Background: The timing of the age at which menopause occurs varies among female populations. This variation is attributed to genetic and environmental factors. This study aims to investigate the determinants of early and late-onset menopause. Methods: We used data from the National Health and Nutrition Examination Survey 2013-2014 for 762 naturally menopause women. Data on sociodemographic, lifestyle, examination, and laboratory characteristics were examined. We used random forest (RF), support vector machine (SVM), and logistic regression (LR) to identify important determinants of early and late-onset menopause. We compared the performance of models using sensitivity, specificity, Brier score, and area under the receiver operating characteristic (AUROC). The top determinants were assessed by using the best performing models, using the mean decease in Gini. Results: Random forest outperformed LR and SVM with overall AUROC 99% for identifying related factors of early and late-onset menopause (Brier score: 0.051 for early and 0.005 for late-onset menopause). Vitamin B12 and age at menarche were strongly related to early menopause. Also, methylmalonic acid (MMA), vitamin D, body mass index (BMI) were among the top highly ranked factors contributing to early menopause. Features such as age at menarche, MMA, sex hormone-binding globulin (SHBG), BMI, vitamin B12 were the most important covariate for late-onset menopause. Conclusions: Menarche age and BMI are among the important contributors of early and late-onset menopause. More research on the association between vitamin D, vitamin B12, SHBG, and menopause timing is required which will produce invaluable information for better prediction of menopause timing.

Backgrounds: Dietary sodium (Na) and potassium (K) relationship with chronic disease has drawn more attention recently. Epidemiological studies reported controversial findings about high salt and Na diets with the risk of nonalcoholic fatty liver disease (NAFLD) and studies about the association between K and NAFLD are scare. Present study aimed to examine the associations between dietary intake of Na, K, and Na:K ratio with the risk of NAFLD. Methods: We analyzed data from a case–control study of 225 patients with NAFLD cases and 450 controls. Dietary intake of Na and K measured using a validated 168 item food frequency questionnaire. Adjusted logistic regression models were used to report odds ratio (OR) 95% confidence interval (CI) of NAFLD across tertiles of Na, K, and Na:K ratio. Results: The mean ± standard deviation of age and body mass index of participants (47% female) were 38.1 ± 8.8 years and 26.8 ± 4.3 Kg/m². In the age- and sex-adjusted model, there was any significant association between Na, K, and Na: K ratio with the risk of NAFLD. In the final adjusted model, the OR (95%CI) of the highest vs the lowest tertiles of K, Na, and Na:K was 0.39 (0.19–0.80), 0.71 (0.40–1.25), and 1.10 (0.61–1.97), respectively. Conclusion: The present study indicates that higher dietary K was related to lower odds of NAFLD; however, there was no association between dietary Na and Na: K ratio with odds of NAFLD.

Background: Since the relation between dietary total antioxidant capacity (DTAC) and the occurrence of gallstone disease (GSD) remains unclear, we conducted, for the first time, a case-control study to clarify this association in the Iranian population. Methods: In the present case-control study, convenience Sampling was performed. A total of 600 participants (300 case and 300 control) were included. Anthropometric, demographic, physical activity, and nutrient intakes data were obtained from each subject. DTAC was calculated using the US Department of Agriculture's database. The odds ratio (OR) and 95% confidence intervals were assessed using unconditional logistic regression. Results: The participants in the highest quartile of DTAC had a significantly lower OR for gallstone than the lowest quartile, which remained significant after further adjustment for age, sex, and education (model 2: OR, 0.34; 95% CI, 0.16–0.71). In addition, after adjustment for age, sex, education, BMI, physical activity, and energy, the results revealed that participants with the highest quartile of DTAC had 71% lower odds of gallstone than those with the lowest quartile (model 3: OR, 0.29; 95% CI, 0.11–0.78). Conclusions: The results of the present study demonstrated that the DTAC had an inverse association with GSD incident. However, interventional approaches are needed to confirm the relation between DTAC and GSD prevention.

Background: Poor health condition may increase the risk of occupational problems and reduces an organization's productivity. Also, there is a direct, bilateral relationship between occupation and health. Objective: To evaluate the health status of health care workers (HCWs) in the largest tertiary general and teaching hospital in southern Iran. Methods: This cross-sectional study (Sep2014-Dec2016) was conducted on HCWs, who were referred to Prevention and Health Promotion Clinic of Shiraz Namazee hospital. The participants' health status was assessed and after the risk assessments and necessary physical examinations, the laboratory and para clinic tests were requested. Using descriptive and analytical tests, all data were analyzed. Results: Totally, 963 HCWs were enrolled, that 64.4% were women, with mean ± SD age of 35.51 ± 8.9 years. Eighty-eight percent and 77.4% of the participants had history of ergonomic and psychological exposures. Impaired glucose tolerance and abnormal serum cholesterol were seen in 13.6% and 29.9%, respectively. Body mass index was a predictive factor for abnormal blood pressure (OR: 1.12; 95%CI: 1.02-1.22), impaired glucose tolerance (OR: 1.08; 95%CI: 1.01-1.16), and abnormal serum cholesterol (OR: 1.17; 95%CI: 1.10-1.25), respectively. Male gender (OR: 1.83; 95%CI: 1.08-3.03) was a predictive factor for abnormal serum cholesterol. Conclusions: The health status of HCWs is not good enough in Iran. They did not have an appropriate lifestyle. They were exposed to different occupational hazards. The prevalence of chronic diseases was notable. Overweight, obesity, and inactivity were the most important causes of metabolic diseases.

Coronavirus disease-19 (COVID-19), a major global public health emergency has significantly impacted human health and livelihoods. The pandemic continues to spread and treatments and vaccines are at different stages of development. Mass vaccination has been rolled out worldwide. This review article provides a narrative summary of the evidence on various non-pharmacological interventions (NPIs) for COVID-19 containment. The authors reviewed the evidence published by the Norwegian Institute of Public Health map of COVID-19 evidence. Additional literature was identified from PubMed and Google Scholar, preprint sites, and news media. The search terms included “Social distancing measures” and “COVID 19”, “Non-pharmacological interventions'' and “COVID 19”, “COVID-19”, “non-pharmacological interventions”, “face mask”, etc. The strength of the evidence for most studies on NPIs was 'weak to moderate' for restrictive NPIs. Ascertaining the impact of each NPI as a standalone intervention is difficult since NPIs are implemented simultaneously with other measures. Varying testing and reporting strategies across the countries and classification of deaths directly caused by COVID-19 create challenges in assessing the impact of restrictive NPIs on the case numbers and deaths. Evidence on hygiene measures such as face mask is more robust in design providing credible evidence on prevention of COVID-19 infection. Evidence from modeling studies, natural before-after studies, and anecdotal evidence from the strategies adopted by 'role model' countries suggests that continued use of NPIs is the only containment strategy until 'herd immunity' is achieved to reduce the severe disease and mortality.

Background: There are uncertainties and contradictions in the literature about the effectiveness of maternity schools. The purpose of this study is to determine the effectiveness of prenatal trainings performed in an institutional and disciplined manner. Methods: This study was prospectively conducted between 2018 and 2019, and 245 primiparous pregnant women who gave birth in our hospital were examined. On a volunteer basis, a study group (n = 108) was created including patients who attended the maternity school trainings and a control group was created including patients who did not attend these trainings (n = 137). Both groups were compared in terms of caesarean section rates, active phase periods of birth, visual analogue scale (VAS) during active labor, Edinburgh Postnatal Depression Scale (EPDS) score, time from birth to first skin contact, newborn Apgar scores, and admission rates to the neonatal intensive care unit. Results: Cesarean section rates were significantly lower in the maternity school group (21.1% versus 29.19%). In the maternity school group, the active phase period of delivery was shorter (p < 0.001), VAS was lower during active labor (p < 0.001), and EDPS score was lower (p < 0.001). Education level was higher in the maternity school group than in the control group (p < 0.001). Conclusions: Institutional and disciplined antenatal pregnancy trainings provide significant benefits during pregnancy, delivery, and postpartum period depression by especially reducing the rates of cesarean section and postpartum depression.

Background: Considering the importance of adolescent obesity on adulthood health, this cross-sectional study aimed 408 students aged 13-18 years from different socioeconomic districts through convenience sampling to investigate nutritional status and physical activity (PA) level focusing on sex and socioeconomic differences. Methods: Weight and height were measured to investigate prevalence of obesity and underweight based on percentile of body mass index (BMI) for age. Information on dietary intake were collected via 3-day food recalls. PA level was investigated using a valid and reliable questionnaire. Results: The prevalence of underweight, overweight, and obesity were 4.9%, 15.9% and 23%, respectively. Weight and height were higher in boys than girls significantly (P-value < 0.001). Calorie intake in prosperous districts was higher than semi-prosperous districts (P = 0.01). Intake of zinc and calcium in prosperous districts was higher than semi-prosperous and disadvantaged districts (P-value < 0.001 and 0.02, respectively). Intake of calcium and zinc in both sexes and iron in girls, was lower than recommended dietary allowances (RDA) in all districts (P-value < 0.001). Conclusions: High prevalence of obesity and low micronutrients intake, especially in disadvantaged districts, suggest an urgent need to plan many efficient programs to prevent serious problems in future.

Background: Evidence showed that partial or complete loss of smell and taste might be a possible primary symptom of the 2019 novel coronavirus (COVID-19). This study aimed to systematically review and pool all available evidence on the olfactory and gustatory dysfunction in COVID-19 patients. Methods: In this systematic review, a comprehensive search was carried out systematically through e-databases including PubMed, EMBASE, Scopus, and Web of Science (WoS); that was limited to English-language studies published from 2019 up to 6^th May 2020. Afterward, all studies reported the taste and smell dysfunction in the COVID-19 patients were included. The quality of the studies was assessed by the Mixed Methods Appraisal Tool (MMAT). The pooled prevalence of olfactory and gustatory dysfunction was estimated using the random effects meta-analysis method. Results: Among 28 eligible included studies in this systematic review, finally, 22 studies met the eligibility criteria and were included in the meta-analysis. According to the random effect meta-analysis, the global pooled prevalence (95% confidence interval) of any olfactory dysfunction, anosmia, and hyposmia was 55% (40%-70%), 40% (22%-57%), and 40% (20%-61%) respectively. The pooled estimated prevalence of any gustatory dysfunction, ageusia, and dysgeusia was 41% (23%-59%), 31% (3%-59%), and 34% (19%-48%) respectively. Conclusions: Olfactory and gustatory dysfunction is prevalent among COVID-19 patients. Therefore, olfactory and gustatory dysfunction seems to be part of important symptoms and notify for the diagnosis of COVID-19, especially in the early phase of the infection.

Background: Neuropathy control and management is an objective in therapeutic exercises prescribed for patients with Type 2 diabetic peripheral neuropathy. We examined the effects of 12-week integrated exercise (IE) on glycemic control and peripheral sensation criteria in patients with diabetic neuropathy. Methods: This study was carried out in 2019–2020 in Janan diabetic society of Najaf Abad in Iran. Based on MNSI scores, we assigned 40 patients into two equal paired random groups (control vs. IE). Pre and posttests were administered before and after three months of intervention. Results: Repeated measures ANOVA showed no significant interaction effect between the FBS of the groups (P = 0.26) but significant interaction effects were observed between the levels of 2 hrs pp G, 4 pm G, HbA1c, Diapason, Monofilament, and Thermofeel in favor of the IE group (P < 0.05). Conclusions: At the beginning of IE, we used massage and foam roller to release pain and improve blood circulation as well as sensation in the neuropathic areas. This may have helped the patients perform the aerobic and resistance exercises more easily. Therefore, better glycemic control and peripheral sensation were achieved. Verification of the long-term effects of this training strategy requires further study. Verification of the long-term effects of this training strategy requires further study.

Background: Nitrate is a compound with adverse effects on human health that can exist also in vegetables. This study aimed to determine the intake of total nitrate/nitrite from lettuce and carrot as high and low nitrate content, respectively. Moreover, the effect of chlorhexidine mouthwash on the elimination of the nitrite level in saliva and urine was surveyed. Methods: This study was designed as a crossover based on the randomized selection method. Thirty-nine participants were divided into two groups; the lettuce and carrot juice consumers (control group). The case group was consumed these two vegetables, while they used antibacterial mouthwash. The background of nitrate/nitrite of the participants was determined before exposure. The intake of total nitrate and nitrite via lettuce and carrot juice consumption was investigated. The Griess colorimetric reaction was used for nitrate and nitrite determination in samples. Results: Total nitrate concentrations in case and control groups were detected 0.79 and 0.78 mM in saliva and 1.78 and 1.38 mM in urine after lettuce consumption, respectively. However, it was determined 1.55 and 2.43 mM in saliva and 2.92 and 3.04 mM in urine after carrot ingestion. Salivary nitrite concentration 0.53 mM was decreased to 0.45 mM after antibacterial mouthwash application (P-value <0.05). Conclusions: This study indicated that the intake of total nitrate/nitrite via leafy vegetables was higher than rooty ones. The chlorhexidine mouthwash is an appropriate recommendation to reduce the nitrite concentration in the human body for preventing the probable side effects of nitrate metabolites such as N-nitrosamines forming.

Background: Behavior is important in dental disease etiology, so behavioral interventions are needed for prevention and treatment. Motivational interviewing (MI) has been proposed as a potentially useful behavioral intervention for prevention of early childhood caries. Methods: Studies have evaluated the effectiveness of MI on reduction of the risk-related behaviors for early childhood caries (ECC) compared to dental health education (DHE) The aim of this systematic review was to assess the scientific evidence on MI applied to change parental risk-related behaviors. The potentially eligible studies involved the assessment of caries-related behaviors in caregivers receiving MI. Electronic search of English published literature was performed in February 2020 in the Scopus, Cochrane, PubMed, and Embase databases. Assessment of risk of bias was done by the Cochrane risk of bias tool. Results: Of 329 articles retrieved initially, seven were eligible for inclusion in this review. Four studies evaluated the behavior of tooth brushing and four studies assessed the cariogenic feeding practice, while only one study investigated the behavior of checking teeth for pre-cavities. Moreover, two studies examined dental attendance for varnish fluoride use and oral health-related knowledge. It was not possible to perform a meta-analysis. Conclusions: Generally, results support the application of MI to improve the “dental attendance behavior for fluoride use” and participants' knowledge. However, the results were inconclusive for other behaviors. We need further and better designed interventions to completely evaluate the impact of MI on specific ECC-related behaviors.

Background: In India, 42 million people suffer from thyroid diseases. One in 10 adults suffer from hypothyroidism. Although coverage of iodized salt utilization has increased after universal salt iodization, we are yet to achieve the goals of NIDDCP for which the present study was planned to identify the hidden factors. The aim is to identify the factors affecting thyroid hormone levels, their association with salt iodine content and suggest strategies for improvement based on patient perceptions. Methods: A hospital based prospective follow up study was conducted among 140 patients, with an in depth interview and testing of salt iodine content. Data were analyzed using the SPSS software. Results: 96 (69%) patients were of age 18–35 years. 129 (92%) were females, 120 (86%) were from rural areas, 95 (68%) were literate, 116 (83%) were unemployed, and 115 (82%) were of low socioeconomic status. Most of them had poor cooking practices and dietary habits. The T3, T4, and TSH levels were within the normal range in 84 (60%) patients. Only in 28 (20%) salt samples, the iodine content was adequate. The association between factors like intake of inadequately iodized salt (P < 0.01), rural distribution (P < 0.05), illiteracy, presence of the comorbid conditions (P < 0.0001), and thyroid hormone abnormality was found to be statistically significant. Conclusion: The factors that adversely affect thyroid levels were higher age, female gender, rural distribution, comorbid conditions and patients with low salt iodine were prone to abnormal levels. Monitoring salt iodine content, training of health care workers to create awareness were the key strategies proposed for improvement.

Background: One of the problems that nutritionists have always faced in research projects is the analysis of food intake of the subjects. Various approaches have been proposed in which the use of food frequency is one of the most used in this field. Many tools have been proposed in this area that aim of present research is to update and optimize one of the most common forms mentioned above. Method: In this study, we attempted to update and optimize the 147-item common food frequency questionnaire using USDA database. Moreover, the values of dietary antioxidant profiles, lipid ratios, dietary fat quality, atherogenic and thrombogenic indices, amino acids, flavonoids, and other requirements are included in the above tool to meet nutrition research needs. Results: The re-analysis of the obtained data with USDA Bank showed no difference due to the similarity of the source of information and the accuracy of the above instrument was confirmed. Conclusion: Due to the applicability of this tool, it can be recommended to researchers to use the above tool. We hope to see the Iranian database in the coming years to optimize the above tools based on the Iranian bank.

Backgroud: Many exercise approaches have been suggested for the treatment of nonspecific chronic low back pain. However, the best exercise approach is still unknown. The purpose of this study was to compare the effect of three exercise approaches based on the Postural Restoration Institute (PRI) and National Academy of Sports Medicine (NASM) on the pain management and motor control of men with nonspecific chronic low back pain. Methods: The study was designed with matched subjects. Thirty-three participants were randomly assigned to three training groups: NASM (n = 11), PRI (n = 11), and NASM-PRI integration (n = 11). Interventions: The participants in each group performed the exercise for eight weeks, three sessions per week and about one hour each session. Pain was measured using a visual analog scale (VAS) scale and functional disability using the Roland–Morris questionnaire. Also, the movement control impairment was measured by the movement control impairment test set. Results: Repeated measures ANOVA showed no significant interaction effect between pain perception, functional disability, and movement control impairment of the groups (P >.05). Conclusions: The findings suggest that different types of exercise rehabilitation were not significantly different on pain reduction, functional disability, and movement control impairment. It is suggested that the participant's preference for an approach should also be considered for encouraging them to adhere to exercise.

Background: Candida albicans is the most important opportunistic fungal that can establish infection in susceptible individuals. Iranian Propolis and Royal jelly are bee products that are traditionally used against fungal infections. This study was aimed to evaluate the antifungal effects of Iranian Propolis extract and Royal jelly against C. albicans in vitro. Methods: Antifungal activities of the extracts were performed according to microbroth dilution method in 96-well microdilution plates. The amount of minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC) based on counting the number of fungal colonies (CFU) were evaluated for each of Royal jelly and Iranian Propolis extracts against C. albicans compared with the control group. Results: In this study, the MIC, MIC₅₀, and MFC of Royal jelly on C. albicans were, respectively, 80, 103 ± 25, and 160 ± 34 mg/mL and for the Iranian Propolis alcoholic extract were, respectively, 0.030 ± 0.015, 0.0618 ± 0.027, and 0.0833 ± 0.0599 mg/mL. Conclusions: The results indicate that both Royal jelly and Iranian Propolis alcoholic extract are effective against C. albicans, but the former species has higher antifungal activity. If the clinical trials confirm the results of this study, Iranian propolis, as a new antifungal agent by replacing chemical drugs, can be used to develop antifungal medicinal herbs.

Background: Congenital hearing loss is one of the important illnesses that affect newborns. Early diagnosis and treatment are a challenge for medical authorities in developing countries to improve children's functional, intellectual, emotional, and social abilities. We aimed to study the prevalence of congenital hearing loss in northern Jordan community and identify factors that could affect hearing screening protocol. Methods: Prospective cross-sectional study of 1595 infants born in our hospital underwent hearing screening tests. Totally, 104 were tested in NICU and the rest examined in the nursery room using Otoacoustic emission (OAE) test as a primary testing tool. The patients were followed in the three hearing screening phases. Factors affecting screening results were studied and analyzed. Results: The total number of newborns who didn't pass the first OAE test in one or both ears were 90 (5.6%); 69 from the nursery group and 21 from the NICU group. In the 2^nd screening phase 21 (23.3%) didn't attend the appointment. Sixty-four passed the second screening OAE test. Five newborns (5.6%) had a second refer result in one or both ears and referred for a diagnostic ABR test. Three infants passed the test and two found to have bilateral hearing loss. Conclusions: Hearing screening test is conducted via a 3-phases-protocol. OAE is used in the first two phases and ABR in the third phase. Hearing results is significantly affected for infants admitted to NICU. The following factors increase OAE fail response: mechanical ventilation for more than 5 days, Hyperbilirubinemia, associated congenital anomalies. Mode of delivery doesn't have statistical significance on hearing screening results.

Background: Migraine is a prevalent health condition associated with significant pain and disability. Neurogenic inflammation has a key role in migraine pathophysiology. Curcumin is a well-known herb compound with anti-inflammatory function. This study was aimed to evaluate the effects of curcumin supplementation on clinical features, as well as on serum levels of calcitonine gene-related peptide (CGRP) and interleukin-6 (IL-6). Methods: This randomized double-blind placebo-controlled clinical trial was carried out on 44 women with migraine, receiving either 500 mg curcumin twice a day or placebo supplements for 8 weeks. Serum CGRP and IL-6 concentration, and clinical symptoms including headache severity, duration and frequency were measured at the baseline and end of study. Results: After 8-week intervention, compared with placebo, curcumin supplementation led to significand reduction in CGRP (P < 0.001), IL-6 (P = 0.041), severity (P = 0.001), and duration of headache (P = 0.007). Headache frequency showed marginal improvement in curcumin group, compared to controls (P = 0.052). Within-analysis indicated significant decrease in CGRP and severity (P < 0.001), frequency (P = 0.014) and duration (P = 0.003) and no significant decrease in IL-6 (P = 0.454), compared to baseline in curcumin group. There were no significant changes in body mass index (BMI), weight, percent body fat (PBF), and percent body muscle (PBM) between the two groups. Conclusions: Curcumin supplementation improved the pro-inflammatory markers and clinical features of migraine headaches and that could be contributed to could be to its anti-inflammatory properties.

Background: Identifying appropriate biomarkers for predicting type 2 diabetes (T2D) patients with increased HbA1c may prove helpful in preventing increased risk of cardiovascular disease (CVD). The present study was conducted to analyze the diagnostic performance of the atherogenic index log (TG/HDL-C) in T2D patients with increased HbA1c. Methods: Patients with T2D were classified into two groups according to having an HbA1c <8% or ≥8%. Atherogenic index was calculated from the logarithmic transformation of TG/HDL-C. Receiver operating characteristic curve was used to evaluate the diagnostic performance of log (TG/HDL-C). Insulin and fasting glucose concentrations were used to determine homeostasis model assessment for insulin resistance (HOMA-IR). Results: Compared with the patients with HbA1c <8%, log (TG/HDL-C) was significantly higher in the patients with HbA1c ≥8% (p = 0.025). The atherogenic index was a biomarker for the prediction of T2D patients with HbA1c ≥8% versus patients with HbA1c <8%, as shown in the area under the curve (AUC = 0.61, P = 0.013). The best cut-off point of log (TG/HDL-C) for the discrimination between patients with HbA1c ≥8% versus patients with HbA1c <8% determined to be 0.44. Atherogenic index was significantly and positively correlated with HOMA-IR in female patients (r = 0.313, P = 0.003) and in patients with an age ≥5o (r = 0.253, P = 0.021). Conclusion: The log (TG/HDL-C) in addition to its known association with enhanced CVD risk could be considered as a biomarker to predict T2D patients with poor glycemic control. Therefore, the increased ratio may provide a simple and useful way of identifying poor glycemic T2D patients who are possibly to be at elevated risk of CVD.

Background: Mortality rate in low-birth-weight infants is almost 30 times more than that in those with normal weight, so the birth of low-birth-weight infants is one of the most serious health problems in the world. Therefore, this nested case-control study was conducted to investigate the risk factors associated with low birth weight among infants in the rural population of Kerman province. Methods: This nested case-control study was performed in rural areas of Kerman province, southeastern Iran. Case (n = 155) and control (n = 310) groups were selected using risk set sampling. Data were analyzed through Point and distance estimation (OR, CI) using conditional logistic regression method by Stata-12 software. Results: The results of multivariate analysis showed that maternal BMI [OR = 0.3, CI 95% (0.1, 0.9)], gestational age [OR = 3.8, CI 95% (0.9, 6.1)], history of stillbirth [OR = 4.8, CI 95% (1.3, 11)], history of pregnancy bleeding [OR = 3.7, CI 95% (0.7, 9)], pregnancy craving [OR = 3, CI 95% (1.1, 3.8)], and the level of health workers' care [OR = 0.4, CI 95% (0.1, 0.9)] are the risk factors affecting LBW in infants (P < 0.05). Conclusions: Low birth weight is a multifactorial phenomenon. Therefore, raising public awareness, providing nutritional counseling to pregnant mothers, regular referral to health homes to receive health care, and identifying risk factors and referral to higher level specialists and health centers can be effective in reducing the risk of birth of LBW infants.

Background: Hypertension is a leading risk factor for cardiovascular diseases with prevalence of 33% in urban and 25% in rural population in India. Studies have suggested that hypertension significantly affects the sleep quality and quality of life of subjects. Therefore, this study aimed to establish a correlation between sleep quality, quality of life, and hypertension in Uttarakhand. Methods: This observational cross-sectional study was carried out on hypertensive subjects at a tertiary care hospital in Uttarakhand following ethics approval. After taking consent from participants, blood pressure and anthropometric measurements were recorded. Then, their sleep quality and quality of life was assessed using Pittsburgh sleep quality index (PSQI) and WHO-QOL BREF questionnaire respectively. Statistical analysis was then carried out to correlate these parameters. Results: 168 participants were recruited for this study, with 43.5% males and 56.5% females. It was found that 77.4% of these subjects were having poor sleep quality with the mean global PSQI score as 7.90 ± 3.713. These subjects assessed their Quality of life to be worst in physical domain (12.68 ± 3.13), followed by psychological, social relationship domain and environment domain. A significant association was found between sleep quality and different stages of hypertension (P value = 0.039) but quality of life and stages of hypertension have no significant association (P value > 0.05). Conclusions: Sleep quality, quality of life and blood pressure are correlated. So, clinicians should also focus on improving their patient's sleep quality and quality of life besides pharmacological treatment.

Background: Calorie restriction (CR) is known as a nutritional gold standard for life extension and different studies have shown that insulin-like growth factor (IGF1) reduction through CR may be involved in CR's anti-aging effects. Besides, time-restricted-feeding (TRF) is also highlighted due to more feasibility and positive health effects. We designed this study to compare the effects of CR and TRF on IGF1 and other metabolic parameters. Methods: Fifty-two male Wistar rats (3 weeks old) were subjected to either a control (CON, n = 11) diet or high-fat diet (HFD, n = 42) for 17 weeks. In the second phase of the study, the HFD group were divided into four groups (n = 9) 1) 30% CR, 2) Night Intermittent Fasting (NIF, active phase), 3) day intermittent fasting (DIF, rest phase), and 4) Ad-Libitum (AL) with a standard diet for 10 weeks. Blood samples were collected at the end of both phases. Results: HFD increased IGF1 and deteriorated lipid profiles, except for triglycerides (P: 0.018, 0.008.0.012, 0.032) but CR in these obese subjects could not lower the IGF1 level. HDL significantly decreased in DIF compared to CON and CR (P; 0.001). Meanwhile, HOMA-IR increased in DIF and was significant compared to CR (P: 0.002). Serum glucose levels decreased in CR compared to all groups except for CON (P: 0.001). Conclusion: Data indicates the role of previous obesity on the effect of CR on the IGF1 level and highlights the effect of inappropriate time of food intake on HDL and APOA1.

Background: Given the limitations of traditional citation indicators, more indicators are needed to examine the effectiveness and improvement of existing indicators. The present study aimed to investigate the association between Altmetrics activity and quality citation indicators in Iranian journals based on Clarivate Analytics, Scopus, and Medline. Methods: The research was carried out using Altmetrics method through scientometric approach. The population of the present study was Iranian medical journals, which were available at three databases of Clarivate Analytics, Scopus, and Medline. In order to obtain quality information, we've used the indicators of CiteScore, SJR, and SNIP at Scopus database as well as the impact factor at JCR database; besides, to find Altmetrics indicators and Altmetrics scores of articles, the Altmetrics explorer database was used. Results: About 16% of the articles in the reviewed journals were cited at least once in the social media and had Altmetrics scores. Among the reviewed journals, the highest rate of social media coverage was related to the Iranian Journal of Basic Medical Sciences, and the highest Altmetrics score obtained from the mean Altmetrics score of the papers was related to Cell Journal (Yakhteh). A review of quality indicators of journals with Altmetrics coverage and Altmetrics score of journals showed that there was a significant and positive correlation between the Altmetrics score and impact factor. However, any significant association was neither found between the journal's coverage and SiteScore, SNIP, SJR, nor between the journal's Altmetrics score and quality indicators. Conclusions: According to the results of this study, policy makers of scientific journals should adopt strategies that bring about social media presence; thus, we will find further Iranian articles in the social media.

Backgroud: Hearing loss is the most common congenital disorder that appears as a unilateral or bilateral deafness. Early detection by screening and appropriate intervention lead to better oral communication and language development. The aim of this study was to evaluate the cost per new case identification of neonate hearing screening. Methods: The cost effectiveness of two stage hospital based newborn hearing loss screening was evaluated in this study. We gathered data for 11168 newborns born in 10 hospitals. We included a direct cost and new case identification as cost and outcome measures from health system prospective in our model. Results: We found 19 new cases with hearing loss from 11168 screened neonates (1.7 per 1000). The referral rates in the first and second stages were respectively 28% and 7%. The total cost of screening program was 132167 US$. The main cost item is screening test (OAE). Conclusions: We concluded cost per new case detection is 6956 US$ in Iranian neonate hearing screening program. Almost, it is equal to GDP per capita and it may be cost effective. Since there are many strategies to screening of newborn, it is suggested that all alternative screening strategies be analyzed by a cost effectiveness method to find the best strategy for hearing loss screening.

Background: Over the last 20 years, internet-delivered cognitive behavior therapy (ICBT) has been tested in a large number of randomized controlled trials, often with positive results. However, it is not widely known about the efficacy of ICBT as compared to face-to-face cognitive behavior therapy (CBT). Methods: In the present systematic review and meta-analysis, ICBT for treatment of anxiety disorders was directly compared to face- to-face CBT within the same trial. This study aimed to reinvestigate the effect of ICBT compared to face-to-face CBT for anxiety disorders. A total of 8 studies out of the 236 articles screened met all the inclusion criteria. The included studies targeting five different anxiety disorders, social anxiety disorder, adolescent anxiety, panic disorder, spider phobia, and fear of public speaking, had been carried out in Australia, Spain, and Sweden. The total number of participants was 348 in ICBT and 316 in face-to-face conditions. Results: The results of our meta-analysis are interesting both from theoretical and practical standpoints, which showed a pooled effect size posttreatment with Hedges' g = 0.01 (95% CI: −0.16 to 0.18), Conclusions: ICBT and face-to-face CBT created equivalent overall effects. in treatment of anxiety disorders. Since there have been similar systematic reviews about anxiety disorders so far, and in majority of them, ICBT has not been compared against face-to-face treatment. More research is needed to establish the general equivalence of the two treatment formats. Also, understanding what makes ICBT work is a challenge for future research.

Background and Aim: Lifestyle changes are associated with an increased incidence of stroke especially in young adults. The purpose of this study was to investigate the lifestyle of ischemic stroke cases under the age of 50 years. Methods: This descriptive cross-sectional study was conducted on young adults with ischemic stroke who were admitted to some hospitals, Tehran, Iran between 2018 and 2019. Total lifestyle information collected in the form then was compared in males and females. Results: Totally 11% ischemic stroke was under age 50 years. 60.7% of young adult patients were men. There was significant difference between body mass index (BMI) (P = 0.03), type of job (P = 0.04), physical activity (P = 0.02), fruit and vegetables consumption, and gender of patients (P = 0.02). Conclusion: According to the association between inappropriate lifestyle and ischemic stroke in young adults, it is recommended to set preventive medicine and health promotion units with insurance coverage in all clinics for risk assessment of stroke in healthy general population specialty young adults.

Background: Aristolochic acid I (AAI) is an extract from Chinese herbs that causes progressive interstitial nephritis. The aim of this research is to know whether chymases play the crucial role in AAI-induced nephropathy. Methods: The mice were treated with AAI via intraperitoneal injection and the accumulated AAI dosages are 30 mg/kg of body weight for two, four, six, and eight weeks. The animals were sacrificed after another two or four weeks for nephropathy development. Collection of blood, urine, and kidney samples for the further biochemical analysis, hematoxylin–eosin (H and E) and Masson's trichrome stained to detected pathologic, and MMP2 and MMP9 activity assays. Results: After the treatment of AAI, of the mice, their body weights were decreased (P < 0.01), and concentration of creatinine and blood urea nitrogen (BUN) in serum (P < 0.01) and urine collection were increased (P < 0.01). In the renal tissue sections, high amount of inflammatory cells were found by H and E stain, and increased fibrosis in renal interstitial tissue were observed by Masson's trichrome stain. In mice kidney tissue, significantly increased chymase activity after treatment of AAI was found (P < 0.01), but ACE activity did not show significant changes. In ACE KO mice, increased MMP2 and decreased MMP9 activity were found in the AAI-treated mice compared with AAI-untreated control (P < 0.01). Conclusions: Moreover, it was also observed that the deficiency of ACE would accelerate the disease development of AAI-induced nephropathy. These results may help to know more information about the role of AAI-induced chronic kidney disease and can be applied in developing new drug targets for nephropathy.

Background: Although the main burden of the Road Traffic Injuries (RTIs) is on the health sector, compared with other sectors, no clear definition is available about its role in the prevention of the RTIs. So this study has been performed to define the role of the health sector in the prevention of RTIs –before the incidence. Methods: In this qualitative study with a grounded theory approach, the possible roles of the health sector in the prevention of the RTIs were identified in three phases. At the first stage of the study, the roles of the health system in the prevention of the RTIs identified from the literature. In the next step, semi-structured interviews (ranged from 45 to 90 minutes) with 42 experts were done for identifyingroles. Finally, Consensus attained on the identified roles by using the Delphi technique and with the participation of 30 experts. Results: Literature review and interviews resulted in 42 and 86 roles for the health sector in the prevention of the RTIs, respectively. After removing the duplicates and merging the similar, 46 roles were entered into Delphi. Five roles excluded in the Delphi leaving 41 roles in 7 dimensions of communications (6 roles), intra-sector cooperation (9 roles), inter-sector leadership (6 roles), evaluation (6 roles), research (5 roles), education (3 roles), and health-specific issues (6 roles). Conclusions: It seems that the health sector can help an impressing reduction of the RTIs by playing the roles identified in this study, which the most important of them is Communication/Informing role. So first the general public and then the health sector itself would benefit from it.

Background: People are increasingly using mobile phones rather than fixed telephones. Nearly everyone has a mobile phone and the vast majority of these are smartphone. The patterns of smartphone activities may put a significant number of populations especially students at risk of negative ocular problems. To determine the prevalence, pattern, and impact of smartphone use on ocular health among University students. Methods: A cross-sectional study was conducted and 760 male and female students were selected from Medical and Pharmacy Colleges by multistage random sampling. A self-administered structured questionnaire including sociodemographic and visual manifestations data was used to collect data. SPSS program version 22 was used to analyze data. Results: Out of 760 students selected, 546 (71.8%) responded. The overall prevalence of smartphone use was 90.84%. However, the age range for the beginning of smartphone use was 12–18 years old (68.3%). In addition, the daily duration of smartphone use was 4–6 h/day (30.2%). Furthermore, females believed that they use smartphone more than usual compared to males. Moreover, ocular pain and/or dryness after prolonged time spent on smartphone use were more among smartphone users (39.7%). Finally, most of the students (66.0%) had one or more ocular problems after smartphone use. Conclusions: There is an association between smartphone use and occurrence of ocular manifestations. Health education programs on smartphone use and its ocular hazards are highly recommended.

Background: The aim of the present study was assessing the changes in Iranian household food basket. The Households Income and Expenditure Survey (HIES) data of 717,432 of Iranian households from 1991 to 2017 were used in this repeated cross-sectional study. Methods: A cross-classified random-effects modeling (CCREM) specifications of hierarchical age-period-cohort (HAPC) in two models, one without controlling for the effects of key individual characteristics, namely socioeconomic status; household size; place; and household head sex, and another one with controlling for the effect of mentioned variables, was used in the present study. Results: The present study showed that the equivalent to an adult male daily consumption of “total calorie” (P value = 0.0001) and “fats, oils, sugars, and sweets” (P value = 0.0002) had an increasing trend from 1991 to 2004 and a decreasing trend from 2005 to 2017 among Iranian households. The daily consumption of “bread, cereal, rice, and pasta” (P value = 0.0001) had a decreasing and “fruits” (P value = 0.0002) had a rising trend during periods. After an increasing trend for the “meat, poultry, fish, eggs, legumes, and nuts” (P value = 0.0002) and “vegetable” (P value=<0.0001) by 2004, there was a decreasing trend from 2004 to 2017, but the share of them in the total calorie consumption increased. The “dairy” (P value = 0.0002) consumption had a decreasing trend in recent years. Conclusions: Iranian household food basket, during these years, had significant changes that some of them (increase in the share of the vegetables and fruits in the total calorie intake) are positive and some of them are negative (decrease in the consumption of dairy).

Background: Although the hospital is known as a safe place for treating patients, due to various reasons, it is prone to several internal hazards, including fire. This study aimed to identify the factors affecting hospital emergency evacuation during fire. Methods: This was a systematic review conducted according to the PRISMA guideline. Thematic Content analysis was utilized to analyze and extract results. We found the studies investigating the factors affecting hospital emergency evacuation during fire through a comprehensive search in various data resources (MEDLINE, Web of Science, Google Scholar, Embase, ProQuest, Scopus, IRANMEDEX, SID, ISC, and Magiran) and other sources from the beginning of January 2000 to the end of December 2019. Thematic Content analysis was also employed to analyze. Results: At first and based on the initial search, 4484 studies were identified, and 48 articles were finally included in the study. Based on the results; five main themes along with 10 sub-themes were identified. The themes included the incident's characteristics, response measures, hospital preparedness, hospital residents, and hospital building, and the sub-themes were emergency evacuation features, fire characteristics, command, operation, patients' and staff's characteristics, planning, logistics, and structure and design hospital. Conclusions: Based on the results of the present study, hospital preparedness as one of the most important factors can reduce the hospital evacuation time. Therefore, hospitals can ensure a timely and more effective response in emergency evacuation during fire by improving their preparedness.

Background: Diabetes distress (DD) is common among the patients with type 2 diabetes (T2D), but few studies investigated this problem and its related factors in the elderly population. This study has focused on the prevalence rate of DD and its determinants in community-dwelling elderly in Qom, Iran. Methods: This study was cross-sectional. A total of 519 subjects community-dwelling with T2D participated in the study. Collected data contained sociodemographic information, some clinical variables (body mass index and duration of diabetes) knowledge, attitude, and self-efficacy. Participants' distress was measured via diabetes distress scale (DDS). The cut of 3 (≥3) was considered as the presence of distress. Also, the attitude, self-efficacy, and knowledge about diabetes were measured by questioner. Multiple logistic regression analysis was applied to detect predictors of DD. Results: The mean age of the participants was 68.38 ± 6.78 and 53.6% were female. Among the participants, 48.6% were identified with positive DD. According to the results of logistic regression analysis, being female (odds ration [OR] = 1.688, P = 0.009), being widowed or divorced (OR = 1.629, P = 0.027), being over-weight or obese (OR = 1.627, P = 0.027), and having less than 10 years in disease duration (OR = 1.721, P = 0.029), attitude (OR = 0.590, P < 0.001), and self-efficacy (OR = 0.658, P = 0.009) were identified as the independent predictors of DD. No significant association was found between DD and age, occupational status, education level, and knowledge (P > 0.05). Conclusions: The prevalence of DD is considerable among the elderly in Qom. It seems that more attention should be paid to the mental aspects of the patients with T2D specially in high risk groups.

Background: Musculoskeletal disorders in diabetic patients are associated with pain and disability, and thus, a significant reduction in quality of life. The current study was conducted with the aim of evaluating the frequency and prevention of rheumatologic manifestations and their association with blood glucose levels in diabetic patients. Methods: In this cross-sectional study, a total of 273 patients with type II diabetes, referred to the diabetes clinic, were selected by using the census method. Using a checklist, demographic, and clinical data, including duration of diabetes, blood glucose level, HbA1c, type of diabetes, BMI, history of smoking, blood pressure, serum cholesterol level, triglyceride, HDL, LDL, and musculoskeletal disorder type were analyzed using SPSS20 software application using independent t-test. Modeling was performed to obtain the best fit using logistic regression. The significance level was considered less than 0.05. Results: 62.6% of patients had at least one of the rheumatologic complications. The most common complication was related to carpal tunnel syndrome (26.4%), followed by muscle contraction (23.8%). By moderating the effects of other variables, the odds ratio for rheumatoid complications was obtained as 1.74 with one unit of increase in HbA1c, which was statistically significant. In examining the influential variables, high age, gender, smoking, and BMI showed statistically significant effects (). Conclusions: Given the high prevalence of musculoskeletal disorders in diabetic patients, early diagnosis and timely treatment of the complications are crucial. It is recommended that musculoskeletal examinations be included as an important part of regular care for these patients.

Context: Obesity is associated with endothelial dysfunction and cardiovascular diseases. Adiponectin and fibroblast growth factor 21 (FGF21) as hormones are highly contributive in cardiovascular system, while they are disrupted through obesity. Weight-bearing high intensity interval training (HIIT) as an effective procedure in preventing obesity-related complications in adults with obesity may be limited due to the subjects' muscular weakness and complications interfering walking. Aims: The purpose of this study was to assess the effectiveness of non-weight bearing all extremity HIIT (all ex. HIIT) on FGF21, adiponectin, nitric oxide (NO), and flow mediated dilation (FMD) in overweight and obese women. Methods: Thirty healthy overweight and obese sedentary university female students within 20.53 ± 1.50 age range and BMI ≥27 kg.m^-2 were assigned in two experimental and control groups. All ex. HIIT consisted of 4 × 4 min at 85–90% max HR with an interspersed with 3 × 3 min recovery per round at 70% max HR by upper and lower ergometers in a simultaneous manner on 10 weeks of four sessions of 40 min each. FGF21, adiponectin, NO, FMD, weight, waist and maximal oxygen uptake (VO_2max) were measured in pre and post-tests. Paired sample t-test and analysis of covariance are applied for statistical analysis. Results: Results indicated a significant increase in adiponectin (P ≤ 0.01) and FMD (P ≤ 0.001), while there existed no changes in FGF21 at (P ≥ 0.10) and NO (P ≥ 0.84). The weight and waist decreased at (P ≤ 0.001), and the VO_2max increased at (P ≤ 0.001). Conclusions: All ex. HIIT may be a safe alternative for overweigh and obese women who have complications with weight-bearing exercises, and may increase adiponectin, and improve the FMD, aerobic fitness, and body composition.

Background: The long-term efficacy of low-dose aspirin for primary prevention of cardiovascular (CV) events in postmenopausal women with type-2 diabetes is controversial. Therefore, it is recommended only on an individual basis, recommendation of grade C. Methods: We enrolled 275 consecutive postmenopausal women with type-2 diabetes, without an increased bleeding risk and without preexisting CV disease as coronary artery disease, stroke, and peripheral vascular disease, but with a high risk assessed by score >10%, aged 60–69 years. All were receiving aspirin (75–100 mg daily), aspirin group (AG). 170 postmenopausal women with type-2 diabetes and without preexisting cardiovascular (CV) disease, but not on aspirin treatment, despite a high risk assessed by score >10%, were control group (CG). Mean age was 66 ± 4 years for AG and 65 ± 7 years for CG. Our goal was to identify the prevalence of low-dose aspirin prescriptions in these populations according to different clinical conditions. Results: Women with only high risk were 41/275 (15%) on AG and 72/170 (42.3%) on CG, Chi-squared 41, Odds ratio 0.2, c.i. 95%, P < 0.0001. Women affected by metabolic syndrome were 105/275 (38.1%) on AG and 47/170 (27.6%) on CG, Chi-squared 5.1, Odds ratio 1.6, c.i. 95%, P < 0.02. Women affected by metabolic cardiomyopathy were 111/275 (40.3%) on AG and 44/170 (25.9%) on CG, Chi-squared 8, Odds ratio 1.8, c.i. 95%, P < 0.004. Women affected by diabetic cardiomyopathy were 18/275 (6.6%) on AG and 7/170 (4.2%) on CG, Chi-squared 1.2, Odds ratio 16, c.i. 95%, P < 0.2 n.s. Conclusions: Low-dose aspirin in our population is prescribed preferentially in postmenopausal women with type-2 diabetes when affected by metabolic syndrome or metabolic cardiomyopathy, at the opposite women with only high risk have lower chance to receive aspirin.

Kefir (a traditional collection of beneficial microbes) is a popular accepted beverage that usually consumed for its health-promoting effects in Iran and Caucasian regions. In this case, the beneficial effects of a kind of kefir were reported on glycated hemoglobin A (HbA1c) level, and weight loss of an indexed diabetic mellitus patient. The patient as a supplement of her routine anti-diabetic drugs consumed Probiotic kefir. After 90 days of consumption the patient, have about 4 kg weight loss, and her HbA1c decreased from 7.9 to 7.1. Depth of sleep and energizing effects of kefir was also from very remarkable findings of this case, as reported by the patient.

Background: The link between diet quality, food insecurity (FI), and metabolic syndrome (MetS) remains unclear in obese adults. The aim of this study was to examine the association of diet quality and FI with MetS in obese Iranian adults. Methods: This cross-sectional study was conducted on 300 obese adults. Dietary intake was assessed using a validated 168-item food frequency questionnaire. Diet quality and FI were measured using the Diet Quality Index-International (DQI-I) and an adapted USDA2000 household food security status questionnaire, respectively. MetS was defined according to the International Diabetes Federation diagnostic criteria. Association was determined using logistic regression analysis adjusting for potential confounders. Results: MetS subjects had lower DQI-I score than subjects without MetS (67.5 ± 8.7 vs 71.5 ± 7.4, P = 0.05). The prevalence of food insecurity was 48.6% (95% confidence interval (CI): 41.2, 56.1) in MetS subjects and 39.4% (95% CI: 29.4, 49.9) in subjects without MetS. After adjustment, participants in the fourth quartile of DQI-I score had 70% lower odds of MetS (Adjusted odds ratio [AOR], 0.3; 95% CI: 0.1–0.7), 70% lower odds of hypertriglyceridemia (AOR, 0.3; 95% CI: 0.2–0.7) and 60% lower risk of reduced high-density lipoprotein [HDL] (AOR, 0.4; 95% CI: 0.2–0.9) compared with the first quartile. Obese food insecure adults had 60% higher odds of high blood pressure (AOR, 1.6; 95% CI: 1.0–2.6) and 70% higher odds of hypertriglyceridemia (AOR, 1.7; 95% CI: 1.0–2.8) compared with food-secure obese adults. There was no statistically significant interaction observed between DQI-I and food insecurity on MetS. Conclusions: Lower DQI-I score and food insecurity were associated with an increased risk of MetS and some features such as hypertriglyceridemia, reduced HDL, and high blood pressure in obese Iranian adults.

Background: The effect of exercise on the cerebellum cells in diabetic-induced neuropathy and healthy situations is not clear yet. Growth-associated protein 43 (GAP-43) and adenylyl cyclase-associated protein 1 (CAP-1) proteins can restore nerve cells. This study aimed to investigate the effect of aerobic exercise on GAP-43 and CAP-1 and their mRNA in the cerebellar tissue of diabetic-induced neuropathy and healthy Wistar rats. Methods: Around 40 healthy male Wistar rats with a mean weight of 271 ± 11.2 g were divided randomly into four groups; healthy aerobic exercise, diabetic-aerobic exercise, healthy-control, and diabetic-control. The exercise group performed aerobic exercise 5 days per week for 6 weeks. Results: Exercise increased CAP1 protein in the cerebellum tissue of healthy (P = 0.002) and diabetic (P = 0.002) groups compared with matched control groups. The effect of exercise on CAP1 was greater in diabetic compared with the healthy group (P = 0.002). The expression of CAP1 mRNA in the cerebellum was higher in the healthy exercise compared with the healthy control group (P = 0.002) and in the healthy exercise compared with the diabetic exercise group (P = 0.026). GAP43 protein was lower in the healthy exercise compared with the healthy control group (P = 0.002) while it was higher in diabetic exercise compared to the healthy exercise group (P = 0.002). Expression of GAP43 mRNA in the cerebellum was higher in the healthy (P = 0.002) and diabetic (P = 0.002) exercise groups compared to non-exercise matched groups and in the diabetic control group compared with the healthy control group (P = 0.002). Exercise improved latency in diabetic (P = 0.001) and healthy exercise groups (P = 0.02). No significant difference was found in blood glucose between exercise and control groups (P > 0.05). Conclusion: Exercise improved cerebellar functions in healthy and diabetic rats, probably mediating by CAP1 protein, even without changing blood glucose.

Background: A low level of vitamin B6 may theoretically cause symptoms of depression. Aims: To investigate the effect of vitamin B6 on the prevention of postpartum depression (PPD) among mothers at risk for PPD. Methods: This single-blind, placebo-controlled clinical trial was conducted on 81 pregnant women who were at risk of PPD from February to July 2016 at six selected health centers in Isfahan, Iran. A simple random sampling method was adopted. Forty cases and 41 controls received 80 mg vitamin B6 and placebo, respectively from the 28^th week until the end of pregnancy. The risk of PPD was assessed as the main inclusion criteria using a structured clinical interview using hospital anxiety-depressive scale (HADS), social support appraisals scale (SS-A), and Holmes and Rahe life change and stress evaluation questionnaire (HRLCSEQ). The Edinburgh postpartum depression scale (EPDS) was used to assess the rate of depression prior to and 1.5 months after the intervention (end of pregnancy). Data were analyzed using SPSS 20 and statistical tests (Chi-square, independent t-test, Mann-Whitney's, and Exact Fisher Test). Results: Forty-three subjects were assigned to each group and the final analysis comprised 81 subjects (40 in the case and 41 in the control groups), the mean age of the case and control groups being 5.8 ± 29.6 and 4.6 ± 28.2, respectively. The mean depression score was 10.4 ± 1.4 in the case and 9.3 ± 4.2 in control groups (P = 0.34) before and 4.2 ± 2.7 in the case and 10.4 ± 3.4 in control groups (P < 0.001) after intervention. Conclusions: Vitamin B6 has a positive effect on reducing postpartum depression scores among mothers at risk for PPD. These may be clinically useful for preventing PPD in high-risk women.

Background: Globally Noncommunicable Diseases is lead causes of mortality. This calls for the need of sensitive and cost appropriate screening tools to identify asymptomatic healthy individuals with higher risk and/or subclinical NCD in the community. The study aims to generate pilot evidence based, validated, good quality, cost appropriate, and sustainable risk assessment score for NCD for developing countries like India. Methods: This descriptive retrospective study of diabetic camp data of 84 patients was conducted. A risk score having 10 questions and three measurements for NCDs appropriate for Indian communities was generated. It was compared to IDRS, FINDRISC, FRS, CBAC, and WHO/ISH prediction charts. Results: The study finally included 36 patients with NCD as case and 44 subjects without NCD as control. The means of weight, waist circumference, blood pressure, and blood sugar were significantly different among the two groups. AMNRAS of more than 14 was highly predictive for an individual to be at risk of NCD or sub clinical case of NCD requiring evaluation. The proposed cut-off of 8 for AMNRAS, the sensitivity and NPV was highest compared to other score, 88.9% and 84.6%, respectively. Score for the Area under curve was significantly higher for AMNRAS [0.83 (0.74 to 0.92)] compared to other scores. Conclusions: AMNRAS has higher performance parameters than the other five tested in the present study. Other scoring system performs only modestly in discrimination of NCD cases. The accuracy of AMNRAS for NCD risk will have to be determined in large size cohorts.

Background: Subcutaneous adipose tissue (SAT) relative to the other adipose tissues may have different roles in health and insulin resistance. The purpose of this study was to investigate the effectiveness of aerobic exercise on SAT thermogenesis indices, serum orexin-A (OXA), and insulin resistance in high-fat diet-induced obesity male Wistar rats. Methods: Thirty-two male Wistar rats with an average weight of 180–200 g were randomly assigned into 4 equal groups: normal fat diet (NFD), high-fat diet obesity (HFDO), normal fat diet after high-fat diet obesity (HFDO-NFD), and aerobic exercise group with normal fat diet after high-fat diet obesity (HFDO-AEX). Fasting levels of serum OXA, insulin, FBS, high-density lipoproteins, low-density lipoproteins, cholesterol and gene expression of peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC-1α) and UCP1 in SAT were evaluated. Samples were taken in the HFDO group after obesity-induced and in other groups 48 h after 8 weeks of aerobic exercise. Results: The results showed that HFD significantly decreased serum levels of OXA, HDL-c and gene expression of PGC1α and UCP1 in SAT. In addition, it caused a significant increase in Lee index, FBS, insulin resistance, and serum lipid profile in comparison with the NFD group (P ≤ 0.001). Aerobic exercise significantly modified the changes caused by HFD to the normal levels (P ≤ 0.001). Conclusions: These data suggest that aerobic exercise caused an improvement in insulin resistance and blood lipid profiles through an increase in the serum level of OXA and alteration in the SAT phenotype from white to brown or beige.

Background: This study was performed to determine the association of Pre–hypertension/hypertension (pre-HTN/HTN) with leisure-time activities and morning exercise at school in a sample of Iranian adolescents. Methods: This secondary study has done using data of 1992 adolescents participated in of Isfahan Healthy Heart Program. The outcome variable was having/not having pre-hypertension/hypertension (pre-HTN/HTN). The students with Blood pressure (BP) between 90^th to 95^th percentiles were considered as positive pre-HTN and students with BP >95^th percentile were considered as positive HTN. Students with pre-HTN or HTN were considered as positive pre-HTN/HTN. The asked leisure-time activities were categorized in three group including first (ping-pong, basketball, and volleyball), second (football, walking, and bicycling) and sedentary activities (watching TV, studying, and computer gaming), using factor analysis. Results: The prevalence of pre-HTN and HTN was 16.1% and 6.7%, respectively. Based on multiple logistic regression pre-HTN/HTN was associated just with sedentary activities and morning exercise at school. Odds Ratio (95% confidence interval) for sedentary activities and morning exercise at school was 1.51 (1.13–2.01) and 0.63 (0.44–0.89), respectively. Conclusion: We observed adolescents who engaged in morning exercise at school had lower prevalence of HTN while those who spent more times on sedentary activities were in higher risk for HTN. We suggest to permanent holding of morning exercise and educational programs on healthy lifestyle skills for adolescents by schools.

Background: Weight management is the key to prevent and treat the adverse consequences of overweight and obesity. The aim of this study was to compare the effect of consuming milk and pistachio snacks on anthropometric indices in overweight or obese women. Methods: In this randomized crossover trial, 60 overweight or obese women with a mean age of 24 ± 4.2 years were randomly divided into two groups. Women in the milk group received 200 mL/day low-fat milk while women in the other group received 30 g/day pistachio for 4 weeks. After a 6-day washout period, the participants received a similar intervention in a crossover manner. Results: Out of the total 60 participants, 52 completed the study. At the end of the study, the weight of women in the milk group significantly decreased (70.8 ± 8.4 vs. 69.9 ± 8.3, P value = 0.001). No statistically significant changes were observed in the weight of participants in the pistachio group (70.3 ± 8.4 vs. 70.6 ± 8.3, P value = 0.06). Further analyses showed a slightly significant beneficial effect on waist circumference (WC) (P-value =0.068) and body mass index (BMI) in the milk group P value = 0.01). Conclusions: Based on the observed positive effects of milk intake on weight loss in this crossover study, milk consumption may be considered an appropriate snack in weight loss programs in overweight or obese women.

Background: The purpose of this study was to determine the effect of systematic corrective exercises on the static and dynamic balance of students with pronation distortion syndrome. Methods: In this randomized controlled clinical trial study, 30 volunteers were selected and randomly divided into the control and experimental groups (15 subjects per group). The experimental group performed systematic corrective exercises for 12 weeks, while the control group performed the routine exercise. Static and dynamic balance was evaluated before and after the interventions. The data were analyzed using independent and paired t-tests (P < 0.05). Results: The results showed significant improvement (P < 0.05) in the static and dynamic balance in the experimental group, but not in the control group. A significant difference was evident between the experimental and control groups in terms of static and dynamic balances, in static balance including Flamingo balance test (42.26 ± 5.35 vs. 10.13 ± 1.92) stabilometr (1.23 ± 0.48 vs. 3.71 ± 1.02), and in dynamic balance including star excursion balance test (anterior direction 82.4 ± 6.2 vs. 66.7 ± 6.9, Posterior-internal direction 87.8 ± 4.7 vs. 69.6 ± 6.3, posterior-external direction 86.06 ± 6.93 vs. 67.2 ± 6.2), stabilometr (3.8 ± 0.6 vs. 11.18 ± 1.8) (P < 0.05 for all variables). Conclusions: It can be concluded that systematic corrective exercises improve static and dynamic balance in students with pronation distortion syndrome and it could be recommended as modalities for these people.

Background: The World Health Organization has identified COVID-19 as a public health emergency and is urging governments to stop the virus transmission by adopting appropriate policies. In this regard, authorities have taken different approaches to cutting the chain or controlling the spread of the disease. The aim of this study was to determine the approaches to biological epidemics and related prevention tools with emphasis on COVID-19 disease. Methods: The present study was a systematize study of publications related to the prevention strategies for Covid-19 disease. The study was carried out based on the PRISMA guidelines, CASP and AACODS. The data resources included ISI/WOS, PubMed, Scopus, science direct, Ovid and ProQuest. WHO website, published reports of countries, as well as the Worldometer website were evaluated. The time-frame of the study was from 1 December 2019 to 30 May 2020. Results: The study findings showed that in order to confronting the COVID-19 epidemic, in general, there are three approaches of “mitigation”, “active control”, and “suppression” and four strategies of “quarantine”, “isolation”, “social distance”, and “lockdown” in both individual and social dimensions to deal with epidemics. Selection and implementation of each approach requires specific strategies and has different effects when it comes to controlling and inhibiting the disease. Conclusion: One possible approach to control the disease is to change individual behavior and lifestyle. In addition to prevention strategies, use of masks, observance of personal hygiene principles such as regular hand washing and non-contact of contaminated hands with the face, as well as observance of public health principles such as sneezing and coughing etiquettes, safe extermination of personal protective equipment must be strictly observed. The use of the previous experiences in the world, along with the current experiences of countries, can be very helpful in choosing the accurate approach for each country in accordance with the characteristics of that country and lead to the reduction of possible costs at the national and international levels.

Background: Oral lichen planus (OLP) is a relatively common chronic autoimmune disease. In the present study, we tried to correlate the histopathological criteria of WHO and modified WHO (mod.WHO) classification systems using two methods, namely, intraobserver and interobserver observations in these samples. Methods: This cross-sectional study was performed on 64 microscopic slides with the diagnosis of the OLP lesions, based on both clinical and histopathological features. At first, each pathologist individually (as intraobserver) examined microscopic slides based on both histopathologic diagnostic criteria. Later, three pathologists in a group (as interobserver) reevaluated microscopic slides 2 months later in the second phase of the study, based on both systems. Eventually, the findings were statistically analyzed with Cohen's kappa coefficient (κ) and reported. Results: According to the results, the lichen planus was detected in 8 cases using the WHO method, and in 41 cases using the Mod.WHO method. Intrarater Kappa coefficients were κ = 0.114, P = 0.299; κ = 0.181, P = 0.012; and κ = 0.062, P = 0.424 for three pathologists, respectively. The findings showed no reproducibility (κ = 0.148, P = 0.024) and there was no correlation between the two systems. Statistical analysis revealed that the histopathological criteria of the WHO classification for detecting the lichen planus microscopy were more sensitive but the Mod.WHO classification criteria were more specific for detecting the lichen planus. Conclusions: Due to the higher specificity of the histopathological criteria of Mod.WHO classification rather than WHO classification, it seems that Mod.WHO classification has more important and useful criteria for histopathological diagnosis. Finally, we can conclude that the use histopathologic criteria of the Mod.WHO classification is more useful in the diagnosis of lichen planus, although it should be in combination with clinical information.

Background: One of the concerns of cell phone users is prolonged exposure to harmful and potentially carcinogenic waves. This study was aimed to investigate the correlation between amount of cell phone use and related factors with percentage of micronucleus containing cells. Methods: This descriptive study was conducted on selected patients referring to Islamic Azad University Faculty of Dentistry using cell phones regarding related inclusion and exclusion criteria. Papanicolaou staining method was approached for mucosal smears of samples and frequency of micronucleus containing cells and also, frequency of micronucleus in each cell were recorded for each sample; then, correlation of these findings with amount of daily cell phone usage was statistically analyzed using the calculation of Pearson correlation coefficient and preparation of regression analysis (backward) with significant level of lower than 0.05. Results: Of 100 samples, the frequency of micronucleus containing cells was 2.94% ± 1.89% and the frequency of micronucleus in each cell was 1.02% ± 1.68%. The amount of cell phone usage was significantly correlated with the frequency of micronucleus containing cells (r = 0.70, P = 0.0001) and also with the frequency of micronucleus in each cell (r = 0.57, P = 0.0001). Also, age and sex were not significantly correlated with the frequency of micronucleus containing cells (P = 0.47 and 0.32) and also with the frequency of micronucleus in each cell, respectively (P = 0.16 and 0.27). Conclusions: The present study showed that the increased amount of cell phone usage had a strong and significant correlation with the higher frequency of the micronucleus containing cells and the higher frequency of micronucleus in each cell in the buccal mucosa. Also, the related factors as age and sex were not significantly correlated with the frequency of micronucleus containing buccal mucosa cells.

Background: Higher rates of Smoking among university students have been reported in various studies. On the other hand, health literacy (HL) can improve health behaviors. In fact, identifying factors affecting the adoption of smoking preventive behaviors such as HL can help prevent and reduce the prevalence of smoking among people. The aim of this study was to identify the relationship between different levels of HL and adoption of smoking preventive behaviors among university student in 2016. Methods: This was a cross-sectional descriptive study. Three hundred and forty-seven dormitory students of Shahid Beheshti University of Medical Sciences in Iran were selected through single-stage cluster sampling for the study. Data were collected using a measure of HL (the HL inventory for adults-HELIA) and a designed questionnaire to assess the adoption of smoking preventive behaviors. The data were analyzed using SPSS software version. 16 and descriptive statistical and Logistic regression test. Results: The mean (SD) of the score for adoption of smoking preventive behaviors and HL were 45.91 (12.99) and 70.52 (14.12) out of 100, respectively. The results showed that the adoption of smoking preventive behaviors had significant relationship with variables such as HL, gender, father's education and not smoking (P < 0.05). Conclusions: Less adoption of smoking preventive behaviors was seen in students with lower levels of HL, female students, students with illiterate fathers and smokers. Therefore, it seems essential to take these factors into consideration in designing preventive programs for smoking in target groups.

Congenital hypothyroidism is one of the most common endocrine disorders in infants and children. Thyroid hormone effects the function of most organs of the body. In premature neonates, thyroid abnormalities are very common but transient. There is a significant difference between the appropriate time for screening in premature and term neonates and there are different viewpoints in treating hypothyroidism in prematurity. According to the probable exceptions in this issue, there is no definite guideline. Therefore, regarding this confusion, this guideline aimed to help clinicians for rapid on-time decision making.

Background: Screening for eating disorders via reliable instruments is of high importance for clinical and preventive purposes. Examining the psychometric properties of tools in societies with differing dynamics can help with their external validity. This research specifically aimed at standardization and validation of the eating attitude test (EAT-16) in Iran. Methods: The Persian version of the EAT-16 was produced through forward translation, reconciliation, and back translation. The current research design was descriptive cross-sectional (factor analysis). A total of 302 nonclinical students were selected through the convenience sampling method and completed a set of questionnaires. The questionnaires included, the EAT-16, eating beliefs questionnaire-18 (EBQ-18), difficulties in emotion regulation scale-16 (DERS-16), weight efficacy lifestyle questionnaire-short form, self-esteem scale, and self-compassion scale short-form. The construct validity of the EAT-16 was assessed using confirmatory factor analysis and divergent and convergent validity. Internal consistency and test–retest reliability (2 weeks' interval) were used to evaluate the reliability. Data analysis was conducted using LISREL (version 8.8) and SSPS (version 22) software. Results: EAT-16 and subscales were found to be valid and reliable, with good internal consistency and good, test–retest reliability in a non-clinical sample. In terms of convergent validity, EAT-16 and subscales showed a positive correlation with the selfreport measures of EBQ-18 and DERS-16. EAT-16 and subscales showed a negative correlation with self-compassion, self-esteem and eating self-efficacy., Therefore, it demonstrated divergent validity with these constructs. The results of this study support the EAT-16 four-factor model. Conclusions: The EAT-16 showed good validity and reliability and could be useful in assessing eating disorders in Iranian populations. The EAT-16 is an efficient instrument that is suitable for screening purposes in the nonclinical samples.

Background: White Blood Cells (WBC) can be a useful marker to predict diabetes. In this study, we aimed to investigate the association between WBC count with type 2 diabetes in a large-scaled population-based cohort study. Methods: In the present study we used a subset of data collected in enrolment phase of Tabari cohort study. Participants with fasting blood glucose ≥126 or those who report as having diabetes or taking glucose-lowering medications were selected as case group (1765 participants) and control group included participants who did not report as having diabetes (1765 participants) and they randomly selected from the baseline population. Hematology indices were measured for all participants using Celltac Alpha MEK-6510 K. Chi-squared and independent t-test were used to compare categorical and continuous variables, respectively. Results: The mean of WBC in diabetic patients and control group was 6.89 ± 1.67 and 6.37 ± 1.49 respectively (P ≤ 0.001). The odds of diabetes based on WBC count in crud model was 1.23 [CI 95% 1.181.28] and after adjustment for all possible confounding factor was 1.17 [CI 95% 1.111.23]. Conclusions: Results of the present study showed a significant association between WBC count and diabetes. This association remained significant after adjustment for all possible confounders.

Background: Diabetes self-management questionnaire (DSMQ) is among the relatively new tools with comprehensive structure measuring various dimensions of self-care behaviors in diabetic patients. This study was carried out to evaluate psychometric properties of Persian version of DSMQ. Methods: A cross-sectional study was carried out from January to March 2017 among patients with type 2 diabetes mellitus (T2DM) referred to urban health centers, in Kerman, southeastern Iran. Data were collected from 589 patients using DSMQ. The DSMQ was translated into Persian by forward and backward translation method. Cronbach's alpha method and intraclass correlation coefficient (ICC) were used to measure internal consistency and test-retest reliability, respectively. In addition, construct validity was assessed by confirmatory factor analysis and exploratory factor analysis (EFA). Results: The sum-scale Cronbach's α of DSMQ was equal to 0.82 for 30 participants. The mean inter-item correlation and mean item-total correlation of “Sum Scale” (SS) were equal to 0.21 (standard deviation (SD) = 0.22) and 0.53 (SD = 0.19), respectively. All items had item-total correlations higher than 0.30 except items 7, 11, and 15. For “SS,” ICC was obtained as 0.93. EFA revealed a four-factor model accounting for 62.5% of the total variance. All indices were acceptable for the modified DSMQ with four factors (χ² = 134.33, degrees of freedom = 89, P = 0.001, comparative fit index = 0.97, root mean square error of approximation = 0.044, Tucker-Lewis index = 0.96, and normal fit index = 0.92). Conclusions: The Persian version of DSMQ was found to have acceptable reliability and validity for assessing self-management among patients with T2DM.

Background: Work-related musculoskeletal disorder (WMSD) is the most important public health challenge among dental staff. The objective of this study is to ascertain the prevalence and associated risk factors, which related to WMSD among dental staff in Dhahran, Saudi Arabia. Methods: It is a cross-sectional study and 130 dental staff were selected through simple random sampling from in Armed Forced Hospital with at least 1 year of working experience. The self-administered validated and structured Standardized Nordic questionnaire was used. Logistic regression analysis was done to determine the association of risk factors with WMSD. Results: The results of the present study revealed that there was a high incidence of MSDs in the neck, shoulder, and lower back pain among dental personnel (72.6%). The common risk factors that contributed to WMSD were more than 5 years of experience (AOR 1.19 (1.03–2.82)), Saudi nationality (AOR 4.88 (1.27–18.72)), working more than 12 h (AOR 3.115 (1.258–7.578)) and resident doctors (AOR 1.14 (1.02–1.94)). Conclusions: The study concludes that WMSDs were a common and high rate of incidence among dental staff. There is a need to make a policy that will reduce the burden of WMSD among dental staff.

Background: The aim of this study was to estimate the effect of smoking on metabolic syndrome (MS) and its components applying inverse probability-of-treatment weighting (IPTW) and propensity score (PS) matching. Methods: Using data from Tehran Lipid and Glucose Study, 4857 participants aged over 20 years with information on smoking and confounders in the third phase (2005–2008) were included, and the MS was assessed in the fifth phase (2011–2014). IPTW and PS matching were used to adjust for confounders. Results: Based on average treatment effect (ATE) estimates, smoking decreased the risk of hypertension (RR: 0.62; 95% CI: 0.43, 0.88), but increased the risk of low HDL cholesterol (1.20; 0.98, 1.48). Similarly, the average treatment effect in the treated (ATT) estimates using IPTW and PS matching suggested that smoking decreased the risk of hypertension (0.63; 0.52, 0.76, and 0.68; 0.54, 0.85), and increased the risk of low HDL cholesterol (1.24; 1.07, 1.43, and 1.28; 1.06, 1.54), respectively. Conclusions: Smoking seems to increase the risk of low HDL cholesterol but decreases the risk of hypertension.

Background: It seems that 14–25% of the women retain at least 5 kg weight from 6 to 12 months after delivery and gestational weight gain is the most important reason of weight retention. Thus, we assessed the effect of prenatal nutrition education program on the retained weights at 8, 26, and 52 weeks after delivery in primiparous women. Methods: This randomized controlled trial was implemented among 192 primiparous pregnant women in five hospitals, fifteen community health centers, and fifteen private offices. Self-developed questionnaire was used to collect the participants' characteristics. A 72-hr dietary recall was applied to evaluate the food intakes before and after intervention. The pregnancy physical activity questionnaire determined the physical activity score. The participants' weights at 8, 26, and 52 weeks after delivery were measured by a digital beam. Results: The means of postpartum weight decreased in both groups, but nutrition education was significantly effective on reducing postpartum weight in intervention group (β = -3.112, SE = .7384, P < 0.001). Also, the women in intervention group had less retained weight compared to control during the follow-up (β = -3.35, SE = 0.75, p < 0.001). The proportion of pregnant women in intervention group who reached to their pre-gravid weight was more than control during the follow-up (OR = 2.86, 95% CI: 1.62, 5.07). Conclusions: Nutrition education considering an individualized calorie-appropriate diet for each pregnant woman and based on the national guideline is effective on postpartum weight retention and reaching to pre-gravid weight.

Background: As a rising epidemic in developing countries, childhood obesity and overweight need particular attention. Methods: The sample (n = 2432) was randomly selected among children aged 24–59 months living in West Azerbaijan Province whose information was recorded in SIB software. The survey questionnaire is derived from the Demographic and Health Survey and the Multiple Indicator Cluster Survey questionnaires designed by the WHO 2017 and UNICEF 2017, respectively. Results: The prevalence of obesity defined as BMIz (body mass index z-score)> +2 was 1.4% among children. Dietary diversity score (DDS) was high in 59.3% of children, moderate in 36.1%, and low in 4.6%. Socio-economic status (SES) of children families was high, moderate, and low in 34%, 28.9%, and 37.1% of families, respectively. Physical activity hours were over 3 in 85.9% of children. The girls were more likely to be obese than the boys (OR = 0.43, P = 0.016). Those with high and moderate DDS were less likely to be obese than those with low DDS (OR = 0.250 and OR = 0.180, respectively). The likelihood of obesity among children with high and moderate SES were 2.6 and 1.6 times more compared to children with low SES, respectively. Conclusions: According to the results, DDS and physical activity levels are related to obesity in children aged 24–59 months. Therefore, establishing proper nutritional behavior and promoting a healthy lifestyle are essential for preventing obesity and non-communicable diseases in this age group.

Background: Postoperative frozen shoulder (FS) or adhesive capsulitis is a relatively frequent complication (5-20%), even after simple arthroscopic shoulder surgeries. The pathophysiology is still unclear, but psychological factors may play a pivotal role. From clinical experience, we hypothesized that patients, who are reluctant to take medications, particularly “pain-killers,” have an increased incidence of postoperative FS. Methods: We identified twenty patients who underwent limited arthroscopic operations of the shoulder and developed postoperative FS. Twenty patients with matching type of surgery, age, and gender served as control group (n = 20). All patients were at least one year postoperative and asymptomatic at the time of examination. Demographic data, the patient's adherence to self-medication (including self-medicating scale, SMS), development the Quality of life (QoL), and depression scale (PHQ-4-questionnaire) were assessed. Results: Patients with FS had a 2-fold longer rehabilitation and 3-fold longer work inability compared to the patients without FS (P < 0.009 and P < 0.003, respectively). Subjective shoulder value SSV (P = 0.075) and post-operative improvement of QoL (P = 0.292) did not differ among the groups. There was a trend—but not significant—toward less coherence to self-medication in the FS-group (26.50 vs. 29.50; P = 0.094). Patients with postoperative FS significantly more often stated not to have “taken pain-killers as prescribed” (P = 0.003). Conclusions: Patients reporting unwillingness to take the prescribed pain medications had a significantly higher incidence of postoperative FS. It remains unclear whether the increased risk of developing FS is due to reduced postoperative analgesia or a critical attitude toward taking medication. However, patients who are reluctant to take painkillers should strongly be encouraged to take medications as prescribed.

Background: Determination of the prevalence of intestinal protozoan infection is a fundamental step to set up an effective control program to improve the health status of society and to establish efficient strategies. Intestinal pathogen and even non-pathogen protozoa consider as major causes of disease in patients with gastrointestinal problems. The objective of this study is to determine the prevalence of intestinal protozoan infection in patients with ulcerative colitis (UC) in Isfahan, Iran. Methods: The descriptive cross-sectional study carried out from 2013 to 2018 in Isfahan, Iran. One thousand nine hundred and sixty-five samples of feces from patients with UC collected and each sample examined using direct wet mounting with normal saline and iodine and sedimentation tests such as formol-ethyl acetate concentration and trichrome-staining methods. Results: From 655 patients, 185 (28.2%) infected with Giardia lamblia followed by Blastocystis hominis (27.3%), Endolimax nana (14.4%), Entamoeba coli (11.5%), Iodamoba butschlii (4.7%), Entamoeba histolytica (1.4%), and Chilomastix mesnili (0.6%). Conclusions: This study revealed a high prevalence of infection with at least one or six non-pathogenic and pathogenic intestinal protozoa in UC patients in the Isfahan region. Intestinal protozoa are a challenging public health problem wherever health care is limited in the area. The emergence of UC in the world results in the need to study etiologic factors. In order to obtain further information about the etiology of disease, we investigated the prevalence of intestinal protozoan infection in patients with UC in Isfahan, Iran.

Background: Children's mortality rate reflects the health level of the community. Therefore, accurate mapping of child mortality is one of the most important ways to reduce this rate. The purpose of this study was to investigate the mortality rate of children under 5 in Isfahan province in 2011–2016. Methods: In this analytical cross-sectional study, all mortalities of children under 5 of Isfahan province related to Child Death Care System Program during 2011–2016 were studied. Mortality rate of children was calculated. Relationship between variables [demographic characteristics, place of death (urban/rural), and underlying cause of death] and child mortality was analyzed using Chi-square test. Mortality rate in the cities of Isfahan province was plotted on a geographical map. Results: Whole number of mortalities of children under 5 was 5247 cases. Most of the mortalities (60.1%) were occurred in neonatal. Mortality rate was higher in boys than girls (12.6 vs. 11.1 per 1000 live births) (P < 0.001); “mortality rate in non-Iranians who live in Iran was more than that of Iranians (21.4 vs. 11.5 per 1000 live birth) (P < 0.001) and rural areas more than urban areas (15.2 vs. 11.4 per thousand live births) (P < 0.001).” Certain conditions originating in the perinatal period were reported as the greatest causes of death (45.9%). Congenital malformations (27.4%) and external causes of morbidity and mortality (6.7%) were the second and third causes of death. Fereidun Shahr had the highest U5MR and Khansar had the lowest U5MR. Conclusions: Considering the major contribution of neonatal to the death of children under 5 and also the most important causes of death, interventions such as preventing early delivery, genetic counseling in high-risk couples, and parent training for accident prevention can play an effective role in reducing child mortality.

Background: To achieve universal health coverage (UHC), the World Health Organization (WHO) Regional Committee for the Eastern Mediterranean (EMRO) reported that the standard requirement for family physicians by 2030 is three family physicians per 10,000 people. The purpose of this study was to select the appropriate method of training family physicians in Iran to achieve this goal. Methods: The present qualitative study was conducted in conjunction with the method of agreement, during three sessions of focus group discussion (FGD) with 13 key persons at the national level to answer two research questions on choosing the most appropriate method of training family physicians and the criteria for this selection. After analyzing the data by content analysis method, a table was designed including family physicians' training methods and selection criteria and evaluated by participants in a 10-point spectrum. Then, the scores were summed and the mean was calculated for each method. Results: The participants cited four methods, as well as 13 criteria. The Family Medicine Residency Program (FMRP) with a score of 93.4 and the Family physician bridging Program (FPBP) with a score of 68.38 were selected as the most appropriate training methods for the family physician to achieve the EMRO-declared perspective by 2030, respectively. Conclusion: According to the results of the study, the training of family physician specialist is the best method; but due to the long course and low output of this method, to meet the immediate needs of the health system and achieve the desired perspective, the FPBP approach was agreed as the most appropriate method of training the family physicians in Iran.

Background: Depression is one of the major psychiatric disorders in the world. The present study was conducted to determine the prevalence of depression among Iranian school students through a meta-analysis. Methods: All national and international information databases including PubMed, Scopus, Web of Science, SID, Magiran, Medlib were searched. The search phase was performed without language and time restrictions, but the searched studies were all in Persian and English, and the sources were updated by 03.08.2020. As the selected studies had high heterogeneity, the random effects model was used. Results: In 51 studies with a sample of 537144 people, the prevalence of depression in Iranian school students was 37% (95%CI: 32, 42). In addition, the prevalence of depression in girl school students was 45% (95%CI: 25-65) and in boys was 28% (95%CI: 20-35). The prevalence of mild, moderate and severe depression in school students is 31%, 18% and 11%, respectively. Also, the prevalence of depression in primary school students was 12%, middle school students 32%, high school students 47% and pre-university students 46%. Conclusions: About a third of Iranian school students suffer from some degree of depression, and the prevalence of depression in girls is about twice that of boys. The prevalence of mild depression among school students is higher than moderate and severe depression. On the other hand, the prevalence of depression in school students from primary to pre-university level is increasing, which is very worrying.

Background: Over the past decades, the consumption of fast foods has increased worldwide and became favored by people of most age groups. The objective of this research was to assess the impact of fast foods on liver enzyme levels and body weight. Methods: A cross-sectional study was conducted at Yarmouk University/Jordan using survey questionnaire and enquired university students about their dietary habits, in addition to laboratory investigations of liver enzymes. Results: In the cross-tabulation analysis, only age and body mass index (BMI) were significantly associated with alanine aminotransferase (ALT) enzyme level. However, all differences between aspartate aminotransferase (AST) level and other variables were statistically insignificant. The AST/ALT ratio was calculated and revealed significant statistical association with BMI of participants (P = 0.001). Change in body weight during one year was significantly associated with eating fast food (P = 0.031), drinking beverages with fast food meals (P = 0.001), and ALT level (P = 0.026). However, this association was statistically insignificant with AST level. Conclusions: Fast food consumption among university students in Jordan was not significantly associated with increasing levels of ALT and AST liver enzymes. However, eating fast food and drinking soft drinks were associated with increasing body weight, which is expected to have adverse effect on liver functions in the long term.

Endometriosis is one of the gynecological disorders and its prevalence is estimated to 8-10% of reproductive-age women. In Iran, the frequency of endometriosis was reported at 29% among infertile women. The etiology of endometriosis is still unclear. Numerous environmental contaminants such as polychlorinated biphenyls (PCBs) may play important roles in endometriosis development and etiology. Iranian population has relatively low levels of PCBs. However, no studies have evaluated PCBs levels in Iranian endometriosis patients so far. At present, there is no systematic review of the relationship between only PCBs exposure and the risk of endometriosis. The aim of this systematic review and meta-analysis protocol will be to evaluate the association between only PCBs exposure and the risk of endometriosis. PubMed/MEDLINE, Web of Science, Scopus, Google Scholar, Embase, key journals, conferences/congress research papers, and the references of included primary studies will be searched. Observational studies (cross-sectional, case-control, and cohort) in humans that investigated the association between PCBs exposure and the risk of endometriosis will be included. The outcome will be endometriosis risk in association with PCBs exposure. The primary screening and data extraction will be performed by three team members independently and will be judged by opinion with the fourth member. The modified Newcastle-Ottawa Scale (NOS) will be used for the quality assessment of studies. Findings from this study will recognize the association between PCBs exposure and the risk of endometriosis. Results may provide a new window for identifying the role of PCBs as environmental risk factors in relation to the development of endometriosis. Registration number: PROSPERO; CRD42019120539

With the onset of Covid 19 disease, the vertical transmission of the disease from mother to neonate was unknown. In this case, a mother affected by a severe Covid 19 a few days before delivery, was examined whether her baby get the disease without breastfeeding and close contact with his mother or not. Finally, the case study show corona virus did not transmitted through blood from mother to the baby and he was completely healthy.

Recently emerged coronavirus, known as SARS-CoV-2 or Covid-19 is considered as a serious threat for human health. Due to unavailable specific drugs for this virus, there is an urgent need for supportive cares. Epigenetic immune boosting approaches and developing anti-inflammatory agents by gut-associated bioactive macronutrients can be plausible protective cares for COVID-19. Suitable intake of bioactive macronutrients including prebiotics, fatty acids, proteins and branched-chain amino acids may result in anti-viral responses through modulating macrophages and dendritic cells via Toll-like receptors, decreasing viral load, inactivating the enveloped viruses, increasing the anti-inflammatory metabolites and inhibiting the proliferation of microbial organisms. Bioactive macronutrients may help in promotion of immunological responses and recovery acceleration against Covid-19. This review focuses on the mechanisms of bioactive macronutrients and related clinical trials on enveloped viruses with emphasis on gut-microbiome-immune axis. Macronutrients and this axis may be conducive strategies to protect host against the viral infection.

Background: Chronic kidney disease (CKD) is a life-threatening disease with numerous complications. Hemodialysis (HD) patients are prone to magnesium deficiency due to malnutrition, which can cause cardiovascular complications and increase mortality. The present study aimed to investigate the effects of sevelamer and calcium carbonate, as phosphate binders, on serum levels of magnesium, calcium, and phosphorus in HD patients. Methods: A parallel clinical trial was conducted on 54 patients undergoing HD at Kosar Hospital of Semnan. The inclusion criteria were end-stage renal disease (ESRD), alternative HD treatment for at least 3 months 3 times a week, and serum phosphate levels greater than 4.5 mg/dL. The participants were randomly assigned to two groups of sevelamer (n = 27) and calcium carbonate (n = 27). If the participants were taking a phosphate binder, they were asked to stop it for 3 weeks. Participants in the sevelamer group received 800 mg of sevelamer at most three times a day and those in the calcium carbonate group were treated with 500 mg of calcium carbonate at most 3 times a day. Before and 3 months after the intervention, the serum levels of calcium, magnesium, and phosphorus were measured through the Arsenazo method using the Pars Azmun kit in the Selectra auto-analyzer. Twenty-one patients in the sevelamer group and 22 patients in the calcium carbonate group finished the study. Results: The results showed that calcium carbonate and sevelamer increased serum magnesium level by 0.20 (P = 0.028) and 0.26 (P = 0.002), on average, which were statistically significant. The administration of calcium carbonate did not significantly change serum calcium levels (P = 0.53), whereas sevelamer reduced serum calcium levels by 0.23 (P = 0.017), on average. This reduction was statistically significant. The results also indicated that none of the calcium carbonate (P = 0.099) and sevelamer (P = 0.543) caused significant changes in serum phosphorus levels. The study findings showed no significant difference between the two groups in terms of changes in the serum levels of magnesium (0.590), calcium (0.116), and phosphorus (0.113). Conclusions: Both drugs (Sevelamer and calcium carbonate) prevented hypomagnesemia and increased serum magnesium levels, but no significant differences were found in blood levels of calcium, phosphorus, and magnesium compared to the two drugs. Considering the effect of magnesium on cardiovascular diseases, increasing the serum magnesium levels through the administration of calcium carbonate and sevelamer can prevent the likelihood of cardiovascular diseases. However, none of the studied drugs was superior to the other in this regard.

Context: Diarrhea characterized by a frequency increased of defecation more than 3 times/day accompanied by changes in consistency (becoming liquid). The causes of diarrhea can be divided into 2 parts, which are direct causes and indirect causes that can facilitate or accelerate the occurrence of diarrhea, including bacteria, nutritional conditions, hygiene and sanitation, social culture such as population density, economic status, low birth weight, and immunization. Aims: The purpose of this study to examine the factors that influence the incidence of diarrhea. Methods: This research used secondary data, the prevalence of diarrhea and risk factors in Pasuruan Regency Health Center. Poisson regression approach with maximum likelihood estimator (MLE) estimation and Generalized Method Moment (GMM) used in this study. Results: The results showed that GMM estimation method in the Poisson regression model gave better performance in terms of significance parameters compared to the MLE method. Conclusions: Factors affecting the increase of diarrhea occurrences in area with an estimated MLE Percentage of non-exclusive breastfeeding and Percentage of normal nutritional status. Whereas the GMM estimation is the percentage of non-exclusive breastfeeding, the percentage of low birth weight, the percentage of population density, the percentage of smokers among family members in the house, the percentage of incomplete immunizations, the percentage of under-five years old children less than 2, the percentage of normal nutritional status, and the percentage of middle class socioeconomic status.

Background: Preventing cancer is better than treating or curing it. Cancer prevention ensures reduced physical, emotional, financial burden to the individual. Methods: The focus of the preventive oncology unit at Healthcare Global (HCG) Enterprise Limited, Bangalore, India, is to increase the understanding of how lifestyle and risk of cancer are related. It also focusses on screening of normal individuals for estimating their risk of developing cancer, which in-turn can lead to earlier detection, improved treatment and outcomes. This unique endeavor started one year back, provides counseling and vaccination services for HPV (Human Papilloma Virus) and HBV (Hepatitis B Virus). Our outreach initiatives in collaboration with the State and City health Departments include screening camps, and awareness sessions focusing on HPV and HBV vaccination. Results: The focus of research is in the areas of cancer epidemiology, prevention, screening, and control. Such research involves a multidisciplinary approach involving the fields of epidemiology, biostatistics, behavioral science, nutrition, and basic science. Conclusion: This novel endeavor at a tertiary cancer hospital in a Developing Country is aimed at preventing the development or progression of the malignant cancer process.

Introduction: Anti-oxidant, antispasmodic, anti-inflammatory, and analgesic effects have been reported for Apium graveolens Linn.) Celery( seeds and its active component luteolin. So, this study was carried out to investigate the protective effects of hexane (AGHE) and methanol (AGME) extracts of A. graveolens seeds and luteolin on acetic acid-induced colitis in rats. Methods: Three doses of AGHE (100, 200, and 400 mg/kg), AGME (200, 400, and 800 mg/kg), and luteolin (5, 10, and 20 mg/kg) were administered orally (p.o.) to separate groups of male Wistar rats, 2 h before ulcer induction (acetic acid 4%) and continued once daily for 4 days. Prednisolone (4 mg/kg) and mesalazine (100 mg/kg) were used as reference and vehicle (2 mL/kg) as control groups. Colon biopsies were taken for weighting, macroscopic and histopathologic evaluation, and measuring myeloperoxidase (MPO) activity. Results: Our findings showed that AGHE (200 and 400 mg/kg), AGME (400 and 800 mg/kg), and luteolin (10 and 20 mg/kg) were effective to reduce colonic ulcer score, area, and index as well as total colitis index, and MPO activity significantly in comparison with controls. Since the lowest doses of extracts and luteolin were not significantly effective to diminish evaluated parameters of colitis, it is concluded that the ameliorative effect was dose related. Conclusion: It is also concluded that both extracts and luteolin, as an important ingredient of celery extract, were effective in the amelioration of colitis in rats, but further clinical and detailed mechanistic experiments are required to introduce these natural agents for colitis treatment or prevention in human.

Background: The under-5 mortality rate in Indonesia is 32 per 1,000 live births, still higher than the SDG target. Acute respiratory infections (ARIs), as one of the leading causes of death, must be prevented. Arguments emerge concerning the association of home crowding, health behavior, and the incidence of ARI. Methods: A cross-section analysis with the Indonesia Demographic and Health Survey (IDHS) 2017 dataset is performed. Samples are restricted to 16,555 children aged 0–59 months who lived with their mother (eligible women interviewed) during the survey. For each of the variables observed during this study, missing data must be omitted as exclusion criteria. A 100 per cent answer rate was achieved. Logistic regression was used to determine ARI-associated factors, by examining the effect of each explanatory factor (independent variables) on the odds ratio of ARI (one dependent binary variable). Results: The prevalence of ARI was more common among children living in the poorest households (AOR 1.66; 95% CI, 1.20 – 2.28) and those exposed to indoor tobacco smoke pollution (AOR 1.27; 95% CI, 1.04–1.56). On the other hand, those aged 0–5 months (AOR 0.59; 95% CI, 0.43–0.82), living at home with improved sanitation (AOR 0.74; 95% CI, 0.61–0.89), and exclusively breastfed (AOR 0.85; 95% CI, 0.73–0.99) were less likely to have ARI. Conclusions: Home crowding is not associated with ARI. Efforts should be focused on preserving family health behavior. The family functioned as a health-support system for their under-5 children by establishing an indoor tobacco smoking-free zone, practicing exclusive breastfeeding, and enhancing hygiene facilities.

Background: The purpose of this research is to determine the prevalence of musculoskeletal disorders and their association with psychological stress among medical students at Taif University, Saudi Arabia. Methods: A total of 640 medical students were selected by multistage cluster sampling. The data were collected by trained students using a standardized Nordic questionnaire and 10-k questionnaire. Statistical analysis was carried out using the statistical package (SPSS.21). Standardized Nordic questionnaire and 10-k questionnaire besides questionnaire assessing sociodemographic characteristics (age, gender, study year, weight, height, smoking, marital status, chronic disease, and educational degree) were used. Results: Among 640 medical students, 45.9% males and 54.1% females reported musculoskeletal pain, it was more prevalent among fourth - and sixth year students, in the last 7 days, neck pain was the highest site of complaint (33.4%) followed by low back pain (15.1%) and shoulder pain (12.8%). Prevention of work was highest due to neck pain (27.7%) and low back (25.1%) followed by knees (19.1%), the stress rate was highest in the second year (67.8%) and third year (67.3%) students followed by the sixth year (65.8%) students. Conclusions: Musculoskeletal disorders are a common health problem reported by more than half of medical students, with a significant association with females and preclinical students. Stress is a common psychological problem that affects two-thirds of medical students. However, we found a nonsignificant association between the onset of musculoskeletal disorders and the level of stress among medical students.

Background: Nosocomial sinusitis is a common and less attended complication in patients admitted to intensive care units (ICU). It can cause several problems, such as prolongation of hospitalization, comorbidity, and mortality in patients. The present study aimed to evaluate the effect of azelastine (second-generation antihistamine) and sodium chloride spray on sinusitis prevention in ICU admitted patients. Methods: In this randomized, open-label, and parallel clinical trial a total of 126 patients were enrolled (63 patients per arm). Finally, 121 patients (61 patients in the control group and 60 patients in the treatment group) completed the study, and 120 patients entered the final analysis. In the treatment group, during 24 h after the insertion of nasogastric tube azelastine and sodium chloride sprays were administered (one puff from each spray every 12 h) while no intervention was conducted in the control group. Primary and secondary end-points were evaluated within 10 days of the study period. Results: The incidence of sinusitis and pneumonia (18.3% and 16.6% in the control group compared to 8.3% and 3.3% in the treatment group, respectively) in the treatment group showed a decreasing trend; however, only the difference of pneumonia was statistically significant between groups (P = 0.03). In addition to the clinical pulmonary infection score, nasal and tracheal secretions were significantly improved in the treatment group (P = 0.03, P < 0.001, and P = 0.01, respectively). Conclusions: The findings of the present study offer an inexpensive, low-risk, and efficacious intervention for the prevention of upper respiratory tract infections in ICU patients.

Background: There is a wide range of challenges through the use of nano-material in buildings. By developing construction industries the use of flame retardant nano-materials is a hurdle for human health. However occupational exposure measurement is not applicable for nano-particles monitoring. Risk assessment is an alternative method for industrial hygiene strategies. In this study, we use the control banding approach for risk assessment of 3 nano-fire retardant (NFR) in the building industry. Methods: We used control banding as a risk assessment approach for decision making about nano-materials in the building industry. The risk of nano-fire retardants such as monokote accelerator, monokote Z-106 G and monokote Z-106 HY in the construction industry was studied. The level of risk was evaluated by the matrix of hazard severity and probability score. Hazard severity was scored by toxicological information. The probability score was estimated by the state work operation. Results: A score of hazard severity in monokot Z-106 HY was higher than other nano-materials. The probability score of spraying tasks was lower than mixing and transportation tasks. The results show the application of all nano-materials had the higher risk level in transportation and mixing tasks. The risk level of monokote accelerator and monokote Z-106 G in spraying task is lower than monokot Z-106 HY. Conclusions: There is a high risk level for studied nano-materials in the coating tasks of the construction industry. In conclusion, powerful controlling strategies such as the substitution of nano-materials was suggested to decrease the risk of nano-fire retardants.

Background: This study aimed to determine the major neurological and psychological elements affecting depression, anxiety (DEPXITY), and the overall quality of life. Methods: This analytical descriptive study was carried out on 141 respondents with formal mood disorder diagnosis, with mental illness identity, with current depression and anxiety symptoms of at least moderate severity and people with mild symptoms. Data were analyzed using descriptive statistics, correlation test, reliability test, and separate regression models. Statistical significant level was set as 0.05. Results: The findings showed that external control by others on one's own life (EC) is the most significant factor (0.45) related to depression and the social conflict (SC) was found to be the most influential factor (0.28) for the anxiety. Internal control over own personal life (IC) is the most significant factor to cure or regulate some of the negative symptoms of the anxiety (−0.66). Good performance in personal life (PP) is a common positive factor to regulate both depression (DEP) and anxiety (XITY). This study shows that DEPXITY is associated with negative life quality. Conclusions: The lack of internal control and the control by others on one's own personal life are associated with impaired cognitive, affective, and behavioral functioning. The results of this study can also be a good indicator and confirmation that the medial prefrontal cortex is able with the support of IC and PP to coordinate self-appraisal processes by regulating activity in the posterior cingulate cortex area of the brain.

Background: Exercise-induced oxidative stress, muscle damage, and inflammation represent major contributors to why athletes use ergogenic aids. Turmeric is used as a spice because of its polyphenol ingredient named curcumin. We assessed the effects of curcumin supplementation on inflammatory, oxidative stress markers, muscle damage, and anthropometric indices in women with moderate physical activity. Methods: This double-blind, placebo-controlled clinical trial was conducted on 80 women with moderate physical activity levels (defined as walking or swimming for at least 1 h per day) for 8 weeks. Mean ± SD of age (years) all participants was 21 ± 2. Participants were randomly assigned into two groups: curcumin (500 mg/day) and placebo (500 mg/day cornstarch). Serum C-reactive protein (CRP), total antioxidant capacity (TAC), malondialdehyde (MDA), lactate dehydrogenase (LDH) levels, body composition, and maximum oxygen uptake (VO2 max) were evaluated before and after an intervention. Results: Sixty-five subjects completed the 8-week intervention. Within analysis indicated a significant decrease in CRP, LDH, MDA levels, and a significant increase in VO2 max in the curcumin group after an intervention (P < 0.05). There were significant decreases in CRP (P = 0.002), LDH (P = 0.041), and MDA (P = 0.005), no significant increase in TAC, and significant increase in VO2 max (P = 0.0001) levels in the curcumin group compared with placebo group. There were no significant changes in weight, body mass index, body fat, and lean body mass between two groups. Conclusions: Our findings indicated that 8-week curcumin administration could significantly improve CRP, LDH, MDA, and VO2 max. Curcumin supplementation did not elicit significant changes in anthropometric indices in this study.

Background: Undergraduate medical schools serve a critical role in providing screenings to medically underserved populations through the use of health fairs. Non-profit community organizations (NPCO) often participate by providing local credibility, administrative resources, and technical knowledge. Here we present a three-year narrative of hepatitis B and C screening efforts to highlight the challenges and benefits of undergraduate medical school and NPCO partnerships. Methods: Hepatitis screenings were conducted at biannual health fairs in Harlem, New York from 2017 to 2019. Meeting minutes from post-event debriefings were analyzed to identify any overarching themes with NPCOs. Results: NPCOs share a common goal in working with the community to advance their access to medical care and treatment. Communication and prompt follow-up are critical to maintaining expectations between NPCOs and health fair organizers. Conclusions: NPCOs can play an important role in encouraging, outreaching, and even managing hepatitis screening initiatives in conjunction with medical school health fairs.

Background: Personality plays an important role in food choices. The aim of this study was to assess the association of personality traits with dietary habits and food preferences. Methods: This cross-sectional study was carried out on 224 healthy female students aged 18–30 years with a normal BMI. Dietary habits, food preferences, and personality were assessed using validated questionnaire. Results: Our results showed that neuroticism and openness were associated with low scores while conscientiousness was related to high scores of dietary habits (r = -0.33 P < 0.001, r = -0.13, P < 0.05 and r = 0.26, P < 0.001, respectively). In addition, neuroticism was correlated with preference to salty, sour and fatty foods and negatively associated with dairy products (P < 0.05). Extraversion showed a positive correlation with preference to fast foods, ice cream, chocolate, cocoa, and negative correlation with meat. Openness was positively correlated with preference for meat and biscuit and negatively correlated with fruits (P < 0.05). Agreeableness was related to having soft drinks and sweetened fruit juices and conscientiousness had a positive association with preference to dairy products, vegetables, nuts, food with salty tastes, and a negative association with biscuits (P < 0.05). Conclusions: Overall, assessing personality traits could be useful to identify young women who may be at risk of unhealthy dietary habits.

Backgroun: In Saudi Arabia, fuel dispensing facilities commonly present around the residential places, educational institutions, and various health care facilities. Fuel pollutants such as benzene, toluene, and xylenes (BTX) and its alkyl derivatives are harmful to human health because of their toxic, mutagenic, or carcinogenic properties. The aim of this study was to determine the BTX concentration levels of common pollutants in and around fuel stations and their harmful health effects in the urban cites of KSA. Methods: Forty fuel dispensing facilities were randomly selected on the basis of three different areas: residential, traffic intersection, and petrol pump locations (refueling stations). Portable ambient analyzer was used for measuring BTX concentration. t-test was applied to determine the difference between these different areas. Results: All mean concentration values of pollutants such as BTX around residential, traffic intersection, and fuel stations are exceeding the limits of air quality standards values (P < 0.01). The mean levels of benzene are 10.3 and 11.07 ppm in Dammam and Khobar, respectively, and they exceed the reference level of 0.5 ppm. Hazard quotient was more than >1, which shows that carcinogenic probability has increased those who were living and working near fuel stations. Conclusions: The results found that the high concentration of pollutants (BTX) is in the environment around fuel stations. The environmental contamination associated with BTX in petrol fuel stations impulses the necessity of preventive programs to reduce the further air quality deterioration and reduce the harmful health effects.

Background: COVID-19 is an unprecedented pandemic that has taken the modern world under seize. In spite of lack of solid evidence, certain federal governments had recommended the use of hydroxychloroquine (HCQ), chloroquine, and azithromycin as prophylactic medications either for contacts or for healthcare providers in particular. The objective of this study is to assess the issues related to intake of prophylactic medications in view of COVID-19 and the proportion and pattern of side effects. Methods: A descriptive cross-sectional study was conducted using mixed methods approach among healthcare workers in Puducherry, India. Results: HCQ was the prophylactic drug taken by all the participants (n = 26). Of the 26, 15.4% had a baseline ECG, 26.9% took HCQ based on the recommended Day 1 dose of 800 mg and 61.5% of the participants had the drug provided by the hospital where they work. Reasons for taking prophylaxis were sense of vulnerability (due to co-morbidities, lack of PPE kits) and peer practice. However, the participants did not recommend prophylactic medication to others due to lack of evidence, death claims related to prophylactic drugs in media, hospitals not taking responsibility of baseline monitoring and need for long follow-up. Conclusions: The data on assessment of HCQ prophylaxis indicates only minor side-effects, though limited by sample size. Evidence-based recommendations on prophylactic drugs for COVID-19, effective risk communication, peer education and support, accountability, ease of baseline, and follow-up investigations were the need of the hour to improve intake and adherence to prophylactic regime for COVID-19.

Background: Tuberculosis remains to be a major public health problem. Lifestyle factors that have indirectly influence to the burden of tuberculosis. The aim of this study is to determine the lifestyle risk factors associated with tuberculosis patients in Asir region of KSA. Methods: We conducted a case-control study at the military hospital of Asir region of KSA. A total of 135 sample which is divided into 67 cases and 67 controls. Cases were included from hospital database between 2017 and 2018. Control were selected from patient attending the same hospital with respiratory disease other than tuberculosis. Data collection done through interview using a structured questionnaire. Lifestyle factors and socio-demographic factors associated with tuberculosis were analyzed using logistic regression. Results: Mean age of study participants (cases and control) are 38.04 ± 9.66 and 40.16 ± 7.72 respectively. Most important factors associated with tuberculosis patients are overweight and obese [OR = 4.40, 95% CI 1.27-15.25 and 2.38 (1.61-9.22)], Smoker [OR = 1.34, 95% CI 0.52-3.43], abnormal sleep at night (<8 hours) [OR = 5.03, 95% CI 1.57-16.10], blue color job worker [OR = 2.69, 95% CI 1.02-7.28], physical exercise <3 days/week [OR = 1.41, 95% CI 1.21-3.47]. Conclusions: In Saudi Arabia, a person's lifestyle and socioeconomic condition are associated with tuberculosis. Interventions focused on improving the quality of life through a reduction of risky lifestyle which prevent the spread of Tuberculosis in Saudi society and improve the efficiency of Saudi national tuberculosis control programme.

Background: Plantar Pressure distribution refers to the distribution of force over the sole of the foot. Recently many studies indicate plantar pressure distribution assisted in determining and managing the impairment related to musculoskeletal disorders. Methods: This cross-sectional study was conducted with forty participants (20 diabetes type 2 patients +20 healthy) from Imam Abdulrahman bin Faisal University. All the measurements were taken in the morning session. To measure height and weight, participants took off their shoes and stood on the stadiometer. The body mass index determined with the help of a bioelectric impedance device to get the health level of the participants—Proclaimed diabetes type 2 patients selected for the data collection. Tekscan's Mobile Mat was used to determine the plantar pressure of healthy and diabetes participants. Results: The finding revealed that diabetes participants have more pressure in the mid-foot section, whereas healthy participants showed more pressure on the heel section. The metatarsal section showed similar types of pressure distribution in both participants. The result also revealed that diabetes participants have more peak pressures, time integral, and gradient than healthy participants. Significant differences between diabetes and healthy participants were existing. Conclusions: The findings highlight the importance of measuring plantar pressure distribution since these are known to incorporate in the main parts of the foot and thus provide a shred of constructive evidence for the total load exposer of a single leg static task.

Background: The shortage and unbalanced distribution of physicians has adverse effects on the provision of equitable services at all levels of health care and especially at the prevention and primary care levels. The choice of specialty can seriously change the structure and composition of the physician workforce. Therefore, this study aimed to investigate the relationship between background characteristics of Iranian general practitioners' (GPs) and their preferred specialty fields. Methods: In this mixed-method study, first, 12 medical doctors participated in a nominal group technique to determine the most important background characteristics that affect GPs' preferences for specialty selection. In the second phase, we conducted a survey among 680 GPs in six provinces from different geographic regions. We gathered data using a researcher-made checklist and analyzed them using an adjusted multivariate regression. Results: The adjusted analysis showed that being female, being married, being in an older age group, having children, graduation from universities located in the provincial centers, and decision for living and practicing in the less-populated areas were significantly associated with the Iranian GPs' preferences for non-surgical specialties. Conclusions: This study provided evidence that could inform national health workforce policy-makers to avoid unbalanced distribution of physicians and accordingly to ensure the provision of equitable services at all levels of healthcare and especially at the primary care level. Other effective factors on the selection of specialty should be evaluated at the national level using specific surveys and econometrics studies such as discrete selection experiment to move toward preventive medicine.

Background: Although selenium is one of the nutrients that has an important role in the metabolism of thyroid hormones, it has been investigated in rare studies. This study aimed to evaluate role of selenium deficiency in children and adolescents with acquired hypothyroidism. Methods: This case and control study was conducted on 60 acquired hypothyroidism and 60 healthy children who had been referred to the pediatrics endocrine clinic in Shiraz, Iran, from November 2018 to April 2019. Some information such as age, gender, weight, height, duration of disease, and level of plasma selenium were recorded. Plasma selenium level was measured by atomic absorption spectrophotometer. Data were analyzed using SPSS software 21.0. Results: The mean of selenium level in the case and control groups were 93.77 ± 24.90 μg/dl and 85.96 ± 25.20 μg/dl, respectively. There was no significant difference between the two groups in the mean levels of selenium. Independent t-test showed no significant difference in the mean levels of selenium in male and female samples in the case group, but this difference was significant in the control group. Conclusion: Selenium deficiency may not have significant role as a cause of acquired hypothyroidism in pediatric and adolescent age group, in south of Iran. Thus, it does not seem necessary to routinely check the level of selenium for patients with thyroid dysfunction.

Background: Although selenium is one of the nutrients that has an important role in the metabolism of thyroid hormones, it has been investigated in rare studies. This study aimed to evaluate role of selenium deficiency in children and adolescents with acquired hypothyroidism. Methods: This case and control study was conducted on 60 acquired hypothyroidism and 60 healthy children who had been referred to the pediatrics endocrine clinic in Shiraz, Iran, from November 2018 to April 2019. Some information such as age, gender, weight, height, duration of disease, and level of plasma selenium were recorded. Plasma selenium level was measured by atomic absorption spectrophotometer. Data were analyzed using SPSS software 21.0. Results: The mean of selenium level in the case and control groups were 93.77 ± 24.90 μg/dl and 85.96 ± 25.20 μg/dl, respectively. There was no significant difference between the two groups in the mean levels of selenium. Independent t-test showed no significant difference in the mean levels of selenium in male and female samples in the case group, but this difference was significant in the control group. Conclusion: Selenium deficiency may not have significant role as a cause of acquired hypothyroidism in pediatric and adolescent age group, in south of Iran. Thus, it does not seem necessary to routinely check the level of selenium for patients with thyroid dysfunction.

Background: Prediabetes is an important stage before diabetes that can be treated with intensive lifestyle changes. The aim of this study was to assess knowledge, attitudes, and practice of primary care physician in Sudan about prediabetes. Methods: A cross-sectional questionnaire-based study was conducted among primary care physicians working at two family and primary health care centers in Khartoum. Data were analyzed using descriptive statistics and expressed as percentages. Results: Out of 200 primary care physicians, 189 completed the questionnaire. 60.8% of the participants had satisfactory knowledge about prediabetes and positive attitude towards prediabetes and their practice was relatively good. Knowledge score was significantly correlated with age (P = 0.000), duration of experience (P value = 0.000), the number of working hours per day (P value = 0.001), and the number patients seen per day (P value = 0.001). Logistic regression analysis showed that attending courses relevant to prediabetes revealed statistically significant result in knowledge, and attending such courses were likely to be associated with gaining sufficient knowledge than those who didn't by 2 times (P value 0.033, OR 2, CI. 1.063-4.079). Conclusions: Primary care physicians in Sudan have satisfactory knowledge, attitude, and practice about prediabetes. As they are in the front line in dealing with community, primary care physicians' efforts can help in slowing down the epidemic of diabetes in Sudan.

Background: Diet quality has been suggested as an important factor in disorders such as obesity and mental health as it controls inflammatory biomarkers. This study aimed to investigate the association between dietary inflammatory index (DII) with bioelectrical impedance parameters and characteristics of health in overweight\obese women. Methods: In this cross-sectional study, we calculated DII for 301 participants from their food frequency questionnaire (FFQ). Body composition was assessed through a multifrequency bioelectrical impedance analyzer (BIA). Depression, anxiety and stress scale-21 (DASS-21) was used to assess the level of characteristics of health. Results: The mean percentage ± SD of fat-free mass (FFM) and fat mass (FM) was 46.81 ± 5.65 and 34.05 ± 8.69, respectively. In this study, 49% (95% CI: 40.8–57.2) of participants had positive DII. Linear regression analysis revealed that FFM (P = 0.004) and total body water (TBW) (P = 0.004) were significantly associated with DII. Conclusions: A significant relationship was found between DII with FFM and TBW in overweight\obese women, supporting the hypothesis that an anti-inflammatory diet is associated with elevated FFM and TBW.

Context: The first stage of Universal Health Coverage (UHC) was founded Iran to achieve better access to needed health services. Aims: The aim of present study was to illustrate the prevalence rate of malnutrition's subtypes in under 5-year old children after UHC in comparison with before that. Settings and Design: In a cross-sectional study in 2018, anthropometric indices of 970 under 5 years old children in rural and small towns of Isfahan province were gathered from their health files by cluster randomized sampling method. Methods: Children whose weight for age, height for age, and weight for height were lower than -2SD based on Z score, were marked as underweight, stunting, and wasting, respectively. Children, whose weight for age was upper than +2SD, were marked as overweight. Statistical Analysis Used: The T-test, Chi-square, and logistic regression tests were used for determination of association between malnutrition's subtypes and demographic variables. Results: A total of 78 (8.04%) of under 5 years old children were wasting, 74 (7.63%) were underweight, and 82 (8.45%) were stunting. Also, 12 (1.23%) of the children from the same group were overweight. Conclusions: The prevalence rate of underweight and stunting in under 5 years old children were less than before UHC implementation period. The prevalence rate of overweight children below 5 in Isfahan province's villages and small towns was low.

Background: Most information on the association of dietary fat intake and gastro-esophageal reflux disorder (GERD) came from developed countries, where lifestyle and other dietary components might be different from those in developing countries. This cross-sectional study was, therefore, conducted to investigate the association between dietary fat intake and odds of having GERD in a large group of Iranian population. Study Design: This cross-sectional study was done among 3362 adult population in Isfahan, Iran. Dietary intakes were collected by the use of a validated semi-quantitative food frequency questionnaire. Methods: Assessment of GERD was done using a validated self-administered questionnaire examining the frequency of heartburn in the last 3 months. Individuals with the presence of heartburn symptoms sometimes, often or always during the last 3 months were defined as having GERD. Results: Participants in the top category of dietary fat intake had higher daily intakes of energy, macronutrients and micronutrients. Dietary intakes of all food groups were also significantly higher among those in the top quintile as compared with those in the bottom category of dietary fat intake (P < 0.001 for all). There were no significant associations between dietary fat intake and incidence of GERD in general population. Crude and multivariable-adjusted models revealed no significant associations between dietary fat intake and having GERD in either gender. Conclusions: We found no significant association between dietary fat intake and odds of having GERD in this population. Further studies, in particular of prospective designs, are warranted to clarify this association.

Background: Anxiety is graded as the sixth major contributor to nonfatal health loss worldwide and is included in the top ten causes of years lived with disability. National Mental Health Survey 2015–2016 too reported the prevalence of anxiety spectrum disorders as 3.5%, and way higher among females than males. The present study was undertaken to find the prevalence of anxiety disorders in homemakers aged 15–59 years and identify factors causing anxiety disorders in this population. Methods: In the present cross-sectional study, a total of 324 ever-married, apparently healthy women aged less than 60 years were included using systematic random sampling from the four selected urban areas after applying proportional sampling. A generalized anxiety disorder-7 (Hindi version) questionnaire was used for screening the anxiety disorders. Additional information was collected using a pretested questionnaire for assessing determinants. The data so collected were coded and compiled in MS Excel and analyzed using IBM^®SPSS^® Statistics (version 17.0). Results: Forty-four (13.6%) out of 324 women were screened positive for anxiety disorder. Moderate anxiety was present in 10.2% and severe anxiety in 3.4% of study subjects. Anxiety symptoms were significantly higher among women with perceived economic instability 4.3 (95% CI 1.5–12.2) and non-cordial relation with family members (11.5 [95% CI 2.4–55.5] with in-laws and 20.2 [95% CI 4.3–94.2] with husband) Health of the children was also seen to be major reason of anxiety (31.1 [95% CI 3.8–256.6]). Conclusion: Anxiety disorder is a significant mental health problem affecting over 13% homemaker women in the Kumaon region of Uttarakhand, India.

Context: The validity of self-reported anthropometric indices has been examined in previous studies in different populations. Aims: The aim of our study was to evaluate the validity of self-reported height, weight, body mass index (BMI), and waist circumference (WC) for the first time in middle-age staffs of Isfahan University of Medical Sciences. Settings and Design: In this cross-sectional study, a total of 171 men and women were selected from staffs of Isfahan University of Medical Sciences, Isfahan, Iran. Methods and Materials: Technician- and self-reported measurements of height, weight, and WC were collected from all participants. BMI was calculated by dividing weight in kg by height in meters squared. Overweight and obesity were defined as BMI ≥25-<29.9 and ≥30 kg/m², respectively. Abdominal obesity was defined as WC ≥94 and ≥80 cm in men and women, respectively. Statistical Analysis: Independent t-test, chi-square, Pearson and intraclass correlation coefficients (ICCs), as well as Kappa measurements, were used. Results: Fifty and 19 percentages of the study population were overweight and obese, respectively. Self-reported height (r = 0.83, P < 0.001, ICC =0.89, 95% confidence interval (CI): 0.85–0.92), weight (r = 0.95, P < 0.001, ICC = 0.979, 95% CI: 0.971–0.98), BMI (r = 0.70, P < 0.001, ICC = 0.81, 95% CI: 0.74–0.86), and WC (r = 0.60, P < 0.001, ICC = 0.71, 95% CI: 0.51–0.81) were highly correlated with actually measured ones. Approximately 80% and 65% of individuals who were defined as overweight and obese, respectively, based on actually measured data were correctly diagnosed as overweight and obese, respectively, based on self-reported data. The Kappa coefficients for different categories of weight situation and abdominal obesity were 0.59 and 0.32, respectively. Fifty-seven percent of participants who were diagnosed with abdominal obesity based on actually measured data were correctly diagnosed with abdominal obesity based on self-reported data. Also, approximately 48% and 69% of men and women, respectively, who were diagnosed with abdominal obesity based on actually measured data were correctly diagnosed with abdominal obesity based on self-reported ones. Conclusions: We found that self-reported data of anthropometric measures are reasonable in middle-age staff of Isfahan University of Medical Sciences. Nevertheless, self-reported data on WC should be cautiously relined on, in particular, among men.

Introduction: A review of the existing literature shows the importance of mental health in preventing traffic accidents. Therefore, the current study aims to determine the mentioned mental disorders in relation with the history of accidents among truck drivers. Methods: This cross-sectional study was done with two groups of truck drivers (with and without a history of accidents) in Iran. 56 people with a history of accidents and 410 people without a history of accidents participated in this study. At first, using questionnaires, the demographic information of the participants including age, education level, cigarette use, and addiction to drug was collected. Then, the mental disorders of the participants were evaluated by a 71-question, short form of the multidimensional Minnesota Multiphasic Personality Inventory (MMPI). The evaluated disorders are the HS or hypochondria, D or depression, HY or hysteria, Pd or social mental deviation, Pa or paranoia, Pt or mental weakness, Sc or schizophrenia, and Ma or hypomania. The tests used for data analysis include descriptive tests and Chi square. Results: Man–Whitney U test showed that status of mental disorders, as revealed by the MMPI questionnaire, had a significant difference between the two groups with and without history of driving accidents (P < 0.001). The results showed that mental disorders of depression, hysteria, social mental deviation, paranoia, schizophrenia, and hypomania in individuals with history of driving accidents led to meaningful differences from individuals without history of driving accidents (P < 0.048). Conclusion: The results of the current study showed that generally, individuals with history of driving accidents had significantly more mental disorders than people without history of driving accidents.

The development, implementation and advancement of technology solutions aimed at combating the COVID-19 outbreak are rapidly taking shape in India. Governments, Venture Capitalists, Academic Institutions, Incubators, Start-ups, and businesses large and small are all doing their part to deploy new innovative solutions as quickly as possible. Various databases were searched to look for different advancements in technology during the current coronavirus pandemic. It is seen that on one end nonpharmacological measure (social distancing, self-isolation, clean hands, and face masks) are time-tested and low-tech ways to help mitigate the viral spread. On the other end, Science and technology sector constituting of data science, machine learning, rapid diagnostic tests, mobile-first telehealth and computational simulation systems for drug development, artificial intelligence, virtual collaboration, and data tracking are complex ways of using the technology that have strengthened our pandemic response.

Background: The purpose of this study was to systematically review the literature to investigate the prevalence of complete edentulism in Iran. Method: An electronic search was performed using three scientific databases: PubMed, Google Scholar, and Irandoc. Moreover, a hand search was performed on theses in the Dental Faculty of Shahed University. Studies published since 2000 were included if they reported on the prevalence of edentulism in Iran in populations at least 35 years old. Eight articles and seven theses were included in the study. Result: The reported prevalence of edentulism in Iran ranges from 3% to 78%. Conclusions: In this study the reported prevalence has remained stable during the studied period.

Background: The basis of prevention of non-communicable diseases is the identification of primary risk factors and the prevention and control of these factors. The purpose is to prevent the spread of the disease and to control it as much as possible. If population growth continues at this rate, by 2030, 52 million people will die from these diseases each year. The aim of this study was to evaluate the challenges of preventing non-communicable diseases. Methods: The present study was a systematic review that conducted in July 2020 and the articles related to prevention of non-communicable diseases on databases of web of science, PubMed, Scopus, science direct, Ovid, Pro Quest and Google Scholar. Strategy for searching and selecting the articles was PRISMA Guidelines. Results: Challenges of non-communicable disease prevention, in 4 main codes, including infrastructure, economic, demographic and management and 12 sub-codes that include, lack of preventive infrastructure, restrictions on access to medicine, restrictions on primary health care, restrictions on access to Technology, disease-oriented disease, unsustainable financial resources, failure to implement poverty reduction projects, increase in aging population, migration, rapid and unplanned urban planning, hasty planning and lack of internal and external coordination were classified. Conclusions: To reduce non-communicable diseases, strengthen global capacities, reduce risk factors for NCDs and place social determinants by creating health-promoting environments, strengthen health systems to implement prevention and control of NCDs, and place determinants Social can play an effective role through people-centered primary health care.

Comprehensive care includes the spiritual and the bio-psycho-social person. The aim of this study is to explain how people with diabetes mellitus manage holistic treatment. Search for multi-database papers: Ovid, CINAHL, and PubMed. PICOT-based keyword description is P: any diabetes population, I: holistic care, C: any comparison, O: blood sugar, T: whenever. The English article, journal quest, full-text article available, and published article were criteria for inclusion in this study. In the quest journal, a strategic manner is performed using three keywords: holistic, diabetes mellitus, and blood sugar. We reviewed ten papers. The result showed that comprehensive care was explained in terms of technology, holistic care program, and holistic care relating to complementary alternative medicine. Discussion in this study is that holistic care services give significant results in the treatment of people with diabetes mellitus.

Background: Mothers of premature infants experience a high level of stress. The current study was conducted aiming at investigating the impact of maternity support program on the stress of mothers in the first encounter with infants. Methods: This experimental study began in neonatal intensive care units (NICUs) of two hospitals of Tehran; that is, Mahdieh (intervention) and Shahid Akbar-Abadi (control), from Feb 14, 2016, to May 14, 2016. Both are educational and referral centers including three levels of NICU that were randomly allocated to intervention and control sites. In the span of study period all 75 infants and mothers with inclusion/exclusion criteria in the Mahdieh hospital were included in the intervention group and vis-à -vis all 68 infants and mothers in Shahid-Akbar-Abadi were enrolled in the control group. The designed intervention was conducted based on the support system pattern of mothers with premature infants in the interventional group. In the first stage of intervention, in the intervention group, mothers were provided informational, emotional, and spiritual support before and during the first exposure and were empowered for comfortable interactions. The control group received routine care. After the first exposure, the mothers' stress was measured by the Parental Stressor Scale: Neonatal Intensive Care Unit (PSS: NICU). The data were analyzed by STATA software as well as t-test, Chi-square, and average treatment effects (ATEs) were estimated using inverse probability treatment weights (IPTW). Results: After adjusting pre-treatment variables by IPTW, the adjusted average difference in the stress score over the NICU environment, infant's behavior and appearance, the special treatments on him/her, and the change in the parental role and total stress were 1.47 (1.19–1.75), 1.06 (0.73–1.14), 1.21 (0.93–1.49), and 1.18 (0.93–1.44), which were lower than the control group (P < 0.001). Conclusions: The intervention reduced significantly the stress of mothers. The policy-makers are suggested to conduct this method.

Background: There is limited information on the relationship between family psychological functions and perceived social support with progress in cigarette smoking stages in adolescents. This study was aimed to determine the relationship between family psychological function and perceived social support through a transition in different stages of cigarette smoking in adolescents of Tabriz, Iran. Methods: In this study, 4,216 students (14–19 years old) from high schools were selected by multistage cluster sampling method. Initially, we used valid and reliable questionnaires for demographic characteristics, risk factors, Iranian family psychological function, and perceived social support. The smoking status questionnaire was administered twice, with an interval of 6 months. Data were analyzed using univariate and multivariate logistic regression analysis. Results: Overall, 3,968 students with the mean (standard deviation) age of 15.96 (0.75) years completed the questionnaire in the first phase of the study. The results showed that lower levels of family psychosocial function (P < 0.001) and perceived social support (P < 0.001) in the univariate state were significantly associated with progress in cigarette smoking stages. By controlling the potential confounding factors, the weak and moderate family psychological function compared to the strong function increased the chance of progress in the cigarette smoking stages by almost 11 and 4 times, respectively (P < 0.001). The low and moderate level of perceived social support compared to the high level increased the chance of progress in cigarette smoking stages by almost 7 and 2 times, respectively (P < 0.001). Conclusions: It is suggested to perform an organized, precise, and operational planning for strengthening the family psychological functions and providing an appropriate social support condition among adolescents to prevent the tendency toward cigarette smoking and its more advanced phases.

Background: Alzheimer disease (AD) is the most common age-dependent dementia. The complex natural accumulation of amyloid beta (Aβ) precursor protein in hippocampus neurons is regarded as the earliest pathological feature of AD, although there are cholinergic assumptions and effective inflammation in AD. In this animal experimental study, we evaluated the preventive effect of hyoscyamoside (Hyo) and donepezil (Dz) on plaque formation and improvement of neurogenic inflammation in AD rats. Methods: Dz was prepared and Hyo (steroidal saponin) was isolated from Hyoscymus niger. Then, Wistar rats divided into five groups including negative and positive controls, AD, Dz, and Hyo treatment groups based on the drug exposure and their behavioral alternation was examined using Morris water maze (MWM) test. Bielschowsky staining was used to detect the nerve fibers. Serum levels of interleukin (IL)-4 and IL-6 were evaluated by ELISA. The RNA expression of cyclin-dependent kinase CDK11-P58 in peripheral blood lymphocytes was performed using quantitative PCR. Results: The MWM test showed significant changes in time the models spent to find the hidden platform. The Hyo treatment group showed a notable speed change (P < 0.01). The histopathological analysis of the hippocampal tissue revealed the inhibition of Aβ formation in the treatment groups. The treatment groups had a significant decline in the serum level of IL-6, and the IL-4 serum level was increased in the Hyo and Dz treated groups. The expression levels of CDK11-P58 was significantly decreased in the treatment groups. Conclusions: In sum, the therapeutic effects of Hyo is comparable with that of Dz in AD rats by suppressing neuroinflammation. Thus, these compounds could be considered as a preventive agent in the AD therapy.

Background: Breast, uterine, and ovarian cancers are the most prevalent types of cancers among women. The aim of this study was to estimate the relative risk of these cancers and recognizing spatial patterns of their shared and specific risk factors in cities of Isfahan province, one of the most populated provinces of Iran, using spatial shared component model. Methods: In this ecological study, the population consisted of all the registered patients having breast, ovarian, and uterine cancers in the cities of Isfahan from 2005 to 2010. In order to simultaneously analyze these diseases and clarify common and specific patterns of disease, spatial Shared component model was applied. Model fitting was done using Bayesian inference in OpenBUGS software. Results: The highest relative risk of breast cancer was seen in Isfahan (4.96), Shahreza (2.37), Dehaghan (5.01), Lenjan (2.33), and Najafabad (2.68), respectively. For ovarian cancer, Isfahan (4.29), Shahreza (2.51), Dehaghan (5.02), Lenjan (2.06), Najafabad (2.00), and Borkhar (2.39) had the highest relative risk, respectively. However, no significant difference was seen among the cities for uterine cancer (P > 0.05). Conclusions: Since ovarian and uterine cancers are the less prevalent disease in comparison with breast cancer, the preciseness of these estimates were improved remarkably over simple mapping models. Based on this model, the estimates were done according to the correlation between the diseases. After recognizing the spatial patterns of the shared and specific risk factors and reviewing of previous studies, regardless of risk factors data, environmental pollution arises as a potential risk factor.

Background: The cell cycle is divided into four phases, G1, G2, S, and M phase. The mammalian cell cycle is controlled and governed by the kinase complexes including cyclin and the cyclin-dependent kinase (CDK), cyclin-CDK complexes. The activity of the complexes is regulated by cyclin-dependent kinase inhibitors (CDKIs), the INK4, and the CDK interacting protein/kinase inhibitory protein (CIP/KIP) families. Promoter hypermethylation and histone deacetylation of CDKIs have been reported in several cancers. These changes can be reversed by DNA demethylating agents, such as decitabine, 5-Aza-2′-deoxycytidine (5-Aza-CdR), and histone deacetylase inhibitors (HDACIs), such as trichostatin A. Previously, we reported the effect of 5-Aza-CdR and trichostatin A (TSA) on hepatocellular carcinoma (HCC). The present study aimed to investigate the effect of 5-Aza-CdR in comparison to and in combination with trichostatin A on p16INK4a, p14ARF, p15INK4b genes expression, cell growth inhibition and apoptosis induction in colon cancer Caco-2 cell line. Methods: The Caco-2 cells were cultured and treated with 5-Aza-CdR and TSA (alone and combined). The cell viability, apoptosis, and relative gene expression were determined by MTT assay, flow cytometry, and real-time quantitative reverse transcription-polymerase chain reaction (qRT-PCR), respectively. Results: Both compounds inhibited cell growth, induced apoptosis, and up-regulated the p16INK4a, p14ARF, p15INK4b gene significantly. The TSA had a more significant effect in comparison to 5-Aza-CdR. Furthermore, maximal apoptosis and up-regulation were observed with combined treatment. Conclusions: our finding indicated that 5-Aza-CdR and TSA can epigenetically re-activate the p16INK4a, p14ARF, p15INK4b gene resulting in cell growth inhibition and apoptosis induction in colon cancer.

Background: We aimed to determine the sensitivity of serum cystatin C (Cys-C) in predicting lupus flare-up. Methods: In a longitudinal study, 77 patients were followed-up for up to 15 months. Cys-C, physician global assessment (PGA), and lupus activity index (SLEDAI) were recorded during each visit. Flare-up was defined as an increase ≥4 scores in SLEDAI compared to the last visit. The predictability of flare-up by Cys-C was evaluated by generalized linear-mixed effect model (GLMM) and generalized estimating equation (GEE). Predictive power of Cys-C, SLEDAI, and PGA was compared by the area under the curves (AUC) and application of receiver operating characteristic (ROC) curves. Results: Lupus flare-up was observed in 14 out of 77 patients on the 1^st visit, 3 out of 41 patients on the 2^nd visit, 2 out of 26 patients on the 3^rd visit, 1 out of 14 patients on the 4^th visit, and 1 out of 3 patients on the 5^th visit. Mean Cys-C levels in patients with flare-up vs. those with no flare-up in the 1^st, 2^nd, and 3^rd visits were 1769 vs. 1603 (P = 0.6), 5701 vs. 2117 (p = 0.2) and 1409 vs. 1731 (p = 0.9), respectively. Cys-C had lower predictive power than PGA and SLEDAI for either flare-up, active nephritis or SLEDAI in GLMM/GEE models. Cys-C also showed lower sensitivity (AUC = 0.701, 95%CI = 0.579-0.823, P = 0.003) than PGA and SLEDAI, to distinguish patients prone to flare-ups. Conclusions: Although Cys-C had some sensitivity for predicting flare-up, active nephritis or SLEDAI, its sensitivity was lower than that in PGA and SLEDAI.

Context: Postoperative sore throat (POST) is a common annoying problem following endotracheal (ET) intubation. Aims: Comparing the impact of low and high doses of ketamine gargle on lowering POST incidence and severity. Settings and Design: 96 patients selected for septoplasty surgery under general anesthesia were investigated through a single-blind randomized controlled trial. Methods: This study was performed on three equal groups. Group K and G gargled 50 and 100 mg ketamine, respectively, solved in normal saline and group C gargled pure normal saline for 30 s at 5 min before tracheal intubation. POST severity measured immediately after the entrance to the postanesthetic care unit (PACU) and then 2 h, 4 h, 8 h, and 24 h after operation. Statistical Analysis Used: Collected data were analyzed by the Chi-square test, Mann-Whitney test, Kruskal-Wallis test, one-way analysis of variance (ANOVA) and Friedman test using SPSS version 20. Results: POST incidence and severity in group C were significantly higher than both K and G groups at all times. Although significant differences between low and high doses of ketamine were acknowledged at 8 h post-operation, 100 mg ketamine could attenuate POST severity further than 50 mg at all times. Conclusions: It seems that 100 mg outperformed 50 mg ketamine without rising complications and dissatisfaction for subjects. So, it gives us a powerful reason to suggest gargling 100 mg ketamine for lessening POST incidence and severity.

Background: Infection with the hepatitis C virus (HCV) occurs globally. It is a substantial cause of chronic liver disease, cirrhosis and hepatocellular carcinoma. Egypt one the countries that has the highest hepatitis C burden in the world. The occurrence of HCV is directly related to the number of individuals who regularly share injection instruments and to the prevalence of inappropriate parenteral procedures in healthcare facilities. The study aimed to identify unhealthy community practices related to HCV infection. Methods: a nested case control study carried out in Damietta Governorate, Egypt. Where150 cases (positive for HCV) and 300 controls (negative for HCV) were randomly chosen. Results: Participant who shared shaving razor was 8.4times more likely to acquire HCV infection followed by IV fluid and needle or sharp stick (about six times more risk).while acupuncture, cupping, tattooing and traditional cauterization carried 1.6 to 3.6 times more risk for HCV infection. Conclusions: Unhealthy community practices carried a higher risk for acquiring HCV infection. It is highly advocated to strengthen infection prevention and control program in health care facilities and health education programs to enhance community awareness and empowerment.

Background: Angiogenesis is an important step in cancer metastasis since it enables the growing tumor to receive nutrients and oxygen. Quercetin is a generic flavonoid and has been investigated for its ability to inhibit angiogenesis in different types of cancers. MALAT1 and MIAT lncRNAs are associated with the angiogenesis process. MALAT1 induces hypoxia-driven angiogenesis via the overexpression of angiogenic genes. Down regulation of MIAT1 could inhibit the proliferation of endothelial cells, tube formation, and migration. In this study, we assessed the anti-angiogenic activity of quercetin on human umbilical vein endothelial cells (HUVEC) via the expression of MALAT1 and MIAT genes. Methods: In the present study, HUVEC cells were incubated with various concentrations of quercetin for 24, 48, and 72 h. Cell proliferation was then evaluated by MTT assay. RNA was extracted by TRIzol and cDNA synthesis. The expression levels of MALAT1 and MIAT genes relative to the GAPDH gene were quantified using the highly sensitive real-time PCR method. Results: Our results demonstrated that quercetin has an inhibitory impact on the cell viability of HUVEC cells. The IC₅₀ values of quercetin after 24, 48, and 72 h were 282.05 μM, 228.25 μM, and 131.65 μM, respectively. The MALAT1/GAPDH ratio was computed as 0.21 for 24h, 0.18 for 48h, and 0.29 for 72 h. The MIAT/GAPDH ratio was computed as 0.82 for 24h, 0.84 for 48h, and 0.78 for 72 h. Conclusions: In conclusion, quercetin treatment had an anti-angiogenic effect on HUVEC cells, at least partially via the down regulation of MALAT1 and MIAT LncRNAs gene expression.

Background: Few studies have evaluated the continuity of primary care in universal health care systems, especially in underserved areas. Methods: This was a cross-sectional study with 4,001 adults (≥18 years old) living in the Manaus Metropolitan Region in 2015. Interviews were conducted in households selected with probabilistic sampling. City and neighborhood variables were collected from databanks. Prevalence ratios (PR) of the continuity of care (defined as using a primary care service and having been previously registered in the Family Health Strategy program) and 95% confidence intervals (CIs) were calculated with multilevel Poisson regression analysis. Results: A total of 20.6% (95%CI 19.4-21.9%) of the participants reported continuity of primary care. Women (PR = 1.38; 95%CI 1.18-1.61), nonwhite individuals (PR = 1.13; 95%CI 1.05-1.21), and poorer people (PR = 1.55; 95%CI 1.19-2.02) had higher levels of continuity, whereas health insurance holders had lower levels of continuity (PR = 0.46; 95%CI 0.34-0.62). Individuals with continuity of care had more physician consultations (PR = 1.06; 95%CI 1.02-1.10), dentist consultations (PR = 1.16; 95%CI 1.05-1.28), fewer depressive (PR = 0.59; 95%CI 0.44-0.79) and anxiety symptoms (PR = 0.64; 95%CI 0.48-0.85), and a higher quality of life (β = 0.033; 95%CI 0.011-0.054) than those without continuity. Conclusions: Continuity of care was attained by two-tenths of the population and the level of continuity was high among socioeconomically disadvantaged people. Good outcomes and health services usage increased with continuity of care.

Background: A correlation between type 2 diabetes and refined carbohydrates has been proven, while several studies have indicated that Iranian daily diets are poor in term of proper carbohydrates. It was thus considered absolutely critical to conduct a qualitative study in terms of people's attitudes toward whole grains, and the feasibility of their replacing existing refined carbohydrates in their diets. The aim of this study is to probe Iranian awareness of whole grains, to explore barriers to refined-grain substitution with whole grains and legumes, and to assess whole-grain sensory perceptions. Methods: Focus group discussions (FGDs) and taste tests conducted between July 2016 and March 2017 in urban and rural areas of Kurdistan, Yazd, and Tehran provinces in Iran. A total of 96 healthy men and women (aged 40-65, BMI ≥25 kg/m²) were selected through purposive sampling with maximum variation. FGDs were categorized by content analysis method. As for taste test, ANOVA analysis with Bonferroni post-hoc was used to determine significant differences (P < 0.05). Results: Four themes and 11 sub-themes emerged. Cultural beliefs, traditional eating patterns, sensory properties, and familial acceptance were the most influential factors in choosing the type of bread and rice. Simultaneously they are the most prominent barriers to consuming whole grains and legumes. Plain cooked brown rice had the lowest mean sensory attribute score and traditional whole-wheat flatbread was the highest. Conclusions: There was a higher acceptance tendency toward using traditional whole-wheat flatbread rather than refined grains, as it was consistent with preference and priority. However, low availability was the largest substitution problem.

Background: Noncommunicable diseases are on the rise in India. Hypertension is one of the major risk factors for cardiovascular diseases and also labeled as a chronic lifestyle disorder. Hence, non-pharmacological interventions leading to lifestyle modifications are of utmost importance to control and prevent hypertension. This trial aims to implement yoga intervention to the experimental group in addition to medicines, advice on diet and physical activity and to compare blood pressure and perceived stress scores with the control group. Methods: It was an open-label, two-armed, non-randomized controlled trial, conducted at a tertiary care center on 145 patients with hypertension: 73 in the intervention group and 72 in the control group. The intervention group received yoga intervention for a period of 4 months on a weekly basis along with advice on physical activity, diet, and routine medicines. The control group did not receive yoga intervention. Results: The mean age of the participants was 51.3 ± 9.4, females (58.2%) outnumbered males (41.3%). Following the intervention, perceived stress score and blood pressure showed a significant reduction between two groups (P < 0.001). Also, perceived stress and blood pressure were found to be reduced significantly within both groups (P < 0.001). Conclusions: Yoga proves to be an effective, safe, and less expensive adjunct therapy for hypertension management. Yoga was also found to be effective in reducing the level of stress. Diet modification and physical activity have got an important role to play in the control and prevention of hypertension.

Background: Figures from Iranian cancer registries indicate that Isfahan ranks first in female breast cancer incidence. Although few previous studies have examined whether the breast cancer incidence trend in Isfahan province has increased over a given period of time, this study employed a joint point regression analysis to answer the same question. Moreover, it compared the data of Isfahan province, from a developing country, with those of England, as a representative of developed countries, and tried to explain the causes of the differences observed between the trends. Methods: This repeated cross-sectional study was conducted on the data of 6057 women in Isfahan province and of 141,011 women in England with breast cancer over the years 2001–2013. The incidence rates were calculated using direct standardization method and based on the 2013 standard European population. For an analysis of the trends in breast cancer incidence rates, Joint Point Regression program, version 4.3.1.0, released in April 2016, was employed. Results: The mean age-standardized incidence rate (ASR) was calculated to be 34.7 per100,000 population over the years 2001 to 2013, which indicated an increase from 22 to 68 in Isfahan province. The corresponding mean ASR for England has also risen from 147.5 to 170.1 per 100,000 women during the same time period. The average annual percentage changes (AAPCs) for Isfahan and England were also calculated to be 9.6 and 1.1, respectively. This indicated an increasing trend in breast cancer incidence rates for Isfahan province over the period in question. Conclusions: The drastic discrepancy in breast cancer incidence rates between these two regions may be attributed to differences in an improved cancer registry system in Iran and women's developing awareness of the cancer over time.

Background: Congenital hypothyroidism (CH) is one of the most prevalent preventable causes of mental retardation. Studies show that the incidence rate of CH is very high in Iran. Disease mapping is a tool for visually expressing the frequency, incidence, or relative risk of illness. The present study aimed to model CH counts considering the effects of the neighborhood in towns and perform mapping based on the relative risk. Methods: In this historical cohort study, data of all neonates diagnosed with CH with TSH level ≥5 mIU/L between March 21, 2017, and March 20, 2018, in health centers in Guilan, Iran were used. The number of neonates with CH was zero in most towns of Guilan Province. The Bayesian spatial zero-inflated Poisson (ZIP) regression model was employed to investigate the effect of the town's neighborhood on the relative risk of CH incidence. Then, the map of the posterior mean of the relative risk for CH incidence was provided. The analysis was performed using OpenBUGS and Arc GIS software programs. Results: The relative risk of CH incidence was high in the West of Guilan. Moreover, the goodness-of-fit criterion indicated that it is more appropriate to fit the Bayesian spatial ZIP model to these data than the common model. Conclusions: Considering the high relative risk of CH in the Western towns of Guilan Province, it is better to check important risk factors in this region.

Background: Dyslipidemia is often associated with obesity and contributes to the increased risk of atherosclerosis, heart disease, and stroke. This study was designed to evaluate the independent or combined effect of calcium and vitamin D (Ca + Vit D) supplementation on blood lipid profile in overweight or obese premenopausal women. Methods: This study is a triple-blind, randomized, parallel, placebo-controlled trial. About 100 overweight or obese (body mass index (BMI) of 25–40 kg/m²) premenopausal (aged 30–50 years) women, recruited from Shiraz University of Medical Sciences (SUMS) clinics, were allocated into 4 groups: (1) calcium (Ca) supplementation (2 tablets per day; each containing 500 mg calcium carbonate), (2) vitamin D (Vit D) supplementation (2 tablets per day; each containing 200 IU vitamin D3), (3) Ca + Vit D supplementation (2 tablets per day; each containing 500 mg calcium carbonate plus 200 IU vitamin D3), (4) placebo supplementation (2 tablets per day, containing micro-cellulose). All participants received a 500 kcal energy-restricted diet. Blood lipids, serum vitamin D, and anthropometric indices were measured at baseline and after 8 weeks. Physical activity and 3-day dietary records were taken at baseline and every 4 weeks during the intervention. Results: At 8 weeks, triglyceride levels were significantly decreased in the Ca group (P = 0.002). Low-density lipoprotein (LDL) levels were decreased in the Ca + Vit D group (P = 0.04) and high-density lipoprotein (HDL) levels decreased in both the Ca and Ca + Vit D groups (P = 0.006, P = 0.004, respectively). The results of one-way ANOVA indicated that changes in the serum lipid profile levels were not significantly different among the four groups (P = 0.90, P = 0.86, P = 0.61, P = 0.27, and P = 0.19, respectively for TG, TC, LDL, HDL, and LDL/HDL). The results were not significant even after adjusting for potential covariates. Conclusions: Although the results were not significantly different among the four treated groups at 8 weeks, within-group changes like the reduction in triglyceride and LDL levels, respectively in the Ca group and Ca + Vit D group, and HDL levels in both the Ca and Ca + Vit D groups were significant. These changes may have potentially significant public health implications.

Background: Assessing children's early development can help health and social policymakers to improve children's well-being. This study aims to develop an early childhood composite index for measuring early childhood care and education among Iranian children considering each child's geographical area, socioeconomic status and gender. Methods: In this cross-sectional secondary study, the data come from Iran's Multiple Indicator Demographic and Health Survey 2010. Of the 9,345 eligible children whose information had been collected, 3,532 fulfilled the inclusion criterion of being 3 or 4 years old at the time of the interview. We examined a composite index and three subscales of early childhood development including “Quality of Care”, “Early Childhood Care and Education”, and “Overall Developmental Status”. Factor analysis and latent class analysis were used for analyzing the data. Results: The results indicate that of the children in the sample, 47.3% were in the “low early child development” class, 6% were in the “middle early child development” class, and 46.7% were in the “high early child development” class. The means of the three subscales and the composite index were significantly different across geographical areas (P < 0.01) and between the socioeconomic classes (P < 0.0001), with children from poorer families having lower scores. The composite index was significantly higher for girls (M = 11.28, SD = 3.96) than boys (M = 10.99, SD = 3.87, P = 0.029). Conclusions: The study presents significant differences in childhood development based on geographical divisions, quartile classes and gender. We suggest that future research is needed to explore the robustness of findings in this study over time and diversity between and within various Iranian populations.

Background: Patients with multiple sclerosis (MS) suffer from a wide range of psychological problems. Application of a valid and reliable tool for psychosocial assessment is required for Iranian patients. The aim of this study is to determine the psychometric properties of the Persian version of the PARADISE-24 questionnaire in Iranian patients with multiple sclerosis. Methods: One hundred and thirteen multiple sclerosis cases were enrolled in this study. Participants were asked to answer the valid and reliable Persian version of the fatigue severity scale, social support scale, Pittsburg sleep quality index, and hospital anxiety and depression scale and translated version of the PARADISE-24 questionnaire. Twenty cases filed the questionnaire 2 weeks later to assess reliability. The intraclass correlation coefficient, Cronbach's alpha, correlation coefficients, and multiple regression analysis were used. Results: Mean age and mean duration of the disease were 35.8 ± 9.9 and 8.7 ± 5.6 years, respectively. The intraclass correlation coefficients ranged from 0.8 to 0.94 and Cronbach's alpha values (Cronbach's alpha was calculated as 0.91 for the whole questionnaire) were also significant. There were significant correlations between PARADISE-24 score and expanded disability status scale (r = 0.42, P < 0.001), fatigue severity scale (r = 0.62, P < 0.001), anxiety (r = 0.43, P < 0.001) and Pittsburg sleep quality index scores (r = 0.46, P < 0.001). Regression analysis by considering PARADISE-24 as dependent and other variables as independent showed that expanded disability status scale, fatigue severity scale, anxiety score, and Pittsburg sleep quality index were positive predictors of PARADISE-24 score. Conclusions: Persian version of PARADISE-24 questionnaire is a valid and reliable instrument for evaluating psychosocial aspects in patients with multiple sclerosis.

Background: Patent ductus arteriosus (PDA) is one of the more common congenital heart defects in preterm neonates. The closure of PDA can be done with ibuprofen; however, this drug is associated with many contraindications and potential side-effects. In the past years, paracetamol has been proposed for the treatment of PDA. This study was designed to evaluate the efficacy and gastrointestinal complications of paracetamol and ibuprofen for the pharmacological closure of PDA in preterm infants. Methods: In a clinical trial study, 40 preterm infants with echocardiographically confirmed PDA were randomly assigned to receive either paracetamol (n = 23; 15 mg/kg every 6 h for 2 days) or ibuprofen (n = 17; initial dose of 10 mg/kg, followed by 5 mg/kg every 12 h for 2 days). The neonates matched for gestational age and weight. We used t-test for parametric, Chi-square for categorial, and Wilcoxson for nonparametric variables. Significant level was considered less than 0.05. Results: Platelet count, BUN and creatinine levels, and closure of PDA had not significant difference between two groups (P > 0.05). Incidence and severity of GI bleeding, feeding intolerance, and NEC were significantly more in infants who received paracetamol than ibuprofen (P < 0.05). Conclusions: There were no differences in the rate of PDA closure between the two drugs, but with respect to complications, rate and severity of GI bleeding, feeding intolerance, and NEC were significantly more in infants who received paracetamol than ibuprofen. Therefore, paracetamol could not be used as a proper alternative agent for ibuprofen in the treatment of PDA in preterm infants.

Background: The cardiovascular mortality rate in Iran has been reported 65% of all death recently. Despite the high prevalence of cardiovascular diseases (CVD) risk factors and its burden in developing countries, public awareness of CVD symptoms and its risk factors are very low, leading to poor control of these risk factors. Methods: Our study is a cross-sectional study that was conducted in an undefined sample of 163 individuals who participated in a public health campaign. We used a validated questionnaire containing demographic, cardiovascular history, family history, lifestyle (exercise, smoking, alcohol, and environment), stress, sleep, bowel toxicity, blood sugar, inflammation/pain, and diet parts for estimating total cardiovascular risk factor. Results: 52.7% of our participants were male. The mean age of our participants was 42.6 ± 47.27 years. Half of our participants (50.3%) were between 30 and 60 years. 12.3% of the participants were diagnosed with CVD. 12.8% were smokers and 25.8% were passive smokers. 73% of our participants had a high level of stress in their individual and work life. 35.5% of participants sleep less than 6 h per night. Half of them complained of initial or intermittent insomnia. 51.5% of our participants were at high or very high risk for CVD with three or more relative risks. There was a significant association between total cardiovascular risk and blood pressure, weight, sleep, and lifestyle in our population. Conclusions: More than half of our participants were on high or very high risk for CVD. The most common risk of CVD events in our participants is attributed to hypertension. Weight, sleep, and lifestyle were other modifiable risks that had a significant association with CVD in our study.

Background: It is known that some elements are needed for normal thyroid gland functions. Iodine and selenium are the most well-known trace elements necessary for thyroid metabolism. Selenium is involved in the formation of thyroid hormones and the structure of the deiodinases associated with the development of the thyroid gland. While the role of zinc in thyroid metabolism is at the T3 receptor level, the role of copper is yet not clear. Objective: To compare the levels of serum trace elements such as selenium, zinc, and copper between the patients with euthyroid nodular goiter and healthy participants. Methods: This cross-sectional study included 98 patients with euthyroid multinodular goiter and 83 healthy subjects without thyroid disease. The demographics, thyroid hormone levels, and thyroid ultrasonography of the participants were recorded. Venous blood samples were centrifuged and sera samples were stored at -80°C until analysis of selenium, zinc, and copper levels. The levels of trace elements were determined by inductively coupled plasma-mass spectrometry (ICP-MS). Results: While serum, zinc, and selenium levels were significantly higher in the control group than the nodular goiter group, the copper levels were similar in the two groups. Trace elements were not correlated with thyroid hormone levels and thyroid volumes. Patients in the nodular goiter group were analyzed according to their solitary and multiple nodule status. The solitary and multiple nodular goiter groups were similar in terms of copper, zinc, and selenium levels. Conclusions: Deficiency of selenium and zinc may be associated with nodular goiter. Replacement of these trace elements may be useful for the prevention of nodular goiter, especially in deficient regions.

Background: Glycation, inflammation, and oxidative stress are the cardinal motivators of diabetes vascular complications. Here, we studied the effect of eucalyptol (EUC) on the formation of atheromatous lesions, glycation, oxidative stress, and inflammatory markers as well as insulin resistance, lipid profile, and activity of glyoxalase-1 (GLO-I) in the atherosclerotic rat model. Methods: Diabetic-atherosclerosis induced in rats with a combination of streptozotocin and atherogenic diet. Two groups of rats, normal and diabetic-atherosclerotic, were treated intragastrically with EUC (200 mg/kg) once daily for 3 months. Fasting blood sugar (FBS), insulin, insulin resistance index, lipid profile, the activity of GLO-I, low-density lipoprotein (LDL) glycation and oxidation markers, inflammatory markers, creatinine in the serum, and proteinuria in the urine of all rats were determined. Results: EUC inhibited the formation of any atheromatous lesions in atherosclerotic rats. Further, EUC displayed the lowering effect on glycemia, insulin resistance, LDL glycation, and oxidation products, and tumor necrosis factor (TNF)-α as well as it exhibited the improving effect on lipid profile, the activity of GLO-I, and renal function in the diabetic rat (P < 0.001). Conclusions: EUC prevented the formation of the atheromatous lesions and improved renal function in the atherosclerotic rat model due to a reduction of glycation, oxidative stress, and inflammatory mediators.

Background: Diabetes is the fifth leading cause of death in the world, which reduces the patients' quality of life (QOL) and is considered as an important subject especially in medicine and medical community. The present study aimed at investigating the QOL of diabetic patients in Iran through meta-analysis. Methods: The search was conducted using relevant keywords in national and international databases including Iranmedex, SID, Magiran, IranDoc, Medlib, Science Direct, PubMed, Scopus, Cochrane, Embase, Web of Science. Questionnaires WHOQOL, SF-36, SF-20, DQOL, QOL, PedsQL, ADDQOL, D-39, DQOL-BCI, SWED-QUAL, IRDQOL, PHG-2, EQ-5D, and IDQOL-BCI were used to assess the QOL. Heterogeneity of studies was assessed using I² index. Data were analyzed using STATA version 11. Results: In 96 studies of 17,994 people, the mean score of QOL in diabetic patients was based on the questionnaires WHOQOL [66.55 (95% CI: 45.83, 87.26)], D-39 [129.43 (95%CI: 88.77, 170.10)], SF-36 [65.64 (95% CI: 59.82, 71.46)], SF-20 [46.50 (95% CI: 37.19, 55.81], DQOL [61.19 (95% CI: 35.73, 86.66)], QOL [117.91 (95% CI: -62.97, 298.79)], PedsQL [34.36 (95% CI: -31.49, 100.22)], ADDQOL [41.76 (95% CI: 12.01-71.50)], SWED-QUAL [59.19 (95% CI: 21.15, 97.23)], IRDQOL [105.92 (95% CI: 102.73, 109.10)], PHG-2 [61.00 (95%CI: 59.63, 62.37)], EQ-5D [0.62 (95% CI: 0.61, 0.64)], DQOL-BCI [3.40 (95% CI: 3.31, 3.49)], and IDQOL-BCI [22.63 (95% CI: -2.38, 47.64)]. Conclusions: The QOL of diabetic patients was evaluated according to different types of questionnaires and the QOL of diabetic patients was found to be lower than normal population.

Background: The fruits of Apiaceae family have been widely used in traditional medicine for the treatment of pain and inflammation. In this study, we evaluated the analgesic and anti-inflammatory effects of wild celery (Smyrniopsis aucheri) seeds, as a member of the Apiaceae family. Methods: Hydroalcoholic and hexane extracts of seeds were prepared and for the evaluation of analgesic activity, acetic acid, formalin, and hotplate tests in male mice (20–30 g) and for anti-inflammatory assessment carrageenan-induced paw edema in rats and croton oil-induced ear edema in mice were used. Results: Hydroalcoholic and hexane extracts (100–400 mg/kg) significantly reduced abdominal spasms in the acetic acid test. In the formalin test, the hydroalcoholic extract at doses of 200 and 400 mg/kg reduced the pain of the chronic phase while hexane extract was effective in both acute and chronic phases. In the hot plate test, both extracts were ineffective. In the carrageenan and croton tests, both extracts at a dose of 400 mg/kg significantly reduced edema. Conclusions: The results revealed the analgesic and anti-inflammatory effects of plant seed extracts. Due to the lack of response of the extracts in the hot plate test, it seems that the plant mainly has a peripheral analgesic effect.

Background: To determine the relationship between serum protein electrophoresis (SPE) and serum immunoglobulin profiles of patients with multiple myeloma (MM). Methods: This is a retrospective study conducted at the Eric Williams Medical Sciences Complex, focusing on patients over 18 years who received diagnostic blood tests for MM. Results for SPE and serum immunoglobulin profiles were obtained using lab logbooks. Descriptive and inferential statistics techniques were used to analyze the data. Results: The median age of MM patients in Trinidad and Tobago is of 69 years. The ratio of male and female patients with the MM is 50:50. Out of 131 patients, 24 (18.32%) had M bands present, 60 (45.80%) had an increase in gamma globulin, and 16 (12.21%) had a decrease in albumin. In cases of M band presence and raised gamma, there was noticeable increase in IgG concentration and a slight increase in IgM concentration. There was also an increase in IgA concentration in patients with the M-band but a decrease in concentration in those with raised gamma. Patients with an elevated gamma had a significant increase in IgG diameter and IgG concentration. Conclusions: This study showed a relationship between the presence of M bands and serum immunoglobulins. It has proven the significance of SPE and immunoglobulins, like IgG and IGM, in the detection of MM in the early and advanced stages. Therefore, it is recommended that SPE be used, along with other laboratory tests, in the diagnosis of MM.

Background: Multiple sclerosis (MS) is an inflammatory disease while there are controversies regarding the role of vitamin D supplements in controlling relapse and disability improvement during treatment. Objective: The goal of this systematic review and meta-analysis was to evaluate the effect of vitamin D supplements on MS-related relapse and the Expanded Disability Status Scale (EDSS). Methods: We searched databases to include randomized clinical trials (RCTs) which were published up to October 2018. We included RCTs, being single-blinded or double-blinded or open-label trials in which one of the main outcomes was EDSS and/or relapse after vitamin D supplementation. All statistical analyses were performed using RevMan 5.3. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for relapse between treatment arms. The mean difference was calculated for EDSS comparisons. Results: Nine articles were included for analysis. Of these nine studies, five compared vitamin D supplement groups with placebo (group 1 studies), and four compared high- and low-dose vitamin D groups. A total of 561 patients were analyzed. Being treated with vitamin D instead of placebo showed no effect on relapse rate (OR = 0.66, 95% CI = 0.28–1.54) as well as EDSS (mean difference = 0.06, 95%CI [-0.31, 0.42]). The results of studies comparing high- vs. low-dose vitamin D interventions showed no significant effect on relapse rate (OR = 1.08, 95%CI [0.29–4.08] as well as final EDSS (mean difference = 0.17, 95% CI = -0.73, 1.07). Conclusions: Our findings show that vitamin D supplements (high or low dose) have no significant effect on relapse rate and disability during treatment in MS patients.

Cardiovascular diseases impose a burden of disease and economic burden on society. With regard to different drugs are used to treat cardiovascular disease; these interventions should be economically evaluated and them that the most cost-effective were selected. The aim of this study was to investigate the studies carried on the cost-effectiveness and cost-utility of statin drugs for the treatment of patients with cardiovascular disease between 2004 and 2020. Quality assessment of the articles was examined by Drummond's checklist. Given that the inclusion criteria, 26 articles included in the review. The results of this review showed that many articles related to the economic evaluation of statin drugs adhered international standards for performing economic evaluation studies. All the studies mentioned the source of effectiveness (the second criteria) and alternative options for the comparison (the third criteria). Atorvastatin and rosuvastatin drugs were the main options for the comparison in the studies. Although the results of the studies were different in some aspects, such as the type of modeling, costs items and the study perspective, they reached the same results which the use of statin drugs versus no-drug can decrease cost, cardiovascular events and deaths and increase QALY. The results were nearly different due to study design, time horizon, efficacy, and drug prices.

Undoubtedly, COVID-19 pandemic is one of the largest pandemics and one of the biggest international challenges for health-care system of various countries in the world. This is a narrative review study based on the studies published related with different aspects of COVID-19. The highest numbers of active cases are in the USA, Brazil, India, Russia, South Africa, as well as Colombia and the disease surveillance system must operate more quickly, timely, effectively, and sensitively in these countries. What is clear is that the SARS-CoV-2 basic reproduction number is significantly higher than one and its transmission power is extremely high. In general, it can be stated that mortality and fatality risk due to COVID-19 in men, age increase, severity of disease, systemic disease, as well as inadequate access to the sufficient health-care services will increase. There is currently no specific treatment and effective vaccine for COVID-19. The novel coronavirus pandemic is more consistent with the epidemiological triangle model, which emphasizes that the disease is the result of the interaction of three factors of host, agent, and environment. Therefore, prevention and treatment activities should focus on cutting the virus transmission chain. The main way to deal with viral epidemics is prevention. The emerging of this ruthless virus has once again reminded us that communicable diseases should never be underestimated and forgotten. Considering the rapid transmission of COVID-19, the health-care authorities and workers should consider timely detection and safeguards to prevent the transmission to healthy individuals.

Aims: The objective of this study was to determine the prevalence of vitamin D and calcium supplement use, and association with serum 25-hydroxy-vitamin D(25(OH)D) and demographic and socioeconomic variables in Iranian elderly. Settings and Design: This cross-sectional study was conducted in health centers of Tehran, capital of Iran. Methods: A total of 600 men and women were recruited using a two-stage cluster sampling method from 60 health centers. Participant's inclusion criteria included enrolling older adults over 60 years old who able to answer questions. We used valid and reliable questionnaires to record dietary intake of vitamin D and calcium. Any dietary supplements which included vitamin D/calcium were recorded. 25(OH)D level was measured. Participants were categorized as supplement users if they had taken supplements during last month. Results: The mean age of participants was 67.16 ± 6.07 years. Vitamin D supplements were used more often by females (OR = 11.89, 95% confidence interval (CI): 4.82–29.34), high educated subjects (OR = 3.49, 95% CI: 1.45–8.44), participants who did more physical activities (OR = 2.75, 95% CI: 1.52–5.00), and subjects who took antiosteoporosis medications (OR = 6.90, 95% CI: 2.84-16.78). Calcium supplements were used more often by females (OR = 13.05, 95% CI: 5.19–32.81), more physical activities participants (OR = 2.17, 95% CI: 1.20–3.92), and antiosteoporosis users (OR = 8.31, 95% CI: 3.43–20.14). Significant positive associations were seen between 25(OH) D levels and osteoporosis (P = 0.020), vitamin D supplement use (P < 0.0001), and sun exposure (P = 0.093). Conclusion: In this population of Tehranian adults, the prevalence of vitamin D and calcium supplement use may be attributed to educational level and underlying disease. Vitamin D supplementation, osteoporosis, and sun exposure were the strong predictors of vitamin D status.

Background: Patient's post-COVID may develop chronic irreversible respiratory failure with “widespread signs of pulmonary fibrosis.” Our study analyzed the causes of this fibrosis to propose a therapeutic protocol. Methods: Identification of the biochemical causes of fibrosis in COVID-19 analysing the literature and chest CT. Results: The CT imaging shows pulmonary fibrosis. The viral infection produces “interleukin-6”, which binds to its receptor, in MUC1 of lung epithelial cells. The biochemical response of the cells promotes an over-expression of MUC1 with fibrosis. Interleukin6 also causes a metabolic imbalance in NO that promotes clots and atherosclerosis of the pulmonary vessels. These results show to promote NO endothelia's formation to block both the excessive expression of MUC1 and the atherosclerosis effect of the vessels. Conclusions: This study proposes to inhibit phosphodiesterase by vasodilatation of the pulmonary vascular bed and the MUC1 over expression by interleukin6, the Sildenafil with the SGLT2 and N-Acetylcysteine.

Background: Patient safety is an important and mandatory component of quality health services. Insecure health services, in addition to inflicting pain and suffering to patients, impose a high financial burden on the health system of every society. The present study was conducted to evaluate the critical standards of patient safety based on the Patient Safety Friendly Hospital Initiative (PSFHI) checklist in Iran. Methods: The present systematic review and meta-analysis were performed based on the PRISMA guideline. For this purpose, articles related to the critical standards of patient safety based on the PSFHI checklist were obtained by searching valid Persian and English keywords in SID, Magiran, PubMed, Scopus, Web of Science, and Google scholar data resource through the end of 2019. The studies were analyzed using the STATA (version 14) software. Results: In the initial search, 533 articles were extracted among which 7 were eligible and entered into the meta-analysis process. Overall, 55 hospitals were surveyed, and the results of the meta-analysis showed that the average critical standards of patient safety were 69.52% (95%, CI = 57.09–81.95, I² = 69%, P = 0.004). Conclusions: The results showed that a moderate level of critical standards of patient safety in hospitals in Iran. Since meta-regression analysis revealed a decreasing trend in compliance rate, hospital managers should implement principals designated by the World Health Organization to achieve the required standards that are the basis and pillar of a patient-friendly hospital. With proper management, hospitals should set goals and take steps based on a strategic plan toward achieving these goals.

Background: Epigenetic changes, including DNA methylation and histone modification, alter gene expression without the nucleotide template alterations and are associated with all stages of tumor formation and progression. Previously, we investigated the effects of DNA demethylating agents and histone deacetylase inhibitors on hepatocellular carcinoma and colon cancers. The current study aimed to investigate the effects of 5-aza-2'-deoxycytidine (5-AZA-CdR, decitabine) and valproic acid (VPA), individually as well as combined on apoptosis induction and cell growth inhibition in colon cancer HT 29 cell line. Methods: The effect of the compounds on the cell viability was measured by MTT assay. To determine cell apoptosis, the cells were treated with 5-aza-CdR and VPA. Propidium iodide was used for staining and the cells were analyzed using flow cytometry. Results: Both agents decreased cell viability in a time and dose-dependent manner significantly (P < 0.002). The results of flow cytometry demonstrated that 5-aza-CdR and VPA induced apoptosis significantly as opposed to control groups. Maximal percentage of apoptotic cells was obtained after 48 h with combined treatment. Coclusions: Our findings suggest that 5-aza-CdR and VPA can significantly inhibit cell growth and induce apoptosis in colon cancer HT 29 cell line.

Background: Due to widespread use of supplement among athletes, determining the prevalence and pattern of dietary supplement consumption and its moderators will be a road map for developing a strategic planning in the national level to achieve healthy lifestyle and avoid harmful nutritional approaches. Methods: A systematic search of the electronic resources including Medline, PubMed, Scopus, Google Scholar and National Persian Databases including Magiran, SID, IranDoc and CIVILICA (between 1979 and November 2019 in Persian and English language) was accomplished. Inclusion criteria were (a) studies containing the prevalence rate of dietary supplement consumption, specifically (b) studies were conducted in athletes. Finally, 32 articles were included. Results: The prevalence rate of supplement use in overall Iranian athletic population was 64.8% (95% CI, 55.8%-73.8%) with significant heterogeneity (I² = 99.7%, P < 0.001). The prevalence rate was reported to be higher in male athletes, athletes aged 25 and older and elite athletes (P < 0.05). The most prevalent source of information about supplement use among athletes were trainers, followed by physicians, friends-teammates and dietitians. Conclusions: According to the high prevalence of supplement consumption among Iranian athletes, policy making for educational programs is mandated. Trainers are the most popular source to provide information about supplements and educational programs should be conducted for this target population.

Background: Unhealthy lifestyle behaviors are a major concern in the development of metabolic syndrome (MetS). This study aimed to develop, implement, and evaluate a lifestyle education package as a strategy to control the biomedical components of MetS. Methods: A total of 72 women and men (aged 18–68 y) with MetS were selected through randomized sampling. They were classified into 2 groups: an intervention group that received a lifestyle educational package with close follow-ups and a control group that received only usual care. Anthropometric indices, blood pressure, lipid profiles, and fasting blood sugar were assessed at baseline and after 3 months. Results: The lifestyle-modification program was associated with a modest weight loss (2 ± 0.4 kg; P < 0.001), a significant reduction in waist circumference (2.3 ± 0.9 cm; P < 0.001) and the hip circumference (1 ± 0.3 cm; P < 0.001), and a sharp decrease in diastolic blood pressure (5.3 ± 1.4 mm Hg; P < 0.001), compared with the baseline values in the intervention group. Additionally, according to the one-way MANOVA analysis, 33.8% of the changes in MetS components were attributable to the educational intervention (P < 0.001, F = 5.27). Conclusions: Improvement in lipid profile and anthropometric measures suggest that a lifestyle package based on multivariable health education is an acceptable method.

Background: After a coronary artery bypass graft (CABG), diabetic patients deal with various hemodynamic disorders. This study aimed to compare the effect of cardiac rehabilitation (CR) on the functional capacity of diabetic and nondiabetic patients following CABG. Methods: This descriptive-analytical study was performed on 40 diabetic and nondiabetic patients attending a similar CR program following CABG. The subjects were selected by convenience sampling and were divided into two diabetes and nondiabetes groups. All patients attended 24 exercise sessions held 3 days a week. The functional capacity of patients was measured and recorded with the metabolic equivalent of Task criterion before and after the CR program. In addition, data analysis was performed in SPSS version 19. Results: In this study, the mean age of the diabetic and nondiabetic patients was 54.45 ± 5.82 and 56.85 ± 5.36 years, respectively. There was no significant difference between the research groups regarding the systolic and diastolic blood pressure (P > 0.05). The mean functional capacity in the diabetes and nondiabetes groups was 4.5 ± 0.79 and 5.2 ± 1.7 before the rehabilitation, respectively. However, the results of Mann–Whitney U-test were indicative of a lack of a significant difference in this respect (P > 0.05). After the CR program, the mean functional capacity in the diabetes and nondiabetes groups was 5.7 ± 1.31 and 6.3 ± 1.7, respectively, demonstrating an insignificant difference in this regard (P > 0.05). Conclusions: According to the results of the study, there was no significant difference between the diabetic and nondiabetic patients, who underwent CABG, after a CR program. However, replication of the study is warranted.

Background: Hypertension (HTN) among children is a major health issue with mounting prevalence rates. The aim of this research is to assess the prevalence of HTN and its associated risk factors among apparently healthy schoolchildren. Methods: We conducted a cross-sectional study of schoolchildren in the academic year 2015 from 38 public primary schools in central Thailand for the prevalence and risk factors of HTN. Apparently healthy children aged 6-12 years were included. Informed consents were obtained before participation. Hypertension was diagnosed as per the new reference cutoff levels recommended by the American Academy of Pediatrics. Results: A total of 3,870 children with a median age of 9.5 years were included in the final analysis. The prevalence of obesity, overweight, and thinness among children was 15.7%, 13.6% and 5.2%, respectively. The overall prevalence of hypertension in the study population was 26.2%. HTN was significantly more prevalent in boys than girls (summary odds ratio (OR) 1.16 [95% confidence interval (CI) = 1.01-1.34]). Overweight and obesity were among the associated risk factors of HTN in the enrolled children with (OR 2.44 [95% CI 1.98-3.00]) and (OR 7.99 [95% CI 6.58-9.70]), respectively. Obese children who had central obesity were at greater risk of hypertension (OR 9.16 [95% CI 7.45-11.27]). Conclusions: The prevalence of HTN among Thai children is markedly high. Obesity, overweight, and male gender are considerable risk factors of HTN in children. Routine blood pressure measurement and further studies are recommended to investigate the potential risks and to lessen the associated complications.

In recent years, published systematic reviews in the world and in Iran have been increasing. These studies are an important resource to answer evidence-based clinical questions and assist health policy-makers and students who want to identify evidence gaps in published research. Systematic review studies, with or without meta-analysis, synthesize all available evidence from studies focused on the same research question. In this study, the steps for a systematic review such as research question design and identification, the search for qualified published studies, the extraction and synthesis of information that pertain to the research question, and interpretation of the results are presented in details. This will be helpful to all interested researchers.

Background: The present study aimed to assess the determinants of waterpipe smoking among women based on a systematic review regarding the increasing prevalence of waterpipe smoking in women and the tendency of them to this type of tobacco. Methods: The present study was a systematic review. The search strategies were based on using a combination of MeSH and free-text terms. Searches were performed in Iranian databases and PubMed, ScienceDirect, Web of Science, EMBASE, Scopus and Medline. Databases inclusion criteria included articles and gray literature in English or Persian, published between January 2000 and December 2018. The keywords were related to women and waterpipe and related terms. The quality of the articles was assessed using the EPHPP tool. Results: In the initial search, out of 1027 articles, 15 articles were studied. Inclusion criteria in this study were the target population of women and girl and descriptive and qualitative studies on waterpipe use among women. The mean prevalence of waterpipe smoking in quantitative studies was 13.980/0. Studies have shown that waterpipe smoking in women is influenced by several individual (awareness, favorable attitudes, and positive prototype), interpersonal (role of family and friends), and socio-political factors. Conclusions: Due to the influence of various determinants on women's inclination to waterpipe smoking, there is a necessity to act and impose interventions such as lessening women's favorable attitude toward waterpipe, increasing women's awareness, encouraging negative prototype about waterpipe smoking, and restricting access to tobacco products that can be useful. Interpersonal factors such as the role of family and friends are one of the major determinants in waterpipe smoking. It seems that developing the skill of saying “no” to the pressure of friends can help prevent waterpipe use. Furthermore, educating the family about the risks of waterpipe use is an effective strategy in this respect.

Background: This systematic review was conducted to review the studies investigating the role of dietary approach to stop hypertension (DASH) diet in prevalence and progression of the metabolic syndrome (MetS) in children, adolescents, and adults. Methods: Electronic searches for included studies were performed in MEDLINE, SCOPUS, EMBASE, Cochrane Trial Register, and ISI Web of Science until 30 March 2020. Study selection, data extraction, and quality assessment were fulfilled independently by two reviewers using predefined criteria. Studies were included if they assessed the role of adherence to DASH diet in risk of incidence, prevalence, and development of MetS. Results: Twelve eligible studies (eight observational studies and four clinical trials) were identified. Despite methodological heterogeneity, limited statistical power, and the cross-sectional nature of most of observational studies, greater adherence to DASH diet was associated with reduced risk of MetS. However, results for change in metabolic characteristics based on dietary intervention with DASH diet in some interventional studies were somewhat controversial. Conclusions: The current study demonstrates that, based on observational studies, greater adherence to a DASH diet is inversely associated with MetS presence and progression. However, more interventional studies are needed in this regard to clarify the exact effect of DASH diet on MetS.

Background: Tobacco smoking is one of the most preventable causes of mortality related to noncommunicable diseases (NCDs). This study aimed to estimate the direct economic burden and years of life lost (YLL) attributable to smoking in NCDs in Mashhad, 2015–2016. Methods: Hospital-based data were utilized to calculate the economic burden of four selected diseases related to smoking. An epidemiological population-attributable risk method was used to determine the smoking-attributable fraction (SAF). Moreover, the study was conducted by data related to disease-specific expenditures and patients' information on cost and the number of mortality for estimating the YLL for each disease, population and life expectancy data, the prevalence of smoking, and the relative risk of smoking. Data analysis was performed with STATA software, version 12. Results: The total costs attributable to smoking for stroke, myocardial infarction, chronic obstructive pulmonary disease (COPD), and lung cancer were 94148, 151272, 1191396, and 574784 US Dollars, respectively (per 100000). In 2015, the YLL per deaths due to COPD were 4217 and 3522 among males and females, respectively. Furthermore, in 2016, the YLL per deaths due to the stroke in males and females were 8317 and 7563, respectively. In the same year, the highest proportion of years of potential life lost per 100000 smoking-attributable deaths belonged to COPD. Conclusions: The results of this study can be used to inform policy-makers about smoking-attributable diseases in Iran. To decrease the smoking-attributable costs, which have resulted in the spread of NCDs, policy-makers should adopt and implement effective policies regarding smoking prevention and control.

Background: The identification of elderly at risk of new functional disabilities in activities of daily living at admission to the hospital may facilitate referral for purposive interventions to prevent decline and institutionalization. This study was aimed at designing a risk prediction model for identifying the elderly at risk of admission in Iran's hospitals. Materials and Methods: This is a cross-sectional descriptive study conducted in 2017. In order to formulate and validate a prediction model, the study was done in two development and validation cohort study. Functional decline was defined as a decline of at least one point on the Katz ADL index at follow-up compared with preadmission status. Results: In development cohort, the mean age was 71 years including 54% of men and 46% women, 22% of men and 17% of women experienced functional decline after 3 months. In the validation cohort, the mean age was 70 years, including 49% of men and 51% women, 19% of men and 15% of women, functional decline after 3 months was observed. Conclusion: On the basis of the findings, aging at risk of hospital admission can be identified by easy designed model with four questions: (1) Is the patient's age more than 85 years? (2) Does the patient's mini mental status <22? (3) Does the patient need help for using general transporting? (4) Has the patient lost weight <5% over the past 6 months and body mass index <18.5? And also geriatrics experts can use the designed model as a predictive tool in order to improve the quality level of healthcare services to elderly as a vulnerable and high risk group. The important point of model is easy to use even for nonspecialists.

Background: Health promotion and preserving patients' safety are the main purposes of care in health-therapeutic systems. With regard to nursing profession, nursing students are exposed to medications errors (MEs) during clinical activities, which can be considered as a threat to patients' safety. The study aimed to determine the prevalence of MEs among nursing students using a systematic and meta-analysis approach. Methods: 8 studies (in 9 groups) in English and Persian from inception to March 2019, were collected. Searched was conducted in SID, MagIran, IranMedex, Google Scholar, Web of Science, PubMed and Scopus. The meta-analysis method and the random effects model were used to analyze the data. In addition, the I2 statistic was used to examine heterogeneity among studies. The analyses were conducted using Stata, version 11. Results: Analysis of 8 studies (in 9 groups) with a total sample size of 688 showed that the overall MEs' prevalence among nursing students was 39.68% (95% CI: 22.07-57.29) and the prevalence of lack of reporting MEs was 48.60% (95%CI: 27.33-69.86). There were no relationships between the prevalence of MEs and lack of reporting MEs in nursing students with the sample size and the mean age of students. Conclusions: Considering the relatively high prevalence of MEs and lack of MEs reporting among nursing students and the importance of their effect on the level of patients' safety, measures such as educations, monitoring by clinical trainers, and examining and eliminating the causes of MEs are essential.

Healthcare research is a systematic inquiry intended to generate robust evidence about important issues in the fields of medicine and healthcare. Qualitative research has ample possibilities within the arena of healthcare research. This article aims to inform healthcare professionals regarding qualitative research, its significance, and applicability in the field of healthcare. A wide variety of phenomena that cannot be explained using the quantitative approach can be explored and conveyed using a qualitative method. The major types of qualitative research designs are narrative research, phenomenological research, grounded theory research, ethnographic research, historical research, and case study research. The greatest strength of the qualitative research approach lies in the richness and depth of the healthcare exploration and description it makes. In health research, these methods are considered as the most humanistic and person-centered way of discovering and uncovering thoughts and actions of human beings.

Background: Diabetes mellitus (DM) is an endocrine disorder characterized by hyperglycemia, polyuria, polydipsia, and glucosuria. γ-aminobutyric acid (GABA) is an inhibitory neurotransmitter in the central nervous system (CNS) of humans and other mammals. GABA acts on two different receptors, which are GABA-_A and GABA-_B. Pancreatic β-cells synthesize GABA from glutamic acid by glutamic acid decarboxylase (GAD). Aim: The objective of this study was to explore the potential role of pancreatic GABA on glycemic indices in DM. Methods: Evidence from experimental, preclinical, and clinical studies are evaluated for bidirectional relationships between pancreatic GABA and blood glucose disorders. A multiplicity of search strategies took on and assumed included electronic database searches of Medline and Pubmed using MeSH terms, keywords and title words during the search. Results: The pancreatic GABA signaling system has a role in the regulation of pancreatic hormone secretions, inhibition of immune response, improve β-cells survival, and change α cell into β-cell. Moreover, a GABA agonist improves the antidiabetic effects of metformin. In addition, benzodiazepine receptor agonists improve pancreatic β-cell functions through GABA dependent pathway or through modulation of pancreatic adenosine and glucagon-like peptide (GLP-1). Conclusions: Pancreatic GABA improves islet cell function, glucose homeostasis, and autoimmunity in DM. Orally administered GABA is safe for humans, and acts on peripheral GABA receptors and represents a new therapeutic modality for both T1DM and T2DM. Besides, GABA-_A receptor agonist like benzodiazepines improves pancreatic β-cell function and insulin sensitivity through activation of GABA-_A receptors.

The burden of gastrointestinal (GI) cancer is increasing worldwide, and in the past decade, cancer had entered the list of chronic debilitating diseases whose risk is substantially increased by hypernutrition. Obesity may increase the risk of cancer by the imbalance of various mechanisms including insulin and insulin-like growth factor1 (IGF-I) signaling, systemic inflammation, immune dysregulation, tumor angiogenesis, adipokines secretion, and intestinal microbiota that usually act interdependently. An increased understanding of the mechanisms underlying obesity-GI cancer link can provide multiple opportunities for cancer prevention. This review discusses various mechanisms involved molecular mechanisms linking obesity with GI cancers including esophagus, stomach, colorectal and hepatocellular. Furthermore, an optional intervention such as diet restriction and exercise is described, which may be preventive or therapeutic in GI cancer.

The world is full of data which is increasing by leaps and bounds. In health care, big data is becoming common with increased electronic health data accumulation and/or accessibility to public data previously held under lock and key. At the same time, health data visualization applications have become popular over recent years. Against this background, a review was done to summarize the application of data visualization in public health & the challenges faced. Peer-reviewed original research articles and review articles searched in Google Scholar and Pubmed databases that were indexed in the last ten years period, using the keywords “Big data” or “data visualization” or “Interactive visualization techniques.” Other related information in books, blogs, and published documents were searched in Google search engine using the same keywords. Contents from the downloaded documents were presented and discussed under three headings viz. (a) the visualizations that are still current and how they have evolved further, (b) tools or methods that can be used by end-users to make their own modifications, (c) the platforms to disseminate them. Usage of different plots in public health is explained with suitable examples using the data from public health datasets. From the discussion it can be understood that when big data is visualized well, it can identify implementation gaps and disparities and accelerate implementation strategies to reach the population groups in most need for interventions. As health administrator may come from diverse specialties, robust training and career development for big data in public health is the need of the hour.

Background: Seizure and epilepsy are among the initial symptoms of multiple sclerosis (MS), yet different prevalence rates are reported for them in the previous studies. The goal of this systematic review is to estimate the pooled prevalence of seizure and epilepsy in patients with MS. Methods: We searched PubMed, Scopus, EMBASE, Web of Science, google scholar, and gray literature including references from identified studies and conference abstracts published up to October 2019. The search strategy included the MeSH terms and text words as ((Epilepsies OR Seizure Disorder OR Seizure Disorders OR Awakening Epilepsy OR Epilepsy, Awakening OR Epilepsy, Cryptogenic OR Cryptogenic Epilepsies OR Cryptogenic Epilepsy OR Epilepsies, Cryptogenic OR epilepsy OR seizure) AND (Multiple Sclerosis OR Sclerosis, Multiple) OR Sclerosis, Disseminated) OR Disseminated Sclerosis) OR MS (Multiple Sclerosis)) OR Multiple Sclerosis, Acute Fulminating). Results: The literature review resulted in 4860 articles; 2593 articles remained after eliminating the duplicates. For the final analysis, 39 articles were included, 9 of which were conference abstracts. The pooled prevalence of seizure in MS cases was 2%, 95% confidence interval (CI)(1%-3%) (I² = 91.8%, P < 0.001). The pooled prevalence of epilepsy in MS cases was 3%, 95% CI (2%-4%) (I2 = 92.9%, P < 0.001). The pooled prevalence of epilepsy in Asia, Europe, and America was 6%, 3%, and 3%, respectively. The level of heterogeneity decreased after subgroup analysis in Asian and American subgroups. Meta-regression analysis showed continent is not a source of heterogeneity (coefficient = -0.007, P = 0.6). Conclusions: The result of this systematic review shows that the pooled prevalence of seizure and epilepsy among MS patients is 2% and 3%, respectively.

Background: Values are at the heart of discussions related to policy-making and any kind of reforms in health systems. Despite wide recognition of its importance, the concept of value is still vague and the policy-making processes remain astray with respect to values. This study aims to provide a model of value-based policy-making and to explain the concept value and how it affects policy-making. Methods: The main question of the current study is to explain the concept of value-based policy-making and developing a model, based on the explained concept. In this line, critical review method and Carnwell and Daly approach and using particular keywords related to stewardship, and searching databases were used. In the initial search, 739 studies were obtained, of which using targeted sampling method, 11 studies were finally selected. Then, in order to design and explain different aspects of the value concept in the health system and to develop a model, selected studies were criticized, and finally, the conceptual model of value is designed and explained. Results: The concept of value and its effects, dimensions and its relation to principles, evidence and criteria were determined at different stages of the policy-making process. It was also revealed that value-based policy-making in a health system is contingent upon the realization of terminal values. Conclusions: In the process of selecting the best policy option, it is necessary to identify the relationship between terminal, instrumental, criterion, and evidence to avoid deviating from the reference value framework in any country and to avoid blindly imitating other experiences in other countries.

A key goal of clinical care is to treat patients as individuals and to approach therapeutics in such a way that it has optimal efficacy and minimal toxicity. With swift technological advances, such as genomic sequencing and molecular targeted drug exploitation, the concept of precision medicine has been robustly promoted in recent years. Precision medicine endeavors to demarcate diseases using multiple data sources from genomics to digital health metrics in order to facilitate an individualized yet “evidence-based” decision regarding diagnostic and therapeutic approaches. In this way, therapeutics can be centered toward patients based on their molecular presentation rather than grouping them into broad categories with a “one size fits all” approach. This review article is aimed to provide a broad overview of the advent and emergence of precision medicine in view of its current implications.

Background: Today, one of the most serious causes of mortality and disability among youth is the traffic accidents. Regarding its importance, this paper aimed to investigate the community-based program to promote the safe traffic behaviors among youth. Methods: This was a quasi-experimental conducted on 5000 youth in five Iranian cities named Lanjan, Gomishan, Fasa, Tehran, and Zahedan in 2015–2016. The questionnaire was based on the constructs of the theory of planned behavior as well as a questionnaire of pedestrian behavior and driving behavior, which was completed before and after the intervention. The educational intervention was carried out based on the theory of planned behavior. Finally, the obtained data were analyzed using STATA software. Results: Six months after the intervention, the mean score of the theory of planned behavior and safe driving behavior in different cities was significantly increased. Here, regarding the safe crossing of the street, the most behavioral changes were observed in Gomishan (P = 0.000), Fasa (P = 0.001), and Tehran (P < 0.0001). The mean score of driving behaviors in Gomishan (P < 0.000), Fasa (P = 0.016), Lanjan (P = 0.047), and Tehran (P < 0.0001) scores was significantly higher. conclusions: In most of the studied cities, it can be concluded that education based on the theory of planned behavior can improve the safe driving behaviors among youth. Therefore, it is recommended to be implemented this program in other cities using the theory of planned behavior.

Background: Women tend to outlive men and are at higher risks of functional disability compared to men. Specifically, women are more likely to develop conditions like osteoporosis and stress urinary incontinence which can further increase the risk of functional disability. Regular physical activity and/or exercise programs can minimize the physiological decline that occurs during aging and can improve overall physical fitness, bone health, and pelvic floor muscle function; however, exercise programs tend to focus on only one parameter. Mini-trampoline jumping is a highly beneficial low-impact aerobic exercise capable of improving aerobic fitness, balance, muscle strength, and potentially bone health as well as pelvic floor muscle functioning. The aim of the proposed research project is to examine the benefits of a 3-month mini-trampoline exercise intervention on physical fitness, bone health, and pelvic floor muscle functioning in postmenopausal women. Methods: Fifty postmenopausal healthy women aged 50–69 years will be recruited. Assessments on physical fitness (aerobic fitness, walking speed, balance, lower extremity strength, flexibility), bone health, and pelvic floor muscle functioning will occur within 1 week before and after the exercise intervention, including a 3-month follow-up assessment. The exercise intervention will last 12 weeks, with three sessions of 40 min each per week. Conclusions: The proposed research has the potential to improve functional ability and women-specific risk factors in older women with an innovative and fun exercise program.

Background: Recurrent event data arise frequently in longitudinal medical studies. In many situations, there are a large portion of patients without any recurrences, manifesting the “zero-inflated” nature of the data. Moreover, there often exists a terminal event which may be correlated with the recurrent events. The goal of this study is to extend the application of joint frailty model to identify the prognostic factors associated with curing in patients with breast cancer. Methods: As a prospective study, medical records of women who had been attended to Cancer Research Center, Shahid Beheshti University of Medical Sciences from January 1998 to February 2016 were reviewed. Finally, after an initial review of medical records, 711 patients were included in the study and analyzed. A checklist that included items drawn from the demographic background of patients was provided in the study. Two joint frailty models for zero-inflated recurrent events, combining a logistic model for “structural zero” status (Yes/No) and a joint frailty proportional hazards model for recurrent and terminal event times were performed to identify factors associated with BCS. Results: The mean age of patients was 38.2 years. The numbers of subjects with 1, 2, 3, and 4 recurrent events were 392, 207, 97, and 15, respectively. The median follow-up time was 6.87 years. There were 137 (19.2%) deaths from cancer during the follow-up. Among the 574 patients who were censored, 418 had no tumor recurrence. Thus, there may exist a large portion of “cured” subjects. We can see that the radiation (OR = 6.02, CI = (3.87, 8.61)) and tumor size interaction with radiation (OR = 1.065, CI = (1.002–1.26)) were significant in the cure model (P < 0.05) which means that patients with smaller tumor sizes were more likely to be cured by radiation therapy. Conclusions: Our proposed models can help investigators to evaluate which treatment will result in a higher fraction of cured subjects. This is usually an important research question in biomedical studies.

Background: This review seeks to determine the relationship between food insecurity among elderly people over the past decades and nutrient deficiency, which is rather unclear. We aim to systematically review the relationship between food insecurity and dietary intake among elderly population. Methods: In this systematic review, we systematically searched the international databases including PubMed, Web of Sciences, and Scopus for scientifically related papers which have been published up until January 2018. For a more refined search, we used the Medical Subject Headings (MeSH) terms and Emtree. In terms of search protocol, no restrictions were placed on time and language. Two independent reviewers conducted the data refining processes. Validated form (PRISMA) was used to conduct quality assessment and data extraction. Results: Eight cross sectional studies have been included in this review. Two of the studies were conducted in Asia and the remaining six studies were largely based in the United States and Canada. Food insecurity was associated with low levels of vitamin and mineral intakes such as vitamins E, A, B, and D and also zinc, calcium, magnesium, and iron. Most studies also reported insufficient energy, and micro and macronutrients intake among elderly people. Conclusions: The findings of this review evidence a considerable amount of food insecurity and nutrient deficiency, including vitamins E, C, D, B 2, and B 12 and zinc, phosphorus, and calcium among elderly population. These findings could be used as reliable evidence by policy makers and future complementary analyses.

Background: The association between dietary patterns and cardiovascular disease (CVD) risk factors has been investigated in very limited studies in patients with type 1 diabetes mellitus (T1DM). The aim of this study was to determine the relationship between the major dietary patterns and CVD risk factors in these patients. Methods: A cross-sectional study was performed on 169 females of 18--35 years who were diagnosed with T1DM attending Iranian Diabetes Association in Tehran. Anthropometric measures, blood glucose, and lipid levels of all participants were measured. Dietary data was collected using a food frequency questionnaire. Dietary patterns were determined by factor analysis. Using the analysis of covariance (ANCOVA), mean value of the biochemical factors across the tertiles of dietary patterns was compared. Results: Three major dietary patterns were identified: the grain, legume and nut (GLN), the fruits and vegetables (FV), and the high calorie foods, salty snacks, sweet and dessert (HSD). After adjustment for age, body mass index and energy intake, subjects who were in the highest tertile of FV pattern had significantly lower levels of LDL-c (P = 0.01), triglyceride (TG) (P = 0.02), and total cholesterol (P = 0.01). GLN and HSD patterns had no significant relationship with blood glucose and lipids. Conclusions: This study demonstrates that a dietary pattern rich in vegetables and fruits may be inversely associated with dyslipidemia in patients with T1DM. The results can be used for developing interventions that aim to promote healthy eating for the prevention of CVD in these patients.

Background: Logotherapy encourages the individual to find meaning in life, which is recognized as the driving force of every individual in their lifetime. Diabetes, caused by the impairment in metabolism of glucose, fat, and protein, is associated with lack of secretion or dysfunction of insulin. This study aims to investigate the effectiveness of logotherapy on death anxiety, hope, depression, and proper use of glucose control medication in diabetic patients with depression. Methods: The population in the present quasiexperimental pretest–posttest study with control group is comprised of diabetic patients with depression attending Baghban Endocrine Clinic in Sari. A sample of 40 diabetic patients (20 in the trial and 20 in the control group) entered the study. Data were collected using Templer Death Anxiety Scale, Miller Hope Scale, Beck's Depression Inventory, and Medication Adherence Scale. Covariance analysis was used to evaluate the effectiveness of logotherapy on death anxiety, hope, depression, and proper use of glucose control medication, where P value lower than 0.05 is considered significant. Results: Death anxiety and depression of diabetic patients with depression were reduced by following logotherapy training, and their hope was increased. The results confirmed the effectiveness of logotherapy training on death anxiety, hope, and depression in diabetic patients with depression (P < 0.05). Logotherapy was effective on proper use of blood- glucose drugs in depressed diabetic patients and 19% of changes in scores of proper use of medication were caused by the effectiveness of logotherapy (P < 0.05). Conclusions: Logotherapy appears to be a suitable psychological treatment for diabetic patients with depression.

Background: Multiple sclerosis (MS) is the third most common cause of adult neurologic disabilities. The aim of this study was to determine the effect of 8 weeks of neuromuscular exercises on strength, proprioceptive receptors, and balance of women with MS. Methods: In this randomized controlled trial study, 20 female volunteers with relapsing-remitting MS were randomly assigned into the experimental group (n = 10) and control group (n = 10). Maximum muscular strength of knee extensor and flexor muscles, knee joint proprioceptive error (Biodex), and balance (Berg Balance Scale) was measured at baseline and after 8 weeks of neuromuscular exercise. The data were analyzed using paired t-test and independent t-test. Results: The results showed a significant improvement (P < 0.05) in the quadriceps strength, hamstring strength, proprioceptive receptor error, and the balance in the experimental group, but not in the control group. A significant difference was evident between the experimental and control groups in terms of strength, balance, and proprioceptive receptor error (P < 0.05). Conclusions: Neuromuscular exercise training is effective in improving balance, strength, and reducing the proprioceptive error in people with MS, and it could be recommended as modalities for these patients.

Backgrounds: Acute respiratory distress syndrome (ARDS) causes high mortality rate in clinic, and the pathogenesis of this syndrome may interact with renin angiotensin system (RAS) components. The main objective of this study was to determine the protective role of AT1R antagonist (losartan) on oleic acid (OA) induced ARDS and kidney injury. Methods: The animal model of ARDS was performed by intravenous administration of 250 μl/kg oleic acid (OA). Male and female rats were subjected to received intravenously vehicle (saline, groups 1 and 4), OA (groups 2 and 5), or losartan (10 mg/kg) plus OA (groups 3 and 6), and six hour later, the measurements were performed. Results: Co-treatment of OA and losartan increased the serum levels of blood urea nitrogen significantly (P < 0.05) and creatinine insignificantly in both gender. However, the OA induced kidney damage was decreased by losartan significantly in male (P < 0.05) and insignificantly in female rats. In addition, co-treatment of OA and losartan decreased lung water content significantly in male rats (P < 0.05). Based on tissue staining, no significant difference in lung tissue damages were observed between the groups, however some exudate were observed in lung male rats treated with OA alone which were abolished by losartan. Conclusions: Losartan may protect the kidney and lung against OA induced tissue injury in male rats. This protective action is not certain in female rats.

Background: Opium addiction, as a major health problem, has been reported in Middle East countries. Recently, contaminated opium has been reported as a probable source of lead poisoning. Thus, the aim of this study is to evaluate blood lead levels (BLL), liver enzymes, and hemoglobin (Hb) concentrations in opium-dependent addicts with healthy controls. Methods: In a cross-sectional study, 75 opium-addicted men (case group) referred to Zahedan Baharan Hospital were evaluated. A group of 75 nonaddicted men were selected as a control group. BLL, Hb, and liver enzymes levels were measured. Body mass index (BMI) was also calculated. Results: The case group had elevated BLL compared to the controls (19.1 ± 1.6 vs. 9.1 ± 0.4; P < 0.0001). Hb concentrations were significantly lower in the patients compared to the controls (13.3 ± 1.6 vs. 15.1 ± 1.3; P < 0.0001). A positive correlation was found between BLL and opium addict duration in the case group (r = 0.52, P < 0.0001). Conclusions: Due to the contamination of opium to lead, it seems that opiate addicts are at risk of lead poisoning. Thus, it is recommended that the blood lead level is frequently monitored to control the adverse effects of poisoning and prevent lead accumulation.

Background: Pyelonephritis is the most common bacterial infection in children that can cause renal failure if not diagnosed or treated early. We used serum biomarker interleukins (IL-6 and IL-8) and then confirmed the results by the findings dimercaptosuccinic acid (DMSA) scan to distinguish upper-tract infection from lower-tract infection. Methods: Serum IL-6 and IL-8 were measured in 57 children with newly diagnosed untreated urinary tract infection (UTI) documented by a positive urine culture. All children had a DMSA to determine whether serum IL6, IL-8 can be used as a marker to predict upper-tract from lower-tract infection. IL-6 and IL8 were determined by the enzyme link immunosorbent assay (ELISA) technique. Results: Of the 57 patients, 24 (42%) had renal parenchymal lesions on the DMSA scan. Patients with abnormal DMSA had significantly higher serum IL-6 and IL-8 compared with those with normal DMSA scan (187.1 ± 113.1 ng/mL vs. 396.1 ± 246.0 ng/mL, P = 0.005; and 165 ± 76.1 ng/mLvs. 190.8 ± 60.8 ng/mL, P = 0.026, respectively). Pyelonephritis was more frequent in children younger than 20 months old (n = 36, 63%, P < 0.005) and more prevalent in girls (n = 36, 63%, P = 0.005). Serum IL-6 had a sensitivity of 67.3% and a specificity of 63.0% and serum IL8 had a sensitivity of 80.1% and a specificity of 73.5% in the differential diagnosis of pyelonephritis and cystitis (P = 0.03). Conclusions: Serum levels of IL-6 and IL-8 are both sensitive biomarkers of UTI and can discriminate the upper from lower tract urinary infections. Determination of these biomarkers may help to identify patients with acute pyelonephritis and need for DMSA study.

Background: There is an increase in the prevalence of head lice among urban communities with high density in recent years. This study was aimed to determine the efficacy of 1% permethrin shampoo and some traditional physical treatment for head lice infestation in Qom Province, central Iran. Methods: This analytical cross-sectional study was carried out on all 11,223 cases in six categories that were referred to Qom health care system from 2016 to March of 2017. The infested people were treated with 1% permethrin shampoo, twice at a 1-week interval and other recommended therapeutic categories, such as the use of physical treatments such as wooden fine-toothed combs impregnated with a mixture of water and white vinegar on infested hair for 30 min and secondly, carrier oils such as olive oil, bitter almond on infested hair over a therapeutic period. After completing the course of treatment, treatment success was checked by questionnaires. Results: A total of 11,223 cases with head lice infestation were confirmed and were enrolled for study. Out of six categories, three therapeutic categories were utilized as follows: (a) 1% permethrin shampoo and the use of physical treatments; (b) 1% permethrin shampoo and the use of carrier oils; (c) the above-mentioned therapeutic categories combined had high treatment success. It was estimated to be 82.00%, 87.31%, and 94.33%, respectively. Conclusions: According to the findings, in addition to the application of 1% permethrin shampoo, the use of physical treatments and carrier oils such as olive oil, bitter almond can increase the treatment success of head lice infestation.