Background: Indonesia has an estimated 61.4 million current smokers, and the smoking prevalence among adults is persistently high while that among youth is increasing. In 2014, Medan city enacted the smoke-free policy (SFP) to protect community members against the adverse effects of smoking. Our study examines the implementation of SFP in terms of compliance and challenges. Methods: We conducted a mixed-methods study. Quantitative analyses examined the compliance with six criteria including having signage, no active smoking, no selling, no advertisement, no smoke, and no ashtray at SFP facilities. They included health facilities, educational facilities, places of worship, workplaces, and indoor/outdoor public facilities. The qualitative analysis examined the challenges through in-depth interviews of six key informants. Results: We found the overall compliance of 44%, ranging from 0% at outdoor public facilities to 83% at health facilities. We found relatively higher compliance among facilities within 1-km from the provincial and city health offices compared to those outside of the buffer (but not significant at 5% level, P = 0.070). The challenges identified were lack of budget, monitoring, enforcement, and sensitization. Conclusions: The implementation of SFP in Medan city still has lower compliance and faces many challenges.

Background: The aim of this study was to outline the Pap smears rate done in women with total hysterectomy, sent to an urban diagnostic center that attends Mexican Government workers in the Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE: State´s Employees´ Social Security and Social Services Institute) at Mexico City. Methods: It was a retrospective study on Pap smear reports taken in 2017. The reports came from users of four family medicine clinics and a general hospital´s gynecology service. Demographic facts, instruments for collection, kind of insurance (ISSSTE-insurance or non-insurance), and total hysterectomy history were evaluated. Results: From 4989 reports, 600 (12%) had a total hysterectomy history. In the patients with ISSSTE-insurance, 586 of 4618 (12.68%) had a Pap smear whereas in the patients with non-insurance, only 14 of 371 (3.7%) had it, and this difference was significant (P < 0.00001; OR 3.7, 95% IC 2.15-6.36). Conclusions: Although Pap smear is not indicated in women with total hysterectomy, this study is still carried out frequently.

Background: Coronary artery disease (CAD) is one of the major causes of mortality that is related to the nutritional habits and lifestyle. The aim of this study was to examine the association between tea, coffee, and soft drink consumption and coronary artery stenosis in patients undergoing coronary angiography. Methods: Out of all the patients, 208 cases (101 Female) with 57.81 ± 12.18 (mean ± SD) were assigned to participate in this cross-sectional study. In total, 168-items, semi-quantitative food frequency questionnaire collected for assessments of dietary intakes of black tea, coffee, caffeine, and soft drinks and record demographic and clinical questionnaire. Results: There were negative association between arteries with stenosis of more than 50% number with dietary intakes of tea (P = 0.011, r = – 0.187), coffee (P = 0.069, r = – 0.098) intakes, and dietary caffeine intake (P = 0.043, r = –0.118). The high consumptions of soft drinks (P = 0.005, r = 0.387) were associated with an enhancement in arteries with stenosis of more than 50% number. In addition, dietary consumption of black tea have a negatively significant association with the history of previous angiography (P = 0.044, r = –0.121), the history of previous Stanton (P = 0.035, r = –0.132), and coronary artery bypass graft surgery nomination (P = 0.008, r = –0.216). Coffee consumption showed a significant negative relationship with engagement for coronary artery bypass graft surgery (P = 0.004, r = –0.598). Conclusions: Dietary intakes of tea, coffee, and caffeine may have a negative relationship with CAD and cardio vascular diseases. Healthy dietary lifestyle is an important issue for the prevention of chronic diseases.

Background: Breast cancer has an impact not only on those who are diagnosed, but also on their social network, creating an even greater need for the availability of reliable information and support. Methods: The purpose of this study was to document the content of posts on the highly popular social media platform, Instagram. Posts were garnered and analyzed from Instagram using the hashtag #breastcancer. Data were collected at three different points in time in 2018 and were then aggregated. Results: The most common attributes were highlighting an individual story (n = 76), discussing support for those with breast cancer (n = 75), discussing treatment (n = 55), or promoting an alternative treatment or product (n = 24). Posts that contained images of people were more likely highlight an individual story (P = 0.001) and discuss treatment (P = 0.046). Conclusions: Future research can focus on best practices for developing breast cancer-related information on social media.

Background: Mouthguards (MGs) remain an important piece of personal protection for athletes for the prevention of injury. Although MGs provide tremendous benefits, the design and fabrication process does not record the position of the mandible or the occlusion, which could lead to injury. This study compared a novel MG to over-the-counter (OTC) and custom MGs on a skull model. Methods: The OTC MG was formed as per manufacturer's guidelines, the custom MG was laboratory fabricated, and the novel MG was fabricated through a proprietary process. Each group of the three MGs was assessed for vertical dimension change, occlusal contacts, and condylar displacement. Results: Average number of occlusal contacts for the OTC, custom and novel MG were 2.4, 4.0, and 10, respectively. There was a significant difference between all values (P < 0.05). Average change in vertical dimension for the OTC, custom, and novel MG were 15.3 mm, 9.3 mm, and 8.0 mm, respectively. The novel MG value was significantly different (P < 0.05). The average distance of condylar displacement for the OTC, custom and novel MG were 1.9 mm, 1.3 mm and 0.6 mm, respectively. Conclusions: The novel MG was significantly different (P < 0.05). The data from this preliminary investigation suggests that the novel mouthguard had maximized occlusal contacts, minimized vertical dimension change and condylar displacement as compared to OTC and custom MGs.

Background: In recent decades, several medical and scientific studies on yoga proved it to be very useful in the treatment of some diseases. This study was conducted to investigate the effects of yoga on stress, anxiety, and depression in women living in Ilam, Iran. Methods: This study is a quasi-experimental study with pre-post test. To collect data, the questionnaire of DASS-21 (Depression Anxiety Stress Scale-21) was used. For eligible samples, hatha yoga exercises and training sessions were held for 4 weeks (3 time/weeks; 60-70 min each) by a specialist. Data were analyzed using SPSS version 20. Results: 52 women with a mean age of 33.5 ± 6.5 were included for analysis. Depression, anxiety, and stress decreased significantly in women after 12 sessions of regular hatha yoga practice (P < 0.001). Conclusions: Yoga has an effective role in reducing stress, anxiety, and depression. Thus, it can be used as complementary medicine.

Background: There is an ongoing debate regarding possible cost and benefits, but also harm of universal screening for the emerging sexually transmitted pathogen Mycoplasma genitalium. Methods: From the initial pool of 8665 samples that were tested, a subset of Chlamydia trachomatis-positive and randomly selected C. trachomatis-negative cervical swabs were further interrogated for M. genitalium by real-time polymerase chain reaction, using a 224 bp long fragment of the glyceraldehyde-3-phosphate dehydrogenase gene. Results: M. genitalium was detected in 4.8% of C. trachomatis-positive samples and none of C. trachomatis-negative samples. Accordingly, a significant association was shown between M. genitalium and C. trachomatis (P < 0.01), but also between M. genitalium and Mycoplasma hominis infection (P < 0.01). Conclusions: Based on the results, routine screening is recommended only for women with one or more identified risk factors. Moreover, younger age does not represent an appropriate inclusion/exclusion criterion for M. genitalium testing in the low-risk female population.

Background: Abnormal lipid profiles are a characteristic feature of persons with chronic conditions in which the diabetic populations are recognized as the dominant group, regardless of gender and ethnicity worldwide. This study was conducted to identify and evaluate the abnormalities of serum lipid profiles in both nondiabetic and diabetic persons. Methods: This study was a case–control investigation conducted between 2013 and 2015. The study enrolled 266 patients from the North Central and South West Regional Health Authorities of Trinidad. Of the 266 patients recruited, 126 were diabetic and 140 were nondiabetic. Results: Our study observed that dyslipidemia was present among the nondiabetic populations as the nondiabetics had 55 women and 20 men with high cholesterol, 22 women and 14 men with high triglyceride (TG), 30 women and 25 men with low high-density lipoprotein cholesterol (HDL-C), 42 women and 21 men with high low-density level-cholesterol (LDL-C), 13 women and 8 men with high very low-density lipoprotein (VLDL), and also 30 women and 11 men with body mass index (BMI) over 30 kg/m². We also observed that diabetic women had significantly lower TGs (P = 0.019) and higher HDL-C (P = 0.001) and LDL (P = 0.003) when compared with the diabetic men. In addition, the nondiabetic females also had higher HDL-C (P = 0.045) when compared to their male counterparts. Both diabetic and nondiabetic women exhibited significantly higher BMI ofP= 0.000. A negative correlation was obtained among TGs and HDL (r = −0.356, n = 83,P= 0.001) and a positive correlation was observed among LDL and HDL (r = 0.230, n = 86,P= 0.035). Conclusions: This study observed the incidences in the abnormalities of serum lipid profiles in both nondiabetic and diabetic persons. It also presents the high occurrence of nondiabetic women with dyslipidemia as they presented with high cholesterol, high TG, low HDL-C, and high VLD-L with BMI over 30 kg/m².

Background: Hypertension (HTN) is a major cause of noncommunicable diseases. In this study, we report the prevalence rate of HTN in Birjand population. Methods: This cross-sectional study was conducted on 1286 individuals in Birjand in 2014. Individuals with systolic blood pressure (SBP) ≥140 mmHg and/or diastolic blood pressure (DBP) ≥90 mmHg were considered as hypertensive. Data were analyzed using Chi-square test, independent t-test, and one-way ANOVA.P < 0.05 was considered as statistically significant. Results: Among the 1286 participants, 659 were women (51.2%). Prevalence of HTN was 20.1% (10.3% systolic HTN and 6.9% diastolic HTN). Prevalence self-reported HTN was 12.3%. SBP and DBP means were higher in men (P < 0.001). Mean scores of SBP and DBP increased by aging and body mass index (P < 0.001). Diabetic individuals had higher SBP scores (P < 0.001). Dyslipidemic patients had greater SBP and DBP (P < 0.001). Conclusions: Prevalence of HTN in our study is high. About one-fifth of the participants had HTN. In addition, BP is higher in men, elderly, and diabetic individual. Therefore, it is necessary to control BP regularly in different groups in society.

Background: Not many studies have examined the risk of emergency medical attendance during stressful life events or special days such as birthdays. This study looked at whether patients had a higher than normal chance of attending the emergency departments around their birthdays compared to the rest of the year. Methods: Patient attendance data were collected from our accident and emergency department from April 2013 to March 2014. The birthday of individual patients was matched with their date of attendance to find out the number of patients attending emergency department on and around their birthdays. Chi-square test and binominal distribution test were used to compare birthday attendances with those occurring at other times of the year. Results: A total of 1028 patients attended within the 7 days starting from their birthday (expected number 49, 211/52 = 946). This was found to be statistically significant (P = 0.0071). Road traffic accidents were more frequent on both the birthday week and the week after birthday. Medical emergencies, injury in a public place, 19–35 years age group and male patients showed similarly significant association but for the week after birthday only. Conclusions: People are more likely to present to emergency departments in the week starting from their birthday than any other week of the year. There is scope for public health initiatives such as sending health education information in the form of a birthday card to raise awareness of this risk.

Background: A report of the activities of countries worldwide for six main policies to control tobacco use is published once every 2 years by the World Health Organization (WHO). Our objective was to perform a quantitative analysis for it in countries and regions to make a simple view of its programs. Methods: This was a cross-sectional study by filling out a validated checklist from the 2015 WHO Report (MPOWER). All ten MPOWER measures got scores and were entered independently by two individuals and a third party compared the values. Results: Fifteen countries, which acquired the highest scores (85% of total 37), included Panama and Turkey with 35, Brazil and Uruguay with 34, Ireland, United Kingdom, Iran, Brunei, Argentina, and Costa Rica with 33, and Australia, Nepal, Thailand, Canada, and Mauritius with 32 points. Conclusions: Comparison of scores of different countries in this respect can be beneficial since it creates a challenge for the health policymakers to find weakness of the tobacco control programs to work on it.

Background: Dietary diversity score (DDS) measurement was used to assessment of diet quality in different disease like cardiovascular disease. One way to improve the cardiovascular patient's ability is cardiac rehabilitation program that include exercise training, nutrition consultation and psychological treatment. No study was designed to compare the DDS before and after dietary consultation among cardiac rehabilitation patients, so this study was designed to examine this purpose. Methods: Subjects were participated in the 2-month cardiac rehabilitation program. All patients that completed the cardiac rehabilitation program and 2 dietary records (before and after nutritional counseling in cardiac rehabilitation program) enrolled in study. Kant et al method was used for scoring dietary diversity. Data were analyzed using the statistical package for social sciences (SPSS version 20). Wilcoxon test were used to compare DDS score for each subgroup and pair sample T test was used to compare total DDS after and before nutrition counseling. P < 0.05 was considered as statistically significant. Results: The differences between DDS of grain, fruit, vegetable and meat before and after nutrition counseling were not significant (P = 0.635, P = 0.423, P = 0.826, P = 0.207 respectively), but differences of DDS for dairy and total DDS before and after nutrition counseling were significant (P = 0, P = 0.001). Conclusions: Dietary diversity was increased after nutrition counseling among patients with cardiac disease.

Background: Today, with the rapid growth of scientific production, research misconduct has become a worldwide problem. This article is intended to introduce the successful experience on the management of research paper misconducts in the field of health research. Methods: Our aim was to design and develop the strategy for research misconduct policy. Focusing on the national regulatory system, we developed a hierarchical model for paper misconduct policy in all the medical sciences universities and their affiliated research units. Results: Through our regulatory policy for paper misconduct management, specific protocol was followed in the field of health research publications through which the capabilities of covering the four main elements of prevention, investigation, punishment, and correction have come together. Conclusions: Considering the proposed strategy, regarding the strengths and weaknesses, utilization of evaluation tool can be one of the best strategies to achieving the prospective of health research papers by 2025.

Background: The presence of noncutaneous neoplasms does not seem to increase the risk of cutaneous malignant melanoma; however, it seems to be associated with the development of other hematological, brain, breast, uterine, and prostatic neoplasms. An ecological transversal study was conducted to study the geographic association between cutaneous malignant melanoma and 24 localizations of cancer in forty European countries. Methods: Cancer incidence rates were extracted from GLOBOCAN database of the International Agency for Research on Cancer. We analyzed the age-adjusted and gender-stratified incidence rates for different localizations of cancer in forty European countries and calculated their correlation using Pearson's correlation test. Results: In males, significant correlations were found between cutaneous malignant melanoma with testicular cancer (r = 0.83 [95% confidence interval (CI): 0.68-0.89]), myeloma (r = 0.68 [95% CI: 0.46-0.81]), prostatic carcinoma (r = 0.66 [95% CI: 0.43-0.80]), and non-Hodgkin lymphoma (NHL) (r = 0.63 [95% CI: 0.39-0.78]). In females, significant correlations were found between cutaneous malignant melanoma with breast cancer (r = 0.80 [95% CI: 0.64-0.88]), colorectal cancer (r = 0.72 [95% CI: 0.52-0.83]), and NHL (r = 0.71 [95% CI: 0.50-0.83]). Conclusions: These correlations call to conduct new studies about the epidemiology of cancer in general and cutaneous malignant melanoma risk factors in particular.

Background: This study aimed to highlight the proportion of disordered eating attitudes among university students in Kuwait by gender and obesity. Methods: A sample of 530 Kuwaiti university students was selected from four universities in Kuwait (203 men and 327 women). The eating attitudes test-26 was used to determine disordered eating attitudes. Results: The prevalence of disordered eating attitudes was 31.8% and 33.6% among men and women respectively. Obese students of both genders had doubled the risk of disordered eating attitudes compared to nonobese students (odds ratio 1.99 and 1.98, respectively). Conclusions: About one third of university students in Kuwait had disordered eating attitudes. There is an urgent need to prevent and treat disordered eating attitudes in university students in Kuwait.

Background: In some primary health care settings, even where the health services are not available, provisions are not made to ensure continuity of care. This study aimed to determine the availability and level of continuity of care for maternal health services in the primary health centers (PHCs) in Nnewi, Nigeria. Methods: This was a cross-sectional survey. Using multistage sampling technique, 280 women utilizing maternal health services from four randomly selected public PHCs in Nnewi, Nigeria were chosen for the study. Data collection employed a mix of quantitative and qualitative methods. Results: The mean ± standard deviation for age of the respondents was 29.2 ± 5.9 years. The facilities studied provided out-patient services, but the only in-patient services provided was for women who delivered or those in labor. None of the facilities is equipped to provide even basic essential obstetric care services. None had standardized a protocol for referring clients, referral forms, a transport system, or a community loan scheme in place. Forty-four (15.7%) women were referred for care outside of the PHCs for the following reasons: Lack of drugs and supplies (9.1%); lack of equipment (90.9%), lack of skilled personnel (45.5%) among others. Conclusions: This study showed that despite the unavailability of some services, appropriate strategies were not in place to ensure the coherent pattern of services within and between the PHCs and other levels of care. Delivery to the clients of comprehensive and integrated maternal health services, and efficient referral systems are thus recommended.

Background: Vitamin C levels are low in pregnancy. The purpose of this study was to determine serum Vitamins C levels among pregnant women attending antenatal care at a General Hospital in Dawakin Kudu, Kano, and this can help further research to determine the place of Vitamin C supplementation in pregnancy. Methods: This was a prospective study of 400 pregnant women who presented for antenatal care in General Hospital Dawakin Kudu, Kano, Nigeria. Research structured questionnaire was administered to 400 respondents. Determination of serum Vitamin C was done using appropriate biochemical methods. Results: Vitamin C deficiency was found in 79.5% of the participants. The values for Vitamin C were 0.20 ± 0.18 mg/dl during the first trimester, 0.50 ± 0.99 mg/dl in the second trimester, and 0.35 ± 0.36 mg/dl in the third trimester and P = 0.001. Conclusions: There is a significant reduction in the serum Vitamins C concentration throughout the period of pregnancy with the highest levels in the second trimester. Therefore, Vitamin C supplementation is suggested during pregnancy, especially for those whose fruit and vegetable consumption is inadequate.

Background: It remains controversial if dairy product intake is associated with risk of stroke. Limited information is available from Middle East countries in this regard. This case-control study was conducted to assess the relationship between dairy consumption and risk of stroke in Iranian adults. Methods: In this study, 195 stroke patients (recognized based on clinical findings and computed tomography scan) hospitalized in neurology ward of Alzahra University Hospital were enrolled. Controls (n = 195) were selected with convenience nonrandom sampling procedure from other wards of this hospital. A validated food frequency questionnaire was used to assess participants' usual dietary intakes. Data on other variables were collected by the use of questionnaires. Results: Patients with stroke were older (P < 0.001), had lower weight and body mass index (P < 0.05) and were more likely to be male (P < 0.05) and less likely to be obese (P < 0.001). After adjustment for age, sex and total energy intake, Individuals with the highest consumption of low-fat dairy had a significantly decreased risk of stroke (odds ratio [OR]: 0.58; 95% of confidence interval [CI]: 0.34-0.99), while those with the highest intake of high-fat dairy had a 2-fold increased risk of stroke. The association between high-fat dairy consumption and stroke even persisted after additional adjustments for physical activity, smoking and dietary variables (OR: 2.02; 95% CI: 1.02-4.02); but the association between low-fat dairy intake and stroke disappeared after these adjustments (OR: 0.84; 95% CI: 0.44-1.58). Conclusions: We found a significant positive association between high-fat dairy consumption and risk of stroke. Further prospective studies are required to confirm this finding.

Background: Renal ischemia/reperfusion injury (RIRI) is the most common cause of acute kidney injury. We tested the protective role of endothelin-1 receptor blocker; bosentan (BOS) in animal model of RIRI in two different genders. Methods: Male and female Wistar rats were assigned as sham operated (sham), control group (ischemia), and case group (ischemia + BOS) treated with BOS (50 mg/kg) 2 h before bilateral kidney ischemia induced by clamping renal vessels for 45 min followed by 24 h of renal reperfusion. Results: The RIRI significantly increased the serum levels of blood urea nitrogen and creatinine in both genders (P < 0.05). These values were significantly decreased by BOS in both genders. In male rats, the serum levels of malondialdehyde in the ischemia + BOS group were decreased significantly when compared with ischemia group (P < 0.05). Conclusions: BOS can be used in both genders to attenuate kidney ischemia injury possibly due to its effect in the renal vascular system.

Background: The major objectives of this study were to evaluate the existing primary health care service provisions in the public and private sector and utilization of the services, and to assess the existing manpower and material resources. Methods: Data were collected through interviews with the primary health care providers. Data were also collected from the records maintained at the polyclinics and the Ministry of Health Statistics. An analysis and discussion of all the available data was conducted to develop a comprehensive primary health care service utilization and resources inventory at the polyclinics. Similar data were collected from the primary care providers in the private sector. Results: In the public sector, there are 8 polyclinics that provide primary health care to the children. All the polyclinics have immunization services and curative acute care. Some of the polyclinics have a range of services, including dental care, eye care, and rehabilitative care services that common to both adults and children. In the private sector, primary health care is delivered through the 76 private office and of the individual physicians and 11 grouped private practices. All of the private offices and group practices have curative acute care for children and some of the offices have immunization services. Over all 87.5% of all the immunizations were done at the polyclinics. Over all 60.1% of acute care visits were to the private sector and 39.9% to the public sector. In the public sector, 59.5% were under 5 years children while 40.5% were 5 years or older. The corresponding figures in the private care settings were 80.9% and 11.9%. Conclusions: The findings demonstrate the complimentary role of the public and the private sector in the primary health care of children in this country. While the private sector has a major role in the curative acute care of children, the public sector plays a pivotal role in the immunization services.

Background: This study was conducted to explore the prevalence of medical error underreporting and associated barriers. Methods: This cross-sectional study was performed from September to December 2012. Five hospitals, affiliated with Hamadan University of Medical Sciences, in Hamedan,Iran were investigated. A self-administered questionnaire was used for data collection. Participants consisted of physicians, nurses, midwives, residents, interns, and staffs of radiology and laboratory departments. Results: Overall, 50.26% of subjects had committed but not reported medical errors. The main reasons mentioned for underreporting were lack of effective medical error reporting system (60.0%), lack of proper reporting form (51.8%), lack of peer supporting a person who has committed an error (56.0%), and lack of personal attention to the importance of medical errors (62.9%). The rate of committing medical errors was higher in men (71.4%), age of 50-40 years (67.6%), less-experienced personnel (58.7%), educational level of MSc (87.5%), and staff of radiology department (88.9%). Conclusions: This study outlined the main barriers to reporting medical errors and associated factors that may be helpful for healthcare organizations in improving medical error reporting as an essential component for patient safety enhancement.

Background: Estimating the prevalence of prehypertension and its risk factors in a population becomes important to design preventive measures and hence reduce the burden of hypertension.The aim of this study was to estimate the prevalence of prehypertension and determine the factors associated with hypertension. Methods: This is a cross-sectional study and was carried out in a rural population. The study included 402 participants. Data regarding basic demographic characteristics were collected along with anthropometric measurements including height and weight. Information regarding smoking alcohol intake, dietary habits were collected. Prehypertension was defined as systolic blood pressure 120-139 mm Hg and/or diastolic blood pressure 80-89 mm Hg. Chi-square-test was used to find the association of various risk factors; t-test was used to compare the means. Multiple linear regression analysis was used to know the relationship of various risk factors. Results: Prevalence of prehypertension was estimated to be 28.8%. Factors such as salt intake, tobacco consumption, alcohol consumption, stress, family history of hypertension, history of diabetes mellitus had a significant association with prehypertension (P < 0.05). Conclusions: The prevalence of prehypertension was found to be high among the rural population. Early intervention is needed to decrease the burden of hypertension and its complications in future.

Background: Diabetes is the most prevalent metabolic disease with a growing spread rate in word wide. Short message service (SMS) is of the most common public communication networks, which have brought about a broad spectrum of applications like social, cultural and service products in the late decade. The objective of this research is, the investigate of using SMS on diabetes patients self-caring. Methods : In an interventional study, 228 diabetes patients have been selected from a community charity. With using of random sampling method, they were divided into two groups of 114 subjects as the control and case. The case group was sent messages reminding them about sports, caring foot, taking insulin and oral tablet for 4 weeks via mobile phone. After 4 weeks, a posttest questionnaire was completed. The data analysis was performed using a descriptive statistic, Chi-square, independent t-test, and paired t-test. Results: There are not significant differences between case and control groups before intervention by studied dependent variables (P > 0.05). Performance score mean of taking care of foot, sport and taking oral tablet and insulin in case group before intervention were 29.90, 10, 11.16 and 3.75 respectively and after intervention were 20.11, 41.36, 13.09 and 4.90, respectively. Furthermore, the performance scores mean difference after intervention, taking care of foot (P < 0.001), sport (P < 0.001), taking oral tablet (P = 0.020) was meaningful in case and control groups. Conclusions: Regarding the study results on using cell phone, to utilize virtual training methods is recommended as an appropriate procedure for different health care, self-caring and follow-up training plans for various groups in society, especially diabetic and chronic patients.

Background: Bilateral ureteral obstruction (BUO) affects renal function adversely. Previous investigations have implied that nitric oxide (NO) improves renal function in obstructive nephropathy. The aim of the current study was to investigate the role of NO precursor, L-arginine, and NO blocker agent, L-NAME on kidney tissue damage in rats after 24 h of BUO. Methods: Forty Wistar rats (18 male, 22 female) were divided into four groups as follows; group 1: Sham or negative control group that received saline 3 days prior to the sham operation, group 2: Vehicle or positive control group that received saline 3 days prior to BUO, and groups 3 and 4: L-arginine and L-NAME groups that were treated same as group 2 except L-arginine (300 mg/kg) and L-NAME (4 mg/kg) instead of saline, respectively. Twenty-four hours after obstruction, the serum levels of blood urea nitrogen (BUN), creatinine (Cr), nitrite, and malondialdehyde (MDA) as well as kidney tissue levels of nitrite and MDA were measured and histopathological studies were done on left kidney. Results: The serum levels of BUN and Cr and kidney and body weights increased and the tissue levels of MDA and nitrite decreased significantly in all BUO groups (P < 0.05). However, the tissue damage score was significantly lower in the L-arginine treated group in comparison to the vehicle and L-NAME groups (P < 0.05). As expected, the serum level of nitrite significantly increased in the L-arginine group (P < 0.05). Conclusions: Endogenous NO donor; L-arginine, may protect the kidney tissue against BUO. However, this renoprotective role of L-arginine did not attenuate the increased kidney function markers (BUN and Cr) induced by obstruction.

Background: Obesity is commonly regarded as a risk factor for asthma development, poor asthma control, and poor response to asthma therapy. Methods: In a cross-sectional study, 85 asthmatics (37 male and 48 female) participated. Pulmonary function tests (PFTs) and anthropometric parameters were measured for each patient. Results: Mean age and median duration were 43.9 ± 10.61 and 6 (3-14) years, respectively. Among anthropometric parameters, only waist-to-hip ratio (WHR) indicated significant correlation with PFTs in both sex (P < 0.05). There were negative associations between waist circumference, hip circumference and WHR with PFTs only in overweight and obese women (P < 0.05). Conclusions: Some anthropometric parameters affected lung function, and it seems that gender differentially contributes to this effect.

Background: The 1978 declaration (Alma-Ata declaration) made at the International Conference on Primary Health Care, meeting in Alma-Ata highlighted the critical role played by Community Health Workers (CHWs) to link communities to the health system. The flagship program of Government of India proposed introduction of CHWs namely Accredited Social Health Activist (ASHA). As a link between community and health system ASHA is in a unique position to generate awareness on tobacco-related issues. However, there is limited evidence on practices of ASHAs in tobacco control in India. The present study explores whether CHWs such as ASHAs can be utilized as a resource for informing and educating community on tobacco and its harmful effects. The study captured perceptions and practices of ASHAs regarding tobacco control. Methods: The study was a cross-sectional study conducted among 512 ASHAs in six intervention districts each in Gujarat and Andhra Pradesh. The study settings (i.e., health facilities and villages) were selected through systematic random sampling. The study participants were selected through simple random sampling. Responses were captured through self-administered questionnaire. Logistic regression model was applied to measure associations between variables such as knowledge level of ASHAs and information provided on different tobacco-related diseases by them in both the states, with statistical significance based on the Chi-square test. Results: Our findings indicate that ASHAs linked tobacco usage to diseases such as respiratory problems, lung cancer, tuberculosis, and oral disease. Only one-third of ASHAs reported informing all patients about the harmful health effects of tobacco, whereas more than half of them reported providing information only to patients suffering from specific illness. ASHAs who reported having received training in tobacco control were about Two times more likely to give information on effects of tobacco on respiratory diseases (odds ratio [OR]-1.5; confidence interval [CI]: 1.1-2.4) and adverse reproductive outcomes (OR-2.1; CI: 1.1-20.2). Conclusions: Study findings reflect suboptimal engagement of ASHAs in providing information pertaining to specific tobacco-related diseases. There is an urgent need to sensitize and train ASHAs in appropriate tobacco control practices.

Background: Stress among diabetic patients is much more as compared to normal individuals. A delayed recognition of stress undoubtedly worsens the prognosis for survival for many diabetic patients. Hence, this study was planned to develop an intervention model for the reduction of stress among diabetic patients and to evaluate the developed intervention model in the proposed group. Methods: This study was conducted in endocrinology outpatient department of a tertiary care hospital. Starting at random, the patients were allocated to control group and test group. Controls were given printed educational materials. Test group were counseled with intense lifestyle education using both printed materials and computers; they were contacted by telephones by the investigator every 3 weeks for 3 months and SMS were sent every week containing some educational tips. Results: Mean age was 54 ΁ 11.5 years overall ranging from 30 years to 80 years. About two-third of participants were males with similar distribution in both the groups (intervention = 66%, control = 64%). Half (50%) of the participants lived in joint families, followed by nuclear families (40%). Most (83%) were married and with either graduate or above graduate education (n = 39%). No significant difference was observed in socio-demographic characteristics among both control and intervention groups (P > 0.05). The average stress scores were similar (18.9) at baseline for control and intervention arms. At 3-month follow-up, however, these scores reduced to 17.05 in the intervention arm while they increased to 20.7 in the control arm. At 3 months follow-up, higher proportion of stress reduction was seen in the intervention group. Conclusions: Intervention in the form of intensive lifestyle education and phone calls and SMS significantly decrease their stress score. Mobile-based education has great potential to improve their mental status and increase patient-provider communication, and to decrease stress.

Background: Under-reporting of adverse drug reactions (ADRs) by the prescribers is a common public health problem. Monitoring of factors that influence ADR reporting will reduce risks associated with drug use; improve patients care, safety and treatment outcome. The aim of this study was to determine the factors associated with the reporting of ADRs by health workers in Nnewi Nigeria. Methods: A cross-sectional study of 372 health workers in different health facilities in Nnewi North Local Government Area of Anambra state, selected using multistage sampling technique was done. Data collection employed pretested, self-administered structured questionnaires. Data were analyzed using Statistical Package for Social Sciences version 17. Tests of statistical significance were carried out using Chi-square tests for proportions. A P < 0.05 was considered significant. Results: Out of the 372 respondents studied, 255 (68.5%) were females, and 117 (31.5%) were males. The modal age range (37.6%) was 31-40 years. Factors related by the respondents to influence ADR reporting include: Unavailability of electronic reporting (83.6%), unavailability of reporting forms (66.4%) and ignorance (58.2%). The difference among medical practitioners who related unavailability of electronic reporting process as obstacle to ADR reporting was not significant (P = 0.18). Conclusions: The study results revealed the factors associated with the reporting of ADRs among health workers in Nnewi Nigeria. It is desirable to initiate electronic reporting process, training programs on ADR reporting and make reporting forms/guidelines available to relevant health workers.

Background: Global burden of cancer is on rise and trends and pattern of cancers are rapidly changing different geographic and population groups. Gall bladder cancers are emerging with increasing proportion among select areas and groups and understanding these variations are important for appropriate strategies and interventions. However, absence of a well-developed universal cancer registry system in India, institution based secondary data analysis can generate useful information. The present study was conducted to determine the trend and pattern of cancer cases (with special reference to gall bladder cancer) treated in a tertiary care hospital in northern part of West Bengal. Methods: Record based cross-sectional study was conducted in Department of Radiotherapy, North Bengal Medical College and Hospital. All newly registered cases between (2010 and 2012) were reviewed. Results: A total of 2058 cancer cases were recorded during the 3-year period. Of these, major types of cancers were oro-pharynx (16.1%), breast (15.4%), cervix (13.2%), lung (12.7%), gall bladder (6.5%) stomach cancer (6.4%), etc., Increasing proportions was observed for breast and gall bladder cancers. The proportion of gallbladder cancer cases in 2010, 2011, and 2012 were 3.8%, 7.3% and 7.8%, respectively. Among 134 gall bladder cancer cases, 93.3% were females, 85.1% alcoholics, 57.4% had a history of fatty liver, 94% had adeno/adenosquamous carcinomas, and 65.7% were metastatic in nature. Conclusions: Increasing trend is observed in gall bladder cancer cases emphasizing the need for further large scale studies.

Background: Early detection and treatment of diabetes mellitus may reduce the burden of diabetes and its complications. Screening of undiagnosed diabetes with gingival blood sample in patients attending to the dental hospital and to check the reliability with standard method. Methods: Five hundred and fifty new patients age ranged from 30 to 50 years were randomly selected. Of 550 patients examined, gingival blood samples of 454 patients were collected from bleeding site and analyzed with self-monitoring device. Blood glucose values were recorded. In addition, all the patients were advised for the second visit with overnight fasting for fasting Blood glucose assessment. Among them, 442 patients returned for fasting blood glucose assessment in laboratory with blood glucose analyzer. Results: In the total of 454 patients gingival blood glucose assessment with self-monitoring device, 64 patients showed ≥200 mg/dL, which indicates diabetes, and the other 390 patients showed ≤200 mg/dL, which indicates patients are not diabetic. Whereas, the results of the laboratory blood glucose analysis, 24 (5.43%) patients showed ≥126 mg/dL, 36 (8.14%) patients showed 100-125 mg/dL and the other 382 patients are not diabetic. Comparison of blood glucose measurements by two methods showed sensitivity 96.66% and specificity 99.47%. Conclusions: The results of the present study showed blood obtained from periodontal pocket probing is a reliable sample to screen diabetes in periodontal disease population. Early diagnosis of diabetes in the dental hospitals can help improve the patient's oral health and overall health status by helping patients avoid or reduce complications from diabetes.

Background: Colonoscopy is the preferred screening method for colorectal cancer (CRC). This study aimed to identify factors motivating a beneficial health behavior, that is, the decision to complete a colonoscopy. Methods: We surveyed 91 primarily urban minority health care workers who were ineligible for a large randomized controlled trial due to self-reported asymptomatic colonoscopy screening. Participants were asked an open-ended question about what made them get screened. Responses were classified as external or internal motivations. Results: The most commonly reported external motivation was a primary care physician's recommendation (n = 60, 65.9%). Other external motivations were familiarity with CRC or polyps through family or work (n = 16, 17.6%) and pressure from relatives or friends (n = 8, 8.8%). Seventeen respondents were deemed self-motivated; these individuals were more likely have income over $50K/year (P < 0.05) and to be US born (P = 0.05); they were more likely to mention being age-appropriate for screening (P < 0.05); knew more people who had colonoscopies (P < 0.001); they were less likely to believe that most of the age-appropriate population in New York City has been screened (P < 0.01) and less likely to be deterred from colonoscopy by work schedule (P < 0.001) or by having to take a powerful laxative (P < 0.001). Conclusions: A primary care physician's recommendation may be the most prevalent motivating factor in patients' decisions to receive a colonoscopy, but a subgroup seeks CRC screening on their own. Analysis of the motivations of individuals who have sought colonoscopy screening may offer useful insights into motivating those who have not.