Background: To evaluate any change in tear indices and confocal microscopic findings after corneal collagen crosslinking (CXL) in patients with progressive keratoconus. Methods: Thirty-two consecutive eyes from 23 patients having progressive keratoconus were enrolled in this prospective, interventional cohort study. The standard crosslinking surgery was performed for all patients. Visual, refractive, and topographic evaluations were done before and at 6 months after surgery. Tear function tests and confocal microscopic examination were performed before and at 1 month and 6 months after the procedure. Results: There was no significant change in Schirmer-1 test results and tear osmolarity at 1 month and 6 months after CXL. Using confocal microscopy, all eyes showed reduced or absent subepithelial nerve plexus. Differences in basal epithelial cell density, epithelial mean cell area, and keratocyte density in anterior and middle stroma and endothelial cell pleomorphism were all significant at 1 month and 6 months after CXL (P < 0.05). No significant change was noted in endothelial cell count and their polymegathism at 6 months follow-up. Significant improvement was noted in uncorrected visual acuity, best corrected visual acuity, flattest corneal meridian (K₂ ), and maximum keratometry in Pentacam (K_max ) after 6 months of the procedure.  Conclusions : While CXL would have no effect on tear indices and endothelial cell count, it can cause a significant reduction in subepithelial nerve plexus and significant alterations in epithelial cell density in the anterior and middle stroma.

Background: Musculoskeletal disorders (MSDs) are known to cause occupational injuries. This study aimed to collate the existed relevant data and develop a general feature of MSDs problem among Iranian workforce. Methods: In this study, we used the raw data related to 8004 employees from 20 Iranian industrial settings distributed throughout the country. In all studies, participants were selected based on simple random sampling method, and the data were collected using demographic characteristics and Nordic MSDs questionnaires. Results: The most prevalent MSDs symptoms were reported in the lower back (48.9%), shoulders (45.9%), neck (44.2%), upper back (43.8%), and knees (43.8%). Prevalence rates of MSDs at least in one body region were found to be the highest (90.3%) among health-care workers. Prevalence rates of MSDs symptoms in all body regions were higher among workers with dynamic activities as compared to those of workers with static activities. Conclusions: MSDs symptoms were common among the study population. Health-care provider and workers with dynamic activities had the highest rate of MSDs. These results merit attention in planning and implementing ergonomics interventional program in Iranian industrial settings.

Background: In this study, the nature of food commercials in children's television (TV) was monitored and analyzed; simultaneously, the relationship between recalling TV food commercials and children's interest in them and in the consumption of the same food products was evaluated. Methods: A total of 108 h children's programs broadcast on two channels (Two and Amouzesh) of Islamic Republic of Iran Broadcasting (IRIB) media organization were monitored (May 6-12, 2015). Simultaneously, a cross-sectional study using 403 primary schoolchildren (201 boys) in four schools of Shirvan, Northeast of Iran, was executed. The children were prompted to recall all TV commercials broadcast on IRIB. Meanwhile, they were directed to define in the list of recalled TV food commercials those were interested in and the commercials (food products) they actually were willing to consume. Results: Regarding the frequency and duration of broadcasting, food commercials ranked fifth and sixth, respectively. Fruit leather and plum paste were the most frequently broadcast food commercials. "High quality" (19%), "good taste" (15%), "novelty," and "message on nutritional composition" (13%) were the most frequent messages used in promoting the sale of food products, respectively. In addition, focus on "high quality/precision in the preparation of the food products" was the most frequently used appeals in TV commercials. There was a significant relationship between recalling TV food commercials and the interest in five out of eight of the commercials (62.5%) (P < 0.05). The relationship between recalling TV food commercials and the interest in the consumption of the same food product ("Tomato paste B") was statistically significant for 12.5% of the commercials (P < 0.05). Conclusions: TV food commercials do not encourage healthy eating. The current study provides convincing evidence for policy-makers and researchers to pay more attention to this area.

Background: Decision-making about patients with critical condition transfer from Intensive Care Unit to the general wards be delegated to their families. The aim of the study was explaining the experiences of family caregiver's about care of chronic critically ill patient. Methods: This study was conducted with a qualitative content analysis using unstructured interview. Participants were selected purposively from May 2014 to May 2015 and data collection continued until data saturation. Analysis was based on conventional content analysis. Results: Participants' experiences classified into three main categories as following: nonprofessional care, enhancing factors of care, and inhibiting factors of care. Conclusions: Finding of the current study showed different aspects of care. Care of chronic critically ill patients is a long-term process that affected by different factors. It seems that the exploration of caregivers needs and planning supportive interventions based on their needs improve the quality of care.

Background: Rapid increasing prevalence of diabetes mellitus is a serious health concern in the world. New data determined that the pathogenesis of diabetes mellitus is chronic low-grade inflammation, resulting insulin resistance. Pomegranate seed oil (PSO) has anti-inflammatory effects; though it may reduce insulin resistance and improve glycemia in diabetes mellitus. The present study has been designed to investigate the effects of PSO as a natural dietary component on metabolic state of patients with Type 2 diabetes mellitus. Methods: In a randomized double-blind clinical trial study, 80 patients (28 men) with Type 2 diabetes were randomly allocated to the intervention and control groups. The intervention group consumed PSO capsules, containing 1000 mg PSO twice daily (2000 mg PSO), whereas controls take placebo for 8 weeks. The participants followed their previous dietary patterns and medication use. Dietary factors and metabolic factors including lipid profile, fasting plasma sugar, and insulin and were assayed at the baseline and after 8 weeks. Results: Participants in two intervention and control group were similar regarding anthropometric and the dietary factors at baseline and after trial (P > 0.05). Mean level of total cholesterol, triglyceride, low-density lipoprotein-cholesterol, and high-density lipoprotein was not different significantly between groups after trial (P > 0.05). Consumption of PSO did not significantly affect the levels of parameters such as fasting blood sugar (FBS), insulin, HbA1c, alanine transferase, and homeostasis model assessment-insulin resistance. Conclusions: Consumption of 2000mg PSO per day for 8 weeks had no effect on FBS, insulin resistance and lipid profile in diabetic patients.

Background: The aim of this study was to evaluate clients' satisfaction regarding health-care services and its determinant factors in South-West of Iran. Methods: Totally, 3400 households were randomly selected for this cross-sectional study, carried out in Shiraz, Iran, from December 2013 to March 2014. Data were collected using a checklist that includes insurance status of the household, enrollment in family physician program, and client's satisfaction level with received health services. The level of statistical significance was set at P < 0.05. Results: The mean age of the interviewees was 51.71 (±14.01) years, including 2427 (71.4%) females. 9.4% were insured while 72.3% had registered in family physician program. With respect to the family physician and governmental clinics, most subjects were "satisfied" or "very satisfied" with distance, time for admission, time spent at the clinic, privacy, and cost. As for private clinics, specialist clinics, and private hospitals, the studied subjects were more "dissatisfied" with cost but were more satisfied with other items. Living in higher socioeconomic regions (P = 0.001), dissatisfaction with family physician (P < 0.001, odds ratio [OR] = 2.3), scarcity of prescribed medication (P = 0.02, OR = 1.6), medication cost (P < 0.001, OR = 1.9), and existing chronic diseases in the household (P = 0.03, OR = 1.4) had determinant role in dissatisfaction with health system. Conclusions: Results of the present study demonstrated a high level of satisfaction with the health-care system and family physician in Shiraz, Iran. Moreover, dissatisfaction with family physicians, socioeconomic status, scarcity and cost of drugs, and existing chronic disease(s) were important predictors for dissatisfaction with the health-care system.

Background: Orally disintegrating tablets (ODTs) are a modern form of tablets that when placed in the oral cavity, disperses rapidly. These tablets have advantages, particularly good applications for children and old patients who have a complication in chewing or swallowing solid dosage forms. The aim of this study was to design, formulate, and evaluate the physicochemical properties of 5 mg montelukast ODTs for the prevention of asthma and seasonal allergies. Methods: Formulations were prepared with different amounts of super disintegrating agents and effervescent bases as disintegrant agents. Flowability and compressibility of mixed powders were evaluated. The prepared formulations were tested for hardness, thickness, friability, weight variation, drug content, wetting time, disintegration time, dissolution study, and moisture uptake studies. Results: The compressibility index and angle of repose were in the range of 15.87%-23.43% and 32.93-34.65, respectively. Hardness, thickness, friability, wetting time, and content uniformity of formulations were in the range of 33.7-37.1 N, 3.00-3.81 mm, 0.27%-0.43%, 31-50 s and 96.28%-99.90%, respectively. Disintegration time of the tablets prepared with super disintegrating agents, effervescent bases, and combination of two were in the range of 30-50, more than 60 and 20-36 s, respectively. Conclusions: Mixture of powders and tablets passed all the specified tests. The results showed formulations prepared by super disintegrating agents and super disintegrating agents with effervescent bases had shorter disintegration time compared to formulations with effervescent bases alone.

Background: The research to date does not present an articulated approach to ensure nutrition and food systems education is systematically implemented within schools. This paper aimed to investigate food experts' views of the best strategies to improve school-leavers' knowledge of nutrition and food systems. Methods: In this qualitative study, 28 Iranian food and nutrition experts from four major provinces (Tehran, Fars, Isfahan, and Gilan) were selected and agreed to be interviewed. Required data were collected through in-depth, semi-structured, face-to-face, or telephone interviews and were analyzed thematically using NVivo. Results: The experts' suggested strategies to improve Iranian school-leavers' knowledge of nutrition and food systems fell into three key themes: Policy, education processes, and supportive environments. Together they formed an overarching theme of a multileveled system approach for transferring knowledge. Conclusions: Development of a scaffolded education program could assist curriculum developers and policy makers to assess and update current nutrition and food systems education programs in schools. Insights gained about education initiatives in one country such as Iran can provide an important impetus to support nutrition and food system education more widely.

Background: Ferrous sulfate is the most used supplement for treating anemia, but it can result in unfavorable side effects. Nowadays, nanotechnology is used as a way to increase bioavailability and decrease the side effects of drugs and nutrients. This study investigates the effects of nanoparticles containing iron on blood and inflammatory markers in comparison to ferrous sulfate in anemic rats. Methods: To induce the model of hemolytic anemia, 50 mg/kg bw phenylhydrazine was injected intraperitoneally in rats on the 1 ^st day and 25 mg/kg bw for the four following days. Then, rats were randomly divided into five groups. No material was added to the nipple of the Group 1 (control). Group 2 received 0.4 mg/day nanoparticles of iron; Group 3 received 0.4 mg/day ferrous sulfate, and Groups 4 and 5 received double dose of iron nanoparticle and ferrous sulfate, respectively for ten days. Results: Hemoglobin and red blood cell (RBC) in Group 2 were significantly higher than Group 3 (P < 0.05). In addition, hemoglobin and RBC in Group 4 and 5 were significantly higher than Group 3 (P < 0.05). The average level of serum iron in Groups 2 and 4 was remarkably more than the groups received ferrous sulfate with similar doses (P < 0.05). C-reactive protein in Group 3 was more than Group 2 and in Group 5 was more compare to all other groups. Conclusions: Single dose of nanoparticles had more bioavailability compare to ferrous sulfate, but this did not occur for the double dose. Furthermore, both doses of nanoparticles caused lower inflammation than ferrous sulfate.

Background: To determine the mean and median delays in pulmonary tuberculosis (PTB) diagnosis among adults in one of the world's highest gross domestic product per capita countries and identify patient and health system-related reasons for these delays. Methods: This is a cross-sectional, face-to-face, prospective study of 100 subjects with confirmed PTB, conducted at main tuberculosis (TB) admitting facilities in Qatar. The mean and median diagnostic delays were measured. The Chi-square test with two-sided P < 0.05 was considered to determine the association between factors and diagnostic delay. Results: The mean and median total diagnostic delays of PTB were 53 (95% confidence interval [CI] 42.61-63.59) and 30 (interquartile range; Q1-Q3, 15-60) days, respectively. The mean patient factor delay was 45.7 (95% CI 28.1-63.4) days, and the median was 30 (interquartile range; Q1-Q3, 15-60) days. The mean health system factor delay was 46.3 (95% CI 35.46-57.06) days, and the median was 30 (interquartile range; Q1-Q3, 18-60) days. The most common cause of patient factor delay was neglect of TB symptoms by patients (in 39% of cases), and for health-care system factor delay was a failure (mostly at general and private care levels) to suspect PTB by doctors (in 57% of cases). There were no significant associations between the presence of language barrier, patient occupation or nationality, and diagnostic delay. Conclusions: Despite a favorable comparison to other countries, there is a substantial delay in the diagnosis of PTB in Qatar. Relevant actions including health education on TB are required to minimize this delay.

Background: Obesity is a major problem in both developed and underdeveloped countries. The aim of this study is to investigate the effects of a physical education program (PEP) on promoting health belief model (HBM) scores, increasing physical activity (PA), and reducing obesity among Iranian high school students. Methods: This quasi-experimental study was accomplished at four high schools that were randomly divided into two groups of experiment (forty) and control (forty) male students in junior high schools in Urmia, Iran. Students in the experimental group received a PEP during 6 months. The essential parameters were used for evaluating the effects of educational program on HBM, PA, and body mass index (BMI) of students. Results: After the intervention of 3 and 6 months, the experimental group showed a significant difference on the results of HBM constructs. According to the result of repeated-measures ANOVA, there is a significant difference between the experimental and control groups about the components of PA constructs. Analysis of covariance showed that although BMI reduced in 6 months after intervention, there was no significant difference in BMI. Conclusions: Results of the study revealed that implementation of PEP was effective on increasing the score of the components of HBM and PA of students.

Background: Due to the attribution of fatty liver with some chronic diseases such as obesity, finding a way to control obesity can be useful for the management of fatty liver. This study was performed to assess the effects of Plantago psyllium (PP) and Ocimum basilicum (OB) on anthropometric measurements in people with hepatic steatosis. Methods: All patients with nonalcoholic fatty liver disease (NAFLD) were enrolled in this four-arm parallel, randomized, and single blind trial. They randomly assigned into four groups receiving (1) OB 10 g/day; (2) PP 10 g/day; (3) mix of OB and PP 10 g/day; and (4) control group without placebo for 12 weeks. Anthropometric measurements were assessed during study baseline and after 12 weeks intervention. The data were analyzed using paired sample t-test for within group and analysis of covariance for between groups. Results: In within group analysis, weight and body mass index show a significant reduction after 12 weeks intervention. In addition, soft lean mass and lean body mass were decreased in PP and mixed of PP and OB groups significantly; another group (OB) shows the same result for mass body fat. Although in intervention groups, we see considerable reduction, between group changes did not demonstrate the same consequences. Conclusions: The results of this study showed that administration of OB, PP, or mix of them for 12 weeks does not affect any of the anthropometric measures in NAFLD.

Background: Diabetes is a leading cause of cardiovascular disease (CVD). Moreover, CVD accounts for primary cause of death among diabetic patients. Physicians, especially in the primary care setting, have effective role in the management of cardiovascular risk factors. Therefore, we aimed to compare the prevalence of modifiable cardiovascular risk factors in Type 2 diabetic patients attending to an urban health center as a primary care center with Institute of Endocrinology and Metabolism Diabetes Clinic (IEMDC) as a tertiary center. Methods: This cross-sectional study was performed on 200 adult diabetic patients attending urban health center (Abouzar Health Center) and 201 diabetic patients in a tertiary center. The patients' cardiovascular risk factors including lipid profile, systolic and diastolic blood pressure (BP), and smoking history were recorded. The number of patients who did not achieve the target according to the American Diabetes Association guidelines was determined and compared. Results: The patients in urban health center were older than those who attending IEMDC (P = 0.004). The duration of diabetes was longer among urban center patients (P < 0.001). Comparison of cardiovascular risk factors between two groups of patients showed a significant number of patients with poor-controlled low-density lipoprotein (75% vs. 44.7%) and triglyceride (74% vs. 51.7%) in patients attending primary center (P < 0.001). However, the prevalence of high diastolic BP (60.6% vs. 44.5%) was significantly higher in patients attending IEMDC (P = 0.001). There was no significant difference between the two centers' findings in glycosylated hemoglobin level, high-density lipoprotein level, and systolic BP. Conclusions: Both centers have failure in target achievement in some risk factors; however, the inability of the primary care center in controlling hyperlipidemia in comparison with the tertiary center is a serious warning to provide training about managing dyslipidemia in these centers.

Background: The objective of this study is to develop a new animal model based on signaling pathways to understand the pathophysiology, therapy of depression, and to investigate the antidepressant activity of Enicostemma littorale which is not yet established. Methods: Animal models of depression were raised by physical methods and administration of methyl isobutyl ketone (100 mg/kg b.w., i.p.,) and a protein tyrosine phosphatase inhibitor, sodium orthovanadate (30 mg/kg b.w., i.p.,) to young Wistar rats. E. littorale aqueous extract (100 mg/kg b.w., oral) was administered. Forced swimming test (FST), biochemical, and histopathological parameters were performed with reference to fluoxetine (20 mg/kg b.w., oral) treatment. Results: High-performance thin-layer chromatography confirmed the presence of swertiamarin, a unique glycoside present in the Gentianaceae family. FST indicated high rates of immobility in depressed groups and low rates in plant extract-administered group with reference to fluoxetine. Biochemical assays indicated significantly (P < 0.05) increased levels of total protein, superoxide dismutase, triglycerides, and total serum cholesterol, whereas significant reduction (P < 0.05) of glutathione peroxidase, catalase, and lipid peroxidation in plant extract-administered groups in comparison to the depressed groups. Histopathological analysis indicated disorganized neuronal architecture during depression whereas rejuvenation of neuronal patterns was observed during treatment with plant extract and fluoxetine. Conclusions: This study shows that sodium orthovanadate induces depression in animals and also establishes the antidepressant activity of E. littorale.

Background: Reported cases of uncontrolled use of pesticides and its produced effects by direct or indirect exposition, represent a high risk for human health. Therefore, in this paper, it is shown the results of the development and execution of an algorithm that predicts the possible effects in endocrine system in Fisher 344 (F344) rats, occasioned by ingestion of malathion. Methods: It was referred to ToxRefDB database in which different case studies in F344 rats exposed to malathion were collected. The experimental data were processed using Naοve Bayes (NB) machine learning classifier, which was subsequently optimized using genetic algorithms (GAs). The model was executed in an application with a graphical user interface programmed in C#. Results: There was a tendency to suffer bigger alterations, increasing levels in the parathyroid gland in dosages between 4 and 5 mg/kg/day, in contrast to the thyroid gland for doses between 739 and 868 mg/kg/day. It was showed a greater resistance for females to contract effects on the endocrine system by the ingestion of malathion. Females were more susceptible to suffer alterations in the pituitary gland with exposure times between 3 and 6 months. Conclusions: The prediction model based on NB classifiers allowed to analyze all the possible combinations of the studied variables and improving its accuracy using GAs. Excepting the pituitary gland, females demonstrated better resistance to contract effects by increasing levels on the rest of endocrine system glands.

Background: We studied the effects of high protein (HP) and balanced diets (BDs) on lipid profiles, and high-sensitive C-reactive protein (hs-CRP) levels in obese and overweight women. Methods: In a parallel designed randomized controlled clinical trial, 60 healthy women with body mass index ≥25 kg/m ² , aged 20-46 years, enrolled in an 8-week investigation at aerobic clubs. They were categorized into two groups (HP and BDs), randomly. Fasting lipid profile and hs-CRP levels were evaluated at the beginning and end of the trial. We assessed dietary intake by 3-day records and also used SPSS (version 18; SPSS Inc., Chicago, IL, USA) for data analyzing. Results: Fifty-six participants completed the intervention. Concentrations of low-density lipoprotein cholesterol (P < 0.001 in BD group vs. P =0.023 in HP group) and high-density lipoprotein cholesterol (P < 0.001 in BD group vs. P =0.002 in HP group) increased significantly in both groups. Circulating triglycerides levels increased in both intervention grows, but the change in the HP group was not significant compared with the other group (P = 0.007 in BD group vs. P =0.099 in HP group). Whereas total cholesterol concentration decreased but not significantly so (P = 0.53 in BD group vs. P =0.73 in HP group). There were marginally significant decreases in the hs-CRP levels due to both diets (P = 0.057 in BD group vs. P =0.086 in HP group); however, there were no significant differences between the groups. Conclusions: Administration of HP and BD in overweight and obese women with regular aerobic exercise showed improvement in lipid profiles and hs-CRP levels within the groups, but there were no significant differences between groups.

Background: Alopecia areata (AA) is a noncicatricial (nonscarring) alopecia. The association between AA and celiac disease (CD) is debatable. Several studies declare the relationship between AA and CD as measurement of celiac autoantibodies (anti-gliadin IgA and anti-gliadin IgG), but a few studies consider anti-tissue transglutaminase IgA. The aim of this study was to evaluate the frequency distribution of celiac autoantibodies (all of them) in patients with AA compared with controls. Methods: This study is a case-control study. Thirty-five patients entered in each group. Anti-gliadin IgA, anti-gliadin IgG, and anti-tissue transglutaminase IgA were tested in all patients. Samples were examined in ELISA method with binding site's kits, and the result was reported as positive/negative. Finally, the frequency distribution of autoantibodies was examined. Results: The age average did not show a significant difference between two groups (P = 0.62). In addition, there was no significant difference between the two groups based on gender (P = 0.15). The prevalence of antibody in case and control groups was 2.85% and 0%, respectively. There was no significant difference between the two groups (P = 0.31). Conclusions: There may be a relationship between CD and AA, but the absence of statistical association between AA and CD does not mean that there is no relationship between gluten and AA in certain patients. Thus, we have shown here that the biological tests to search for CD do not bring information and proof enough, and it is why we recommend another approach to disclose gluten intolerance in AA patients.

Background: Food aid programs are strategies that aim to improve nutritional status and to tackle food insecurity. This study aimed to evaluate the effect of a National Food Supplementary Program for Children on households' food security. Methods: The study sample included 359 mothers of children aged 6-72 months under the coverage of the program in two provinces of Iran. Demographic and socioeconomic characteristics of the households and percentage of supplementary food items consumed by target child were assessed by a questionnaire and checklist. Data on household food security were collected by locally adapted Household Food Insecurity Access Scale at the baseline of the study and 6 months thereafter. Results: At the baseline, only 4.7% of families were food secure, while 43.5% were severely food insecure, and these proportions were changed to 7.9% and 38%, respectively (P < 0.001), at the end of the study. Odds of having worse food insecurity in households with medium and high wealth index was 65% and 87% lower than those with low wealth index, respectively (odds ratio [OR] = 0.35, 95% confidence interval [CI]: 0.2-0.61, and OR = 0.23, 95% CI: 0.12-0.43). Food sharing was common among more than 95% of the studied households. Mean maternal body mass index (BMI) increased significantly after 6 months (P < 0.001). However, there was no significant association between mother's BMI and household food security in the baseline and at the end of the study (P > 0.05). Conclusions: Findings show that the food supplementary program for children can also improve the household food security status. Further research is needed to assess other factors that affect the effectiveness of this kind of programs.

Background: This study investigated the effects of Lignosus rhinocerotis (LRS) supplementation and resistance training (RT) on isokinetic muscular strength and power, anaerobic and aerobic fitness, and immune parameters in young males. Methods: Participants were randomly assigned to four groups: Control (C), LRS, RT, and combined RT-LRS (RT-LRS). Participants in the LRS and RT-LRS groups consumed 500 mg of LRS daily for 8 weeks. RT was conducted 3 times/week for 8 weeks for participants in the RT and RT-LRS groups. The following parameters were measured before and after the intervention period: Anthropometric data, isokinetic muscular strength and power, and anaerobic and aerobic fitness. Blood samples were also collected to determine immune parameters. Results: Isokinetic muscular strength and power were increased (P < 0.05) in participants of both RT and RT-LRS groups. RT-LRS group had shown increases (P < 0.05) in shoulder extension peak torque, shoulder flexion and extension average power, knee flexion peak torque, and knee flexion and extension average power. There were also increases (P < 0.05) in anaerobic power and capacity and aerobic fitness in this group. Similarly, RT group had increases (P < 0.05) in shoulder flexion average power, knee flexion and extension peak torque, and knee flexion and extension average power. In addition, increases (P < 0.05) in anaerobic power and capacity, aerobic fitness, T lymphocytes (CD3 and CD4), and B lymphocytes (CD19) counts were observed in the RT group. Conclusions: RT elicited increased isokinetic muscular strength and power, anaerobic and aerobic fitness, and immune parameters among young males. However, supplementation with LRS during RT did not provide additive benefits.

Background: It is hypothesized that the impacts of life events accumulate and can trigger and promote atherosclerosis in susceptible individuals. In the current study, the correlation of total life stressors during 1 year was investigated relative to coronary artery disease (CAD). Methods: The study population consisted of 148 males and 152 females aged 35-76 years. The subjects were classified as CAD cases and controls according to the results of coronary angiography. The severity of CAD was scored on the basis of the number and the extent of lesions at coronary arteries. The stressful events of life were assessed using Holmes-Rahe Questionnaire and was presented as total psychological stress scores per year (TPSS). Results: The frequency of cigarette smoking, diabetes mellitus, and hypertension was more prevalent in CAD cases than control subjects. The levels of TPSS were increased in patients with CAD compared to the controls (160.3 ± 71.3 vs. 139.8 ± 66.5, P = 0.020). TPSS was also associated positively with the levels of uric acid, erythrocytes counts, erythrocyte sedimentation rate, aspirin consumption, and negatively with high-density lipoprotein-cholesterol and apo-AI. In logistic regression analysis, TPSS correlated with the occurrence of CAD by the odds ratio of 1.773 (1.073-2.930), P = 0.025, but the association was weakened after adjustment for classical risk factors, especially hypertension. TPSS exhibited significant association with the severity of CAD [F (3,274) = 2.6, P = 0.051]. Conclusions: The results suggest that TPSS are associated with the occurrence and severity of CAD significantly, but the association is not independent.

Background: It is clear that tobacco smoking and substance abuse have negative consequences on adolescent and youth's health. Tobacco smoking especially hookah smoking has increased worldwide especially among university students. This study aimed to determine the prevalence of risk-taking behaviors such as cigarette smoking, hookah smoking, alcohol use, and drug abuse and its predictors in students of Karaj universities. Methods: This cross-sectional study took place in Karaj in January and February 2014. The randomly selected sample consisted of 1959 college students. A self-administered questionnaire was used to measure risk-taking behaviors as well as demographic and related risk factors. Logistic regression model was performed in data analysis. Results: The prevalence of cigarette smoking was 9.3%. The prevalence of hookah smoking was 9.3%. 7% of students used illegal drugs and 9.5% of students used alcohol at least once in last 30 days. After adjustment for other factors, being male, living without parents, having smoker friends, and presence any smoker in the family were factors associated with students' risk-taking behaviors. The results showed the co-occurrence of risk-taking behaviors. Conclusions: The prevalence of tobacco smoking and substance abuse, particular in males, are high. It seems that planning preventive interventions for this part of the population are necessary. This study emphasized the co-occurrence of risky behaviors, so, it is better high-risk behaviors simultaneously targeted at reducing or preventing interventions.

Background: Despite the progress made, animal bites and rabies are one of the important health problems in the country. The purpose of this study was to investigate the epidemiology of animal bites and rabies during 2004-2014 in Lorestan Province to prevent them in population of the province for the future prospective aspects. Materials and Methods: In a descriptive cross-sectional study, all those cases bitten in the province, during 2004 and 2014, were studied. The required information about the age, sex, the bitten organ, type of the invasive animal time, and location of the event were collected in questionnaires and then analyzed. Results: The total number of cases of animal rabies during the period of study was 43,892, shown at the rate of 223.23 in 100,000 people. Seventy-eight percent of animal bites in rural areas, 41.42% in the ages 10-29-year-old, 26.8% of cases were students, 56.77% leg bites, and 82.5% of dog bites. Four cases of human rabies were observed during this period. Conclusions: Rate of animal bites and rabies is high in Lorestan Province. Controlling animals such as dogs and cats in the province through training people at risk, especially among the students, rural areas and inter-sectorial coordination to eliminate stray animals should be considered over and over. Preventive actions to avoid bites are a priority.

Background: Traditional cigarette advertising has existed in the US for over 200 years. Studies suggest that advertising has an impact on the initiation and maintenance of smoking behaviors. In recent years, electronic cigarettes (e-cigarettes) emerged on the market as an alternative to the traditional tobacco cigarette. The purpose of this study was to describe advertisements in popular US magazines marketed to women for cigarettes and e-cigarettes. Methods: This study involved analyzing 99 issues of 14 popular US magazines marketed to women. Results: Compared to advertisements for traditional cigarettes, advertisements for e-cigarettes were more often found in magazines geared toward the 31-40-year-old audience (76.5% vs. 53.1%, P = 0.011) whereas traditional cigarette advertisements were nearly equally distributed among women 31-40 and ≥40 years. More than three-quarters of the e-cigarette advertisements presented in magazines aimed at the higher median income households compared to a balanced distribution by income for traditional cigarettes (P = 0.033). Conclusions: Future studies should focus on specific marketing tactics used to promote e-cigarette use as this product increases in popularity, especially among young women smokers.

Background: The present work was planned to evaluate the antihyperglycemic, lipid-lowering, and antioxidant effect of Lactobacillus casei and Bifidobacterium bifidum in streptozotocin (STZ)-induced diabetic rats. Methods: Single daily dose of 1 × 10 ⁷ cfu/ml of L. casei and B. bifidum alone and in combination of both was given to Wistar rats orally by gavaging for 28 days. Glucose tolerance test, fasting blood glucose (FBG), lipid profile, and glycosylated hemoglobin (HbA1c) were measured from blood. Glycogen from thigh muscles and liver and oxidative stress parameters from pancreas were analyzed. Results: Administration of L. casei and B. bifidum alone and in combination of both to diabetic rats decreased serum FBG (60.47%, 55.89%, and 56.49%, respectively), HbA1c (28.11%, 28.61%, and 28.28%), total cholesterol (171.69%, 136.47%, and 173.58%), triglycerides (9.935%, 8.58%, and 7.91%), low-density lipoproteins (53.27%, 53.35%, and 52.91%) and very low-density lipoproteins (10%, 8.58%, and 11.15%, respectively) and increased high-density lipoproteins (13.73%, 15.47%, and 15.47%), and insulin (19.50%, 25.80%, and 29.47%, respectively). The treatment also resulted in increase in muscle (171.69%, 136.47%, and 173.58%) and liver (25.82%, 6.63%, and 4.02%) glycogen level. The antioxidant indexes in pancreas of diabetic rats returned to normal level with reduction in lipid peroxidation (30.89%, 46.46%, and 65.36%) and elevation in reduced glutathione (104.5%, 161.34%, and 179.04%), superoxide dismutase (38.65%, 44.32%, and 53.35%), catalase (13.08%, 27%, and 31.52%), glutathione peroxidase (55.56%, 72.23%, and 97.23%), glutathione reductase (49.27%, 88.40%, and 110.86%), and glutathione-S-transferase (140%, 220%, and 246.6%, respectively) on treatment with L. casei, B. bifidum, and combination treatment. Conclusions: Administration of L. casei and B. bifidum alone and in combination of both ameliorated hyperglycemia, dyslipidemia, and oxidative stress in STZ-induced diabetic Wistar rats.

Background: Cigarette smoking is one of the most important health-related risk factors in terms of morbidity and mortality. In this study, we introduced a new method for deriving the transitional probabilities of smoking stages from a cross-sectional study and simulated a long-term smoking behavior for adolescents. Methods: In this study in 2010, a total of 4853 high school students were randomly selected and were completed a self-administered questionnaire about cigarette smoking. We used smoothed age- and sex-specific prevalence of smoking stages in a probabilistic discrete event system for estimating of transitional probabilities. A nonhomogenous discrete time Markov chain analysis was used to model the progression of the smoking in 10 years ahead in the same population. The mean age of the students was 15.69 ± 0.73 years (range: 14-19). Results: The smoothed prevalence proportion of current smoking varies between 3.58 and 26.14%. The age-adjusted odds of initiation in boys is 8.9 (95% confidence interval [CI]: 7.9-10.0) times of the odds of initiation of smoking in girls. Our study predicted that the prevalence proportion of current smokers increased from 7.55% in 2010 to 20.31% (95% CI: 19.44-21.37) for 2019. Conclusions: The present study showed a moderately but concerning prevalence of current smoking in Iranian adolescents and introduced a novel method for estimation of transitional probabilities from a cross-sectional study. The increasing trend of cigarette use among adolescents indicated the necessity of paying more attention to this group.

Background: In the present times, arsenic poisoning contamination in the ground water has caused lots of health-related problems in the village population residing in middle Gangetic plain. In Bihar, about 16 districts have been reported to be affected with arsenic poisoning. For the ground water and health assessment, Simri village of Buxar district was undertaken which is a flood plain region of river Ganga. Methods: In this study, 322 water samples were collected for arsenic estimation, and their results were analyzed. Furthermore, the correlation between arsenic contamination in ground water with depth and its distance from river Ganga were analyzed. Results are presented as mean ± standard deviation and total variation present in a set of data was analyzed through one-way analysis of variance. The difference among mean values has been analyzed by applying Dunnett's test. The criterion for statistical significance was set at P < 0.05. Results: This study shows novel findings ever done in this area. Halwa Patti and Doodhi Patti strips were the most affected strips with high-arsenic concentration in hand pumps. Furthermore, a correlation between the arsenic concentration with the depth of the hand pumps and the distance from the river Ganga was also a significant study. Conclusions: The present study concludes that in Simri village there is high contamination of arsenic in ground water in all the strips. Such a huge population is at very high risk leading the village on the verge of causing health hazards among them. Therefore, an immediate strategy is required to combat the present problem.

Background: There is a long lasting dilemma over the ideal screening and diagnostic method in gestational diabetes mellitus (GDM). Even though universal screening is commonly practiced, selective screening based on risk factors is also practiced in some center. The aim of this study is to evaluate the most appropriate method to screen GDM in high-risk pregnant women in Sri Lanka. Methods: This study was a clinic-based, cross-sectional study conducted in a tertiary referral center, Sri Lanka. All women underwent 75 g oral glucose tolerance test at 24-28 weeks of gestation. Diagnosis of GDM was made according to the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) and World Health Organization (WHO) criteria. Results: With universal screening using IADPSG criteria, 23.2% (105/452) were found to have GDM and with risk factor-based screening 20.1% (91/452) were detected to have GDM. The prevalence of GDM dropped to 18.1% when GDM was diagnosed using the WHO criteria with universal screening approach. It was further dropped to 15.7% when the WHO criteria were used along with risk factors-based screening approach. Conclusions: The IADPSG criteria labeled considerably higher number of women as having GDM compared to the WHO criteria. With regards to the screening methods, the risk-based screening had a lower detection rate of GDM; however, it reduced the necessity of screening of women by around 20%.

Background: Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in the world. Although some studies have been conducted about dietary intakes of these patients, but the results are inconsistent. The aim of this study was to survey all macronutrients and micronutrients included in dietary intake of these patients for better understanding the factors influencing this disease. Methods: The present study is a case-control conducted in Isfahan city, Iran. The cases were recently diagnosed patients with NAFLD who identified by ultrasonography. The case (159) and control (158) individuals were matched in age and gender. Data of general characteristics and physical activity of individuals were collected through questionnaire. Dietary intake was also collected using 24 h dietary recall questionnaire. Results: Waistline and body mass index for the case group were more than the control group (P < 0.05). Physical activity level in healthy individuals was more than patients with NAFLD. Dietary intake of saturated fatty acids and sugar in patients with NAFLD was more than healthy individuals (P < 0.05). Intake of total dietary fiber, folic acid, Vitamin D, zinc, and potassium in healthy individuals was more than patients with NAFLD (P < 0.05). Conclusions: In total, it seems the type of dietary intake source is associated with NAFLD. Increasing saturated fatty acids and sugar and decreasing fiber, folic acid, Vitamin D, zinc, and potassium intake might play a role in the progression of this disease.

Background: Lippia citriodora Kunth is one of the Iranian traditional medicines for the treatment of convulsive disorders. The goal of this study is to investigate the anticonvulsant activity of the plant's leave ethanolic extract against electro- and chemoconvulsant-induced seizures in mice. Methods: The anticonvulsant activity of the extract (200, 400, 800 mg/kg, per os, p.o.) was investigated in pentylenetetrazole (PTZ) and maximal electroshock (MES)-induced seizures in mice. Diazepam (1 mg/kg) and phenytoin (25 mg/kg) intraperitoneally (i.p.) were used as reference drugs. In addition, for investigating the role of GABAergic system, flumazenil (2 mg/kg, i.p.) was also injected before L. citriodora. Results: The extract had not any toxicity and significantly decreased the duration and increased the latency of the seizures induced by PTZ (90 mg/kg). In the MES test, L. citriodora displayed statistically significant reduction in hind limb tonic extension duration in a nondose-dependent manner. Flumazenil reversed the anticonvulsant activity of the plant's extract in the PTZ model. Conclusions: The results propose that L. citriodora leave ethanolic extract has anticonvulsant activity against convulsive disorders. It seems that this plant's extract generates its antiseizure effect through GABAergic system potentiation. Further studies will be needed in order to investigate the exact mechanisms of it. Moreover, one may conclude that the present results are in accordance with the positive effect of L. citriodora extract to treat convulsion mentioned in old Iranian literature.

Background: The rapid rise in noncommunicable diseases (NCDs) is one of the main health challenges affecting the global development in the present era. This raising challenge is a major threat to countries' socioeconomic development as well as millions of people health. Methods: It was a retrospective study with analysis of reported death in Isfahan Province during a 5-year period from 2007 to 2011. Required data were collected from statistics provided by Deputy of Health in Kashan and Isfahan Universities of Medical Sciences in 2012. Excel software was used for data analysis. Results: During this period, the cardiovascular events, cancers and tumors, unintentional injuries, respiratory diseases, and prenatal mortality were the main reasons of mortality in Isfahan Province. The overall rate of cardiovascular events rose 5.10% in the 5-years of the study observation, and Khor - Biabanak was on the top of the list; while in cancer rating Khor - Biabanak, Golpayegan, and Khansar both stood at the outset (per 1,000 people). For injuries, the highest rate belonged to Golpayegan, Tiran-Kervan, and Chadegan. Meanwhile, for mental illnesses, the highest rate was observed in Khomeini Shahr. Moreover, the highest maternal and fetal mortality was reported in Fereydunshahr, Khor - Biabanak and Mobarakeh. Conclusions : Given the sharp rise of NCD, programs by health care system should be directed toward lifestyle modification while a proper framework should be determined to deal with these kinds of disease. Furthermore, optimal allocation of resources based on needs can provide better facilities for different cities.

Background: This study was performed to effects of garlic and lemon juice mixture on lipid profile and some cardiovascular risk factors in people 30-60 years old with moderate hyperlipidemia. Methods: In a parallel-designed randomized controlled clinical trial, a total of 112 hyperlipidemic patients 30-60 years, were recruited from Isfahan Cardiovascular Research Center. People were selected and randomly divided into four groups. Control blood samples were taken and height, weight, and blood pressure were recorded. (1) Received 20 g of garlic daily, plus 1 tablespoon lemon juice, (2) received 20 g garlic daily, (3) received 1 tablespoon of lemon juice daily, and (4) did not receive garlic or lemon juice. A study technician was done the random allocations using a random numbers table. All participants presented 3 days of dietary records and 3 days of physical activity records during 8 weeks. Blood samples were obtained at study baseline and after 8 weeks of intervention. Results: Results showed a significant decrease in total cholesterol (changes from baseline: 40.8 ± 6.1, P 0< 0.001), low-density lipoprotein-cholesterol (29.8 ± 2.6, P < 0.001), and fibrinogen (111.4 ± 16.1, P < 0.001) in the Group 1, in comparison with other groups. A greater reduction in systolic and diastolic blood pressure was observed in Group 1 compared with the Groups 3 and 4 (37 ± 10, P = 0.01) (24 ± 1, P = 0.02); respectively. Furthermore, a great reduction in body mass index was observed in the mixed group compared with the lemon juice and control groups (1.6 ± 0.1, P = 0.04). Conclusions: Administration of garlic plus lemon juice resulted in an improvement in lipid levels, fibrinogen and blood pressure of patients with hyperlipidemia.

Background: Conventional hepatitis B virus (HBV) vaccination fails to achieve efficient protection in about 5-10% of the world population. Hence, different strategies have been adopted to ameliorate HBV antibody titers. This study aimed to evaluate the concurrent application of tetanus-diphtheria (Td) and HBV vaccination on hepatitis B surface (HBs) antibody titer in low-responder healthy individuals. Methods: This was a randomized clinical trial, which was implemented among 140 of medical staff working as health-care workers assumed as low-responders. The subjects were randomly allocated to either control or interventional groups. The control and interventional groups received HBV recombinant vaccine while the latter group was also vaccinated through Td. Enzyme-linked immunosorbent assay was applied to measure HBs antibody (HBsAb) titers just before and 6 months after the last vaccination. All data were entered into SPSS software. Independent t-test, paired t-test, and Chi-square or Fisher's exact test were applied for data comparison. Results: Antibody titers of the subjects in the intervention and control groups soared from 49.08 ± 20.08 IU/L to 917.78 ± 204.80 IU/L and from 46.95 ± 18.55 to 586.81 ± 351.77 IU/L, respectively (both P < 0.001); nevertheless, by comparison with control group, variation of antibody titer in the interventional group was significantly higher (P < 0.001). Conclusions: Concurrent application of Td and HBV vaccine could effectively enhance protective levels of HBsAb titers in low-responder individuals.

Background: Smoking is a well-known public health problem in women as well as men. In many countries including Iran, there is an increase in tobacco use among women. Exploring the experience of smoking by educated women in order to develop effective tobacco prevention programs in these women is necessary. This study aimed to explore the experiences of smoking among Iranian educated women. Methods: This study used a method of qualitative content analysis with the deep individual, semi-structured interviews on a sample of 14 educated female smokers, selected purposefully. Data were analyzed using qualitative content analysis with conventional approach while being collected. Results: The data analysis led to 16 subcategories which were divided into four main categories: (1) Personal factors including subcategories of imitation, show-off and independence, inexperience and curiosity, personal interest and desire, improved mood, and social defiance; (2) family factors including smokers in the family, intrafamily conflicts, and family strictures and limitations; (3) social factors including subcategories of effects of work and school environment, gender equality symbols, peer pressure, and acceptance among friends; and (4) negative consequences of smoking including subcategories of a sense of being physically hurt, psychological and emotional stress, and being looked upon in a negative and judgmental manner. Conclusions: The findings of this study showed that smoking among Iranian educated women is a multifactorial problem. Thus, it is necessary to address smoking among educated women in a holistic approach that focuses on different determinants including personal, family, and social factors particularly the gender roles and stereotypes.

Background: Physical exercises can influence some anthropometric and fitness components differently. The aim of present study was to evaluate how a relatively long-term training program in 11-14-year-old male Iranian students affects their anthropometric and motor performance measures. Methods: Measurements were conducted on the anthropometric and fitness components of participants (n = 28) prior to and following the program. They trained 20 weeks, 1.5 h/session with 10 min rest, in 4 times trampoline training programs per week. Motor performance of all participants was assessed using standing long jump and vertical jump based on Eurofit Test Battery. Results: The analysis of variance (ANOVA) repeated measurement test showed a statistically significant main effect of time in calf girth P = 0.001, fat% P = 0.01, vertical jump P = 0.001, and long jump P = 0.001. The ANOVA repeated measurement test revealed a statistically significant main effect of group in fat% P = 0.001. Post hoc paired t-tests indicated statistical significant differences in trampoline group between the two measurements about calf girth (t = −4.35, P = 0.001), fat% (t = 5.87, P = 0.001), vertical jump (t = −5.53, P = 0.001), and long jump (t = −10.00, P = 0.001). Conclusions: We can conclude that 20-week trampoline training with four physical activity sessions/week in 11-14-year-old students seems to have a significant effect on body fat% reduction and effective results in terms of anaerobic physical fitness. Therefore, it is suggested that different training model approach such as trampoline exercises can help students to promote the level of health and motor performance.

Background: Malnutrition is prevalent among patients hospitalized in Intensive Care Units (ICUs) and causes various complications. Dietary supplementation to provide appropriate nutritional support may reduce the malnutrition and complications through improvement in nutritional status. This study was carried out to assess the association between dietary supplementation and malnutrition among patients in ICUs. Methods: A case-control study was conducted on 180 male patients aged 20-60 years in the ICUs of the hospitals in Ahvaz, Iran in 2013. Data of two groups including 83 patients (cases) who had consumed regular hospital meals and dietary supplements and 97 patients (controls) who had received regular hospital meals were compared. Anthropometric measurements, laboratory values, and dietary intakes were extracted from medical records, and Maastricht index (MI) was calculated. Data were analyzed using the IBM SPSS Statistics 21. T-test and paired-sample t-test were used to determine the difference between groups. Results: Taking supplements increased daily energy intake, carbohydrate, and protein in case group (n = 83) significantly (P < 0.05). MI changed to 3.1 ± 3.8 and 4.3 ± 4.2 in case (n = 83) and control (n = 97) groups, respectively. Although the MI fell in both groups, it showed a greater reduction in case group (from 6.3 ± 5.3 to 3.1 ± 3.8). Conclusions: Since consuming dietary supplements besides the regular hospital meals increased intake of energy and macronutrients and reduced the MI significantly, it was concluded that it helped supply nutritional requirements more effectively and improved the malnutrition in ICU.

Background: Untreated or poorly controlled gestational diabetes can cause serious complications for mother and newborn. Glibenclamide is rarely used in treating mothers with this disease. This study aimed at comparing the effect of glibenclamide and insulin on neonatal outcomes in women with gestational diabetes mellitus. Methods: In this randomized controlled clinical trial, 249 pregnant women aged 18-45 years within the 11 ^th -33 ^rd weeks of gestation with gestational diabetes, single fetus pregnancy, and in need of hyperglycemia treatment were entered and grouped randomly as either glibenclamide or insulin. In the insulin group (n = 129), insulin was administered with an initial dose of 0.2 IU/kg subcutaneously twice per day, whereas in the glibenclamide group (n = 120), 1.25 mg oral glibenclamide was administered once daily and increased if needed. Results: The results showed no significant difference in means age, gestational age, and body mass index between women in the two groups. In addition, there were no significant differences in the frequency of neonatal hypoglycemia, anomaly, hyperbilirubinemia, admission in Neonatal Intensive Care Unit (NICU), and neonatal respiratory distress between two groups. Macrosomia was lower in the glibenclamide group than the insulin group (3.3% vs. 13.2%, respectively, P = 0.005). Regression logistics model results showed that the type of treatment (odds ratio [OR]: 4.62; confidence interval [CI]: 1.45-14.02; P = 0.01) and gestational age at delivery (OR: 1.41; CI: 1.04-1.74; P = 0.01) were as predictor factors of macrosomia. Conclusions: The results of this study revealed that glibenclamide is able to reduce the risk of fetal macrosomia without increasing neonatal anomalies, jaundice, hypocalcemia, infant respiratory distress, and NICU admission.

Background: Describing trend in tuberculosis (TB) over time can play an important role to assess the disease control strategies and predict the future morbidity and mortality. This study aimed to determine the incidence trend of smear-positive pulmonary tuberculosis (SPPT) in sub-age and sex groups during the years of 1995-2012. Methods: This retrospective cohort study was performed in 2015 by using the dataset regarding National Statistics of SPPT reported by World Health Organization during 1995-2012. Annual percent changes (APCs) and average annual percent changes (AAPCs) were estimated to determine the summery statistics of trend using segmented regression model. Results: During 1995-2012, there were 96,579 SPPT case notifications in Iran (male to female ratio: 0.99). There was only one change point in 1997 for SPPT incidence in subgroups of age and sex during 1995-2012. The AAPCs for both genders and also all three age groups had a significant descending trend during the time period (P < 0.05). Conclusions: Our results showed a downward trend in the SPPT incidence. It seems that to achieve the set goals and high successful in TB control program especially reduction in SPPT, pay more attention to old age and males should be considered. In addition, improvement of clinical and medical care services and notification processes would be imperative.

Background: Daunorubicin-induced acute cardiotoxicity caused by oxidative stress and free radical formation. Pomegranate possessed a significant in vitro free radical scavenging activity. Therefore, the aim of this study was estimations of the role of pomegranate effects in daunorubicin-induced cardiotoxicity. Methods: A total of 21 Sprague male rats were allocated into three groups, seven animals in each group. Group A: Control group received distilled water. Group B: Treated group with daunorubicin 20 mg/kg via intraperitoneal injection daily for the 12 ^th day for total cumulative dose of 240 mg/kg. Group C: Pretreatment group with pomegranate 25 mg/kg for 6 days orally, then daunorubicin 20 mg/kg administrated concomitantly for the next 6 days with a cumulative dose of 120 mg/kg. Cardiac troponin I [cTn I] pg/ml), malondialdehyde (MDA) (ng/ml), interleukin 17 (IL-17 pg/ml), and cardiac lactate dehydrogenase (LDH) (pm/ml), all these biomarkers were used to measure the severity of cardiotoxicity. Results: Daunorubicin at a dose of 20 mg/kg lead to pronounced cardiac damage that reflected on through elevations of serum cTn and serum LDH levels significantly P < 0.01, it induced lipid peroxidation during cardiotoxicity that reflected through an elevation in the serum MDA significantly P < 0.01, moreover, daunorubicin induces pro-inflammatory changes in cardiotoxicity; it raises the IL-17 serum level significantly P < 0.01 as compared with control. Pomegranate pretreatment demonstrated a significant cardioprotection from daunorubicin-induced cardiotoxicity; it attenuated the cardiac damage through reduction of cTn, LDH, MDA, and serum IL-17 level significantly P < 0.01 as compared with daunorubicin-treated group. Conclusions: Pomegranate demonstrated significant cardioprotection in daunorubicin-induced cardiotoxicity through reduction of oxidative stress, lipid peroxidation, pro-inflammatory, and cardiac injury biomarkers.

Background: As key determinants of many favorable health and quality of life outcomes, it is important to identify factors associated with mobility and social participation. Although several investigations have been carried out on mobility, social participation and neighborhood environment, there is no clear integration of these results. This paper presents a scoping study protocol that aims to provide a comprehensive understanding of how the physical and social neighborhood environment is associated with or influences mobility and social participation in older adults. Methods: The rigorous methodological framework for scoping studies is used to synthesize and disseminate current knowledge on the associations or influence of the neighborhood environment on mobility and social participation in aging. Nine databases from public health and other fields are searched with 51 predetermined keywords. Using content analysis, all data are exhaustively analyzed, organized, and synthesized independently by two research assistants. Discussion: A comprehensive synthesis of empirical studies provides decision-makers, clinicians and researchers with current knowledge and best practices regarding neighborhood environments with a view to enhancing mobility and social participation. Such a synthesis represents an original contribution and can ultimately support decisions and development of innovative interventions and clear guidelines for the creation of age-supportive environments. Improvements in public health and clinical interventions might be the new innovation needed to foster health and quality of life for aging population. Finally, the aspects of the associations or influence of the neighborhood environment on mobility and social participation not covered by previous research are identified. Conclusions: Among factors that impact mobility and social participation, the neighborhood environment is important since interventions targeting it may have a greater impact on an individual's mobility and social participation than those targeting individual factors. Although investigations from various domains have been carried out on this topic, no clear integration of these results is available yet.

Background: Waist circumference (WC) is an accurate and simple measure of abdominal obesity as compared to waist-hip ratio (WHR). The aim of this study was to determine the correlation between body mass index (BMI) with WC and WHR and suggest cutoff points for WC among Rural Malaysian adults. Methods: A cross-sectional study was conducted among 669 respondents from three villages in Tanjung Karang, located in the district of Kuala Selangor. Data collection was carried out by guided questionnaires and anthropometric measures. Results: The prevalence of abdominal obesity for BMI was almost similar for both gender across Caucasian and Asian BMI cutoff points. Based on Caucasian cutoff points, the prevalence of abdominal obesity for WC was 23.8% (male) and 66.4% (female) while for WHR was 6.2% (male) and 54.2% (female). Asian cutoff points gave higher prevalence of abdominal obesity compared to that of WC among male respondents and WHR for both genders. WC showed strong and positive correlation with BMI compared to WHR (in male WC r = 0.78, WHR r = 0.24 and in female WC r = 0.72, WHR r = 0.19; P < 0.001). Receiver operating characteristic curve analysis suggested WC cutoff points of 92.5 cm in men and 85.5 cm in women is the optimal number for detection of abdominal obesity. Conclusions: WC is the best indicator as compared with WHR for abdominal obesity for Malaysian adults.

Background: Hydroxymethylglutaryl-coenzyme A reductase inhibitors (statins) are antihyperlipidemic drugs with an established efficacy in stabilizing atherosclerotic plaques and preventing atherogenesis and reducing cardiovascular events. The purpose of this study was to determine the effect of simvastatin on serum Vitamin D status in dyslipidemic patients as Vitamin D status has an impact on monocyte/macrophage function and may also contribute to cardiovascular risk. Methods: Selected individuals (n = 102) were treated with simvastatin (40 mg/day), or matching placebo in a randomized, double-blind, placebo-controlled, crossover trial. Each treatment period (with simvastatin or placebo) lasted for 30 days and was separated by a 2-week washout phase. Serum Vitamin D concentration was assessed pre- and post-treatment. Results: Seventy-seven completed the trial, noncompliance with the study protocol and drug intolerance or relocation were the causes for drop-out. No significant carry-over effect was observed for the assessed parameters. There was a reduction in the serum levels of low-density lipoprotein cholesterol (P < 0.001), total cholesterol (P < 0.001), and triglycerides (P < 0.05). Nevertheless, simvastatin therapy did not significantly affect serum level of high-density lipoprotein cholesterol and Vitamin D level (P > 0.05). Conclusions: Short-term treatment with simvastatin (40 mg/day) does not have a significant affect on serum levels of Vitamin D.

Background: Obesity and overweight among children is a major public health problem in developed and developing countries and has important health and economic implications. This longitudinal study aimed to assessing the prevalence trend of overweight and obesity in West Azerbaijan in North West of Iran. Methods: This study was a longitudinal follow-up study and was conducted in school children at 2009-2011 year. The subjects were all school children (12 years of age) that were recruited from rural and urban schools in West Azerbaijan. Overall, 22,820 girls and 28,763 boys were enrolled in 2009 and were followed for 3 years. A body mass index (BMI) 85 ^th -95 ^th percentile was classified as overweight and a BMI >95 ^th percentile was classified as obese. All statistical analyses were performed using the Excel Software. Descriptive statistics were used to characterize the sample in different time periods. The prevalence was calculated as the ratio of number of present cases to a given population number in a given subgroup at a given time. Results: In urban schools, the prevalence of overweight among girls and boys was 118.26 and 103.9 per 1000 persons in 2009 year, respectively, and this trend was increased in both girls (152.90 per 1000 persons) and boys (125.72 per 1000 persons) in 2011. The obesity trend was increased among both girls and boys (22.26 and 26.52 among girls and boys in 2009 to 24.66 and 28.65 per 1000 persons in 2011), respectively. In rural schools, the prevalence of overweight among girls was increased from 84.5 in 2009 to 108.89 per 1000 persons in 2011, but this trend was decreased among boys (from 95.49 in 2009 to 43.9 per 1000 persons in 2011), and the prevalence of obesity among boys was increased at the end of follow-up, but this trend was decreased among girls. Conclusions: Overweight and obesity in children has increased. Further studies are necessary to evaluate the relationship between obesity and overweight and risk factors such as dietary pattern and physical inactivity.

Background: Fatty acids play various physiological roles in the organism; they are crucial for the structure of cell membranes, metabolic processes, transmission of nerve impulses and brain functions. In recent years, particular attention has been paid to the rich sources of omega-3 for the treatment of many diseases, especially mental illnesses. The present study aimed to investigate the effects of omega-3 supplement in the treatment of patients with bipolar I disorder (BID). Methods: In this double-blind clinical trial, 100 patients suffering from BIDs were randomly divided into two, i.e. control (n = 50) and experimental (n = 50) groups. In addition to the other standard treatments, 1000 mg of omega-3 supplement was given to the experimental group on daily basis for 3 months and placebo was given to the control group. The Young Mania Rating Scale was completed for both groups before and after the intervention. Afterward, data were analyzed using paired t-test, independent t-test, and Chi-square test. Results: Before intervention, mean severity of mania in the experimental group (23.50 ± 7.02) and control group (23.70 ± 8.09) was not significant (P ≤ 0.89). The difference after the intervention in the experimental group (10.64 ± 3.3) and control group (20.12 ± 6.78) was significant (P < 0.01). The mean intensity of mania before (23.50 ± 7.02) and after (10.64 ± 3.3) intervention reported to be significant at P < 0.05. Conclusions: Since omega-3 supplement was effective for the treatment of BID, it is suggested to use omega-3 supplements as an adjuvant therapy along with the other pharmacotherapies.

Background: High fasting plasma glucose (FPG) is one of the main leading risk factors of ischemic heart disease (IHD), stroke, and chronic kidney diseases (CKDs). We estimated population attributable fraction (PAF) and attributed death of these fatal outcomes of high FPG at national and subnational levels in 25-64 years old Iranian adult. Methods: We used national and subnational data of the Non-Communicable Disease Surveillance Survey for exposure to risk factors in 2005 and 2011 among Iranian adults of 25-64 years old. For estimating the attributed death, using the death registration system data of Iran, we multiply the cause-specific PAFs by the number of outcome-specific deaths. Results: In Iran, high FPG was responsible for about 31% of attributed total deaths of IHD, stroke, and CKD in 2011. The related attributed deaths had increased from 2005 to 2011. In females, the PAFs for the effect of high FPG on IHD, stroke, and CKD were higher in 2011 than 2005 in all age groups. In males, this increase has occurred in over 45 years old. The highest PAFs of high FPG outcomes mostly related to central provinces of Iran. The central region of Iran had the highest and the southeast of the country had the lowest levels of attributed deaths. Conclusions: Considering the global 25 × 25 targets for noncommunicable disease mortality reduction, high FPG as a leading risk factor of fatal outcomes should be more targeted through the dietary, behavioral, and pharmacological interventions in Iran.

Background: With increasing age, the prevalence of chronic diseases increases. Since health-promoting behaviors (HPB) are considered a basic way of preventing diseases, especially chronic diseases, it is important to assess HPB. This study examines the validity and reliability of the Health Promoting Lifestyle Profile II (HPLP-II). Methods: This is a cross-sectional study which is conducted on 502 elderly individuals aged 60 and over in Tehran, Iran. In order to determine the validity, content and construct validity were used. The content validity index (CVI) was used to assess the content validity and to assess construct validity, confirmatory factor analysis (CFA), and item-total correlations were employed. For reliability, test-retest analysis was used, and the internal consistency of the HPLP-II was confirmed by Cronbach's alpha. For data analysis, SPSS-18 and Amos-7 software was used. Results: The mean age of the subjects was 66.3 ± 5.3 years. The CVI for the revised HPLP-II and all its subscales was higher than 0.82. The CFA confirmed a six-factor model aligned with the original HPLP-II. Pearson correlation coefficients between the revised HPLP-II and their items were in range of 0.27-0.65. Cronbach's alpha of the revised HPLP-II was obtained as 0.78 and for their subscales were in the range of 0.67-0.84. Intraclass correlation coefficient was obtained 0.79 (95% confidence interval: 0.59-0.86, P < 0.001). Conclusions: The Iranian HPLP-II scale is an appropriate tool for assessing HPBs of the Iranian elderly.

Background: Diabetes mellitus is a chronic disease which many factors are involved and is developing considerably worldwide. Increasing aging population and obesity in the societies has improved the scale of the type 2 diabetes significantly. The aim of this study was to determine the direct medical costs of outpatient cares of diabetes in Iran. Methods: Active patients of Isfahan Endocrinology and Metabolism Research Center (IEMRC) by the end of March 2011 were employed for data extraction. Type 2 diabetics were classified into 4 groups based on their therapeutic regimens. Type and frequency of health care services were extracted from the patients' profiles manually. The incidence of major diabetes complications were also examined from the subjects' profiles. The numbers of services used by the patients in different treatment groups were multiplied by the desired medical tariffs to calculate the direct medical costs. Results: 2898 number of cases was reviewed in this study; 63.8 % women and 36.2% men. 4.3% of the patients were placed group I; 50.1% in group II, and 34.6% and 11% in groups III and IV respectively. The age distribution of the patients varied widely from 30 to 90 years; 5.8% between 30 and 39 years, 62.3% between 40 and 59, and 31.9% at 60 and over. Nephropathy (72.4%), and neuropathy (39%) were the most frequent adverse effect between the type 2 diabetics in Isfahan. The group III with spending $192.3 in total was absorbed the highest amount of the resources between the patients' groups. The average direct medical cost of outpatient cares of diabetics per year was 155.8 US $. Conclusions: The direct medical cost of diabetes management is progressed sharply in past years in Iran. Pharmaceutical expenditures was the main cost component of outpatient cares for diabetes. It is estimated that the Iranians directly spend approximately $4.05 milliard annually to manage 5.2 million diabetics in the country.

Background: Identifying the pattern of tobacco use and its related factors in employees is crucial. This study aimed to investigate the pattern of tobacco use and its related factors in employees of Kermanshah Province, Iran. Methods: In 2012, 7129 employees were investigated in a cross-sectional study using the census method. Data on tobacco use and on several chronic diseases obtained using a standardized questionnaire on noncommunicable diseases risk factors of the World Health Organization through face-to-face interviews. Statistical analysis was performed based on the Chi-square test and multivariate logistic regression. Results: In general, the prevalence of tobacco use, smoking cigarettes, and smoking waterpipe was 9.9%, 8.9%, and 1.2% among the employees, respectively. Tobacco use was significantly higher in the age group over 40 (14.0%), in male gender (13.3%), in married individuals (10.8%) and in those with diploma and lower degree (16.4%), (P < 0.001). At the individual level, the odds ratio of tobacco use was 1.5 (95% confidence interval [CI]: 1.2-1.8) in hypertensive, 1.8 (95% CI: 1.2-2.6) in diabetic employees and 1.7 (95% CI: 1.3-2.3) in those with heart diseases, compared to healthy individuals. After adjusting for age, gender, marital status and educational level, there was not any significant relationship between tobacco use and health complaints and only the demographic variables remained significant. Conclusions: Preventive public health policies are mandatory especially in younger ages and male employees to promote their knowledge on disadvantages of tobacco use.

Background: Long-term effects of diabetes could be prevented or delayed by adopting a proper diet. The aim of this study was to adapt and provide a pilot test using health action process approach (HAPA)-based inventory to capable of capturing significant determinants of healthful diet for diabetics. Methods: The inventory was reviewed by eight diabetes patients and verbal feedbacks with regard the comprehension, item relevance, and potential new content were obtained. Then, the inventory items were evaluated by an expert panel. Next exploratory factor analysis (EFA) was conducted to assess the scale constructs. Criterion validity was measured by Pearson correlation. Finally, reliability measures of internal consistency and test-retest analysis were determined. Results: A total of 121 diabetic patients participated in this study. EFA extracted seven factors (risk-perception, action self-efficacy, outcome expectancies, maintenance self-efficacy, action and coping planning, behavioral intention, and recovery self-efficacy) explaining 81.14% of the total variance. There were significant correlations between behavioral intentions and both outcome expectancies (r = 0.55, P < 0.05) and action self-efficacy (r = 0.31, P < 0.004) and small to moderate correlations (rs = 23-40) between behavior and the volitional constructs of the HAPA model. Cronbach's alpha ranging from 0.65 to 0.95 and intraclass correlation coefficients ranging from 0.71 to 0.92 indicated an acceptable internal consistency. Conclusions: Developed scales were valid and reliable for measuring HAPA variables to be used with type 2 diabetes mellitus patients. Further examination with minority persons is warranted.

Background: The risk of cardiovascular diseases (CVDs) increases with age. The objective was to determine whether lifestyle and dietary behaviors and anthropometric measures, which are affected by these behaviors, contribute to the increase of CVD risk factors across age categories of 20-50-year-old. Methods: In a cross-sectional design, 437 adults aged 20-50-year-old were selected from households living in Shiraz. Risk factors of CVD, including body mass index (BMI), waist-to-height ratio (WHtR), blood pressure, fasting blood glucose (FBG), serum triglycerides, total cholesterol, and low- and high-density lipoprotein cholesterol (LDL-C and HDL-C, respectively) as well as lifestyle behaviors (physical activity and smoking), dietary habits, and food intakes were assessed across the age categories of 20-29, 30-39, and 40-50 years. Linear regression was used to examine the contribution of different variables to the age-related increase of CVD risk factors. Results: All CVD risk factors, except for HDL-C, significantly increased across age categories. Older subjects had healthier dietary habits and food intakes, but they possessed nonsignificantly lower physical activity and higher smoking rate compared to younger adults. Adjusting for physical activity, smoking, and BMI did not change the significant positive association between age and CVD risk factors but adjusting for WHtR disappeared associations for blood pressure, triglycerides, and metabolic syndrome although significant associations remained for FBG and total and LDL-C. Conclusions: Age-related increase of CVD risk factors occurred independent of lifestyle habits. WHtR, but not BMI, may partially contribute to the age-related increase in CVD risk factors.

Background: Nigella sativa has been a nutritional flavoring factor and natural treatment for many ailments for so many years in medical science. Earlier studies have been reported that thymoquinone (TQ), an active compound of its seed, contains anticancer properties. Previous studies have shown that TQ induces apoptosis in breast cancer cells but it is unclear the role of P53 in the apoptotic pathway. Hereby, this study reports the potency of TQ on expression of tumor suppressor gene P53 and apoptosis induction in breast cancer cell line Michigan Cancer Foundation-7 (MCF-7). Methods: MCF-7 cell line was cultured and treated with TQ, and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay was carried out for evaluating the half-maximal inhibitory concentration (IC50) values after 24 h of treatment. The percentage of apoptotic cells was measured by flow cytometry. Real-time polymerase chain reaction (PCR) was performed to estimate the messenger RNA expression of P53 in MCF-7 cell line at different times. Results: The IC50 value for the TQ in MCF-7 cells was 25 mM that determined using MTT assay. The flow cytometry and real-time PCR results showed that TQ could induce apoptosis in MCF-7 cells, and the P53 gene expression was dramatically up-regulated by ascending time, respectively. Hence, there was significant difference in 48 and 72 h. Conclusions: Our results demonstrated that TQ could induce apoptosis in MCF-7 cells through up-regulation of P53 expression in breast cancer cell line (MCF-7) by time-dependent manner.

Background: Healthy lifestyle is a major strategy to promote current and subsequent health status. The aim of this study was to assess the status of health-promoting the lifestyle and its determinants among students. Methods: A stratified random sample of 500 students in a university in the city of Sabzevar, Iran participated in this cross-sectional study. Health-promoting lifestyle was measured using Walker's health-promoting lifestyle profile II. Results: There was a significant correlation between all domains of health-promoting the lifestyle. The highest score among the domains was for an interpersonal relationship (70.8%), and the lowest score was for nutrition (53.6%), and physical activity (53.4%). Significant differences were found in physical activity by gender (P ≤ 0.05). There were significant differences in health responsibility, spiritual growth and body mass index by marital status (P < 0.01). Conclusions: Since one out of five students in this study were overweight/obese, health program planning to promote lifestyle, especially physical activity and nutrition among students is recommended. Our findings may be helpful for faculty administrators, curriculum planners, and health educators in designing guidelines to structuralize a healthier campus and to develop health promotion programs supporting healthy choices among students.

Background: Development of a manual or well-defined criterion for prioritizing the topics of clinical practice guidelines (CPGs) will help validate and organize this process evermore. This study was conducted to design an applicable manual that would prioritize the CPG topics for family physicians. Methods: This study was a multi-stage method using a qualitative approach that was conducted for the manual developing. The manual development process took place in four steps, as follows: Literature review, interviews with ten experts, preparing a list of criteria and determining its appropriateness by applying the RAND/UCLA Appropriateness method, and development of the final draft of the manual and pilot study. Results: Interview transcripts went under content analysis and were classified into eight main groups, 12 subgroups, and 85 themes. A comprehensive list consisting of fifty preliminary criteria were extracted. After summarizing and classifying the criteria, 12 appropriate criteria were evaluated using the RAND appropriateness method. Eventually, based on the literature review and our own results of the interview analysis, a manual consisting of five main sections and one clause on ethics was developed. Later, a pilot study was conducted on ten family physician topics, and prioritized by nine experts. Conclusions: The manual can be eyed as a tool ensuring the quality of the process of prioritizing CPG topics for family physicians, as it takes into account the issues involved in priority-setting. Selecting informed stakeholders for rating the criteria and ranking the topics was an issue that was greatly emphasized by the experts. Eventually, the application of this manual can be the first step toward systematizing the process of prioritizing CPG topics in the country.

Background: The goals of the present work were to retrieve the scientific articles published on addiction to the Internet, video games, and cell phones and to analyze the pattern of publications in this area (who is doing the research, when and where it is taking place, and in which journals it is being published), to determine the research being conducted as well as to document geographical trends in publication over time in three types of technological addictions: Internet, cell phones, and video games. Methods: Articles indexed in PubMed and PsycINFO between 2006 and 2010 related to the pathological use of Internet, cell phones, and video games were retrieved. Search results were reviewed to eliminate articles that were not relevant or were duplicates. Results: Three hundred and thirty valid articles were retrieved from PubMed and PsycINFO from 2006 to 2010. Results were compared with those of 1996-2005. The year with the highest number of articles published was 2008 (n = 96). The most productive countries, in terms of number of articles published, were China (n = 67), the United States (n = 56), the United Kingdom (n = 47), and Taiwan (n = 33). The most commonly used language was English (70.3%), followed by Chinese (15.4%). Articles were published in 153 different journals. The journal that published the most articles was Cyberpsychology and Behavior (n = 73), followed by Chinese Journal of Clinical Psychology (n = 27) and International Journal of Mental Health and Addiction (n = 16). Internet was the area most frequently studied, with an increasing interest in other areas such as online video games and cell phones. Conclusions: The number of publications on technological addictions reached a peak in 2008. The scientific contributions of China, Taiwan, and Korea are overrepresented compared to other scientific fields such as drug addiction. The inclusion of Internet Gaming Disorder in the Diagnostic and Statistical Manual of Mental Disorders, 5 ^th Edition could change the publication trends in the technological addiction area and underline the relevance of this upcoming disorder in dissatisfaction with life in general.

Background: Recently, tissue engineering has developed approaches for repair and restoration of damaged skeletal system based on different scaffolds and cells. This study evaluated the ability of differentiated osteoblasts from adipose-derived stem cells (ADSCs) seeded into hydroxyapatite/tricalcium phosphate (HA-TCP) to repair bone. Methods: In this study, ADSCs of 6 canines were seeded in HA-TCP and differentiated into osteoblasts in osteogenic medium in vitro and bone markers evaluated by reverse transcription polymerase chain reaction (RT-PCR). Scanning electron microscopy (SEM) was applied for detection of cells in the pores of scaffold. HA-TCP with differentiated cells as the test group and without cells as the cell-free group were implanted in separate defected sites of canine's tibia. After 8 weeks, specimens were evaluated by histological, immunohistochemical methods, and densitometry test. The data were analyzed using the SPSS 18 version software. Results: The expression of Type I collagen and osteocalcin genes in differentiated cells were indicated by RT-PCR. SEM results revealed the adhesion of cells in scaffold pores. Formation of trabecular bone confirmed by histological sections that revealed the thickness of bone trabecular was more in the test group. Production of osteopontin in extracellular matrix was indicated in both groups. Densitometry method indicated that strength in the test group was similar to cell-free group and natural bone (P > 0.05). Conclusions: This research suggests that ADSCs-derived osteoblasts in HA-TCP could be used for bone tissue engineering and repairing.

Background: Regarding to the growing prevalence of nonalcoholic fatty liver disease (NAFLD), concentrating on various strategies to its prevention and management seems necessary. The aim of this study was to determine the effects of symbiotic on C-reactive protein (CRP), liver enzymes, and ultrasound findings in patients with NAFLD. Methods: Eighty NAFLD patients were enrolled in this randomized, double-blind, placebo-controlled clinical trial. Participants received symbiotic in form of a 500 mg capsule (containing seven species of probiotic bacteria and fructooligosaccharides) or a placebo capsule daily for 8 weeks. Ultrasound grading, CRP, and liver enzymes were evaluated at the baseline and the end of the study. Results: In the symbiotic group, ultrasound grade decreased significantly compared to baseline (P < 0.005) but symbiotic supplementation was not associated with changes in alanine aminotransferase (ALT) and aspartate transaminase (AST) levels. In the placebo group, there was no significant change in steatosis grade whereas ALT and AST levels were significantly increased (P = 0.002, P = 0.02, respectively). CRP values remained static in either group. Conclusions: Symbiotic supplementation improved steatosis in NAFLD patients and might be useful in the management of NAFLD or protective against its progression.

Background: Multiple sclerosis (MS) is an autoimmune disease of the central nervous system. Etiology of the disease is not well understood; however, it is more common in women than in men and occurs mainly during reproductive age. The aim of this study was to evaluate some risk factors in women of childbearing age with MS in Isfahan Province. Methods: This analytic case-control study was conducted in MS Clinic in Isfahan, 2014. The study was done on 200 patients with MS and 200 nonpatients (matched controls) that were randomly selected for inclusion in the study. The data collection tool was a researcher-designed questionnaire consisting of three parts: Demographics, disease characteristics, and some risk factors related to reproductive age. Data were analyzed by SPSS version 20, using descriptive and inferential statistics. Results: The results showed that risk of MS had a significant relationship with age at menarche (P < 0.001), prior use of oral contraceptives (OCs) (P = 0.002), duration of use of OCs (P = 0.008), and number of pregnancies (P < 0.001). However, there was no significant relationship between age of onset of use of OCs (P = 0.80) and age at the first pregnancy (P = 0.45) with the risk of MS. Conclusions: Results of this research determined that the following risk factors were associated with developing MS, age at menarche, history, and duration of use of OCs and number of pregnancies.

Background: Sonoelastography is a new ultrasound method which could be helpful to determine which thyroid nodule is malignant. We designed this study to evaluate the accuracy of sonoelastography in differentiating of benign and malignant thyroid nodules in Iranian patients. Methods: Forty thyroid nodules in forty consecutive patients who had been referred for sonography-guided fine-needle aspiration biopsy were evaluated. Gray scale ultrasound and elastosonography by real-time, freehand technique applied for all patients. Elastography findings were classified into four groups. Nodules which were classified as patterns 1 or 2 in elastogram evaluation were classified as benign and probably malignant if elastogram scans were patterns 3 and 4 of elastogram scan. Results: Mean age ± standard deviation (SD) was 42.2 ± 12.6 years, and mean ± SD thyroid-stimulating hormone level was 1.4 ± 1.9 IU/ml. Thirty-five cases (87.5%) were female and 5 (12.5%) were male. Histological examination indicated 27 (67.5%) benign and 13 (32.5%) malignant nodules. The most elastogram score was 2 (50%) followed by score 3. The cut-off point of 2 considered as the best value to differentiate benign and malignant thyroid nodules with sensitivity and specificity of 61% and 78% (area under the curve = 0.76, 95% confidence interval: 0.6-0.92, P = 0.007). Conclusions: Sonoelastography could help to differentiate benign and malignant thyroid nodules. As our sample size was limited, larger studies are recommended.

Background: Although physical activity (PA) has long been associated with cardiovascular disease (CVD), assessment of PA status has never been used as a part of CVD risk prediction tools. The aim of the present work was to examine whether the inclusion of PA status in a CVD risk model improves its predictive accuracy. Methods: Data from the 10-year follow-up (2002-2012) of the n = 2020 participants (aged 18-89 years) of the ATTICA prospective study were used to test the research hypothesis. The HellenicSCORE (that incorporates age, sex, smoking, total cholesterol, and systolic blood pressure levels) was calculated to estimate the baseline 10-year CVD risk; assessment of PA status was based on the International Physical Activity Questionnaire. The estimated CVD risk was tested against the observed 10-year incidence (i.e., development of acute coronary syndromes, stroke, or other CVD according to the World Health Organization [WHO]-International Classification of Diseases [ICD]-10 criteria). Changes in the predictive ability of the nested CVD risk model that contained the HellenicSCORE plus PA assessment were evaluated using Harrell's C and net reclassification index. Results : Both HellenicSCORE and PA status were predictors of future CVD events (P < 0.05). However, the estimating classification bias of the model that included only the HellenicSCORE was significantly reduced when PA assessment was included (Harrel's C = 0.012, P = 0.032); this reduction remained significant even when adjusted for diabetes mellitus and dietary habits (P < 0.05). Conclusions: CVD risk scores seem to be more accurate by incorporating individuals' PA status; thus, may be more effective tools in primary prevention by efficiently allocating CVD candidates.

Background: Gallic acid (GA) is an endogenous plant phenol known to have antioxidant, free radical scavenging ability, anti-inflammatory, anti-cancer, and anti-fungal properties. The aim of this study was to assess the protective effect of GA on cyclophosphamide (CPA)-induced hepatotoxicity in male Wistar rats. Methods: Sixty rats were grouped into six groups of 10 rats per group. Group 1 received distilled water. Group 2 received CPA at 200 mg/kg single dose intraperitoneally on day 1. Groups 3 and 4 received a single dose of CPA (200 mg/kg) intraperitoneally on day 1 and then were treated with GA at 60 and 120 mg/kg body weight for 14 days, respectively. Rats in Groups 5 and 6 only received GA at 60 and 120 mg/kg body weight for 14 days, respectively. GA was administered orally. Results: CPA induced hepatic damage as indicated by significant elevation (P < 0.05) in aspartate aminotransferase, organ weight, and evidence by the histological study. CPA also induced hepatic oxidative stress as indicated by significant elevation (P < 0.05) in malondialdehyde content, hydrogen peroxide (H ₂ O ₂ ) generation, nitrite level, and the level of glutathione (GSH) peroxidase crashed in the CPA-treated group. GA enhanced the antioxidant defense system as indicated by significant elevation (P < 0.05) in GSH level, catalase activity, and GSH-S-transferase activity. Conclusions: Taken together, the result of this present study shows that GA has a protective effect on CPA-induced hepatotoxicity.

Background: Regular physical activity (PA) has been shown to reduce risk of morbidity and overall mortality. A study has displayed that achieving 10,000 steps/day is associated with important health outcomes and have been used to promote PA. Pedometers are a popular tool for PA interventions in different setting. This study investigated the effects on pedometer-based and self-reported PA among Tabriz University employees. Methods: This experimental study assessed the effects of 16 weeks pedometer-based workplace intervention. Participants (n = 154) were employees of two worksites. Pedometer-based and self-reported PA from one intervention worksite was compared with the data of a comparison workplace. International Physical Activity Questionnaire (IPAQ) for self-reported measure of PA, and demographic (age, marital status, educational level, employment status, and stage of change) variables were obtained. To measure PA objectively pedometer was used. Results: Participants reported to increase the step counts from baseline (end of summer) to posttest (winter). The intervention effect revealed significant increase in the intervention group (8279 ± 2759 steps/day than in the comparison work place (4118 ± 1136). Self-reported based on IPAQ concluded women in intervention worksite had a significant increase in the leisure time domain, but similar finding was not found in the comparison worksite. Conclusions: Pedometer used might rather benefit those individuals who want feedback on their current PA, also walking should be considered to increase PA in employee women.

Background: Pregnancy is associated with unfavorable metabolic profile, which might in turn result in adverse pregnancy outcomes. The current study was designed to evaluate the effects of calcium plus Vitamin D administration on metabolic status and pregnancy outcomes in healthy pregnant women. Methods: This randomized double-blind placebo-controlled clinical trial was performed among 42 pregnant women aged 18-40 years who were at week 25 of gestation. Subjects were randomly allocated to consume either 500 mg calcium-200 IU cholecalciferol supplements (n = 21) or placebo (n = 21) for 9 weeks. Blood samples were obtained at the onset of the study and after 9-week trial to determine related markers. Post-delivery, the newborn's weight, length, and head circumference were measured during the first 24 h after birth. Results: Consumption of calcium-Vitamin D co-supplements resulted in a significant reduction of serum high-sensitivity C-reactive protein levels compared with placebo (−1856.8 ± 2657.7 vs. 707.1 ± 3139.4 mg/mL, P = 0.006). We also found a significant elevation of plasma total antioxidant capacity (89.3 ± 118.0 vs. −9.4 ± 164.9 mmol/L, P = 0.03), serum 25-hydroxyvitamin D (2.5 ± 3.5 vs. −1.7 ± 1.7 ng/mL, P < 0.0001), and calcium levels (0.6 ± 0.6 vs. −0.1 ± 0.4 mg/dL, P < 0.0001). The supplementation led to a significant decrease in diastolic blood pressure (−1.9 ± 8.3 vs. 3.1 ± 5.2 mmHg, P = 0.02) compared with placebo. No significant effect of calcium-Vitamin D co-supplements was seen on other metabolic profiles. We saw no significant change of the co-supplementation on pregnancy outcomes as well. Conclusions: Although calcium-Vitamin D co-supplementation for 9 weeks in pregnant women resulted in improved metabolic profiles, it did not affect pregnancy outcomes.

Background: The phase change materials (PCMs) have the appropriate properties for controlling heat strain. One of the well-known PCMs is paraffin. This study aimed to design the cooling vest from the cheap commercial paraffin compound and evaluation of its effectiveness under laboratory hot conditions. Methods: the cooling vest was made of the polyester fabric and it had 17 aluminum packs. The each of aluminum packs was filled by 135 g of prepared paraffin with a proper melting point in the range of 15-35°C. an experimental study was conducted on ten male students under warm conditions (air temperature = 40°C, relative humidity = 40%) in a climatic chamber. Each participant was tested without cooling vest and with cooling in two activities rate on treadmill to include: light (2.8 km/h) and moderate (4.8 km/h). The time of this test was 30 min in each stage. During the test, the heart rate, the oral temperature, the skin temperature were measured every 4 min. Finally, data were analyzed using the Kolmogrov-Smirnov and repeated measurement ANOVA test in SPSS 16. Results: The latent heat of the prepared paraffin compound and the peak of the melting point were 108 kJ/kg and 30°C, respectively. The mean and standard deviation of heart rate, oral temperature, and skin temperature with cooling vest in light activity were 103.9 (12.12) beat/min, 36.77 (0.32)°C, and 31.01 (1.96)°C and in moderate activity were 109.5 (12.57) beat/min, 36.79 (0.20)°C, and 29.69 (2.23)°C, respectively. There is a significant difference between parameters with a cooling vest and without cooling (P < 0.05). Conclusions: The designed cooling vest with low cost can be used to prevent thermal strain and to increase the physiological stability against the heat. However, the latent heat of this cooling vest was low.

Background: Intensity of depressive symptoms could be exacerbated due to the paucity of appropriate treatments. We assessed the effectiveness of bibliotherapy and text messaging, which aimed at amelioration of patient's behavior and consciousness, which could lead to suicide prevention. Methods: This was a randomized clinical trial implemented in rural health centers of Isfahan district (Iran). Health centers were assigned in three trials consisting of the booklet, text messaging, and control groups. Each group consisted of 70 patients. Inclusion criteria were being affected by depressive symptom, <18 years, and cell phone accessibility. Mental retardation, drug and alcohol abuse, visual disability, dementia, suicide attempt history, electrotherapy, and receiving psychological interventions were our not met criteria. Our patient outcomes comprised intensity of depressive symptom and treatment compliance. The first two trials were requested to study instructive booklets in 30 days while the second cohort was demanded to study the booklet in accordance with the daily delivered text messaging. Results: Out of 210 individuals, 198 patients finished this study. The intensity of depressive symptom was significantly affected through time and group factors as well as time-group interaction (F = 12.30, P < 0.001). Based on treatment compliance, the interactive effect of group factor and the time factor was statistically significant. Conclusions: It seems that bibliotherapy could efficiently decrease the intensity of depressive symptoms. Nevertheless, in comparison with our booklet trial, the text messaging group achieved neither durable nor significant success; thus, bibliotherapy could be utilized as a complementary methodology aiming depression treatment.

Background: The aim of this study was to evaluate the results of amblyopia screening in Ardabil Province in three examination levels by kindergarten teacher, optometrist, and ophthalmologist. Methods: In a cross-sectional study, the results of the national amblyopic prevention program in 2-6 years old children in Ardabil Province were investigated in 2012. The results pertained to the examinations of children participating in this research were collected in the national approved forms. The data were entered into the computer and were analyzed using statistical methods in SPSS 18. Results: Around 38,844 children (51.7%) out of 75173 with 2-6 years old qualified children participated in the screening program in Ardabil Province. In the first stage of screening, 1068 children (33.1%) are visually impaired in one eye and 2160 children (66.9%) are visually impaired in two eyes. In the second stage, the results related to the examinations by optometrists indicated that the prevalence of refractive errors, strabismus, and others were 70%, 27.8%, and 2.2%, respectively. Refractive errors problem was most prevalent in Ardabil city (72.6%).The prevalence of refractive errors, strabismus, and other reasons in amblyopic children was 51.3%, 23.9%, and 24.8%; respectively. Conclusions: The present investigation showed that coverage of amblyopia screening program was not enough in Ardabil Province. To increase the screening accuracy, standard instruments and examination room must be used; more optometrists must be involved in this program and increasing the validity of obtained results for future programming.

Background: Low health literacy (HL) of patients has obtained more attention as a risk factor for poor adherence to treatment and adverse outcomes in chronic disease's management particular in diabetes care. Diabetes Numeracy Test-15 (DNT-15) has been developed specifically for this purpose. The objective of the current study is to evaluate psychometric properties of Iranian (Persian) version of the DNT-15. Methods: The shortened version of the DNT (15-items) was completed by 120 patients with diabetes. The Kuder-Richardson Formula 20 for internal consistency was conducted. Content validity, criterion-related validity, and construct validity were also evaluated. Results: The average score on the DNT was 72% and took an average of 25 minutes to complete. The DNT-15 had a very good internal reliability (KR-20 = 0.90) and also content validity (content validity ratio: 089 and content validity index: 0.86). Conclusions: The DNT-15 (Persian version) is a reliable and valid measure of diabetes-related numeracy skills for Iranian patients with diabetes; however, additional studies are needed to further explore the association between diabetes-specific numeracy and acculturation and their impact on diabetes-related outcomes in Iranian population.

Background: Cardiovascular disease is the most common cause of disease in the developed world. Early detection and risk prediction are a key component in reducing cardiovascular mortality. The Framingham Risk Score uses age, sex, cholesterol, blood pressure, diabetes, and smoking to calculate the 10-year risk probability of developing cardiovascular disease for a given patient. The aim of this study was to examine cardiovascular disease risk in men aged over 40 years in Boa Vista, Brazil and identify socioeconomic factors contributing to the risk. Methods: This was an epidemiological, cross-sectional, descriptive study. Physical examination and questionnaire survey were conducted on the participants. Results: Of the 598 participants (average age = 55.38 ± 10.77 years), 346 completed all the examinations and answered the survey, while 252 completed the survey and the physical examinations but did not undertake the laboratory tests. A large proportion of participants were overweight (42.6%) or obese (23.6%), 14.5% were hypertensive, and 71.9% were prehypertensive. Consumption of red meat and junk food was high, while participation in the exercise was low. Framingham scores ranged from −3 to 13 (mean score: 3.86 ± 3.16). A total of 204 participants (34.1%) had a low risk of cardiovascular disease, 98 (16.4%) had a medium risk, and 44 (7.4%) possessed high risk. Increased abdominal circumference (P = 0.013), resting pulse (P = 0.002), and prostate-specific antigen levels (P < 0.001) were associated with increased risk of cardiovascular disease. Conclusions: Our study highlights a worrying trend in increasing obesity and hypertension, most likely associated with increasingly poor diet and reduced participation in exercises. As the Brazilian population ages, this will drive increasing rates of cardiovascular mortality unless these trends are reversed. This study suggests that such campaigns should focus on men over the age of 40, who are married or divorced and of lower income.

Background: Metabolic syndrome (MetS) is a prevalent disorder in pediatric age groups, described by a combination of genetic and environmental factors. Sterol regulatory element-binding transcription factor 1 (SREBF-1) induces the expression of a family of genes involved in fatty acid synthesis. Moreover, dysregulation of miR-33b, which is located within the intron 17 of the SREBF-1 gene, disrupts fatty acid oxidation and insulin signaling, thus leading to MetS. The aim of the present study was to investigate the association between SREBF-1 rs8066560 polymorphism and MetS in Iranian children and adolescents. Methods: This study includes 100 MetS and 100 normal individuals aged 9-19 years. Anthropological and biochemical indexes were measured. The -1099G > A polymorphism was genotyped by TaqMan real-time polymerase chain reaction. Results: Significant differences were observed in anthropometric measurements and lipid profiles between MetS and normal children. There were no differences in the genotype frequencies or allele distribution for -1099G > A polymorphism between MetS and control groups. High-density lipoprotein cholesterol levels were significantly higher in the MetS GG group than in the A allele carrier group. The genotype AA controls had significantly increased cholesterol and low-density lipoprotein cholesterol levels than AG genotypes. By logistic regression using different genetic models, no significant association was observed between SREBF-1 rs8066560 polymorphism and the risk of MetS. Conclusions: We conclude that the -1099G > A variant on SREBF-1 gene associated with serum lipid profiles, however, it may not be a major risk factor for the MetS in Iranian children and adolescents.

Background: Behavioral disorders are common in the pediatric age group. This study aims to assess the relationship between the frequency of behavioral and mental disorders and counseling with family members and friends in a representative sample of Iranian children and adolescents. Methods: In this nationwide study, 14880 school students, aged 6-18 years, were selected by cluster and stratified multi-stage sampling method from 30 provinces in Iran. The World Health Organization Global School-based Health Survey questionnaire was used. Results: Overall, 13486 students (49.2% girls) with the mean (standard deviation) age of 12.47 (3.36) years completed the study. According to the students' self-report, 56.1% of boys and 42.2% of girls shared their problems with their fathers. All behavioral disorders were less prevalent in children and adolescents who consulted with their father compared with those who did not (P < 0.001). In addition, 84.6% of boys and 84.0% of girls shared their problem with their mother. All behavioral disorders were less prevalent in children and adolescents who consulted with their mother compared with those who did not (P < 0.001). 45.6% of boys and 44.8% of girls shared their problem with their brother or sister. Some behavioral disorders were less prevalent in children and adolescents who consulted with their brother or sister (P < 0.01); however, the prevalence was not statistically different for most disorders (P > 0.05). Moreover, 60.4% of boys and 66.0% of girls shared their problems with their friends. The prevalence of most behavioral disorders was lower in those who consulted with their friends (P < 0.001). Conclusions: Children and adolescents should be encouraged to consult with their parents and friends about their problems. Parents should offer their children an opportunity to express their views and wishes about their problems.

Background: Diabetes mellitus (DM) is a public health challenge worldwide and to manage it the patient is required to make some fundamental changes in behavior. Patients should be involved in care program to improve their diabetes condition and quality of life (QOL). This study aimed to examine the effect of educational program on beliefs, behavior, glycemic control indicator, and QOL among diabetic women. Methods: In this interventional study, 90 female outpatients with type 2 diabetes were randomly selected from those referred to diabetes clinic in Khoy, Iran, during 2011. They were divided into two groups, 45 participants as the intervention group and 45 subjects as the comparison group. Knowledge, beliefs, and behavior by valid and reliable questionnaires, and health-related QOL (HRQOL) by means of WHOQOL-BREF questionnaire were assessed. Hemoglobin A1c level (HbA1c) was measured by the colorimetric method, educational program was conducted on the intervention group for 4 weeks, and changes were compared in two groups after a 3-month follow-up. Results: After intervention, there was a significant difference between two groups in terms of the mean scores of knowledge (P < 0.001), attitude (P < 0.01), self-efficacy (P < 0.001), and behavior (P < 0.001). The findings also indicated that there were significant differences between the groups in mean scores of physical, psychological, and social domains of QOL after intervention (P < 0.001). In addition, there was a statistically significant difference between two groups in the mean value of HbA1c after educational intervention (P < 0.01). Conclusions: Instructional interventions based on interactive approaches can be useful, and applicable for behavior modification and improvement of HbA1c level and HRQOL in people with DM.

Background: To test the change in the knowledge of the study participants following a Blended Training and Learning Approach (BTLA). Secondly, the paper also tries to discuss the use of this method over the classical classroom based trainings. Frontline health functionaries are the backbone of almost all health goals. It is therefore essential to ensure proper training of this cadre of workers for optimum service delivery. The present paper tries to discuss the use of an effective new training pedagogy over the classical classroom based trainings. Methods: A cross-sectional study was conducted from August 2013 to April 2014 in all districts in the state of Odisha. The study participants comprised of two groups. Group 1: Integrated Child Development Services supervisors, Child Development Project Officers received training on reduction of stunting. Group 2: Nutrition Counselors and Auxiliary Nurses and Midwifes received training on management of severe acute malnutrition (SAM). Selection of participants was done following complete enumeration technique. The training effectiveness was measured using paired t-test. Out of approximately 2400 participants identified across the state of Odisha, 2350 participants provided consent to participate in the study. Results: The change in knowledge was determined by using paired t-test. The results of the paired t-test for the training on reduction of stunting were significant, P < 0.001, indicates that there was a significant increase in the score from (mean = 11.4; standard deviation [SD] = 2.34) to the post-test (mean = 13.8; SD = 2.34). The mean increase was 2.4 with 95% confidence interval [CI] for the difference between means of 11.4 and 13.8. Similar test was conducted to evaluate the training on SAM. The results of the paired t-test were significant, P < 0.001, indicates that there was a significant increase in the score from (mean = 14.7; SD = 2.8) to the post-test (mean = 15.8; SD = 2.3). The mean increase was 1.12 with 95% CI for the difference between means of mean = 14.7 to mean = 15.8. There are different approaches that can be adapted during any training ranging from the traditional form of classroom teaching to the new technologically advanced forms of training such as e-learning. Understanding the merits and demerits, there was the felt need to try a newer approach of training. Thus, the method of BTLA was tried in the study and was proved to be effective. Conclusions: The newly tried and tested pedagogy of training would provide the necessary evidence for future policy decisions.

Background: Despite considerable investment in research, the existing research evidence is frequently not implemented and/or leads to useless or detrimental care in healthcare. The knowledge-practice gap proposed as one of the main causes of not achieving the treatment goals in diabetes. Iran also is facing a difference between the production and utilization of the knowledge of diabetes. The aim of this study was to assess the status of diabetes knowledge translation (KT) in Iran. Methods: This was a survey that executed in 2015 by concurrent mixed methods approach in a descriptive, cross-sectional method. The research population was 65 diabetes researchers from 14 diabetes research centers throughout Iran. The research was carried out via the self-assessment tool for research institutes (SATORI), a valid and reliable tool. Focus group discussions were used to complete this tool. The data were analyzed using quantitative (descriptive method by Excel software) and qualitative approaches (thematic analysis) based on SATORI-extracted seven themes. Results: The mean of scores "the question of research," "knowledge production," "knowledge transfer," "promoting the use of evidence," and all aspects altogether were 2.48, 2.80, 2.18, 2.06, and 2.39, respectively. The themes "research quality and timeliness" and "promoting and evaluating the use of evidence" received the lowest (1.91) and highest mean scores (2.94), respectively. Except for the theme "interaction with research users" with a relatively mediocre scores (2.63), the other areas had scores below the mean. Conclusions: The overall status of diabetes KT in Iran was lower than the ideal situation. There are many challenges that require great interventions at the organizational or macro level. To reinforce diabetes KT in Iran, it should hold a more leading and centralized function in the strategies of the country's diabetes research system.

Background: The prevalence of colorectal cancer (CRC) is rapidly increasing in Iran. It holds the most prevalent cancer after skin, breast, and gastric cancers among the Iranian population. The current study was designed to investigate the effects of leisure time, occupational and household physical activity as well as exercise on the risk of CRC in the Iranian population. Methods: In this population-based case-control study, 100 individuals with a recent diagnosis of CRC who were eligible for the study were recruited between 2006 and 2008. The control groups were selected from patients' companions (excluding first- and second-degree relatives) without past history of cancer or any physical disability. Physical activity of the participants was evaluated using a Kriska retrospective physical activity questionnaire. The relation between CRC and physical activity was assessed via logistic regression model and calculating the odds ratio (OR) as well as a confidence interval (CI) of 95%. Results: According to the findings, the adjusted OR of occupational (OR = 0.98, 95%, CI: 0.95-1.02) and house holding physical activities (OR = 1.03, 95% CI: 0.99-1.08) were not significantly different between the case and control groups for women (P > 0.05). The risk of CRC shows a significant reduction in individuals with moderate leisure physical activities compared to those with minimal activities (OR = 0.82, CI 95%: 0.73-0.98). Conclusions: The study suggests that the risk of CRC will decrease in individuals with higher leisure physical activities (especially with an increase in hours of brisk walking during the day).

Background: Esophageal cancer is the sixth cause of death in the world, there was a lack of population-based information on the trend and incidence rate of esophagus cancer, so this study aimed to determine the incidence and pathological changes of esophagus cancer in Iran. Methods: In this study, data were extracted from annual cancer registry reports of Iranian ministry of health between 2003 and 2008. Standardized incidence rates were calculated using the world standard population, and incidence rate was calculated by age groups, sex, and histological type. Data on epidemiologic trend and histology were analyzed using Joinpoint software package. Results: In this study, there were 18,177 recorded cases of esophagus cancer. Of all cases, 45.72% were females and 54.28% were males. Sex ratio was 1.19. The most common histological types related to squamous cell carcinoma NOS and adenocarcinoma NOS were 64.53% and 10.37%, respectively. The trend of annual changes of incidence rate significantly increased in both sexes. The annual percentage changes, the incidence rate was 7.9 (95% confidence interval [CI]: 3.3-12.6) for women and 9.6 (95% CI: 6.0-13.2) for men. The histology type of SCC, large cell, nonkeratinizing and SCC, keratinizing and SCC, NOS had a significant decreasing trend in total population (P < 0.05). Conclusions: According to this study, the trend of age-standardized incidence rate of esophagus cancer in Iran is rising. Hence, to prevent and control this cancer, it is necessary to investigate related risk factors and implement prevention programs in Iran.

Background: Control of blood sugar, hypertension, and dyslipidemia are key factors in diabetes management. Cucurbita ficifolia (pumpkin) is a vegetable which has been used traditionally as a remedy for diabetes in Iran. In addition, consumption of probiotics may have beneficial effects on people with Type 2 diabetes. The aim of this study was an investigation of the effects of C. ficifolia and probiotic yogurt consumption alone or at the same time on blood glucose and serum lipids in diabetic patients. Methods: Eighty eligible participants randomly were assigned to four groups: 1 - green C. ficifolia (100 g); 2 - probiotic yogurt (150 g); 3 - C. ficifolia plus probiotic yogurt (100 g C. ficifolia plus 150 g yogurt); and 4 -control (dietary advice) for 8 weeks. Blood pressure, glycemic response, lipid profile, and high-sensitive C-reactive protein (hsCRP) were measured before and after the intervention. Results: Total cholesterol (TC) decreased significantly in yogurt and yogurt plus C. ficifolia groups (within groups P = 0.010, and P < 0.001, respectively). C. ficifolia plus yogurt consumption resulted in a decrease in triglyceride (TG) and an increase in high-density lipoprotein cholesterol (HDL-C) (within groups P < 0.001 and P = 0.001, respectively). All interventions led to a significant decrease in blood sugar, hemoglobin A1c (HbA1c), hsCRP, and low-density lipoprotein cholesterol (LDL-C) level within groups. Blood pressure decreased significantly in Cucurbita group and yogurt group (within groups P < 0.001, and P = 0.001 for systolic blood pressure [SBP] and P < 0.001, and P = 0.004 for diastolic blood pressure [DBP], respectively). All variables changed between groups significantly except LDL-C level. Conclusions: Variables including TG, HDL-C, TC, fasting blood sugar, HbA1c, SBP, DBP, and hsCRP changed beneficially between groups. It seems that consumption of C. ficifolia and probiotic yogurt may help treatment of diabetic patients.

Background: Green tea is one of the most popular beverages in the world. It is believed to have beneficial effects in the prevention and treatment of many diseases, one of which is nonalcoholic fatty liver disease (NAFLD). The present study investigated the effects of consumption of green tea in NAFLD patients. Methods: This study was a double-blind, placebo-controlled, randomized clinical trial. Ultrasonography was used to diagnose fatty liver in patients with alanine aminotransferase (ALT) >31 mg/dl and 41 mg/dl and aspartate aminotransferase (AST) >31 mg/dl and 47 g/dl in women and men, respectively and without other hepatic diseases. A total of 80 participants (20-50 years) with NAFLD were randomly allocated into two groups to receive either green tea extract (GTE) supplement (500 mg GTE tablet per day) or placebo for 90 days. At baseline and at the end of the intervention weight, serum ALT, AST, and alkaline phosphatase (ALP) were measured in fasting state, and dietary data were collected at baseline and end of the study. Results: Green tea group showed significant reductions in ALT and AST levels after 12 weeks period (P < 0.001). The placebo group showed a reduction in ALT and AST levels at the end of the study, but it was no significant. ALP levels showed significant reductions in both groups after 12 weeks period (P < 0.001). Conclusions: According to the findings of this study, GTE supplementation decrease liver enzymes in patients with NAFLD. It can be claimed that GTE prescribed can be considered as a treatment to improve serum levels of liver enzymes in NAFLD patients.

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.

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.