Background: Pruritus is a common complication of intrathecal opioids and numerous medications have been used to prevent or treat this complication. However, the efficacy of these medications vary. The choice of medications also depends on the availability and the cost. We performed a randomised double-blind study to evaluate whether nalbuphine is as effective as chlorpheniramine, a medication that is commonly used for treating pruritus for the treatment of intrathecal opioid-induced pruritus in parturients undergoing lower-segment caesarean section. Materials and Methods: Two hundred and thirty four parturients with American Society of Anaesthesiologists (ASA) physical status I or II who had intrathecal opioid-induced pruritus were assigned to receive either intravenous nalbuphine (4 mg eight-hourly) or intravenous chlorpheniramine (5 mg eight-hourly) for a period of 24 hours. Pruritus was assessed using a qualitative scale at pre-treatment, six, nine, 12 and 24 hours post-treatment. Results: The occurrence of intrathecal opioid-induced pruritus was significantly reduced in parturients treated with intravenous nalbuphine as compared to intravenous chlorpheniramine at all intervals studied. Conclusion: In conclusion, nalbuphine is more effective than chlorpheniramine in reducing intrathecal opioid-induced pruritus for parturients undergoing lower-segment caesarean section.
Anesthesia ; Histamine H1 Antagonists ; Injections, Spinal ; Analgesics, Opioid ; Pregnancy

OBJECTIVES: This study aimed to explain the health-related quality of life (HRQoL) gap between the poorest and the wealthiest quintiles in the capitals of Kermanshah and Kurdistan Provinces (Kermanshah and Sanandaj), in western Iran. METHODS: This was a cross-sectional study conducted among 1772 adults. Data on socio-demographic characteristics, socioeconomic status (SES), lifestyle factors, body mass index, and HRQoL of participants were collected using a self-administered questionnaire. The slope and relative indices of inequality (SII and RII, respectively) were employed to examine socioeconomic inequality in poor HRQoL. Blinder-Oaxaca (BO) decomposition was used to quantify the contribution of explanatory variables to the gap in the prevalence of poor HRQoL between the wealthiest and the poorest groups. RESULTS: The overall crude and age-adjusted prevalence of poor HRQoL among adults was 32.0 and 41.8%, respectively. The SII and RII indicated that poor HRQoL was mainly concentrated among individuals with lower SES. The absolute difference (%) in the prevalence of poor HRQoL between the highest and lowest SES groups was 28.4. The BO results indicated that 49.9% of the difference was explained by different distributions of age, smoking behavior, physical inactivity, chronic health conditions, and obesity between the highest and lowest SES groups, while the remaining half of the gap was explained by the response effect. CONCLUSIONS: We observed a pro-rich distribution of poor HRQoL among adults in the capitals of Kermanshah and Kurdistan Provinces. Policies and strategies aimed at preventing and reducing smoking, physical inactivity, chronic health conditions, and obesity among the poor may reduce the gap in poor HRQoL between the highest and lowest SES groups in Iran.
Adult ; Body Mass Index ; Cross-Sectional Studies ; Health Status Disparities ; Humans ; Iran* ; Life Style ; Obesity ; Prevalence ; Quality of Life* ; Smoke ; Smoking ; Social Class ; Socioeconomic Factors*

OBJECTIVES: The lower mortality rate of obese patients with heart failure (HF) has been partly attributed to reverse causation bias due to weight loss caused by disease. Using data about weight both before and after HF, this study aimed to adjust for reverse causation and examine the association of obesity both before and after HF with mortality. METHODS: Using the Atherosclerosis Risk in Communities (ARIC) study, 308 patients with data available from before and after the incidence of HF were included. Pre-morbid and post-morbid obesity were defined based on body mass index measurements at least three months before and after incident HF. The associations of pre-morbid and post-morbid obesity and weight change with survival after HF were evaluated using a Cox proportional hazard model. RESULTS: Pre-morbid obesity was associated with higher mortality (hazard ratio [HR], 1.61; 95% confidence interval [CI], 1.04 to 2.49) but post-morbid obesity was associated with increased survival (HR, 0.57; 95% CI, 0.37 to 0.88). Adjusting for weight change due to disease as a confounder of the obesity-mortality relationship resulted in the absence of any significant associations between post-morbid obesity and mortality. CONCLUSIONS: This study demonstrated that controlling for reverse causality by adjusting for the confounder of weight change may remove or reverse the protective effect of obesity on mortality among patients with incident HF.
Atherosclerosis* ; Bias (Epidemiology) ; Body Mass Index ; Heart Failure* ; Heart* ; Humans ; Incidence ; Mortality* ; Obesity* ; Proportional Hazards Models ; Weight Loss

Adherence to coronavirus disease 2019 (COVID-19) preventive guidelines (ACPG) is an important strategy to control the COVID-19 pandemic effectively. The present study aimed to identify and summarize the social determinants of ACPG among the general population. A comprehensive review was performed from December 2019 to February 2021 through searching electronic databases. Two independent reviewers assessed and selected relevant studies. Next, the characteristics and main findings of the included studies were summarized. Finally, the World Health Organization’s conceptual framework of social determinants of health was used to synthesize the identified social determinants of ACPG. Forty-one of 453 retrieved articles met the inclusion criteria. The study results showed different patterns of ACPG among various communities. Furthermore, 84 social determinants were identified and categorized into structural and intermediary determinants. ACPG is a set of complex behaviors associated with different individual sociodemographic and behavioral characteristics; living and working conditions; COVID-19 knowledge, attitudes, and risk perceptions; exposure to sources and information level; leisure activities; social support; trust; social norms; psychosocial well-being; socio-economic position; and the socio-economic and political context. Interventions to promote ACPG among the general population should consider the identified social determinants of ACPG.

Objectives: This study investigated preventive behaviors toward coronavirus disease 2019 (COVID-19) and related factors in a Kurdish Iranian sample. Methods: This online survey was conducted among the population aged 18 and above in Kermanshah Province, in western Iran, in April 2020. Samples were invited and recruited through social media. Data were collected using a questionnaire consisting of 4 sections (questions on demographic variables, risk perception, risk communication, and COVID-19 preventive behaviors) and analyzed using Stata ver. 8. Results: The Pearson correlation test showed that risk communication was significantly correlated with COVID-19 preventive behaviors (r = 0.320, p < 0.01). In the final model, where the explanatory power increased with the entry of the risk communication variable, the variables explained a total of 14% of variance in COVID-19 preventive behaviors. Sex (β = −0.482), risk perception (β = 0.047), and risk communication (β = 0.662) were significant determinants. Conclusion Risk communication and risk perception related to COVID-19, as well as being a woman, were determinants of COVID-19 preventive behaviors.