Background: The rising incidence of breast cancer is complicated by late presentation, which marks breast cancer diagnosis in Nigeria with about 70% of cases presenting at advanced stages of the disease. The aim of this study is to determine the general level of awareness of breast cancer, breast cancer risk factors, signs/symptoms as well as preventive measures nothern Nigerian women. It also aimed at determining their attitudes toward breast cancer cure, prevention and cause. Finally, it aims to determine their practices toward breast cancer and its associated factors. Methods: A cross-sectional community survey was used to study 230 women aged 15-60 years in Chikun Local Government Area. The subjects were selected based on nonprobability sampling. Data collected using self-administered questionnaire were analyzed using Statistical Package for Social Science students (version 16). Test of associations employed Chi-square statistical tool with the level of significance taken at 0.05. Results: About 75.2% knew about breast cancer with health facility (29.13%) being the greatest source of information. An average of 29.35% had knowledge of the risk factors tested. Mean knowledge of the signs and symptoms was 50.1% Average knowledge of breast cancer screening methods was 34.26% with breast self-examination (BSE) (46.1%) being the most recognized. In relation to perception, about 21.7% strongly agreed with the fact that breast cancer is treatable following early detection while 18.3% strongly agreed that screening is effective in detecting breast cancer. Concerning practice, an average of 10.2% practiced any of the screening methods, with BSE (17.4%) being the most practiced. Strongest reasons for nonpractice was ignorance (17.4%). An association was established between knowledge and practice of all the screening methods (P = 0.001 respectively). Conclusions: There is insufficient knowledge, as well as poor practices in relation to important factors associated with breast cancer prevalence.

Background: A small proportion of physicians adhere to tuberculosis (TB) notification regulations, particularly in the private sector. In most developing countries, the private sector has dominance over delivering services in big cities. In such circumstances deviation from the TB treatment protocol is frequently happening. This study sought to estimate TB notification in the private sector and settle on determinants of TB notification by private sector physicians. Methods: A population-based study has been conducted; private physicians at their clinics were interviewed. The total number of 443 private sectors' physicians has been chosen by the stratified random sampling method. Appropriate descriptive analysis was used to describe the study's participants. Logistic regression was used for bivariable and multivariable analysis. Results: The response rate of the study was 90.06 (399%). Among responders, who had stated that they were suspicious of TB over the recent year, 62 (16.45%) stated that they reported cases of TB at least once during the same period. Having reporting requirements and the number of visited patients was significantly related to TB suspicious (odds ratio = 2.84, confidence interval: 1.62-5, P < 0.01). Workplace and access to relevant resources are associated with TB notification (P < 0.05). Conclusions: In poor resource settings with a high burden of TB, the public health administration can promote notification activities in the private sector by simple and quick interventions. It seems that a considerable fraction of private sector physicians, not all of them, will notify TB if they are provided with primary information and primary resources. To optimize the TB notification, however, intersectoral interventions are more likely to be successful.

Background: HIV/AIDS is one of the diseases which not only makes threats to physical health, but also, due to the negative attitudes of people and the social stigma, affects the emotional and social health of patients. The aim of this study was to identify the psychological, social, and family problems of people living with HIV/AIDS (PLWHA) in Iran. Methods: In this qualitative study, we used purposive sampling to enroll PLWHA, their families, and physicians and consultants in two cities of Kermanshah and Tehran. Each group of PLWHA, their families, physicians, and consultants participated in two focus group discussions (FGDs), and a total of eight FGDs were conducted. Six interviews were held with all key people, individually. Results: Based on the views and opinions of various groups involved in the study, the main problems of PLWHA were: Ostracism, depression, anxiety, a tendency to get revenge and lack of fear to infect others, frustration, social isolation, relationship problems, and fear due to the social stigma. Their psychological problems included: Marriage problems, family conflict, lack of family support, economic hardships inhibiting marriage, and social rejection of patient's families. Their family problems were: Unemployment, the need for housing, basic needs, homelessness, and lack of social support associations. Conclusions: It seems that the identification and focusing on psychological, social, and family problems of affected people not only is an important factor for disease prevention and control, but also enables patients to have a better response to complications caused by HIV/AIDS.

Background: While many studies have previously focused on fingolimod's effect on immune cells, the effect it has on circulating and local central nervous system platelets (Plts) has not yet been investigated. This study will elucidate what effects fingolimod treatment has on multiple sclerosis (MS) patients' plasma Plt levels. In addition, it will propose possible reasoning for these effects and suggest further investigation into this topic. Methods: This quasi-experimental study used patients from the Isfahan Multiple Sclerosis Society to produce a subject pool of 80 patients, including 14 patients who ceased fingolimod use due to complications. The patients had their blood analyzed to determine Plt levels both 1-month prior to fingolimod treatment and 1-month after fingolimod treatment had been started. Results: The mean level of Plts before initiation of fingolimod therapy (Plt1) among these MS patients was 256.53 ± 66.26. After 1-month of fingolimod treatment, the Plt level yielded an average of 229.96 ± 49.67 (Plt2). This number is significantly lower than the average Plt count before treatment (P < 0.01). Conclusions: MS patients taking oral fingolimod treatment may be at risk for side-effects caused by low Plt levels. This may not be a factor for patients with higher or normal Plt levels. However, a patient with naturally low Plt levels may experience a drop below the normal level and be at risk for excessive bleeding. In addition to these possible harmful side-effects, the decreased Plt population may pose positive effects for MS patients.

Background: We aimed to assess the effects of administering prophylactic acetaminophen on short-term complications of vaccination in 6-month-old infants admitted to a private pediatric clinic in Rasht (Iran) during 2002-2013. Methods: This quasi-experimental study was conducted on 696, infants aged 6-month-old admitted to a pediatric clinic in Rasht before vaccination during 2002-2013. Overall, 31 infants were excluded during the course of the study. While prophylactic acetaminophen was administered in 322 participants (intervention group), 343 infants (control group) received acetaminophen after vaccination. Data were collected by a checklist including complications such as fever, drowsiness, anorexia, seizure, long and excessive crying, mood change, pain, and wound at the site of injection, abscess, induration, limb swelling, and erythema. The time of occurrence of each complication was also recorded. Data were analyzed by Chi-square test in SPSS 16.0. P < 0.05 was considered significant. Results: Six hundred sixty-five participants (49.6% boy) were assessed in this study. The intervention and control groups had no significant difference in terms of sex distribution (P = 0.53). Short-term complications occurred in 45% of the infants. The most common complications were erythema (24.4%), induration (19.9%), and low-grade fever (16.1%). There was a significant relation between administering prophylactic acetaminophen and the incidence of low-grade fever (P = 0.01), induration (P = 0.01), and anorexia (P = 0.03). Conclusions: Our findings indicated the efficacy of prophylactic acetaminophen in reducing postvaccination complications in a population of Iranian infants. According to our findings, further research is required to determine the preferred dose and time of administering acetaminophen.

Background: Welding is among the most important frequently used processes in the industry with a wide range of applications from the food industry to aerospace and from precision tools to shipbuilding. The aim of this study was to assess the level of steel industry welders' exposure to ultraviolet (UV) radiation and to investigate the health impacts of these exposures. Methods: In this case-control study, we measured the intensity of UV at the workers' wrist in Fars Steel Company through manufacture of different types of heavy metal structures, using UV-meter model 666230 made by Leybold Co., from Germany. Results: The population under the study comprised 400 people including 200 welders as the exposed group and 200 nonwelders as the unexposed group. The results of the questionnaire were analyzed using SPSS software, version 19. The average, standard deviation, maximum and minimum of the UV at the welders' wrist were 0.362, 0.346, 1.27, and 0.01 μW/cm ² , respectively. There was a significantly (P < 0.01) higher incidence of cataracts, keratoconjunctivitis, dermatitis and erythema in welders than in their nonwelders. Conclusions: This study showed that the time period of UV exposure in welders is higher than the permissible contact threshold level. Therefore, considering the outbreak of the eye and skin disorders in the welders, decreasing exposure time, reducing UV radiation level, and using personal protective equipment seem indispensable. As exposure to UV radiation can be linked to different types of skin cancer, skin aging, and cataract, welders should be advised to decrease their occupational exposures.

Background: Deranged body fat and muscle mass are aftermaths of uncontrolled diabetes. Anthropometric methods like body mass index (BMI) do not give qualitative inferences like total body fat (TBF), visceral fat (VF) or subcutaneous fat (SF) that can be given by bio-electrical impedance analysis (BIA). We studied body composition of type 2 diabetics in comparison to controls matched by age-sex, weight and BMI separately. Methods: Seventy-eight under-treatment type 2 diabetics of either sex with known glycemic and lipidemic control and equal number of controls with three patterns of matching were taken from our city. We derived parameters of body composition in both groups by Omron Karada Scan (Model HBF-510, China), using the principle of tetra poplar BIA and compared them for statistical significance. Results: We found significantly more SF (30.47% ± 7.73%), VF (11.94% ± 4.97%) and TBF (33.96% ± 6.07%) and significantly lesser skeletal muscle mass (23.39% ± 4.49%) in type 2 diabetics as compared to controls, persisting even after matching with weight or BMI. On assessing qualitatively, the risk of high VF, high TBF, low skeletal muscle mass was significantly high in type 2 diabetics, which were 10.41, 3.01, 9.21 respectively for comparable BMI and 6.78, 3.51, 11.93 respectively for comparable weight. Conclusions: BIA reveals that type 2 diabetics have more ectopic fat on the expense of skeletal muscle that persists even after matching by weight or BMI, both quantitatively and qualitatively. Measurement of body composition can be included as a primary care strategy to motivate lifestyle modifications while managing metabolic derangements of type 2 diabetes.

Background : Low birth weight is considered a risk factor for cardiovascular disease (CVD) in later life. Because data in children and adolescents are sparse and controversial, we assessed the association of birth weight with CVD risk factors in German youths. Methods : We categorized 843 urban children and adolescents aged 3-18 years by quintiles of birth weight and measured nine traditional risk factors in terms of body mass index (BMI), waist circumference (WC), systolic (SBP) and diastolic (DBP) blood pressure, total cholesterol (TC), LDL-C, HDL-C, Non HDL-C and triglycerides (TG). SPSS 21 was used for statistical analysis. Results: Mean values and prevalence of nine anthropometric and lipid risk variables were equally distributed over the five birth weight groups. Though risk factors clustered between 3.0 kg and 4.0 kg of birth weight in both genders we found only one significant correlation of birth weight with TG for males and females and another one for HDL-C in males. The strongest clustering of significant regression coefficients occurred in the 2 ^nd birth weight quintile for SBP (ß 0.018), TC (ß -0.050), LDL-C (ß -0.039), non LDL-C (ß -0.049) and log TG (ß -0.001) in males and females. Conclusions: Overall we did not find significant associations between birth weight and nine traditional cardiovascular risk factors in children and adolescents. However, the 2 ^nd quintile of birth weight might suggest clustering of risk factors.

Background: Most medical errors are preventable. The aim of this study was to compare the current execution of the 3 patient safety solutions with WHO suggested actions and standards. Methods: Data collection forms and direct observation were used to determine the status of implementation of existing protocols, resources, and tools. Results: In the field of patient hand-over, there was no standardized approach. In the field of the performance of correct procedure at the correct body site, there were no safety checklists, guideline, and educational content for informing the patients and their families about the procedure. In the field of hand hygiene (HH), although availability of necessary resources was acceptable, availability of promotional HH posters and reminders was substandard. Conclusions: There are some limitations of resources, protocols, and standard checklists in all three areas. We designed some tools that will help both wards to improve patient safety by the implementation of adapted WHO suggested actions.

Background: Today, beside immunization coverage the age appropriate vaccination is another helpful index in public health. Evidences have shown that high immunization coverage rates do not necessarily imply age-appropriate vaccination status. The current study aimed to show the predictive factors of delayed vaccination by survival models. Methods: A historical cohort study conducted on 3610 children aged between 24 and 47 months who was living in the suburbs of five big cities of Iran. Time of delay in vaccination of first dose of mumps-measles-rubella (MMR) was calculated from date of vaccination minus age appropriate time according to vaccine card. Kaplan-Maier and Log rank tests were used for comparison the median of delay time. For controlling of confounding variables, multivariate cox model was used and hazard ratio with 95% confidence interval (95%) was reported. Results: The mean ± standard deviation and median interquartile range of delay time was 38.34 ± 73.1 and 16 (11-31) days in delayed group. The Log rank test showed that city of living, nationality, parents' education, and birth order are related with prolonged delay time in MMR vaccination (P < 0.05). Nevertheless, child sex, prior living place (rural or city) and parent's job are not related with delay time of vaccination (P > 0.05). Cox regression showed that city of living, mother education, and nationality are the most predictive factors of delay time duration in MMR vaccination. Conclusions: Delay time duration of vaccination increased by faring from capital to the east south. Moreover, concentration of foreign immigrants in big cities and low level of mother education are the most predictors of delayed vaccination. Educational intervention should focus on immigrants and mothers with low education level.

Background: Current study aimed to investigate whether perceived neighborhood as unsafe during adolescence predicts the subsequent perceived health two decades later. Methods: In a prospective study of an ethnically diverse urban sample (83.2% Black), conducted from 1994 to 2012, 851 adolescents were enrolled at 9 ^th grade. Three hundred and seventy-eight participants were followed from 9 ^th grade for 18 years. The outcome was subjective health (feeling as healthy as other people of the same age) measured at baseline (mean age 15 years) and end of follow-up (mean age 33 years). The independent variable was neighborhood perceived as unsafe measured at 9 ^th grade. Baseline age, family structure, and parental employment were control variables. We ran logistic regressions in the pooled sample and also specific to each gender. Results: Perceived neighborhood as unsafe at 9 ^th grade predicted deterioration of subjective health over the next 18 years (unadjusted odds ratio = 1.742, 95% confidence interval = 1.042-2.911). This association remained significant in a multivariable model that controlled for baseline subjective health, family structure, and parental employment. The association between perceived neighborhood safety at 9 ^th grade and subsequent deterioration of perceived health during the next 12 years was significant for females but not males. Conclusions: Our findings suggest that perception of unsafe neighborhoods during adolescence has negative consequences years later for the health of females. Further research is needed to replicate the findings using objective measures of health.

Background: Heat stress is a known occupational hazard, which cause reduced exercise capacity. The purpose of this study was to evaluate the relationship among environmental, physiological, and perceptual heat stress indices in Iranian men. Methods: This analytical study was carried out on 24 healthy men (age 23.34 ± 1.64 years) with normal body weight (body mass indices 21-25 kg/m ² ) in low workload for 120 min under hot climates (22-32°C, 40% relative humidity). Physiological strain index (PSI), wet-bulb globe temperature (WBGT), oral temperature, heart rate (HR), and heat strain score index (HSSI) questionnaires were simultaneous measurements taken at any 5 min during the exposure and resting state the initial measurements. Results: The results showed that the range of WBGT index was 20.47-31.40°C. Significant correlation were found among WBGT and HSSI (r = 0.995), PSI (r = 0.990), oral temperature (r = 0.991), and HR (r = 0.972) indices. Also, significant correlation were found among HSSI and oral temperature (r = 0.983), HR (r = 0.978), and PSI (r = 0.987). Conclusions: The results have shown that simultaneous with the increase in valid indices of heat stress such as WBGT and PSI indices, the amount of HSSI has also increased with high power. Therefore, when there is no access to a reliable heat stress method such as WBGT, or PSI indices, HSSI, an observative and subjective heat strain method, can be used as a simple, fast in least 5 min, and inexpensive for evaluating the heat strain in Iranian men.

Background: Osteoporosis is the most common metabolic bone disease. The study's objective is to investigate the effect of an educational program based on Health Belief Model (HBM) on preventing osteoporosis in women. Methods: In this quasi-experimental study, 120 patients (60 experimental and 60 control) who were registered under the health centers in Fasa City, Fars Province, Iran, were selected in 2014. A questionnaire consisting of demographic information, HBM constructs was used to measure nutrition and walking performance for the prevention of osteoporosis before, immediately after intervention, and 6 months later. Bone mineral density (BMD) was recorded at the lumbar spine and femur before and 6 months after intervention. Results: The mean age of women participated in the study was 41.75 ± 5.4 years for the experimental group, and 41.77 ± 5.43 years for the control group. The mean body mass index was 22.44 ± 3.30 for the experimental group and 22.27 ± 3.05 for the control group. The average number of women deliveries for the experimental group was 2.57 ± 1.47 and 2.50 ± 1.19 for the control group. There is no significant difference between the two groups in education level (P = 0.771), marital status (P = 0.880), occupation (P = 0.673), breastfeeding (P = 0.769), smoking (P = 0.315), history of osteoporosis in the family (P = 0.378), history of special diseases (P = 0.769), and records of bone densitometry (P = 0.543). Immediately and 6 months after intervention, the experimental group showed a significant increase in the knowledge, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, self-efficacy, internal cues to action, nutrition, and walking performance compared to the control group. Six months after intervention, the value of lumbar spine BMD T-score in the experimental group increased to 0.127, while in the control group it reduced to −0.043. The value of the hip BMD T-score in the intervention group increased to 0.125, but it decreased to −0.028 in the control group. Conclusions: This study showed the effectiveness of knowledge, walking, and diet on bone mass by HBM. Hence, these models can act as a framework for designing and implementing educational interventions for the osteoporosis prevention.

Background: Regarding failure to establish the statistical presuppositions for analysis of the data by conventional approaches, hierarchical structure of the data as well as the effect of higher-level variables, this study was conducted to determine the factors independently associated with hospital mortality due to myocardial infarction (MI) in Iran using a multilevel analysis. Methods: This study was a national, hospital-based, and cross-sectional study. In this study, the data of 20750 new MI patients between April, 2012 and March, 2013 in Iran were used. The hospital mortality due to MI was considered as the dependent variable. The demographic data, clinical and behavioral risk factors at the individual level and environmental data were gathered. Multilevel logistic regression models with Stata software were used to analyze the data. Results: Within 1-year of study, the frequency (%) of hospital mortality within 30 days of admission was derived 2511 (12.1%) patients. The adjusted odds ratio (OR) of mortality with (95% confidence interval [CI]) was derived 2.07 (95% CI: 1.5-2.8) for right bundle branch block, 1.5 (95% CI: 1.3-1.7) for ST-segment elevation MI, 1.3 (95% CI: 1.1-1.4) for female gender, and 1.2 (95% CI: 1.1-1.3) for humidity, all of which were considered as risk factors of mortality. But, OR of mortality was 0.7 for precipitation (95% CI: 0.7-0.8) and 0.5 for angioplasty (95% CI: 0.4-0.6) were considered as protective factors of mortality. Conclusions: Individual risk factors had independent effects on the hospital mortality due to MI. Variables in the province level had no significant effect on the outcome of MI. Increasing access and quality to treatment could reduce the mortality due to MI.

Background: High concentrations of elements such as aluminum (Al) and silicon (Si) in drinking water can affect human health. It is suggested that high daily intake of Al is associated with increased risk of neurodegenerative disorders. Si, as an antidote of Al, may decrease Al bioavailability. The study was conducted to estimate Al and Si concentration and correlation in water and evaluate their health risk. Methods: In this cross-sectional study, water samples were collected from 20 points of water distribution system and the water treatment plant of Isfahan in spring and summer. Samples were analyzed using DR-5000. The health risk was evaluated via calculating chronic daily intake (CDI) and hazard index (HI). Results: Significant negative correlation was documented between Al and Si (R = −0.482, P = 0.037 in spring, and R = −0.452, P = 0.049 in summer). These values were approximately similar in all types of Al and Si. The amounts of CDI for Al in spring and summer were 6.67E-04 and 0.002 mg/kg/day, respectively. The Al HI values were below 1 in both seasons. Conclusions: The significant correlation between Al and Si concentrations suggests that Si can eliminate Al in water, and probably it might do the same in the body. The health risk of Al intake from tap water was negligible, it was assessed in an acceptable range with an HI value of less than the standard levels. The health risk of Si remained unknown due to lack of information regarding its toxicity and adverse health effects.

Background: The current study was conducted to examine the effect of cognitive behavior therapy on the reduction postpartum mood disorder and increasing the self-esteem of at-risk Iranian mothers. Methods: In this quasi-experimental study, 135 at-risk mothers were selected from the population by means of cluster sampling and randomly assigned into one of two groups: Intervention (n = 64), or control (n = 71). The control group received usual medical care, and the intervention group received an eight sessions' cognitive behavior program during pregnancy. Assessments were administered at two time points (pretest at the beginning of the third trimester and posttest at 2 weeks postpartum). Beck anxiety, beck depression, Edinburgh postpartum depression, (PPD) Coopersmith self-esteem, and religious attitude questionnaire were used to collect data. Results: The mean age of participants was 25.8 ± 3.7 years. One-third of them had either bachelor or higher degrees in education (33%). About two-third of participants were unemployment with similar distribution in both the groups (intervention = 80%, control = 83%). The majority (70%) of the participants had cesarean section deliveries. There were no statistically significant differences respects to sociodemographic characteristics between the control and intervention groups (P > 0.05). The multivariate analysis of covariance results showed that the average scores of PPD were reduced significantly in the intervention group (P < 0.001). Also while the mean score of anxiety in the intervention group decreased from 23.31 (standard error [SE] =12.11) to 16.64 (SE = 8.33) and self-esteem increased from 29.09 (SE = 3.51) to 31.81 (SE = 2.76), no change was statistically significant in comparison to the control group. Conclusions: According to the findings of the present study, cognitive behavior intervention is effective in reducing PPD in at-risk mothers.

Background: The prevalence of obesity continues to rise worldwide with alarming rates in most of the world countries. Our aim was to compare the mortality of fatal disease attributable to excess body mass index (BMI) in Iran in 2005 and 2011. Methods: Using standards implementation comparative risk assessment methodology, we estimated mortality attributable to excess BMI in Iranian adults of 25-65 years old, at the national and sub-national levels for 9 attributable outcomes including; ischemic heart diseases (IHDs), stroke, hypertensive heart diseases, diabetes mellitus (DM), colon cancer, cancer of the body of the uterus, breast cancer, kidney cancer, and pancreatic cancer. Results: In 2011, in adults of 25-65 years old, at the national level, excess BMI was responsible for 39.5% of total deaths that were attributed to 9 BMI paired outcomes. From them, 55.0% were males. The highest mortality was attributed to IHD (55.7%) which was followed by stroke (19.3%), and DM (12.0%). Based on the population attributed fractions estimations of 2011, except for colon cancer, the remaining 6 common outcomes were higher for women than men. Conclusions: Despite the priority of the problem, there is currently no comprehensive program to prevention or control obesity in Iran. The present results show a growing need to comprehensive implications for national and sub-national health policies and interventional programs in Iran.

Background: Malaria elimination efforts face with substantial challenges and the role of health workers in address this challenge, particularly advocates and mobilizes communities. The aim of the study was to explore perceptions of health workers in relation to eliminating malaria in order to better understand the level their involvement in malaria elimination efforts. A qualitative approach was adopted based on key informant interviews with 26 health workers who working at community-level in malaria low endemic areas, southern Iran. Methods: Data were collected through key informant interviews. Data were analyzed using thematic content analysis. Results: Findings reveal that the majority of participants concerned with the imported malaria cases, without to address an effective solution to the issue. Health workers had positive perceptions on their basic knowledge and opinions in relation to their field work with emphases to integrate methods. Participants expressed willingness to contribute to malaria elimination effort. They also emphasized on continuous training, resource mobilization, and support. In addition, their perceptions on malaria elimination policy such as sustained financial investment to achieve elimination and integrated management of vector control were rather negative. Conclusions: A mechanism should be considered that allow the health workers to feedback positively on their quality of their practice to health providers.

Background: Peripheral neuropathy is one of the most important limitations of oxaliplatin base regimen, which is the standard for the treatment of colorectal cancer. Evidence has shown that Vitamin E may be protective in chemotherapy-induced peripheral neuropathy. The aim of this study is to evaluate the effect of Vitamin E administration on prevention of oxaliplatin-induced peripheral neuropathy in patients with colorectal cancer. Methods: This was a prospective randomized, controlled clinical trial. Patients with colorectal cancer and scheduled to receive oxaliplatin-based regimens were enrolled in this study. Enrolled patients were randomized into two groups. The first group received Vitamin E at a dose of 400 mg daily and the second group observed, until after the sixth course of the oxaliplatin regimen. For oxaliplatin-induced peripheral neuropathy assessment, we used the symptom experience diary questionnaire that completed at baseline and after the sixth course of chemotherapy. Only patients with a score of zero at baseline were eligible for this study. Results: Thirty-two patients were randomized to the Vitamin E group and 33 to the control group. There was no difference in the mean peripheral neuropathy score changes (after − before) between two groups, after sixth course of the oxaliplatin base regimen (mean difference [after − before] of Vitamin E group = 6.37 ± 2.85, control group = 6.57 ± 2.94; P = 0.78). Peripheral neuropathy scores were significantly increased after intervention compared with a base line in each group (P < 0.001). Conclusions: The results from this current trial demonstrate a lack of benefit for Vitamin E in preventing oxaliplatin-induced peripheral neuropathy.

Background: Dehydration of elderly people living independently is a very important public health issue. This study compares two interventions to prevent dehydration in elderly people at risk: an educational intervention and an educational intervention in combination with a drink reminder device. Methods: This is an experimental two-armed parallel study. A Public Health Service develops the interventions and will be partnering with a general practice and a university to evaluate the effects. Two groups - all people aged 80 years and older, and people of 65 years and older who have cardiovascular disease - receive a letter from the general practice in which they are asked whether they want to participate in the study and if so to return the form. People who want to participate and whose daily fluid intake is insufficient are randomized to receive either the educational intervention or the educational intervention in combination with a drink reminder device. The participants are asked to fill in a questionnaire before the intervention, 6 weeks after the start of the intervention and 6 months after the start (or after the end) of the intervention. Changes between the two groups in fluid intake, knowledge, awareness of the risks of dehydration, and quality-of-life will be tested by Linear Mixed Model analyses. Conclusions: This study will improve the knowledge of the effectiveness of interventions designed to prevent dehydration in elderly people.

Background: Although obesity is expected to be associated with intention to reduce weight, this effect may be through perceived overweight. This study tested if perceived overweight mediates the association between actual obesity and intention to control weight in groups based on the intersection of race and gender. For this purpose, we compared Non-Hispanic White men, Non-Hispanic White women, African American men, African American women, Caribbean Black men, and Caribbean Black women. Methods: National Survey of American Life, 2001-2003 included 5,810 American adults (3516 African Americans, 1415 Caribbean Blacks, and 879 Non-Hispanic Whites). Weight control intention was entered as the main outcome. In the first step, we fitted race/gender specific logistic regression models with the intention for weight control as outcome, body mass index as predictor and sociodemographics as covariates. In the next step, to test mediation, we added perceived weight to the model. Results: Obesity was positively associated with intention for weight control among all race × gender groups. Perceived overweight fully mediated the association between actual obesity and intention for weight control among Non-Hispanic White women, African American men, and Caribbean Black men. The mediation was only partial for Non-Hispanic White men, African American women, and Caribbean Black women. Conclusions: The complex relation between actual weight, perceived weight, and weight control intentions depends on the intersection of race and gender. Perceived overweight plays a more salient role for Non-Hispanic White women and Black men than White men and Black women. Weight loss programs may benefit from being tailored based on race and gender. This finding also sheds more light to the disproportionately high rate of obesity among Black women in US.

Background: Sophora belongs to the family of Fabaceae and the species in this genus are currently used as a folklore medicine for preventing a variety of ailments including cancer. Our aim was to identify and validate an anticancer compound from Sophora interrupta using multi-spectroscopic, anticancer screening, and molecular docking approach. Methods: The cytotoxicity of the various solvent extracts, petroleum ether, n-butanol, and ethyl acetate (EtOAc) of the S. interrupta root powder was evaluated in a breast cancer cell lines (MCF-7). The extract that had anticancer activity was subjected to column chromatography based on the polarity of the solvents. The anticancer activity of the elution fractions was validated using a 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. The isolated metabolite fraction with anticancer activity was run through a C18 column isocratic and gradient high-performance liquid chromatography (HPLC). The structure of the isolated compound was characterized using ¹ H nuclear magnetic resonance (NMR), ¹³ C-NMR, Fourier transform infrared spectroscopy, and liquid chromatography-mass spectrometer methods. Results: The crude EtAOc extract effectively inhibited the proliferation of MCF-7 cells. The column eluted chloroform and EtOAc (4:6) fraction of the EtOAc extract showed significant anticancer activity in the MCF-7 cells compared with normal mesenchymal stem cells. This fraction showed three major peaks in the HPLC chromatogram and the first major peak with a retention time (RT) of 7.153 was purified using preparative-HPLC. The structure of the compound is a piceatannol, which is a metabolic product of resveratrol. Piceatannol formed direct two hydrogen bond interactions between Cys912 (2H), and Glu878 of vascular endothelial growth factor receptor 1 (VEGFR1) with a glide-score (G-score) of −10.193, and two hydrogen bond interactions between Cys919, and Asp1046 of VEGFR2, with a G-score of −8.359. The structure is similar to that of the crystallized protein for VEGFR1 and R2. Conclusions: Piceatannol is a secondary metabolite of S. interrupta that has anticancer activity. Moreover, piceatannol has been isolated for the first time from S. interrupta.

Background: The aim of the present study is to assess the elementary schoolchildren's nutritional status based on anthropometric indices due to the sudden spread of obesity in children and adolescents in both developed and developing countries. Methods: This cross-sectional study was conducted on 3647 children with an age range of 7-11 years of primary schools in Babol using cluster random sampling method in 2012. Children younger than 7 years or older than 11 years, children with chronic diseases, pupils treated with corticosteroids or growth hormone replacement therapy and children with chromosomal abnormalities were excluded from the study. Anthropometric indices were measured by medical students and evaluated according to the Centers for Disease Control and Prevention standard percentiles. Data were analyzed using statistical software SPSS version 18 with Chi-square and independent samples t-test. Results: The body mass index of 26.1% of children was greater than the 85 ^th percentile, and 4.7% was less than the 5 ^th percentile. The prevalence of obesity among boys was significantly higher than girls (P = 0.007). Moreover, urban children (P = 0.0001) and children who studied in private schools (P = 0.0001) had a significantly higher proportion of obesity and overweight than the urban and private schoolstudents. The highest prevalence of obesity and overweight belonged to 18.0% of the students among fifth graders and 15.3% of schoolchildren among third graders, respectively (P < 0.001). Conclusions: The results showed that the prevalence of overweight and obesity in the study was higher. It seems it is necessary to implement the intervention programs to prevent overweight and obesity among schoolchildren.

Background: As food insecurity has negative effects on health, the aim of this study was to determine tahe relationship between household food security and type 2 diabetes mellitus and its related risk factors. Methods: In this case-control study, 200 individuals with and 200 individuals without type 2 diabetes mellitus, aged over 40 years, were randomly selected from among participants of the Tehran Lipid and Glucose Study. The questionnaire on household food security proposed by the United States Department of Agriculture was completed for them by trained personnel. Logistic regression was used to determine the variable that had the most significant relationship with food security status. Results: The average of food security score was 2.38 ± 2.0 in non-diabetic and 2.25 ± 2.0 in diabetic individuals (P = 0.6). In both groups, the risk for food insecurity in women was more than in men. In the diabetic group, being single and having education levels below high school increased the risk of food insecurity. In the non-diabetic group, the risk of food insecurity in obese individuals was 3.3 times higher than normal individuals (odds ratio = 2.1, 95% confidence interval: 1.2-4.1). Conclusions: There were no significant differences in food security levels of diabetic and non-diabetic groups. However, some risk factors of type 2 diabetes including sex, marital status, educational level, and obesity were associated with food insecurity.

Background: This study was designed to examine the effects of purslane seeds on biomarkers of oxidative stress in type 2 diabetic patients. Methods: This cross-over randomized controlled clinical trial was conducted on 40 patients with type 2 diabetes. Participants were randomly assigned to receive either 10 g/day purslane seeds with 240 cc low-fat yogurt (intervention group) or only 240 cc low-fat yogurt (as a control group) for 5 weeks. After a 2-week washout period, subjects were moved to the alternate arm for an additional 5 weeks. At baseline and end of each study phase, fasting blood samples were collected to quantify biomarkers of oxidative stress. Results: We observed a slight decrease in plasma total antioxidant capacity in both groups, however, between-group changes were not significant (−2.67 vs. −2.95 μg/dL, P = 0.94). Plasma malondialdehyde in purslane group increased slightly, however, we observed no significant effect in the control group (1.62 vs. −0.47 μg/dL, P = 0.58). Although both groups had a slight reduction in plasma oxidized low-density lipoprotein (ox-LDL), we failed to find any significant effect of purslane on plasma ox-LDL (−1.06 vs. −1.71 μg/dL, P = 0.85). Conclusions: This cross-over clinical trial revealed that consumption of purslane seeds for 5 weeks in type 2 diabetic patients did not result in improved oxidative stress.

Background: Prognostic tools are widely used in the practice of Oncology and have been developed to help stratify patients into specific risk-related grouping. We sought to apply of two such tools used for patients with early-stage breast cancer and to correlate them with actual outcomes. Methods: A retrospective study was designed to include early-stage breast cancer cases seen from 1994 to 2014 at the Seyedoshohada Hospital in Isfahan, Iran. Information was derived from the patients' records, and indices were derived from prognostic tools. Information was analyzed using descriptive statistics and one sample t-test. Results: In 233 patients, the difference between the predicted overall survival (OS) by the Adjuvant Online (AO) prognosis tools (69.28) and the observed OS (71.2) was not statistically significant (P = 0.52), and the AO prognosis tools had predicted the patients' OS correctly. In the Nottingham prognosis index (NPI), this difference in all groups except the very poor prognosis group was not statistically significant. Conclusions: Adjuvant Online prognosis tools were capable of predicting the 10-year OS rate although not in all of the subgroups. The NPI was capable of distinguishing good, moderate, and poor survival rates, but this ability was not visible in more specific groups with moderate and poor prognosis.

Background: Nicotine is a major pharmacologically active substance in cigarette smoke. It is mainly metabolized in liver and causes devastating effects. Crocin is the chemical ingredient primarily responsible for the color of saffron. It has different pharmacological effects such as antioxidant and anticancer. This study was designed to evaluate the protective role of crocin against nicotine on the liver of mice. Methods: Forty-eight mice were equally divided into 8 groups; control (normal saline), nicotine (2.5 mg/kg), crocin (12.5, 25 and 50 mg/kg) and crocin plus nicotine treated groups. Saline, crocin, nicotine and crocin/nicotine (once a day) were intraperitoneally injected for 4 weeks. The liver weight and histology, aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), and serum nitric oxide levels have been studied. Results: The results indicated that nicotine administration significantly decreased liver weight (48.37%) and increased the mean diameter of hepatocyte (239%), central hepatic vein (28.45%), liver enzymes level (ALP 29.43%, AST 21.81%, ALT 21.55%), and blood serum nitric oxide level (57.18%) compared to saline group (P < 0.05). However, crocin and crocin plus nicotine administration significantly boosted liver weight (49.54%) and decreased the mean diameter of hepatocyte (40.48%), central hepatic vein (15.44%), liver enzymes (ALP 22.02%, AST 19.05%, ALT 23.11%), and nitric oxide levels (35.80%) in all groups compared to nicotine group (percentages represent the maximum dose) (P < 0.05). Conclusions: Crocin showed its partly protective effect against nicotine-induced liver toxicity.

Background: Regarding cases of infectious diseases tuberculosis (TB) is the most important cause of death and according to the DALY criteria, this disease has the seventh position in global disease ranking. In this study, we aim to determine the risk factors, which have a significant effect on the treatment completion and mortality of TB patients. Methods: This study is a retrospective cohort study. The sample is made up of registered TB patients in the Isfahan Province from 2006 to 2011. Information of the patients was collected from their files in health centers in the Isfahan Province. Variables such as age, sex, weight, nationality, residence, type of TB, imprisonment, human immunodeficiency virus, TB case were measured. Descriptive statistics (including frequency, percentage, mean and standard deviation) and statistical analysis (including Cox proportional hazard model) were used. Results: The result showed that imprisonment (hazard ratio [HR] = 4.76, P = 0.019), age (HR = 4.44, P = 0.001) and the TB case (HR = 2.73, P = 0.037) of pulmonary TB had significant impacts on mortality of the patients, also in the case of treatment completion, the TB case (HR = 0.34, P < 0.001) proved to have a significant impact on completion of the treatment. Type of extra-pulmonary TB in extra-pulmonary TB patients also had an effect on treatment completion. Conclusions: We can conclude that factors such as age, imprisonment, TB case and type of extra-pulmonary TB are effective on the treatment completion and mortality of the patients. It may be useful for policy makers to make more control of high-risk patients.

Background: Adolescents who suffer from depression early in life, have an increase in suicidal tendency, anxiety, conduct disorders, substance abuse, and continue to be depressed, later on in life. This study was conducted to identify the prevalence and correlates of depression among adolescent girls in Riyadh city in order to carry out early intervention. Methods: A cross-sectional, school-based survey was conducted among 1028 adolescent girls aged 15-19 years in secondary schools of Riyadh city. Riyadh was divided into clusters and within each cluster, both public and private schools were enrolled. From the selected schools students from grade 10-12 were surveyed. Survey was conducted using a structured questionnaire including the beck depression inventory-II, and questions exploring the correlates of depression. Results: About 30% of participants were found to be depressed. Depression was more prevalent among female adolescents whose household income was <12,000 Saudi Riyal/month (odds ratio [OR] 2.17, confidence interval [CI] 0.97-6.84), did not have a good relationship with peers and family members (OR 4.63, CI 2.56-8.41), lived with single parent or alone (OR 1.77, CI 0.97-3.23), been emotionally abused (OR 3.45, CI 2.56-8.41), and those who had been subjected to physical violence, at least once (OR 3.34, CI 1.89-5.91). Conclusions: Strategies need to be developed to identify early signs and symptoms of depression among Saudi female adolescents. Training can be given to groups of students to help their peers, and also to the teachers to identify, and help students identify early signs of depression and provide them with better-coping strategies to combat progression of depression and anxiety among such adolescents.

Background: Hepatitis C virus (HCV) is the leading cause of transfusion transmitted infections (TTIs) among patients with b-thalassemia major. A high prevalence of HCV was reported among these patients. The aim of this study is seeking the trend of the prevalence of HCV infection among the patients with b-thalassemia major in Guilan province, Northern Iran over a 10-year period. Methods: A retrospective study was conducted on 1113 patients with b-thalassemia major in the Guilan province, northern Iran from 2002 to 2012, using multiple data sources. A blood sample was taken from each patient, and a questionnaire regarding demographic data and risk factors was completed for them. Enzyme-linked immunosorbent assay and recombinant immunoblot assay for HCV were performed in all cases. A stepwise forward logistic regression analysis was done. Results: The prevalence of hepatitis C infection among b-thalassemia major patients was 13.6%. The risk of hepatitis C among b-thalassemia major patients was greater before screening program for HCV (odds ratio = 9.6, 95% confidence interval: 2.3-40.5). In addition, the prevalence of anti-HCV seropositivity was decreased dramatically among patients who have received transfusions after implementation of blood donor screening for HCV. There were no positive HCV cases in the patients younger than 10 years. Conclusions: The risk of TTIs including HCV can be reduced by implementing screening program for healthy blood.

Background: Low vitamin D and diminished bone minerals with the potential for fractures are one of the nonapparent late effects of acute lymphoblastic leukemia (ALL). Chemotherapy and radiation were known as two important risk factors. We evaluated these late effects in ALL survivors who were treated with chemotherapy or chemo plus cranial radiation therapy. Methods: In a case-control study, 33 of ALL survivors who were treated with chemotherapy (Group A), and 33 subjects who were treated with chemoplus cranial radiation (Group B) were compared against 33 matched age, sex, and pubertal stage of their healthy siblings (Group C). Standard anthropometric data were collected as well as Tanner staging for puberty, number of fractures since treatment, serum calcium (Ca), phosphorus (P), magnesium (Mg), alkaline phosphatase, parathyroid hormone, and 25-hydroxyvitamin D (25(OH) D). The independent t-test, one-way ANOVA, Chi-square test, and Tukey's test were used to analyze the data. Results: The findings indicated that the mean serum levels of 25(OH) D in ALL survivors (i.e. Groups A and B) with age mean score of 11.2 years and 12.3 years, average treatment length: 3.25 years and average time after treatment completion: 4 years, was lower compared to the controls group (12.94 ± 6.69, 14.6 ± 8.1, 20.16 ± 10.83, respectively, P < 0.001) but no significant difference was observed between Group A and B in this regard (P > 0.05). Other clinical and laboratory parameters had no significant differences between the survivors and control. Vitamin D deficiency (<20 ng/ml) was observed in 27% of group A and 24% of group B and vitamin D insufficiency (20-30 ng/ml) in 72.7% and 69.6% survivors of Group A and B and 48.5% of controls group (P = 0.003). Conclusions: ALL treatment is associated with the increase in prevalence of vitamin D insufficiency in the childhood ALL survivors and since the low vitamin D level potentially increases the risk of low bone density, subsequent malignancies, and cardiovascular disease in the survivors, close follow-up of such patients are highly recommended to prevent the stated complications.

Background: Health consequences of food insecurity among infants and toddlers have not been fully examined. The purpose of this study was to assess the relationship between household food insecurity, mother's infant feeding practices and iron status of 6-24 months children. Methods: In this cross-sectional study, 423 mother-child pairs were randomly selected by multistage sampling method. Children blood samples were analyzed for hemoglobin and serum ferritin concentrations. Household food security was evaluated using a validated Household Food Insecurity Access Scale. The mother's feeding practices were evaluated using Infant and Young Child Feeding practice variables including: The duration of breastfeeding and the time of introducing of complementary feeding. Results: Based on the results, of the studied households only 47.7% were food secure. Mild and moderate-severe household food insecurity was 39.5% and 12.8%, respectively. Anemia, iron deficiency (ID), and iron deficiency anemia were seen in 29.1%, 12.2%, and 4.8% of children, respectively. There was no significant association between household food insecurity; mother's feeding practices and child ID with or without anemia. Conclusions: We found no association between household food insecurity and the occurrence of anemia in the 6-24 months children. However, these findings do not rule out the possibility of other micronutrient deficiencies among the food-insecure household children.

Background: This study explored cross-country differences in how multi-morbidity explains the effects of socioeconomic characteristics on self-rated health. Methods: The study borrowed data from the Research on Early Life and Aging Trends and Effects. Participants were 44,530 individuals (age > 65 years) who were sampled from 15 countries (i.e. United States, China, India, Russia, Costa Rica, Puerto Rico, Mexico, Argentina, Barbados, Brazil, Chile, Cuba, Uruguay, Ghana and South Africa). Multi-morbidity was measured as number of chronic medical conditions. In Model I, main effects of socioeconomic factors on self-rated health were calculated using country-specific logistic regressions. In Model II, number of chronic conditions were also added to the models to find changes in coefficients for demographic and socioeconomic factors. Results: In the United States, number of chronic medical conditions explained the effect of income on subjective health. In Puerto Rico, number of chronic medical conditions explained the effect of marital status on subjective health. In Costa Rica, Argentina, Barbados, Cuba, and Uruguay, number of chronic medical conditions explained gender disparities in subjective health. In China, Mexico, Brazil, Russia, Chile, India, Ghana and South Africa, number of chronic medical conditions did not explain the effect of demographic or socioeconomic factors on subjective health. Conclusions: Multi-morbidity explains the effect of demographic and socioeconomic factors on subjective health in some but not other countries. Further research is needed.

Background: The aim of the current study was to determine effects of probiotic yoghurt and multispecies probiotic capsule supplementation on biomarkers of oxidative stress and inflammatory factors in petrochemical workers. Methods: This randomized, double-blind, placebo-controlled trial was done among petrochemical workers. Subjects were randomly divided into three groups to receive 100 g/day probiotic yogurt (n = 12) or one probiotic capsule daily (n = 13) or 100 g/day conventional yogurt (n = 10) for 6 weeks. The probiotic yoghurt was containing two strains of Lactobacillus acidophilus and Bifidobacterium lactis with a total of min 1 Χ 10 ⁷ CFU. Multispecies probiotic capsule contains seven probiotic bacteria spices Actobacillus casei 3 Χ 10 ³ , L. acidophilus 3 Χ 10 ⁷ , Lactobacillus rhamnosus 7 Χ 10 ⁹ , Lactobacillus bulgaricus 5 Χ 10 ⁸ , Bifidobacterium breve 2 Χ 10 ¹⁰ , Bifidobacterium longum 1 Χ 10 ⁹ and Streptococcus thermophilus 3 Χ 10 ⁸ CFU/g. Fasting blood samples were obtained at the beginning and end of the trial to quantify biomarkers of oxidative stress and inflammatory factors. Results: Although a significant within-group decrease in plasma protein carbonyl levels was seen in the probiotic capsule group (326.0 ± 308.9 vs. 251.0 ± 176.3 ng/mL, P = 0.02), the changes were similar among the three groups. In addition, significant within-group decreases in plasma iso prostaglandin were observed in the probiotic supplements group (111.9 ± 85.4 vs. 88.0 ± 71.0 pg/mL, P = 0.003) and in the probiotic yogurt group (116.3 ± 93.0 vs. 92.0 ± 66.0 pg/mL, P = 0.02), nevertheless there were no significant change among the three groups. Conclusions: Taken together, consumption of probiotic yogurt or multispecies probiotic capsule had beneficial effects on biomarkers of oxidative stress in petrochemical workers.

Background: Health systems play key roles in identifying tobacco users and providing evidence-based care to help them quit. This treatment includes different methods such as simple medical consultation, medication, and telephone counseling. To assess different quit smoking methods selected by patients in tobacco cessation centers in Iran in order to identify those that are most appropriate for the country health system. Methods: In this cross-sectional and descriptive study, a random sample of all quit centers at the country level was used to obtain a representative sample. Patients completed the self-administered questionnaire which contained 10 questions regarding the quality, cost, effect, side effects and the results of quitting methods using a 5-point Likert-type scale. Percentages, frequencies, mean, T-test, and variance analyses were computed for all study variables. Results: A total of 1063 smokers returned completed survey questionnaires. The most frequently used methods were Nicotine Replacement Therapy (NRT) and combination therapy (NRT and Counseling) with 228 and 163 individuals reporting these respectively. The least used methods were hypnotism (n = 8) and the quit and win (n = 17). The methods which gained the maximum scores were respectively the combined method, personal and Champix with means of 21.4, 20.4 and 18.4. The minimum scores were for e-cigarettes, hypnotism and education with means of 12.8, 11 and 10.8, respectively. There were significant differences in mean scores based on different cities and different methods. Conclusions: According to smokers' selection the combined therapy, personal methods and Champix are the most effective methods for quit smoking and these methods could be much more considered in the country health system.

Background: In Iranian women, the use of hookah is the most common method of tobacco smoking. This study aimed to find the role of psycho-social needs and gaps as a possible risk factor for hookah smoking initiation in women. Methods: This qualitative study was conducted during 2012-2013 in Tehran, Iran. Thirty-six women participated in the study. They were current or former users of hookah. Data were collected through in-depth individual interviews and was analyzed through content analysis. Results: Four main categories were identified from the data. This study focused on the category: Psycho-social needs and gaps. This category has five sub-categories which explain why women begin to smoke hookah including curiosity; desire for non-feminine, forbidden, and negative activities; need for amusement and recreation; for others: To show off; attract attention; satisfy and join others and protection. Conclusions: From this study, a variety of factors which contribute to the initiation of hookah smoking among women have been identified. Keeping young girls and women away from seemingly happy gatherings of hookah smokers; Providing appropriate recreational facilities for young women and training families on how to help their children in the event of a crisis-like intention to take up smoking behavior, can be some effective ways for reducing hookah smoking initiation among women.

Background: The incidence of heat stress is one of the most common problems in workplaces and industries. Many heat stress indices have been developed, and these indices have some disadvantages. The purpose of this study is to validate the perceptual strain index (PeSI) in experimental hot conditions. Methods: This study is of cross-sectional carried out on 15 men at five different thermal conditions (35°C, 30°C, 27°C, 24°C, and 21°C) in a climate chamber and on a treadmill at three levels of light (2.4 kph), medium (4.8 kph) and heavy activity (6.3 kph). Heart rate and oral temperature were respectively measured to calculate the physiological strain index. Also, thermal sensation and rate perceive exertion were respectively measured to calculate the PeSI. Finally, the correlation between the indices was analyzed using Pearson correlation test and regression analysis. Results: Pearson correlation test showed a high correlation (r = 0.94) between the PeSI and physiological strain index (P = 0/001). It was also observed a high correlation between the PeSI and the oral temperature (r = 0.78, P = 0/001) and the heart rate (r = 0.90, P = 0/001). In addition, there was found a moderate correlation (r = 0.71) between the PeSI and the wet bulb glob temperature (P = 0/001). However, there was no correlation between the PeSI and the body mass index (r = 0.0009, P = 0.79). Conclusions: The research findings showed when there is no access to other forms of methods to evaluate the heat stress, it can be used the PeSI in evaluating the strain because of its favorable correlation with the thermal strain.

Background: This paper presents the methodology and primary findings of a national project on determinants of weight disorders among Iranian children and adolescents at national and sub-national levels. Methods: This nationwide study was conducted in 2011-2012 in Iran as part of the fourth phase of a national surveillance program entitled Childhood and Adolescence Surveillance and PreventIon of Adult Noncommunicable disease-IV study. It had two phases of qualitative and quantitative study. This multicentric study was conducted among 25,000 students aged 6-18 years, living in urban and rural areas of 30 provinces of Iran. Students were selected by multistage cluster sampling method. Data regarding weight disorders including sociodemographic variables, perinatal factors, lifestyle factors, family and student dietary habits, quality of life, and family history of chronic diseases as well as body image were gathered via validated questionnaires. Results: Overall, 23043 students completed the survey (participation rate: 92.17%). The mean age of participants was 12.55 ± 3.31 years; 50.8% were boys, and 73.4% were from urban areas. Underweight was found in 10.4% of boys and 9.2% of girls, the corresponding figure for overweight and obesity was 21% and 18.3%. Abdominal obesity was found in 17.6% of students. Among parents, obesity was more frequent than other weight disorders, with higher prevalence in parents of girls than boys (24.5% vs. 21.5%, respectively, P < 0.001). Overweight and obesity were more prevalent in urban than in rural parents (66.7% vs. 59.7%, respectively, P < 0.001). Conclusions: This survey serves as confirmatory evidence on the prevalence of dual burden of weight disorders in Iran. Its findings on determinants of weight disorders would help policymakers to implement relevant programs at national and sub-national levels.

Background: Thyroid absorption of iodine could be encumbered by nitrate drinking water when it is transported to the fetal thyroid gland. Therefore, nitrate potentially causes congenital hypothyroidism (CH) due to thyroid dysfunction. In this study, we have not only aimed at spatial determination of CH distribution and nitrate concentration (NC) existing in drinking water, but also we intended to evaluate the probable impact of nitrate on CH incidence. Methods: Annual average of nitrate in drinking-water as well as number of CH infants diagnosed through the screening program were applied to determine the incidence ratio of the disease for each town (from 2010 to 2013). Afterward, Arc GIS 9.3 was used to draw choropleth maps with quantile classification. Data were entered into SPSS 16.0 and Excel 2010 software. Finally, linear regression was applied for data analysis. Results: The incidence rate of CH (considering transient and permanent cases) was about one in every 413 births. Khansar, Golpaygan, Naein, and Ardestan had the highest incidence rate of CH respectively. On the other hand, Tiran, Dehaghan, Khansar, and Fereydan had the highest level of nitrate drinking water. There was a strong relationship between the NC and incidence of CH in Khansar; however, this relationship was not significant (P = 0.392) in Isfahan province. Conclusions: Since there was not a significant relationship between NC in drinking-water and incidence of CH through linear regression analysis, more studies should be implemented to confirm or refute our observations.

Background: One of the core responsibilities of health system is to treat tobacco dependence. This treatment includes different methods such as simple medical consultation, medication, and telephone counseling. To assess physicians' opinions towards quality and result of different quit smoking methods provided in tobacco cessation services centers in Iran. Methods: In this cross-sectional and descriptive study, random sampling of all quit centers at country level was used to obtain a representative sample size of 100 physicians. Physicians completed a self-administered questionnaire which contained 10 questions regarding the quality, cost, effect, side effects, and the results of quitting methods using a 5-point Likert-type scale. Percentages, frequencies, mean, T-test, and variance analyses were computed for all study variables. Results: Most experts preferred to use combination quit smoking methods and then Nicotine Replacement Therapy (NRT) with 26 and 23, respectively. The least used methods were quit line and some methods without medication with 3 cases. The method which gained the maximum scores were telephone consultation, acupuncture, Willpower, Champix, combined method, and Interactive Voice Response (IVR) with the mean of 23.3, 23, 22.5, 22, 21.7 and 21.3, respectively. The minimum scores were related to e-cigarette, some methods without medication, and non-NRT medication with the mean of 12.3, 15.8 and 16.2, respectively. There were no significant differences in the mean of scores based on different cities (P = 0.256). Analysis of variance in mean scores showed significant differences in the means scores of different methods (P < 0.000). Conclusions: According to physicians acupuncture, personal methods and Champix are the most effective methods and these methods could be much more feasible and cost effective than other methods.

Background: The present investigation was aimed to improve the inflammatory factors and lipoproteins concentration in patients with myocardial infarction (MI) by supplementation with coenzyme Q10 (CoQ10). Methods: In a double-blind, placebo-controlled study, we measured serum concentrations of one soluble cell adhesion molecules (intercellular adhesion molecule-1 [ICAM-1]), serum concentration of intereukin-6 (IL-6) and lipid profiles (high-density lipoprotein-cholesterol [HDL-C], low-density lipoprotein-cholesterol [LDL-C], total cholesterol and triglyceride [TG]) in CoQ10 supplementation group (n = 26) compared with placebo group (n = 26) in hyperlipidemic patients with MI. Fifty-two patients were randomized to receive 200 mg/day of CoQ10 or placebo for 12 weeks. Results: There were no significant differences for serum LDL-C, total cholesterol, and TG between two mentioned groups after the intervention. A significant enhancement in serum HDL-C level was observed between groups after the intervention (55.46 ± 6.87 and 44.07 ± 6.99 mg/dl in CoQ10 and placebo groups, respectively P < 0.001). Concentrations of ICAM-1 (415.03 ± 96.89 and 453.38 ± 0.7 ng/dl CoQ10 and placebo groups, respectively, P = 0.001) and IL-6 (11 ± 9.57 and 12.55 ± 8.76 pg/ml CoQ10 and placebo groups, respectively P = 0.001) in serum were significantly decreased in CoQ10 group. Conclusions: Supplementation with CoQ10 in hyperlipidemic patients with MI that have statin therapy has beneficial effects on their aspects of health.

Background: Under nutrition is a health problem in developing countries and the main aim of this study was determine of the nutritional status and some sociodemographic factors among rural under-5-year children in the North of Iran in 2013. Methods: This was a descriptive, cross-sectional study, which carried out on 2530 children (637 = Fars-native, 1002 = Turkman and 891 = Sistani) from 21 villages in the North of Iran. Villages were chosen by random sampling among 118, and all of under-five children were chosen by simple sampling. For all of cases, a questionnaire with contain questions on the socialdemographic condition was completed and anthropometric indexes were measured by a learned team. Anthropometric data were compared with those in Centers for Disease Control and Prevention reference population. SPSS 18.0 software was used for statistical data analysis and P value under 0.05 included significations. Results: Generally, under nutrition (Z-score ≤ −2) was observed in 6.6%, 18.5% and 3.3% based on underweight, stunting and wasting, respectively and there were in boys more than girls and in Sistani more than other ethnic groups. Based on underweight and stunting, under nutrition was seen in Sistani more than other ethnic groups. Among three ethnic groups, stunting was significant both in boys (P = 0.013) and in girls (P = 0.004), but wasting was significant only in girls (P = 0.001). The estimated odds ratio (OR) with 95% confidence interval of under nutrition was obtained from logistic regression. Compared with good economic group, the OR was 1.831 in poor economic groups (P = 0.001). The risk of under nutrition in Sistanish ethnic group was 1.754 times more than Fars-native group (P = 0.001). Conclusions: Under nutrition is a health problem among under-5-year children in rural area in the North of Iran and stunting was seen in an alarming rate among them. Among ethnic groups, Sistanish children more than others were under nourished. Poor economic status is a risk factor for under nutrition in this area.

Background: The most reliable indicator of Vitamin D status is circulating concentration of 25-hydroxycalciferol (25(OH) D) routinely determined by enzyme-immunoassays (EIA) methods. This study was performed to compare commonly used competitive protein-binding assays (CPBA)-based EIA with the gold standard, high-pressure liquid chromatography (HPLC). Methods: Concentrations of 25(OH) D in sera from 257 randomly selected school children aged 9-11 years were determined by two methods of CPBA and HPLC. Results: Mean 25(OH) D concentration was 22 ± 18.8 and 21.9 ± 15.6 nmol/L by CPBA and HPLC, respectively. However, mean 25(OH) D concentrations of the two methods became different after excluding undetectable samples (25.1 ± 18.9 vs. 29 ± 14.5 nmol/L, respectively; P = 0.04). Based on predefined Vitamin D deficiency as 25(OH) D < 12.5 nmol/L, CPBA sensitivity and specificity were 44.2% and 60.6%, respectively, compared to HPLC. In receiver operating characteristic curve analysis, the best cut-offs for CPBA was 5.8 nmol/L, which gave 82% sensitivity, but specificity was 17%. Conclusions: Though CPBA may be used as a screening tool, more reliable methods are needed for diagnostic purposes.

Background: Although the frequency of self-medication has been well-documented in the public health literature, but no study has examined the relationship between health literacy and self-medication yet. This study was aimed to investigating the relationship between health literacy and self-medication in a community-based study. Methods: This cross-sectional study was conducted on 924 adults to survey association between health literacy and self-medication among peoples in Ardabil city in 2014 who were selected using a multi-stage random sampling method. Health literacy was measured by the test of functional health literacy in adults and general health status was measured by the 12-item General Health Questionnaire, and self-reported self-medication (overall, sedative, antibiotic and herbal) in last 3 months was assessed. All statistical analysis was performed using the SPSS version 18 and a P < 0.05 was considered significant. Results: The mean age and weight of respondents were 37 years and 74.7 kg, respectively. The prevalence of self-medication was 61.6%, and the percentage of self-administering antibiotics, sedative, and herbal medicines were 40%, 54.4%, and 59.1% in the last 3 months, respectively. Significant relationship was found between of total health literacy and general health status with self-medication. The prevalence of self-medication among participants with poor and very poor self-rated physical and mental health was significantly higher than other participants (P < 0.001). Conclusions: Self-medication had a significant relationship with health literacy and health status. Therefore, the design and implementation of training programs are necessary to increase the perception on the risk of self-medication.

Background: Vitamins A and E deficiency is prevalent in developing countries, and plasma levels are low in pregnancy. This study was undertaken to determine the serum Vitamins A and E status among pregnant women attending antenatal care at a General Hospital in Dawakin Kudu, Kano and to provide the necessary information needed to suggest the supplementation of Vitamins A and E during pregnancy. Methods: The study was done in General Hospital Dawakin Kudu Local Government Area. Dawakin Kudu, a rural community in Kano State is about 12 km from Kano metropolis which is the most populous city in Nigeria and commercial nerve center of Northern Nigeria. Most of the women are housewives, however, some engage in subsistent farming and petty trading. This was a prospective study of 200 pregnant women at various maternal ages, gestational ages, and parities. Informed consent was obtained from the participants. Research structured questionnaire was administered to 200 respondents which showed age and parity distributions. Determination of Serum Vitamins A and E was done using methods of Bessey, et al. and Tsen. Ethical approval for the research was obtained from General Hospital, Dawakin Kudu, Kano. Statistical Analysis Used: Data obtained were analyzed using SPSS version 17 statistical software (SPSS Inc., IL, Chicago, USA). Descriptive statistics was done. Mean serum Vitamins A and E concentration between trimesters were compared using two-way ANOVA and P < 0.05 was considered statistically significant. Results: Majority of the women were aged 20-39 years with mean of 23.67 ± 6.11. Most were in the 1-4 parity range. Mean birth weight was 2.42 ± 0.74 kg. Above 65% were deficient while 34.5% had normal levels of Vitamin A and 51% were deficient of serum Vitamin E. Serum Vitamins A and E levels showed a marked reduction from first through third trimester. The differences were statistically significant (P < 0.05). Conclusions: There is a significant reduction in the serum Vitamins A and E concentration throughout the period of pregnancy with the highest levels in the first trimester. Therefore, further studies should evaluate the value of Vitamins A and E supplementation during pregnancy especially for those whose fruit and vegetable consumption is inadequate.

Background: One of the most common cancers is skin cancer worldwide. Since incidence and cost of treatment of the cancer are increasing, it is necessary to further investigate to prevent and control this disease. This study aimed to determine skin cancer trend and epidemiology in Iran. Methods: This study was done based on existing data. Data used in this study were obtained from a national registry of cancer cases and the Disease Management Center of Ministry of Health in Iran. All cases registered in the country were included during 2004-2008. Incidence rates were reported based on the direct method and standard population of World Health Organization. Results: Based on the results of this study, the incidence of skin cancer is rising in Iran and the sex ratio was more in men than women in all provinces. The age-standardized incidence rate (ASR) of skin cancer was highest in males in Semnan, Isfahan, and Hamedan provinces (34.9, 30.80, and 28.84, respectively). The highest ASRs were seen in females in Semnan, Yazd, and Isfahan provinces (26.7, 24.14, and 18.97, respectively). The lowest ASR in male was observed in Sistan and Baluchestan, and in female in Hormozgan provinces. Conclusions: The incidence of skin cancer is increasing in the country. Therefore, the plan for the control and prevention of this cancer must be a high priority for health policy makers.

Background: Cetuximab is a monoclonal antibody which acts against the epidermal growth-factor receptor. Randomized controlled trials show that the addition of cetuximab to folinic acid, 5-flourouracil, irinotecan (FOLFIRI), folinic acid, 5-flourouracil, oxaliplatin (FOLFOX) and capecitabin + oxaliplatin (CAPOX) regimens, as the first-line treatment for metastatic colorectal cancer (CRC), increases the overall survival (OS) and progression-free survival (PFS) compared to FOLFIRI, FOLFOX and CAPOX regimens alone. The aim of this study was to analyze the cost-effectiveness of different treatment programs for managing metastatic CRC with and without cetuximab in the first-line treatment of unresectable metastatic CRC in Iran. Methods: A systematic search of the literature was performed in PubMed, Centre for Reviews and Dissemination Databases and Cochrane Library to assess the effectiveness of the drug in the context of PFS, OS and the adverse events. The incremental cost-effectiveness ratio of each treatment program was calculated. An extensive sensitivity analysis was conducted on the results regarding the effectiveness. Results: The addition of cetuximab to FOLFIRI, FOLFOX and CAPOX programs increased PFS by 0.1, 0.042 and 0.042 years, respectively. Similarly, the addition of cetuximab to FOLFIRI, FOLFOX and CAPOX increased OS by 0.325, 0.442 and 0.442 years and also cost $212825, $202484 and $204198 individually. Whereas, based on the World Health Organisation (WHO) suggested threshold for cost-effectiveness analysis, even FOLFOX + cetuximab was very higher than the threshold in Iran (37.4 times higher). Conclusions: The FOLFOX regimen + cetuximab provides lower costs per additional life years gained (more cost-effective) compared with its alternatives in the treatment of patients with unresectable metastatic CRC. However, according to the WHO indicator, none of the cetuximab regimens could be considered as cost effective for the Iranian health care market.

Background: The objective of this study was to determine the favorable effects of multi mineral-Vitamin D supplementation on pregnancy outcomes among women at risk for pre-eclampsia. Methods: This randomized double-blind controlled clinical trial was conducted among 46 women at risk for pre-eclampsia at 27 weeks' gestation with positive roll-over test. Pregnant women were randomly assigned to receive either the multi mineral-Vitamin D supplements (n = 23) or the placebo (n = 23) for 9-week. Multi mineral-Vitamin D supplements were containing 800 mg calcium, 200 mg magnesium, 8 mg zinc, and 400 IU Vitamin D3. Fasting blood samples were taken at baseline and after 9-week intervention to measure related factors. Newborn's outcomes were determined. Results: Although no significant difference was seen in newborn's weight and head circumference between the two groups, mean newborns' length (51.3 ΁ 1.7 vs. 50.3 ΁ 1.2 cm, P = 0.03) was significantly higher in multi mineral-Vitamin D group than that in the placebo group. Compared to the placebo, consumption of multi mineral-Vitamin D supplements resulted in increased levels of serum calcium (+0.19 vs. −0.08 mg/dL, P = 0.03), magnesium (+0.15 vs. −0.08 mg/dL, P = 0.03), zinc (+8.25 vs. −21.38 mg/dL, P = 0.001) and Vitamin D (+3.79 vs. −1.37 ng/ml, P = 0.01). In addition, taking multi mineral-Vitamin D supplements favorably influenced systolic blood pressure (SBP) (−1.08 vs. 6.08 mmHg, P = 0.001) and diastolic blood pressure (DBP) (−0.44 vs. 3.05 mmHg, P = 0.02). Conclusions: Multi mineral-Vitamin D supplementation for 9-week in pregnant women at risk for pre-eclampsia resulted in increased newborn's length, increased circulating levels of maternal serum calcium, magnesium, zinc and Vitamin D, and led to decreased maternal SBP and DBP.

Background: The prevalence of hypertension is on the increase in Nigeria. Prehypertension is considered a precursor of hypertension and a predictor of excessive cardiovascular risk. Identifying individuals with prehypertension and initiating effective measures will aid in reducing the incidence and prevalence of hypertension in our environment. The aim of this study was to quantify the magnitude of prehypertension and determine its associations among adults in a representative semi-urban Nigerian population. Methods: A cross-sectional study which was carried out in a semi-urban setting in Southeast Nigeria. Blood pressure (BP) was measured using the standard methods. A cardiovascular risk factor screening based on physical characteristics, individual medical, and family history of participants was done. Results: There were a total of 389 participants comprising 223 (57.3%) males and 116 (42.7%) females; male:female ratio been 1.9:1. The prevalence of prehypertension and hypertension were 45.5% and 37.8%, respectively. Males were significantly more likely to have prehypertension than females (61% vs. 39% respectively; OR = 1.32, P = 0.03). There was a weak positive significant correlation between age and both systolic (r = 0.16, P < 0.01) and diastolic (r = 0.12, P = 0.02) blood pressures. Up to 72.6% of individuals with prehypertension have abnormal body mass index (BMI). While up to 8.5% of the participants had a family history of cardiovascular disease, 20.3%, and 17.3% had a history of significant intake of alcohol and smoking, respectively. Conclusions: The prevalence of prehypertension in the community was high. It was associated with increasing age, male gender, and increasing BMI. Interventions at this stage may aid in stemming the rising prevalence of hypertension in our environment.

Background: The aim was to assess the validity and reliability of the Persian version of shortened disabilities of the arm, shoulder, and hand (Quick-DASH) questionnaire in patients with upper extremity conditions. Methods: We administered the Persian version of Quick-DASH to 202 patients with upper extremity conditions, of which 71 patients randomly returned after 3 days to respond to the questionnaire for the 2 ^nd time. In order to test the construct validity of the questionnaire, patients responded to the Michigan Hand Outcome Questionnaire (MHOQ) and Short Form 36 Health Survey (SF-36) as well. Internal consistency was tested using the Cronbach's alpha, and test-retest reliability was measured using intra-class correlation coefficient (ICC). Results: Cronbach's alpha was 0.90. ICC was 0.89. Convergent validity was confirmed, as the Spearman correlation between the Quick-DASH and MHOQ was 0.67 and ranged from 0.24 to 0.56 between the subscales of the SF-36 and Quick-DASH. Conclusions: Observation of excellent internal consistency, good to excellent test-retest reliability, and moderate to strong construct validity confirms the validity and reliability of the Persian version of Quick-DASH for evaluating the magnitude and level of disability in upper extremity conditions.

Background: Cisplatin (CP) is a chemotherapy drug and nephrotoxicity is a major concern for CP therapy. CP-induced nephrotoxicity is gender-dependent, and the effect of aerobic exercise in females has not been reported yet while it has a beneficial effect in males. Hence, this study was designed to determine the protective role of aerobic exercise against CP-induced nephrotoxicity in female rats. Methods: Twenty-eight adult female rats were divided into four groups. Groups I and II had aerobic exercise on a treadmill for 8 weeks. Then, the exercise protocol was continued for another week in group I and stopped in group II. All animals in these groups received CP (2.5 mg/kg/day; i.p.) for 1-week. Groups III and IV were treated with CP and vehicle, respectively, without exercise. Finally, the animals were sacrificed for biochemical measurements and tissue histopathology investigations. Results: CP alone without exercise increased serum levels of blood urea nitrogen (BUN) and creatinine (Cr), kidney weight, and kidney tissue damage score (KTDS); while exercise could not attenuate these parameters in female rats. Exercise in females increased the serum levels of BUN and Cr and KTDS and weight loss (P < 0.05). Kidney nitrite levels reduce significantly in group I in compared to positive and negative control groups. Exercise also did not have beneficial effects on malondialdehyde levels in plasma and kidney. Conclusions: Aerobic exercise cannot reduce CP-induced nephrotoxicity in female rats. Increasing the damage in female rats may be related to female sex hormone estrogen or gender differences in renal hemodynamic and renin-angiotensin system activity in the presence of exercise. In general, it is recommended that the females under CP chemotherapy avoid exercising during treatment.

Background: Health information system (HIS) has been utilized for collecting, processing, storing, and transferring the required information for planning and decision-making at different levels of health sector to provide quality services. In this study, in order to provide high-quality HIS, primary health care (PHC) providers' perspective on current challenges and barriers were investigated. Methods: This study was carried out with a qualitative approach using semi-structured audiotaped focus group discussions (FGDs). One FGD was conducted with 13 Behvarz and health technicians as front-line workers and the other with 16 personnel including physicians, statisticians, and health professionals working in health centers of the PHC network in KUMS. The discussions were transcribed and then analyzed using the framework analysis method. Results: The identified organizational challenges were categorized into two groups: HIS structure and the current model of PHC in urban areas. Furthermore, the structural challenges were classified into HIS management structure (information systems resources, including human, supplies, and organizational rules) and information process. Conclusions: The HIS works effectively and efficiently when there are a consistency and integrity between the human, supplies, and process aspects. Hence, multifaceted interventions including strengthening the organizational culture to use the information in decisions, eliminating infrastructural obstacles, appointing qualified staff and more investment for service delivery at urban areas are the most fundamental requirements of high-quality HIS in PHC.

Background: Natural compounds including flavonoids like genistein (GE) are able to inhibit cell proliferation and induce apoptosis. GE is the main representative of these groups. GE inhibits carcinogenic tumors such as colon, stomach, lung, and pancreas tumors. The aim of the present study was to analyze the apoptotic effect of GE in the hepatocellular carcinoma (HCC) PLC/PRF5 cell line. Methods: Cells were treated with various doses of GE (1, 5, 10, 25, 50, 75, and 100 μM/L) at different times (24, 48, and 72 h) and the MTT assay was commonly used. Furthermore, cells were treated with single dose of GE (25 μM) at different times and flow cytometry was performed. Results: GE inhibited the growth of liver cancer cells significantly with a time- and dose-dependent manner. The percentage of living cells in GE treatment groups with a concentration of 25 μM at different times were 53, 48 and 47%, respectively (P < 0.001). Result of flow cytometry demonstrated that GE at a 25 μM concentration induces apoptosis significantly in a time-dependent manner. The percentage of apoptotic cells at different times were 44, 56, and 60%, respectively (P < 0.001). Conclusions: GE can significantly inhibit the growth of HCC cells and plays a significant role in apoptosis of this cell line.

Background: This study aimed to investigate the additive effects of socio-economic factors, number of psychiatric disorders, and religiosity on suicidal ideation among Blacks, based on the intersection of ethnicity and gender. Methods: With a cross-sectional design, data came from the National Survey of American Life, 2001-2003, which included 3570 African-American and 1621 Caribbean Black adults. Socio-demographics, perceived religiosity, number of lifetime psychiatric disorders and lifetime suicidal ideation were measured. Logistic regressions were fitted specific to groups based on the intersection of gender and ethnicity, while socioeconomics, number of life time psychiatric disorders, and subjective religiosity were independent variables, and lifetime serious suicidal ideation was the dependent variable. Results: Irrespective of ethnicity and gender, number of lifetime psychiatric disorders was a risk factor for lifetime suicidal ideation (odds ratio [OR] ranging from 2.4 for Caribbean Black women to 6.0 for Caribbean Black men). Only among African-American men (OR = 0.8, 95% confidence interval = 0.7-0.9), perceived religiosity had a residual protective effect against suicidal ideation above and beyond number of lifetime psychiatric disorders. The direction of the effect of education on suicidal ideating also varied based on the group. Conclusions: Residual protective effect of subjective religiosity in the presence of psychiatric disorders on suicidal ideation among Blacks depends on ethnicity and gender. African-American men with multiple psychiatric disorders and low religiosity are at very high risk for suicidal ideation.

Background: Methylphenidate (MPH) is a neural stimulant agent, which its neurochemical and behavioral effect remain unclear. Venlafaxine is a serotonin-norepinephrine reuptake inhibitor antidepressant, which was used for management of depression and anxiety. In this study, protective effects of venlafaxine on MPH induced anxiety, depression and cognition impairment were investigated. Methods: Forty-eight adult male rats were divided randomly to 5 groups. Group 1, received normal saline (0.2 ml/rat) for 21 days and served as control group. Group 2, received MPH (10 mg/kg) for 21 days. Groups, 3, 4, 5 and 6 concurrently were treated by MPH (10 mg/kg) and venlafaxine at doses of 25, 50, 75 and 100 mg/kg respectively for 21 days. On day 22, elevated plus maze (EPM), open field test (OFT), forced swim test (FST) and tail suspension test (TST) were used to investigate the level of anxiety and depression in animals. In addition, between days 17 and 21, Morris water maze (MWM) was used to evaluate the effect of MPH on spatial learning and memory. Results: MPH caused depression and anxiety in a dose-dependent manner in FST, OFT, EPM and TST, which were significantly different compared with control group. Furthermore, MPH can significantly attenuate the motor activity in OFT. Venlafaxine in all doses can attenuate MPH induced anxiety, depression and motor activity alterations. MPH also can disturb learning and memory in MWM, but venlafaxine did not alter this effect of MPH. Conclusions: We conclude that venlafaxine can be protective in the brain against MPH induced anxiety and depression.

Background: Urban family physician program has been launched as a pilot in Fars and Mazandaran provinces of Iran since 2012. Attitudes of policy makers and people toward urban family physician program have become challenging. This study shows what people know and practice toward this program. Methods: This cross-sectional population-based study was conducted by a multistage randomized sampling in Shiraz, Southern Iran. Knowledge and practice of adults toward urban family physician program were queried through filing the questionnaires. Single and multiple variable analyzes of data were performed. Results: Participation rate was 1257 of 1382 (90.9%), and the mean age of the respondents was 38.1 ± 13.2 years. Of 1257, 634 (50.4%) were men and 882 (70.2%) were married. Peoples' total knowledge toward urban family physician program was 5 ± 2.7 of 19, showed that 1121 (89.2%) had a low level of knowledge. This was correlated positively and in order to being under coverage of this program (P < 0.001), being under coverage of one of the main insurance systems (P = 0.04) and being married (P = 0.002). The mean score of people's practice toward the program was 2.3 ± 0.9 of total score 7, showed that 942 (74%) had poor performance, and it was correlated positively and in order to being under coverage of this program (P < 0.001) and having higher than 1000$ monthly income (P = 0.004). Correlation of people's knowledge and practice toward the program was 24%. Conclusions: Current evidences show a low level of knowledge, poor practice and weak correlation of knowledge-practice of people toward urban family physician program.

Background: Health services for those in need. Inpatient care shows a more serious side of individual care and patients and their family members perceive a high level of stress and urge. We conducted this study to determine inequalities of in-patient health care utilization in Iranian people and to assess factors that influence utilization. Methods: In each province, the sample was comprised of 380 urban and 380 rural households that were recruited by a systematic random sampling method. A total of 23,560 households, which included around 102,000 individuals were recruited. We used the questionnaire for data collection. Met admission need (MAN) was the main variable and was considered household assets for determining the economic status. We did all analyses using the STATA version 9.1. Results: The rates of MAN for urban and rural areas were 83% and 81.3% respectively. The rate of MAN was significantly higher in patients with higher educational level. Patients with primary health insurance coverage had significantly higher rate of MAN. Conclusions: Meeting admission needs was estimated around 84% and it seems that modifying insurance coverage is the most feasible intervention for increasing utilization of health services.

Background: Considering the problem of drug abuse in Iran especially in adolescents and the youth, recent alterations in drug abuse rate and its trend, the necessity to have local information about this problem, applied research has a determining role in management of this problem and making proper decisions. Therefore, the current study was conducted to develop a questionnaire to assess the status of drug abuse among high school students of Isfahan Province, Iran. Methods: This cross-sectional study was conducted out in 2009 in 20 cities of Isfahan Province. A researcher-made questionnaire was developed to determine knowledge, attitude, and practice of high school students regarding addictive drugs and their associated causes. This was accomplished by recruiting 7137 students who were selected by multistage random cluster sampling. Results: The designed questionnaire identified the status quo of drug abuse according to age, gender, and different cities of Isfahan Province. We also accessed information about the type of abused drug, the most common causes of drug abuse for the first time, the most important causes of drug abuse, mean age of abusers and mean age at the first abuse, common time and locations of drug abuse, and the most common routes of drug abuse according to gender as well as urban and rural areas of Isfahan Province. Reliability of the questionnaire, based on the calculated Cronbach's alpha coefficient, was 77% considering a cut-off point of 0.07. Conclusions: According to the obtained results, the designed questionnaire is capable to assess the drug abuse status among high school students of Isfahan Province. Regarding the importance of teenage years in forming the future behaviors of adolescents and the opportunities provided at schools, it is prudent to pay more attention to interventions in this age group in order to increase their knowledge and correct their attitude toward illegal drugs and strengthening their confidence in this regard. These interventions can have an important role in decreasing the rate of drug abuse in this age group and consequently in the whole community.

Background: The present study aims to assess and compare the reduction in salivary Mutans Streptococci counts after chewing Xylitol, herbal and placebo gums among high school children. Methods: The study was conducted among 72 school children (12-15 years) from 3 randomly selected schools (blocks). Xylitol, herbal and placebo gums were randomly allocated to 3 blocks. Subjects were instructed to chew one pellet four times a day for 21 days. The mean reduction in salivary Streptococcus mutans count was assessed. Results: The 100% Xylitol sweetened chewing gum "Xylitol"has shown statistically signif icant reduction in salivary Mutans Streptococci colony forming units at the end of 21 days (P < 0.01). The reduction was not statistically significant in herbal and placebo chewing gum. Conclusions: Hundred percentage Xylitol sweetened chewing gum was found to be more effective in reducing salivary Mutans Streptococci count when compared to herbal and placebo chewing gums.

Background: The aim of this study was to determine the cumulative prevalence rate of every sexual dysfunctions (SDs) in Iranian population. Methods: We searched international database such as: PubMed/Medline, Scopus, PsychNET, and Scholar Google and Iranian database such as Iran Psych, IranDoc, IranMedex, and SID. Search duration was between 1990 and 2013. Results: From 449 articles were retrieved, then 11 articles on male with total sample size of 2142 and 8 articles on female with total sample size of 4391 were selected after critical appraisal. For quality assessment check list to evaluate a prevalence article was contained study population, sampling method, sample size, criteria for SD diagnosis, specific rates, study location, and authors list. In male, erectile dysfunction was 56.1%. In female, pooled estimation prevalence of hypoactive sexual desire disorder in complained group was 65.8% (95% confidence interval [CI]: 51.1-80.6%) compared to general population 35% (95% CI: 17.6-52.1%). Sexual arousal disorder in clinical patient was 59.6% (95% CI: 39-80%) against 33.8% (95% CI: 18.3-49.3%) in general population. Orgasmic disorder in complained was 35.5% (95% CI: 16-55%) and in general population was 35.3% (95% CI: 26.8-43.8%). Sexual pain disorder pooled estimation prevalence were 35.2% (95% CI: 14.5-56%) versus 20.1% (95% CI: 6.4-33.8%) in complained and general population consecutively. Conclusions: The rate of SD in Iran was approximately the same of worldwide except orgasmic disorder which was two times more than the worldwide average.

Background: Opium abuse as a relatively common behavior among Iranian population may have an association with the other coronary artery disease (CAD) risk factors. Here, we reported the prevalence of opium abuse and its co-exposures with oral health and other CAD risk factors. Methods: We recruited 5900 inhabitant aged 15-75 years using a randomized cluster household survey. All were interviewed for level of physical activity (PA), depression, anxiety and opium use and assessed for hypertension, diabetes, hyperlipidemia, and oral health status. Regarding to opium abuse, participants were grouped into: "Non-," "occasional," and "dependent" users. Using logistic regression model for every CAD risk factor, we assessed whether the co-exposure of opium and CAD risk factor is significant. Results: Overall, 10.6% reported ever opium use including 5.6% dependent and 5% occasional users. The prevalence of opium abuse was increased from 2.1% in 15-25 years to 24.5% in 55-64 years group. Opium abuse, in occasional and dependent forms, was associated with depression (adjusted odds ratio [AOR] 1.81 and 2.49) and low PS (AOR 1.43 and 1.71 respectively). Dependents were less obese than nonusers (P < 0.01). Opium abuse had no significant association with hypertension, diabetes, oral health status and lipid profile. Conclusions: Opium abuse was associated with depression and low PA. No ameliorative effect was observed on hypertension, diabetes, and plasma lipid profile. Therefore, positive association of opium with depression and LPA and the incorrectness of belief on its ameliorative effect on three other important risk factors of CAD should be clearly highlighted in public health messages to the community.

Background: Considering the role of kisspeptin (KISS) in the process of puberty, this study aimed to determine the mutation of KISS1 gene among a group of patients with idiopathic central precocious puberty (ICPP). Methods: In this case control study, a group of children with diagnosed ICPP and a group of healthy children were selected. Genomic DNA was extracted from peripheral blood of selected population. After proving the quality and quantity of extracted DNA samples by nano-drop instrument, PCR was performed using 3 set of primers to amplify all coding exons and flanking intron region of Kiss1 gene. Results: In this study, 33 patients with idiopathic PP and 30 control age and sex matched children were studied. Genetic analysis indicated that there was not any polymorphism or mutation in studied participants of the control group. Among patients with ICPP, 4 single nucleotide polymorphisms within the promoter and coding regions of KISS1 gene were determined in 9 patients (5 boys and 4 girls). Among them, the c.-148 T > A was novel variant. Conclusions: The results of the current study identified one novel polymorphism and three reported polymorphism in KISS gene among patients with ICPP. It is recommended to design further studies for analysis other genes related to ICPP in accordance with more complementary biochemical evaluations is recommended also.

Background: Baby-friendly Hospital Initiative (BFHI) is a vital intervention supported by World Health Organization and UNICEF to reduce infant mortality and has been included as a part of the curriculum in nursing and medical courses. To know the extent of knowledge of students about BFHI along with its understanding and to find out the gap in their knowledge about BFHI steps. Methods: A descriptive cross sectional study was carried out among the nursing (4 ^th year) and medical students (3 ^rd year MBBS) about ten steps of BFHI by a pretested and predesigned questionnaire. After ethical clearance, information was collected about their awareness and correct understanding concerning ten steps. Results : A total of 102 (51.6%) medical and 96 (48.4%) nursing students comprising of 57 (28.8%) males and 141 (71.2%) females were interviewed, had similar mean score about the ten steps of BFHI. Female respondents 82.3% had best understood the step 2 (training), as compared to males 80.7%. About step 6 (no supplements) 94.3% females and 86% males had well understood the step. Step 7 (rooming in) was known to 85.8% females and 54.4% males respectively. Step 9 (no pacifiers) was known to 80.1% females while among males 56.1% were aware. There was statistically significant difference in their knowledge about the steps 2 and 4 (skin to skin), 5 (counseling), 7, and 9 as females were more aware about these steps than males. The least understood steps in medical and nursing students were step 1 (written policy) (15.7%, 15.6%), step 3 (prenatal education) (27.5%, 29.2%), step 8 (cues) (10.8%, 24%) and step ten (community support) (8.8%, 11.5%) respectively. Conclusions: BFHI is one of the successful international efforts undertaken to promote, protect and support breast feeding. Acquiring knowledge about the same by medical and nursing students is most crucial tool for better practices by them in the future. Continued medical education, workshops and seminars by lactation specialists in addition to the regular teaching about BFHI as part of the curriculum may be considered to ensure and update their knowledge about BFHI.

Background: Obesity among children and adolescents is a growing public health problem. The purpose of this study is to assess the prevalence, socioeconomic and demographic determinants of overweight and obesity in schoolchildren from Geneva. Methods: A cross-sectional study was undertaken at the Public School of Geneva canton in Switzerland. A total of 8544 public school children were collected and analyzed: 2577 were in second grade, 2641 in fifth grade and 3326 in eighth grade. To identify overweight and obesity we used the definition issued by the International Obesity Task Force. Child characteristics included gender, age, socioeconomic status (SES) of father and mother, and school grade. The multivariate logistic regression model was used to examine potential predictors of overweight/obesity. Results: The prevalence of overweight or obese children was 14.4% in second grade, 17.3% in fifth grade and 18.6% in eighth grade. Multivariate logistic regression analyses reveal that children that have a low economic status or certain citizenships are more likely to be overweight or obese. Children of Kosovar origin, have a higher risk of OBO in second grade (adjusted odds ratio [OR] = 2.19; 95% confidence interval [CI]: 1.20-4.00), fifth grade (adjusted OR = 2.36 95% CI: 1.27-4.39) and in eighth grade (adjusted OR = 2.15 95% CI: 1.27-4.39). Association between SES and overweight was high with regards to the father's SES in fifth grade (adjusted OR = 4.21 95% CI: 2.83-6.25). Conclusions: Overweight and obesity is associated to socioeconomic and sociodemographic factors. The analyzes reveals that children with a low economic status and/or from certain countries are more likely to be overweight or obese than Swiss children. There is an urgent need for action to prevent further increase in overweight or obesity among children.

Background: Researchers, practitioners, and policy-makers call for updated valid evidences to monitor, prevent, and control of alarming trends of obesity. We quantify the trends of obesity/overweight researches outputs of Middle East countries. Methods: We systematically searched Scopus database as the only sources for multidisciplinary citation reports, with the most coverage in health and biomedicine disciplines for all related obesity/overweight publications, from 1990 to 2013. These scientometrics analysis assessed the trends of scientific products, citations, and collaborative papers in Middle East countries. We also provided Information on top institutions, journals, and collaborative research centers in the field of obesity/overweight. Results: Over 24-year period, the number of obesity/overweight publications and related citations in Middle East countries had increasing trend. Globally, during 1990-2013, 415,126 papers have been published, from them, 3.56% were affiliated to Middle East countries. Iran with 26.27%, compare with other countries in the regions, after Turkey (47.94%) and Israel (35.25%), had the third position. Israel, Turkey, and Iran were leading countries in citation analysis. The most collaborative country with Middle East countries was USA and within the region, the most collaborative country was Saudi Arabia. Conclusions: Despite the ascending trends in research outputs, more efforts required for promotion of collaborative partnerships. Results could be useful for better health policy and more planned studies in this field. These findings also could be used for future complementary analysis.

Background: Socioeconomic status (SES) can greatly affect the clinical outcome of medical problems. We sought to assess the in-hospital mortality of patients with the acute coronary syndrome (ACS) according to their SES. Methods: All patients admitted to Tehran Heart Center due to 1 ^st -time ACS between March 2004 and August 2011 were assessed. The patients who were illiterate/lowly educated (≤5 years attained education) and were unemployed were considered low-SES patients and those who were employed and had high educational levels (>5 years attained education) were regarded as high-SES patients. Demographic, clinical, paraclinical, and in-hospital medical progress data were recorded. Death during the course of hospitalization was considered the end point, and the impact of SES on in-hospital mortality was evaluated. Results: A total of 6246 hospitalized patients (3290 low SES and 2956 high SES) were included (mean age = 60.3 ± 12.1 years, male = 2772 [44.4%]). Among them, 79 (1.26%) patients died. Univariable analysis showed a significantly higher mortality rate in the low-SES group (1.9% vs. 0.6%; P < 0.001). After adjustment for possible cofounders, SES still showed a significant effect on the in-hospital mortality of the ACS patients in that the high-SES patients had a lower in-hospital mortality rate (odds ratio: 0.304, 95% confidence interval: 0.094-0.980; P = 0.046). Conclusions: This study found that patients with low SES were at a higher risk of in-hospital mortality due to the ACS. Furthermore, the results suggest the need for increased availability of jobs as well as improved levels of education as preventive measures to curb the unfolding deaths owing to coronary artery syndrome.

Background: Early childhood development is one of the most social determinants of health that must be notified in order to reducing social gap and inequity. In spite of increasingly developing intensive neonatal care wards and decreasing neonatal mortality rate, there is no follow-up surveillance system to identify high-risk infants (HRI) and their health problems for timely intervention after discharge. This study was carried out to design and pilot high-risk infant follow-ups (HRIFs) surveillance system, in Alzahra Hospital, a tertiary level center of Tabriz University of Medical Sciences (TUOMS), in 2012-2013. Methods: In this qualitative research after studying international documents, consensus about criteria of HRIs accomplished by focus group discussion. Then, Delphi agreement technique was used to finalizing assessment timetable. In the second phase, we piloted the designed surveillance system in Alzahra Hospital, a tertiary level center of TUOMS. Pilot study was implemented by follow-up team organized in designed model at the first phase of the study. Then, the findings of the pilot study were being assessed by an expert panel. If the members agreed on made decisions, they were being placed on the agenda of the national committee of development care of newborns for final approval. Results: High-risk infants follow-up surveillance system was designed in following steps: Defining of evidence-based criteria of HRIs, organizing the follow-up team, regulating the organs and neurodevelopment assessment timetable, publishing a health certificate notebook for HRIs, and designing Access database software for data collection, report and evaluation. Conclusions: We designed and piloted HRIFs surveillance system, so this system was institutionalized in Alzahra Hospital, finally. It can be prepared to apply in the whole country, after detecting the quantitative outcomes and developing the program in East Azarbijan.

Background: To compare two methods of weaning premature infants from nasal continuous positive airway pressure (NCPAP). Methods: Between March and November 2012, 88 preterm infants who were stable on NCPAP of 5 cmH ₂ O with FIO ₂ <30% for a minimum of 6 h were randomly allocated to one of two groups. The high flow nasal cannula (HFNC) group received HFNC with flow of 2 L/min and FIO ₂ = 0.3 and then stepwise reduction of FIO ₂ and then flow. The non-HFNC group was maintained on NCPAP of 5 cmH ₂ O and gradual reduction of oxygen until they were on FIO ₂ = 0.21 for 6 h, and we had weaned them directly from NCPAP (with pressure of 5 cmH ₂ O) to room air. Results: No significant differences were found between 2 study groups with regards to gestational age, birth weight, Apgar score at 1 and 5 min after birth, patent ductus arteriosus and use of xanthines. The mean duration of oxygen therapy after randomization was significantly lower in HFNC group compared to non-HFNC group (20.6 ± 16.8 h vs. 49.6 ± 25.3 h, P < 0.001). Also, the mean length of hospital stay was significantly lower in HFNC group compared to non-HFNC group (11.3 ± 7.8 days vs. 14.8 ± 8.6 days, P = 0.04). The rate of successful weaning was not statistically different between two groups. Conclusions: Weaning from NCPAP to HFNC could decrease the duration of oxygen therapy and length of hospitalization in preterm infants.

Objective: To examine vertical transmission rates of Cytomegalovirus, Toxoplasma Gondii and Rubella infections according to amniotic fluid PCR analysis. Methods: A retrospective analysis of mid-trimester amniocenteses performed in in pregnancies with diagnosed maternal infection by Cytomegavirus (CMV), Rubella or Toxoplasma gondii during 1994-2008 was performed. Vertical transmission rates were observed according to the presence of the infectious agent's DNA in the amniotic fluid. A univariate regression model was also performed to investigate possible correlations between transmission and epidemiological parameters. Results: Overall, 7033 amniocenteses were performed during study's period, of which 166 (2.4%) with the indication of maternal infection by CMV, Rubella or Toxoplasma. Mean maternal age was 27.4 ΁ 2.5 years and the mean gestational age at amniocentesis was 18.7 ΁ 2.5 weeks. Vertical transmission was observed in 21 cases (12.7%). Transmission rate was 17.3% in cases with infection from CMV, 9.5% from Toxoplasma gondii and 7.8% from Rubella (P = .05). Maternal age was the only parameter being significantly associated with increased risk for vertical transmission (P = .04). Conclusions: According to our results, overall vertical transmission rate marginally exceeds 10%. CMV infection is characterized by relatively higher transplacental transmission rate, while increased maternal age appears to be associated with a higher risk for vertical transmission

Background: Adiponectin is an abundant adipose tissue-derived protein with anti-atherogenic, anti-inflammatory and antidiabetic properties. Plasma adiponectin levels are decreased in obesity, type 2 diabetes, and coronary artery disease and low adiponectin levels also predict insulin resistance (IR). Methods: Case-control study in which 642 male and female subjects were participated from the North Indian population. Lipid, insulin, leptin and adiponectin level were estimated using standard protocols by commercially available test kits. Single nucleotide polymorphisms +45T>G and +276G>T of the AMP1 (adiponectin) gene was genotyped by polymerase chain reaction restriction fragment length polymorphism method. Results: Levels of adiponectin, insulin, homeostasis model assessment-IR index (HOMA-IR index), systolic blood pressure and fat mass showed significant differences between male and female subjects. Serum adiponectin level showed highly significant association with both the +45 and the +276 genotypes. The common haplotype triglyceride (TG) showed a significantly lower adiponectin value than other haplotypes (P = 0.0001). A clear trend of decreasing adiponectin levels per copy of the common haplotype was observed. Nonobese insulin sensitive subjects showed a higher adiponectin value (P = 0.0006) than nonobese insulin resistant subjects. The values of blood pressure, adiponectin, insulin, HOMA-IR, total-cholesterol, and low-density lipoprotein-cholesterol significantly associated with TG haplotype. Conclusions: We observed the very strong association of the adiponectin 45-276 genotypes and haplotypes with adiponectin levels in healthy north Indian population and TG haplotypes also associated with metabolic parameters of the IR syndrome.

Background: To facilitate analysis, interpreting and sharing cancer data and investigation spatial and geographical aspect of cancers in Isfahan province, cancer cases distribution was displayed using geographic information systems (GIS). Methods: About 118,000 cancer data, which were confirmed in national cancer registration unit were extracted. Age-specific incidence rate and age standardized rate (ASR) of cancer cases from 2006 to 2010 was calculated for Isfahan province and its different districts. Distribution of ASR was determined according to sex and age groups. Spatial maps were drawn with the help of Arc GIS version 10 (ESRI, Redland, CA, USA) software in choropleth based maps. The data are classified in GIS environment by means of quantile method. Data were described with the help of maps spatially. Results: Age standardized rate of cancers was higher in men than in women (134.58 vs. 115.4). The highest ASR was reported in the Isfahan (ASR: 133) and lowest in the Chadegan counties (ASR: 28). Different geographical distribution patterns of cancers were seen in district level. Cancer incidence was higher in the Isfahan, Lenjan, Fereidon Shahr and Falavarjan districts (134.3, 117.2, 113.5 and 111.1 respectively) among men and in Isfahan, Shahin Shahr, Lenjan and Najafabad districts (122.8, 102.3, 94 and 93 respectively) among women. The incidence rates of most cancers were lowest in the North East region of the province compared to the rest of the region Conclusions: Using GIS for visual displaying of cancers facilitated communication with the policymakers and community. This study provided hypotheses about differences in the incidence of cancer in Isfahan districts. Higher age-specific incidence rate in the Isfahan city is probably a reflection of problems in addressing the patients in cancer registration. Complementary studies are needed to evaluate lower ASR in the North East regions of the province.

Background: This study aimed at investigating the impact of an educational intervention based on transtheoretical model to increase physical activity and improve metabolic syndrome indicators in women. Methods: In this quasi-experimental study, 142 women with metabolic syndrome were randomly assigned to the case and control group (each group 71 participants). SECQ (Marcus), processes of change (Marcus), decisional balance (Bandura) and self-efficacy (Nigg) questionnaires and International Physical Activities Standard Questionnaire in preintervention, 3 and 6 months after intervention were completed. Furthermore, abdominal obesity, triglycerides (TG), and high-density lipoprotein (HDL) were measured. Physical activity intervention based on transtheoretical model (TTM) was performed in the case group. Finally, data were analyzed by SPSS (16) (SPSS Inc., Chicago, IL, USA) and repeated measure ANOVA, independent t-test and Freidman was used. A two-tailed P value, lower than 0.05, was considered to be statistically significant. Results: After the intervention, physical activity level increased in the intervention group, and they also progressed in stages of change, but the people in the control group had regressed. All changes in TTM constructs were significant in the intervention group during the time and differences in pros and cons were not significant in the control group. Abdominal obesity and TG has significantly reduced, and HDL has increased in the intervention group. In the control group, there was a significant increase in TGs and a decrease in HDL. Conclusions: Physical activity training based on TTM can improve physical activity and metabolic syndrome indicators in women.

Background: Polycystic ovary syndrome (PCOS) is a polygenic endocrine disorder in women of reproductive age that lead to infertility. The aim of this study was to investigate the effects of probiotic on pancreatic b-cell function and C-reactive protein (CRP) in PCOS patients. Methods: This randomized double-blind placebo-controlled clinical trial was conducted among 72 women aged 15-40 years old diagnosed with PCOS. Participants were randomly assigned to two groups receiving: (1) Probiotic supplements (n = 36), (2) placebo (n = 36) for 8-week. Fasting blood samples were taken at baseline and after 8-week of intervention. Results: Probiotic supplementation, compare with placebo, reduced fasting blood sugar (−4.15 ± 2.87 vs. 2.57 ± 5.66 mg/dL, respectively P = 0.7), serum insulin levels in crude model (−0.49 ± 0.67 vs. 0.34 ± 0.82 mIU/mL, respectively, P = 0.09), homeostasis model of assessment-insulin resistance score (−0.25 ± 0.18 vs. −0.05 ± 0.18, respectively, P = 0.14) nonsignificantly. Serum insulin levels after adjustment with covariates reduced significantly in probiotic group (P = 0.02). We did not found any significant differences in mean changes of CRP between groups (−0.25 ± 0.18 vs. −0.05 ± 0.18, respectively, P = 0.14). Conclusions: A 8-week multispecies probiotics supplementation had nonsignificantly beneficial effect on pancreatic b-cell function and CRP in PCOS patients. After adjustment for some covariates, serum insulin changes were significantly different between groups.

Background: Renal ischemia-reperfusion (RIR) is the main cause of renal failure. The incidence of RIR injury seems to be gender-related due to female sex hormone; estrogen. This study was designed to investigate the protective role of estrogen against RIR injury in male and ovariectomized female rats. Methods: Thirty-nine Wistar rats were used in this study as male and ovariectomized female rats in the sham-operated, RIR, and estradiol-treated plus RIR groups. The RIR was induced by clamping the renal vessels for 45 min and then 24 h of reperfusion. All animals finally were sacrificed for the measurements. Results: The serum levels of creatinine and blood urea nitrogen and kidney tissue damage score significantly increased in both male and female RIR rats (P < 0.05). Estradiol however significantly attenuated theses parameters (P < 0.05) toward normal levels in female (P < 0.05), but not in male rats. Kidney weight increased in both genders and estradiol intensified it in the male rats (P < 0.05). Uterus weight was increased by estradiol in female rats (P < 0.05) and testis weight did not alter in male rats. Conclusions: Estradiol demonstrated a protective role against RIR injury in female rats; however, estradiol as an antioxidant could not protect the male kidney from RIR injury.

Background: The patient decision aids (PDAs), which can facilitate the decision-making process when choosing the optimal method of treatment, are a challenge to patients. This study tried to determine the attitude of physicians on the barriers of using PDAs in the way of prioritizing and proposing solutions to them. Methods: This study was a cross-sectional research carried out on 150 clinical faculty members of research centers and scientific associations affiliated with Tehran University of Medical Sciences. The participants were chosen using the convenience sampling method. The attitude of physicians toward the application of PDAs was interviewed using a self-made questionnaire composed of 23 questions. The association between physicians' attitude to the use of PDAs and their characteristics was examined using the t-test, analysis of variance, and correlation test. Results: The mean score of physicians' attitude was 76.2 (standard deviation =11.9) and the range was 33-107. There was a significant and direct association between the attitude toward the use of PDA and the respondents' age (r = 0.237, P = 0.007), years of experience (r = 0.205, P = 0.02), being male (P = 0.04), and working in the private sector (P = 0.009). The attitude score of instructors was significantly lower than that of professors (P = 0.02). Conclusions: The general attitude of physicians toward the use of PDAs was positive. However, apparently as a result of problems mentioned in this study for the developing countries such as Iran, it is much easier to employ these tools in centers run by the private sector. Usage of such tools in public centers necessitates systemic infrastructure as well as credits and budgets required for the training of patients and physicians.

Background: Considering the controversial information regarding the effects of perchlorate on thyroid function of high risk population as neonates, and given the high prevalence rate of thyroid disorders specially congenital hypothyroidism in our region, this study aims to investigate for the first time in Iran, the relationship between drinking groundwater perchlorate and cord blood thyroid hormones level in an industrial region. Methods: In this cross-sectional study, drinking groundwater perchlorate level of rural areas of Zarinshahr, Isfahan was measured. Simultaneously, cord blood level of thyroid hormones of neonates born in the studied region was measured. Thyroid function test of neonates in regions with low and high perchlorate level were compared. Results: In this study, 25 tap water samples were obtained for perchlorate measurement. Level of cord blood thyroid stimulating hormone (TSH), T4 and T3 of 25 neonates were measured. Mean (standard deviation) of perchlorate, TSH, T4 and T3 was 3.59 (5.10) μg/l, 7.81 (4.14) mIU/m, 6.06 (0.85) mg/dl, and 63.46 (17.53) mg/dl, respectively. Mean levels of thyroid function tests were not different in low (<5 μg/l) and high level of drinking ground water perchlorate (P > 0.05). Conclusions: Perchlorate did not appear to be related to thyroid function of neonates in the studied industrial region. It seems that iodine status of the regions, as well as other environmental contaminants and genetic background, could impact on its relation with thyroid function of neonates.

Background: Breast cancer is the most common cancer in women. Prostate-specific antigen (PSA) is a marker of prostate gland malignancy, which has been considered in cases with breast cancer in recent years. The goal of this study was to determine total and free PSA levels in cases with malignant and benign breast lesions. Methods: In this case-control study, ninety women with histological proved malignant breast masses and 90 with benign breast masses were enrolled. Total and free PSA levels along with Histological grade and conditions of vascular and perinural invasion, status of hormonal tumor receptors, immune-histo-chemistry markers recorded for all cases. Total and free PSA levels were assessed after treatment in cases with malignant masses. Results: Total and free PSA levels were significantly higher in cases with malignant masses. The best cut-off point for total PSA to differentiate benign and malignant masses was 0.31 with sensitivity and specificity of 100%, 100% (area under the curve [AUC] =1, P < 0.001) and the best cut-off point for free PSA to differentiate benign and malignant masses was 0.19 with sensitivity and specificity of 100% and 100% (AUC = 1, P < 0.001). After treatment, mean free PSA level was significantly lower than free PSA before treatment (0.23 ± 0.1 vs. 0.3 ± 0.08, P < 0.001). Conclusions: Serum PSA level could be applied for differentiating benign and malignant breast masses.

Background: Cardiovascular disease is the main reason for mortality in men and women. Clinical epidemiology of myocardial infarction (MI) in men and women has not been yet studied in Iran, one of the largest Middle East countries in South-Western Asia. This study was conducted to determine the clinical epidemiology of MI in men and women in Iran. Methods: This hospital-based, cross-sectional study used the data of 20,750 MI patients in Iran in 2012 (the codes I22, I21, I24, and I25.2). Univariate comparisons used Chi-square test for categorical variables and t-test for continuous variables. P < 0.05 was considered as significant. Results: Totally, 20,750 MI patients (15,033 men and 5,717 women) with age range of 13-106 (mean; 61.2 ± 13.4) years were enrolled. Only 9 (0.04%) patients (8 men and 1 woman) were ≤18 years (mean age: 14.8 ± 1.9), out of whom only two men were diabetic. 22.2% (18% men and 33.4% women) of the patients had diabetes, 26.2% (28.5% men and 20.1% women) were smoker and 35.5% (28.6% men and 53.7% women) had hypertension. ST-segment elevation MI incidence was 2.8 times higher in men than women. Left bundle branch block was significantly more prevalent in men than women. Men used percutaneous coronary intervention more frequently than women did. No difference in coronary artery bypass graft was noted between men and women. Mortality incidence was approximately twice higher in men than women. The prevalence of chest pain was higher in women than men. Conclusions: The MI incidence pattern, mortality from MI, and risk factors prevalence are significantly different between men and women in Iran. More emphasis on these issues in training people and healthcare professionals seems to contribute partially to patients' timely referring to health care centers and preventing MI-associated mortalities.

Background: In pediatric resuscitation, it is necessary to distinguish the weight in order to provide proper doses of drugs, equipment selection, and ventilator settings, therefore, access to a simple, unbiased, and accurate formula can decrease mistakes. The aim of this study is to determine the percentage of error (PE) of different weight estimation methods toward actual weight in children admitted to17 Shahrivar Hospital. Methods: This is a descriptive cross-sectional study conducted on 1-10 years children admitted in the pediatric clinic of 17 Shahrivar Hospital in Rasht. Data were collected by a checklist, including age, sex, height and mid-arm circumference (MAC). Investigators compared estimated weight by ten different methods with the actual weight. Finally, clinicians measured the PE and data were analyzed in SPSS software version.18. Results: About 50.9% of participants were male. The mean age was 4.59 ± 3.35 years and the mean weight was 17.4 ± 5.69 (6.5-45) kg. Results showed no significant difference between the estimated weight and the actual one based on visual expert estimation and advanced pediatric life support (APLS) method. Visual estimation (0.017%) and MAC (25.48%) noted the lowest and highest PE, respectively. Conclusions: Results indicated a significant difference between the estimated weight and the actual one based on visual expert's estimation and APLS method. As, these methods were easy, rapid and accurate for body weight estimation in emergencies and may be more accurate than parent's estimation, it seems that it could be helpful for prescribing medication dosage and equipment sizes.

Background: Physical activity is a complex behavior. To designing the effective intervention, qualitative researches may be allowed for greater understanding of the reasons behind the adolescences' physical activity-related behaviors'. Methods: Using the grounded theory approach, including semi-structured focus group discussions (FGDs) and in-depth interviews, we conducted a quantitative study to elicit the adolescents and key informants' opinion regarding the satiation, needs, social and environmental barriers of adolescents' physical activity. For FGDs, participants were selected from volunteered adolescent (aged 10-19 years) of the populated western part of Tehran, which was selected as a research field. Key informants were invited from the health professionals and experts in the field of adolescents' health. Results: According to findings, although the majority of participants agreed on the important role of physical activity, the lack of essential motivation and the pressure of educational assignments remove it from the daily program priorities. Lack of a safe environment for girls' physical activity and high cost of professional sports were two first mentioned barriers. It was also suggested that future interventions should focus on improving more parents' engagement and their direct participation in physical activities with their adolescents. Conclusions: We proposed the participatory strategies for adolescent's physical activity promotion. Through which target groups participation during the designing, development, and implementation of health programs led to more effective interventions.

Background: According beneficial effects of Tribulus terrestris (TT) extract on tissue damage, the present study investigated the influence of hydroalcoholic extract of TT plant on cisplatin (CIS) (EBEWE Pharma, Unterach, Austria) induced renal tissue damage in male mice. Methods: Thirty mice were divided into five groups (n = 6). The first group (control) was treated with normal saline (0.9% NaCl) and experimental groups with CIS (E1), CIS + 100 mg/kg extract of TT (E2), CIS + 300 mg/kg extract of TT (E3), CIS + 500 mg/kg extract of TT (E4) intraperitoneally. The kidneys were removed after 4 days of injections, and histological evaluations were performed. Results: The data were analyzed using one-way analysis of variance followed by Tukey's post-hoc test, paired-sample t-test, Kruskal-Wallis and Mann-Whitney tests. In the CIS treated group, the whole kidney tissue showed an increased dilatation of Bowman's capsule, medullar congestion, and dilatation of collecting tubules and a decreased in the body weight and kidney weight. These parameters reached to the normal range after administration of fruit extracts of TT for 4 days. Conclusions: The results suggested that the oral administration of TT fruit extract at dose 100, 300 and 500 mg/kg body weight provided protection against the CIS induced toxicity in the mice.

Background: This study aims to explore the frequency of aggressive behaviors among a nationally representative sample of Iranian children and adolescents. Methods: This nationwide study was performed on a multi-stage sample of 6-18 years students, living in 30 provinces in Iran. Students were asked to confidentially report the frequency of aggressive behaviors including physical fighting, bullying and being bullied in the previous 12 months, using the questionnaire of the World Health Organization Global School Health Survey. Results: In this cross-sectional study, 13,486 students completed the study (90.6% participation rate); they consisted of 49.2% girls and 75.6% urban residents. The mean age of participants was 12.47 years (95% confidence interval: 12.29, 12.65). In total, physical fight was more prevalent among boys than girls (48% vs. 31%, P < 0.001). Higher rates of involvement in two other behaviors namely being bullied and bulling to other classmates had a higher frequency among boys compared to girls (29% vs. 25%, P < 0.001 for being bullied) and (20% vs. 14%, P < 0.001 for bulling to others). Physical fighting was more prevalent among rural residents (40% vs. 39%, respectively, P = 0.61), while being bullied was more common among urban students (27% vs. 26%, respectively, P = 0.69). Conclusions: Although in this study the frequency of aggressive behaviors was lower than many other populations, still these findings emphasize on the importance of designing preventive interventions that target the students, especially in early adolescence, and to increase their awareness toward aggressive behaviors. Implications for future research and aggression prevention programming are recommended.

Background: Several measures of adiposity have been used for predicting diabetes. The results of studies regarding superiority of waist circumference (WC) to body mass index (BMI) are inconsistent. This study designed to compare the ability of different anthropometric measures in predicting diabetes and to determine their optimal cut-off values. Methods: A population-based cross-sectional study was conducted with 1,000 representative sample among adults aged 20-80 years in Babol, the Northern Iran. The demographic data were collected in a household survey, and the anthropometric measures of weight, height, waist, and hip circumference were measured with a standard method. Fasting blood sugar (FBS) ≥126 mg/dl was considered as diabetes. receiver operating characteristic analysis was used to estimate the predictive ability of different anthropometric indexes and their optimal cut-off values for high FBS. Results: The overall prevalence rate of diabetes was 14.0% (14.4% in men vs. 13.5% in women, P = 0.65). The prevalence rate was significantly higher in older age (>60 years), low educated and obese (P = 0.001). The mean of BMI, WC, waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR) were significantly higher among diabetic in both sexes (P = 0.001). Among men, WC (area under the ROC curve [AUC] =0.64) and WHtR (AUC = 0.63) have slightly higher accuracy index compared with BMI (AUC = 0.62) or WHR (AUC = 0.60). In contrast, among women, WHtR (AUC = 0.69) and WC (AUC = 0.68) yielded slightly better predictive than BMI (AUC = 0.67). The optimal cut-off values obtained for BMI and WHtR were similar between two sexes (BMI = 24.95 kg/m ² for men and BMI = 25.2 kg/m ² for women, WHtR = 0.51 for both sexes) whereas the optimal cut-off value for WC was higher in men than women (98.5 cm men vs. 89.5 cm women). Conclusions: Overall WC and WHtR exhibited a slightly better discriminate performance than BMI for diabetes in both sexes, particularly in women.

Background: The purpose of this study was to evaluate the validity and reliability on the Persian translation of the Modifiable Activity Questionnaire (MAQ) in a sample of Tehranian adolescents. Methods: Of a total of 52 subjects, a sub-sample of 40 participations (55.0% boys) was used to assess the reliability and the validity of the physical activity questionnaire. The reliability of the two MAQs was calculated by intraclass correlation coefficients, and validation was evaluated using Pearson correlation coefficients to compare data between mean of the two MAQs and mean of four physical activity records. Results: Intraclass correlation coefficient was calculated to assess the reliability between two MAQs and the results of leisure time physical activity over the past year were 0.97. Pearson correlation coefficients between mean of two MAQs and mean of four physical activity records were 0.49 (P < 0.001), for leisure time physical activities. Conclusions: High reliability and relatively moderate validity were found for the Persian translation of the MAQ in a Tehranian adolescent population. Further studies with large sample size are suggested to assess the validity more precisely.

Background: In most of the studies, the association of vascular events is limited to migraine with aura or it is stronger in this group, whereas the link between migraine without aura (MO) and vascular events remained uncertain . Therefore, we decided to evaluate endothelial function by chemical and functional markers of endothelium in MO and compare with normal population. Methods: In this study, 39 patients and 25 healthy subjects were enrolled and flow-mediated dilatation (FMD), C-reactive protein (CRP), nitrite and nitrate were measured in these two groups. Results: The mean of FMD in healthy people was higher than the migraine patients (mean difference − 7.67%; 95% confidence interval [CI] −9.90-−5.44). The means of nitrite concentration in migraineurs was significantly lower than healthy subjects (mean difference − 2.0 μmol/L; 95% CI − 3.45-−0.54). But the CRP concentrations in both groups were not significantly different (mean difference 0.42 pmol/L; 95% CI − 0.13-0.98). Conclusions: This study can show the endothelial dysfunction in migraineurs without aura and suggest that MO could also be a risk for cardiovascular disease.

Background: Irrational antibiotic prescribing as a global health problem has a major influence on medical care quality and healthcare expenditure. This study was aimed to determine the pattern of antibiotic use and to assess the seasonality and physician-related factors associated with variability in antibiotic prescribing in Isfahan province of Iran. Methods: This cross-sectional survey was conducted on all prescriptions issued by general physicians from rural and urban areas in 2011. Associations between season of prescribing and physician-related variables including gender, practice location and time since graduation with antibiotic prescriptions and also the pattern of antibiotic prescribing were assessed using Chi-square tests and multiple logistic regression models. Results: Of the 7439709 prescriptions issued by 3772 general practitioners, 51% contained at least one antibiotic. Penicillins were the most frequently prescribed antibiotics, followed by cephalosporins and macrolides. Over-prescription of penicillins was associated with female gender (odds ratio [OR], 2.61; 95% confidence interval [CI] 2.13-3.19) and with moderate duration of time in practice (10-20 years) (OR, 1.42; 95% CI 1.14-1.76). Higher rates of cephalosporins prescription were observed in urban areas than rural areas and by male physicians. Seasonal peak was detected for penicillins and cephalosporins prescriptions in autumn. Conclusions: These findings showed the widespread use of antibiotics by general practitioners that was associated with the physicians' gender, time since graduation and practice location and also season of prescribing. More researches are needed on other factors related to the overprescribing of antibiotics and they could be used to project educational programs for improvement of antibiotic prescribing quality in our country.