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

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

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

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

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

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

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

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

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

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

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

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

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

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

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