Vol 48 No 2 (2019)


Review Article(s)

  • XML | PDF | downloads: 268 | views: 382 | pages: 189-197

    Background: The angiotensin-converting enzyme inhibitors (ACEIs) could improve the symptoms of diabetic nephropathy. Whether the calcium channel blockers (CCBs) could be as effective as ACEIs on treating diabetic nephropathy is controversial. Here, we aimed to compare the efficacy of ACEIs with CCBs on the treatment of diabetic nephropathy by performing a meta-analysis of randomized controlled trials (RCTs).

    Methods: The Pubmed, Medline, Embase and The Cochrane Database were searched up to July 2017 for eligible randomized clinical trials studies. Effect sizes were summarized as mean difference (MD) or standardized mean difference (SMD) with 95% confidence intervals (P-value<0.05).

    Results: Seven RCTs involving 430 participants comparing ACEIs with CCBs were included. No benefit was seen in comparative group of ACEIs on systolic blood pressure(SBP) (MD=1.05 mmHg; 95% CI: -0.97 to 3.08, P=0.31), diastolic blood pressure (DBP) (MD= -0.34 mmHg; 95% CI: -1.2 to 0.51, P=0.43), urinary albumin excretion rates (UAER) (MD=1.91μg/min; 95% CI: -10.3 to 14.12, P=0.76), 24-h urine protein (24-UP) (SMD=-0.26; 95%CI: -0.55 to 0.03, P=0.08), glomerular filtration rate (GFR) (SMD=0.01; 95% CI: -0.38 to 0.41, P=0.95). On safety aspect, the risk of adverse reactions between ACEIs group and CCBs group are similar (RR=1.18; 95% CI: 0.61 to 2.28; P=0.61).

    Conclusion: Both ACEIs and CCBs could improve the BP, UAER, 24h-UP, and GFR of diabetic nephropathy to a similar extent.



  • XML | PDF | downloads: 274 | views: 401 | pages: 198-205

    Background: Breast cancer is the most common cancer type in women not only in world but also in Malays ethnicity between Malaysia and Indonesia. Breast cancer has varying incidence in every country, but genetic factor by family history influence the incidence of breast cancer. This systematic review and meta-analysis was performed to determine family history of breast cancer and breast cancer risk between Malays ethnicity in Malaysia and Indonesia.

    Methods: This meta-analysis was conducted on published research articles on family history of breast cancer and breast cancer risk between Malays ethnicity in Malaysia and Indonesia published between Jan 1999 and Jul 2018 in the online article databases of PubMed, ProQuest and EBSCO. Pooled odds ratios (OR) were calculated with fixed and random-effect models. Publication bias was visually evaluated by using funnel plots and statistically assessed through Egger’s and Begg’s tests. Data were processed using Review Manager 5.3 (RevMan 5.3) and Stata version 14.2 (Stata Corporation).

    Results: We reviewed 1123 articles. There are 10 studies with number of samples 4511 conducted a systematic review and continued with Meta-analysis of relevant data. The results showed significant association between family history of breast cancer with breast cancer risk in Malays ethnicity in Malaysia and Indonesia (OR = 3.34 [95% CI 2.68-4.15, P<0.00001]). There was not significant publication bias for studies included in family history of breast cancer and breast cancer risk in Malays ethnicity in Malaysia and Indonesia

    Conclusion: This analysis confirmed the association of family history of breast cancer and breast cancer risk between Malays ethnicity in Malaysia and Indonesia.



  • XML | PDF | downloads: 298 | views: 439 | pages: 206-216

    Background: Human cytomegalovirus (CMV) able to cause infection for an entire lifetime. This systematic review and meta-analysis was conducted to determine seroprevalence of CMV among women of reproductive age in Iran.

    Methods: English and Persian databases such as Web of Science (WOS), PubMed, Scopus, Cochrane Library, SID, Iran doc, Iran Medex, Magiran, and Medlib were searched (from 2008 to 2017) accurately using the

    Results: Results of 15 studies with total samples of 5253 persons from 2008 to 2017 were combined and meta-analyzed. The pooled prevalence rate of IgG among women was estimated 90% (95% CI: 87-93%). The highest prevalence rate of IgG was in Tehran, Rasht, Mashhad and Yasoj, all 100% (95% CI: 100-100%), and the lowest prevalence was in Jahrom 0.62% (95% CI: 53-71%). The overall prevalence rate of IgM among women was estimated at 0.06% (95% CI: 0.03-0.13%). The highest prevalence rate of IgM was in Kerman 0.34% (95% CI: 0.29-0.39%) and Mashhad 0.25% (95% CI: 0.2-0.31%), and the lowest prevalence was in Yasoj 0% (95% CI: 0.00%-0.00%)

    Conclusion: The prevalence of immunity in Iran, is satisfactory. Nevertheless, to maintain and increase the level of immunity across the country, it is necessary to routinely screen the women of reproductive ages across the country.

  • XML | PDF | downloads: 235 | views: 380 | pages: 217-226

    Background: We aimed to estimate the global prevalence of HIV, as well as cross-countries comparison in people who are in prison.

    Methods: We systematically assessed published studies reporting HIV prevalence among prisoners in the world. We searched international datasets banks, including PubMed, SCOPUS, Cumulative Index to Nursing and ISI web of science along with local databases and included original articles reporting data on the prevalence of HIV from 1980 to 2017.

    Results: We included 72 studies that reported HIV prevalence for 2,275,930 adult male and female prisoners. The pooled estimate of HIV prevalence was 3.4% (95% CI 3.2%-3.6%); however, the prevalence of HIV across individual studies varied considerably (ranging from 0 in Bosnia and Herzegovina to More than 20% in Iran, Zambia, Spain) and statistical heterogeneity was substantial (I2=0.99, Q=121; P<0.0001). The prevalence of HIV among prisoners in the continents Asia, Africa, North America and Europe was estimated as 3.0% (95% CI 3.3%-4.3 %), 6% (95% CI -0.0%–2.0%), 4% (95% CI 3.0%-4.0%), 5.0% (95% CI 0.0%–11%), respectively.

    Conclusion: Protecting prisoners’ health protects general public health. Successful HIV preventive measures in prisons include provision of HIV education and information; clean needles and syringes; drug treatment; and condoms. Governments have a moral and ethical obligation to prevent the spread of HIV/AIDS in prisons and to provide compassionate care, treatment and support for those infected.


  • XML | PDF | downloads: 313 | views: 418 | pages: 227-237

    Background: One of the most important effects of many drying lakes in the world is increasing the emergence and outbreak of different diseases. For this sake, the present study aimed to systematically review the effects of lakes drying on human health.

    Methods: The present systematic review was designed and conducted in 2017. Data were gathered by searching the Science Direct, Cochrane Library, Google Scholar, Scopus, PubMed, and Web of Knowledge databases, along with hand search of key journals and unpublished resources and contact with experts. There was no specific time span for the search.

    Results: Overall, 22 articles were selected with 20 articles about Aral Lake drying. Almost all studies were cross-sectional and retrospective. In 8 studies, the participants were children. Seventeen articles lakes drying have adverse effects on human health. Based on the type of effect, the studies were classified into 7 categories (respiratory problems, reproductive system problems, kidney and urological diseases, cancers, anemia, and diarrhea).

    Conclusion: Most studies depicted the harmful effects of lakes draught on human health; they had low level of evidence as they were mostly retrospective and cross-sectional. There is not enough evidence to accept or reject with high level of certainty the very effects of lakes drying on human health. To provide such evidence we suggest conducting middle and long term cohort and observational studies with scientific bases.



Original Article(s)

  • XML | PDF | downloads: 323 | views: 470 | pages: 238-246

    Background: China has implemented numerous pilots to shift its hospital payment mechanism from the traditional retrospective cost-based system to prospective diagnosis-related-group (DRG) -based system. This study investigated the impact of the DRG payment reform with global budget in Zhongshan, China.

    Methods: A total of 2895 patients diagnosed with acute myocardial infarction (AMI) were selected from local two largest tertiary hospitals, among which 727 were discharged prior to the payment reform and 2168 afterwards. Difference-in-difference (DID) regression models were used to evaluate the policy effects on patients’ percutaneous coronary intervention (PCI) use, hospital expenditures, in-hospital mortality, and readmission rates within 30 days after discharge.

    Results: Patients’ PCI use and hospital expenditures increased quickly after the payment reform. With patients with no local insurance scheme as reference, PCI use for local insured patients decreased significantly by 4.55 percent (95 percent confidence interval [CI]: 0.23, 0.72), meanwhile the total hospital expenses decreased significantly by US$986.10 (b=-0.15, P=0.0037) after reform. No changes were observed with patients’ hospital mortality and readmission rates in our study.

    Conclusion: The innovative DRG-based payment reform in Zhongshan suggested a positive effect on AMI patient’s cost containment but negative effect on encouraging resource use. It had no impacts on patients’ care quality. Cost shifting consequence from the insured to the uninsured was observed. More evidence of the impacts of the DRG-based payment in China’s health scenario is needed before it is generalized nationwide.


  • XML | PDF | downloads: 274 | views: 484 | pages: 247-255

    Background: Equal access to healthcare facilities, patient’s satisfaction, and respect for the desire of the patient were recognized as the basic principles of each of the health care system. Each person must be given the opportunity to access health services in accordance with the requirements of their health. We aimed to prove the existence of disparities hospital utilization based on the category of urban-rural areas.

    Methods: The research used the 2013 Indonesian Basic Health Survey (RKD) as analysis material, that was designed a cross-sectional survey. With the multi-stage cluster random sampling method, 722,329 respondents were obtained. Data were analyzed using Multinomial Logistic Regression tests.

    Results: The results showed adults living in urban were likely to use hospital outpatient facilities 1.246 times higher than adults living in rural areas (OR 1.246; 95% CI 1.026 – 1.030). The likelihood of utilizing at the same time outpatient and inpatient facilities at 1.134 times higher in adults living in urban than those in rural areas (OR 1.134; 95% CI 1.025 - 1.255). While for the category of hospital inpatient utilization, there was no significant difference.

    Conclusion: There was a disparity in hospital utilization between urban-rural areas. Urban show better utilization than rural areas in outpatient and at the same time the use of inpatient care.



  • XML | PDF | downloads: 173 | views: 280 | pages: 256-261

    Background: We intended to investigate the effects of lung protective ventilation on the cognitive function level of patients with esophageal cancer.

    Methods: Overall, 132 patients with esophageal cancer admitted to Taian Central Hospital, Taian China from January 2013 to January 2017 were enrolled in the study. According to the random number table method, they were divided into observation group and control group, 66 cases each. All patients underwent general anesthesia for thoracoscopic esophageal cancer radical operation, and lung protective ventilation and conventional positive pressure ventilation were used respectively. The levels of SOD, NSE and MDA, MMSE score and WMS memory quotient in the blood of the elbow vein were compared between the two groups at different times.

    Results: The levels of SOD and MMSE in the observation group at T2 and T3 were higher than those in the control group, and the NSE and MDA levels were lower than those in the control group (P=0.013, 0.033, 0.015, 0.044, 0.034, 0.029, 0.014, 0.017). The incidence of postoperative cognitive impairment was lower in the observation group than in the control group (P=0.007). The WMS memory quotient scores of the patients in the T2, T3, and T4 observation groups were higher than those in the control group (p=0.009, 0.032, 0.040).

    Conclusion: Lung protective ventilation can reduce the oxidative stress injury for patients and improve their postoperative cognitive function and memory ability.



  • XML | PDF | downloads: 242 | views: 336 | pages: 262-269

    Background: This study investigated how experiencing school violence affects depression and suicidal ideation in multicultural adolescents.

    Methods: Overall, 63444 adolescents from grades 7–12 (ages 12–18 yr) who participated in the 11th Korea Youth Risk Behavior Web-based Survey (KYRBS-Ⅺ) were enrolled from Jun 1 to Jun 30, 2015. Adolescents with at least one parent of non-Korean nationality were classified as multicultural adolescents. A logistic regression analysis of depression and suicidal ideation on the experience of violence was conducted with age, gender, city size, academic achievement, economic status, and level of stress as control variables.

    Results: Multicultural adolescents were found to have low grades, low economic status, come from smaller cities, and experience more school violence and stress compared to non-multicultural adolescents. Multicultural adolescents who experienced school violence were 5.41 times (95% CI 3.22, 9.11) more likely to be depressed than those who did not experience violence, whereas, non-multicultural adolescents were 3.75 times (95% CI 3.34, 4.20) more likely to be depressed. The effect of school violence on suicidal ideation was also stronger for multicultural adolescents. Multicultural adolescents who experienced school violence were 7.78 times (95% CI 4.34, 13.96) more likely to have suicidal ideation than those who did not experience violence, while non-multicultural adolescents were 4.17 times (95% CI 3.64, 4.78) more likely to have suicidal ideation.

    Conclusion: Adolescents who experience school violence more frequently showed a higher risk for depression and suicidal ideation, and the effect of school violence on depression and suicidal ideation was relatively stronger in multicultural adolescents.


  • XML | PDF | downloads: 258 | views: 386 | pages: 270-277

    Background: This study investigated the nonsuicidal self-injury (NSSI) presentation and the features of coping methods among college students, in addition to analyzing the factors that influence self-injury behavior.

    Methods: From April to November 2016, 2,520 undergraduate students who were studying in some colleges in Anhui Province in China were surveyed using the Self-Injury Behavioral Survey Questionnaire and the Coping Styles Questionnaire (CSQ).

    Results: The detection rate of self-injury behavior among college students was 13.73%. Frequent Internet use and smoking were associated with self-injury behavior (P < 0.05). There were statistically significant differences between the self-injury group and the non-self-injury group in terms of the coping methods of problem-solving, self-reproach, help-seeking, and illusions (P < 0.01). According to the logistic regression analysis of the students, their place of origin, mother’s education, family finances, family type, family relationships, gender, frequent Internet use, and smoking were associated with self-injury behavior (P< 0.01). Self-reproach and withdrawal were risk factors for self-injury behavior while problem-solving and rationalization were protective factors for self-injury behavior.

    Conclusion: Students who frequently use the Internet and smoke are more prone to self-injury. College students’ choices of problem-solving and rational coping styles in the face of pressure are conducive to preventing nonsuicidal self-injury.



  • XML | PDF | downloads: 316 | views: 2864 | pages: 278-288

    Background: Using data collected by the Office for Civil Rights, Department of Health and Human Services (HHS), over half of the population in the USA might have been affected by security breaches since Oct 2009. This study provided analysis of the data, presenting the numbers of individuals affected in one breach and the number of breaches.

    Methods: Statistical analysis has been conducted with visualizations. Visualizations include categorized histograms and tables. Histograms are presented as bar charts with categories: location and breach type. Tables show case counts (across top 10 breaches and those with more than one million stolen records) in successive years and covered entity types. All statistics were calculated with the use of package R. Analyzed data were collected from Oct 2009 till Jun 2017.

    Results: This study presents evidence of health data breaches taking place at an unprecedented level. Medical records of at least 173 million of people, gathered since Oct 2009, have been breached and might have adversely influenced over half of the population in the USA.

    Conclusion: Results of this study are expected to motivate public care authorities to develop similar laws and regulations as the USA while striving for better law enforcement. It takes a considerable amount of time to educate public and it takes substantial financial resources to prevent data breaches.



  • XML | PDF | downloads: 139 | views: 274 | pages: 289-298

    Background: The clinical gender-dependent characteristics of visuospatial neglect between men and women have not been elucidated in Korean patients with cognitive impairment. The goal of this study was to observe the asymmetric lateralization in patients using a novel e-pen based cognitive assessment system.

    Methods: A total of 31 patients, 16 men and 15 women, with early stage hemispheric cerebral dysfunction were recruited for the assessment of unilateral neglect suing a novice paper-and-pencil based electronic evaluation system from a rehabilitation center of Inha University hospital in 2016. Results were assessed for degrees of deviations, and numbers of neglected lines. Degree of deviation was assessed using the positions and distances from the horizontal line centers. Effect sizes were calculated to assess proximities between the assessed results.

    Results: Comparatively greater left and rightward biasness for the right-sided and left-sided horizontal lines were observed for the male patients, respectively. Moreover, greater degree of left to rightward biasness was observed as the horizontal lines shortened in both groups. However, the magnitude of biasness in female patients showed comparatively less directional bias, indicating greater prevalence for the center of mass effect in male patients.

    Conclusion: Gender difference in visuospatial neglect seems to exist with less accuracy in recognition for the bisecting center for the female and asymmetrical lateralization and magnitude of deviation for the male patients.


  • XML | PDF | downloads: 139 | views: 269 | pages: 299-304

    Background: We aimed to explore the effect of comprehensive cerebral protection on cerebral oxygen metabolism and vascular endothelial function in elderly patients with acute cerebral infarction.

    Methods: A total of 168 elderly patients with acute cerebral infarction treated in The First Affiliated Hospital of Nanchang University, China from January 2016 to January 2018 were selected. The patients were divided into a control group and an observation group using random number method, n=84. Patients in the observation group were given comprehensive cerebral protection treatment, and patients in the control group were treated with conventional standardized treatments. The changes of cerebral oxygen metabolism, hemorheology and vascular endothelial function before and after treatment were compared between the two groups.

    Results: After treatment, oxygen content in arteries and internal jugular veins (Da-vO2), ofoxygen uptake fraction (OEF), Oxygen saturation (SpO2), nitric oxide (NO) were increased in both groups in comparison to before treatment, jugular venous oxygen saturation (SjvO2), brain oxygen uptake rate (ERO2), endothelin (ET), intracranial pressure (ICP), whole blood viscosity, plasma viscosity, reduced viscosity of whole blood, and hematocrit were decreased. However, the changes in the observation group were larger than those in the control group, the difference was statistically significant (P<0.05).

    Conclusion: The treatment of cerebral infarction in elderly patients with acute cerebral infarction can effectively improve the cerebral oxygen metabolism and vascular endothelial function and improve the blood rheology, which has important clinical value.


  • XML | PDF | downloads: 153 | views: 285 | pages: 305-313

    Background: Carpal tunnel syndrome (CTS) is the most frequent entrapment neuropathy in the upper limb. Although more objective methods for assessment have been reported in literature, there is a lack of evidence concerning the best methods for assessment of CTS. This study aimed to investigate whether there was a difference in the first web space in patients with different severities of CTS in relation to healthy controls as easy screen method.

    Methods: This prospective controlled trial was conducted on 126 patients at the Physical Medicine and Rehabilitation Clinic, Ankara Diskapi Yildirim Beyazit Education and Research Hospital, University of Health Science, Ankara, Turkey, from January 2016 to January 2018. Hand grip and pinch strength of patients were determined. Also, first web angle were measured by goniometer. Patients were divided into 3 CTS groups as electrophysiologically: "mild: group 1", "moderate: group 2" and "severe: group 3". Patient and healthy groups were compared in terms of the evaluation parameters. Comparisons were also made between these groups.

    Results: There was significant reduction in hand strengths and first web angle in patient groups compared to healthy groups (P<0.05). Moreover, the first web angle was significantly different between the CTS groups (P= 0.001). The cut-off value for CTS was <38.5º.

    Conclusion: The possibility of CTS can be evaluated by measuring the first web space angle with a simple goniometer as a easy and in-expensive method in outpatient clinics.


  • XML | PDF | downloads: 274 | views: 362 | pages: 314-322

    Background: We aimed to evaluate the whether AFP levels alone is an adequate screening indicator, or a combination of Generally, alpha-fetoprotein (AFP), CA19-9 and CEA could provide a better diagnostic tool in detecting and screening asymptomatic patients with primary hepatic cancer (PHC), and also evaluate the correlation of degree of differentiation with serum biomarker levels.

    Methods: We retrospectively reviewed the medical records of 1362 patients form 2014-2018 who visited the first Affiliated Hospital of Zhejiang University, Hangzhou, China for health check-ups or were diagnosed with cancer or cirrhosis. We then analyzed preoperative tumor markers level of AFP, CA19-9, and CEA. The standard reference values (AFP ≤20 ng/L CEA ≤ 5 ng/L, and CA19-9  ≤ 37 U/mL) were as positive or negative cut off values. Further, the histological sections of patients were categorized and correlated them with the three serum biomarkers.

    Results: Serum AFP, CEA, and CA19-9 levels in the PHC group were significantly higher compared to those with liver cirrhosis and healthy control groups (P < 0.03). With AFP as a single tumor marker for PHC diagnosis, it had a sensitivity of 63.3% with a specificity of 80.8%. AFP combined with CA19-9 and CEA showed specificity of 100%, a sensitivity 2.5% with the positive and negative predictive values of 100% and 22% respectively. Furthermore, histological evaluation revealed the highest AFP level of 9366.14±23902.61 ng/L associated with poorly differentiated HCC, while well-differentiated HCC, had the lowest mean AFP level of 45.19±181.27 ng/L.

    Conclusion: Combined serum levels of AFP, CA19-9  and CEA does not provide a superior advantage over AFP alone as a screening and diagnostic tool for HCC detection.


  • XML | PDF | downloads: 163 | views: 323 | pages: 323-330

    Background: To assess the clinical value of two-dimensional (2D) plus four-dimensional (4D) ultrasonography in diagnosis of fetal craniocerebral anomalies.

    Methods: Retrospective analysis was performed on the sonographic features of 83 maternity patients admitted to Northwest Women’s and Children’s Hospital, Xian China from January 2013 to December 2017 diagnosed with suspected fetal anomalies of the brain and skull through 2D and 4D ultrasonography.

    Results: Fifty six patients were diagnosed with the anomalies by 2D ultrasonography only, 65 patients by 4D ultrasonography only, and 74 patients by 2D plus 4D ultrasonography.76 patients were confirmed to have fetal craniocerebral anomalies after birth or induced labor. Diagnostic accuracies of 2D ultrasound only, 4D ultrasound only, and 2D plus 4D ultrasound were 68.67%, 81.93% and 95.18%, respectively (P<0.05). The accuracy of 2D plus 4D ultrasound was greater than those of 2D ultrasound only and 4D ultrasound only, and the accuracy of 4D ultrasound only was higher than that of 2D ultrasound only (P<0.05). The sensitivity of 2D plus 4D ultrasound was greater than those of 2D ultrasound only and 4D ultrasound only (P<0.05). The specificity of 2D plus 4D ultrasound was greater than those of 2D ultrasound only and 4D ultrasound only (P<0.05).

    Conclusion: Combined ultrasonography can better differentiate fetal craniocerebral anomalies, providing early and more accurate information for clinicians as well as maternity patients to make a decision. This clinical practice would be valuable for improving the quality of the newborn population.





  • XML | PDF | downloads: 220 | views: 385 | pages: 331-337

    Background: Otomycosis is a superficial infection of the ear caused by a spectrum of various fungal agents and its epidemiology depends on geographical region and climatic condition. The aim of this study was to investigate the causal agents and clinical manifestations of otomycosis at a tertiary referral center in Tehran, Iran.

    Methods: From Apr 2016 to Jan 2017 a set of 412 subjects with suspicion of external otitis were included. Clinical examination and specimen collection were performed by an otorhinolaryngologist. Subsequently, direct examination and culture were performed on specimens and isolated molds were identified morphologically. Yeast isolates were identified using CHROMagar Candida medium and PCR-RFLP of ribosomal DNA whenever needed. Data were analyzed using SPSS.

    Results: Otomycosis was confirmed in 117 cases (28.39%) including 64 (54.7%) males and 53 (45.3%) females. Patients were within the age range of 10-75 yr and the highest prevalence was found in the age group of 46-55 yr (30.77%). Pruritus (89.74%) and auditory manipulation and trauma (83.76%) were the predominant symptom and predisposing factor, respectively. Among 133 isolates from 117 patients, Aspergillus niger (n=50, 37.59%) was the most common etiologic agent and Candida glabrata (n=25, 18.8%) was the predominantly isolated yeast. Furthermore, 16 cases of mixed infection were identified and coinfection due to A. niger and C. glabrata (seven cases) was the predominant pattern.

    Conclusion: Our results revealed the high prevalence of C. glabrata and mixed infections in otomycosis patients. Therefore, mycological examinations should be considered for proper treatment.


  • XML | PDF | downloads: 205 | views: 392 | pages: 338-344

    Background: Anemia is a common nutritional disorder that is more prevalent in pregnant women than other population groups. This study aimed to assess the frequency of anemia and its association with health care determinants among Iranian pregnant women from provinces with different Maternal Mortality Rate (MMR).

    Methods: This cross-sectional survey was carried out on 2737 pregnant women referred to public health centers in Iran, 2015. The participants were randomly selected by multistage sampling from six provinces with low, moderate or high MMR. The level of hemoglobin lower than 11 g/dl were defined as anemia in first and third trimester of pregnancy.

    Results: The rate of anemia in first and third trimester were respectively 8.2 and 26.7%. The most determinants of anemia among women in both first and third trimester of pregnancy were geographical classes with high MMR, no care before pregnancy, and type of house. Moreover, lower number of previous pregnancies (OR, 0.48; 95% CI, 0.27 to 0.85) and adequate care during pregnancy (OR, 0.66; 95% CI, 0.47 to 0.92) were protected women from anemia and high number of children (OR, 2.07; 95% CI, 1.13 to 3.80) enhanced risk of anemia in first trimester of pregnancy. Moreover, higher body mass index had lower odds of anemia in third trimester.

    Conclusion: The rate of anemia is differed in various parts of Iran, and this disorder gets worse in third trimester of pregnancy than first. Strengthening health care programs may be a useful strategies to prevent and control anemia.



Letter to the Editor