factors that pose safety and health risks among workers in factories. This systematic review focuses on the activities that cause noise hazards toward workers’ heart rate, other physiological conditions, and strategies to prevent noise exposure in the manufacturing industry.
Methods: Through a comprehensive literature review, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Cochrane method were used. The appraisal of quality was conducted by using the Critical Appraisal Skills Programme (CASP) to fulfil the selected keywords.
Results: Occupational noise exposure not only affects the workers’ most common issues, such as heart rate, but also other physiological factors, such as blood pressure. The outcome showed that different level of continuous noise exposure with high intensity decibels affects the heart rate of the workers. Source, path, receiver was recommended strategies for basic noise prevention in engineering control.
Conclusion: Therefore, noise give significant effects towards human workers in related industry. Study related to noise effects towards heart rate performance led to future prevention and innovation.
Background: We comprehensively investigated and summarized the current situation of parenting programs for multicultural families in South Korea.
Methods: Two researchers independently searched and selected 16 studies on parenting programs for multicultural families and analyzed the major dependent variables, including parenting stress, parenting efficacy, parenting attitude, and parental satisfaction, in a meta-analysis of parenting stress and parenting efficacy (n=6 each). This study was dealt with a Bayesian meta-analysis to perform examine the effect sizes for parenting stress and parenting efficacy. Sensitivity to prior distributions was evaluated before the Bayesian meta-analysis, and an optimal prior distribution was selected based on the Watanabe–Akaike information criterion.
Results: The combined effect sizes for parenting stress and parenting efficacy were found to be >1 in both the frequentist and Bayesian meta-analyses, indicating that the parenting programs for multicultural families in South Korea are highly effective.
Conclusion: These basic data can facilitate the expansion of customized social services for reducing parenting burdens in multicultural families.
Background: The prevalence of pelvic organ prolapse (POP) is expected to increase in the next few decades, imposing a substantial medical burden. The effect of local estrogen therapy (LET) on POP in postmenopausal women is still controversial; therefore, we aimed to provide reliable evidence to address this issue from the perspective of vaginal health and quality of life (QoL).
Methods: We searched in the PubMed, the Web of Science, Embase and the Cochrane Library databases for eligible RCTs from beginning to Apr 2021. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed in our study.
Results: Seven RCTs(n=570) were included. No significant improvement of the epithelial thickness (SMD=1.38, 95%CI -0.54 to 3.31, P=0.16) or vaginal pH (SMD=-0.98, 95%CI -2.65 to 0.69, P=0.25) after LET compared with the control. A slight increase was observed in the VMI (MD=16.58, 95%CI 1.14 to 32.02, P=0.04). Regarding QoL, no significant differences between the estrogen group and the control group in PFIQ-7 (6m: MD=3.60, 95%CI –3.13 to 10.33, P=0.29; 12m: MD=3.53, 95%CI -3.35 to 10.41, P=0.31), PISQ-12(6m: MD=0.62, 95%CI –0.73 to 1.98, P=0.37; 12m: MD=0.36, 95%CI –1.06 to 1.77, P=0.62), or PGI-I (6m: RR=0.99, 95%CI 0.92 to 1.07, P=0.88; 12m: RR=1.01, 95%CI 0.95 to 1.07, P=0.72) score. Moreover, no more specific adverse events (AEs) (RR=1.11, 95%CI 0.84 to 1.48, P=0.46) were observed in the interventional group.
Conclusion: Not find LET caused either a significant improvement in vaginal health and QoL or more AEs.
Background: ICU patients typically experience diverse kinds of distress factors, which make them vulnerable to delirium thereby resulting in a higher rate of delirium occurrence. We aimed to review systematically current states of preventive nursing intervention in ICUs, and to analyze delirium occurrence and the length of ICU stay to provide suggestions for the preventive nursing practice in ICU.
Methods: Data collection was done with literature search databases including PubMed, Ovid-MEDLINE, EMBASE, CINAHL, KMbase, KoreaMed, Korean Studies Information Service System (KISS), Korea Institute of Science and Technology Information (KiSTi), Research Information Service System (RISS) and with hand searching, from Apr 20 to May 10, 2020. Two researchers independently selected research literature, and three researchers summarized and identified related variables based on data extraction methods.
Results: Overall, 236 articles identified, 11 articles met the inclusion criteria for review. The systematic review of the contents of preventive nursing intervention other than drug administration rendered the four types of intervention. The Peto odds ratio (OR) of the rate of delirium occurrence appeared as 0.29 (95% Confidence Interval (CI)=0.20∼0.43) which was statistically significant (Z=6.23, P<.01) in both group. The magnitude of the effect for the length of ICU stay demonstrated insignificant values, Mean difference (MD) –0.23 (95% CI=-0.51∼0.05) (Z=1.60, P=.11).
Conclusion: For management of delirium among ICU patients, multi-component intervention packages, suitable for care setting in ICUs, need to be taken into account for the preparation of nursing intervention for prevention of delirium applicable to nursing practices.
Background: Sexual child abuse is a form of anti-social behavior with the children that cause potential harm to the health, development and dignity of the child. Knowledge of children about these issues can help to protect themselves against sexual abuse. This study aimed to review systematically available documents about the importance of knowledge on self-protection of sexual abuse in children.
Methods: In this systematic review, “sexual abuse”, “self-protection” and “knowledge” were searched in Scopus, Google Scholar, Ovid, PubMed, and Science Direct as the search words, and after considering the inclusion criteria and excluding irrelevant articles, the relevant articles were included for data extraction. In the included studies, children were educated about sexual abuse, and questionnaires were designed to compare the impact of education and the level of knowledge in children before and after education.
Results: Overall, 19 articles with overall 6582 children were found that were published from 1987-2020. The main awareness of children was from parents, educators and then the media. Age of the child, education level of family, good relationship between family members, adequate education by school teachers in the form of educational programs and even media play an important role in increasing knowledge of children about sexual abuse. Education to children, on average, led to 77.43% more awareness and as a results self-protection against sexual abuse and rape.
Conclusion: Insufficient education or lack of knowledge about sexual abuse is a critical issue in children. Therefore, it is necessary to design educational programs to increase their knowledge about sexual abuse and strategies for self-protection in this age group.
Background: Evaluate the patient's safety status in Iranian hospitals using the Patient safety friendly hospital initiative (PSFHI) assessment tool provided by the World Health Organization. PSFHI assessment tool of 140 patient safety standards, they are classified as mandatory (20 standards), basic (90 standards) and advanced (30 standards). Mandatory standards are necessary criteria that hospitals must meet to register for PSFHI. The first stage of the patient safety program in Iran is to achieve the implementation of the mandatory standards to enter the patient safety friendly hospital program. We aimed to evaluate the patient's safety status in Iranian hospitals in terms of implementing mandatory patient safety standards.
Methods: In this systematic review, articles were searched between 2001 and 2021 in Web of Science, PubMed, Scopus Google Scholar, and Iranian SID and Magiran databases. Keywords including patient safety, quality assessment, standards, patient safety friendly hospital, Iran were performed. These articles were evaluated independently by two researchers and the contradictions were discussed with the third author.
Results: Finally, 7 eligible studies were included in the study. The highest score (75%) was related to the fourth domain of safe environment and the lowest score with (47%) was related to the second domain of engaging and interacting with the patient and the community. The overall average of compliance with standards in all four areas was 70%.
Conclusion: Institutionalizing a patient safety culture, paying more attention to creating a culture to identify patients, educating staff and patients, and removing legal barriers, Increases the observance of mandatory patient safety standards in the Iran.
Background: Clinical investigations repurposing a disintegrin and metalloproteases 10 (ADAM10) as metastatic and thrombus marker have achieved encouraging results, but the mechanism behind this association remains unclear.
Methods: This study was carried out in NingXia and Wuhan, China from 2017 to 2021. The effects of ADAM10 expression on the metastatic and thrombus-associated genes: tissue factor (TF), P-selectin glycoprotein ligand-1 (PSGL-1), cathepsin G (CTSG) and mucin 1 (MUC1) were examined by immunofluorescence, qRT-PCR and Western blotting analysis. Metastatic and thrombotic behaviors were evaluated using NODSCID mouse model.
Results: The ADAM10 expression controlled the migration and invasion of pancreatic carcinoma cell-1(PANC-1), and significantly regulated the metastatic and thrombus-associated genes (P＜0.05). ADAM10 and MUC1 were regulated and aberrantly expressed by a dependent mechanism. Moreover, ADAM10 expression induced the progression of adenocarcinoma cells and thrombus formation in vivo.
Conclusion: Regulation of ADAM10 expression in cancer cells might effectively pave the way for a more potent anti-metastatic and anti-thrombotic approach and could regulate the invasion and migration of cancer cells.
Background: Dietary factors play an important role in gastric cancer risk. They have not been investigated extensively in Hanzhong area, China.
Methods: We conducted a population-based case-control study of gastric cancer in Hanzhong area, China in 2018-2020. A total of 121 patients with historically confirmed gastric adenocarcinomas were interviewed. Controls were an age-stratified random sample of residents of Hanzhong area. The dietary questionnaire was a 70-item semiquantitative food frequency adapted for the Hanzhong diet. Odds ratios were calculated for quartiles of consumption of food groups and were adjusted for age, gender, calories, chili pepper intake, cigarette smoking, socioeconomic status, added salt, and history of peptic ulcer disease.
Results: There was approximately a threefold increased risk of gastric cancer for frequent consumption (highest quartile) of both fresh meat (odds ratio (OR) = 3.0) and processed meat (OR = 3.3). Odds ratios were also significantly elevated for frequent consumption of dairy products (OR = 3.1) and fish (OR = 3.1). The authors observed a decreasing gradient of risk with increasing frequency of vegetable consumption due to a significant inverse trend for the yellow and orange vegetables.
Conclusion: High intake of citrus fruits showed a slight inverse association. These findings are consistent with many studies around the world that indicate important roles for salt, processed meats, and vegetable consumption in gastric cancer risk.
Background: Thyroid disorders are an area of public health concern worldwide. The study aimed to examine the incidence and severity of psychosomatic symptoms (distress, depression, anxiety and somatization) in patients with hypothyroidism, hyperthyroidism, Graves' disease and Hashimoto thyroiditis in relation to clinically healthy subjects.
Methods: This case control study was carried out from Feb to Jul 2019 in Serbia. Total sample consisted of 335 subjects, of both sex. The examined group included patients with thyroid disorders treated at the Special hospital for thyroid gland and metabolism disease. Control group included clinically healthy subjects. The Four Dimensional Symptom Questionnaire a self-assessment questionnaire for psychosomatic symptoms was the measuring instrument. Groups were compared using parametric (t-test) and nonparametric (Pearson chi-square test, Mann-Whitney U test, Kruskal-Wallis test) tests.
Results: The incidence of all psychosomatic symptoms was high in patients with thyroid disease. Distress was found in 59.8% of the patients in the examined group comparing to the control group (12.8±8.2 vs. 8.9±8.1). The score of depression was twice higher in the examined group (2.05±2.99 vs. 1.23±2.47). Anxiety was present in 46.2% patients in the examined group, while somatization was found in 69.7% subjects. In hypothyroidism there was no difference between the examined and the control group regarding the level of anxiety, likewise with the level of depression in the control group and subjects with Graves' disease and Hashimoto thyroiditis.
Conclusion: Psychosomatic symptoms were significantly more severe in patients with thyroid disorders compared to the control group.
Background: Epidemiology of male reproductive cancers (MRC) is relatively well studied in developed world nations, but little is known about Central Asian states. We aimed to analyze the changing trends for incidence, mortality and 5-year survival MRC across provinces of the Republic of Kazakhstan.
Methods: This was a retrospective cohort study based on data obtained from the Kazakhstan Cancer Registry, which serves as a nationwide database for all histologically confirmed cancer cases. From this, information on all male patients with prostate (PCa) and testicular cancers (TCa) was retrieved for the period from 2010 to 2019. The statistical analysis of official data on incidence, survival, and mortality rates was performed for both the whole country and its provinces.
Results: There was a substantial instability of PCa incidence rates, attributed to the execution of screening program from 2013 to 2017. Still, there was a lack of variations in TCa incidence rates. However, PCa screening program had no influence on reduction of mortality rates, which remained relatively stable. There is much heterogeneity between country’s provinces in incidence and mortality rates. TCa patients were younger than PCa patients and had better 5-year survival.
Conclusion: As compared with many other countries, Kazakhstani men with PCa and TCa have poorer five-year survival, which requires further investigation. Moreover, a careful analysis of diagnostic and treatment strategies utilized at different hospitals across the country would be highly desirable.
Background: We aimed to analyze the predictive role of serum test and questionnaire in Early Gastric Cancer in The First Affiliated Hospital of Xingtai Medical College, Hebei Province from 2019 to 2020.
Methods: In this prospective study, 280 medical examiners underwent questionnaire, serum test and gastroscopy. They were divided into Gastric cancer (GC) and Non-Gastric cancer (NGC) group. NGC group was divided into Low-grade intraepithelial neoplasia (LGIN), Chronic atrophic gastritis (CAG) and Non-chronic atrophic gastritis (NCAG) group.
Results: Age, drinking, sex and Gastrin-17(G-17) was respectively independent risk factors for GC. Age, drinking and G-17 was independent risk factors for GC in men. G-17 of GC group was higher than that of LGIN and NCAG group (P<0.05). Pepsinogen I/II ratio (PGR) of GC was lower than that of NCAG group (P<0.05). There was no significant difference between Pepsinogen I (PGⅠ) and Pepsinogen II (PGII) in the four groups. Helicobacter pylori-immunoglobulin G antibodies (H. pylori-IgG) of LGIN group was significantly higher than that of CAG and NCAG group in gastritis group (P<0.008). G-17≥42.95 pmol/L, age≥69years, male and drinking can predict GC.
Conclusion: Older, drinking, men and high G-17 could respectively predict GC. Especially in men, older, drinking and high G-17 could affect the occurrence of GC. G-17, age, drinking and sex used respectively to screen high-risk populations for GC were more efficient than combined screening. GC had a higher serum G-17 and a lower PG than other gastric diseases.
Background: Type 2 diabetes (T2DM), a chronic disease, is associated with obesity and inflammation. This study investigated the effects of body mass index (BMI), leukocytes, and high-sensitivity C-reactive protein (hs-CRP) on type 2 diabetes mellitus in South Korean adults.
Methods: Secondary analysis of data from 5,420 adults’ subject in the Korea National Health and Nutrition Examination Survey (KNHANES Ⅶ-3, 2018) was performed. The collected data were analyzed by n (%), mean ± SD, t-test, χ2 -test, and multiple logistic regression methods.
Results: BMI and leukocytes count were higher in the T2DM-diagnosed group. The probability of T2DM increased by 4.76 times for obesity compared to normal weight, but high obesity was not an influencing factor for T2DM. As the leukocytes increased, the probability of T2DM increased by 1.15 times. However, hs-CRP was not an influencing factor for T2DM. Age was higher in the T2DM-diagnosed group and appeared to be an influencing factor in T2DM.
Conclusion: Obesity and inflammation indicators, including WBC, appeared to be risk factors for T2DM. This study presented the basis of diet and exercise interventions for weight loss and white blood cell count in a T2DM prevention and management program.
Background: Breast cancer is a heterogeneous disease and differences in the expression levels of the ER, PR, and HER2 the triplet of established biomarkers used for clinical decision-making have been reported among breast cancer patients. Furthermore, resistance to anti-estrogen and anti-HER2 therapies emerges in a considerable rate of breast cancer patients, and novel drug therapies are required. Several anomalous signaling pathways have been known in breast cancer have been known; heat shock protein 90 (HSP90) is one of the most plenty proteins in breast cells. The family of ubiquitin ligases such as SIAH1 and SIAH2 is known to specifically target misfolded proteins to the proteasome; also, they have been illustrated to play a role in RAS signaling and as an essential downstream signaling component required for EGFR/HER2 in breast cancer.
Methods: The expression of SIAH2, HSP90, and HER2 was assessed by quantitative Real-Time PCR in 85 invasive ductal carcinoma breast tumor samples at Uludag University Hospital in Turkey during the years 2018–2019, and its association with the clinicopathologic variables of patients was evaluated.
Results: HSP90, SIAH1, and SIAH2 were significantly (P=0.0271, P=0.022, and P=0.0311) upregulated tumor tissue of patients with breast cancer. Moreover, this study observed a significant association between the high expression of SIAH2/ HSP90 with ER status, high expression of HSP90 with Recurrence/ Metastasis, and high expression of SIAH2 with Ki-67 proliferation index.
Conclusion: The HSP90 and SIAH2 expressions play a significant role in breast cancer development by combining the experimental and clinical data obtained from the literature.
Background: We aimed to detect the genetic diversity of samples identified morphologically as Fasciola spp. from sheep, cattle and goat from Lorestan Province, western Iran using PCR-RFLP method. Besides, we evaluated the genetic diversity indices, sequencing and phylogenetic analysis using mitochondrial gene (ND1 and CO1).
Methods: PCR-RFLP analysis of ribosomal ITS1 fragment by RsaI restriction enzyme to investigate the genetic characteristics of Fasciola species obtained from different hosts (18 sheep, 21 cattle, and 17goats) was conducted. The samples were sequenced. Sequences were evaluated using BLAST software and the parasite species were identified with similarity percentage and overlap with the species registered in the gene bank. Then similarity and diversity of intra-species and intra-species diversity of Fasciola species were calculated.
Results: In Lorestan, based on RFLP pattern, 93% (52) of the Fasciola spp. isolates had a RFLP pattern related to F. hepatica and 7% (4) were F. gigantica. No hybrid forms were detected. The CO1 gene could clarify 19 haplotypes against ND1 gene that found 22 haplotypes among livestock. Sequencing results of the mtDNA showed intra-species identity 98. 5%-100% and Intra-species-diversity: 0-1.5% compared to the GenBank sequences.
Conclusion: Using PCR-RFLP method, two species of F. hepatica and F. gigantica, were present in Lorestan Province, but F. hepatica was more prevalent. Mitochondrial genes could better test variability indices in different hosts than ribosomal genes, consequently among mitochondrial genes, the ND1 gene could better examine differences and similarities than CO1.
Background: Access to and utilization of eye care services may improve vision-related quality of life (VRQoL) of older people. This study aimed to evaluate the VRQoL of older adults and its associations with access to and utilization of eye care services.
Methods: This is a community-based cross-sectional survey conducted in Tehran, Iran, on 566 older people in 2018. The NEI-25 VFQ was used to measure the VRQoL. Multilevel Linear Regression analysis used to test the study hypotheses.
Results: The average score of the VRQoL was 80 out of 100. About 61% of the participants did not utilize the annual routine eye examination and the mean score of overall access to eye care was 85 out of 115. Having a higher physical, socio-cultural and overall access were significantly associated with higher VRQoL, but those with regular utilization had no better VRQoL status compared to non-users.
Conclusion: Access to eye care services showed to be very important in improvement of the VRQoL, whereas higher utilization was not found to be associated with better VRQoL statue of older people, as there might have a reverse causality with using more eye services with higher Visual impairment.
Background: Recently, genome-wide association studies (GWAS) have discovered several single nucleotide polymorphisms (SNPs) and loci associated with the risk of systemic lupus erythematosus (SLE). rs6445975 (T>G; intronic variant) polymorphism in the PXK gene is one of these loci. However, there was an inconsistency between the results of replicative studies on European and Asia ancestry. This study aimed to assess the possible association between rs6445975 polymorphism with SLE risk in the Iranian population.
Methods: Genotype and allele distribution of rs6445975 polymorphism were investigated in 110 patients with SLE and 115 healthy controls in Isfahan University of Medical Sciences, Isfahan, Iran in 2019 via real-time PCR high resolution melting method (HRM).
Results: GG and TG genotypes, but not TT genotype, were associated with increased risk of SLE (GG vs TT; OR= 7.538; 95%CI [3.47, 17.066] and TG vs TT; OR=2.21; 95%CI [1.06, 4.72]). Inheritance analysis revealed that TG + GG was correlated with the increased risk of SLE disease in the dominant model (OR=3.928; 95%CI [2.056, 7.74]). Moreover, subjects with the G allele were more frequently affected with SLE than individuals with the T allele (OR= 3.55; 95%CI [2.37, 5.36]). The G allele in patients was correlated with serum concentration of CRP, ESR, anti-dsDNA antibody, C3, and C4 and presentation of some clinical manifestations such as kidney involvements and skin lesions (P<0.05).
Conclusion: Our findings suggest a substantial association between rs6445975 polymorphism in the PXK gene with susceptibility and clinical characteristics of SLE in the Iranian population.
Background: We aimed to investigate the epidemiological, clinical and paraclinical aspects of Visceral Leishmaniasis in Ardabil Province, from 1986 to 2018.
Methods: The disease has been diagnosed by a serological validate test as Direct Agglutination Test, parasitological methods, and clinical manifestations. The data were collected and then analyzed.
Results: Overall, 2824 out of 69007cases (4.1%) had anti-Leishmania antibodies at titers≥1:3200. The majority of VL cases belonged to Meshkin-Shahr, and then Germi County. The percentages of both male and female cases were 52.8 % and 46.6%, respectively. Approximately 78.1% of cases were less than 5 yr old. The high incidence rate of the disease was recorded in the years 1987 and 2003. 48.6%, 3.2%, and 1.9% of the patients had low titer (1:3200), high titer (1:102400), and suspicious titer (1:1600), respectively. Out of 1200 bone marrow aspiration, 23% were positive, and 77% were negative. Fever, paleness, and hepatosplenomegaly were the main symptoms in patients. Moreover, abdominal swelling, edema, weight loss, lymphadenopathy and jaundice were some other symptoms in the patients. Among biochemistry factors, the levels of aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, triglyceride and cholesterol have been increased. The death rate was estimated to be 2.8%, mainly related to the Ardabil and Germi cases.
Conclusion: Kala-Azar is still one of the most important infectious diseases in Ardabil Province, and is responsible for considerable death rate in infants. More attention should be done to parasite control and early diagnosis.
Background: Families, especially fathers, are continuously interested in selecting the child's sex in most societies. This study was conducted to Use non-invasive methods to choose gender in order that sex selection with diet and determination of ovulation time in Iran.
Methods: This study was a clinical experimental trial of convenient samples conducted as a retrospective study. Overall, 285 women were referred to Dr. Farhud's Genetic Clinic in 2013 and 2014 in Tehran, Iran. For two years (from June 2013 to Jun 2015), samples were followed-up. Participants used diet, the timing of ovulation, and considering lifestyle to have the sex selection.
Results: Overall, 88 women became pregnant in the first group among 179 participants in 2013, and talking to the participants showed that 82.95% achieved the wanted gender. Fifty-two women became pregnant among 106 participants in 2014 in the second group and 86.79%, achieved the wanted sex.
Conclusion: Diet and ovulation timing could be very efficient, and it is recommended that families Use safe procedures such as natural, and non-invasive methods to achieve the wanted sex for gender balance.