Background: Phototherapy is the most common form of treatment and prevention of neonatal nonconjugated hyperbilirubinemia. It seems that intravenous fluid therapy as a complementary method of phototherapy can accelerate the healing process in affected infants. This study aimed at investigating intravenous fluid therapy's effect in decreasing serum bilirubin in healthy term neonates with nonhemolytic hyperbilirubinemia under intensive phototherapy. Methods: As many as 160 healthy term infants with severe nonhemolytic hyperbilirubinemia and without exclusion criteria were enrolled. Infants were randomized to the two treatment groups (phototherapy alone and combination with intravenous fluid therapy). Serum bilirubin at admission time, 6, 12, 24, and 48 h later were measured. We evaluated decreasing serum bilirubin levels and duration of hospitalization in both groups. Results: In this study, the mean levels of serum bilirubin on admission time, 6, 12, 24, and 48 h after treatment gradually reduced in both groups; still, the decrease was not statistically significant between the two groups. Conclusions: Intravenous fluids therapy does not have a significant advantage in the process of phototherapy in healthy term neonates with severe nonhemolytic hyperbilirubinemia.

Background: Too much crying is a self-limiting problem and disappears within a few weeks. However, it can lead to maternal depression and parental stress. This study aimed to evaluate the effect of lavender oil inhalation on the duration of night crying within a week of intervention among infants with infantile colic. Methods: In this double-blind randomized clinical trial, the inclusion criteria for infants were being healthy, not taking any medications for colic, having an episode of crying two hours a day, and having a healthy mother. The intervention group received lavender oil inhalation and the control group received sweet almond oil inhalation for seven days. The data pertaining to the duration of crying were collected four times a day (morning, afternoon, evening, and night) via telephone contact. Mothers' mood scores were also assessed at the beginning of the study and on the seventh day of the intervention. Results: At first, the two groups were not different in terms of the duration of crying. After the intervention, however, a significant difference was observed in this regard on all seven days of the study (P < 0.001). Based on the results of the repeated measures analysis, the difference between the two groups was statistically significant (P < 0.001). Conclusions: The results showed that inhalation of lavender oil at low concentrations could reduce colic symptoms and improve maternal mood.

Background: According to World Health Organization (WHO), cardiovascular diseases (CVDs) are the leading cause of death globally. Although significant progress has been made in the diagnosis of CVDs, more investigation can be helpful. Therefore, this study aimed to predict the risk of myocardial infarction (MI) using data mining algorithms. Methods: The applied data were related to the admitted patients in Rajaei specialized cardiovascular hospital located in Tehran. At first, a literature review and interview with a cardiologist were conducted to understand MI. Then, data preparation (cleaning and normalizing the data) was performed. After all, different classification algorithms were applied in IBM SPSS Modeler (14.2) software on the prepared data; and, power of the applied algorithms and the importance of the risk factors in predicting the probability of getting involved with MI was calculated in the mentioned software. Results: This study was able to predict MI % 75.28 and 77.77% in terms of accuracy and sensitivity, respectively. The results also revealed that cigarette consumption, addiction, blood pressure, and cholesterol were the most important risk factors in predicting the probability of getting involved with MI, respectively. Conclusions: Predicting studies aim to support rather than replace clinical judgment. Our prediction models are not sufficiently accurate to supplant decision-making by physicians but have considerable tips about MI risk factors.

Background: Coronavirus disease 2019 (COVID-19) quickly spread to the world, causing a pandemic. While some studies have found no link between opioid use disorder (OUD) and COVID-19, the role of opioid on COVID-19 is challenging. The present study aimed to determine the relationship between OUD and COVID-19. Methods: This was a prospective cohort study. We used data from the third phase of the Shahroud Eye Cohort Study on 4394 participants which started in September 2019 and ended before the COVID-19 epidemic in Shahroud in February 2020. The participants were followed for about 13 months till March 26, 2021. COVID-19 was detected by RT-PCR on swap samples from the oropharynx and nasopharynx. The incidence of COVID-19 compared in OUD and non-OUD participants, and relative risk was calculated in log-binomial regression models. Results: Among the 4394 participants with a mean age of 61.1 years, 120 people had OUD. The incidence of COVID-19 in participants with OUD and non-OUD was 4.17% and 6.22%, respectively (P-value: 0356). The relative risk of OUD for COVID-19 was 0.60 (95% confidence intervals: 0.25–1.44; P value: 0.251). Conclusions: OUD was not associated with COVID-19. The claim that people with OUD are less likely to develop COVID-19 is not supported by these data.

The current pandemic coronavirus disease-19 (COVID-19) is still a global medical and economic emergency with over 244 million confirmed infections and over 4.95 million deaths by October 2021, in less than 2 years. Severe acute respiratory syndrome (SARS), the Middle East respiratory syndrome coronavirus (MERS), and COVID-19 are three recent coronavirus pandemics with major medical and economic implications. Currently, there is no effective treatment for these infections. One major pathological hallmark of these infections is the so-called 'cytokine storm,' which depicts an unregulated production of inflammatory cytokines inducing detrimental inflammation leading to organ injury and multiple organ failure including severe pulmonary, cardiovascular, and kidney failure in COVID-19. Several studies have suggested the potential of curcumin to inhibit the replication of some viruses similar to coronaviruses. Multiple experimental and clinical studies also reported the anti-inflammatory potential of curcumin in multiple infectious and inflammatory disorders. Thus, we hypothesized that curcumin may provide antiviral and anti-inflammatory effects for treating COVID-19. Although these studies suggest that curcumin could serve as an adjuvant treatment for COVID-19, its molecular mechanisms are still debated, especially its potential to modulate the toll-like receptors/TIR-domain-containing adapter-inducing interferon-β/nuclear factor kappa-light-chain-enhancer of activated B cells (TLR/TRIF/NF-κB) pathway. The preliminary results showed that curcumin modulates the nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) pathway, a common pathway controlling cytokine production in multiple infectious and inflammatory disorders. Here, we hypothesize and discuss whether curcumin treatment may provide antiviral and anti-inflammatory clinical advantages for treating COVID-19 by modulating the TLR/TRIF/NF-κB pathway. We also review the current data on curcumin and discuss potential experimental and clinical studies that require defining its potential clinical implications in COVID-19.

Bakground: Ulcerative colitis (UC) is an inflammatory bowel disease that can be treated with many medications but they have various side effects and low cure rate. So, the need for finding novel drugs with better healing characters and less toxicity would be mandatory. Achillea millefolium (A. millefolium, Yarrow) has been traditionally used to treat bleeding, ulcers, wounds, liver, and bile disorders, and recently it has been shown to have anti-ulcer, analgesic, anti-inflammatory, antioxidant, and appetizing effects that make it as a good candidate for UC. Methods: UC was induced with intra-rectal instillation of acetic acid. A. millefolium hydroalcoholic extract (AMHE, 200, 400, and 600 mg/kg/day) and essential oil (AMEO, 62.5, 125, and 250 μl/kg/day) were given to six groups of male Wistar rats for 5 days. Dexamethasone (1 mg/kg/day, intra-peritoneal) and mesalazine (100 mg/kg/day, orally) were used as reference drugs. Colon tissue specimens were separated for assessing macroscopic, pathologic, and biochemical markers. Results: For AMHE, 77.2 mg/g equivalent to gallic acid was obtained for total phenols. Main assessed markers, including ulcer index, total colitis index, colon weight/length ratio, rats' weight gain, and malondialdehyde levels were significantly improved in AMHE (400 and 600 mg/kg/day) and AMEO (125 and 250 μl/kg/day) groups compared to controls. Myeloperoxidase activity was only attenuated in AMHE groups significantly. Conclusions: Both AMHE and AMEO were effective in healing experimental colitis. It seems antioxidant, anti-inflammatory, and anti-ulcer activities of Yarrow are responsible for these beneficial effects. Further studies are warranted to elucidate the exact mechanisms involved.

Background: Secondhand tobacco smoke exposure is one of the morbidity causes but it is ignored occasionally. Various studies have shown that hookah and cigarette smoke contain significant volume of heavy metals. This study was designed aiming biological monitoring of the level of heavy metals in the urine samples of workers in smoking cafés and its association with their lung function and respiratory symptoms in Tehran City. Methods: The list of cafés in Tehran was provided, and they were divided into water pipe cafés (WPC), cigarette smoking cafés (CSC), and non-smoking cafés (NSC); and then, 10 cafés were randomly selected from each group. Sampling was performed after explaining the study and obtaining the consent of the manager and staff. A check list of demographic data and smoking history was completed and analyzed. Results: A total of 96 individuals were studied; there were 32 subjects in each group. All subjects were male. Six days a week, they worked about 10 h a day in café. The concentration of heavy metals in the groups of hookah and cigarettes was significantly higher and respiratory indices in these groups were significantly lower than non-smoking group. Conclusions: Exposure to secondhand smoke increases the urinary level of heavy metals and reduces the respiratory capacity of people and this can be highly pathogenic in the future. Comprehensive informing on human rights should be provided in this regard and smoking bans in public places must be properly enforced.

Background: Perfectionism is a key construct for understanding psychopathology. In societies with varying cultures, studying the psychometric properties of tools can help with their external validity. This research aimed at standardization and validation of the Eating Disorder Inventory-Perfectionism (EDI-P) scale in Iran. Methods: The Persian version of EDI-P was formed through forward translation, reconciliation, and back translation. A total of 302 students were selected using convenience sampling method and' they completed a set of questionnaires, including the EDI-P, Weight Efficacy Lifestyle Questionnaire-Short Form (WEL-SF), Eating Attitude Test-16 (EAT-16), Self-esteem scale (SES), Difficulties in Emotion Regulation Scale-16 (DERS-16), and Self-compassion scale (SCS) Short Form. The construct validity of the EDI-P was assessed using confirmatory factor analysis and divergent and convergent validity. Internal consistency and test-retest reliability (2 weeks' interval) were applied to evaluate reliability. LISREL (version 8.8) and SSPS (version 22) software were used for data analysis purpose. Results: EDI-P scales and subscales were found to be a valid and reliable measure, with good internal consistency and good test-retest reliability in the nonclinical sample. Cronbach's alpha coefficient for the whole scale, socially prescribed, and self-oriented were found to be 0.74, 0.68, and 0.67, respectively. Test-retest reliability for the whole scale, socially prescribed, and self-oriented were found to be 0.88, 0.80, and 0.87, respectively. Convergent validity and divergent validity were good (Normed Fit Index [NFI] = 0.94, Incremental Fit Index = 0.95, root mean square error of approximation = 0.08, goodness of fit index = 0.97, Non-normed Fit Index [NNFI] = 0.91, and comparative fit index = 0.95). The results of this study provide support for the two-factor model of EDI-P. Conclusion: The EDI-P showed good validity and reliability and could be useful in assessing perfectionism in Iranian population. The EDI-P shows notable promise as a measure for use in eating research and clinical settings.

Background: Few studies have shown that smokers are more likely than non-smokers to have coronavirus disease 2019 (COVID-19), whereas some reports indicate that smokers are under-represented among those requiring hospital treatment for this illness. This study was designed and implemented for investigating the severity and outcome of COVID-19 based on smoking. Materials and Methods: This was a cross-sectional study implemented in Tehran and Ahvaz with all COVID-19 hospitalization patients from February to June 2021. Four categories selected for severity and worst outcomes. They are admission in the intensive care unit (ICU), lung involvement more than 50%, using more than three medications, and death. A check list of demographic data and smoking history was completed and analyzed. Results: A total of 11,112 patients were male (61.1%), and the mean age was 47.9 ± 11.3. A total of 1508 smokers (8.3%) were seen with any type of tobacco consumption. The frequency of ICU admission in the smokers is significantly higher than that in non-smokers (23.9% vs. 18.8%). A total of 668 (44.3%) smokers had more than 50% ground glass opacity in lungs, whereas 5340 non-smokers (32.1%) had so. Use of more than three medications in the smokers was significantly higher (70.6% vs. 52%). A comparison between patients based on smoking indicates that the death rate was significantly higher in smokers (31.6% vs. 25.6%). Conclusions: Although smoking rates in COVID-19 patients are lower than those in the general population, the consequences and mortality are higher in smokers.

This is a comprehensive review based on the published papers in the field of COVID-19 vaccines and vaccination. Many efforts have been made to develop vaccines to combat this pandemic. Since December 2020, more than 200 vaccines have been tested in various research stages and in clinical trials on humans, of which eight vaccines reached phase four clinical trials in humans and approved by FDA and EUA. After the Pfizer–BioNTech vaccine that had the highest efficacy (95%), the efficacy of the other vaccines are as follows: Moderna 94.5%, Sputnik V 91%, Novavax 89.7%, Sinopharm 79.3%, Oxford/AstraZenaca 70.4%, Johnson and Johnson 66.9%, and Sinovac 50.7%. At present, protein-based vaccines, with 35% of all available COVID-19 vaccines, are the most common technique in the vaccine production, and then there are vaccines of non-replicating viral vector (13.3%), mRNA1 (12.1%), DNA (10.2%), replicating viral vector (9.8%), and inactivated vaccines (8.2%). The most frequently recognized adverse effects within 7 days of each vaccine dose involved fever, fatigue, headache, chill, and myalgia. The mRNA-based vaccines were associated with a higher occurrence of local side effects (78.3 vs. 70.4%; Sig. = 0.064), whereas the viral vector-based vaccine was associated with a higher prevalence of systemic side effects (87.2 vs. 61%; Sig. < 0.001). Based on the evidence and articles in the field of vaccination, AstraZeneca-Oxford and Sinopharm vaccines reported the highest and lowest side effects, respectively. Because of being emerging, pathogenicity, and high infectivity of COVID-19, vaccination against the disease to prevent its incident rate and decrease the prevalence rate is recommended immediately. Being informed of various aspects of the existing vaccines such as efficacy, effectiveness, safety, etc.can accelerate to make effective and useful choices and consequently have a vaccinated community against the epidemic.

Background: Congenital anomalies are among the causes of disability and death in infants. This study aimed to determine the incidence of major congenital anomalies (MCA) recorded at birth and also their relationship with some related factors in neonates born. Methods: In this cross-sectional study, all infants born from March 2016 to March 2017 in the hospitals of Chaharmahal and Bakhtiari Province were evaluated for MCA at birth. Information recorded in the medical file including parent and infant characteristics is extracted from the maternal and newborn electronic files. Data were analyzed using Generalized Linear Model with function of Poisson. Results: Of the 19666 newborns studied, 63 (3.2 per 1000) had MCAs at birth. Variables such as number of pregnancies, parity, gestational age, neonatal birth weight, height, and head circumference were found to be significantly associated with MCA based on the crude model (P value < 0.05). Using adjusted model 1, the incidence of MCA was found to be significantly related to mother's place of residency and her parity. Finally, in adjusted model 2, the incidence of MCA was found to be related to gestational age, neonatal birth weight, and head circumference. Conclusions: In some MCA, early diagnosis and treatment can prevent disability. Consequently, the emphasis on public education to consider appropriate gestational age, proper nutrition before and during pregnancy, and prenatal care is necessary to inhibit MCA.

Background: The objective of this research is to consider the incidence of brain cancers in Iran during the years 2004–2008 to improve reporting, distribution of the disease. Methods: In this cross-section study, the study population was all brain cancer cases diagnosed in Iran between 2004 and 2008. Age-standardized rate (ASR) per 100,000 persons and crude rate were calculated using direct standardization. Data were analyzed using Statistical Package for the Social Sciences (SPSS version 16) and Microsoft Office Excel 2010. Results: During the period 2004–2008, the ASR and crude rate of brain cancers among males were 2.37, 2.46, 2.77, 2.84, 4.16 and 2.13, 2.11, 2.40, 2.49, 3.61, respectively, and among females the ASR and crude rates were (1.64, 1.67, 2.04, 2.17, 3.09) and (1.45, 1.45, 1.76, 1.84, 2.62), respectively. Conclusions: According to the study results, a significant increase in the incidence of brain cancer was observed over a 4-year period in Iran. Hence, screening and early detection programs for this type of cancer are highly recommended.

Background: There has recently been a high increase in the prevalence of adolescent pregnancies, especially in developing countries, because they are considered vulnerable populations. The objective of this study was to determine the risk factors for low emotional intelligence and for depression in pregnant Peruvian Andean adolescents seen in a public health centre. Methods: The study was a correlational analysis of 280 pregnant Peruvian Andean adolescents using logistic regression analysis. Emotional intelligence and depression were considered dependent variables, while independent variables were age, marital status, and education. The instruments used were Beck's Depression Inventory and the BarOn Emotional Quotient Inventory: Youth version. The threshold of significance was P < 0.05. Results: Age, marital status, and level of education were not risk factors for lower emotional intelligence, because they had respective ORs of 0.8 (95% CI: 0.5-1.4), 1.6 (95% CI: 0.8-3.4), and 0.7 (95% CI: 0.0-1.1). Nor were they risk factors for depression, showing ORs of 0.8 (95% CI: 0.4-1.5), 0.6 (95% CI: 0.2-1.3), and 0.6 (95% CI: 0.3-1.1), respectively. Conclusions: Thus, the risk factors studied do not significantly influence emotional intelligence or depression in pregnant Peruvian Andean adolescents.

Background: Breast cancer is the most common cancer in the world, which accounts for 21.4% of all kinds of cancers for women in Iran. However, the treatment of breast cancer is costly and given that the budget devoted to the healthcare sector is limited, the present study aimed to investigate the cost-effectiveness of breast cancer screening for women, who referred to breast clinic located in Shahid Motahari clinic affiliated to Shiraz University of Medical Sciences, Shiraz city, Iran in 2017-2018. Methods: This study is a cross-sectional study analyzing the cost-effectiveness of breast cancer screening versus no screening. The study was conducted on 3500 women, who referred to the breast clinic in Motahari clinic, at 2017–2018 in Shiraz, Iran. The patients were identified and direct costs, which were correlated to cancer breast screening, were calculated based on the patients' records with public tariff per person. Tree age pro 2011 used to analyze cost effectiveness. Results: Based on the results obtained, the expected cost of screening and no screening were 7556 $ppp and 7840 $ppp, respectively. Given their difference in effectiveness (16%), screening was dominant (less costly and more effective) compared to no screening. Tornado diagram showed that the results had the maximum sensitivity to the increase in screening cost. Conclusions: In general, according to the results obtained from the current study, the screening was more cost effective compared with no screening.

Background: Although previous studies have described a positive correlation between physical activity and 25-hydroxyvitamin D levels (25(OH)D), the relationship between participation in school sports and 25(OH)D levels among children has not been well characterized. Methods: The present study analyzed data from participants aged 5 to 15 years in the National Health and Nutrition Examination Survey cycle 2013-2014. General linear models adjusted for potential confounders were assembled to examine 25(OH)D levels according to participation in school sports. Results: Of 1,670 children in the study sample, 17.9% were defined as having 25(OH)D inadequacy (< 50 nmol/L). Overall, 38% of children reported participation in school sports. In general, 25(OH)D levels were increased among children examined between May 1^st and Oct 31^st non-Hispanic whites, normal weight, higher income, and daily vitamin D intake ≥ 400 IU/d. After adjusting for potential confounders, 25(OH)D levels were 3.7 nmol/L higher among children who played in any school sports than those who did not. In general, higher 25(OH)D levels were seen among children examined during summer and fall seasons than those during winter and spring seasons, regardless the type of sport activities. Moreover, children who played mixed sports during summer and fall seasons had significantly higher 25(OH)D levels than their physically inactive counterparts. Conclusions: 25(OH)D concentrations were significantly higher in children playing school sports than those who did not. Thus, children's participation in school sports, particularly during summer and fall seasons should be considered as an effective public health intervention to reach optimal 25(OH)D levels.

Background: Type 2 Diabetes Mellitus (T2DM) is the prominent public health issue. Pharmacotherapy and diet modification should be integrated into T2DM management. Aims: To investigate the effects of vegetables consumption before carbohydrates on blood glucose and GLP-1 levels in T2DM patients. Methods: A non-randomized quasi experimental study was conducted to recruit T2DM patients who attended at the Gatot Soebroto Central Army Hospital, Jakarta, Indonesia from April to May 2016. The Lemeshow's formula was used to determine sample size. A total of 12 non-diabetic and 24 diabetic patients were participated in our study. Glucose levels were measured using a routine hexokinase method while serum GLP-1 levels were determined using the ELISA. The student t-test was used to compare two groups with parametric data. The significant difference was at P < 0.05. Results: Our data showed that T2DM patients who consumed vegetables before carbohydrates, had relatively stable glucose levels at 0, 60 and 120 mins (164.25 ± 86.89 vs 183.5 ± 55.96 vs 167.83 ± 65.53, P = 0.163) and stay lowered within the normal range compared to T2DM patients who consumed vegetables after carbohydrates (165.08 ± 67.89 vs 241.92 ± 68.03 vs 204.92 ± 81.76, P = 0.022). Additionally, GLP-1 levels remained stable after 60 and 120 min at day 1 (P = 0.816) and day 3 (P = 0.955). Conclusions: Vegetables consumption before carbohydrate is a promising and simple method of diabetes diet for maintaining blood glucose and GLP-1 levels and preventing from vascular complication.

Backround: Noise is one of the most important occupational and environmental health hazards. Exposure to loud noise can cause irrevocable hearing damage and loss of hearing. The aim of this study was to determine the efficiency of two samples of earmuff and earplug in low frequency noise reduction in comparison to subjective method. Methods: All the procedures of the work were done using the simulated human ear canal and the required microphone in the eardrum. At the octave frequencies, that is 31.5 and 63.5, 125, 250, 500, 1000, 2000, 4000, and 8000 Hz, and intensities of 85-90 dB, one stage was done by using the individual's subjective response relative to the received sound before and after using the ear protector. Results: The sound levels before and after the protection were significantly different in both the model and humans (P < 0.05). However, at 315 Hz frequency, the rate of attenuation is increased by 4 dB after placing the earplug and 14 dB after placing the earmuff, showing a reduction of 18 dB. Conclusions: This study verifies the increasing protection by simultaneous application of earplugs and earmuffs. Because of the laboratory evaluation of ear protectors, it is possible not to justify the proficiency of ear protectors in a subjective method.

Background: This meta-analysis was performed to investigate the effect of serum lipids on the risk of breast cancer incidence. Methods: PubMed, Web of Science, Scopus, and EMBASE were searched systematically from January 1998 to April 2019. Inclusion criteria were English observational studies (cohort or case-control) and the concentration of at least one of the lipid profile components (total cholesterol/triglycerides/low-density lipoprotein cholesterol/high-density lipoprotein cholesterol) measured before a diagnosis of breast cancer (BC). The studies were included in which the relative risk (RR) had been reported with 95% confidence intervals (CIs). A random-effects model was used. Results: A total of 25 studies were found, including 2,882,789 participants in cohort studies with 45,481 cases with BC, and 1983 BC cases and 2963 case-control studies. Combined RR of cohort studies for the highest versus lowest for the BC was LDL-C: 0.95 (95% CI: 0.89–1.01), triglycerides (TG): 0.95 (95% CI: 0.91–0.99; P = 0.02), total cholesterol (TC): 0.98 (95% CI: 0.91–1.05), and HDL-C: 0.86 (95% CI: 0.63–1.18). Combined RR of case-control studies for the highest versus lowest was LDL-C: 1.08 (95% CI: 0.78–1.48), TG: 1.73 (95% CI: 0.94–3.18), TC: 1.02 (95% CI: 0.80–1.29), and HDL-C: 0.79 (95% CI: 0.65–0.97). Conclusions: Based on the results, it can be concluded that only TG but not TC and/or LDL-C had a significant inverse association with the risk of BC incidence. HDL-C showed a significant protective effect against breast cancer in postmenopausal women and case-control studies.

Background: The first need of any society is to have a healthy life that can be achieved through preventive education. Despite providing training in the prevention of risk factors for noncommunicable diseases in the country's educational programs, we are witnessing an increase in the incidence of these diseases. We aimed to summarize the views of experts in the field of health and education on improving the effectiveness of these trainings. Methods: This study was conducted with a qualitative approach and conventional content analysis method. Participants were 12 experts in the field of health and 19 employees in education who were selected by purposive and available sampling method with maximum diversity. The data collection method was semistructured interview with note-taking. Results: A total of 32 subcategories and 9 main categories were extracted: “Macro health policies,” “Strategic health system,” “The role of education system in health promotion,” “Schools and Lifestyle modification,” “Informal learning,” “Preventive strategies in promoting health,” “ Lifestyle, multifactorial phenomena,” “The impact of stress on health,” and “Factors affecting preventive education.” Conclusions: Providing preventive education to students is one of the ways to prevent noncommunicable diseases. If these trainings have the necessary attractiveness and support by the authorities (and especially the health system), then it will not only raise students' awareness, but also change their attitude and improve their performance.

Background: The role of anti-phospholipid antibodies (aPLs) in the prognosis of COVID-19 patients is controversial. In order to prove the role of this factor, the necessary measures such as early initiation of anticoagulants should be started even in the early stages of the disease and in outpatients or the use of other drugs in addition to anticoagulants. We decided to investigate the role of these antibodies in ICU admission outcomes in critically ill COVID-19 patients. Methods: The case-control study was carried out in Isfahan, Iran, from March to September 2021. One hundred nine patients in the case group were selected, including patients admitted to the ICU with a COVID-19 diagnosis. The 140 patients in the control group were selected from hospitalized and outpatients with COVID-19 with PCR + and pulmonary involvement, similar to the case group without the need for ICU hospitalization. The anti B2GP1 (IgM, IgG) and anti-cardiolipin (IgM, IgG)) were compared in two groups. Results: The frequency percentage of patients in the abnormal group of anti-phospholipid antibodies was about 10% in total. No statistically significant difference in these aPLs in continued measures was observed between the two groups of patients admitted to the ICU and those outside the ICU. Also, in the logistics regression analysis, no significant association was observed. Conclusions: Therefore, the cause of coagulation in patients admitted to the ICU is not related to these aPLs. This means that aPLs could not be a good predictor of patient admission to the ICU.

Background: Some circulating microRNAs, such as miR15b, are predictors of diseases associated with adulthood obesity. This study aimed to evaluate the effect of two selected school-based and high-intensity interval training (HIT) on miR15b expression and lipid profile of obese adolescents. Methods: Thirty-eight adolescent males (12 ± 1 years) with obesity (body mass: 74.7 ± 13.2 kg, body mass index (BMI): 26.0 ± 2.3 kg/m², and body fat (BF): 27.2 ± 3.6%) were randomly assigned to the following based on the age-related body mass index: (i) HIT (n = 13), (ii) school-based exercises (SBE, n = 13), and (iii) control (n = 12) groups. Mir15b was extracted using the RT-PCR system, and lipid profile was studied using the enzymatic colorimetric method before and after 12 weeks. Three training sessions were held each week during the course. Results: Following the exercise interventions, in both training groups, miR15b (HIT: –63.8 vs. SBE: –56. 7%; P = 0.001), cholesterol (HIT: –8.8 vs. SBE: –9.2%; P = 0.025), and low-density lipoproteins levels (SBE: –13.1 vs. –20.8%; P = 0.48) decreased; however, the peak oxygen uptake of subjects increased (HIT: 4.0 vs. SBE: 4.0%; P = 0.003). However, there were no significant differences in triglyceride (HIT: –16.9 vs. SBE: –8.3%; P = 0.134), and high-density lipoprotein (HIT: 3.1 vs. SBE: 4.8%; P = 0.479) levels between both intervention and control groups (P > 0.05). Conclusions: The results showed that both types of exercises had almost similar effects on reducing miR15b expression and improving the lipid profile. Hence, based on the difficult nature of HIT for children with obesity, further use of school-based exercises is suggested.

Background: Malnutrition is a major public health issue worldwide. It has significant consequences, including weakened immune systems, which may lead to increased incidences of infectious disease and higher mortality, particularly in children. A systematic review and meta-analysis were conducted to estimate the overall prevalence of malnutrition (wasting, underweight, and stunting) among children of 6–14 years of age in Iran. Methods: Data were collected in 2018 based on searches of the PubMed, Science Direct, Scopus, Google Scholar, Science Information Database (SID), Magiran, Irandoc, and Iranmedex databases using the following keywords: childhood, childhood malnutrition, children, nutrition, malnutrition, wasting, underweight, stunting, child, student, boy, girl, cause, prevalence, and Iran, in order to identify studies eligible for inclusion in the review. Comprehensive Meta-Analysis, version 2 (CMA: 2) was used to estimate the overall prevalence of malnutrition. Results: Nine out of 328 articles were included in our analyses. The overall of wasting among children of 6–14 years of age in Iran based on the random-effects model (according to nine studies and 18,296 participants) was 12.5% (95% Confidence Interval, 7.1-21.2). The overall prevalence of underweight based on the random-effects model (according to 10 studies and 19,185 participants) was 19% (95% CI, 8.1-38.6). Also, the overall prevalence of stunting based on the random-effects model (according to 10 studies and 19,185 participants) was 20% (95% CI, 9.4-37.8). Conclusions: The results of this study show that the prevalence of malnutrition among 6–14-year-old children in Iran is similar to the global average. We need solutions that can be used for both prevention and reduction of malnutrition, especially in areas with middle or low socioeconomic status. It is necessary to identify factors associated with malnutrition in various geographic regions in order to implement appropriate programs based on factors with the highest impact in each region.

Background: One billion worldwide population is living in slum areas that mostly accompanied with high rates of poverty, illiteracy, unemployment, unhealthy situation, and inappropriate health-care services. The prediction of enormous growth of slums by 2030 led to a raise to address the “plight of slums” in Sustainable Development Goals (SDGs). Methods: To address evidence-based health-related priorities, we conducted a systematic review to summarizing evidences on health situations of slums population in Iran. Six electronic databases were systematically searched for published studies without any restriction on age, sex, and language to assess health situations of slums in Iran reported by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. All identified articles were screened, quality assessed, and data extracted by two authors independently. Results: The finding of this systematic review in addition to overall view categorized in five categories: health system, reproductive health, infectious diseases, noncommunicable diseases and their risk factors, social issues besides overall situation of Slums. Conclusions: Community-based participatory interventions with socioeconomic approach on modifiable risk factors; active response of health system; establishment new health care centers in slum areas; augmenting the quality of care; active case finding; and elevating health knowledge, attitude, and practice is crucial to achieve SDG's in Slum area.

Background: Obesity is a chronic medical illness with a higher risk of physical and mental cascade. People who seek obesity treatment were reported to have some psychiatric disorders affecting their disease and selection of management. Aims of the Study: This study aims to estimate the prevalence of depressive and anxiety disorders in obese patients seeking obesity management and explore the relationship between common psychiatric disorders (depression and anxiety disorders) and selection of the type of obesity management (surgical or non-surgical). Methods: Patients were recruited from Alazhar Universityhospitals,Egypt, and the total number completing the study was 1115 patients. All subjects underwent psychiatric interview through Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (SCID-5 for DSM-5) for diagnosis of psychiatric disorders and completed two questionnaires, Hamilton Rating Scale for Depression (HRSD) and Hamilton Rating Scale for Anxiety (HRSA). Results: The prevalences of depressive and anxiety disorders were 29.23% and 25.56%, respectively, in all subjects. The most prevalent diagnoses were dysthymic disorder (20.7%), general anxiety disorder (16.95%), major depressive disorder (13.04%), and social phobia (12.4%). Our sample was divided into two groups (surgical and non-surgical). Dysthymia was more common in the surgical group (21.4% versus 19.8% P = 0.560), whereas major depressive disorder was more common in the non-surgical group (7.4% versus 5.4 P = 0.593); also, the non-surgical group was more likely to have “anxiety disorders” (29.23% versus 22.4%, P = 0.840), but severity of anxiety was higher in the surgical group according to HRSA score with a highly significant difference. Conclusions: A high prevalence of depression and anxiety disorders was found among patients who sought obesity treatment. Severity of anxiety was higher in the surgical group according to HRSA score with a highly significant difference, which may affect selection of treatment, so psychiatric evaluation and management are needed before and after obesity management to improve the outcome.

Background: Colorectal cancer (CRC) is the third most common cancer among adults in Iran. The aim of colorectal cancer screening is to reduce the cancer burden in the population by diagnosing the disease in its early stages. Methods: We adapted this guideline for the moderate CRC risk population for Isfahan to determine how to screen them and when to start and end the CRC screening. This guideline was developed by clinical appraisal and review of the evidence, available clinical guidelines, and in consultation with members of the Isfahan Chamber of Iranian association of gastroenterology and hepatology. Results: In screening people with average risk for CRC who use personal resources and personally pay all the costs, colonoscopy is recommended as the first choice to be done every 10 years. In case of negative colonoscopy, we recommend FIT test to prevention of interval cancer every 5 years. In screening of people with average risk of CRC, FIT is suggested to be done every 2 years as a first-choice method test for those who use public resources and do not pay for this service personally. In screening individuals with average risk for CRC, g-FOBT is not recommended as the first method of choice. Repeating positive guaiac test is not recommended and if positive, colonoscopy is suggested.

Introduction: Considering the key role of physicians in providing genetic counseling services and the lack of studies in this field in Iran, it seems necessary to design a valid and reliable instrument for measuring the awareness, attitude, and performance of general and specialist physicians in genetic counseling. Materials and methods: In this descriptive study, the design and psychometrics of the questionnaire were performed in 4 steps: first, defining the concept of awareness, attitude, and performance of general and specialist physicians in relation to genetic counseling by reviewing texts and articles; second, designing questionnaire items; third, determining the face and content validity by 10 university experts; and forth, determining reliability using Cronbach's alpha coefficient method. Results: The primary version of the questionnaire was designed taking into account 60 items during the first and second stages. In the third step, one item was removed and in the final version of the questionnaire 59 items and the content validity index (CVI) and content validity ratio (CVR) were reported to be 0.98 and 0.92, respectively. Reliability with Cronbach's alpha coefficient was determined 0.82. Conclusion: The final questionnaire with 59 items had appropriate psychometric properties. This questionnaire has the ability to be used by health care providers in health care systems to measure the awareness, attitude, and performance of physicians about genetic counseling. The need for further studies is suggested to measure the other types of validity, such as the structural validity of the questionnaire.

Background: These days, silver nanoparticles (Ag NPs) have been given considerable attention and applied in medical technology due to their great antimicrobial and antioxidant features. In the present study, we aimed to synthesize Ag NPs through the reduction of silver nitrate in the presence of Vitex agnus castus L fruit extract. Methods: After collecting fruits, their extract was prepared and added to Ag NO₃ to produce Ag NPs. The effect of different parameters like AgNO3 concentration (0.5, 1, 3, and 5 mM), sunlight exposure, and sunlight irradiation time (10, 20, 30, and 40 min) was investigated in the synthesis of Ag NPs. The features of Ag NPs were characterized using UV-visible spectroscopy, scanning electron microscope (SEM), X-ray diffraction (XRD) analysis, and dynamic light scattering analysis. Moreover, antimicrobial function of Ag NPs was evaluated using Escherichia coli and Bacillus cereus bacteria species and minimal inhibitory concentration (MIC) of Ag NPs against these two pathogens was measured. Results: The results showed that the synthesized nanoparticles had a spherical shape and the range size of 30-60 nm. For the first time, the antimicrobial activity of synthesized Ag NPs of Vitex agnus castus L fruit extract was shown. Conclusions: It can be stated that the biosynthesis of Ag NPs using fruit extract of this plant is an environmentally friendly, economic and harmless method without any use of poisonous substances and no side effects. These Ag NPs can be considered as suitable antibacterial agents and replacements for antibiotics.

Background: Choosing the right temperature probe location is important, especially in VLBW infants. We aimed to determine five points of the skin surface and compare them with the axillary temperature of potentially suitable locations as well as the best location for skin probe placement. Methods: In a cross-sectional study, 400 neonates with gestational age above 26 weeks were enrolled. The axillary temperature was measured using a mercury thermometer at 0 and 30 min. Then, the body temperature was measured using a surface probe on the five skin areas, including the thoracic area, epigastric region, RUQ area, hypogastric area, and left flanking area. Data recorded were compared with the axillary temperature at 0 and 30 min. Results: Mean neonatal axillary temperatures at 0 and 30 min were 36.60 and 36.61, respectively. The mean temperature was recorded using skin probes at 0 and 30 min in the thoracic region (36.34 and 36.35) in the epigastric region (36.45 and 36.47), in the RUQ region (36.50 and 36.52), in the Flank region (36.26 and 36.20), and in the hypogastric region (36.24 and 36.26). The lowest mean difference recorded by surface probes with the temperature measured by the thermometer in the axillary region was related to the surface probe RUQ (mean difference: 0.1 and 0.09), which was not statistically significant. Conclusions: RUQ area probe has the lowest difference with the temperature calculated using the thermometer in the axillary region and is the best place to put the skin probe for prevention of hypo/hyperthermia.

Background: Infectious diseases are one of the most important problems that affect the whole world. The World Health Organization (WHO), an active health organization, has identified coronavirus disease 19 (COVID-19) as a public health emergency and advises governments not to waste time on effective measures and interventions to attack and suppress the virus. In Iran, so far, the total number of screening tests has exceeded 21 million tests and more than 5 million doses of vaccine have been injected. However, we are still far from controlling the epidemic wave. Given the current situation, it is necessary to identify the challenges of managing the new coronavirus epidemic (COVID-19) in the country's medical universities. Methods: This qualitative study was conducted from January 2020 to January 2021 to explore the views of a group of service providers and staff managers of medical universities who were selected via purposeful sampling (n = 47). Data were collected through semi-structured interviews and analyzed using Graneheim and Lundman's conventional content analysis methods. The trial version of MAXQDA 16 software was used to manage the coding process. Results: Upon analysis of data by service providers and staff managers of medical universities, five main themes including governance and leadership, service delivery, human resources, medicine and technology, and financing and 15 sub-themes including management and leadership, culture and society, process, infrastructure, manpower, training and skills, mental pressure, work pressure, nutrition, safety, employee motivation, medical equipment, medicine, payment, and funds were found. Conclusions: Identification of the most important challenges of service providers and staff managers can play an important role in improving the management of the new coronavirus epidemic (COVID-19). It seems that in order to solve some of these challenges, coordination is needed outside the field of health, and considering the formation of the National Corona Headquarters at the national level, it is possible to use this infrastructure to provide the necessary policies and strategies.

Background: In the name of extensive vaccine uptake, understanding the public's attitude, perception, and intent toward COVID-19 vaccination is a significant challenge for public health officials. Methods: A cross-sectional survey via an online questionnaire rooted in the Health Belief Model and Integrated Behavioral Model was conducted to evaluate COVID-19 vaccination intent and its associated factors. Factor analysis and multivariate logistic regression were operated to be satisfactory. Results: Among the 4,933 respondents, 24.7% were health care workers, and 64.2% intended to accept COVID-19 vaccination. The adjusted odds (aOR) of COVID-19 vaccination intent was higher for individuals with greater exposure to social norms supportive of COVID-19 vaccination (aOR = 3.07, 95% Confidence Interval (CI) = 2.71, 3.47) and higher perceived benefits of COVID-19 vaccination (aOR = 2.9, 95% CI = 2.49, 3.38). The adjusted odds of vaccination intent were lower for individuals with greater COVID-19 vaccine safety concerns (aOR = 0.28, 95%CI = 0.25, 0.31). Lower vaccination intent was also associated with increasing age ((aOR = 0.99, 95% CI = 0.98, 0.999), female sex (aOR = 0.76, 95% CI = 0.65, 0.88), and working in the health care field (aOR = 0.75, 95% CI = 0.63, 0.9). Conclusions: The odds of COVID-19 vaccination intent were higher three or more times among those with a greater belief in vaccine effectiveness, lower concerns about vaccine safety, and greater exposure to cues to vaccinate, including from doctors. This last finding is concerning as vaccine acceptance was surprisingly lower among health care workers compared to others. The remarkable results of factor analysis and reliability of the questionnaire may encourage local health authorities to apply it to their regional population.

Background: To assess the psychological consequences of changes during the coronavirus 2019 (COVID-19) pandemic in the Iranian population. Methods: We performed an anonymous online survey in the first 3 weeks of March 2020. Individuals older than 14 who could read Persian, and lived in Iran, were eligible for the study. The participants had to rate their stress levels and depressive symptoms (using a nine-item Patient Health Questionnaire PHQ-9) during the last 2 weeks and before the pandemic retrospectively. The changes in the psychological measurements and their association with the sociodemographic factors and burdens due to confinement were assessed. Results: Overall, among the 3,210 subjects who participated in our study, both the stress levels and average depression scores increased. However, about 23% of the subjects reported a decrease in their stress levels. The burden of childcare, restrictions in private life, and thoughts about the future were positively correlated with the changes in the stress levels and depression scores (,r,> 0.15). However, feeling relieved in the pandemic condition, and enjoying more family time were associated with less change in the stress and depression scores. Being religious (odds ratio [OR] [CI]: 1.5 [1.3-1-8]) and older age (OR [CI]: 2.9 [1.8–4.6] for >55 years old) were identified as the resilience factors, whereas being a student (OR [CI]: 2.1 [1.6;2.7]), seeking a job (OR [CI]: 2.6 [1.8;3.9]), and history of a psychiatric disorder (OR [CI]: 3.2 [2.6;4]) were identified as the risk factors for depression. Conclusions: The stress levels and depressive symptoms have increased during the COVID-19 pandemic and this increase is related to different social and personal burdens due to the confinement conditions.

Background: Waterpipe smoking is associated with maternal and fetal complications, and valid data contribute to evidence-based planning. This study was conducted to determine the prevalence and factors related with waterpipe smoking among pregnant women of Zahedan city in 2020. Methods: This cross-sectional study was conducted in 2020, and 400 pregnant women in the third trimester of pregnancy who lived in Zahedan participated in it by single stage randomized cluster sampling. A questionnaire was used to measure awareness of waterpipe complications, and another one investigated the status of waterpipe smoking to collect data. For data analysis, descriptive statistics and multiple logistic regression were used through SPSS 21. Results: The findings indicated that the prevalence of waterpipe smoking was 18.8%. In the waterpipe smoking group, 46.6% smoked every day, 89.3% had tried to reduce the smoking, and 64.8% reported fetal death as their main motivation to reduce smoking. Only 5.6% of subjects stated receiving training as the reason for reduction of their waterpipe smoking. The women's level of education, economic status, ethnicity, and awareness of the risks of waterpipe smoking were the predictors for waterpipe smoking (P < 0.05, P = 0.03, P = 0.006, and P < 0.001, respectively). Conclusions: The results of this study show the high prevalence of waterpipe smoking in pregnant women of Zahedan. Further investigation and training in this regard are essential for pregnancy as well as pre-pregnancy care. Special attention should be paid to groups with better economic status and level of education, Baluch women, and those with low level of awareness.

Background: The overuse and abuse of the Internet incur the risk of Internet addiction. Besides, as adolescents spend many hours on the Internet, their general health is at stake. Methods: The present study was a descriptive cross-sectional study. The study sample included 1000 female and male high school students in Bushehr City in 2018. The students took part in this study by completing Kimberly Young's Internet Addiction Test (IAT) and Goldenberg's Mental Health Questionnaire. The frequency, mean, and standard deviation measures were also used to explain the results, and data analysis was performed using the Chi-squared tests technique, which was also used to analyze the data and to examine the relationship among mental health and Internet addiction and logistical regression. Results: According to the results of the prevalence of Internet addiction it was found that 1.1% (10 individuals) were Internet-addicted and 33.1% (299 individuals) were at the risk of Internet addiction. The findings of this study indicated that four different areas of mental health including physical condition, anxiety, depression, and social functioning have a direct relationship with Internet addiction (P < 0.05). Conclusions: In the present study, a large percentage of the students were prone to Internet addiction. Hence, it is necessary to plan and perform preventive, controlling, and interventional measures for high school students.

Coronavirus disease-19 (COVID-19) caused by SARS-CoV-2 is a novel viral infectious disease, which broke out in the end of winter season 2019 in China and soon became a pandemic. Characteristically there was severe local and systemic immune-inflammatory response to the virus, damaging the respiratory system and other organ systems. The morbidity and mortality caused by the disease are producing tremendous impact on health. The understanding about pathogenesis and manifestations of the disease was obscure. To date, no classic treatment or preventive measure was available for COVID-19 other than symptomatic and supportive care or few drugs under trial. A possibility exists that maintaining vitamin A adequate levels can protect the affected respiratory mucosa, increase antimicrobial activity, produce better antibody response, and have antiinflammatory effects, thereby promoting repair and healing as well. It has been discussed in the review that by various mechanisms, immune regulation through vitamin A supplementation is beneficial to boost immunity in the current outbreak situation when the population is susceptible to the disease. There is a high possibility that vitamin A supplementation to cases as well as population at risk of COVID-19 has a key role in prevention and control. Hence, it is believed that along with other therapeutic and preventive measures, maintaining vitamin A sufficiency during and prior to the development of active disease may act as an adjuvant in population at risk and cases to prevent and control COVID-19.

Background: Evidence suggests that dietary pattern is related to incidence and grades of nonalcoholic fatty liver disease (NAFLD). The aim of this study was to investigate the relationship between major dietary patterns and hepatic histologic features of newly diagnosed patients with NAFLD. Methods: This cross-sectional study included 260 newly diagnosed NAFLD patients. Hepatic fibrosis and steatosis were diagnosed using Fibroscan. Dietary information was obtained using a validated 168-item semiquantitative food frequency questionnaire. The association between dietary patterns and odds ratio of the grade of fibrosis and steatosis was examined by multinomial logistic regression. Results: The mean ± SD age participant was 46.53 ± 11.71 years. Fifty-seven percent of the participants were women. Two major dietary patterns were recognized: “Western dietary pattern” and “Mediterranean dietary pattern.” After adjustment for various confounders, adherence to the two extracted dietary patterns was not associated with odds of fibrosis and steatosis (P > 0.05). However, P was not significant. Patients in the second quartile of the Mediterranean dietary pattern had a higher risk for being in the F1 grade compared to those in the reference group in the crude and adjusted model. Conclusions: The major dietary patterns of NAFLD patients living in Gilan were not related to the severity of their disease. More precise study design such as cohort or interventional studies is suggested to reveal the strength of this study findings.

Background: Oxidative stress (OS) is caused by an imbalance between prooxidant substance production and antioxidant defense. OS is involved in physiologic interactions in the body and the pathogenesis of various disorders. This study aimed to evaluate serum prooxidant-antioxidant balance (PAB) as a selective prooxidant, antioxidant defense, and acute phase reactant protein in patients with subclinical and clinical hypothyroidism. Methods: This case-control study was conducted in three groups including clinical hypothyroidism (32 patients), subclinical hypothyroidism, (42 cases), and healthy controls (32 individuals). This study was performed in the Endocrine Clinic of Arash Training and Research Hospital, Tehran, 2017. In the study groups, thyroid hormones including T4 and Thyroid Stimulating Hormone (TSH), fasting blood glucose (FBG), lipid profile, PAB, and hs-CRP as inflammatory markers were measured and compared between the groups. Results: Among 106 participants, 95.3% were females, the gender balance was similar across groups and mean age was 30.79 ± 7.65 years. FBG and lipid profile except for cholesterol level were not significantly different between the three study groups. However, cholesterol level in the clinical hypothyroid group was significantly higher than the other two groups. PAB was higher in subclinical hypothyroidism compared to healthy controls after adjustment for age and TSH levels (P value: 0.04) but there was no significant difference in the clinical hypothyroid group in comparison with healthy controls. In addition, there was no significant difference in high-sensitivity C-reactive protein (hs-CRP) between the three study groups. Conclusions: This study suggests that that subclinical hypothyroidism increases PAB in comparison to healthy control which could indicate OS response in patients with subclinical hypothyroidism, respectively.

Background: Efforts to increase the coverage of exclusive breastfeeding require extraordinary innovation supported by many parties, such as community leaders, including Housewives Peer Group activist living as a neighborhood of lactating mothers. The aim of this study was to analyze the effect of a short course on the knowledge and practice of Housewives Peer Group activists as assistance to lactating mothers in providing exclusive breastfeeding. Methods: The method of the research was pre and post-test of quasi-experimental. The population was Housewives Peer Group activists in the working area of Tlogosari Wetan Community Health Center, Semarang City. Samples were chosen using purposive random sampling to 37 Housewives Peer Group activists. The intervention given was a short course which should be attended by the group, and the post-test was assessed 1 month after conducting the pre-test. Results: The results of the Wilcoxson Match Paired test showed differences in knowledge (P < 0.05) and practice (P < 0.05) of the Housewives Peer Group activists before and after attending a short course regarding exclusive breastfeeding and lactation management. At the end of the study, the knowledge and practice of the Housewives Peer Group activists increased by 4.21 points and 3.73 points, respectively. Conclusions: Short course on exclusive breastfeeding and lactation management significantly influences the increased knowledge and practice of Housewives Peer Group activists that further improve the quality of transferred information, monitor public health, especially to increase the coverage of exclusive breastfeeding and lactation management for breastfeeding mothers.

Background: Self-care is an essential component of diabetes mellitus (DM) treatment and often depends heavily on family support. In skip generation families, children's grandparents are their primary caretakers, many of whom have chronic diseases such as DM. The objective of this study was to determine the proportion of DM patients receiving treatment at a primary care unit in Khon Kaen Province in the skip generation families and the effects of this family structure on clinical indicators of treatment outcomes. Methods: This was a prospective descriptive study in DM patients who visited a primary care unit in Khon Kaen Province from July to October 2019. Patients were asked to fill out a questionnaire interviewed, and demographic and clinical data were analyzed. Results: This study included 202 participants. We found that 11.4% of patients were in skip generation families, 91.3% of whom were elderly. We found no statistically significant association between family structure and either self-care practices or clinical indicators of treatment outcomes. Conclusions: Neither clinical indicators of treatment outcomes nor self-care practices differed between DM patients in skip generation families and those with other family structures. However, additional studies should be conducted to examine other possible factors, such as the age of the grandchildren of whom patients are the primary caretakers.

Background: There are randomized controlled trials (RCTs) about the zinc supplementation effect on circulating levels of brain-derived neurotrophic factor (BDNF). However, the findings of these studies are inconsistent. The purpose of this systematic review and meta-analysis was to determine the zinc supplementation effect on BDNF and zinc levels in published RCTs. Methods: We searched PubMed/Medline, Cochrane, Scopus, ISI Web of Science, EMBASE, “Clinicaltrials.gov”, “Cochrane Register of Controlled Trials”, “IRCT” and also key journals up to 2019. RCTs with two intervention (zinc) and control (placebo) groups that evaluated zinc supplementation efficacy on BDNF levels were included. Study heterogeneity was assessed, and then, meta-analysis was performed using the fixed-effects model. Results: Four studies were included in the present secondary analysis. Compared with placebo, zinc supplementation significantly enhanced circulating levels of BDNF [(SMD): 0.31, 95% confidence interval (CI): (0.22, 0.61)] and zinc [(SMD): 0.88, 95% CI: (0.54, 1.22)] with no considerable heterogeneity among the studies [(Q = 3.46; P = 0.32; I2% = 13.4); (Q = 2.01; P = 0, 37; I2% = 0.5), respectively]. Conclusions: Our results propose that zinc supplementation can increase the circulating levels of BDNF and zinc. This study was registered at PROSPERO as CRD42020149513.

Background: Among the common mental disorders in societies, depression is one of the most common mental disorders that affects all groups and classes of society. Students are among the groups with the highest rates of depression. Therefore, the need for a short and effective tool for screening and early detection of depression is felt. The aim of this research is to determine validity, reliability and the best cut-off point of the patient health questionnaires-9 (PHQ-9) and patient health questionnaires-2 (PHQ-2) in university students. Methods: This cross-sectional study was conducted on 246 students of Kermanshah University of medical science in Kermanshah province of Iran. They completed the PHQ-2, PHQ-9, and the Beck Depression Inventory-II (BDI-II). A structured interview was used to diagnose depression. To analyze the data, Cronbach's alpha for internal consistency, the intra-class correlation (ICC) for test–retest reliability, confirmatory factor analysis for construct validity, Pearson Correlation for Convergent validity, and receiver-operating characteristic (ROC) curve for Criterion validity was used. Results: The mean age of the participants was 20.43 ± 2.29. Cronbach's alpha coefficient for PHQ-9 and PHQ-2 was 0.82 and 0.80, respectively. The test–retest reliability based on intra-class correlation (ICC) for PHQ-9 and PHQ-2 after two weeks was 0.81 and 0.73, respectively (P < 0.001). The correlation coefficient between the PHQ-9 and PHQ-2 with the BDI-II was 0.74 and 0.64, respectively (P < 0.001). Confirmatory factor analysis showed that two-factor model and one factor model had good model fit. The best cut-off point score for the PHQ-9 was 10 with a sensitivity of 0.90 and specificity of 0.93, and the best cut-off point score for the PHQ-2 was 3 with the sensitivity of 0.71 and specificity of 0.92. Conclusions: The PHQ-9 and PHQ-2 are suitable tools to screen depression in the university students in Iran.

Background: Breast cancer is the most common cancer in women. Delay in the diagnosis of breast cancer is a major challenge that can lead to disease progression. Identifying the predictors of breast cancer screening behavior is necessary to promote early detection of breast cancer. This study aims to investigate the predictors of breast cancer screening behavior in women aged 20–69 referred to public health centers. Methods: This cross-sectional study was conducted on 17255 women aged 20–69 years old in Isfahan Province referred to Public Health Centers by the multi-stage random sampling method. data were collected based on the paper forms of women's care aged 20–69 at public health centers, Isfahan, Iran, in 2012. Using STATA 14, logistic regression was employed to explore predictors of breast cancer screening behavior at a 5% significance level. Results: The mean age of women was 36.75 ± 10.46. About 6006 (34.8%) of women had a history of breast self-examination, and among women aged over 40 years, 17.7% reported ever having a mammogram. The most important factors influencing breast self-examination were age 40–49 (OR = 1.18; 95% CI: 1.06-1.33), history of hormone consumption (OR = 1.23; 95% CI: 1.15-1.33), family history of breast cancer in first-degree relatives (OR = 14.22; 95% CI: 9.83-20.57. The most important factors influencing mammography were hormone consumption (OR = 1.26; 95% CI: 1.05-1.51), and family history of breast cancer in first-degree relatives (OR = 32.55; 95% CI: 20.08-52.70). Conclusions: Our findings indicated that the performance of breast self-examination and mammography was low. The frequency of BC screening behavior was higher among women with BC risk factors The results revealed the need for health authorities to pay attention to education in BC detection methods.

Background: According to the importance of physical activity in the child's physical and mental development and cognitive health, developing a valid, reliable, and comprehensive assessment tool for children's physical activity is mandated. The purpose of this study is the translation, cross-cultural adaptation, and validation of the Persian version of the Thailand Physical Activity Children Survey questionnaire to measure the level of physical activity in children aged between 6–9 years in Iran. Methods: This study consisted of three stages, first, the questionnaire translation into Persian language and modification of the sections according to the Iranian culture, then the evaluation of the questionnaire via a pilot study, and finally, assessing the reliability and validity of the tool. Participants of the pilot study were 250 healthy children, aged 6 to 9 years, meeting eligibility criteria, recruited through a stratified cluster sampling method from schools across Tehran. Results: The Persian version of the questionnaire demonstrated an acceptable content validity (Content Validity Index between 0.88-1). The test-retest reliability reported the Intra-Class Correlation coefficient in the acceptable range in all sections (between 0.71-1). Cronbach's alpha was reported 0.993, which indicated excellent internal consistency. Conclusions: According to the acceptable validity and reliability of the Persian version of the Thailand Physical Activity Children Survey for children aged 6–9 years, it is recommended in research and surveillance studies to determine the level of physical activity of children of that age group in Iran.

Background: The 2019 coronavirus disease (COVID-19) is a mysterious and highly infectious disease that was declared a pandemic by the World Health Organization. The virus poses a great threat to global health and the economy. Currently, in the absence of effective treatment or vaccine, leveraging advanced digital technologies is of great importance. In this respect, the Internet of Things (IoT) is useful for smart monitoring and tracing of COVID-19. Therefore, in this study, we have reviewed the literature available on the IoT-enabled solutions to tackle the current COVID-19 outbreak. Methods: This systematic literature review was conducted using an electronic search of articles in the PubMed, Google Scholar, ProQuest, Scopus, Science Direct, and Web of Science databases to formulate a complete view of the IoT-enabled solutions to monitoring and tracing of COVID-19 according to the FITT (Fit between Individual, Task, and Technology) model. Results: In the literature review, 28 articles were identified as eligible for analysis. This review provides an overview of technological adoption of IoT in COVID-19 to identify significant users, either primary or secondary, required technologies including technical platform, exchange, processing, storage and added-value technologies, and system tasks or applications at “on-body,” “in-clinic/hospital,” and even “in-community” levels. Conclusions: The use of IoT along with advanced intelligence and computing technologies for ubiquitous monitoring and tracking of patients in quarantine has made it a critical aspect in fighting the spread of the current COVID-19 and even future pandemics.

Background: The world experienced the greatest pandemic of the 21^st century with the emergence of a new and readily transmissible the coronavirus disease. Understanding knowledge, attitudes, and practices (KAP) of the public towards the pandemic is an essential part of developing effective preventive strategies. Aim: The objective of this study was to investigate the knowledge, attitudes, and practices (KAP) concerning the coronavirus (COVID-19) among population in Istanbul. Methods: This is a cross-sectional and multi-stage, stratified random sampling based on multi-center population of Istanbul. A total of 5,414 persons were contacted and 4361 participants (80.5%) gave consent. The data were analyzed using descriptive and multiple regression analyses. Results: There were significant differences between low education and high educational level with respect to age groups, gender, occupation, income, residence, number of rooms and family members (P < 0.001). Responses concerning knowledge of COVID-19 indicated that subjects with high education level were significantly higher regarding knowledge of the signs and symptoms of COVID-19 and methods of detecting COVID-19 respectively. Majority of the participants consider COVID-19 risk is higher than AIDS or Cancer (75.8% of low education vs. 67.2% of high education level (P < 0.001). Multivariate stepwise regression analysis revealed that monthly income status (P < 0.001), appropriate method of detecting COVID-19 (P < 0.001), occupational status (P < 0.001), medical mask prevent against COVID-19 (P < 0.001), eating or contacting wild animals (P < 0.001), isolation and treatment of people reduce risk (P < 0.001), isolation 14 days (P < 0.001), avoid going to crowded places such as train-metro, bus, restaurants and shopping (P = 0.003), COVID-19 spreads via-respiratory droplets (P = 0.004), afraid of travel (P = 0.026) were significantly associated with COVID-19 knowledge. Conclusions: The current study results revealed that the educational level and occupation especially sedentary are correlated positively with knowledge, attitude and practices. This finding is not surprising since higher education levels and professional status are associated with good KAP in most epidemic diseases including COVID-19. Nevertheless, the recent experience with COVID-19 has provided lessons on strategy and policy making.

Background: Various recent studies have reported that exclusive right nostril breathing (RNB) and left nostril breathing (LNB) has an immediate and sustained effect under various medical conditions. In the present study, we evaluated the effect of short-term left nostril breathing on various sleep parameters in medical students. Methods: We hypothesized that the increase in vagal tone because of LNB can help in improving the quality of sleep. The baseline sleep quality was documented before the start of study in the case and the control group using the 'Pittsburgh Sleep Quality Index' (PSQI) questionnaire. A PSQI global score of more than 5 indicates poor sleep quality. The case group practiced LNB in a graduated manner for a period of 4 weeks. Thereafter, sleep quality was documented for both the groups using the PSQI questionnaire. Results: Practicing LNB significantly lowered all the seven component scores (p < 0.05) and the global PSQI score in the case group (p-value < 0.0001), suggesting that this practice effectively improved the sleep quality in the individuals of this group. Conclusions: Overall, this study suggested that exclusive LNB practice could serve as an important lifestyle modification that can be incorporated in the routine of medical students for improving their sleep quality.

The 2019 Coronavirus Virus Disease (COVID-19) represents a global public health challenge in the twenty-first century. As of June 2020, the virus had spread across 216 countries across the globe. This paper aims to analyze and identify those existing comorbidities among COVID-19 patients that represent potential risk factors for COVID-19 complications, severe illness, and death. Multiple database resources were searched. The resources include the University of Saskatchewan library USearch, Google Scholar, PubMed, Medline, and the Google search engine. Thirty-seven articles, which included 15 different types of chronic diseases, were selected. Among the reviewed diseases and conditions, cancer, diabetes, lymphopenia, hypertension, kidney disease, smoking, chronic obstructive pulmonary disease (COPD), and organ transplant were found to represent potential risk factors for COVID-19 complications, severe illness, and death. Other conditions that require further research as to whether they predispose subjects to severe illness and death include coronary artery disease, cerebrovascular disease, valvular heart disease, gastrointestinal diseases, HIV/AIDS, asthma, and liver disease. In conclusion, this article explains the association between diseases mentioned above and the severity of COVID-19 and clearly shows the population at risk. This paper will help government bodies and decision-makers prioritize resources for these populations to reduce mortality rates and overall quality of life.

Background: Data for COVID-19 incidence and the source of infection among health care workers (HCWs) in Indian population are limited. The main objective of the study was to assess the incidence of COVID-19 infection and identify the source of infection among the HCWs in a tertiary teaching hospital. Methods: A prospective cohort study was conducted among the 2134 HCWs recruited by purposive sampling from a tertiary teaching hospital from May to August 2020 (4-month period—123 days). Over the 4-month period, all the HCWs who had symptoms or those were close contacts of COVID positive patients were traced and tested using validated COVID diagnostic test (reverse transcription–polymerase chain reaction [RT–PCR] test). A semi-structured questionnaire was used to interview each positive HCW to identify the source of exposure of the infection. Results: Incidence proportion was 9.3% among HCWs and was two times higher among males compared to females. Hazard ratio was found to be higher among males and HCWs working in the non-COVID areas. Test positivity rate was found to highest (around 57.8%) among those aged less than 30 years. The most common source of infection was infected HCW colleagues (40.9%) followed by exposure to patients in non-COVID areas (27.3%). Only 5.1% of total infection was found in HCWs who had worked in COVID zones. Conclusions: People working in non-COVID areas, those using shared workplace, dining halls, and staff hostels, must follow strict COVID protocols by using appropriate Personal Protective Equipment (PPE) and following social distancing measures.

Background: Fecal calprotectin (FC) is suggested as a novel biomarker for the diagnosis of gastrointestinal (GI) diseases; however, few studies have investigated its diagnostic value for Helicobacter pylori (H. pylori). Therefore, the current study evaluated the level of FC and its diagnostic value in patients with H. Pylori and its related conditions including gastritis and duodenitis. Methods: In this case-control study, 120 children with upper GI symptoms, who were indicated to undergo upper GI endoscopic examination, were consecutively included. Patients were categorized into different groups based on their endoscopic findings including H. pylori, gastritis, duodenitis or normal. Results: Patients with gastritis (P = 0.014) and those with duodenitis (P < 001) had significantly higher FC. The level of FC was higher in patients with H. pylori but this difference was marginally significant (P = 0.054). The level of FC had poor ability to diagnose the presence of H. pylori (P = 0.054) and gastritis (area under the curve, AUC = 0.639, P = 0.014). However, it had acceptable power to diagnose patients with or duodenitis (AUC = 0.718, P < 0.001). The sensitivity and specificity of FC for diagnosis of gastritis were 64 and 65 percent (cut-off = 45.2 μg/g), and for duodenitis were 77 and 61 percent (cut-off = 46.2 μg/g), respectively. Conclusions: FC can be considered as an objective and diagnostic tool for duodenitis. However, due to the low sensitivity and specificity, it is suggested to consider it as an objective supplementary test beside other established diagnostic modalities.

Background: Dietary quality indices are practical as an instrument to investigate the extent of adhering to a special diet to prevent cardiovascular disease (CVD) in type 2 diabetes mellitus (T2DM). Considering the lack of any systematic review with regards to this issue, our aim was to examine observational studies to test the relationship between dietary quality indices and CVD risk factors in T2DM. Methods: Systematic search was performed in Web of knowledge, PubMed, Cochrane, Science direct, Google Scholar and Scopus databases from January 1990 to July 2020. The studies exploring the relationship between dietary quality indices (diet quality score (DQS), dietary diversity score (DDS), healthy diet indicator (HDI), healthy eating index (HEI), diet quality index (DQI), Mediterranean diet score (MDS)) and lipid profile, anthropometric indices, glucose profile as well as blood pressure were eligible to be included in this review. Overall, mean changes, odd ratio (RR), correlation coefficients, and beta coefficient of outcomes were extracted, with the quality assessment of studies performed applying The Newcastle-Ottawa scale. Results: From among 1627 papers, 10 articles were included: Eight cross-sectional and two prospective (cohort) studies. The association between HEI as well as MDS and CVD risk factors was more evident in the included studies. Fasting blood sugar, hemoglobin A1c, body mass index, and waist circumference revealed the greatest inverse significant relationship with dietary quality indices in adults with T2DM. Conclusion: Overall, the findings of this study suggest that the level of CVD risk factors in T2DM decreases significantly with increase in the score of dietary quality indices. Further studies in future are required to confirm these findings.

Background: Tobacco use is an established preventable risk factor for many noncommunicable diseases and is considered as an important indicator for monitoring progress towards Universal Health Coverage (UHC) and Sustainable Development Goals (SDGs). This study aimed to determine the situation of tobacco use among Iranian adults using 2016 household survey. Methods: This is a secondary analysis of the data from 2016 nationally representative STEPwise approach to Surveillance (STEPs) survey with a sample size of 31,050. The data on tobacco consumption was gathered using questions incorporated in the survey questionnaire. Results: The prevalence of current tobacco use in Iran was 25.2 % (24.4-25.9) in men versus 4% (3.7-4.3) in women. The prevalence was higher in rural areas and among second wealth group. The prevalence of current daily cigarette smoking was 20.1% (19.4-20.7) in men versus 0.9% (0.8-1.1) in women). Average number of cigarettes per day among current cigarette smokers was 14.5% (14.1-14.9), mean age at start smoking among daily cigarette smokers was 21.6% (21.1-22), and 95.2% (94.4-96) of daily current daily cigarette smokers attempted for cessation during past 12 months. Prevalences of exposure to secondhand cigarette smoke among nonsmokers at homes and workplaces were 23.21% (22.65-23.76) and 18.04% (17.2-18.87), respectively. Conclusions: There was a large difference between the prevalence of tobacco use between men and women (25.2% vs. 4%). Higher prevalences of tobacco use in rural areas and among lower wealth quintiles require more equity-based approaches in tobacco combatting actions.

Background: Patient safety as a goal can be achieved by reporting medical errors (ME); however, most errors are never reported. The aim of this study is to explore the causes of ME, and the obstacles in reporting them amongst nurses. Methods: We conducted semi-structural interviews, with 12 nursing managers in the biggest teaching hospital in southern Iran (2015-2016). The interview guide concentrated on the causes of ME and barriers in reporting them. All face-to-face interviews were recorded and transcribed verbatim and analysed using thematic analysis. Results: In this study 4 main themes were extracted for the causes of ME: personal/social characteristics, nonprofessional practice, hospital related factors/organization contextual factors, and poor management. Also, 5 main themes (such as; personal characteristics, fear from reporting, nonprofessional practices, cultural and social factors, and error surveillance system features) were obtained with regards to barriers in reporting. Conclusions: ME can be reduced by improving professional practice and better human resource management. Also, reporting errors can be increased by focusing on cultural and social factors.

Background: Patients with multiple sclerosis (MS) are considered at higher risk of COVID-19 infection due to treatment with immune modulators and immune-suppressive agents. The exact risk factors are not clear. So, we aimed to conduct a study to determine the predictors of catching COVID-19 infection during the pandemic stage in patients with multiple sclerosis (MS). Methods: We conducted a multicenter screening study and developed an online questionnaire to collect patients' self-reported demographic features along with MS-related and COVID-19–related information. The online questionnaire link was released by the Iran Multiple Sclerosis Society (IMSS) social media channel, accessible for 4160 MS patients totally and also was sent by WhatsApp for nonmember cases. Results: Totally, 1448 MS patients participated in our study. Twenty-five (1.7%) patients were diagnosed with COVID-19, from which 4 were hospitalized, 4 were treated with medical therapy, and 17 patients had home-quarantine. The patients with COVID-19 diagnosis were more frequently treated with rituximab (28% vs 24%, P = 0.001) than others, and cardiovascular comorbidity was more frequent in this group (8% vs 1.6%, P = 0.01). Regression analysis showed that cardiovascular disease was a significant positive predictor of COVID-19 infection (OR = 5.2, 95% CI: 1.1–23.7). Conclusions: Patients with MS who have cardiovascular disease should be more monitored for COVID-19 infection as they are at higher risk of infection.

Background: Prevention of the incidences of mental disorders, psychological problems, or their rapid diagnosis is an important issue that has led to the creation of a mental health literacy concept and the development of standard tools for evaluating them. This study is the first step in the designing and psychometrics of the Mental Health Literacy Questionnaire (MHLQ) in Iran. The purpose of this study was to design the psychometric properties of the MHLQ in soldiers. Methods: This study is a methodological study that was designed in three phases: 1) Designing the instrument, 2) Assessing the items, and 3) Psychometric assessment. This study was conducted during 2017-2018, and the soldiers were selected by using a convenience sampling method from different garrisons of Tehran, Iran. To evaluate the content validity of the questionnaire 10 experts, to evaluate the face validity 9 soldiers, and for the pilot study 103 soldiers formed the sample size. Finally, construct validity was assessed among 251 soldiers. Results: In the first phase, 78 items were collected and designed. Then, based on the experts' opinions and preliminary studies, the items were reduced to 52 in the “Assessing the items phase” and then to 42 items in the psychometric phase. In the third phase, 31 items remained in the final version. The CVR and CVI scores of the 52 items were 0.91 and 0.94, respectively. Exploratory factor analysis revealed a 4-factor structure with 31 items of special value that were higher than five that accounted for 55.04 of the total scale variance. The fit indices values indicated that the model is fit for the data. In the total scale, the test–retest reliability and Cronbach's alpha were 0.81 and 0.76, respectively. Conclusion: The MHLQ of soldiers has appropriate psychometric properties and can be considered as a suitable tool for evaluation and screening as well as a basis for educational and research interventions.

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the pathogen responsible for an acute respiratory disease designated COIVD-19, which has spread throughout the world. Despite all the struggles with this virus, still, the majority of societies are affected by COVID-19, which raises many questions such as are these ways of management enough, which is crucial in order to contain the virus spread, and which is not effective. In this systemic review, we tried to summarize the data on different ways of managing COVID-19 outbreaks. Through understanding the efficacy and downsides of different approaches to manage COVID-19, public health officials, governing bodies, and health care administrators may be better equipped with the tools necessary to best manage COVID-19 and pandemics. Methods: This systematic review was carried out by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Articles were selected using several databases PubMed, ScienceDirect, and Google Scholar, all peer-reviewed and published articles from December 1, 2019 to April 23, 2020 that met the inclusion criteria were selected. Results: The majority of the included articles were mathematical modeling, cohort studies (n = 9), cross-sectional (n = 6), and one case series. Most articles originated from China and then Singapore. The measures that have been practiced in these articles consisted of close contact tracing and case isolation, quarantine, strict surveillance, lockdown, and travel surveillance. Conclusions: The most effective approach is at least the combination of case detection and isolation, and contact tracing or containment measures. In the literature, travel controls seem to be ineffective, personal hygiene should be tough and emphasized.

Background: Essential hypertension is one of the fastest rising noncommunicable diseases among adolescents and poses a major public health issue globally. This study aimed to estimate the prevalence of prehypertension and hypertension among school-going adolescents in Chennai and also to delineate the role of nutritional and environmental determinants in the development of hypertension. Methods: This cross-sectional study was conducted among school-going adolescents aged 14 to 18 years in northern Chennai. Four schools (two private, two public) out of 21 were selected randomly using probability proportionate to sampling size and 401 students were recruited after consent. Data were collected using an adapted modified World Health Organization (WHO) Global School-based student Health Survey (GSHS) questionnaire; anthropometry and blood pressure measurements were done by trained healthcare professionals using standard procedures. Prehypertension was defined when systolic or diastolic pressure >90^th percentile and <95^th percentile; hypertension when systolic or diastolic pressure >95^th percentile. Data were analyzed using SPSS, descriptive statistics like frequencies, mean, and percentages were used and inferential statistics like Chi-square test and logistic regression were used to elicit predictors of essential hypertension. Results: Out of 401 participants, 185 (46.1%) were males and 216 (53.9%) were females. Overall prevalence of prehypertension and hypertension was 14.2% and 5.5%, respectively. Gender (P = 0.039), overweight/obese (P = 0.000), junk food intake for >3 days/week (P = 0.000), physical inactivity for <3 days/week (P = 0.000), and parent's history (P = 0.005) were significant determinants in the development of prehypertension and hypertension. Conclusions: Nutritional and environmental determinants play a critical role in influencing blood pressure status among adolescents, this requires lifestyle and behavioral modification.

Background: The value framework governing the health system can guide the policymaking. This study presents a set of values governing the health policies for adopting policies that are in harmony with the ideology of Iran. Methods: This study was conducted in two phases. In the first phase, using the qualitative approach, Shams et al. framework was adopted to identify values. Identification of health-related national documents (nine documents) was performed purposefully. In the next phase, semi-structured interviews on individual experts in the health system were carried out. The key question was “What values and principles govern the health policy system?” Participants included 15 individuals. Both phases were analyzed based on qualitative content analysis. Results: In this study, a taxonomy of values governing policymaking is presented. Results show that equity in different dimensions, comprehensive health and a healthy human being, pioneering in health in the region, and accountability are the most important terminal vaqlues. Individual responsibility, government responsibility for health, endogenous and extrinsic economics, fair access, transparency, efficiency, quality and integrity in the supply, development and fair allocation of public health resources, and professional commitment are the most important instrumental values in Iran. Participants believed that, despite the many higher-order documents available, the health system policymaking was not based on a predetermined value. Conclusions: It is not enough to provide a set of values in upstream documents for implementation. It is necessary to specify the relative weight of the reference values in policymaking and their relation to each other in order to apply them in policymaking.

Two highly overriding problems that the society is facing today are stress and obesity. This narrative review article explains the vicious cycle of how stress leads to obesity and vice versa. Stress and obesity are interconnected to each other through different lines of cognition, behavior, and physiology. Stress can interfere with cognitive processes like self-regulation. Stress can also influence behavior by indulging in overeating of foods that are high in calories, fat, and sugar. Stress also invigorates the generation of biochemical hormones and peptides, for example, leptin, ghrelin, and neuropeptide Y. This article also extracts the contribution of weight stigma and social stress in producing obesity in an obesogenic process. Recent Studies describe that psychological distress and elevated cortisol secretion promote abdominal fat, a feature of the metabolic syndrome, improvements in mindfulness, chronic stress, and cortisol awakening response (CAR) were associated with reductions in abdominal fat. Mindfulness intervention for stress suggests that mindfulness training improves eating patterns and the CAR, which may reduce abdominal fat over time. Obesity has a multifaceted etiology. In this review, several factors of stress are identified that affect the development of obesity. This review also provides valuable insight into the relationship between obesity and stress.

Background: Patients with multiple sclerosis (MS) suffer from a wide range of psychological and physical problems. Employment status is a crucial issue for patients with MS as unemployment while it is not completely evaluated in patients with MS. Objectives: To assess psychometrical properties of the Persian version of the Multiple Sclerosis Work Difficulties Questionnaire (MSWDQ). Methods: One hundred and sixty patients were enrolled. They were asked to fill valid and reliable Persian version of the Fatigue Severity Scale (FSS), social support scale, and Short Form Health Survey (SF-36) and translated version of the MSWDQ questionnaire. Twenty cases filed the questionnaire two weeks later to assess reliability. The intra-class correlation coefficient (ICC), Cronbach's alpha, correlation coefficients were used. Results: Mean age and mean duration of the disease were 36.8 ± 9.1, and 7.5 ± 5.1, respectively. The Cronbach alpha for psychological/cognitive barriers subscale was 0.87, for Physical barriers was 0.83 and for external barriers was 0.86. The Cronbach α for the whole questionnaire was 0.89. There was a significant positive correlation between FSS and MSWDQ score, and a significant correlation with SF-36 and social support. The ICCs of all questions were acceptable. Conclusions: Persian version of MSWDQ questionnaire is a valid and reliable instrument for evaluating work-related problems in patients with MS.

Purpose: Non-alcoholic fatty liver disease (NAFLD) is the most common liver disorder. The purpose of this study was to determine the relationship between the dietary inflammatory index (DII) and the serum oxidative stress markers in patients with NAFLD. Methods: In this case-control study, 121 patients with NAFLD and 119 healthy subjects were frequency-matched on gender. DII scores were calculated by using a 168-item food frequency questionnaire (FFQ). Blood samples were collected to measure serum oxidative markers. Linear regression and odds ratio (OR) were also used in this study. Results: The mean ± standard deviation of age for case and control group was 38.04 ± 6.7 and 35.6 ± 10.2, respectively. The gender ratio (female to male) for the case and control group was 1:1.42 and 1:1.38, respectively. The mean of the DII in the patient group was significantly higher than the healthy group, (P-values < 0.01). There was a significant negative relationship between TAC and DII (B = -2.63 (95%CI: -4.59, -0.68) and there was also a positive relationship between Malondialdehyde (MDA) and DII (B = 0.15 (95%CI: 0.02, 0.28) in the healthy group, but they were not significant in the case group. After multivariate adjustment, subjects in the most pro-inflammatory DII group had 73 times higher odds of NAFLD compared to subjects in tertile 1 (OR = 72.9; 95%CI (14.3-371.9)). Conclusions: Our findings suggest a direct association between the pro inflammatory properties of diet in patient and healthy group, but no relationship between TAC, MDA, and DII in the case group.

Background: Considering the importance of non-communicable diseases (NCDs) in Iran, the aim of this study is to identify the trend in the salt (NaCl) levels of various types of traditional bread (sangak, barbari, taftoon, and lavash breads) in Tehran in 2016 and 2018 and its implication for public health. Methods: A total of 777 samples of various traditional breads were randomly collected from various districts located in Tehran in 2018. The salt content (expressed as g/100 g dry weight) in these breads were determined according to Volhard method. Results from this study were compared with those reported in 2016. Results: The present study indicated that the mean salt content in traditional breads in 2018 was significantly higher than that reported in 2016. Salt content in traditional breads collected in 2018 ranged from 0.03 to 6.52/100 g dry weight, with mean value of 1.43 g/100 g dry weight. When comparing with the permitted limit set by Institute of Standards and Industrial Research of Iran (ISIRI), there was an increase in the percentage of samples complying with the permitted limit; 50.8% (2016) vs 54.1% (2018). Conclusions: The daily salt intake increased from 1.56 g per person in 2016 to 2.31 g per person in 2018. Considering the high bread per capita consumption in Iran, it seems that half of the daily recommended salt intake could be reached exclusively through breads. Hence, the main strategies for salt intake reduction from bread could be achieved through evaluation of salt reduction programs and development of technological factors in bread baking.

Background: To estimate the pooled odds of oral contraceptive pills consumption (OCPs) use as well as pregnancy history and multiple sclerosis (MS) risk. Methods: We systematically searched PubMed, Embase, Scopus, Web of Science, Google scholar, and gray literature including references of the references as well as conference papers. The search strategy in PubMed was ((Oral contraceptive pills) OR OCP) AND (Multiple Sclerosis OR Sclerosis, Multiple) OR Sclerosis, Disseminated) OR Disseminated Sclerosis) OR MS (Multiple Sclerosis)) OR Multiple Sclerosis, Acute Fulminating) AND (gravidity) OR (pregnancy). Results: Four studies were included. The pooled odds of developing MS in women with pregnancy history compared with nulligravid women was 0.64 (95%CI = 0.53 − 0.78) (I² = 0, P = 0.5), which means that pregnancy reduces the risk of MS by 36%. The pooled odds of OCP consumption and risk of MS were 1.09 (95% CI = 0.67 − 1.76). By comparing the pooled odds of OCP consumption and risk of MS according to the country of the origin, we found that the pooled odds in Iranian studies was 1.03 (95% CI = 0.31 − 3.45) and the pooled OR in studies that were conducted in the United States was 1.13 (95% CI = 0.65 − 1.98), which showed that the country of the origin was not the cause of heterogeneity. Conclusions: The results of this systematic review show that pregnancy history is a protective factor for MS development, whereas OCP use has no significant effect.

Background: Psychological conditions aggravate during outbreaks. Here, we have discussed the existing COVID-19 depression, anxiety, and stress and the resulting stigma and its different aspects in Iranian health care workers and their 1^st-degree relatives. Methods: In this cross-sectional study, information of our study groups (237 participants including health care workers and their nuclear family members) was collected via two online stigma and depression, anxiety, and stress scale (DASS) questionnaires. Results: The DASS questionnaire's mean depression, anxiety, and stress scores were 13.59 ± 5.76, 11.07 ± 4.38, and 15.05 ± 5.86, respectively, in our study population. Marriage status was effective on depression and stress scores. Married participants were having less depression (P = 0.008) but more stressful (P = 0.029) than single ones. Education was found to be effective on anxiety and stress scores. Those with an associate, master, Ph.D., and higher college degrees were significantly less anxious and stressed than those with a diploma or bachelor's degrees (P = 0.032 and 0.016, respectively, for anxiety and stress). Participants with a history of psychiatric conditions showed significantly higher depression, anxiety, and stress rates than those without a past psychiatric condition (P = 0.001). Healthcare workers and their nuclear family members suffer from severe stigma (mean stigma scores were 33.57 and 33.17, respectively). Conclusions: Healthcare workers and their nuclear family members in Iran suffer from severe COVID-19 related stigma. We also showed that depression, anxiety, and stress are common among Iranian Healthcare workers and their nuclear family members during this pandemic. This study showed that people with preexisting psychiatric conditions need extra mental care during the pandemic.

Background: Nonalcoholic fatty liver is the most common chronic liver disease. Regarding the side effects of synthetic medicines and the variety of natural products in Iran climate, the present study aimed to investigate the effect of medicinal plants and natural products on liver enzymes in patients with non-alcoholic fatty liver disease in Iran using meta-analysis. Methods: To extract the intended studies, internal and external databases, including SID, Magiran, IranDoc, PubMed, Scopus, Web of Science, Embase, Cochrane, and Clinical Trial Registration System of Clinical trial.gov, the ISRCTN system, as well as Clinical Trial Registration System affiliated to the World Health Organization were searched. The obtained data were analyzed in STATA.14 software. A P value less than 0.05 was considered statistically significant. Results: A total of 44 rstudies were reviewed with a sample size of 1298 participant; they were published in the period from 2009 to 2018, silymarin had the highest effect on the reduction of AST (SMD = -2.68), cinnamon excreted the most profound effect on ALT (SMD = -2.69). In addition, cinnamon had the highest effect on gamma-glutamyl transferase (GGT) (SMD:-3.17), and curcumin had the highest effect on alkaline phosphatase (ALP) (SMD = -1.88). In the lipid profile, the effect of medicinal herbs and natural products on lowering total cholesterol and LDL was statistically significant. In the glycemic profile, the effect of medicinal plants and natural products on the reduction of fasting blood sugar, insulin, and hemoglobin A1c levels was statistically significant. Conclusions: As evidenced by the obtained results, the highest effect of using natural products was observed in the reduction of GGT, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) levels, respectively; nonetheless, the effect of natural products on ALP reduction was not statistically significant.

In December 2019, an unusual form of pneumonia of unknown origin was identified in Wuhan and soon expanded into an intercontinental pandemic that affected nations all over the world. The unusual pneumonia was subsequently named COVID-19. The management of COVID-19 disease has been highly dependent on the early identification of patients who are positive for SARS-CoV-2 infection. For detecting the SARS-CoV-2 virus in upper or lower respiratory tracts, the Centers for Disease Control and Prevention (CDC) recommend strategic sampling approaches. Most countries collect nasopharyngeal swabs and oropharyngeal swabs for rapid viral testing by experienced healthcare workers. Due to the increase in single-day cases, the high cost of RT-PCR, and the requirement for greater coverage in order to detect COVID-19 infections, the screening method has been changed to the Rapid Antigen Test during this phase of the pandemic in India. Considering the limited sensitivity of the fast antigen test compared to the sputum test, and the benefit of having additional resources available from an already established TB network, policymakers should consider implementing COVID-19 with sputum testing. For India, which has 1.3 billion people and limited resources, contemplating a community level sample collection of COVID-19 samples will be an effective decision if scientific data is used for this purpose will be an effective choice for the country with more than 1.3 billion population and limited resources.

Background: Diabetes as a chronic disease requires a change in the paradigm of treatment and health care system based on acute illnesses to chronic conditions. Chronic Care Model has been designed to address this need. This study aimed to explore the lived experiences of the diabetes team and diabetic patients regarding the health care system after redesigning delivery system and supporting self-management based on the Chronic Care Model in Iran. Methods: Research was conducted with a qualitative descriptive approach in one of the Isfahan city clinics in 2018. The participants were diabetes team (composed of diabetes physician, nurse, assistant nurse and dean of the clinic) and 17 type- 2 diabetic patients who were selected through purposive sampling. Data collection was performed through semi-structured interviews and then were analyzed using content analysis with an inductive approach. Results: The findings of this study were composed of the following two main categories: (1) educational function change, including the sub-categories of evidence-based nurse education and patients' demand to ongoing participation in the training classes; and (2) treatment and care method upgrade, including the sub-categories of nurse's role change in a team approach, continuity in cares and upgrading patients' self-care behaviors. Conclusions: Delivery system redesign and diabetes self-management support based on Chronic Care Model changed organizational structure and performance of the diabetes care system. It also reformed the structure of treatment providers from a vertical and hierarchical form to a team arrangement. Nurse's educational function became evidence-based and patients' self-care behaviors upgraded.

Background: This study was designed and performed to investigate the relationship between fetal chromosome aberrations and screening markers in the first trimester of pregnancy in order to prevent the birth of infants with chromosome aberrations with early prenatal diagnosis. Methods: We conducted an analytic cross-sectional study on result of chromosomal culture of 762 pregnant women with high-risk combined screening test from December 2018 to June 2020 and analyzed by SPSS program. Results: There was a significant relationship between chromosome structural abnormalities with free beta-human chorionic gonadotropin (free β-hCG) values equal to and higher than 1.5 multiples of the median (MoM) (P: 0.05). The highest incidence of disorder in number of chromosomes with abnormal nuchal translucency (NT) percentiles (≥99%) was seen (P < 0.001). It also shows that the cumulative number of chromosome aberrations of 25 (78.12%) occurred in individuals with a NT less than 99^th percentile and at the same time a risk of 1/50≤ risk <1/10. Discussion: According to the results, Comparative Genomic Hybridization (CGH) array method is recommended to detect structural abnormalities in chromosomes in samples with NT ≥3.5. In addition, it is noteworthy that chromosomal structural abnormalities occur in free β-hCG ≥1.5 MoM. Conclusion: Due to the frequency of chromosomal structural disorders and its effect on the incidence of fetal abnormalities, the study of chromosomal structural disorders is recommended.

Background: Most of the aged women experience the deterioration of bone due to the gradual decrease in bone mineral density (BMD). According to different studies, a continuous progressive decline in bone density results in risks of fractures. Aims: The study aimed to identify the fracture risk factors among post-menopausal women with the deterioration of bone density. Settings and Design: Cross-sectional study design was used, and was conducted clinic at Hospital Tengku Ampuan Afzan (HTAA) Kuantan, Pahang, Malaysia. Methods: In total, 116 post-menopausal women were selected as a sample from a public hospital in Malaysia. An assessment checklist on fracture risks; including age, menopause year, BMD, serum calcium level, balance and gait score, body mass index (BMI) was used to collect data. Descriptive statistics and Pearson correlation were used to analyze data. Results: Findings showed that 87.1% participants confidently performed daily activities. Normal TUG score was revealed for 76.7%, and Fall Free Prevention Questionnaire (FFPQ) findings show that no risk of falling prevailed. Pearson correlation showed negative weak correlation between BMD with the age of respondents, year of menopause and TUG (r = –.373), (r = –. 284) and (r = –.237). Moderate correlation was found between BMD in BMI status (r = .343) and weak correlation was found between BMD and ABC scale (r = .200). Conclusions: The study emphasized on instigation of the intervention to improve population literacy related to menopause and bone density deficiency.

Context: Fractional exhaled nitric oxide can be used as a biomarker of some respiratory diseases. Aims: This study was conducted to compare exhaled nitric oxide in cigarette and water-pipe smokers with nonsmokers. Methods: This cross-sectional study was conducted on 549 adult subjects as a sub-study of Shahedieh cohort in Yazd. Participants were divided into 5 groups according to their smoking habits: non-smokers (n = 202), cigarette smokers (n = 121), water-pipe smokers (n = 129), cigarette ex-smokers (n = 58), water-pipe and cigarette smokers (n = 39). The smokers were also categorized into heavy and light smokers. Fractional exhaled nitric oxide was compared between the groups. Statistical Analysis Used: The data were analyzed by SPSS (ver. 20) using Kolmogorov-Smirnov, Kruskal-Wallis, and Mann-Whitney U tests. Results: Fractional exhaled NO was lower in all smokers than nonsmokers, but cigarette smokers showed the least level of NO than other groups. Fractional exhaled NO was not significantly lower in water-pipe smokers than nonsmokers. Conclusions: Cigarette smoking significantly affect fractional exhaled NO, but water-pipe smoking did not significantly affect exhaled NO level.

Background: Today, cardiovascular disease (CVD) is the leading cause of mortality in both sexes. There are several risk factors for heart diseases; some controllable, others not. However, socioeconomic, technological, and environmental factors can impact CVD as well as exclusive risk factors. Accurate identification and assessment of these factors are often difficult. In the present systematic review, we aimed to explore factors affecting CVD. Methods: Multiple databases (MEDLINE, Scopus, ISI Web of Science, and Cochrane) and gray literature were searched. The included studies described at least one determinant of CVD. The framework method was applied to analyze the qualitative data. Results: A total of 64 studies from 26 countries were included. The contextual determinants of CVD were categorized into 45 determinants, 15 factors, and 4 main social, economic, technological, and environmental categories. The 15 potentially reversible factors were identified as sociodemographic, violence, smoking, occupation, positive childhood experience, social inequalities, psychological distress, eating habits, neighborhood, family income, rapid technology, environmental pollution, living environments, noise, and disaster. Conclusions: Devolution and more efficient health policies are required to achieve further sustained reduction in CVD mortality, increase life expectancy, and reduce its associated risk factors. Policymakers should fully address the value of social, economic, technological, and environmental factors. In fact, a prevention agenda should be developed and updated collaboratively in terms of the determinant factors.

Background: The bacteriological quality of drinking water has become a public health concern according to its association with water-borne diseases. Nowadays, there are several different types of drinking water, including water cooler dispensers (WCDs), which are becoming a popular device in educational institutions. Therefore, this study aims to determine the bacteriological quality of drinking water from WCDs, and inspect their hygienic conditions in students' dormitories at a university in Nakhon Si Thammarat, Thailand. Methods: Water samples from 53 WCDs installed in 13 dormitories were collected and analyzed coliform bacteria by using the multiple-tube fermentation technique. The hygienic inspection form from the Department of Health, Ministry of Public Health, was used for inspection of the sanitary conditions. The hygienic factors of water cooler sanitation were analyzed using the generalized linear model. Results: Coliform bacteria were found in 10 out of 53 samples; moreover, Escherichia coli was recovered in three samples. Maintenance/cleaning and monitoring were the most two sanitary issues found in 100% (53/53) of the WCDs. Location and features of machine were found the correlation with the prevalence of coliform bacteria in drinking water. Conclusions: The findings of this study suggest regular monitoring of water quality in educational institutions. Also, the Sanitary Standard and Operational Procedures (S.S.O.P.) should be developed to improve the hygienic conditions of the water cooler dispensers.

Background: There was the association between the metabolic syndrome (MS) and obstructive sleep apnea (OSA). Also, the genetic factors have been implicated in the OSA. Our aim was to compare the frequency of MS in first-degree relatives (FDRs) of OSA patients with healthy controls. Methods: 39 FDR (parents, siblings, and children) of patients diagnosed with OSA at Bamdad Respiratory and Research Center as cases and age- and sex-matched healthy controls were included in the current case–control pilot study. The sampling method was convenience sampling based on having inclusion criteria and consent to participate in the study. Demographic characteristics and essential criteria for diagnosing MS included blood pressure, anthropometric [weight (kg), height (cm), waist circumference (cm) and body mass index (BMI) (kg/m²)], and biochemical indices (lipid profile and blood glucose) were assessed based on standard protocols. Results: In the comparison of the demographic and clinical characteristics of two39 cases and control groups, weight and diastolic blood pressure were significantly higher in case group than controls (P < 0.05). Case and control groups were not significantly different in the frequency of MS (P > 0.05). Although, the frequency of hypertension as an important cardiovascular risk factor was higher in cases than controls (P < 0.05). Conclusions: The present study demonstrates that the frequency of MS is not significantly different between FDRs of OSA patients and controls. However, further large-scale studies are warranted to detect the frequency of MS in people with hereditary background for OSA compared to general population.

We describe a visual algorithm to help prevent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) contagion as well as manage COVID-19 disease according to categories of clinical severity. The algorithm is timely, with multiple countries worldwide declaring repeat surges in SARS-CoV-2 infections following the easing of lockdown measures. Its flowchart assimilates key effective interventions in a visual manner that will assist healthcare workers to manage COVID-19 disease algorithmically, and policymakers to suppress further SARS-CoV-2 waves. Importantly, we include the innovative use of topical p-menthane-3,8-diol spray by the British Army for COVID-19 Support Force personnel, which in light of its coronavirucidal properties, deserves wider dissemination. This algorithm has the potential to be updated as numerous studies are concluded globally.

One of the most important occupational and environmental pollutants are biological agents such as various types of viruses. Recently the 2019-nCoV causes lower respiratory tract disease, called novel coronavirus pneumonia that in addition to causes physical disorders, can lead to mental health problems. This study looks at some of the articles that deal with psychological problems caused by the coronavirus pandemic in different groups of people. For this purpose, a review of the published literature was performed in some databases (PubMed, Google Scholar, Elsevier) and related references were used.

Background: The existing system of outpatient drug provision of citizens allows providing certain categories of citizens and patients with certain types of diseases on a free basis. The purpose of the study is to analysis and evaluate the system of providing preferential categories of citizens with antihypertensive drugs at the level of primary health care. Materials and Methods: To determine the level of satisfaction of citizens with drug provision at the outpatient level, 3118 respondents were interviewed using a questionnaire for persons who received free medicines for the treatment of hypertension. The questionnaire consisted of 20 questions. They were distributed by sex and age criterion. The ratio of male and female respondents was 51.7% and 48.7%, respectively. Results: Thus, the results of a sociological study to study the opinions of the population about the existing system of free outpatient care revealed some organizational and managerial problems. Although that patients with hypertension since 2012 receive drugs for free, 37% noted that they bought at full cost in pharmacies, which should be released free of charge for privileged categories of citizens. Also, 77% of respondents claimed that they were not invited to outpatient organizations to receive drugs. Conclusions: In solving the problems of improving the organization and management, it is necessary to take into account regional peculiarities, which allow, based on the use of a set of methods of analysis and forecasting, to assess the state and trends of development, to identify its strengths and weaknesses, to assess the factors of the external and internal environment.

Background: Obesity and diabetes are common public health issues in Saudi Arabia. The aim of this study is to evaluate the association of maternal obesity and diabetes with exclusive breastfeeding among Saudi Mothers at the Royal Commission Service Primary Health Care Centers in Jubail City, Saudi Arabia. Methods: It is a cross-sectional study and 360 mothers were selected from primary health center through a simple random sampling. A validated and structured questionnaire was used. Body mass index was used for calculation of obesity and fasting blood sugar to find out the diabetic status. Chi-square test was used to assessing the difference between obese and nonobese and diabetic and nondiabetic group with respect to exclusive breastfeeding. Logistic regression was used to determine the association of obesity and diabetes with exclusive breastfeeding. Results: Obesity and diabetic prevalence among study participants were 81.9% and 65.5%, respectively. Exclusive breastfeeding prevalence among total study participants was 36.9%. Among obese, it was 28.8% and diabetes, it was 29.1% and this difference is statistically significant when compared to nonobese and nondiabetic group (P-value 0.04). The obese [OR1.30 (1.12–4.85) with P value 0.02] and diabetic [OR 1.56 (1.35–3.9) with P value 0.00] mothers were more than one time more likely associated with nonexclusive breastfeeding. Conclusions: The study concludes that the rate of exclusive breastfeeding decreased among obese and diabetic mothers and the positive association of obese and diabetes with nonexclusive breastfeeding. Intervention is required to reduce the prevalence of obesity and diabetic among breastfeeding mothers.

Background: Indoor air pollution is an important environmental health problem. Nanotechnology is one of the most important methods to reduce the indoor air pollution. Titanium dioxide (TiO₂) is generally accepted as one of the most effective photoinduced catalysts. It is frequently used to oxidize organic and inorganic compounds in the air due to its strong oxidative ability and long-term photostability. The aim of this study was to determine the effectiveness of nanotechnology in the purification of ambient air by using Saudi myrtle plants treated with TiO₂. Methods: Experiments were conducted in two academic departments of the laboratories at the Public Sector University. Concentration of formaldehyde, nitrogen dioxide (NO₂), sulphur dioxide (SO₂) and other toxic gases was measured in the environment of the laboratories. Myrtus plant was growing in the growth media which contained TiO₂. After 8 hours of exposure of the plant, concentration of NO₂, SO₂ and other toxic pollutant gases in the air was measured. The total duration of the experiment was 4 days. Results: It was found that the levels of formaldehyde, volatile organic compounds (VOCs) and other pollutants were significantly reduced the concentration from 10% to 98% in the air. After intervention, air containing the concentration of formaldehyde, TVOCs, NO₂ SO₂ and carbon monoxide (CO) on the fourth day reduced from 0.251, 401, 0.032, 0.009 and 0.99 to 0.014, 54,0.0003, 0.003 and 0.01 after exposure of Myrtus plant to ambient air. Conclusions: Significant reduction of air pollutants in the air after application of TiO₂ in the green plant (Myrtus communis). It is a novel approach and economically feasible for purification of indoor air.

Background: Nutrition-related factors have been of great interest as one of risk factors of biliary stones. This study evaluated the association of dietary patterns with biliary stone among Iranians. Methods: This is a hospital-based case-control study, which was conducted in a general hospital in Tehran, Iran. A total of 110 patients with gallstone or common bile duct (CBD) stone confirmed by Ultrasonography within the last 6 months before collecting data were recruited. Controls were age-matched patients admitted to the other wards of the same hospital for a broad spectrum of disorders including traumas and orthopedic conditions, or elective surgeries, or throat/ear/nose disease and had no gallbladder disorders, participated in this study. We used a valid and reliable food frequency questionnaire to assess dietary intakes of participants. Dietary patterns were determined by factor analysis. Results: By design, age was similar in both groups (57.66 ± 16.39 years vs. 56.00 ± 10.64 years in cases and controls, respectively). Two dietary patterns were extracted; “Unhealthy” (high consumption of artificial juice, processed meats, refined grains, sweets and desserts, pickles, snacks, and red meats), and “Healthy” (high consumption of vegetable oils, vegetables, fruits, fish, legumes, and nuts, as well as low consumption of hydrogenated fats and salt). Participants in the highest tertile of “Healthy” dietary pattern were significantly less likely to have the gallstones disease (OR: 0.33, 95% CI = 0.120.89) compared to the reference group (low tertile of “Healthy” dietary pattern) (P = 0.02). Conclusions: High consumption of vegetable oils, vegetables, fruits, fish, legumes, and nuts, as well as low consumption of hydrogenated fats and salt in context of healthy dietary pattern are inversely associated with risk of gallstones.

Background: End-stage renal disease is one of the most important chronic diseases. Selenium is one of the so-called rare elements which are essential for our body functions. Here, we aimed to investigate and the effects of selenium supplement therapy on weight gain, physical activity, and triglyceride (TG) and total cholesterol in patients under hemodialysis. Methods: The current study is a double-blinded clinical trial performed on patients with ESRD under hemodialysis in 2019. In the beginning, serum selenium levels were assessed. All patients were randomly divided into two groups. The first group was under treatments with tablets of selenium 400 μg. Patients received selenium tablets three times after each hemodialysis session (3 times a week) and the other group received placebo tablets. 3 months after the beginning of the study, blood selenium levels, TG and total cholesterol, and weight and physical activities of patients were evaluated again and compared with the beginning. Results: A total of 78 patients were included. Serum selenium levels at the beginning of our study were 40.06 ± 8.50 in the intervention group and 45.00 ± 8.16 in control groups. Selenium levels and physical activities of patients were increased significantly in intervention group compared to baseline (P < 0.001 for both). Weight, physical activity, total cholesterol, and TG in both intervention and control groups did not change significantly after interventions (P > 0.05). Conclusions: We showed that selenium supplement therapies have beneficial effects in patients under hemodialysis. Furthermore, we showed that selenium supplement therapies have positive effects on serum selenium levels but no effects on total cholesterol and TG.

Background: Turner syndrome is a common genetic disorder in females. It is a disorder characterized by variable number of clinical features, so it needs a multidisciplinary approach for care. Therefore, we aimed to define the cutoff of gonadotropins for close evaluation of cardiometabolic risk factors in Turner syndrome. Methods: This is a case-control study on 31 patients with Turner syndrome and 31 healthy individuals. Clinical examination including blood pressure measurement and systems evaluation was performed. Laboratory testing, which included 12-h fasting, assessed lipid profile, glucose, and serum gonadotropin. Results: Turner syndrome had a higher BMI, systolic, and diastolic blood pressure than the normal group (P < 0.001) Patients with Turner syndrome had significantly higher total cholesterol, low-density lipoprotein, triglyceride, and TG-to-high-density lipoprotein ratio compared to the healthy individuals (P < 0.05). With increasing LH and FSH, BMI values, systolic blood pressure, and total cholesterol increased significantly (P < 0.001). Serum TG levels in Turner syndrome were only positively correlated with LH and not correlated with FSH. The cutoff point of LH and FSH for triglyceride in upper 75 percentile were 31 (sensitivity = 38.1%, specificity = 80%) and 48 (sensitivity = 61.9%, specificity = 70%), respectively. Conclusions: Based on dyslipidemia and lower level of ejection fraction, considering cardiometabolic risk factors in lower age groups in Turner syndrome can be recommended.

Background: Inflammatory markers of blood are critical predictors of chronic diseases as well as exacerbating risk factors. Exercise is a well-known strategy to reduce the risk of inflammation and chronic disease. The present study aimed to investigate the anti-inflammatory effects of a period of aerobic training and vitamin D supplementation (AT + Vit D) in postmenopausal women with metabolic syndrome. Methods: This quasi-experimental research was performed on forty-six patients with metabolic syndrome who were selected according to the available sampling method, and were randomly divided into four groups: AT + Vit D (50,000 IU), AT, Vit D (50,000 IU), and control (C). The training protocol consisted of 40–60 min of AT 60–75% of maximal heart rate, three times a week, for 8 weeks. One-way Analysis of variance (ANOVA) and t-test were used to compare the between and within groups; the Bonferroni post hoc test was used if significant differences were found. Results: The combination of exercise and vitamin D significantly reduced C-reactive protein (CRP) (P = 0.001), interleukin-6 (IL-6) (P = 0.001), and improved the metabolic syndrome indices (P = 0.001 in all indices). The results also show that the improvement in the metabolic syndrome indices, CRP, and IL-6 was more significant in AT + Vit D, compared to AT or Vit D alone. Conclusions: The findings from the present study suggested that a sedentary lifestyle and vitamin D deficiency accelerated the occurrence of metabolic syndrome probably by increasing the anti-inflammatory. Additionally, adequate levels of plasma vitamin D are necessary to achieve the beneficial metabolic effects of AT.

Background: Cigarettes Smoking is a major social and global health problem. Cigarette smoking continues to be a major contributor to deteriorated health status across different age categories. Clarifying the impact of the cigarette smoking on young adults' lungs health and functional aspects can serve eliminating further deterioration in health status and establishing proper management regimens. This study aimed to investigate the impact of cigarette smoking on lung health (age and functions) and functional performance in the university smoker students. Methods: One hundred and Thirty eligible volunteer, current smoker students participated in this study to objectively evaluate their pulmonary functions (including forced vital capacity “FVC”, forced expiratory volume in one second “FEV1”, FEV1/FVC, peak expiratory flow rate “PEFr”), lung age and functional performance (via the 6-minutes' walk test “6MWT”) and compare “the observed” with “the predicted normal” mean values. Data were analyzed via SPSS program using the student t-test. Results: There were significant differences (P < 0.05) between the “observed” and the “predicted normal” FVC, FEV₁, FEV1/FVC, PEFr, lung age, and the 6MWT mean values. The “observed” and the “predicted normal” FVC, FEV₁, FEV1/FVC, PEFr, lung age and the 6MWT mean values were [(4.47 ± 0.53, 4.77 ± 0.5 liter), (3.95 ± 0.42, 4.08 ± 0.4 liter), (88.74 ± 7.17, 85.59 ± 4.91%), (550.75 ± 114.96, 572.72 ± 53.02 liter/minute), (32.77 ± 9.44, 21.55 ± 1.37 year), (387.06 ± 56.47, 466.82 ± 18.45 meter)], respectively. Conclusions: Cigarette smoking negatively impacts the lung age, functions, and functional performance of the university smoker students; the concept that can be used to encourage prevention and early smoking cessation.

Background: Seizure and syncope have similar clinical symptoms but different etiologies. Hence, differential diagnosis is crucial prior to intervention. This study evaluates the diagnostic importance of neuron specific enolase (NSE), creatine phosphokinase (CPK), and serum lactate dehydrogenase (LDH) for admitting patients with seizure medical history to emergency department (ED) in order for differential diagnosis between syncope and seizure. Methods: Patients with a short-lasting loss of consciousness admitted to the ED were recruited. All patients with a short-lasting loss of consciousness were eligible and EEG was conducted several times and was taken over a long period. Patients were then divided into two groups of seizure and syncope. The biochemical markers levels of all the eligible patients were measured by a reputable laboratory. Results: In order to define specificity and sensitivity of different levels of biomarkers and the optimal cut-off points, ROC curves for each biomarker of syncope and seizure patients admitted to ED were performed. AUC for NSE, CPK, and LDH were 0.973 ± 0.023, 0.827 ± 0.047, and 0.836 ± 0.043 respectively in 95% confidence level. Cut-off points for NSE, CPK, and LDH were determined 25.12, 218.09, and 193.88 respectively. Conclusions: It was concluded that NSE, CPK and LDH levels were different significantly in seizure patients compared to syncope ones. The seizure group showed an increase in NSE, CPK and LDH level. Determining biomarkers level for differential diagnosis of seizure and syncope can be applied as a supplementary test in addition to tests like EEG.

Background: Little observational studies have been conducted on the association between diet and sleep. We conducted a cross-sectional study to evaluate the associations of dietary patterns with sleep duration in an Iranian population. Methods: This study was conducted on the baseline data of two population-based Iranian cohorts: the YaHS-TAMYS and Shahedieh studies. Dietary intakes were assessed in 10451 Yazdi people aged 20–75 years. Dietary habits were derived from answers to a food frequency questionnaire, and a factor analysis using principal component analysis (PCA) was used to identify dietary patterns. The reported sleep duration was categorized as short (<6 h), normal (6–8 h) or long (>8 h). Multivariable logistic regression was used to determine the relationship between dietary patterns and the odds of short and long sleep duration. Results: Four major dietary patterns were identified: “healthy,” “western,” “traditional,” and “high-carbohydrate, high-fat.” In the Shahedieh study, participants in the top quartile of the western dietary pattern had greater odds of short (<6 h) and long (>8 h) sleep duration (OR = 1.49; 95% CI: 1.17, 1.90; P trend <0.001 and OR = 1.46; 95% CI: 1.12, 1.90; P trend = 0.014, respectively) than those in the bottom quartile. Also, participants in the highest quartile of the high-carbohydrate, high-fat pattern had higher odds of long sleep duration compared with those in the lowest quartile (OR = 1.36; 95% CI: 1.05, 1.75; P trend = 0.005). Pooling the two studies revealed that the western dietary pattern was significantly associated with short sleep duration (OR = 1.31; 95% CI: 1.08, 1.59). Conclusions: The western dietary pattern might inversely be associated with sleep duration. Future prospective studies are recommended to confirm these results.

Despite the reduction of mortality secondary to cardiovascular diseases observed in the last decades, ischemic heart disease remains the most common cause of death worldwide. Among the spectrum of ischemic heart disease, myocardial infarction accounts for most deaths. Since the introduction of the coronary care units in the 1960s, and until the latest antithrombotic drugs, myocardial infarction survival improved by 40–50%. However long-term mortality after myocardial infarction has not improved as short-term mortality. Moreover, the decline of mortality has apparently reached a “plateau” in the past 15 years. In this review we describe the steps of the improvement in ischemic heart disease mortality, from the bed rest to the possible future of treating microcirculation. In fact, coronary artery disease is not only a disease of large vessels that can be visualized with coronary angiography. The small network of pre-arterioles and arterioles that supply the myocardium can be also affected in ischemic heart disease. Thus, despite the introduction of effective recanalization strategies for epicardial coronary arteries such as thrombolysis and, more recently, primary percutaneous intervention, some patients may not achieve effective myocardial reperfusion due to microvascular dysfunction or damage after myocardial myocardial infarction. This phenomenon is named no reflow. We believe that no reflow, through the incomplete reperfusion that can account for a higher rate of adverse event in the follow up, should be regarded as one of the open issues in the modern treatment of myocardial infarction.

Background: Recently, the importance of chemokines and their receptors in carcinogenesis and the protective role of aerobic exercise in primary cancer development and progression is highlighted. Based on the facts that endurance exercise may result in hypoxia condition, and in addition, the effect of exercise therapy on the levels of CCL2, CCR2, and their related receptors in breast cancer (BC) model has not been investigated so far, therefore we aimed to evaluate the effect of eight-week noncontinuous aerobic training on the levels of CCL2, CCL5, and their related receptors; CCR2 and CCR5 in female BALB/C mice with BC. Methods: Thirty-two BALB/C mice (4–5 weeks old) were randomly divided to four 8-member groups of control and experimental. The experimental group received 8 weeks of noncontinuous aerobic exercises (AEs) while the control group did not receive any exercises during these 8 weeks. After last of experiment, 5 ml of blood was taken from each rat's lower inferior vein. The plasma levels of CCL2 and CCL5 were measured by ELISA and CCR2 and CCR5 by western blot. Tumor volume also measured in each step. Data were analyzed using the ANOVA test and the SPSS v. 0.24 Software. Results: After 8 weeks of participation in noncontinuous AEs, a statistically significant decrease was made between the control and experimental groups in terms of CCL2, CCL5, and CCR2 levels, as well as tumor volume. However, there was no significant difference between groups in terms of CCR5 level. Conclusions: It can be concluded that the 8 weeks of noncontinuous AEs did not result in CCR5 reduction while resulting in a statistically significant decrease in CCL2, CCL5, CCR2, and tumor volume.

Background: Mobile health intervention shows the positive effects on the management of chronic diseases. Therefore, the study was planned to study the effectiveness of a mobile-based application promotion of physical activity among newly diagnosed patients with type II diabetes. Methods: The present study was a parallel-design randomized controlled trial conducted over 2 years. The participants were type II diabetes patients between 18 and 60 years within 3 months of diagnosis who attended the endocrinology outpatient department having knowledge of using smart phone. The sample size was calculated to be 66 and 33 for each arm. The block random design method was adopted for allocation into different arms. A pretested interview schedule was used for the collection of data. Outcomes included body mass index, waist circumference, body fat percentage, and changes in the physical activity was obtained by global physical activity questionnaire (GPAQ). The information thus collected were processed and analyzed using SPSS v 20. Results: The study included 66 patients aged between 18 and 60 years, out of which 33 were enrolled into control and 33 into intervention group. The mean age of the participants was 42.29 ± 9.5 years ranged from 25 years to 59 years, 65.2% were males and 34.8% were females. It was observed that a higher proportion of intervention participants met WHO recommendations of physical activity level. Total metabolic equivalent of task (MET) value per minute (Mean ± SD) was 1347.27 ± 1028.5 in the control group and 1223.03 ± 584.87 in intervention group at baseline and was not different (P = 0.538). The total MET value per minute was found to be higher among the intervention group in all follow-ups. There was a significant decrease in weight, BMI, waist circumference, hip circumference, body fat percentage, and systolic blood pressure (SBP) in the intervention group. Conclusions: Cost-effective, simple mobile applications may help in routine clinical practice to encourage the patients for the promotion of physical activity.

Background: Adverse effects related to treatment negatively affect the quality of life of patients with thyroid cancer. The current study aimed to evaluate the psychometric properties of the Persian version of the thyroid-cancer-specific health-related quality of life (TC-specific HRQoL) questionnaire among patients with thyroid cancer in Kerman province, Iran. Methods: This research was a cross-sectional study conducted on 240 patients with thyroid cancer in Kerman province from 2000 to 2015. The patients were selected through the census method and were asked to complete the thyroid-cancer-specific quality of life questionnaire. Data were analyzed by SPSS version 19.0 and LISREL version 8.80. The reliability of the Persian version was determined by Cronbach's α coefficient and the intraclass correlation coefficient (ICC). Exploratory and confirmatory factor analysis (CFA) was also conducted. Results: The Cronbach's α and ICCs were determined as 0.92 and 0.88, respectively. Five factors were extracted in the exploratory factor analysis with a total of 55.76% explained variance. Acceptable goodness of fit indices were found in CFA. Conclusions: The Persian version of the TC-specific HRQoL has sufficient psychometric properties and can be used to assess HRQoL among patients with thyroid cancer.

Measles is an infectious childhood disease with some death annually. The expansion of the coverage of vaccination plan has significantly reduced the mortality rate of this disease. Given that the endemic measles virus is not transmitted in the country and based on Regional Verification Commission (RVC) for Measles and Rubella Elimination has declared that measles and rubella have been eliminated in three countries of Eastern Mediterranean Region including Islamic Republic of Iran, Bahrain, and Oman. Therefore, to continue and preventing from reemerging of measles in Iran, it is essential to maintaining the immunization programs, diagnose, and investigate all suspicious cases and outbreaks. This article investigates the challenges facing to measles after elimination declaration in Iran. However, the elimination of these diseases to be sustainable needs a vigorous case identification protocol and contact follow up.

Background: Evidence suggests that there is some relationship between circadian clock gene variants and obesity. However, there are few examinations supporting this observation in human subjects. This study was aimed to investigate the interaction between Cry1 circadian gene polymorphism and major dietary patterns on obesity measurements. Methods: Healthy overweight and obese women aged 18–53 years old were recruited from health centers in Tehran, Iran by a multistage cluster random sampling method (n = 377). Major dietary patterns were elicited after assessing the intake of 16 food groups using a valid and reliable 147-item food frequency questionnaire (FFQ). Anthropometric measurements were performed for each and every participant. Body composition was analyzed using bioelectrical impedance analysis (BIA). Socio-demographic and physical activity data were also collected by a validated Farsi demographic questionnaire and the international physical activity questionnaire (IPAQ). The Cry1 rs2287161 polymorphism were genotyped using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Generalized linear models were used for interaction analysis. Results: Two major dietary patterns, including healthy and unhealthy dietary pattern (HDP and UDP, respectively) were determined using factor analysis. Our study showed a significant higher weight (P = 0.003), body mass index (BMI) (P = 0.042), hip circumference (P = 0.052), and body fat mass (P = 0.028) in carriers of C allele compared with G allele. Moreover, a significant gene-diet interaction was observed between being a carrier of C allele and BMI (P = 0.099 for CC genotype; P = 0.1 for CG genotype) and fat mass (P = 0.1 for CG genotype). Conclusions: The current study suggests a significant interaction of Cry1 rs2287161 gene polymorphisms in people following a healthy dietary pattern on BMI and fat mass among carriers of C allele compared to carriers of G allele.

Background: Travelers are at higher risk of developing health-related problems, especially travel-related diseases, and this remains a major public health burden. Aims: To assess pretravel health behavior-seeking factors, knowledge of vaccine, and travel health attitudes. A cross-sectional design among Malaysian travelers. Methods: An online survey was conducted from December 2017 till March 2018 among 226 participants. Demographic data, pretraveling health behaviors, knowledge of vaccine-preventable diseases, and travel health were asked. Independent t-test and ANOVA were performed using SPSS version 20. Results: Among travelers, 51.3% and 63.7% used health-related information on their destination before departure and collected information on possible travel hazards at their destination. Participant age (P = 0.02), monthly income (P = 0.01), predeparture health information (P = 0.03), information on possible hazards (P = 0.04), and travel health advice from medical professionals (P = 0.03) have been reported as a major predictor of knowledge of vaccine-preventable disease. Travelers' gender (P = 0.01), household income (P = 0.01), and travel health advice from professionals (P = 0.002) were significantly associated with travel health attitude. Conclusions: Sociodemographic and pretravel health-seeking behavior influence knowledge of vaccine-preventable disease and attitudes towards travel health which requires a public health need for community outreach programs targeting this group.

Background: The use of Complementary and Alternative Medicine (CAM) is on the increase globally and found to be more pronounced among those with chronic illnesses even in the face of insufficient scientific evidence to support its efficacy. Hence, this study was conducted to assess the level of use of CAM and its predictors among patients on long term care in tertiary health institution. Methods: This was a cross-sectional study conducted among 176 patients accessing treatment for chronic medical conditions in Jos University Teaching Hospital using quantitative method of data collection. Epi Info statistical software version 7 was used for data analysis and a value of P < 0.05 was considered statistically significant. Results: The median age of respondents was 50 (IQR 30–84) years with 83 (47.2%) being 51 years and above. Utilization of CAM was reported among 72 (40.9%) with herbal preparation ranking highest among 56 (77.8%) the respondents. Absence of side effects (AOR = 2.23; 95% CI = 1.6918–3.2135) and consistency with culture (AOR = 4.46; 95% CI = 1.4695–6.1851) were identified predictors of CAM use. Conclusions: This study has demonstrated a relatively high level of CAM use with perceived absence of side effects, peer influence, and consistency with culture predicting its use.

Coronavirus, discovered in the 1960s, is able to infect human hosts and causes mild to serious respiratory problems. In the last two decades, the severe acute respiratory syndrome coronavirus (SARS-CoV), Middle East respiratory syndrome coronavirus (MERS-CoV) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been recognized. It has long been demonstrated that MERS-CoV binds to dipeptidyl peptidase 4 and SARS-CoV binds to angiotensin-converting enzyme 2. A “cytokine storm” is the main pathophysiology of aforementioned viruses. Infiltration of neutrophils at the site of the infection is a risk factor for the development of acute respiratory distress syndrome and death. The new coronavirus, SARS-CoV-2, has infected more people than SARS-Cov and MERS-CoV as it can easily be transmitted from person to person. Epidemiological studies indicate that majority of individuals are asymptomatic; therefore, an effective and an efficient tool is required for rapid testing. Identification of various cytokine and inflammatory factor expression levels can help in outcome prediction. In this study we reviewed immune responses in SARS-CoV, Mers-CoV, and SARS-COV-2 infections and the role of inflammatory cells.

Background: The promoter methylation and single nucleotide polymorphisms (SNPs) affect the transcription activity of cancer-related genes in several cancers including diffuse gastric cancer (DGC). Here we aimed to evaluate the promoter methylation status and the rs16260 at the promoter region of the CDH1 gene in DGC. Methods: This case-control study was performed of 48 formalin-fixed paraffin-embedded (FFPE) blocks of DGC patients and 41 fresh frozen tissue samples of healthy individuals. Methylation status was evaluated using methylation-specific polymerase chain reaction (PCR) and the rs16260 at the promoter region of the CDH1 gene was assessed using PCR and sequencing method. Results: The occurrence of methylation at the promoter region of the CDH1 gene in DGC patients was significantly higher than control samples (P < 0.0001). The methylated status was significantly associated with the poor differentiated histological type of DGC (P = 0.0428). The frequency of AC genotype and the A allele in DGC patients was significantly higher than the control subjects (P = 0.006 and 0.003, respectively). Conclusions: Here we showed that methylation at the CDH1 promoter may contribute to the DGC development, and also the AC genotype was associated with the risk of DGC.

Background: Although poor dietary habits have a great effect on the health status of children, especially in toddlers, a few questionnaires exist for the assessment of dietary imbalances. This study aims to assess the validity and reliability of the NutriCHEQ in Iranian healthy toddlers. Methods: In this cross-sectional study, first, the NutriCHEQ was translated to Persian and culturally adapted by the forward–backward translation technique. In order to assess the face validity, we used a cognitive interviewing technique of 25 parents/caretakers of healthy toddlers. In the next step, experts assessed content validity, respectively. One item was removed during the content validity process. Then, a blueprint of NutriCHEQ was distributed among 156 parents/caretakers of healthy toddlers in different focal points in Tehran for assessing construct validity by nonlinear principal components analysis. In addition, the anthropometric indices checklist and Food Frequency Questionnaire (FFQ) were filled out for toddlers. Then, construct validity was assessed. The Varimax rotation ran for two sections separately. The four-factor structure was confirmed. Results: The model showed a good fit, and all the extracted variance of four factors were satisfactory (F1 = 20.77; F2 = 22.30; F3 = 14.75; and F4 = 13.71). All of the extracted items of the NutriCHEQ in two parts showed 71.53% cumulative variance. For criterion-related validity, there was a statistically significant positive correlation between the NutriCHEQ and Z-score (rho = 0.632, P < 0.001). The Bland-Altman result indicates 95% limits of agreement between the NutriCHEQ questionnaire and Z-score. Conclusions: Therefore, we concluded that NutriCHEQ is a valid, reliable, and convenient instrument to identify the Iranian toddlers' nutritional status. Therefore, it can be used for research and clinical settings.

Identifying factors that impact physical function in older populations is important for the maintenance of good health with aging. Age-related hyperkyphosis, an excessive curvature in the thoracic spine, affects up to 40% of the older adults and is more common in older females than males. An association of age-related hyperkyphosis with impaired physical function has been reported in numerous studies, however, other studies have reported that a greater magnitude of kyphosis did not associate with impaired physical function. Given the inconsistencies regarding the impact of hyperkyphosis on physical function, the purpose of our study is to perform a systematic review of the existing studies in order to better describe the association between hyperkyphosis and physical function. Prospective and retrospective cohort, case-control, and cross-sectional studies which measure physical function by valid functional tests and questionnaires in older females will be included. We will search Scopus, ISI Web of Science, Cochrane Library, PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PEDro databases. Studies will be searched and then selected by two independent reviewers based on quality assessment tools from the National Heart, Lung, and Blood Institute (NHLBI). A meta-analysis will be conducted if data reported for individual studies allow. Specifically, if two or more individual studies provide measures of central tendency and variability from any of the categories of physical function measures, data will be gathered for meta-analysis. If a meta-analysis is not possible, data will be synthesized and described in a narrative form by size and variability of effect, direction of effect, and association with hyperkyphosis.

Background: Health managers often do not have adequate information for decision making on what strategy makes an effective impact on suicide prevention. Despite the availability of global Suicide Prevention Programs (SPP), no previous investigation has developed combinations of a review study with expert opinions. This study was aimed to identify effective programs for suicide prevention. Methods: We used two methods for selecting the effective SPP. (1) review of systematic reviews: we systematically searched to find relevant review studies through Medline, Cochrane Library, PsycINFO, and gray literatures. (2) Expert panel opinions: effective programs identified from the previous step were combined with expert views via the Hanlon method. Results: A total of 27 since some of them were reports met the inclusion criteria. After full-text screening 9 records included. We found the following 12 SPP for prioritizing and rating the most effective interventions by an expert panel: (1) case management of Suicide Attempters (SAs), (2) identification and treatment of depression, (3) registry for suicide, (4) identifying local determinants of Suicidal behavior (SB), (5) public awareness campaigns, (6) gatekeepers' training, (7) conducting research, (8) school-based training, (9) improving knowledge and attitudes, (10) restricting access to means, (11) at-risk people screening, (12) mass media. Conclusions: Seven effective SPP identified after combined 12 included interventions with expert panel opinion: (1) Case management of SAs, (2) Identification and treatment of depression, (3) Improving a registry for suicide, (4) Identifying local determinants of SB, (5) Public awareness campaigns, (6) Training gatekeepers, and (7) Conducting research.

Background: This study aimed to determine the effect of garlic consumption and endurance training on the serum levels of some pro-inflammatory and anti-inflammatory cytokines in female mice with breast cancer. Methods: This study is an experimental research randomly conducted on 32 female BALB/c mice divided into 4 equal groups (N = 8), including: Cancer Control (CC), Garlic Supplementation (GS), Endurance Training (ET), Endurance Training + Garlic Supplementation (ET + GS). One million cancerous cells were injected to all mice's upper right thigh using the subcutaneous injection method. Exercise groups performed endurance training for 8 weeks (5 days a week .(Garlic supplement groups received 1 ml of the garlic extract orally per kilogram of body weight. The control groups -were not given any task, activity or exercise during the research. At the end of the research, all the mice were anesthetized, and their blood samples were collected. Results: The period of 8-week simultaneous endurance exercise and consumption of garlic supplement significantly decreased the serum level of interleukin-6 (F = 75 P = 0.00), interleukin-8 (F = 97.9 P = 0.00), and interleukin-17 (F = 95.7 P = 0.00), and increased the serum level of interleukin-10 (F = 50.4 P = 0.00). Conclusions: Along with other existing methods, reduction of inflammatory factors, endurance exercises and consumption of garlic supplement have been proved to be an extremely effective treatment for breast cancer patients.

Background: The prevalence of obesity is increasing worldwide. Obesity is associated with severe health effects. Abdominal obesity has a strong association with metabolic dysfunction. A subgroup of people with central obesity has been identified without typical metabolic disorders associated with obesity that has been known metabolically healthy abdominal obese (MHAO). The purpose of this review is to evaluate the MHAO phenotype in the context of type 2 DM incidence, risk of cardiovascular diseases, and all-cause of mortality. Methods: This is a protocol of systematic review. We will search PubMed/MEDLINE, EMBASE, Web of Science, Cochrane Library, and ProQuest. Additional studies will be identified through manual searching of reference lists. Quantitative studies evaluating abdominal obesity phenotype outcomes in adults will be included. Primary results will be assaying abdominal obesity phenotype results, including DM2 incidence, cardiovascular disease risk, and all-cause mortality. Two reviewers will independently screen full-text articles and abstract data. Statistical Analysis Used: Potential conflicts will be resolved through discussion. Results: The study methodological quality (or bias) will be appraised using appropriate tools. If feasible, we will conduct a random-effects meta-analysis. The researchers will also assess the quality of the articles independently based on Newcastle-Ottawa scale. Conclusions: The results of this review will provide a useful reference for the effect of abdominal obesity on metabolic dysfunction and cardiovascular or all-cause mortality

Background: In this study, we aimed to investigate the prevalence of nonalcoholic fatty liver disease (NAFLD) in children with renal failure under treatment with dialysis and its association with biochemical measurements. Methods: In this cross-sectional study, children aged less than 18 years with chronic kidney disease (CKD) who were under treatment with dialysis at least 3 months ago were enrolled. To evaluate fatty liver in those patients who had no recent liver ultrasonography (last 6 months), liver ultrasonography was performed. The characteristics of patients with renal failure with and without NAFLD based on the ultrasonographic evaluation were compared. The association between NAFLD and the studied variables was evaluated. Results: In this study, 39 children (31 males and 8 females) with renal failure who underwent treatment with dialysis were included. From the studied population, six (19.4%) had NAFLD based on ultrasonographic evaluation. There were no differences between renal failure patients with and without NAFLD regarding the biochemical and anthropometric characteristics (P > 0.0). Conclusions: The prevalence of NAFLD in our studied children with renal failure who underwent treatment with dialysis was like the general population and it was not associated with the biochemical and anthropometric characteristics of the patients. Given the importance of NAFLD in renal failure patients as well as its subtle nature, it is recommended to screen patients with CKD for NAFLD.

Background: Obstructive sleep apnea (OSA), which has a known correlation with cardiovascular disease, is a possible risk factor of coronary artery disease (CAD) that is preventable. Aims: We sought to put lights on the relationship between OSA based on the STOP-BANG questionnaire (SBQ) and the severity and complexity of coronary artery involvement. Methods: This cross-sectional, single-center, retrospective study was conducted among 145 patients who underwent selective coronary angiography (SCA) between October 2018 and March 2019, admitted to the Tehran Heart Center, Tehran, Iran. OSA risk was assessed in patients based on SBQ categories. Also, the severity and complexity of coronary artery involvement calculated according to SYNTAX and Gensini scores. Analysis performed by statistical software SPSS 25. Results: Based on SBQ risk assessment categories, 22 (15.2%), 64 (44.1%), and 59 (40.7%) of the patients were low, intermediate, and high-risk for OSA, respectively. By comparing the means of coronary artery involvement, there was no significant difference in SYNTAX score 17.15 ± 13.67 (10.56–23.74) in low, 15.67 ± 9.78 (13.19–18.16) in intermediate, and 16.93 ± 9.21 (14.42–19.45) in high-risk groups; P value: 0.754, and Gensini score 66.4 ± 70.75 (35.04–97.77) in low, 66.21 ± 55.05 (52.45–79.96) in intermediate, 74.61 ± 56.33 (59.93–89.3) iin high risk groups; P value: 0.697 with groups of OSA risks. Also, after adjusting confounding factors, there was still no statistically significant difference in terms of coronary involvement scores. Conclusions: There was no statistically significant difference in SYNTAX and Gensini scores of different groups of OSA risk categories based on the SBQ. However, our results can't be extended into the connection between OSA and CAD.

Background: Low-frequency noise is produced from different sources in the working environments such as pumps. Thus, the aim of this study was to investigate the effect of low-frequency noise on precision and focusing of the studied subjects. Methods: This cross-sectional–interventional study was performed on 13 students of Isfahan University of Medical Sciences. The precision of individual subjects was evaluated using the mental arithmetic test. The sound sources with frequencies of 125, 250, and 1000 Hz at 75, 85, and 95 dB sound pressure levels. Also, the rate of precision was measured before the exposure (time “zero”), and at 45 and 90 min. SPSS (Ver. 26) software was used to analyze the data. Results: Comparison of the precision scores of the individuals between the frequencies of 125 and 250 Hz at the sound pressure level of 75 dB and at 45 min (P = 0.032). And 90 min (P = 0.006). And also, the frequencies of 250 Hz and 1000 Hz at the time of 45 min. At the sound pressure levels of 85 dB (P = 0.019). And 95 dB (P = 0.043) and at the time of 90 min. At the sound pressure levels of 85 dB (0.027). And 95 dB (P = 0.009) demonstrated a significant difference. Conclusions: We concluded that low frequency noises could reduce the person's precision. While for 125 Hz noises, just increasing of the exposure time was effective on the precision reduction. But for 250 Hz noises, both parameters increasing including exposure time and sound pressure levels, was effective.

Background: The aim of this study was to evaluate the nutritional habits of premenopausal women using the Food Consumption Frequency Questionnaire (FCFQ) and to evaluate the relationship between anthropometric measurements, lipid parameters, and the presence of anemia with the findings obtained. Methods: This study was carried out in the internal medicine outpatient clinics of the Health Sciences University Bursa Yüksek İhtisas Training Research Hospital (located in Yıldırım districts) and Gürsu State Hospital (located in Gürsu districts) of Bursa province between 1 June–31 August 2019. We used clustered sampling in patient selection. One hundred seventy-one premenopausal participants aged between 18 and 55 who were known to be healthy and who came for routine control to the internal medicine outpatient clinics were included in the study. The FCFQ was used to determine how often the participants consumed different food groups in the last 1 month. Results: Overweight participants were 29.20% and 17% were obese. 43.90% of the women had anemia and 65.50% of the women had iron deficiency. The milk-dairy products nutrition score of the group with triglycerides (TG) <150 mg/dL was higher than the group with TG ≥150 mg/dL (P = 0.029). The meat-egg-legumes nutrition score (2.11 ± 0.57) of the group with high density lipoprotein (HDL) ≥50 mg/dL was higher than the group with HDL <50 mg/dL (1.91 ± 0.58) (P = 0.04). Conclusions: Anemia and obesity are high in premenopausal women. Community-based screening programs are needed to evaluate premenopausal women for anemia and obesity. Scales to assess the nutritional habits of the population are also needed in screening programs.

Background: According to NFHS-4 survey, obesity has doubled in India. BMI cannot differentiate body fat from lean mass. Normal weight obesity was defined to distinguish people with normal BMI and increased body fat percentage (BF%). In contrast to conventional atherogenic prediction, Apolipoprotein B level is elevated before LDL cholesterol. Adiposity is also known for causing insulin resistance. Hence this study is an attempt to find the correlation of apo B and Insulin sensitivity in predicting future cardiovascular risk among normal weight obese. To study the role of apoB and insulin resistance in predicting cardio vascular risk. Methods: 269 participants of age group 18-24 in a medical teaching institute were selected for the first phase of the study through systematic random sampling. BF% was calculated with Harpenden skinfold callipers using Jackson Pollock's method. Second phase of the study involved biochemical investigation of 30 NWO participants. ApoB level and insulin sensitivity using HOMA model was estimated. Spearman correlations and simple linear regression were used. Analysis done using SPSSv16. Results: Male and Females were 56.4% and 43.6%, respectively. Out of 269, 44 were found to be having NWO. Hence Prevalence was 16.4%.There is a positive correlation found between apoB and insulin resistance with increasing body fat percentage. Conclusions: Elevated levels of apo B and insulin resistance are seen in NWO individuals as the BF% increases. NWO should be diagnosed early and thus apoB and insulin resistance can be screened for cardio vascular risk prediction.

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

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

Background: A better understanding of the spatial pattern of stomach cancer can be helpful in the implementation of preventive strategies. This study is one of the first studies to establish a study unit based on the smallest possible size for cluster analysis. This study includes a novel evaluation of spatial differences in different geographical areas of Arak. The present study seeks to discover the spatial clusters of stomach cancer from 2009 to 2014 in Arak. Methods: All of the addresses of the stomach cancer cases were geocoded. After that, the number of stomach cancer cases in each census block was calculated to be entered in the SaTScan software. A discrete Poisson-based probability model was used to analyze this cluster. Results: In Arak, there are 5502 census blocks with a population of about 526,182. The number of identified and registered stomach cancer cases with an acceptable residence address was 392. Totally, 11 stomach cancer clusters were established in the area of Arak, from these; two clusters were detected statistically significant. Relative risks of the first and second clusters were 1.75 (P = 0.01) and 17.60 (P = 0.04) and those are located within the radius of 1.73 and 0.085 km, respectively. Conclusions: Our results have confirmed that two areas are at a higher risk than others. However, based on the results of this study, community-based interventions in certain geographical areas can be designed to reduce and control the incidence of stomach cancer.

Background: Repair index (RI) using DNA changes reveals the activity of carcinogenesis. Cigarette and waterpipe smoking are important contributors to oral cavity malignancy. The RI in cigarette and waterpipe smokers has not been compared so far. The aim of this study was to compare the RI in cigarette and waterpipe smokers using the human exfoliated buccal mucosa cells. Methods: The exfoliated buccal mucosa cells of 60 cigarette and waterpipe smokers and 20 nonsmokers were evaluated in a case-control study. The number of micronuclei (MN), broken egg (BE), karyorrhexis (KR), and karyolysis (KL) were counted in 1000 cells from randomly selected fields. The RI = (KL + KR)/(MN + BE) was calculated and compared between subjects and controls. Data were analyzed by one-way analysis of variance (ANOVA), Tukey's Honest Significant Difference (HSD), and Spearman's correlation coefficient test at P < 0.05 probability level. Results: The difference of MN (P < 0.0001), BE (P < 0.0001), KR (P < 0.0001), and KL (P < 0.0001) count was significant between cigarette smokers, waterpipe smokers, and nonsmokers. The RI was significantly different between groups (P = 0.007). The RI was significantly higher in cigarette smokers compared to waterpipe smokers (P = 0.04) and nonsmokers (P = 0.009). Conclusions: The RI was significantly higher in cigarette smokers compared to waterpipe smokers. The finding suggests that due to higher interrupted cellular hemostasis, the risk of carcinoma in waterpipe smokers can be greater than that in cigarette smokers.

Background: Breast cancer (BC) is the most frequent cancer in Iranian females. Due to the changes in lifestyle and reproductive risk factors, the BC incidence rate has been rapidly increasing. Knowing risk factors of BC could significantly contribute to improve preventive behaviors. To investigate the relationship between menstrual and reproductive factors and BC in Iranian female population. Methods: Web of Science, PubMed, Scopus, and SID as well as references of included studies were searched. Among relevant published observational studies, 27 studies met the inclusion criteria. Pooled risk estimates for the risk factors were determined using random-effects models due to the presence of substantial heterogeneity (P < 0.05). Results: All of the selected studies had case–control design. There was a positive relationship between maternal age at first pregnancy and risk of BC (OR = 1.79 95% CI: 1.36–2.35). Also, menopausal status was associated with higher risk of BC (OR = 1.60 95% CI: 1.18–2.17), whereas, there was no association between menarche age and increased risk of BC (OR = 0.55 95% CI: 0.29–1.03). History of abortion (OR = 1.21 95% CI: 0.97–1.5), nulliparity (OR = 1.43 95% CI: 0.89–2.31), and breastfeeding history (OR = 0.68 95% CI: 0.42–1.09) were not associated with BC risk. Conclusions: Our findings suggest that age at the first pregnancy and menopausal status were significantly associated with BC risk among Iranian women, whereas menarche age, nulliparity, and history of breastfeeding were not. In regard to the history of abortion, our findings revealed no association with BC, but in high-quality studies, this relationship was significant.

Aim: To assess the influence of gender and age on different parameters of alveolar bone loss using specific radiomorphometric indices on panoramic radiographs to aid in identifying patients with possible low bone mineral density (BMD). Materials and Methods: The present cross-sectional study included 80 subjects in whom mandibular cortical index (MCI), mandibular cortical width (MCW), panoramic mandibular index (PMI), alveolar bone loss (ABL), and bone height in 1^st premolar (Hp) and 1^st molar (Hm) were assessed to evaluate the alveolar bone loss. Results: The findings of the present study revealed a significant association between MCI and age for females with C2 and C3 categories being more common with advancing age. Also, a significant difference could be seen in relation to gender (p-value = 0.0315) for MCW with a concomitant decrease in values of MCW in females >60 years of age. The vertical bone height of the edentulous mandible at 1^st premolar (Hp) (p-value = 0.0071) and 1^st molar (Hm) (p-value = 0.0044) regions were also found to be more in males than females. Conclusion: Panoramic radiographic measurements provided valuable information for alveolar bone loss in terms of gender and age based on specific radiomorphometric parameters.

Background: Health literacy index (HLI) was developed to provide a proper framework for educational material in all levels. So, the aim of this study was to determine the effect of education based on (HLI) on the self-care ability among older adults. Methods: This randomized clinical trial was conducted with 68 older adults during the period of May–August 2019. The research setting was health centers in the south of Tehran, Iran. Samples were selected with considering the inclusion criteria. Then Block randomization was used to assign the participants into two groups. The intervention group for 4 weeks in groups of 8–10 in the intervention group. Self-care ability was measured using a self-care questionnaire in two stages, before and two months after the implementation of intervention. The control group received no education and only used the routine community house services. Statistical analyses were performed using the SPSS software (version 16.0). Data were analyzed using the Chi-square, Fisher's exact test and independent t-test. P < 0.05 was considered statistically significant. Results: The mean total self-care ability scores in the intervention group were 165.38 ± 10.69 and 184.28 ± 10.07 before and after intervention, respectively. These scores in the control group were 163.65 ± 13.27 and 167.52 ± 13.58, respectively (P < 0.001). The results showed significant differences between the two groups regarding self-care ability after the intervention (P < 0.001). Conclusions: The implementation of education based on HLI significantly improve the self-care behaviors in older adults. It is suggested that this approach should be established to fit of educational content appropriate to the age of the elderly in order to health promotion. Trial Registration: The trial was registered in the Iranian Registry of Clinical Trials on May 23, 2018, identifier: IRCT20170912036150N1.

Currently, the COVID-19 pandemic is the most discussed subject in medical researches worldwide. As the knowledge is expanded about the disease, more hypotheses become created. A recent study on the viral protein interaction map revealed that SARS-CoV-2 open reading frame 8 (ORF8) interacts with human DNA methyl transferase1 (DNMT1), an active epigenetic agent in DNA methylation. Moreover, DNMT1 is a contributor to a variety of chronic diseases which could cause some epigenetic dysregulation in infected cells, especially leukocytes, pancreatic beta, and endothelial cells. Regarding the fact that epigenetic alterations have a partial, but not completely reversible phenomena, it raises the question that if this interaction may cause long-term complications such as diabetes, atherosclerosis, cancer, and autoimmune diseases. Accordingly, long follow-up studies on the recovered patients from COVID-19 are recommended.

Backgrounds: Most of the cancer patients with solid tumor are subjected to chemotherapy with cisplatin (CP) in clinic. However, the most side effect of CP is nephrotoxicity, which limits the treatment. The aim of study was to develop a general consensus statement for CP therapy in clinic to limit the drug-induced nephrotoxicity. Methods: A total of 30 oncologist-hematologists, adult and pediatric nephrologists, radiation oncologists, clinical pathologist clinical pharmacologist, and renal physiologist participated in a workshop, and in order to reduce the incidence of CP-induced nephrotoxicity, a general consensus was developed. Results: The developed general consensus was focused on some items such as age, sex, female hormone, nonsteroidal anti-inflammatory drugs (NSAID), renin–angiotensin system inhibitor drugs, glomerular filtration rate, hydration methods, contrasts, antioxidants, dextrose, and magnesium. Conclusion: The agreement between participants for CP therapy in clinic was achieved, and this general consensus was announced to be implemented in the hospitals.

Background: Oxidative stress has a prominent role in the pathogenesis of diabetes complications. Pramlintide is an injectional amylin analogue used for the treatment of type 1 and type 2 diabetic patients. The present investigation evaluated the effect of pramlintide against oxidative damage induced by hydrogen peroxide (H₂O₂) in human umbilical vein endothelial cells (HUVECs). Methods: Cell viability was assessed using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide method. Hydroperoxides level, ferric reducing antioxidant power (FRAP), and expression of transcription factor NF-κB were measured in HUVECs that pretreated with pramlintide and, then exposed to H₂O₂. Results: Pramlintide significantly decreased the cytotoxicity caused by H₂O₂ at the concentrations of 5 and 10 μg/mL. Pretreatment of HUVECs with pramlintide reduced hydroperoxides and increased FRAP value in intra- and extra-cellular mediums at different concentration ranges compared with H₂O₂ stimulated cells. Pramlintide (10 μg/mL) remarkably ameliorated the expression of NF-κB gene after 1, 3 and 24 h exposure to H₂O₂. Conclusions: Findings of the current investigation displayed that pramlintide may act as a protective against oxidative conditions in endothelial cells through modulation of oxidative markers and transcription factor NF-κB.

Novel Coronavirus disease (COVID-19) is a contagious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV 2) presenting mainly as an acute respiratory illness with interstitial and alveolar pneumonia. It can also affect multiple organs such as the kidney, heart, intestinal tract, blood, and nervous system. We report a 10-year-old boy presenting with severe cough, tachypnea, retraction and respiratory distress, fever, myalgia, oliguria, and anuria thereafter. He had no history of diarrhea, vomiting, or a runny nose. Laboratory findings include leukopenia and lymphopenia. CRP, ESR, and procalcitonin levels were high, but serum LDH was normal. RT-PCR test was positive. In the initial days of admission, he needed mechanical ventilation support due to ARDS and received antiviral drugs, renal replacement therapy, hemoperfusion, and other necessary supportive cares. Thirty-five days later, he weaned from the ventilator and discharged from hospital. Two weeks later, COVID-19 specific IgG was found in serologic test.

Background: Ready-to-use therapeutic food (RUTF) spread has been highly effective in the treatment of malnutrition in those affected by disasters since it does not require preparation and baking and has a long shelf life and sufficient energy to improve growth and weight loss. Such features may be crucial during crises such as wars and natural disasters. The present study aimed to design a high-energy and nutrient-dense RUTF formulation. Methods: Soybean flour and milk protein concentrate were used as protein sources, corn flour, and sugar were employed as carbohydrate sources, cacao butter substitute was used as the lipid source, and vitamin/mineral, beta-alanine, arginine, Nigella sativa, and sesame seeds were used as a functional food. The study was performed in accordance with the guidelines of the Institute of Medicine (IOM) and criteria for food products. Results: To design the formulation, we used carbohydrates (45% of total energy), protein (13% of total energy), fat (42% of total energy), vitamins, minerals, beta-alanine, and arginine, and 100 grams of the diet was considered to release 525 kilocalories of energy. The experimental results of food safety at the determined intervals (at the beginning and 45 and 90 days after the production) showed acceptable values. Conclusions: Since nutritional requirements are among essential human needs (especially in the management of malnutrition in crisis), it is of utmost importance to prepare RUTF products in order to meet all human nutritional needs by facilitating the easy use of these products, particularly for the prevention of malnutrition and diseases.

Background: The rapid migration from rural to urban region results in mushrooming of slums in India. Urban-slums are comparatively poor vulnerable groups which are mostly affected with oral cancer due to higher exposure to risk factors like tobacco use. Aims: To assess pattern of tobacco consumption, awareness about oral cancer and related health education needs in urban slums of Jodhpur city. Methods: Study was conducted during July 2018Nov 2018 in slum of Jodhpur city. On the basis of cluster sampling strategy data were collected from 1200 participants regarding tobacco use and perception regarding oral cancer to identify health education needs in urban slums. Descriptive statistics, Chi-square test, multivariate logistics analysis were used and P < 0.05 was considered statistically significant. Results: A total of 1200 participants were surveyed, out of which 48.5% were males. Among the study population, 58.5% (n = 462/789) males and 41.45% (n = 327/789) females were consuming tobacco in one or more forms. The statistical association between: age and bidi, gutka, zarda consumption; gender and bidi, cigarette, gutka consumption was found to be significant (P < 0.001). The younger population (1530 years) has more willingness to quit tobacco than the older population. (OR = 1.52, 95% CI = 1.092.11). Almost 56% were aware of oral cancer. Conclusions: An effective information, education and communication (IEC) strategy for tobacco cessation should be designed with focus on different education needs according to age, gender, and education status of slum population.

Background: Irritable bowel syndrome (IBS) is a common chronic functional gastrointestinal (GI) disorder. The aim of this study is to assess the prevalence of IBS and its risk factors among the general population of Saudi Arabia, as there is no previous study has done so. Methods: A cross-sectional study was carried out to evaluate the prevalence of IBS, IBS subtypes and IBS risk factors among the general population of Saudi Arabia from June 22 to November 30, 2019. A designed questionnaire that is based on ROME IV criteria and licensed from Rome Foundation was used. A total of 1,680 eligible individuals from different parts of Saudi Arabia took part in this national survey and were included in the statistical analysis. The statistical analysis was carried out using Statistical Package for the Social Sciences (SPSS) program (version 22). Results: The prevalence of IBS in the study was 18.2%. IBS-M was the most common subtype among IBS patients (42.3%). Risk factors that are significantly associated with IBS were shown to be smoking habits, gastroesophageal reflux disease (GERD), food allergy, anxiety, psychological stress, family history of IBS, regular use of non-steroidal anti-inflammatory drugs (NSAIDs), history of infection before occurrence of symptoms and residence in the south of Saudi Arabia (P < 0.05*). Conclusions: IBS is prevalent in Saudi Arabia. The most common risk factor among IBS patients is a positive family history of IBS (80%). Raising public awareness and further prospective studies are both advocated and needed.

Aims: At present, there is no definitive treatment for COVID-19 and to break the pandemic chain, prevention is the best choice. Meanwhile different controlling strategies are considered, in this study, we aimed to understand public insights toward the medical advisement. Material: A self-constructed questionnaire including information regarding various preventive elements such as wearing a mask, using gloves, attention to safe social distance, using disinfectant materials was prepared. After content validity, the questionnaire was circulated in cyberspace and the public was invited to complete it. After five days, the percentage of risky behavior related behaviors to the mask (RBM), hygiene (RBH), and social distance (RBD) were analyzed and compared in different situations with tableau and SPSS 26. Results: A total of 7,000 people with the mean age of 31.5 ± 12.2 years completed the questionnaire, of which 39% were men. RBM was 76.54% whereas hand hygiene and distance risky behaviors were 11.49% and 15.33%, respectively (P = 0.01). RBD was significantly higher among people with COVID-19 patients in their families. The pattern of RBH based on the level of worry about getting COVID-19 was similar in the group without worry and with the highest level of worry. Conclusions: In this ever-changing situation of the COVID-19 pandemic, community awareness, and logical perception regarding correct use and has a crucial role in optimal COVID-19 controlling, which should not be neglected. It is important to have the latest information, which comes from trustworthy sources as a preventive key in both healthcare and community settings.

Background: Osteoporosis in the elderly has dangerous complications, the most important of which are bone fractures and reduced quality of life in the elderly. The present study was aimed at estimating the prevalence of osteoporosis in Iranian elderly using systematic review and meta-analysis. Methods: This search was conducted using authentic Persian and English keywords in national and international databases including Scientific Information Database, Magiran, IranDoc, PubMed, Scopus, Cochrane, Embase, and Web of Sciencewith no time limit until 20.06.2020. Heterogeneity of studies was assessed using I² index. Data were analyzed using STATA Ver. 15 software. Results: In 30 studies with a sample size of 13,347 people, the prevalence of osteoporosis and low bone density in people over 60 years in Iran were 34% (95% CI: 27%, 42%) and 47% (95% CI: 41%, 53%), respectively. We also found that 34% of women and 41% of men over the age of 60 suffer from osteoporosis. Prevalence of osteoporosis was in lumbar bone 23% (95% CI: 20%, 26%), spine 25% (95% CI: 19%, 31%), hip 35% (95% CI: 7%, 62%), and femur 23% (95% CI: 15%, 31%). Prevalence of low bone density was in lumbar bone 41% (95% CI: 19%, 63%), spine 30% (95% CI: 15%, 46%), and femur 35% (95% CI: 21%, 48%). Conclusion: The prevalence of low bone density in people over 60 years is higher than the prevalence of osteoporosis in them. About one-third of Iranian elderly people suffer from osteoporosis, but about half of them have low bone density.

Background: Collaboration, as a key factor in disaster risk management, is a mechanism that prevents the loss of time, investment, and resources. The variety of units in the health sector has made collaboration a major challenge. The present study aimed at developing a tool for assessing collaboration in the health sector during disasters. Methods: In this mixed-methods study, a questionnaire was developed by integrating the findings of a systematic literature review and a qualitative study. Face and content validation were performed. The reliability of the tool was tested through a 15-day interval test–retest by Cronbach's alpha and intraclass correlation coefficient (ICC) with 30 participants. Confirmatory factor analysis was done to test the validity and reliability of instrument using SmartPLS in a case study with 450 health sector staff. Results: The factors affecting intraorganizational collaboration of the health sector were identified in six categories and 19 subcategories by searching 46 articles in the systematic review and content analysis of 16 semistructured interviews with health sector staff. The results of content validity ratio (=0.81), content validity index (=0.92), Cronbach's alpha (=0.975), and ICC (=0.970) confirmed the validity and reliability of the tool. Convergent validity, discriminant validity, and reliability were approved by AVE (average variance extracted) >0.5, Fornell and Larcker matrix, and CR (composite reliability) >0.7. According to the positive result of R², Q², and goodness-of-fit (GOF) criteria, the model fit was confirmed. Conclusion: The results of validity and reliability measurements approved the proposed tool. The use of this tool is recommended for developing collaboration in the health sectors of different countries.

This qualitative systematic review was conducted to summarize the policies for prevention of common gastrointestinal cancers worldwide. This study was conducted using PubMed, Web of Science, SCOPUS, and ProQuest databases. Two independent reviewers assessed included studies for methodological quality and extracted data by using standardized tools from Joanna Briggs Institute (JBI). Primary study findings were read and reread to identify the strategies or policies used in the studies for prevention of gastrointestinal cancers. The extracted findings were categorized on the basis of their similarity in meaning. These categories were then subjected to a meta-synthesis. The final synthesized findings were graded according to the ConQual approach for establishing confidence in the output of qualitative research synthesis. From the nine included studies in this review, 39 findings were extracted and based on their relevance in meaning were aggregated into 12 categories. Four synthesized findings were developed from these categories. We used World Health Organization report on 2000 for synthesizing the findings. The four synthesized findings were “service provision”, “resource generation”, “financing”, and “stewardship”. In order to reach a comprehensive evidence informed policy package for the prevention of gastrointestinal cancers, there should be a great communication among the interventions conducted directly on patients, health system infrastructures, and resources.

Background: Malignant middle cerebral artery infarct (mMCAI) largely contributes to high mortality and physical disability among adults. Surviving individuals may not have proper outcomes and suffer from severe lasting disabilities. Utilization of stem cells and paracrine factor for regenerative purposes is considered as a potential strategy for patients with neurological deficits. While preclinical stroke studies have shown that mesenchymal stem cells (MSCs) reduce post-treatment neurological deficits and prevent disability and also promote recovery, few randomized clinical trials (RCT) have assessed exosome therapy in humans. Methods: In this RCT, we assessed the safety of intraparenchymal injection placenta MSC-derived Exosome in mMCAI patients with average age of 62 years between January, 2019, till September, 2020. The study was done in a single-center as an open-label RCT, with a 3-months follow-up. Primary outcomes assessed the safety and also disability indexes were followed. Results: Five mMCAI patients were included with mean NIHSS: 17.6 ± 5.02. The mean MRS was 3.25 ± 0.95 in three patients. No serious adverse events were observed. Hematoma or local reaction as excessive edema were not seen at the site of injection. Conclusions: Intraparenchymal implantation of MSC-EXO showed no post-interventional adverse effects in five ischemic stroke patients. It is proposed Local injection Exosome treatment following mMCAI can be safe and in future, it would be applied as a supportive, restorative and preventive treatment in patients who suffer from acute ischemic stroke and post ischemic disability.

Relative internet search volumes (RSV) is now being consider as a measurement of awareness for most of the trending topics. During the recent coronavirus disease (COVID-19) outbreak, many researchers used the RSVs to interpret the population responses to the pandemic in various ways. By using the RSVs searched by Persian language people, we demonstrated that the Iranian people increased their knowledge and awareness of COVID-19 during the early phases of the disease before the first peak. However, their relative searches about the COVID-19 and its clinical symptoms decreased gradually despite of the gradual rise of the confirmed cases. Their less tendency to seek information about the COVID-19 could be one of the possible explanation for the increasing number of confirmed cases even several days after easing the disease related lockdown.

Background: Cardiovascular diseases are the leading causes of mortality all around the world. Patients with Ischemic heart disease (IHD) are at an increased risk of ischemic events; therefore, secondary prevention measures should continue for these patients. Although Cardiac rehabilitation (CR) is one of the secondary prevention measures for IHD patients which has favorable clinical outcomes, only 50% of patients are referred and among them, a small percentage attends CR. Therefore, other strategies should be considered, one of which is home-based cardiac rehabilitation. Methods: A multicenter, parallel-group randomized controlled trial has been conducting in three hospitals in Isfahan and patients have been assigned into a 1:1 ratio for the evaluation of the effectiveness of home-based cardiac rehabilitation versus usual care. Psycho-educational consultation based on the Health Action Process Approach including heart-healthy diet, stress management, lifestyle changes, smoking cessation, and physical activity has been performed. Primary outcomes, including the quality of life, psychological and smoking status, body mass index, blood pressure, blood cholesterol level, and physical activity level have been measured at 6 months after the randomization and intervention. One year after the intervention, primary and secondary outcomes, including cardiovascular events, the frequency of hospital admissions, and the death rates due to cardiovascular reasons will be assessed. Conclusion: HBCR program can increase patient accessibility to CR services its implantation can be reduce burden IHD.

Background: Neonatal jaundice is a prevalent disease that causes many complications, including kernicterus and even death. Previous studies have shown that clofibrate as an aryloxy isobutyric acid derivate can be effectively applied for the treatment of neonatal jaundice. Thus, this review was carried out to investigate the effects and mechanism of action of clofibrate on neonatal jaundice. Methods: The keywords such as “Clofibrate” in combination with “Neonatal jaundice” or “Neonatal hyperbilirubinemia” or “Newborn Jaundice” were used to search for relevant publications indexed in the Institute for Scientific Information (ISI), Scopus, PubMed, and Google Scholar databases. Finally, after reviewing the studies, 24 papers were included in this study. Results: Results showed that the processes of albumin-bound bilirubin transfer to the hepatocytes, hepatic uptake, and storage via ligandin, hepatic conjugation via uridine diphosphate glucuronosyltransferase 1A1 (UGT1A1), conjugation into the bile via MRP2 represent the main action mechanism of clofibrate that turns it into the bilirubin conjugates and expels it from the bile. Besides, clofibrate has been shown to reduce the level of Total Serum Bilirubin (TSB) in infants even at a dosage of 25 mg/kg without leaving side effects. Conclusions: The results of this review revealed that clofibrate effectively reduces TSB in short-term usage and can even have a promising effect at the dosage of 25 mg/kg in full-term infants. Most studies have shown this property over a short period in term infants, and there is no evidence about long-term usage in this regard.

Background: Iran is one of the fastest ageing countries in the world. The model of Active Ageing (AA) could be a strategy contributing in addressing the problem of population ageing in Iran. This study measured the status of AA in Iran and examined its associations with the health-related quality of life of older people. Methods: A quantitative cross-sectional survey of a random sample of 623 people aged 55 + years resident in Tehran was conducted. In total, 590 people responded. The AA was measured using the Active Ageing Index (AAI) questionnaire and the health-related quality of life was measured using SF-36 questionnaire. Associations between the domains and the overall AAI scores with the quality of life were examined by MANCOVA analysis in four models using the STATA software. Results: The score of overall AAI was calculated at 26.8 (men 33.9 vs. women 20.6) out of 100. We found a stronger association of the AAI with the physical component than the mental component of the SF-36. Generally the 1^st (employment) and the 2^nd (participation in society) domains of the AAI showed little or no association with SF-36, but there was an association between the 3^rd domain (enabling environment for active ageing) and the SF-36 and a particularly strong associations with the 4^th domain (independent, healthy and secure living capacity). Conclusions: Iranian elderly, particularly women, are experiencing relatively inactive life, which negatively influence on their health-related quality of life. To improve the AAI status in Iran, some aspects including “enabling environment” and “independent, healthy and secure living capacity” need special attention.

Background: Different strategies can promote healthy behaviors. Although the human papillomavirus (HPV) vaccine is very important due to its effect in reducing cervical cancer, the behavior of HPV vaccination is low among young adults in Iran. Therefore, this study aimed to determine strategies for improving HPV vaccination among young adults. Methods: The present study was conducted with a qualitative content analysis method. The participants were 30 health professionals and young adults in Tehran city who were selected using purposive and snowball sampling. The data were collected through semistructured interviews and analyzed by Graneheim and Lundman's approach. Results: In total, two categories were identified: (1) access to services: access to the vaccine, vaccine insurance coverage; (2) educational coverage: subgroup training, educational content, time for training, educational channels, education strategies, and educational conditions. Conclusions: This is the first study conducted to determine strategies for improving HPV vaccination in Iran. The policymakers and planners, schools, and health centers are recommended to use the strategies obtained from this study to increase HPV vaccine imports, as well as increase the community members' knowledge and acceptance of the HPV vaccine.