Background: Cardiovascular diseases remain the leading cause of death worldwide. Metabolic syndrome (MetS) is the clustering of risk factors for developing the disease. Strong evidence exists for the efficacy of screening for MetS. However, the potential of novel web-based studies for MetS and online assessing of the quality of life (QOL) for these high-risk participants have not been explored. Methods: This was a web-based, cross-sectional study. Participants were recruited through online registering on the study website. Then, those who met the study criteria (waist circumference [WC] ≥90 and blood pressure [BP] ≥130/85) were contacted and invited for the clinical assessments, if they wish. Baseline measurements were MetS risk factors (weight, WC, body mass index and BP, total cholesterol, low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol, triglycerides, and fasting blood glucose) and health-related QOL (HRQOL) that was measured using the  short form-36 (SF-36). Results: There were 1436 (male: 928, female: 508) registration data on the study website. Reviewing the data, of 317 eligible participants that were invited to the study, 229 persons were responded to invitation in the screening program. The mean age of participants was 43.8 (standard deviation [SD] = 9.9) years. MetS was more frequent in male and married persons. In addition, participants with MetS had lower mean (SD) scores than participants without MetS for the following subscales of HRQOL as: role-physical (with MetS 51.1±35.2; versus without MetS 65.3 ± SD = 40.1), vitality (with MetS 65± 21; versus without MetS 75.3 ± 21.1), mental health (with MetS 49.5±30.1; versus without MetS 34.1±17.2)(P < 0.05 for all). Conclusions: People with MetS experienced lower HRQOL than without MetS. Internet as a powerful medium offers a novel setting for delivery health information. It seems that high BP and abdominal obesity are associated with lower HRQOL in the participants with MetS. A web-based prevention program could make people aware for their vulnerability to MetS and its complications.

Background: High blood pressure (BP) has been known as a major risk factor for many chronic diseases. It should be noted, a psychiatric disorder which is common in the people living modern lifestyle may be one of the leading causes of hypertension, and many people are prescribed antidepressant each year. Hence, the purpose of this study was to evaluate the effect of selective serotonin reuptake inhibitors (SSRIs) and alprazolam which defined as antidepressant on the BP levels, and to compare the BP levels between the group of users and nonusers. Methods: This randomized clinical trial study was conducted at the Nohom Dey Hospital in the Torbat-e Heydarieh, Iran between December 2011 and March 2012. Participants comprised 101 psychiatric patients with hypertension that randomly separated into users and nonusers of antidepressant. The period of intervention lasted for 3 months. The mean of BP calculated by this formula (systolic BP [SBP] +2 diastolic BP [DBP])/3 which was the main outcome of the study. Results: Users of antidepressant drugs did not have any significant changes in BP levels, except in patients who received SSRIs alone, significant improvement was observed in DBP (P = 0.04) and mean of BP (P = 0.03). While, in nonusers of antidepressant, significant development was observed in DBP, and mean of BP. Comparing the users and nonusers did not show any significant differences in SBP, DBP, and Mean of BP; even, when outcomes were adjusted for risk factors and antihypertensive drugs. Conclusions: Three months treatment with SSRIs and alprazolam did not have any effect on lowering BP level in patients with the psychiatric disorder.

Background: Multiple sclerosis (MS) affects all aspects of patients. Recently, the "PERception de la Scle'rose En Plaques et de ses Pousse'es" (PERSEPP) scale was designed to assess MS-related relapse on quality of life (QoL). The aim of this study was to evaluate validity and reliability of Persian version of PERSEPP scale in Iranian patients with MS. Methods: Two-hundred eleven patients with relapsing-remitting form of the disease asked to fill the PERSEPP scale, MSQOL-54, and SF-36 questionnaires. Fifty cases filed the questionnaire 2 weeks later to assess reliability. The intraclass correlation coefficient (ICC) and Cronbach's alpha analysis were used. Results: Mean age and mean duration of disease were 32.2 ± 8.4 years and 6.5 ± 2.5 years, respectively. One hundred sixty-seven (79.1%) were female and 44 (20.9%) were male. Forty-one (19.4%) were in relapse phase of the disease. ICC score of all items was above 0.8. Cronbach's alpha of all items was above 0.8. The results show that the mean scores of four items (relationship difficulties, time perspective, and symptoms) were significantly different between cases in relapse and none relapse. Coping and relationship difficulties scores were significantly different between different expanded disability status scale groups. Pearson correlation score for QoL 54 and PERSEP calculated as r = 0.44, P < 0.001 and r = 0.66, P < 0.001 between SF36 and PERSEP. Conclusions: Persian version of PERCEPP questionnaire provides valid and reliable instrument to assess MS-related QoL.

Background: This study has aimed to evaluate the level of knowledge about the first aid process among the university students in Jordan. Methods: The study population consisted of students of the 14 scientific and unscientific faculties at Yarmouk University, Jordan. Data were obtained via questionnaires from 883 students. Results: The majority of participants were females (65.9%) with mean age (standard deviation) of 19.9 (2.6) years. Only 29.2% of students had previous first aid experience. When asked, only 11% of students knew the normal respiration rate of an adult in 1 min. Results revealed that female students, having previous first aid experience, and being a student of the health sciences and scientific colleges were the only factors had significant statistical associations with better level of first aid knowledge. Conclusions: The students' knowledge about first aid is not at an adequate level. It would be advisable that first aid course be handled as a separate and practical course at secondary school level.

Background: Silymarin is a flavonoid complex with nephro-protective properties. We evaluated the efficacy of silymarin in the prevention of contrast-induced nephropathy (CIN). Methods: This placebo-controlled clinical trial was conducted on 143 patients with chronic stable angina referring for elective coronary angiography. Patients with low to moderate risk for CIN were included and were randomized to receive silymarin (280 mg) or placebo 2 h before administration of the contrast material. A nonionic, iso-osmolar contrast material was used. Serum creatinine was measured before and 48 h after injection of the contrast material. CIN was defined as an increase in creatinine of ≥0.5 mg/dL or ≥25% from the baseline. Results: Serum creatinine was increased by 0.02 ± 0.07 mg/dL (P = 0.004) with silymarin and by 0.04 ± 0.15 mg/dL (P = 0.008) with placebo after contrast material injection (between group difference = 0.01 ± 0.02 mg/dL, P = 0.881). CIN was occurred less frequently, though statistically nonsignificant, with silymarin compared with placebo (2.9% vs. 10.8%, Odds ratio [OR] [95% confidence interval (CI)] = 0.246 [0.050-1.203], P = 0.099). In the logistic regression analysis controlling for patients characteristics and baseline creatinine level, silymarin was nonsignificantly associated with lower frequency of CIN (OR [95% CI] = 0.203 [0.037-1.117], P = 0.067). Conclusions: We found a trend toward the efficacy of silymarin in preventing contrast-induced renal dysfunction. Further trials with larger sample size and in patients with higher risk of CIN are warranted.

Background: Nowadays, administering noninvasive positive airway pressure (PAP) is considered as the building block for the management of respiratory distress syndrome (RDS). Since nasal continuous PAP (n-CPAP) established its roots as an interventional approach to treat RDS, there have always been concerns related to the increased work of breathing in newborns treated with this intervention. Therefore, respiratory support systems such as nasal bi-level PAP (N-BiPAP) and sigh-PAP (SiPAP) have been developed during the last decade. In this study, two respiratory support systems which, unlike n-CPAP, are categorized as cycled noninvasive ventilation, are studied. Methods: This study was a randomized clinical trial done on 74 newborns weighing 1500 g or less affiliated with RDS hospitalized in NICU at Al-Zahra Hospital from October 2012 to March 2014. Patients were randomly assigned to two respiratory support groups of N-BiPAP and SiPAP. Each group contained 37 newborns who were compared, according to their demographic characteristics, duration of noninvasive ventilation, the need to administer surfactant, apnea incidence, the need for mechanical ventilation, pneumothorax, intraventricular hemorrhage (IVH), patent ductus arteriosus (PDA), the duration of oxygen supplement administration, and chronic lung disease (CLD). Results: The average duration of noninvasive respiratory support, and the average duration of the need for oxygen supplement had no significant difference between the groups. Moreover, apnea incidence, the need for mechanical ventilation, pneumothorax, IVH, PDA, CLD, the need for the second dose of surfactant, and the death rate showed no significant difference in two groups. Conclusions: In this study, SiPAP showed no significant clinical preference over N-BiPAP in the treatment of the newborns with RDS weighing <1500 g.

Tobacco smoking is one of the greatest causes of mortality in the world, responsible for over 5 million deaths per annum. The prevalence of smoking is over 1 billion people, with the majority coming from low or middle income countries. Yet, the incidence of smoking varies vastly between many countries. Some countries have been able to decline the smoking and tobacco related morbidity and mortality through the introduction of health promotion initiatives and effective policies in order to combat tobacco usage. However, on the other hand, in some countries, the incidence of smoking is increasing still further. With the growing body of evidence of detriment of tobacco to health, many control policies have been implemented as health promotion actions. Such methods include taxation of smoking, mass advertising campaigns in the media, peer education programs, community mobilization, motivational interviewing, health warnings on tobacco products, marketing restrictions, and banning smoking in public places. However, the review of the effectiveness of various health promotion methods used for smoking prevention and cessation is lacking. Therefore, the aim of this review is to identify and critically review the effectiveness of health promotion methods used for smoking prevention and cessation. All available studies and reports published were considered. Searches were conducted using PubMed, MEDLINE, Ovid, Karger, ProQuest, Sage Journals, Science Direct, Springer, Taylor and Francis, EMBASE, CINAHL, and Cochrane and Wiley Online Library. Various relevant search terms and keywords were used. After considering the inclusion and exclusion criteria, we selected 23 articles for the present review.

Background: Renal ischemia-reperfusion injury (IRI) is one of the most important causes of kidney injury, which is possibly gender-related. This study was designed to investigate the role of g-aminobutyric acid (GABA) against IRI in ovariectomized estradiol-treated rats. Methods: Thirty-five ovariectomized Wistar rats were used in six experimental groups. The first three groups did not subject to estradiol treatment and assigned as sham-operated, control, and GABA-treated groups. GABA (50 μmol/kg) and saline were injected in the treated and control groups 30 min before the surgery, respectively. The second three groups received the same treatments but received estradiol valerate (500 μg/kg, intramuscularly) 3 days prior to the surgery. The IRI was induced in the control and treated groups by clamping the renal artery for 45 min and then 24 h of reperfusion. All animals were sacrificed for the measurements. Results: The serum levels of creatinine and blood urea nitrogen, kidney weight, and kidney tissue damage score significantly increased in the IRI rats (P < 0.05). GABA significantly decreased the aforementioned parameters (P < 0.05). The uterus weight increased significantly in rats that received estradiol (P < 0.05). Serum and kidney levels of nitrite (nitric oxide metabolite) did not alter significantly. Serum level of malondialdehyde increased significantly in the ovariectomized rats exposed to IRI (P < 0.05). Conclusions: It seems that GABA improved IRI in ovariectomized rats. Estradiol was also nephroprotective against IRI. However, co-administration of estradiol and GABA could not protect the kidney against IRI.

Background: Preventive care is an important part of primary care medicine, yet much variation in its practice exists. The aim of this study is to assess physicians' perspectives of practicing preventive medicine and evaluate which topics are deemed most important. Methods: All primary care medicine providers at two separate academic medical centers (Mayo Clinic, MN and Mayo Clinic, FL) were surveyed via an E-mail questionnaire assessing physicians' perception of the role of preventive medicine during both acute/routine and yearly visits, physicians' perception of patients' response to preventive medicine topics, and which preventive medicine topics are commonly practiced. Results: Of 445 providers meeting inclusion criteria, a total of 183 (41.1%) responded. Providers were more likely to engage patients in preventive medicine during yearly visits more so than acute visits (3.82 vs. 4.72, range 1-5 Likert Scale), yet providers were very likely to partake in such practices during both visits. Providers perceived that patients received the practice of preventive medicine very well (4.13 on 1-5 Likert Scale). No significant difference between provider practice and patient perception was noted between the two sites, although there was some variation based on clinical experience of the provider. Providers were found to most commonly practice topics recommended by the United States Preventive Services Task Force. Conclusions: Our study found a high predisposition to practicing preventive medicine. Providers seem to practice according to published evidence-based medicine recommendations.

Background: A national project of extending a family physician program to urban areas has been started since May 2013 in Iran. The present study aimed to detect correlates of people's satisfaction and dissatisfaction about urban family physician program. Methods: This cross-sectional and population-based study was conducted in Shiraz, Southern Iran. Multistage and proportional to size random sampling were used. Different items about satisfaction and dissatisfaction toward urban family physician program were queried. Single variable and then multiple variable analyses of data were done using SPSS software (Chicago, IL. USA). Results: Mean age of 1257 participants in the study was 38.1 ± 13.2 years. Respondents included men (634; 50.4%), married (882; 70.2%), those who were educated at universities (529; 42%) and self-employed groups (405; 32.2%). One thousand fifty-eight (84.1%) were covered by the family physician program. Mean of referral times to a family physician was 2.2 ± 2.9 during the year before the study. Satisfaction toward urban family physician program was high in 198 (15.8%), moderate in 394 (31.3%), and low in 391 (31.1%). Dissatisfaction about this program was more among younger than 51-year-old groups (for 31-50 years odds ratio [OR] =2.3, 95% confidence interval [CI] =1.4-3.7, P < 0.001 and for 18-30 years OR = 2, 95% CI = 1.2-3.4, P = 0.005), less knowledgeable ones (OR = 2.2, 95% CI = 1.3-3.6, P = 0.001), singles (OR = 2.1, 95% CI = 1.2-3.4, P = 0.003), and those with more than 4 of family members (OR = 1.3, 95% CI = 1-1.7, P = 0.05). Conclusions: Overall, the majority of the people are not very satisfied with the urban family physician program. This shows the need for a multi-disciplinary approach including training, improvement of infrastructures and referral system, continuous supervision, and frequent monitoring of user's and provider's feedback about this program. According the results, the family physician program should be improved prior to extending this program to other provinces in Iran.

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