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.