Background: Adherence with lifestyle recommendations is low among hypertensive patients. The main objective of this study was to assess the prevalence of diagnosed hypertension among the Greek urban population and to examine how lifestyle and sociodemographic characteristics differ between already known hypertensive and the rest of the population. Methods: In this cross-sectional survey, data were collected from 1,060 participants (mean age 47.1 ± 16.9 (mean ± 1^standard deviation), 52.7% females). Sociodemographic characteristics, health risk factors, and medical history were involved. Body mass index (BMI) (kg/m²) was calculated, according to reported height and weight. Parametric tests and multiple logistic regression analysis were applied to identify whether socio-demographic characteristics and health risk factors differed between known hypertensive and the rest of the population. Results: Already known hypertensives were 179 (101 females-78 males). The prevalence of known hypertension was 16.9% (18.1% in females and 15.6% in males). In multivariate analysis, known hypertensives were more likely to have advanced age (P < 0,001, OR = 1.101, 95%CI 1.081–1.121) and increased BMI (P < 0,001, OR = 1.138, 95%CI 1.085–1.194). Moreover, they had a higher probability of suffering from other cardiovascular diseases or sharing other risk factors for cardiovascular diseases. Conclusions: Among Greek urban population, almost one to six adults knows to suffer from hypertension. In spite the recommendations, patients who were aware of their illness have increased BMI compared with the rest of the population.

Background: Given the fact that the quality of care of diabetic children and their mothers' psychological health and family life quality have mutual effects on each other; in this study, we aimed to compare family life quality of type 1 diabetic (T1DM) patients with healthy children from the perception of their mothers. However, our findings would be helpful for further interventional studies in order to improve both diabetes management and psychological health of their parents. Methods: In this case control study, mothers of children with T1DM, who referred to endocrine and metabolism clinics of Isfahan city, were enrolled. Demographic and familial characteristics of studied population were recorded. Family life quality was evaluated using Retting and Leichtentritt questionnaire and compared between two groups. The questionnaire consists of 32 items, which were representative of six resources including love, status, services, information, goods, and money. Results: In this study, 50 children with T1DM and 50 healthy children and their mothers were evaluated. Mean total score of family life quality and its resource classes were significantly higher in mothers of T1DM patients than mothers of healthy children (P < 0.05) except for love (P = 0.05). Conclusions: The findings of this study indicated that the total family life quality score was significantly lower in families of diabetic patients than healthy children families from the perception of their mothers. Our results indicated that most of the family-life-related dimensions including attitude and service, services, information, goods, and money affected by the disease conditions and its related comorbidities.

Background: Falling is a serious challenge for public health and a leading cause of morbidity and mortality among the elderly. This study conducted to evaluate the psychometric properties of the Persian version of fall risk screening tool (P-FRST). Methods: A cross-sectional study carried out from September 2018 to March 2019 on 537 elders who referred to urban health centers in Kerman, Iran. Demographic data recorded and fall-risk assessment was performed using P-FRST and the timed up and go test (TUG). The maximum possible score is 33 for P-FRST and score ≥18 is considered as high risk. The time ≥12 s in TUG test considered as a risk for falling. Data analyzed by SPSS using t-test, analysis of variance, and linear regression. Results: The mean age of participants was 67.18 ± 6.93. According to P-FRST, 22% of the elderly were high risk and 62% had a moderate risk for falling. The mean score for falling risk was significantly higher in the females, illiterates, income <10 million IRRLs, and the unemployed. Conclusions: Due to the risk of falling in the elderly, it is suggested that in the comprehensive health care for the elderly, to assess the risk of falling, especially in high-risk groups, so that preventive interventions can be made.

Background: Self-management remains poor among most of the diabetic patients due to various individual and environmental barriers which affect it. These barriers should be identified and intervened promptly. The current study aimed to determine self-management barriers perceived by patients with type 2 diabetes. Methods: A cross-sectional study carried out on 681 patients with type 2 diabetes who referred to the diabetes center which is affiliated to Kerman University of Medical Sciences, Kerman, Iran during 2018. Through a structured interview, demographic and disease-related data were recorded and the Persian version of the modified Personal Diabetes Questionnaire (PDQ) was used to assess self-management barriers. The tool has four subscales including diet, medication, monitoring, and exercise barriers. The higher score in each subscale indicates a higher level of barriers in that section. Data analyzed by SPSS 20 using T-test, ANOVA, and multiple linear regressions. Results: The majority of the patients (62.8%) were female, married (78.3%) with monthly income 10 to 20 million IRRLs (78.4%) and the mean age of 55.65 ± 14.65 years. Body Mass Index, marital status, monthly income, and HbA1C significantly predicted the barriers' score. The instrument had excellent reliability (α = 0.95). In confirmatory factor analysis, the fit indices had approximately acceptable levels. Conclusions: The Persian version of modified PDQ had good psychometric properties and can be used as a valid and reliable instrument in the primary health care setting. The significant perceived barriers should be identified and intervened by health care providers through the comprehensive management of diabetic patients.

Background: Inflammation is one of the effective factors, in the development of functional disorders of the nervous system. Pentoxifylline (PTX) has an inhibitory effect on inflammatory factors. Therefore the aim of this study was to evaluate the effect of PTX on learning, memory and expression of genes, involved in neuronal survival in the rat hippocampus, following systemic lipopolysaccharide (LPS) injection. Methods: Male rats were randomly divided into 5 groups of control, LPS and LPS + PTX, receiving doses of 10, 25 and 50 mg/kg of PTX, respectively. In LPS groups, LPS was injected (5 mg/kg; intraperitoneal), and after one week, rats received intraperitoneal PTX for 14 days, in the treatment groups. Learning and memory were evaluated by object location task (OLT) and novel object recognition (NOR). Then, the hippocampus was dissected in order to measure the expression of the associated genes. Results: The results showed that peripheral LPS injection caused significant damage (P < 0.01) to learning and memory with respect to controls, but PTX with doses of 10 and 50 mg/kg prevented these impairments. Results from reverse transcription polymerase chain reaction (RT-PCR) showed that LPS significantly increased the expression of Bax and TNF- α with respect to controls. PTX in the LPS + PTX group significantly increased the expression of Bcl-2, BAD and Caspase-3. Conclusions: Other than the increased Bcl-2 expression, PTX had no significant effect on the expression of other genes, therefore further studies are needed to find out how PTX improves the learning and memory impairments, following the peripheral inflammation.

Background: Since 2009, the MPH course has been implemented in Iran. After eight years, this study aimed to evaluate family physician MPH program in Iran. Methods: This cross-sectional study was conducted on 255 graduates of family physician MPH, selected through simple random sampling and 95 managers who were involved in the design and implementation of the course in 13 universities, selected by census method, in 2017. Data collection tools were two researcher-made questionnaires, delivered to the subjects through emails. Data analysis was performed in SPSS version 21 using central and dispersion indices, Chi-square, and independent t-test. Results: Approximately half of the participants considered the course length as appropriate, 14.5% of them considered the duration of the course short, and 28.9% of them considered it long and there was no significant difference between the views of managers and physicians in this regard. On the other hand, there was a significant difference between managers and physicians regarding the variables of cost-effectiveness, motivation to participate in the course, the necessity of presenting the thesis, applicability of the content, comprehensibility of the content of the course, and desirability of the course load. Thus, a higher percentage of managers acknowledged the necessity of theses and duties as well as the applicability of the content, and a higher percentage of physicians referred to cost-effectiveness and the motivation to participate in the course. Conclusions: According to the results of the study, the participants have proposed some strategies, such as revising the educational content, clarifying the future position of the trained physicians and granting privileges, specifying the program goals, being accurate in selecting motivated applicants with an interest in this field in order to improve the quality of educational courses.

Background: Cellular activity such as gene expression is regulated by epigenetic mechanisms and modifications. In mammals, DNA methylation is an essential component of the epigenetic machinery of the cells. DNA hypermethylation of the several tumor suppressor genes (TSGs) is associated with transcriptional gene silencing resulting in colon tumorigenesis. Overexpression of DNA methyltransferase 1 (DNMT1) in colon cancer has been reported in several studies. The methylation of estrogen receptor alpha (ERα) and estrogen receptor beta (ERβ) have been demonstrated in various cancers. Previously, we indicated that genistein can reactivate ERα in hepatocellular carcinoma (HCC). The present study was designed to investigate the effect of 5-aza-2′-deoxycytidine (5-aza-CdR) on ERα/ERβ and DNMT1 gene expression, apoptosis induction, and cell viability inhibition of the colon carcinoma HT 29 cell line. Methods: The effect of 5-Aza-CdR on the colon carcinoma HT 29 cell viability was measured by MTT assay. To determine the apoptotic cells, the cells were assessed using the Annexin V-FITC/PI detection kit. The expression of ERα, ERβ, and DNMT1 genes was determined using real-time quantitative RT-PCR. Results: The results indicated that 5-Aza-CdR can inhibit cell growth significantly versus control groups, induce significant apoptosis, down-regulate DNMT1, and up-regulate ERα and ERβ genes expression at different time periods. The percentage of apoptotic cells was 85.83% and 86.84% after 24 and 48 h, respectively (P < 0.01). The IC50 value for 5-Aza-CdR was obtained at 2.5 μM. Conclusions: 5-Aza-CdR can up-regulate ERα and ERβ genes expression through DNMT1 down-regulation resulting in apoptosis induction and cell growth prevention.

Background and Aims: Prostate cancer screening applied for early diagnosis of prostate cancer. But it is not usually pursued by men. This study was conducted to determine the effect of educational program based on the Theory of Planned Behavior (TPB) on prostate cancer screening. Methods: A randomized clinical trial was carried out on 68 middle-aged men referring to community houses in Iran. Samples were selected consecutively considering the inclusion criteria. Then block randomization was used to assign the participants into two groups. Data collection included demographic characteristics, knowledge and construct of TPB (Attitude towards the behavior, Subjective norms, Perceived behavioral control, behavioral intention) and behavior. The participants in the intervention group attended a theory based program 4 session twice per week. The participants were evaluated before and two month after the intervention. P <0.05 was considered statistically significant. Results: After the 2 months intervention, the pretest-posttest changes in the intervention group compared to the control group were in the Knowledge 9.26 ± 3.5 vs. 0.03 ± 1.68, Attitude 11.46 ± 3.5 vs. -0.16 ± 1.39, Subjective norms 3.16 ± 2.6 vs. 0.29 ± 1.3, Behavioral control 6.76 ± 4 vs. 0.12 ± 1.60 and Behavioral intention 1.4 ± 1.54 vs. 0.00 ± 1.00 (P < 0.05). While none of the subjects in control group performed the prostate screening, 10 people (33.2%) performed it in the intervention group. (P < 0.001). Conclusions: Educational program based on TPB has a positive effect on prostate cancer screening. It is recommended to set up regular training programs based on TPB to encourage middle-aged men for prostate cancer screening.

Background: Aerobic exercises induce adaptations that improve physiological function. However, aerobic exercises, oxidative reproduction may lead to injury and other health issues such as adverse cardiac effects. The aim of this study is to evaluate the effect of aerobic exercises on protein expression change in the heart left ventricle to determine the advantages and disadvantages related to this mode of exercise.Methods: Male Wistar rats were randomized into two groups; trained (T) and control (C). Animals from T group were trained for 8 weeks, and then 2D LC-MS/MS iTRAQ method was used for extracting and analyzing the left ventricular proteins. Certain proteins that were highlighted in the special process were selected for further analysis via protein-protein interaction network (PPI) method. The identified proteins were enriched via gene ontology (GO) to find biological terms.Results: We identify five overexpressed antioxidant proteins in T group compared with C group including extracellular superoxide dismutase [Cu-Zn], Frataxin, protein kinase C delta type, STE20/SPS1-related proline-alanine-rich protein kinase, and amyloid-beta A4 protein. Conclusions: Findings indicate that catalase and insulin are two exercise-related proteins. However, they were not included in the significant differentially expressed proteins. Finally it was found that enhancement of antioxidative activity is a direct effect of aerobic exercises.

Background: This study was carried out to design and validate a questionnaire to measure the majority of factors influencing food choices among adults in Iran. Methods: A sequential exploratory mixed-method approach was applied to develop the initial item pool of the Food Choice Determinants Questionnaire (FCDQ) starting with a qualitative study to explore the food choice dimensions and its components. Designing the initial questionnaire using these dimensions and the 36-item Food Choice Questionnaire (FCQ) was then performed. The face, content, and construct validity were also assessed. The construct validity of the questionnaire was assessed using the exploratory factor analysis (EFA). Cronbach's alpha was applied for each main theme to examine the internal consistency. Results: After content and face validity process, a 60-item FCDQ was developed with total items' content validity index (CVI) of 0.69 indicating a reasonable level. The Cronbach's alpha coefficients for each of the six constructs in the scale have shown satisfactory internal consistency. Conclusions: This instrument is valid and reliable to measure food choice determinants in adults and could be applied to design interventions aiming to better food choice.

Background: Metabolic syndrome (MetS) refers to a cluster of risk factors for cardiovascular disease and type 2 diabetes. The aim of this study is to assess the effects of acarbose as an antihyperglycemic agent (drug) on late complications of MetS. Methods: This double-blind randomized clinical trial was done on patients with MetS admitted to Isfahan Endocrine and Metabolism Research Center. They were assigned randomly to two groups: A who received acarbose (n = 32) and group B who received a placebo (n = 42) for 6 months. Cardiovascular indexes including flow-mediated dilation (FMD), intima-media thickness (IMT), epicardial fat thickness (EFT), and C-reactive protein (CRP) were measured at baseline and 6 months after the treatment and compared between the two groups. Results: Post-intervention mean of weight (mean difference: −2.5 ± 0.89) and abdominal obesity (mean difference: −2.2 ± 0.64) in acarbose group were significantly decreased (P value < 0.001). High-density lipoprotein (HDL) level in acarbose group was significantly higher than control group (44.7 ± 7.6 vs 41.1 ± 6.4; P value = 0.043), while the other metabolic parameters were not significantly different between the two groups (P value > 0.05). In both groups, CRP and EFT decreased significantly after the intervention, and the levels of CRP, EFT, and IMT markers in the acarbose group were significantly lower than control group (P value < 0.05). Conclusions: The administration of acarbose in patients with MetS can decrease weight and abdominal obesity as well as the reduction of inflammatory and cardiovascular markers, including CRP, EFT, and IMT and also increases HDL.

Background: Impaired fasting plasma glucose (IFG) as well as diabetes mellitus (DM) may influence the presence of another metabolic syndrome (MetS) components resulting in the different risk of cardiovascular (CV) morbidity and mortality. This study aimed to determine the impact of IFG as well as DM on the 10-year CV risk using Thai CV risk score and primary prevention in complying with CV risk score in these patients. Methods: This cross-sectional study was conducted at the internal medicine clinic, Pathum Thani Hospital, Thailand. The study was approved by the hospital ethics committee and written informed consent was obtained from all patients. Patients having MetS according to the criteria of the International Diabetes Federation were enrolled while those with a history of CVD were excluded. The 10-year CV risk was assessed using the Thai CV risk score. Results: The total of 112 patients were enrolled in the study. They were in old age and female sex was a significantly higher proportion (61.70% vs 35.50%, P = 0.013). Of these, 72.32% had IFG or DM. Proportions of patients with moderate and high CV risk score were significantly greater in IFG/DM group and only 34.48% and 79.31% of patients with moderate or high CV risk score received aspirin and statin. IFG or DM significantly elevated CV risk score (OR = 6.66, 95% CI = 2.29, 19.58). Conclusions: IFG/DM significantly elevated CV risk score in these patients with the strongest impact. The assessment of CV risk is highly recommended for primary prevention and long-term CVD benefit.

Aim: To probe into the possible connection between gastroesophageal reflux disorders (GERDs) and functionally occurring dyspepsia as a factor raising the risk of chronic periodontitis. Materials and Methods: A cross-sectional study was carried out on 40 patients with chronic periodontitis with age group between 40–60 years. The test group included 20 people diagnosed with gastroesophageal reflux disease (GERD), according to the Montreal Definition and Classification agreement, and chronic periodontitis. Symptomatic diagnoses were done to confirm functional dyspepsia. The control group comprised 20 systematically healthy people suffering from chronic periodontitis. Indices measured included flow-rate of saliva, repetitive saliva swallowing test for swallowing function, papillary marginal attachment index of gingiva, oral hygiene index-simplified and decayed, missing, filled teeth index. Data was analyzed using SPSS version 22 (IBM Inc. Chicago, USA). Descriptive statistics, such as mean and standard deviation (SD) for continuous variables and frequency and percentage for categorical variables were determined. T test was performed for intergroup comparison and Pearson correlation test was done for evaluating correlation between various parameters. P≤ 0.05 considered as significant. Results: Statistically significant differences were observed between the test and control groups with regard to all the clinical parameters of interest. Pearson's correlation test revealed a strong negative correlation between salivary flow rate and OHI-S and DMFT scores. The RSST swallow function values demonstrated a moderate negative correlation with OHI-S scores, while OHI-I scores and DMFT scores were observed to be strongly correlated in a positive direction. A statistically significant difference was present in the probing depth and CAL levels between both the groups with higher levels in test group. Conclusion: GERD was linked to incremental incidences of chronic periodontitis and was established as an independent risk-raising factor.

Background: Isfahan Antibiotic Resistance Surveillance System-1 has been instituted in Isfahan, Iran to construct a project for surveillance of clinically significant bacteria, and to help raise a logic regional stewardship program for prevention and control of disseminating-resistant organisms. Methods: During March 2016 to March 2018, an antibiotic resistance surveillance system was designed and implemented by Isfahan Infectious Diseases and Tropical Medicine Research Center. The surveillance program was implemented in three general hospitals in Isfahan. In addition to the routine microbiology data, clinical data (differentiation between true infections and contamination, healthcare-associated infections (HCAI) and community-acquired infections (CAI), as well as determination of the infection site) were obtained and analyzed by WHONET software. Results: During a 2-year period, from 7056 samples that revealed growth of bacteria, 3632 (51.5%) isolates were detected as contamination and 3424 (48.5%) true bacterial isolates were identified. Of these, about 32% of isolates were recognized as HCAI. Totally, the most recognized infections were urinary tract infection, bloodstream infection and skin and soft tissue infections. In patients with HCAIs, 70% of isolates were gram negative and in patients with CAIs 73% isolates were gram negative bacteria. Conclusions: The strength of the project is gathering enough clinical information in addition to microbiologic data, which would increase application of the results for empiric treatment and prevention of the infectious diseases in clinical settings.

Background: There is limited information about the relationship between extraversion, as a personality trait, and the modes of tobacco smoking. The aim of this study was to investigate the relationships between extraversion and cigarette and water-pipe smoking among a representative sample of Iranian high school students. Methods: A sample of 2,312 tenth-grade students in Tabriz (Northwest of Iran) was selected through multistage proportional cluster sampling. Participants completed a self-administered questionnaire including information on cigarette smoking, water-pipe smoking, extraversion, socioeconomical information, as well as demographic characteristics. An ordinal logistic regression model was used for data analysis. Results: In total, 4.2% and 3.5% of the students were regular cigarette and water-pipe smokers, respectively. The adjusted odds ratios were 1.10 (95% CI: 1.04–1.15, P < 0.001) and 1.10 (95% CI: 1.06–1.15, P < 0.001) for the relationships between extraversion and the stages of cigarette smoking and water-pipe smoking status, respectively. Conclusions: It seems that extraversion is in a positive relationship with a cigarette and water-pipe smoking among adolescents. Longitudinal studies are needed to examine the effect of this personality trait on the modes of tobacco smoking and the transition in the stages of cigarette and water-pipe smoking in adolescents.

Background: Diet has an important role in systemic inflammation and development of cardiovascular diseases (CVD). Dietary Inflammatory Index (DII) is a new tool for evaluating the inflammatory potential of the diet. Firefighting is one of the most important occupations with stressful situations and high rates of CVD. In this study, we aimed to investigate the association between dietary inflammatory index (DII) and risk of cardiovascular diseases (CVD) among firefighters. Methods: Two hundred and seventy-three male firefighters aged 18–50 years in various regions of Tehran participated in this cross-sectional study. Assessment of anthropometric, blood pressure, and biochemical parameters including glucose, total cholesterol, triglyceride, high-density lipoproteins (HDL-C), low-density lipoproteins (LDL-C), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and high-sensitivity C-reactive protein (hs-CRP) was done in all firefighters. A validated semi-quantitative questionnaire (168 items) was used for assessment of DII. Results: HDL (P-value = 0.03) and hs-CRP (P-value = 0.05) were significantly higher in third tertile of DII scores than first. After adjustment for confounding factors, there was no significant difference in means (P-value >0.05). The association between DII and hs-CRP was not significant (P-value >0.05). Conclusions Participants in higher DII scores intake less polyunsaturated fatty acids (PUFAs), monounsaturated fatty acids (MUFAs), eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and some antioxidant. The association between hs-CRP and DII was not significant among firefighters.

Background: It has been proven that probiotic Lactobacillus bacteria have inhibitory effects on human cancer cell lines. The aim of this study is to isolate and characterize the antioxidant probiotic Lactobacillus and determine the possible anticancer activities of the selected strain. Methods: One of the Lactobacillus strain isolated from camel doogh sample showed the high antioxidant activity by using of different methods such as resistance to hydrogen peroxide, hydroxyl radical and superoxide anions. The antioxidant strain was characterized by sequencing of 16S rRNA V2-V3 regions and the 16S-23S intergenic spacer (ITS). The methanol extract of this strain supernatant was fractionated using thin layer chromatography (TLC) and antioxidant activity of fractions was detected by 0.1% of DPPH through TLC-DPPH bioautography. In vitro anticancer activity of each fraction was investigated by using MTT and flow cytometry methods. Results: According to the phylogenetic results, the antioxidant Lactobacillus strain was closely related to Lactobacillus hilgardii strain E91 (Accession No. EF536365). After fractionation and anti-proliferation assessments of Lactobacillus hilgardii strain AG12a extracellular materials, one of the antioxidant fraction (F4) showed maximum DPPH radical scavenging activity (IC₅₀of 535.27 μg/mL). MTT assay of the F4 fraction demonstrated cytotoxic activity against Caco-2 with the IC50 value of 299.05 μg/mL. The cell death activity of the fraction was confirmed by flow cytometry with 30.925. Conclusions: In this study, the anticancer and apoptotic properties of Lactobacillus hilgardii against Caco-2 cell line was reported for the first time. The isolated bioactive fraction from the extracellular methanol extract needs to be further investigated in human studies of cancer therapy.