Background: Hemodialysis (HD) is one of the treatments provided to end-stage renal disease (ESRD) patients. A few studies have investigated the survival rate of HD patients in Iran. Hence, we decided to investigate the survival rate and it is predictors among Iranian ESRD patients. Methods: This is a retrospective cohort study conducted in 165 HD patients in Tuyserkan city (Hamadan province) during 20 years from 1996 to 2015. The checklist used to gather information was comprised of patients' demographic and clinical information. The analysis was performed using Kaplan–Meier curves, log-rank test, and cox regression model. Results: The most prevalent cause of ESRD was reported to be high blood pressure (32.7%). The probability of survival rate at the end of 1^st, 5^th, and 10^th year was 0.65, 0.16, and 0.05, respectively. Results of multivariate cox regression showed that old age, catheter vascular access, and high hemoglobin level have a negative significant effect on survival of HD patients (P < 0.05). Conclusions: Overall, the survival of HD patients seems to be low in Tuyserkan as compared to other studies. Age, ESRD cause, vascular access, marital status, and hemoglobin level among other factors are proved to have a significant effect on survival probability.

Background: Smoking has deleterious effects on bone mass and is associated with the subsequent development of osteoporosis, particularly in elderly participants. The purpose of this study was to determine the influence of smoking in the elderly male smokers. Methods: All male participants aged 60 years and older of the Amirkola cohort who performed bone densitometry entered the study. Bone mineral density (BMD) was measured at the lumbar spine (LS) and femoral neck (FN) using the dual-energy X-ray absorptiometry method. In statistical analysis, the smokers and nonsmokers were compared according to BMD, frequency of low bone mass defined as BMD T-score <−1 at either LS or FN, and the number of bone fractures. SPSS software version 18 was used for analysis. Results: A total of 203 smokers with mean smoking duration of 21.67 ± 17.7 years and the mean number of 36.4 + 15.8 cigarettes per day were compared with 408 nonsmokers. The mean BMD values in LS (0.90 ± 0.14 vs. 0.94 ± 0.19) and FN section (0.87 ± 0.13 vs. 0.89 ± 0.15) and also the frequency of bone fractures were significantly lower, and the frequency of low bone mass at either LS and FN was significantly higher in smokers (P = 0.014, 0.038, 0.003, and 0.004, respectively). In multiple logistic regression analysis, smoking was independently associated with low bone mass by odds ratio of = 2.27 (95% confidence interval: 1.49–3.44). Conclusions: These findings indicate a significant association between low bone mass and bone fracture at either LS or FN in the elderly male smokers.

Background: Diabetes mellitus (DM) is a prime risk factor for cardiovascular disease. The convincing experimental and clinical evidence indicated that the onset of DM is closely associated with oxidative stress and that the generation of reactive oxygen species increases in both the types of diabetes. The aim of the present study was to evaluate the effect of Teucrium polium (TP) hydroalcoholic extract on the blood glucose, cholesterol, triglyceride, and oxidative stress markers of the heart and aorta in streptozotocin (STZ)-induced diabetic rats. Methods: The male Wistar rats assigned into six groups (n = 8 in each group): Control, diabetic, and diabetic rats treated with TP extract (100, 200, and 400 mg/kg) or met and metformin (300 mg/kg) formin (300 mg/kg) group, by daily gavage for 6 weeks. Diabetes was induced by injection of STZ (60 mg/kg, i.p). Serum lipids and glucose, malondialdehyde (MDA) level, total thiol level, and also the activities of Cu, Zn-superoxide dismutase (SOD) in the cardiac and aortic tissues were assessed. Results: TP extract reduced serum glucose, triglyceride and cholesterol. The MDA levels were reduced significantly in all TP-treated groups and metformin. Total thiol levels were improved in the heart and aorta of TP extract-treated groups and metformin compared to the diabetic rats. The activity of SOD in the cardiac and aortic tissues of TP extract- and metformin-treated groups was higher than diabetic group. Conclusions: The results showed that chronic administration of TP in STZ-induced diabetic rats could decrease blood glucose, cholesterol, and triglyceride and also attenuate the oxidative stress in the aortic and cardiac tissues.

Background: Social determinants of health (SDH) provide a platform in improving health society such as safety. Safety is essential for children because it is directly related to the health and development. The objective of this study was to evaluate the current home safety in the capital city of Iran for children below five years by community-based initiative and its association with common SDH variables. Methods: This is a cross-sectional study, considering community- and family-based initiative. According this five domains checklist which was including physical, kitchen, bath, toys, and fi rst-aid kit , 200 family home safety were evaluated. Moreover, the relation between children safety and social determinants of health was assessed. Furthermore, the research team designed an attractive record card for each child that was distributed among families by community volunteers. Results: The result was extracted into two age groups: less and more than 6 months. We designed an attractive card for each child and distributed among families by volunteers. It showed that children of age above 6 months had higher home safety score. We found a positive association between mother's education and total safety score. Conclusions: This study was a part of MAZDAK project which means friendly environment for children in Persian word. It showed that an effective way for promoting children safety in the community would be community engagement and family cooperation. As the family education can help reduce children injuries, MAZDAK as a model can been run in the other places to check the effects of SDH on home safety for children. This was an experience of improving community knowledge and behavior about home safety by the parents themselves to improve their children safety environment, and it is going to continue the efficacy of Intervention.

Background: L-arginine is an important precursor for the formation of nitric oxide (NO). According to previous studies, NO function is related to gender. Likewise, chronic renal diseases have lower prevalence in female. Gentamicin (GM) is an aminoglycoside antibiotic. According to some studies, males are more sensitive to GM renal nephrotoxicity. This study attempts to find protective effects of L-arginine on GM nephrotoxicity in male and female rats. Methods: Male and female rats were divided into eight groups: Rats were randomly assigned to 8 groups each including both male and female rats. The first and second groups received vehicle (saline), the third and fourth groups received gentamicin (80 mg/kg), the fifth and sixth groups received L-arginine (150 mg/kg), and finally, seventh and eighth groups received gentamicin+ L- arginine. Next, 9 days after administering drugs, blood samples were collected from the heart. After making sacrifices, the level of blood urea, creatinine (Cr), nitrite, and malondialdehyde (MDA) was measured in serums. Likewise, nitrite and MDA were measured in the homogenized kidney tissue. Results: GM significantly increased serum level of urea and Cr in male and female rats (P < 0.05). However, co-administration of GM + L-arginine significantly did not decrease urea and Cr level in male rats, whereas, in female rats, they significantly reduced (P < 0.05). In response to GM, renal MDA level increased in male and female rats (P < 0.05), and in the presence of GM + L-arginine, the level of MDA significantly decreased in both genders (P < 0.05). Conclusions: L-arginine demonstrated some protective effects in female rats but did not protect against GM nephrotoxicity in male rats for unknown reasons, probably related to the effects of sex hormones which needs further studies to be confirmed.

Objectives: The PEP Family Heart Study is a perspective community-based long-term project for the whole family to improve cardiovascular health aiming to assess and to amend risk factors in children and their parents by lifestyle change. Methods: A total of 48,667 subjects (24,927 adults and 23,740 children) from 3,370 families living in 94% of the elementary school districts of Nuremberg (Germany) participated in this observational study from 1993/1994 -2007/2008. The yearly surveys consisting of personal and family histories, structured interviews on leisure time physical activity and tobacco smoke exposition, physical examinations and nutritional intake as documented by seven days weighed dietary protocols and sustained healthy lifestyle counselling were mainly performed at home. Fasting blood collections for biochemical analyses in the study laboratories, cooking courses and seminars on healthy lifestyle were performed on weekends in central school buildings. Results: Here we report some of the main results demonstrating e.g., that at least one CVD risk factor in a child conferred a 2–4 fold higher risk among their parents, that obese children and adolescents had a nearly five times higher prevalence of hypertension than non-overweight youths. Conclusions: Sustained healthy lifestyle behavior can be implemented in daily life of family members which results in amended nutritional intake and improved cardiometabolic risk factors.

Background: Smoking is a modifiable risk factor for noncommunicable diseases with a wide range of harmful health outcomes. Identification of sociodemographic characteristics of smokers can be a guideline to development of effective intervention proportional to target population. This study aimed to determine smoking pattern and its associated sociodemographic factors in Iran. Methods: This cross-sectional study was conducted based on data from the sixth round of nationwide STEPwise approach to Surveillance (STEPS) survey in the 31 provinces of Iran. A total of 10,834 participants aged ≥15 years were selected through a multistage cluster sampling method. Collecting data was performed via three-step questionnaire (ecological, behavioral risk factors, and physical and biochemical measurements). Data analysis was performed via Epi Info and then SPSS version 21 softwares using descriptive methods and analytical tests. Results: Of all participants, 9.6% were current cigarette smokers, which was significantly more frequent among men than women (21.5% vs. 1.1%, respectively, P < 0.001). Smoking was significantly associated with being self-employed and having under diploma education level (P < 0.05). Of all current cigarette smokers, 8.7% were daily smokers. The mean ± standard deviation of systolic blood pressure and history of cardiovascular symptoms in current smokers were higher than nonsmokers (P = 0.005 and P < 0.001, respectively). Coughing for >4 weeks, frequent wheezing, and shortness of breath were significantly more frequent in current smokers than nonsmokers (P < 0.001, P < 0.001, and P = 0.02, respectively). Conclusions: Our results draw a picture of sociodemographic distribution of smoking pattern to determine the specific characteristics of the target population affecting cigarette smoking and identified specific demographic strategies for preventive and control action plan.

Background: According to the last report of Iran cancer registry, stomach, colorectal, and bladder cancers are the most prevalent cancers. The present study focused on separating the latent risk surface into shared and disease-specific components. Methods: In this study, data consisting of stomach, colorectal, and bladder cancers in 30 provinces of Iran during 2004–2009 are considered. These data are analyzed by polytomous logit model. The incidence of stomach cancer acts as the reference category (the surrogate for smoking). Then, the log odds are decomposed into shared and specific structured spatial and unstructured spatial components. These latent components help to detect spatial patterns of shared and disease-specific risk factors. Results: Central, Southern, Eastern, and Southwestern provinces are supposed as high-risk regions for shared risk factor for colorectal and bladder cancers. This shared risk factor is slightly associated more with bladder than with colorectal cancer. Northern, northwestern, and central regions and also three borderline provinces in southwestern are high-risk regions for colorectal cancer. Central, eastern, southern, and western strip of the country except Ilam are found as the high-risk regions of bladder cancer. Conclusions: After considering known shared risk factor of the three cancers, it turns out that colorectal and bladder cancers have unknown shared risk factor. The significant difference in their lifestyle and eating habits could be an assumption of the risk factor.

Background: Multiple sclerosis (MS) is an autoimmune disease associated with inflammation of the central nervous system in humans. This disease is the most common neurological disease, especially in young people. Various factors, including biological, genetic, and environmental factors, are effective on the prevalence of MS disease. This study intends to determine the relationship between geographical factors, and the prevalence of MS disease was performed. Methods: This ecological study was carried out on 2000 patients with diagnosis of MS during the years 2001–2014 in Isfahan province. All patients' data including age, sex, marital status, year, and location of patients were extracted from the files. Arc geographic information systems version 10.3 software was used for geographical maps, and for statistical analysis of data, SPSS.16 software ANOVA tests, independent t-test, and Kruskal–Wallis were used. Results: Based on recorded cases of MS, the highest and lowest cumulative incidence of diseases was related to the city of Isfahan (75.92 in one hundred thousand) and Aran Bidgol (1.16 in one hundred thousand), respectively. A significant relationship was observed between the incidence and height above sea level (P = 0.001), the average annual rainfall (P = 0.001), and land use (P = 0.001). With increase in the height above sea level and the average annual precipitation, the incidence of disease decreased. Conclusions: MS disease incidence is high in Isfahan province. The distribution of the disease is not the same in the cities of this province, and some cities have a higher incidence. Furthermore, the incidence of the disease is influenced by geographical factors such as height above sea level, average annual rainfall, and land use. Therefore, it is recommended that relevant authorities by the implementation of screening programs in high-risk areas take action to identify and treat patients in the early stages.

Background: Patients who experienced transient ischemic attack (TIA) are at high-risk for cardiovascular events. This study aims to evaluate diagnostic value of carotid artery intima-media thickness (CIMT) and ABCD2 score for predicting cardiovascular events in long-term follow-up after TIA. We prospectively included sixty patients with TIA who admitted to hospital from March 2016 to August 2016. Methods: Duplex ultrasonography of internal carotid arteries was performed. ABCD2 scores were evaluated for each patient. At a median follow-up of 20 months, patients were asked about new cardiovascular events. We used IBM SPSS software version 22.0 with Chi-squared, t-test, ANOVA, receiver operating characteristic, and area under the curve (AUC) analysis for our work. Results: Sensitivity and negative predictive value of the combined score (ABCD2+CIMT) was the highest (96.3% and 90.9%, respectively), and the specificity and positive predictive value of the CIMT were the highest (57.5% and 63.1%, respectively) to predict cardiovascular events in long-term. Conclusion: Compared to ABCD2 score, CIMT proved to be more accurate to predict cardiovascular events in long-term follow-ups (AUC = 0.736 vs. AUC = 0.640). However, adding CIMT value to ABCD2 score was even better (AUC = 0.750). Therefore, CIMT measurement in the ABCD2 score after TIA enables prediction of long-term cardiovascular events.

Background: Walnut green husk (WGH) extract has been known as potential preventive and therapeutic antioxidants and antimicrobials due to its high polyphenol content. In this study, preparation of spray dried WGH extract-loaded microcapsules by maltodextrin and its blending with two other natural biodegradable polymers, pectin, or alginate were investigated. Methods: In this study, encapsulation efficiency (EE), total phenol content (Folin–Ciocalteu reagent method), antioxidant (DPPH scavenging assay) and antimicrobial activities (agar well diffusion method) structural (SEM and FTIR studies), and release properties of WGH extract-loaded microcapsules were investigated. Results: High retention of phenolic content in microcapsules indicated the successful encapsulation of WGH extract. Addition of biopolymers to maltodextrin matrix has a positive effect on EE and other properties of microcapsules. The microcapsules prepared with mixture of maltodextrin and pectin had higher EE (79.35 ± 0.87%) and total phenolic (TP) content (56.83 ± 1.04 mg gallic acid equivalents [GAE]/100 g) in comparison to maltodextrin and alginate mixture (EE: 75.21 ± 0.24%, TP content: 54.33 ± 1.53 mg GAE/100 g) and maltodextrin only matrix (EE: 72.50 ± 1.00%, TP content: 50.67 ± 1.35 mg GAE/100 g). Extract-loaded microcapsules also showed nearly spherical structure, good antioxidant (with the percentage DPPH inhibition ranged from 75.17 ± 1.42% to 80.87 ± 2.29%), and antimicrobial properties (with mean inhibition diameter zone ranged from 7.76 ± 0.86 mm to 11.53 ± 0.45 mm). Fourier transform infrared analyses suggested the presence of extract on microcapsules. The in vitro extract release from microcapsules followed an anomalous non-Fickian diffusion mechanism with almost complete release. Conclusions: WGH extract microcapsules can be used as novel and economic bioactive phytochemical and therapeutic agents to prevent oxidation and microbial activity.

Background: Petrol is an integral ingredient in industrial world. According to the US Agency for Toxic Substances and Disease Registry, there are typically more than 150 chemicals in petrol, including small amounts of benzene, toluene, xylene, ethyl benzene, and trace amounts of some contaminants, such as lead. The aim of this study was to measure the possible deleterious effect of long-term exposure to petrol on blood parameters and liver function. Methods: This is a case–control study conducted on 160 participants. Among them, 80 participants worked in a gas station for at least 4 years and 80 participants appeared with no history of occupational exposure to petrol. Blood sample was taken at the time of admonition to the tardive office at each station at 10 AM to measure the association of number of total and differential leukocyte and liver functions. Results: Based on the results, significant reduction in total leukocyte numbers was found in exposed group compared to unexposed group (1347 ± 4.59, <0.001). However, there was a significant increase in neutrophil (75.9 ± 3.50 in exposed group compared with 58.9 ± 3.15 among unexposed group, P < 0.001). However, no significant difference was found in liver enzymes between both groups. Conclusions: Long-term exposure to petrol fumes has deleterious effect on white blood cells. A significant reduction in the number of total and differential lymphocyte seems to be attributed to the toxic effect of petrol ingredients.

Background: Screening is the most important action in the early diagnosis of breast cancer. This study investigates the impact of educational intervention based on the integrated behavioral model on breast cancer screening behavior in women in Karaj City, 2016. Methods: This semi-experimental study was conducted on 138 women who were attended to health centers in Mohammad Shahr city. The samples were selected using cluster sampling and were randomly divided into two groups, experimental and control group. Data gathering tool was a four-part questionnaire (demographic characteristics, knowledge, Champion's Health Belief Scale, subjective norms). Two 50-min sessions were held for educational intervention in the experimental group. Training was presented through lecture, questioning and answering and group discussion. The data were completed in three steps (before, immediately after and 2 months after the intervention) and were analyzed using SPSS 16 software. Results: The results showed that the mean score of all structures except the perceived benefits of mammography and mammography behavior have a significant difference in the intervention group than the control group in 2 months after intervention (P < 0.001). In all the studied structures, except the perceived benefits of mammography (P = 0.083) and mammographic behavior (P = 0.156), there was a significant difference between the two groups before and immediately after the intervention (P < 0.001). Conclusions: The finding of this study showed that the efficiency and effectiveness of an educational intervention based on health belief model along with subjective norms that emphasize the opinions of others about the behaviors of individuals also has a very dramatic effect on the promotion of breast cancer screening behaviors.

Background: Germinal matrix-intraventricular hemorrhage (IVH) is the most common brain hemorrhage in preterm neonates. The importance of this hemorrhage lies in its severe complications. There is no definite treatment for IVH in neonates; therefore, the prevention of IVH should be considered. Some studies have shown that Vitamin E can probably decrease the risk of IVH and the other study has not shown its efficacy. The aim of this study is to evaluate the effects of Vitamin E on incidence and severity of IVH in preterm neonates. Methods: This study is a randomized clinical trial conducted on 76 neonates with gestational age of ≤30 weeks in the Isfahan University of Medical Science. The neonates were divided into two groups. The group one was administered with 10 units of Vitamin E for 3 days and the second group with placebo. In the 4th and 7th days after birth, brain sonography was conducted to evaluate IVH. The presence of sepsis, incidence of necrotizing enterocolitis, and hypotension were examined. Results: In this study, 76 neonates with the mean age of 28.49 ± 1.46 weeks participated. The incidence of hemorrhage in the 4th day was 26.3% in cases and 42.1% in controls with no significant difference (P = 0.3). The findings of the second sonography reported the incidence of IVH in 17.1% of cases and 36.8% of control group. Conclusions: Based on findings of the current study, Vitamin E use did not significantly decrease IVH in neonates. Further studies with larger sample size are needed.

Introduction: High-cost sharing in physician care may result in worse health outcomes and financial burdens for individuals, and it reduces needed health-care utilization. Hence, this study examines the impact of cost sharing on utilization of Physician care. Methods: In the present study, multistage sampling (n = 1610) was done to collect general physician utilization and quality of life. Count data model was used to analyze the effect of cost sharing and other factor on the ratio of referring to the general physician. Negative binomial regression was employed to analyze the utilization model. Results: People who have high-cost sharing had used general physician services much less, so that ratio of incidence among them was 0.18 less than individuals with low-cost sharing (P < 0.05). Gender and age variables showed a significant effect on the demand for the general physician visit (P < 0.05). Conclusions: A low cost-sharing policy would remove the clinically and financial threat from the patient decision-making so as to provide them with access to needed care.

Background: The present research conducted with aim to determine the health-promoting behaviors (HPBs) of public of Isfahan, and study the associations of HPBs with demographic characteristics. Methods: In a cross-sectional study conducted on 369 people without heart disease living in Isfahan, HPBs were assessed using a questionnaire which consists of two parts: personal information and Health-Promoting Lifestyle Profile II (HPLP-II). Data were analyzed by t-test and one-way analysis of variance. Results: The mean score for overall HPLP-II (158.30 ± 19.38) indicated the acceptable level of performing HPBs in Isfahan. Physical activity got the lowest score (16.36 ± 5.13), and the highest score was for interpersonal relations (53.16 ± 5.59). There were significant differences on physical activity and interpersonal relation dimensions between males and females (P < 0.05). The mean score of physical activity was highest in single participants (P < 0.05). Mean score of physical activity for people with college education was greater than others (P < 0.05). Overall HPLP-II and its domains mean scores for people that received education about prevention of cardiovascular disease were greater than others (P < 0.05). Conclusions: Results showed HPBs in people of Isfahan society is acceptable but physical activity is in the worst condition. The role of physical activity in preventing and controlling cardiovascular disease is well established. Therefore, it seems that providing information about physical activity can lead to an improvement of health-promoting lifestyle.

Background: Pneumonia is one of the most common hospital-acquired infections among bedridden patients in Intensive Care Units (ICUs). Colonization of mouth and pharynx by pathogenic bacteria and their aspiration into the lower respiratory tract is an important step in pathogenesis of hospital-acquired pneumonia. The purpose of this study was to compare the effects of chlorhexidine and potassium permanganate mouthwashes in preventing incidence of hospital-acquired pneumonia in hospitalized patients in the ICU. Methods: This study is a clinical trial, conducted on 150 patients on ventilator in ICU. Patients were divided into three groups: Chlorhexidine group, potassium permanganate group, and control group. Mouthwashing three times a day, each time 5 min for 1 week by sterile gas with 10 cc solution of chlorhexidine, potassium permanganate, or placebo, was performed. Finally, pneumonia incidence was recorded, according to the Center for Disease Control and Prevention criteria. The data were analyzed by SPSS software version 20. Results: In the present study, 28 cases of pneumonia among 150 patients on ventilator were investigated. There were 15 (30%), 6 (12%), and 7 (14%) incidences of pneumonia in control, chlorhexidine, and permanganate group, respectively. Pneumonia incidence in these groups differed significantly (P = 0.041). Conclusions: The use of common mouthwashes, especially chlorhexidine solution, for washing oropharynx of ICU patients, can decrease pneumonia incidence, especially in patients under ventilation. Thus, washing and sterilizing mouth of patients with mouthwashes is recommended due to the high risk of hospital-acquired pneumonia in these patients.

Background: Rosa damascena (R.D) is an aromatic plant with numerous therapeutic effects including cardiovascular effect. The mechanism cardiovascular effect of R.D is unclear and suggested mediated through renin–angiotensin system (RAS). Therefore, in this study, the role of hydroalcoholic extract of R.D on acute hypertension induced by AngII was evaluated. Methods: After anesthesia, femoral artery and vein of rats were cannulated for recording cardiovascular responses and drug injection, respectively. Systolic blood pressure (SBP), mean arterial blood pressure (MAP), and heart rate (HR) were recorded continuously by power lab software. Rats were divided into saline, AngII (50 ng/kg), AngII + Losartan (10 mg/kg), and three groups of R.D extract (250, 500, and 1000 mg/kg). Losartan and AngII were administered intravenously and the other ones intraperitoneal. In the R.D groups, 30 min after injection of the extract, AngII was injected and the maximum changes in SBP, MAP, and HR were calculated and compared to that in control and AngII groups. Results: Results show that AngII significantly increased SBP, MAP, and decreased HR than the control group which was blocked by losartan. SBP and MAP in R.D + AngII groups were significantly lower than AngII alone (P < 0.05 –P < 0.001). Only MAP in higher dose (1000 mg/kg) was significantly lower than low dose (250 mg/kg; P < 0.05). Two higher doses also significantly decreased bradycardia induced by AngII (P < 0. 01). Conclusions: The preventive effect of hydroalcoholic extract of R.D on cardiovascular parameters maybe is mediated by suppression of AngII activity.

Background: Health literacy has been considered as a predictor of starting, maintaining, and stop smoking. However, such relations have not been well documented in previous texts. Therefore, the purpose of this study was to investigate the relation between health literacy and changes in the behavior of smoking in Tabriz University of Medical Sciences. Methods: In this correlational descriptive study, a total of 297 employees of Tabriz health centers were examined. To collect data, a demographic-social questionnaire, Iranian Health Literacy Questionnaire, and DiClemente's behavior change questionnaire were used. Besides, SPSS 13 software (significance level = 0.05) was employed to analyze the data. Results: The average health literacy rate of participants was 70, and most respondents had adequate health literacy. Nearly 41.1% were in the precontemplation phase which is one of the stages of behavior change. There was a positive and significant statistical relation between behavior change variable with all health literacy areas (except the scope of understanding) and total health literacy score (P = 0.011 and r = 0.147). The results of ordinal regression analysis demonstrated that there is a significant positive relationship between the score of health literacy and behavioral change (b = 0.019, 95% confidence interval = (0.010–0.029), P < 0.001). Conclusions: Improving the level of health literacy can lead to change people's behavior in relation to tobacco consumption. However, due to the lack of relevant texts, there is a need for further studies in this field.

Background: The study investigated the effects of isokinetic versus isotonic training among adolescent state-level weightlifters in terms of total leukocytes, total lymphocytes, and its subsets following 24 sessions of training program and a month following training program cessation. Methods: Nineteen adolescent state-level weightlifters were assigned into isokinetic or isotonic groups. All participants were recruited from a pool of weightlifters with standardized training program provided by their coach. Series of immunological tests were carried out before the commencement, immediately upon the completion, and a month after the cessation of the additional training program to evaluate total leukocytes and lymphocytes count. Results: The results revealed a significant time and group interaction and main effects of time on mean total leukocytes (P < 0.05). Mean total leukocytes count at posttest decreased in both groups. In isotonic group, it was further decreased following 1 month of training cessation (P < 0.05) but not in the isokinetic group. However, the decrement was not high and the values were in the normal range. No significant time and group interaction was observed in total lymphocytes and its subsets count. Conclusions: Eight weeks of isokinetic and isotonic additional training with emphasis on shoulder joint only affect mean total leukocytes count in state-level adolescent weightlifters.

Background: The growth, learning, and contribution to active life in the communities are better in well-nourished children, and various factors influence infants' feeding. In this study, we assessed whether household socioeconomic status (SES) affects infants' length-for-age, weight-for-age (indicators of health and nutritional status) and breastfeeding (BF) (a necessity for optimal growth and health) status. Methods: In this cross-sectional study, 150 households with infants of 1–1.5 years old were interviewed on these variables: family size, dwelling ownership, duration of BF, exclusive BF (EBF) for 6 months, parents' age, parents' ethnicity, birth order, delivery type, and parents' education. Weight and length at 4 and 12 months were obtained from centers' records. To determine SES, we assessed total years of parents' education and household asset ownership by an index of nine owned assets. Results: The average of 4-month length in the low SES group was significantly lower than the two others (P < 0.05). In middle socioeconomic group, duration of BF was significantly higher (19.5 ± 7.3 months vs. 18.0 ± 8.0 months in low and 17.5 ± 7.9 months in high SES groups) (P < 0.05). Comparing illiterate mothers, university degree holders and university students were 73% less likely to not having EBF. Moreover, those with middle SES showed to be about 40% less likely to not having EBF. Conclusions: Nutritional status, duration of BF, and EBF might be determined by household SES and maternal education. Therefore, these findings can be used to decide how to focus on appropriate target groups in family education planning to improve children's development to its most possible.

Background: Zinc deficiency is common in developing countries and increases the risk for several infectious diseases. Low serum zinc levels have been reported in children with dengue virus infection (DVI). This study aimed to assess the effects of zinc supplementation on DVI outcomes. Methods: A double-blinded, randomized trial was conducted in 50 children with dengue fever (DF)/dengue hemorrhagic fever admitted to the pediatric unit of MSMC Srinakharinwirot University Hospital, Thailand, between January 2016 and April 2017. Bis-glycinate zinc or placebo was orally administered three times a day for 5 days or until defervescence. The primary outcome was to evaluate the DVI defervescence phase; the secondary outcome was to assess hospitalization length and presence of severe DVI and zinc deficiency. Results: The mean time of defervescence was 29.2 ± 24.0 h in the supplementation group and 38.1 ± 31.5 h in the placebo group (P = 0.270). Meantime of hospital staying was 62.5 ± 23.8 h in the supplementation group and 84.7 ± 34.0 h in placebo group with the mean difference of hospital staying between groups of 22.2 h (95% confidence interval [CI]: 5.5–38.5 h; P = 0.010). Overall prevalence of zinc deficiency was 46%. Serum zinc levels increased from baseline to the end of the study. the mean gain was 26.4 μg/dL (95% CI: 13.6–39.1 μg/dL) in the supplementation group and 14.4 μg/dL (95% CI: 7.4–21.3 μg/dL) in placebo group. No signs of severe DVI were observed in both groups. Zinc supplementation was well tolerated. Conclusions: Overcoming zinc deficiency among Thai children may reduce DF duration and limit the hospitalization, in addition to other advantages that normal serum zinc levels have on overall children health.

Background: An appropriate snack for patients with diabetes mellitus should be considered to help them in their treatment due to their hard administrative diet. This study was conducted to evaluate the effect of dark chocolate on inflammatory markers, serum adiponectin, and certain biochemical factors in patients with type 2 diabetes (T2D). Methods: This study was a randomized parallel clinical trial. Thirty grams of 84% dark chocolate, along with therapeutic lifestyle changes (TLCs) guidelines, were administrated to patients with T2D. Control group received only TLC guidelines. The intervention period was 8 weeks. Twenty-one subjects in dark chocolate and 23 subjects in control group completed the study. Fasting blood samples were collected before and after the intervention period and inflammatory markers, biochemical factors, and adiponectin levels were assessed. Results: Fasting blood sugar, hemoglobin A1C, low-density lipoprotein and triglyceride levels declined significantly in the dark chocolate group and this decrease was significant between the intervention and control groups. Tumor necrosis factor-alpha, interleukin-6, and high sensitive C-reactive protein were significantly decreased in the dark chocolate group. Adiponectin levels were not significantly different between the two groups. Conclusions: In this study subjects who received dark chocolate along with TLC guidelines had lower levels of inflammatory markers such as hs-CRP, TNF-α, and IL-6, compared with the subjects who were devoid of dark chocolate and followed only the TLC guidelines. Other studies should be conducted to evaluate the most effective and administrative dosage of dark chocolate as a snack along with the common treatment of diabetes.

Objective: Several factors lead to memory loss, the most important of which is brain aging that is caused mostly by neuroinflammation and oxidative stress. The need of finding preventive treatments of memory impairment in elderly encouraged authors to assess the effect of Acorus calamus on memory loss, anxiety, and antioxidant indices on neuroinflammation rat models. Materials and Methods: Different fractions of A. calamus were prepared. The subject rats were grouped in 11 groups of 10 each. In the nine treated groups, the extract gavage began 1 week before intraperitoneal (i.p.) injection of lipopolysaccharide (LPS) and continued for 2 weeks after the last injection of LPS. Behavioral tests, including passive avoidance and elevated plus-maze (EPM) tests, were run on days 24, 25, and 26 and the subjects were sacrificed on the day after the last behavioral test, and their hippocampus was isolated to measure the oxidative stress markers. Results: Assessment of oxidative stress markers in hippocampus samples revealed that the amounts of endogenous antioxidant enzymes (superoxide dismutase, glutathione peroxidase, and total antioxidant activity) in the groups that received different fractions were less than their equivalent figures in LPS-control group, and levels of malondialdehyde (MDA) in treatment groups were less than MDA level in LPS-control group. Moreover, the treatment groups with different fractions of A. calamus revealed better performance compared to LPS-control group in shuttle-box test. In EPM test, the groups with different fractions revealed lower stress level in comparison with LPS-control group. The best performance in memory test and the lowest level of stress in EPM was observed in the group with aqueous fraction at 600 mg/kg dose, and the least figures of oxidative stress markers were of the group with aqueous fraction at 600 mg/kg dose. Conclusion: The oral administration of different fractions of A. calamus, especially aqueous fraction, prevented from memory deficits and stress through controlling oxidative stress and inflammation processes.

Background: Diabetes is the most common disease related to metabolism disorders. Today, diabetes in the elderly is one of the major epidemics of the century. This study aimed to investigate the effect of nutrition and jogging-based Belief, Attitude, Subjective Norm, and Enabling Factors (BASNEF) model in changes in metabolic parameters that performed in elderly patients with type II diabetes in Fasa city. Methods: This study was a randomized clinical trial on 108 elderly patients with type II diabetes (54 patients in the experimental group and 54 in control group) referred to the diabetes center in Fasa City, Fars Province, Iran, in 2016. Data were collected using a valid self-reported questionnaire including demographic variables and BASNEF Model (knowledge, attitudes, subjective norms, and enabling factors), checklist for patient's practices nutrition and jogging based on self-reporting patients, assess the level of fasting blood sugar (FBS), low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides (TG), and HbAlc patients which was completed by both groups before and 3 months after the intervention. The experimental group received the training in eight sessions; each session lasted for 70 min. Then, the data were entered into the SPSS 22 software (SPSS Inc., IBM, Chicago, IL, USA) and were analyzed using descriptive statistics, Chi-square test, independent t-test, and paired t-test. P <0.05 was considered as statistically significant. Results: The results showed that the mean scores of the BASNEF components (knowledge, attitudes, subjective norms, and enabling factors) in two experimental and control groups after intervention were a significant difference. After training program, nutritional and jogging performance in the experimental group was better than the control group. Furthermore, FBS (P < 0.001), LDL (P < 0.001), HDL (P < 0.001), TG (P < 0.001), and HbAlc (P < 0.001) improved significantly in the experimental group compared to the control group. Conclusions: Plan and implement nutrition and jogging education using the BASNEF model to improve metabolic parameters in diabetic patients are very effective and beneficial. Moreover, in the implementation of these programs, control, monitoring, and follow-up educational are recommended.

Background: Little is known on the food consumption habits and adherence to dietary guidelines among young adults. We examined students' adherence to recommended guidelines, and the associations between importance of eating healthy and guidelines adherence. Methods: A total of 3271 undergraduates at 11 faculties, Assiut University, Egypt (2009–2010), completed a questionnaire reporting their consumption of 12 food groups; number of servings of fruits/vegetables/day; and how important it is for them to eat healthy. We employed the WHO guidelines for the Eastern Mediterranean region (WHO 2012) to compute students' adherence to dietary guidelines for the different food groups. Chi-square tested the differences for adherence to guidelines by gender, and the associations between the importance of healthy eating and guidelines adherence for the whole sample and by gender. Results: Except for cereal products, no food group had an adherence level >45%. Gender differences were observed (men had better adherence for sweets, cake/cookies, snacks, and raw vegetables but not for fast food/canned food or cooked vegetables, P < 0.001 for each). There was a significant positive trend between the increase of subjective importance of eating healthy and adherence to guidelines (P = 0.012–<0.001). However, this association was only for some food groups and gender dependent. Conclusions: Across the majority of food groups we examined, this sample exhibited low adherence levels to International Nutrition Guidelines. Healthier eating educational/intervention efforts should target foods exhibiting low adherence (most food groups, particularly salad/raw vegetables, fresh fruits, dairy/dairy products, meat/sausage products); consider gender differences (females reported lower adherence across most food groups); and note the relation between adherence and subjective importance of eating healthy by food groups and gender.

Background: Peritonitis is one of the important complications of peritoneal dialysis and one of the reasons for failure of this therapeutic technique. As one of the important reasons for development of peritonitis is disregard for health behaviors, this study aims to investigate the effect of education based on health belief model (HBM) on behaviors preventing peritonitis in peritoneal dialysis patients. Methods: This double-blind clinical trial study conducted on 60 patients with peritoneal dialysis in Isfahan, Iran. A researcher-made questionnaire was used to evaluate knowledge, HBM constructs, and peritonitis preventive behaviors in three stages (before, immediately after and 2-month after intervention). The intervention group received four HBM-based educational sessions and the control group received a lecture session. Data were analyzed using Chi-square, Mann–Whitney, Fisher's exact test, independent t-test, and repeated measures ANOVA. Results: There was no significant difference between the two groups' background variables and level of knowledge, perceived, sensitivity, severity, benefits, arriers, self-efficacy, personal and environmental hygiene behaviors and fluid-replacement technique before the intervention. Immediately after the intervention, all of the variables, except perceived barriers, personal, and environmental hygiene, were significantly higher in the intervention group than the control group (P < 0.05); 2 months after the intervention, all of the variables, except personal hygiene and perceived barriers, were significantly higher in the intervention group (P < 0.05); in three stages, personal hygiene was not significantly different between the two groups; and 2 months after the intervention, the variable of perceived barriers decreased significantly in the intervention group (P < 0.05). Conclusions: Education based on HBM is effective on promoting behaviors preventing peritonitis. Education based on HBM is suggested in peritoneal dialysis patients to prevent peritonitis.

Background: Formaldehyde is a common hazardous indoor air pollutant which recently raised public concerns due to its well-known carcinogenic effects on human. The aim of this study was to investigate a potted plant-soil system ability in formaldehyde removal from a poor ventilated indoor air to promote dwellers health. Methods: For this purpose, we used one of the common interior plants from the fern species (Nephrolepis obliterata), inside a Plexiglas chamber under controlled environment. Entire plant removal efficiency and potted soil/roots contribution were determined by continuously introducing different formaldehyde vapor concentrations to the chamber (0.6–11 mg/m³) each over a 48-h period. Sampling was conducted from inlet and outlet of the chamber every morning and evening over the study period, and the average of each stage was reported. Results: The results showed that the N. obliterata plant efficiently removed formaldehyde from the polluted air by 90%–100%, depending on the inlet concentrations, in a long time exposure. The contribution of the soil and roots for formaldehyde elimination was 26%. Evaluation of the plant growing characteristics showed that the fumigation did not affect the chlorophyll content, carotenoid, and average height of the plant; however, a decrease in the plant water content was observed. Conclusions: According to the results of this study, phytoremediation of volatile organic compound-contaminated indoor air by the ornamental potted plants is an effective method which can be economically applicable in buildings. The fern species tested here had high potential to improve interior environments where formaldehyde emission is a health concern.

Background: Considering that better understanding of the underlying mechanisms and risk factors of arterial ischemic stroke (AIS) would be helpful for better management of stroke and its outcome in children as well as preventing or reducing the occurrence of its related potential disabilities, the aim of this study was to investigate the most common risk factors and causes of AIS in patients referred to the referral hospitals in Tehran and Isfahan cities of Iran. Methods: In this study, medical files of all pediatric patients admitted to the Mofid and Imam Hossein children's hospitals with the diagnosis of AIS from 2001 to 2011 and 2011 to 2016, respectively, were evaluated. Identified risk factors of AIS were categorized as arteriopathies, cardiac disorders (CDs), infection, acute head-and-neck disorders, acute systemic conditions, chronic systemic conditions, prothrombotic states, chronic head-and-neck disorders, atherosclerosis-related RFs, and others. Results: In this study, 61 patients were evaluated. Mean (standard deviation) age of the patients was 5.1 (3.9) years. About 62.3% of the patients were boys while 37.7% were girls (P < 0.01). A total of 36 patients (59%) had at least one risk factor for AIS. About 40.9% of patients had undetermined risk factors. CDs (21.31%) and vascular disease (21.31%) were the most common risk factors of AIS in the studied children. Nearly 11.5% of the patients had moyamoya vascular disease (MMD). Conclusion: The findings of our study indicated that the most common risk factors for AIS in the two studied regions are congenital heart and vascular diseases. The results of the current study could be used for planning more preventive strategies in patients suffering from the mentioned diseases. In addition, the obtained data could be used for conducting targeted education and management of high-risk patients.

Background: Neuromyelitis optica spectrum disorder (NMOSD) is a central nervous system inflammatory disorder in which immunoglobulin G (IgG) autoantibodies possibly play a pathogenic role against the aquaporin-4 water channel protein. Vitamin D may modulate B-cell function and decrease the IgG synthesis and may play a role in NMOSD as a crucial factor. The aim of this study was to investigate the relation between Vitamin D intakes from food, Vitamin D intake from sunlight exposure, blood Vitamin D levels, and IgG-neuromyelitis optica (NMO) level in serum of patients with NMOSD and NMO. Method: In this cross-sectional study, food Frequency Questionnaires (FFQ) and Sun Exposure Questionnaire (SEQ) were completed to evaluate of vitamin D intakes from food and sun light exposure. Moreover, serum levels of 25(OH) vitamin D3 and IgG-NMO were assessed in patients with NMOSD and NMO. Results: We assessed IgG-NMO levels in 29 patients with NMOSD that nine patients (n = 31%) were positive and for the rest it was negative. Sunlight exposure scale (P = 0.01) and 25(OH) D3 (P = 0.04) in IgG-NMO-negative patients were significantly more than patients with positive IgG-NMO. Age, gender, and latitude were not confounder variables. A positive significant correlation was observed between the sun exposure scale and serum levels of 25(OH) D3 in all participants (r = 0.747, P ≤ 0.001). Conclusions: Physiological variation in Vitamin D may apply a significant effect on IgG-NMO synthesis in patients with NMO. Vitamin D may have significant role in pathogenesis of NMOSD and NMO.

Background: The prevalence of Type 2 diabetes mellitus (T2DM) has been increasing globally in the recent decades. Physical activity (PA) helps preventing diabetes complications by keeping the blood sugar of T2DM patients within the normal range. The objective of this study was to explore underlying beliefs corresponding to PA in T2DM patients using health action process approach (HAPA). Methods: This cross-sectional study was conducted in Isfahan, 2015. A convenience sample of 203 participants with T2DM was collected. Participants completed HAPA inventory containing the following constructs: Risk perception, outcome expectation, task self-efficacy, intention, action and coping planning, coping self-efficacy, recovery self-efficacy, and PA questionnaire. Structural equation modeling was used for statistical analysis. Results: The common fit indices revealed that the HAPA had an acceptable fit to the observations (CMIN/df = 2.36 [P < 0.001], root mean square error of approximation = 0.089, comparative fit index = 0.891, normal fit index = 0.902). Intention was associated with task self-efficacy (β = 0.92, P < 0.001), whereas risk perception (β = 0.16, P = 0.073) and outcome expectation (β = 0.32, P < 0.081) did not predict intention to participate in PA behavior. PA was well predicted by planning (β =0.84, P < 0.01) while it was not significantly associated to coping self-efficacy (β = 0.66, P = 0.73) and recovery self-efficacy (β = 0.6, P = 0.69). Conclusions: HAPA could be used as a proper framework to identify the beliefs of the patients with T2DM and guide for effective theory-based interventions regarding PA.

Background: Demographic transition has led to rethinking of strategies that are in place to address health issues of the elderly. A study was done to estimate the prevalence and correlates of common mental disorders (CMDs) among the rural elderly in Puducherry. This would help prioritize and plan opportunistic screening for CMDs among the elderly at the primary care level. Materials and Methods: A cross-sectional community-based study was conducted among all the elderly, n = 243 (60 years and above), from one of the four villages catered by a rural health center in Puducherry. Data were collected at home from subjects using a questionnaire on (1) sociodemographic details and (2) CMDs using the general health questionnaire-12 (GHQ-12). Multivariable logistic regression was used to identify independent correlates of CMDs. Results: A total of 243 subjects were studied. Women constituted 63% of the study subjects. The univariable analysis showed that the odds of having CMDs was higher among women (odds ratio [OR] =1.76 [1.03–2.97]), widowed elderly (OR = 2.44 [1.46–4.11]), and among those with a per capita per month income less than USD 19.6 (USD 19.6 to USD 9.9: OR: 4.02 [1.22–13.22]; less than USD 9.9: OR: 3.67 [1.008–13.34]). Elderly with an education of upper primary level (OR: 0.37 [0.33–0.15]) and above (OR: 0.22 [0.22–0.06]) had lower odds of having CMDs compared to those with no formal education. On multiple logistic regression analysis, after adjusting for other confounders, widowed elderly were found to have 2.1 times the odds of having MDs as opposed to elderly with living spouse (OR: 2.107 [CI: 1.09–4.06]). Conclusions: Fifty-one percent of the elderly in our sample suffered from CMD. Widowhood emerged as the single independent predictor of CMDs in this study population.

Background: Dietary phytochemical index (DPI) has introduced as an inexpensive method for quantifying the phytochemicals in foods. For the first time, this study was conducted to investigate the relationship between DPI and the risk of prediabetes. Methods: Three hundred participants were assigned to 150 prediabetics (cases) and 150 healthy (controls) groups. Anthropometric values, fasting blood glucose, and 2-h oral glucose tolerance test (OGTT) were measured. The DPI was calculated based on data collected from 168-item validated food frequency questionnaire. Results: The sex-specific energy-adjusted DPI was inversely related to fasting blood glucose (FBG) and OGTT (P < 0.001). The odds ratio (OR) of prediabetes was assessed across sex-specific energy-adjusted DPI quartiles. After adjusting for body mass index, physical activity, education, dietary intake of energy, fiber, carbohydrate (% of energy), fat (% of energy), and protein (% of energy), the OR of prediabetes across the sex-specific energy-adjusted DPI quartiles decreased significantly (P-trend < 0.001). Conclusions: We found that higher DPI score is related to lower prediabetes OR. This simple method may be used for the improvement of dietary intake to prevent prediabetes.

Introduction: Vitamin D (vit D) deficiency has defined as a health problem worldwide. World Health Organization (WHO) has declared that obesity is an epidemic of the 21^st century. Previous studies have shown that obesity may increase the risk of Vit D deficiency. Furthermore, other studies have demonstrated that vit D insufficiency was accompanied with higher risk of type 2 diabetes, cardiovascular diseases, hypertension, and obesity. The aim of this study was to survey the effect of vit D supplementation on weight loss among overweight and obese women aged 20–40 years in Isfahan. Methods: This double-blind clinical trial was done on 50 overweight and obese women who were divided into two groups, in which one group received vit D supplements and the other group received placebo. Intervention group received vit D with dozes 50,000 IU/w for 6 weeks. The levels of total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c), fasting blood sugar (FBS), insulin (ins), homeostasis model assessment of ins resistance (IR), C-reactive protein (CRP), height, weight (WT), waist circumference (WC), hip circumference (HC), and blood pressure (BP) were measured before and after intervention. Results: After using vit D supplementation for 6 weeks, WT, WC, and body mass index (BMI) were decreased significantly and serum vit D increased significantly compared to control group (P < 0.001). Other factors including TC, TG, LDL-c, HDL-c, FBS, CRP, ins, IR, and waist to hip ratio (WHR) did not change significantly (P > 0.05). Conclusions: After 6 weeks of intervention, the means of WT, BMI, WC, and HC decreased significantly. Previous studies have shown that vit D deficiency was more prevalence in obese people and there was an inverse association among vit D with BMI and WC. The relationship between vit D and lipid profiles such as glycemic indexes, anthropometric indexes, CRP, and BP is not clear and needs more study in the future.

Background: Hypertension (HTN) is linked to cardiac dysautonomia that can end up as life-threatening arrhythmias. The same can be screened by simple electrocardiogram (ECG)-based QTc (QT corrected for heart rate) interval which indicates repolarization abnormality. We quantified QTc interval among treated hypertensives in comparison to controls, testing effect of age, gender, and blood pressure. Methods: We conducted a cross-sectional study was done at a tertiary care teaching hospital of Gujarat, India, on 142 hypertensives on monotherapy (60 males, 82 females) and 72 age-, sex-, and time-matched normotensives. ECG was recorded with minimum 10 complexes of Lead II. QTc was derived from average of 10 values, using Bazett's formula. QTc > 0.43 s in male and > 0.45 s in female was considered abnormal. Results: Hypertensives (mean age 40 and duration 5 years) had significantly higher QTc value than normotensives among males (0.42 vs. 0.40, P < 0.001), females (0.44 vs. 0.41, P < 0.001), and in total (0.43 vs. 0.41, P < 0.001) with 24% prevalence of ECG-based left ventricular hypertrophy. Hypertensives had odds ratio 1.63 in males (P = 0.15), 23.71 in females (P = 0.003), and 3.83 in total (P < 0.001) for prolonged QTc. QTc values were significantly affected by increasing age amongst hypertensives but not by duration of HTN or current blood pressure. Conclusions: Our study showed a high prevalence of prolonged QTc, both qualitatively and quantitatively, in hypertensives on monotherapy with poor pressure control, associated with female gender and age but not duration or blood pressure. This underscores high risk of repolarization abnormality induced future event, suggesting QTc screening as primary prevention.

Background: Analyzing the possible negative effects of using cell phones on the users' health is an important and vital affair due to rapid growth and extensive use of these devices on human communications and interactions. The aim of this study was to determine the effect of increasing the distance of cell phones to brain tissue on the temperature of the central and gray matters of brain due to the heat generated by radio frequency waves. Methods: This study was an experimental study. A cow's brain tissue was analyzed in a compartment with three thicknesses of 2, 12, and 22 mm, in the distances of 4 mm and 4 cm from a cell phone for 15 min. Lutron thermometer was used to measure the tissue temperature, and the data analysis were done by Lutron and MATLAB software packages. Results: The tissue temperature was increased while confronting with a cell phone in distances of 4 mm and 4 cm in all the three thicknesses of 2, 12, and 22 mm. The tissue temperature was higher after removing the confrontation at 4 mm distance as compared to the distance of 4 cm. Conclusions: During confrontation and after that with the cell phone, reducing the distance of brain tissue and the cell phone increased the tissue temperature intensely. In fact, by increasing the cell phone distance from brain tissue, the thermal effect of radiofrequency waves was reduced.

Background: Sodium arsenate (As), a toxic substance with induced oxidative stress, lead to hepatotoxicity. Olive oil (OO) with antioxidant property has protective effect on toxicity. The aim of this study was to investigate protective effect of OO on sodium As-induced hepatotoxicity in mice. Subjects and Methods: In this experimental study, 32 adult male BALB/c mice were divided randomly into four groups: control group (received only normal saline, the same volume as other groups), OO (0.4 mL/day, gavage), sodium As (15 mg/kg, gavage), and OO + sodium As (received OO 1 h before sodium As). Drugs were given for 30 consecutive days. After the last receipt of the drugs, oxidative stress parameters [malondialdehyde (MDA), glutathione (GSH)] in tissue, liver function parameters [alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP)] in serum, ferric reducing ability of plasma (FRAP) in plasma, and histopathological assays were performed. Results: Sodium As induced hepatic injury as indicated by significant increase in AST, ALT, ALP, and LDH in serum and pathologic evidences. It also induces hepatic oxidative stress biomarkers as indicated by significant increase in levels of MDA and significant decrease in FRAP and GSH concentration. OO administration significantly improved oxidative stress parameters, histopathological changes, and enzymatic markers of liver injury. Conclusions: It was concluded that antioxidant activity of OO has hepatoprotective effect on As-induced hepatic injury.

Background: Dementia as a major cognitive neurological disorder is defined as impairment in one or more cognitive territories compared with the former level of performance. This disorder disrupts patient's independence, and the patient would need others aid in order of doing daily and complex activities. The aim of this study was to evaluate the efficacy of Rosa damascena extract in the improvement of cognitive function in patients with dementia. Methods: This study is a randomized double-blind, placebo-controlled clinical trial on 40 patients older than 55 years with dementia referred to Specialized Elderly Patients Clinic in 2015–2016. Patients were divided randomly into two groups (control and intervention). The intervention group used donepezil and R. damascena capsules, and in control group, placebo capsule instead of R. damascena added on donepezil. Four test was filled three times at the study initiation, after month one and also after month three: Mini–Mental State Examination (MMSE) and Addenbrooke's Cognitive Examination Revised (ACE-R) were used for cognition evaluation, for depression assessment, Geriatric Depression Scale was administered, and checklist of memory and behavioral disorders were filled. Results: The results showed add-on donepezil and R. damascena versus placebo improved cognitive impairment based on MMSE with P = 0.002, ACE-R with total P = 0.001, depression (P = 0.012), behavioral disorders (P < 0.001), and daily activity (P < 0.001). Conclusions: The R. damascena extract affected cognitive impairment of dementia patients significantly and also have significant effects on improving depression and behavioral problems.

Background: The present study describes the burden of occupational diseases in Iran based on the results of the Global Burden of Disease study conducted in 2010 (GBD 2010). This study aimed to determine the burden of occupational diseases in Iran based on the results of GBD 2010. It is a cross-sectional study. Methods: Disability-adjusted life years (DALYs) of occupational diseases were calculated based on the prevalence rates obtained through model estimation, as well as GBD 2010 disability weights and mortality rates obtained from different data registry systems of Iran. Causal association criteria application to select risk outcome pairs, estimation of exposure to each risk factor in the population, estimation of etiological effect size, selection of a counterfactual exposure distribution, risk assessment, and identification of burden attributable to each risk factor were the main conducted statistical steps. Results: There was an increasing trend of DALYs (710.08/100,000 people in 1990 and 833.00/100,000 people in 2005) followed by a slight decrease (833.00/100,000 in 2005–784.55/100,000 people in 2010). A total of 50.4% and 36% of total DALYs per 100,000 people were due to the adverse effects of musculoskeletal disorders and work-related injuries, respectively. Conclusions: Musculoskeletal disorders and work-related injuries are the most important adverse consequences of work-related risks that require urgent interventions to be controlled. Male workers (15–25 years and over 60) with the highest DALYs and mortality rates need more training programs, safety regulations, and higher level of protection support. In spite the decreasing trend of occupational disease related DALYs and death rates in Iran in recent years, a long-term effort is required to maintain the currently decreasing trend.

Background: Undernutrition is common and has been recognized as a public health problem in Bangladesh. It has devastating effects on any population as it increases morbidity children and reduces the quality of life of all affected. The study was done with the objective to assess the undernutrition and morbidity profile in children who have completed exclusive breastfeeding. Methods: This was a descriptive cross-sectional study, which was carried out among children aged 6–12 completed months attending a tertiary level hospital in Bangladesh. A total of 251 children were selected through convenient sampling from January to December 2015. Nutritional assessment was done in terms of underweight, stunting, and wasting. Results: One hundred and forty-three (57.0%) were boys while 108 (43.0%) were girls. The prevalence of undernutrition (Z-score ≤−2) was observed in 11.2%, 16.3%, and 12.0% based on stunting, underweight, and wasting. Among 251 children, 16.7% were not suffering any diseases, whereas majorities (69.7%) were suffering from single disease and 13.5% were suffering from multiple diseases. Cough and fever (55.0%), pneumonia (18.3%), measles (9.9%), and diarrhea (8.3%) were the most common cause of infectious morbidity observed in children. Conclusions: The prevalence of undernutrition was high in the study population, and it continues to be a public health burden because of its major effect on morbidity and impairment of intellectual and physical development in long-term. Increasing the practice of exclusive breastfeeding, the introduction of timely complementary feeding, and standard case management of morbidities would be beneficial to combat the problem of undernutrition.

Background: Reference citation analysis and reference publication year can help to demonstrate the historical context of a research field. Therefore, this study aimed to determine the most important historical publications regarding depression prevention. Methods: This was a bibliometric study carried out using reference publication year spectroscopy(RPYS) method. Data gathering was carried out using Thomson Reuters Web of Science in the period of 2007–2016. A total of 17,043 records were retrieved which were uploaded as full record and cited references in plain text format. Then modified data were analyzed using RPYS.exe software. Results: Distribution of cited references in the area of depression prevention based on publication year revealed nine peaks in the twentieth century in years 1921, 1935, 1944, 1977, 1983, 1990, 1994, 1999, and 2000. Moreover, our analysis showed that some peaks occurred in the 21^st century in years 2001–2005. Conclusions: Researchers have investigated depression prevention with physiological, epidemiological, biological as well as physical approaches. Furthermore, created criteria for measuring depression in different target societies have played an important and vital role in depression prevention.

Background: Dental health is one of the most important health burdens of children health. The association between dental health and endocarditis has been already demonstrated, but there is controversy about different frequency of dental caries, periodontitis, and saliva microorganism in comparison to healthy population and children with congenital heart diseases (CHDs). In this study, we evaluated these differences. Methods: Seventy-six healthy children and 68 CHD patients were enrolled in the present case–control study. Dental decay, periodontitis, oral microorganisms, serum calcium, phosphorus, and frequency of carbohydrate and protein consumption of all participants were evaluated by standards method. Results: CHD patients experienced more periodontitis, but the difference was not significant (0.12 vs. 0.09, P = 0.2). In healthy children, the mean saliva colony counts of Streptococcus mutans were more significant (50639 ± 3324 vs. 35285 ± 27226, P = 0.03), which was diminished by adjusting the carbohydrate consumption. The mean colony count of Lactobacilli in children with CHD was nonsignificant higher than healthy children (P = 0.3). Conclusions: Pediatric patients with CHD experience insignificantly higher dental decay, periodontitis, and saliva Lactobacilli colony counts. The frequency of decayed tooth and gingival diseases in healthy children is high, and hence, more dental care attention in our health system is needed for healthy children.

Background: Today, using cellular phone and its harmful effects in human life is growing. The aim of this study is to investigate the effect of the global system for mobile communication (GSM) 900 MHz cellular phone radiofrequency waves on growth, morphology, and proliferation rate of mesenchymal stem cells and Michigan Cancer Foundation (MCF-7) cells within the specific distance and intensity. Methods: MCF-7 and human adipose-derived stem cells (HADSCs) were exposed to GSM cellular phones 900 MHz frequency with intensity of 354.6 μW/cm² during different exposure times 6, 21, 51, and 101 min/day with an interval of 10 min for each subsequent radiation exposure for 3 and 5 days at 10 and 20 cm distances from antenna. 3-(4,5-dimethythiazol- 2-yl)-2,5-diphenyl tetrazolium bromide assay and trypan blue test were used to determine the growth of cells and cell viability, respectively. Statistical analyses were carried out using three-way ANOVA. Differences were significant when P < 0.05. Results: The proliferation rates of both MCF-7 and HADSCs cells in all exposure groups were significantly lower than controls (P < 0.05). There was a significant effect on the percentage of cell survival with increase the period of time from 3 to 5 days for MCF-7 (P < 0.01) and HADSCs (P = 0.02), respectively. Variations in distance had no significant effect on the percentage of cell survival (P = 0.35) on MCF-7 (P = 0.02) and HADSCs (P = 0.09) cells, respectively. Conclusions: The results showed that radiation of GSM 900 MHz cellular phone may be reduced cell viability and proliferation rates of both cells. It is recommended to reduce exposure time, increase distance from antenna, and reserve the use of cell phones for shorter conversations to prevent its biological and harmful effects. Further studies with other intensities and frequencies on different cells are recommended.

Background: Despite major public health efforts in addressing the burden of disease caused by sexually transmitted infections (STIs), rates among young adults continue to rise in Canada. The purpose of the study was to examine the prevalence and risk factors associated with acquiring STIs among postsecondary students in Canada. Methods: A secondary analysis of the American College Health Association-National College Health Assessment II-C Spring 2016 survey data (n = 43,780) was conducted. Sexually active participants (n = 28,831) were examined for their demographics, sexual behavior, alcohol and marijuana use, testing for human immunodeficiency virus (HIV), and human papillomavirus vaccination history. These factors were analyzed to help identify their possible association with acquiring an STI using logistic regression and multivariate modeling. Results: Among the study participants, 3.88% had an STI, with the highest rates observed among females and individuals aged 21–24 years old. Multivariate logistic analysis showed that participants who engaged in anal intercourse within the past 30 days (odds ratio [OR] = 1.634; 95% confidence interval [CI], 1.343–1.988), had four or more sexual partners in the last 12 months (OR = 4.223; 95% CI, 3.595–4.962), used marijuana within the past 30 days (OR = 1.641; 95% CI, 1.387–1.941), and had ever been tested for HIV (OR = 3.008; 95% CI, 2.607–3.471) had greater odds of acquiring an STI. Conclusions: The findings of this study highlight certain high-risk behaviors that are strongly associated with acquiring an STI among postsecondary students. Thus, efforts to design and deliver relevant educational programming and health promotion initiatives for this particular population are of utmost importance.

Background: Close contact investigation is the essential key in tuberculosis (TB) case finding and an effective strategy for TB control program within any society. Methods: In this prospective study, 1186 close family contacts of hospitalized TB patients (index) in a referral TB hospital in Tehran-Iran were passively studied. These people were studied to rollout TB infection and disease. Demographic characteristics, clinical and laboratory data of these individuals were reviewed and summarized for analysis. Results: A total of 886 (74.4%) close-family contacts completed their investigation. The index TB patients of these individuals were sputum smear negative for acid-fast bacilli in 137 cases (11.6%) and the rest were smear positive. A total of 610 (68.8%) close-family contact ruled out for TB infection or disease (Group I). A total of 244 cases (27.5%) had latent TB infection (Group II) and active TB (Group III) was confirmed in 32 cases (3.6%). A significant difference was shown for female gender, signs and symptoms, family size, and positive radiological finding between Group I and Group II. The study of index parameter including positive sputum smear/culture did not reveal any significant difference, but positive cavitary lesion significantly more has seen in active TB group (P = 0.004). Conclusions: This study emphasizes on sign and symptoms and radiological finding in TB contact investigation, where index parameters including positive smear/culture, does not implicate any priority. Although cavitary lesions in index patient have more accompanied by active TB, close contact study should include all of TB indexes. This investigation should include chest radiography for these individuals.

Background: The 7^th package of health reform in Iran has been implemented in May 15, 1393, is concerned with the “promotion of natural childbirth.” It has been focusing on reducing cesarean section (CS) and promoting normal vaginal delivery (NVD) as broadly as possible. This study evaluated the changes in the vaginal delivery and cesarean before and after implementation of the 7^th package of health reform in public and private hospitals of Isfahan Province in 2014. Methods: This was a quasi-experimental research. The population of this study contained all public and private hospitals in Isfahan Province covered by the Health Reform Program. It included 22 public and 6 private hospitals. The data collected from the vice chancellor of treatment in 6 months before and after the implementation of the program have been analyzed. SPSS software version 18.0 (SPSS Inc., Chicago, IL, USA) and independent t-test have been employed for data analysis. Results: It was demonstrated that the increasing rate of NVD (P = 0.001) and decreasing rate of CS in public hospitals (P = 0.027) after the implementation of the plan were significant. On the other hand, the increasing rate of CS in private hospitals was significant (P = 0.026). Conclusions: Although this scheme has achieved its targets in public hospitals of Isfahan Province, it has not met its objectives in private hospitals. It seems CS operations were shifted from public hospitals to private ones, which is conflict with the objectives of the health reform plan.

Background: Scientists perceive drug users (DUs) as a high-risk population for hepatitis B virus (HBV) infection. Effective strategies aiming at the reduction of HBV infection can be depicted when its epidemiological status is clearly defined. The present study provides new insight into associated risk factors of HBV infection and its seroepidemiological status among DUs attending drop-in centers (DICs). Methods: This was a cross-sectional study, which was implemented in 7 DICs of Isfahan province. The sample size included 539 participants. Demographic data and risk factors for HBV infection were obtained by a trained social worker using a self-made structured questionnaire. Venous blood sample was obtained and tested for hepatitis B surface antigen (HBsAg), hepatitis B surface antibody, and total hepatitis B core antibody (HBcAb) using enzyme-linked immunosorbent assay. Results: Mean age of the participants was 31.76 ± 8.4 years. They were generally male, Iranian, urban, with an education level of high school or less. The prevalence of HBV infection (HBsAg and/or HBcAb) was 18% (88.490). Regression analysis showed that age, bloodletting, and drug injection, being the sexual partner of injecting DU (IDU), as well as frequency and duration of imprisonment positively correlated with HBV infection. Conclusions: Drug injection bloodletting, and being the sexual partner of IDU, as well as frequency and duration of imprisonment could be considered as contributing factors in HBV infection.

Background: The former Nyanza Province of Kenya bore the brunt of HIV-driven tuberculosis (TB); 62% of the 19,152 cases in 2010 were HIV co-infected. The use of laypersons to improve TB case finding in community settings has shown rewarding results in other countries. We have no documented Kenyan experience in health facility settings. We evaluated the benefit of using laypersons to support TB screening and referrals at the former Nyanza Province of kenya province's largest regional referral facility. Methods: In 2010, five high school graduates were trained on symptomatic recognition of TB suspects and assisted sputum production by the region's District's TB and Leprosy Coordinator. They then identified and referred TB suspects (from hospital patients and visitors) at waiting-areas and wards to clinicians and documented their TB screening and referral outcomes. We describe results from one waiting-area with complete documentation between January and December 2011. Results: Of the 217 TB suspects identified, majority were male (55%); their median age was 36 (range 1–70) years. 11% (23) were aged <15 years; 65% (15) were diagnosed with TB by, a combination of sputum microscopy and chest X-rays (5) followed by chest X-ray alone (50), then sputum microscopy alone (1), and TB score chart (4). Of those aged 15+ years, 72% (140) were diagnosed with TB by a combination of sputum microscopy and chest X-rays (75) followed by sputum microscopy alone (38), and chest X-ray alone (27). Excluding cases that transferred out, this process contributed to 33% of Jaramogi Oginga Odinga Teaching and Referral Hospital's annual TB case burden. Conclusions: TB case detection in high TB burden regions can be supported the use of laypersons in hospital settings.

Background: Postexposure prophylaxis (PEP) with antiretroviral therapy (ART) and vaccination against hepatitis B virus (HBV) aides in preventing human immunodeficiency virus (HIV) infection and HBV, respectively, from accidental or occupational exposure. We assessed compliance to guidelines for HIV and HBV prevention after occupational exposure among hospital staff at a referral Kenyan hospital. Methods: We reviewed PEP registers for hospital staff reporting an occupational injury at a referral hospital in Western Kenya between January 2011 and December 2012. Proportions were used to summarize number of participants receiving the recommended services, Kaplan–Meier curves were used to describe time to ART initiation, and Chi-square statistics was used to describe the association between participant characteristics and PEP completion rates. P < 0.05 was considered statistically significant. Results: Majority of documented hospital staff (n = 52) were health workers (63%) and students (27%) and had high HIV risk exposures (97%). All had timely PEP initiation with 50% completing PEP. Completion rates did not vary by gender (P = 0.78), exposure type (P = 1.0), or department of exposure (P = 0.75). Retesting for HIV and negativity rates at months 1.5, 3, and 6 were 96%, 25%, and 17% and 100%, 100%, and 100%, respectively. At the time of exposure, 17% (9) of staff were HBV vaccinated and HBV status of sources was unknown; no intervention was provided for HBV prevention. Conclusions: Low rates of completion and follow-up negate intended benefits of PEP. Efforts should be directed to enforce universal precaution practices and completion of PEP. Low rates of HBV testing and vaccination illustrate the need for support for the implementation of HBV prevention guidelines.

Background: Neck circumference (NC) is an index of subcutaneous adipose tissue distribution in an area of the upper part of the body. The aim of this study was to assess whether NC can be used as an indicator of central obesity and to determine the prevalence of central obesity in apparently healthy Bosnian young adults. Methods: Participants for this cross-sectional study were recruited using the snowball method. NC was measured in horizontal straight position by placing the top edge of a plastic tape only below the laryngeal prominence and perpendicular to the longitudinal axis of the neck, with the head positioned in the Frankfort horizontal plane. Body mass index, waist circumference (WC), and waist-to-hip ratio were taken following the WHO guidelines. Results: The study included 111 second year University of Sarajevo Dentistry students (49 students of male gender and 62 students of the female gender). Determined the optimal cutoff value of NC in the detection of central obesity based on WC values in healthy young participants of male gender was ≥37.45 cm (P < 0.001), while in healthy young participants of the female gender, it was ≥32.75 cm (P < 0.001). Based on the WHO guidelines for WC, central obesity was determined in 24.49% (n = 12) of male patients, and in 29.03% (n = 18) of female participants included in our investigation (P < 0.05). Conclusions: The results of the present study indicate that NC may be used as a screening tool for central obesity in healthy young adults. Prevalence of central obesity observed among student population suggests that there is a justified need for an implementation of healthy lifestyle programs in this population that would have preventive purposes.

Introduction: Urban family physician program (UFPP) was launched in Fars province of Iran in 2012. We aimed to assess the knowledge and practice of people toward this 5-year-old program. Methods: In this population-based study, through a multistage random sampling from 6 cities of Fars province, 1350 people older than 18 years were interviewed. For data collection, a questionnaire consisting of sociodemographic characteristics and items about knowledge and practice toward UFPP was used. Results: The mean age of the interviewees was 42.4 ± 14.2 years; male (674; 49.9%)-to-female (651; 48.2%) ratio was 1.03. Mean score of knowledge was 4.2 ± 1.7 (out of 14), while 961 (71.1%) had <50% of the desirable knowledge. Mean score of practice was 4.4 ± 1.3 (out of 9), while only 443 (32.8%) had a good performance toward this program. Knowledge and practice did not show a significant correlation (r = 0.06, P = 0.05). Among cities, the highest and the lowest mean of knowledge belonged to Pasargad (5.6 ± 2.1) and Lar (3.0 ± 1.0) (P < 0.001), respectively. Pasargad (4.8 ± 1.4) had also the highest level of practice compared to Farashband (3.8 ± 1.4) which had the lowest score (P < 0.001). Multivariable analysis showed that supplemental insurance coverage (odds ratio [OR] = 2.5, %95 confidence interval [CI]: 1.6–3.9), female gender (OR = 1.9, %95 CI: 1.2–2.9) and higher level of education (OR = 1.7, %95 CI: 1.1–2.5) were the significant determinants of knowledge, while practice in those who were not covered by supplemental insurance was better (OR = 1.6, 95% CI: 1.2-2.5). Conclusions: After 5 years of implementation of UFPP, knowledge and practice of people toward UFPP are not satisfactory. This finding calls for a serious revision in some aspects of UFFP.

Background: Worries have recently been increased in the absorption of radiofrequency waves and their destructing effects on human health by increasing use of cell phones (mobile phones). This study performed to determine the thermal changes due to mobile phone radio frequency waves in gray and white brain tissue. Methods: This study is an empirical study, where the thermal changes of electromagnetic waves resulted from cell phones (900 MHZ, specific absorption rate for head 1.18 w/kg) on the 15 brain tissue of a cow were analyzed in a compartment with three different thickness of 2 mm, 12 mm, and 22 mm, for 15 min. The Lutron thermometer (model: MT-917) with 0.01°C precision was used for measuring the tissue temperature. For each thickness was measured three times. Data analysis is done by Lutron and MATLAB software packages. Results: In confronting of the tissue with the cell phone, the temperature was increased by 0.53°C in the 2 mm thickness that is the gray matter of the brain, increased by 0.99°C in the 12 mm thickness, and also increased by 0.92°C in the 22 mm thickness. Brain temperature showed higher rates than the base temperature after 15 min of confrontation with cell phone waves in all the three thicknesses. Conclusions: Cell phone radiated radio frequency waves were effective on increasing brain tissue temperature, and this temperature increase has cumulative effect on the tissue, being higher, for some time after the confrontation than the time with no confrontation.

Background: Protecting the youth and adolescents' health is considered to be an indicator of health equity. The current study was conducted to analyze health status of the Iranian youth and adolescents, identify service gaps, and design action-oriented interventions. Methods: In this study with multimethods design conducted in 2014, first to identify and analyze the current situation, related articles and national and international documents were searched and reviewed. Then, stakeholders' analysis, interviews, group discussion, and analysis of the youth and adolescent health management system were done, and the policy document was drew up in three sections of recognition, orientation, and suggested interventions. Results: The most important focus areas of the youth and adolescents' health were identified to be their behavior and lifestyle, less advantaging of primary health care in cities, and high rates of educational dropouts. Considering a responsive national structure to develop and implement a comprehensive and integrated program for educating healthy lifestyles and reducing risky behaviors and focusing on accident prevention as a first priority at the level of impact and planning on risk factors of noncommunicable and communicable diseases related to sexually transmitted infections and AIDS at the outcome-level indicators is a necessity through intersectoral collaboration and community participation strategies. Conclusions: Achieving premiere indicators of the Iranian youth health requires political commitment and support of the state, more than ever. To cooperation and utilize the capacity of other sectors to implement the Ministry of Health and Medical Education programs, establishment of the youth health commission is recommended with participation of the main partners.

Background: Disinfection of dental impression is mandatory for preventing the cross infection between dental staff and dental laboratory. Ozone as a disinfectant can be used in various ways in dentistry. The aim of this study was to evaluate the efficacy of ozonated water for disinfection of irreversible hydrocolloid impression materials and preventing cross-contamination. Methods: Thirty-two circular specimens (1 cm diameter and 2 mm thickness) of irreversible hydrocolloid impression material were made. Thirty specimens were contaminated with Pseudomonas aeruginosa (ATCC 27853), Staphylococcus aureus (ATCC 51299), and Candida albicans (PTCC 5027). Except control samples (n = 2), the other specimens were immersed in ozonated water for 5 and 10 min (5 sample each group). Trypsin was used for separating microorganisms. Diluted microbial solution was analyzed microbiologically for colony-forming units (CFUs). Two-way repeated measure ANOVA and Scheffe post hoc test were used for data analysis (α = 0.05). Results: The number of CFUs after disinfection with ozonated water was decreased significantly (11.84%, 61.55%, and 20.27% after 5 min and 11.03%, 14.50%, and 16.99% after 10 min for P. aeruginosa, S. aureus, and C. albicans, respectively) (P < 0.001). Increasing the time of disinfection resulted in significant reduction in a number of S. aureus only (P < 0.001) although they did not vanish microorganisms completely. Conclusions: Immersion of irreversible hydrocolloid impression material in ozonated water for 10 min will not lead to complete disinfection but decreases the microorganisms to a level that can prevent infection transmission.

Background: To determine the association between problematic Internet use (PIU) and disordered eating attitudes (DEAs) and to detect the potential risk factors for PIU among University students in Minia, Egypt. Methods: A cross-sectional study was carried out among a random sample (n = 2365) of Minia University students. PIU was assessed using The Problematic Internet Use Scale (PIUS), and the DEAs were assessed using eating attitudes test-26 questionnaire. Results: Of the 2365 students, 424 (17.9%) had DEAs, and it was more in females than males (22.3% and 14.5%, respectively). The mean of the PIUS score also was significantly higher in males than females (120.3 ± 30.5, and 117.5 ± 30.6, respectively). A positive moderate correlation (r = 0.48, P < 0.05) was detected between PIU and DEAs. Conclusions: The results of this study indicate that PIU is significantly correlated with DEAs among University students in Minia, Egypt, and further studies are needed to identify the association between DEAs and PIU.

Background: Stroke as a devastating condition is one of the major causes of death worldwide. It is accountable for long time disability with high personal and social cost in adults. There are several risk factors for stroke such as diabetes and hypertension. Alpha-lipoic acid (ALA) as an antioxidant can be a risk modifier in these patients. We designed this trial to scrutinize the possible effects of ALA consumption on some cardiovascular risk factors in patients experienced stroke. Methods: In this randomized, double-blind, placebo-controlled clinical trial, 67 patients experienced stroke were randomly allocated into two groups (taking a 600 mg ALA supplement or placebo daily for 12 weeks). Fasting blood sugar (FBS), fasting insulin and systolic (SBP), and diastolic blood pressure (DBP) were measured before and after intervention in this study. Statistical analyses were performed using SPSS version 16 (SPSS Inc., Chicago, IL, USA) software. Results: Primary features were similar in the intervention and placebo groups (P > 0.05). After the intervention period, SBP (P < 0.001), DBP (P < 0.001) and FBS (P < 0.001) reduced in ALA group compared with placebo group, significantly. No significant change was seen in insulin level (P = 0.82). Conclusions: Results of this trial indicated that 12 weeks supplementation with 600 mg ALA has beneficial effects on SBP, DBP, and FBS but has no effect on insulin level.

Background: The prevalence of glomerular hyperfiltration and chronic kidney disease is increasing worldwide in parallel with obesity hypertension epidemic. The effect of increases in glomerular filtrations (GFR) in children with metabolic syndrome has not been studied. The purpose of the present study is to investigate the relationship between GFR and cardiometabolic risk factors in a large sample of pediatric population. Methods: In this nationwide survey, 3800 participants were selected by cluster random sampling from 30 provinces in Iran. Anthropometric measures, biochemical, and clinical parameters were measured. We also measured estimated GFR (eGFR) using the recently modified Schwartz equations and other known cardiometabolic risk factors such as elevated total cholesterol, high low-density lipoprotein cholesterol (LDL-C), and obesity. Results: The response rate was 91.5% (n = 3843). The mean and standard deviation (SD) (Mean ± SD) of eGFR for girls, boys, and total population were 96.71 ± 19.46, 96.49 ± 21.69, and 96.59 ± 20 ml/min/1.73 m², respectively. Overall, 38.7% of the participants did not have any cardiometabolic risk factor. In multivariate models, the risk of elevated systolic blood pressure (BP) (odds ratio [OR]: 1.48; 95% confidence interval [CI]: 1.08–2.02), elevated diastolic BP (OR: 1.48; 95% CI: 1.08–2.02), elevated LDL-C (OR: 1.35; 95% CI: 1.07–1.70), and obesity (OR: 1.70; 95%CI: 1.24–2.33) were significantly higher in participants with higher eGFR level than those with the lower level but not with low level of high-density lipoprotein cholesterol (OR: 0.72; 95% CI: 0.60–0.88). Conclusions: This study demonstrates an association between glomerular hyperfiltration and obesity-related hypertension in a large sample of the Iranian pediatric population, independently of other classical risk factors.

Background: This study was aimed to screen the antihyperlipidemic effect of different fractions of Teucrium polium to obtain the most efficient herbal fraction for isolation of bioactive constituents responsible for hypolipidemic activity. Methods: Chloroform, butanol, and aqueous fractions were obtained from hydroalcoholic extract of T. polium aerial parts using partitioning process. To induce hyperlipidemia, dexamethasone (Dex) was injected 10 mg/kg/day (s.c.) for 8 days. In the test groups, animals received 50, 100 and 150 mg/kg of T. polium hydroalcoholic extract and different fractions orally simultaneously with Dex. Serum lipid profile and hepatic marker enzymes were evaluated using biochemical kits. Results: All treatments, especially chloroform and aqueous fractions, reversed serum lipid markers in hyperlipidemic rats. Maximum reduction in triglyceride (60.2%, P < 0.001) and maximum elevation in high-density lipoprotein (HDL) (35.0%, P < 0.01) was observed for chloroform fraction. Maximum cholesterol-lowering effect (29.0%, P < 0.001) and maximum reduction in low-density lipoprotein were found for hydroalcoholic extract (72.9%, P < 0.001). Aqueous fraction improved all lipid markers at the highest dose. Butanol fraction decreased triglyceride at the lowest dose (43.9%, P < 0.001) and increased HDL (33%, P < 0.05) at the highest dose. There was a significant increase in alanine aminotransferase and aspartate aminotransferase levels in all tested groups compared to normal group (P < 0.001). Conclusions: This study showed strong antihyperlipidemic effect of various fractions derived from hydroalcoholic extract of T. polium. Chloroform and aqueous fractions may be worthy candidates for isolation of bioactive hypolipidemic constituents. However, possible hepatotoxicity should be considered for clinical application.

Background: Using cell phones while driving contribute to distractions which can potentially cause minor or major road traffic injuries and also stress among other drivers. With this background, the study was done to ascertain the proportion of handheld cell phone use while driving among road users in Mysore city and also patterns of the use by the day of week, type of road, and type of vehicle. Methods: The study was conducted in Mysore, Karnataka, India. Four stretches of roads were observed thrice daily for 1 week. The total number of vehicles passing through the stretch and the number and characteristics of drivers using hand-held cell was noted. Pearson's Chi-square test was used to ascertain the significance of the difference in proportions. Results: The overall proportion of cell phone users was calculated as 1.41/100 vehicles. The observed use of handheld cell phones was 1.78 times higher on nonbusy roads than busy roads (Χ² = 25.79, P < 0.0001). More than 50% of the handheld phone users were driving a two wheeler, the proportion being 50.5% in busy roads, and 67% in nonbusy roads. There was no difference in the proportion of cell phone use by time of the day or across different days of the week. Conclusions: The proportion of drivers who use cell phones is found to be relatively lower, and use of cell phones was higher on nonbusy roads.

Background: Obstructive sleep apnea (OSA) is a common disorder characterized by snoring, daytime sleepiness, fatigue, and repeated termination of airflow (apnea). Standard polysomnography (PSG) is diagnostic gold standard for OSA. PSG is expensive and not available everywhere. To identify the best OSA questionnaire for screening in Persian population, we compared Berlin, STOP-BANG, and Epworth Sleepiness Scale (ESS). Methods: In a cross-sectional study conducted on 400 adult patients suspected of OSA in Bamdad Respiratory Research Center, patients completed three questionnaires. For each questionnaire, patients were divided into high risk and low risk. Then, PSG was performed for all patients. According to PSG, patients categorized into without OSA (apnea-hypopnea index [AHI] <5), mild OSA (15> AHI ≥5), moderate OSA (30> AHI ≥15), and severe OSA (AHI ≥30). Based on questionnaires and PSG results, predictive parameters for screening tests were calculated. Results: There were 234 (58.5%) males and 166 (41.5%) females in study population. Mean age of patients was 49.29 ± 9.75 standard deviation years. There was significant association between age with OSA (P = 0.005) and between body mass index (BMI) and neck circumference, with moderate and severe OSA (P < 0.001). Sensitivities of Berlin, STOP-BANG, and ESS were 86.42%, 81.46%, and 59%, respectively. Specificities of Berlin, STOP-BANG, and ESS were 52.94%, 82.35%, and 76.47%, respectively. Conclusions: This study suggested that Berlin and STOP-BANG are more sensitive and accurate than ESS for OSA screening in Iran.

Background: This study aimed to examine the relationship between mothers' knowledge related to treatment management of type 1 diabetes (T1D), with perceptions of coping with diabetes-related stress and to examine the relationship between children's metabolic control and maternal coping. A cross-sectional study was done among ninety-two mothers of T1D children. Methods: Data were collected using a structured questionnaire, Ways of coping questionnaire (WCQ), and Diabetes Knowledge questionnaire-24 (DKQ-24). Results: The most important predictors of the total knowledge scores among mothers were father education (P < 0.0001), followed by child age and sex (P < 0.0001), while the most important coping scales affected by total knowledge scores was accepting responsibility (P = 0.01). There were positive correlation between HBA1C and escape-avoidance and positive reappraisal coping scales (r = 0.24, P = 0.02 and r = 0.23, P = 0.02, respectively). Blood glucose level was the most important clinical characteristics affecting the use of seeking social support coping scale among mothers. Conclusions: Parents with more knowledge of diabetes and with better education were able to cope more effective and maintain a better glycemic control of their diabetic children.

Background: Sacopenia is a common problem in elderly with the adverse outcomes. The objective of this study was to estimate the peak appendicular skeletal muscle mass (ASM) and age of its attainment by sex among the Iranian population. Methods: A total of 691 men and women aged 18–94 years participated in this cross-sectional, population-based study in Bushehr, Iran. ASM was measured by dual X-ray absorptiometry. Cutoff points for men and women were established considering two standard deviations (SDs) below the mean values of the skeletal muscle index (SMI) for young reference groups. The relationship between ASM and age was described by the second-degree regression models. Two SDs below the mean SMIs of reference groups were as cutoff values of low muscle mass in Iranian population. Results: The peak ASM values were 21.35 ± 0.12 Kg and 13.68 ± 0.10 Kg, and the age at peak ASM were 26 (24–28) years and 34 (33–35) years for men and women, respectively. Mean and SD of SMI in those ages were 7.01 ± 0.02 Kg/m² and 5.44 ± 0.02 Kg/m² among men and women, respectively. Calculated cutoff values of low muscle mass among the Iranian population were 7.0 Kg/m² and 5.4 Kg/m² among men and women, respectively. Conclusions: Iranian reference values of SMI for both genders were similar to Asia Working Group for Sarcopenia recommendation and lower than the United States and European values. Further studies from different nations and the Middle East countries are needed to obtain reference values for populations, enabling the researchers for comparison and also more valid reports on sarcopenia prevalence.

Background: Hypovitaminosis D is highly prevalent and has several adverse health effects. This study aims to assess the relationship of serum concentrations of 25-hydroxyvitamin D (25[OH] D) and liver enzymes in adolescents. Methods: This population-based cross-sectional survey was conducted among a nationally representative multistage sample of 1095 adolescents (52% boys), aged 10–18 years, living in different provinces of Iran. Serum 25(OH)D concentration <30 ng/mL was considered as hypovitaminosis D, and liver enzymes (alanine aminotransaminase [ALT] and aspartate aminotransaminase [AST]) of >40 U/L was considered as high level. To determine the association between serum 25(OH)D categories and elevated levels of liver enzymes, multiple regression models and linear regression analysis were applied, after adjustment for potential confounders. Odds ratios (95% confidence interval) of serum 25(OH)D and elevated liver enzymes were assessed by logistic regression analysis. Results: Higher rates of Vitamin D deficiency were documented among individuals with increased levels of liver enzymes. Compared to boys, median of 25(OH)D was lower in girls with elevated levels of liver function tests (12.75 vs. 25.60 ng/mL for ALT and 13 vs. 14.10 ng/mL for AST), with marginally significant gender differences regarding AST. Conclusions: We found a relatively high frequency of hypovitaminosis D among adolescents with abnormal liver function. Further prospective studies are needed to examine these associations from early life.

Background: This study aimed Persian translation and validation of the hip disability and osteoarthritis outcome score (HOOS) questionnaire. Methods: The study was carried out in two phases. First, we translated the HOOS according to acceptable guidelines. We assessed HOOS content convergent validity on 203 hip osteoarthritis patients using SF-36. Internal consistency was tested using Cronbach's alpha coefficient if each item removed and intraclass correlation coefficient (ICC) for the assessment of test-retest reproducibility. Results: Patients had mean (standard deviation) age of 39 (17). Test-retest ICC in whole was 0.95 (P = 0.014) showing excellent reliability. ICC was 0.92 for the “pain” subscale (P = 0.02), 0.81 for the “symptom” subscale (P = 0.002), 0.81 for the “function of daily living (FDL)” (P = 0.022), 0.88 for the “function of sports and recreational activities” (P = 0.006), but it was 0.62 (P = 0.1) for the “quality of life (QOL).” Cronbach's alpha was 0.92, 0.73, 0.97, 0.86, 0.80, and 0.80 for the pain, symptom, FDL, function of sports, QOL, and stiffness, respectively, showing good to excellent internal consistancy. Having SF-36 for the assessment of convergent validity, there was a strong correlation between total HOOS score and the physical component summary domain of SF-36 (r = 0.64, P = 0.0001), whereas the t correlation with the mental component summary domain was weak (r = 0.16, P = 0.04). Conclusions: The Persian version of the HOOS questionnaire is a valid (regarding physical not mental aspects) and reliable assessment tool in patients with hip osteoarthritis.

Background: Case finding was improved to the population-based method at the Isfahan Cancer Registry (ICR) during 2005–2008. However, its effects on the number of registered colorectal cancer (CRC) cases and patients' age are not investigated. Therefore, present study designed to investigate the effect of that improvement on the trend of incidence of CRC, and age of CRC cases in ICR's catchment area. Methods: Data from the ICR were retrieved by years for 2000–2011. Annual age-standardized incidence rates (ASRs), truncated ASRs and 95% confidence intervals (95% CIs) were estimated for both genders. Rates were standardized based on the 2000 world standard population. Trends were analyzed, and significant change-points were identified using Joinpoint Regression software. Age of CRC cases compared between periods before and after the improvement. Results: A total of 2902 CRC cases had been registered by ICR. Estimated ASRs (95% CI) for 2000 and 2011 were 3.47 (3.45, 3.50) and 10.22 (10.19, 1025) per 100,000 persons, respectively. Two significant change-points were identified (i.e., at 2003 and 2006). However, estimated average annual percent change was as 11. There was no significant difference between mean of patients' age before and after the time of improvement (P = 0.88). Conclusions: Trends of incidence of CRC had been rising in central Iran for males and females, during 2000–2011. It seems that the estimated slope for this trend had been partially artificial and significantly affected by the improvement of case-finding method. However, the improvement had no effect on the patients' age.

Background: There is not enough studies to determine the frequency of using the prophylaxis against deep venous thrombosis (DVT) based on the American College of Chest Physician's (ACCP) guidelines in Iran. Thus, providing such statistics is essential to improve thromboprophylaxis in hospital. The present study aimed to determine the frequency of using the prophylaxis against DVT based on ACCP guidelines in patients hospitalized in surgical wards in one of teaching hospital in Ilam, Iran. Methods: In a cross-sectional, the samples were selected among medical records of patients who were hospitalized and underwent surgery in surgical wards of the hospital from April 2012 to September 2013. Type of prophylaxis was determined based on ACCP guidelines. After reviewing inclusion and exclusion criteria, patients' data were extracted from medical records based on required variables. Results: In reviewing 169 qualified samples, 46.2% (78 patients) were women. Of these, 132 patients were at risk of DVT and needed prophylaxis, only 39 patients (29.5%) received prophylaxis. Thromboprophylaxis based on ACCP guidelines had been fully implemented only in 30 cases (22.7%) of patients with the risk of DVT. The highest thromboprophylaxis was in the intensive care unit (46.6%) and neurosurgery (37.5%), and the least rate was in urology (0%). Conclusions: As the results of this study, there are differences between clinical practice and the ACCP guidelines recommendation in prophylaxis against DVT. Thromboprophylaxis has not been implemented based on ACCP guidelines in more than 75% of patients with the risk of DVT. Thus, new strategies are needed to implement thromboprophylaxis against DVT in Iranian hospitals.

Background: Considering how many people obtain information about their health online, the aim of this study was to describe the content of the currently most widely viewed YouTube videos related to concussions and to test the hypothesis that consumer videos would be anecdotal, while other sources would be more informational. Methods: The term “concussion” was used to search for videos with 100,000 or more views on YouTube that were posted in English or Spanish. Descriptive information about each video was recorded, as was information on whether certain content was conveyed during the video. The main outcome measures are sources of upload and content of videos. Results: Consumer videos accounted for 48% of the videos, television based accounted for 50% of the videos, and internet based accounted for only 2% of the videos. None of the videos viewed fell into the professional category. Television based videos were viewed significantly more than consumer or internet based videos. Consumer and television based videos were equally anecdotal. Many of the videos focused on adolescents and were related to sports injuries. The majority of the videos (70.4%) addressed concussion causes, with 48% stating sports. Few videos discussed symptoms of concussion and prevention. Conclusions: The potential for widespread misinformation necessitates caution when obtaining information on concussion on a freely accessible and editable medium, such as YouTube.

Background: Previous studies have indicated that exercise training improves body composition and cardiovascular disease risk factors. The aim of the present study was to investigate the effect of 12 weeks of aerobic, strength and combined training on body composition, intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), and C-reactive protein (CRP) in sedentary middle-aged men. Methods: Forty-seven male aged 40–60 years voluntarily participated in this study and were divided in four groups: aerobic (n = 12), strength (n = 12), combined (n = 11), and control (n = 12) groups randomly. Body composition, ICAM-1, VCAM-1, and CRP were measured before and after 12 weeks. Data were analyzed using paired t-test and analysis of variance statistical methods. Results: There were significant differences in body weight between aerobic and strength training (P = 0.004) and aerobic and control groups (P = 0.018), body mass index between combined and strength training (P = 0.004) and combined and control groups (P = 0.001), fat percentage between aerobic training and control group (P = 0.017) and combined training and control groups (P = 0.004), and finally, fat-free mass between aerobic and strength training (P = 0.024), aerobic and combined training (P = 0.0001), strength and control groups (P = 0.035), and combined and control groups (P = 0.0001). Conclusions: The results indicated that 12-week workout, 20–60 min/session, 3 days a week of moderate intensity exercise improved body composition, ICAM-1, VCAM-1, and CRP compared to those who did not participate in any training. However, all three types of exercises had small benefits on body composition, ICAM-1, VCAM-1, and CRP in sedentary middle-aged men, and the importance of combined training required further investigations.

Background: Morphine is a pain medication .It is mostly processed in liver and reasons disturbing effects. It can increase the production of free radicals. Thymoquinone is a phytochemical compound found in the plant Nigella sativa. It has diverse pharmacological properties such as antioxidant and anticancer. This study was intended to assess the effects of thymoquinone against morphine damages on the liver of mice. Methods: In this study, various doses of thymoquinone (4.5, 9, and 18 mg/kg) and thymoquinone plus morphine wasadministered (once a day) intraperitoneally to 48 male mice for 20 consequent days. These mice were randomly assigned to eight groups (n = 6). Aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, serum nitric oxide (NO) levels, liver weight, and histology have been studied. Results: The results indicated that morphine administration significantly increased the mean diameter of central hepatic vein and hepatocyte, blood serum NO level, liver enzymes level, and decreased liver weight compared to saline group (P < 0.05). However, thymoquinone and thymoquinone plus morphine administration significantly enhanced liver weight and reduced the mean diameter of hepatocyte, central hepatic vein, liver enzymes, and NO levels in all groups compared to morphine group (P < 0.05). Conclusions: It seems that antioxidant effect of thymoquinone could protect damage of liver parameters against morphine toxicity.

Background: Methodology of Failure Mode and Effects Analysis (FMEA) is known as an important risk assessment tool and accreditation requirement by many organizations. For prioritizing failures, the index of “risk priority number (RPN)” is used, especially for its ease and subjective evaluations of occurrence, the severity and the detectability of each failure. In this study, we have tried to apply FMEA model more compatible with health-care systems by redefining RPN index to be closer to reality. Methods: We used a quantitative and qualitative approach in this research. In the qualitative domain, focused groups discussion was used to collect data. A quantitative approach was used to calculate RPN score. Results: We have studied patient's journey in surgery ward from holding area to the operating room. The highest priority failures determined based on (1) defining inclusion criteria as severity of incident (clinical effect, claim consequence, waste of time and financial loss), occurrence of incident (time - unit occurrence and degree of exposure to risk) and preventability (degree of preventability and defensive barriers) then, (2) risks priority criteria quantified by using RPN index (361 for the highest rate failure). The ability of improved RPN scores reassessed by root cause analysis showed some variations. Conclusions: We concluded that standard criteria should be developed inconsistent with clinical linguistic and special scientific fields. Therefore, cooperation and partnership of technical and clinical groups are necessary to modify these models.

Background: Approximately 20%–25% of the world adult population and nearly 30% of Indians have metabolic syndrome disorder. Our objective was designed to find out the association between important nutrients and potential lifestyle risk factors such as diet, physical inactivity, and smoking and alcohol consumption with the number of metabolic syndrome components. Methods: This was a cross-sectional study. A total of 205 patients of metabolic syndrome were enrolled for this study. Diagnosis of metabolic syndrome was done on the basis of National Cholesterol Education Program Adult Treatment Panel III criteria (NCEP ATP III 2004).Dietary data were collected with the validated food frequency questionnaire and 24 h dietary recall method, and the nutrient intake was calculated with the specially designed software. Results: Unhealthy dietary habits were seen more among the participants who had more than 3 risk factors. Results showed the odds of taking >5 times junk foods was 3 times higher (odds ratio [OR]: 2.97; 95% confidence interval [CI]: 1.61–5.47), and sweet dishes was 2.3 times higher (OR: 2.33; 95% CI: 1.28–4.24) among the participants who had 4–5 risk factors. However, milk and dairy products > 4 servings/day (OR: 0.54; 95% CI: 0.175–1.67) and pulses and legumes more than 2 servings/day (OR: 0.57; 95% CI: 0.25–1.29) was protective against hypertension. Mean carbohydrate, saturated fat, and sodium intake was significantly higher in the participants who had 4–5 metabolic risk factors compared to 3 risk factors (P < 0.0001). Conclusions: It was concluded that low intake of fruits, vegetables, and higher intake of flesh food and inadequate physical activity significantly associated with the metabolic syndrome risk factors.

Background: Multiple sclerosis (MS) is a demyelinating disease of the central nervous system which has no any known definitive treatment. Studies have shown that thyroid hormones (THs) in addition to their roles in the development of the nervous system and the production of myelin have important roles in the adult's brain function. Since the only way to treat MS is the restoration of myelin, the aim of this study was to evaluate the effects of levothyroxine on visual evoked potential (VEP) impairment following local injections of lysolecithin into the rat optic chiasm. Methods: To induce demyelination, lysolecithin was injected into the optic chiasm of male Wistar rats. VEP recording was used to evaluate demyelination and remyelination before and 10, 17, and 24 days after the lysolecithin injection. The rats received an intraperitoneal injection of levothyroxine with doses 20, 50, and 100 μg/kg in different experimental groups. Results: VEP latency and amplitude showed demyelination at 10 and 17 days after an induced lesion in MS group which was reversed at day 24. Levothyroxine prevented these impairments, especially in high doses. Conclusions: According to the results, lysolecithin-induced demyelination at optic chiasm and VEP impairments can be restored by administration of levothyroxine. Therefore, THs probably have positive effects in demyelinating diseases.

Background: Considering all the latest achievements in neonatal respiratory care, bronchopulmonary dysplasia (BPD) is still among the most prevalent morbidity causes in premature infants. Involvement in this process results in longer period of hospitalization for the newborn and in the long run makes the living conditions more difficult. Taking the multifactorial pathogenesis into account, approaches to tackle chronic lung disease (CLD) are mainly focused on interventions and prevention procedures. This study tries to investigate the potential capability of inhaled budesonide in the prevention of BPD in newborns with gestational age of <28 weeks with the respiratory distress syndrome (RDS). Methods: This study was a randomized clinical trial done on seventy newborns with gestational ages of 23–28 weeks with RDS in Isfahan Shahid Beheshti Educational Hospital from June 2014 to April 2016. Patients were randomly assigned to two groups of intervention with budesonide and control. There were 35 newborns in each group. Upon recording demographic characteristics, the newborns in two groups were compared based on the length of noninvasive ventilation, the need for invasive mechanical ventilation, the number of surfactant administrations, pneumothorax, intraventricular hemorrhage, patent ductus arteriosus (PDA), CLD, and death. Results: The length of the need for nasal continuous positive airway pressure showed no statistically significant difference between the groups (P = 0.54). The number of newborns who needed invasive mechanical ventilation also revealed no meaningful difference (P = 0.14). Similarly, the number of newborns who were characterized as affected by CLD also showed no significant difference between the groups (P = 0.053). Moreover, the number of newborns who experienced pneumothorax was not significantly different for the groups (P = 0.057). The number of newborns who received three administrations of surfactant had also no statistically meaningful difference between the groups (P = 0.69). However, the number of newborns who received two doses of surfactant was statistically lower in budesonide intervention group than the control (P = 0.041). The prevalence of intraventricular hemorrhage with degrees of I, II, and III also showed no statistically meaningful difference between the groups with P = 0.74, 0.32, and 0.49, respectively. The occurrence of PDA had no meaningful difference between the groups (P = 0.66). Relative death cases also revealed no significant difference between the groups (P = 0.53). Conclusions: The current study revealed a decrease in CLD prevalence for newborns in interventional group; however, this decrease was not statistically meaningful. The newborns, in the intervention group, who had received two doses of surfactant (survanta) showed a significant decrease, which can be the basis for further research in this field.

Background: We evaluated the relationship between secondhand smoke (SHS) inhalation, as verified by urinary cotinine levels, and bone health. Methods: We analyzed the nationwide, population-based, cross-sectional health survey. We included 1936 men aged 50 years or older who checked bone mineral density (BMD) from the Korean National Health and Nutrition Examination Survey (2008–2010). Current smokers assessed by urinary cotinine levels higher than 500 ng/mL were excluded (n = 616). Exposure to SHS was determined using a 50 ng/mL urinary cotinine threshold. Results: The estimated prevalence of SHS exposure in our cohort was 13.9%. After adjusting for age and body mass index (BMI), T-scores at total femur (P < 0.001), femoral neck (P < 0.001), and lumbar spine (P = 0.004) were lower in SHS exposure versus nonexposure groups. Impaired bone health (osteopenia or osteoporosis) at femoral neck or lumbar spine was evident in 61.7% and 48.6% of SHS exposure and nonexposure cases, respectively (P = 0.004). Moreover, after adjusting for age, BMI, and health habits, the odds ratio for impaired bone health in the SHS exposure group was 1.89 (95% confidence interval: 1.31–2.74). Conclusions: Our findings suggest that SHS exposure, determined by urinary cotinine levels, is negatively associated with BMD and is a leading cause of impaired bone health in Korean men.

Background: Maternal thrombophilia has been identified as a risk factor for recurrent pregnancy loss (RPL). The aim of this study was to investigate the association between prothrombin G20210A and factor V Leiden (FVL) polymorphisms in women with RPL and a control group of parous women in Isfahan province of Iran. Methods: We studied 250 women with idiopathic RPL and 116 control cases. Prothrombin and FVL different genotypes were determined using polymerase chain reaction and reverse hybridization technique. Results: The frequencies of heterozygous mutation prothrombin G20210A were 6% and 0.9%, respectively (P = 0.025), in cases compared to the control group. The frequencies of homozygous mutation prothrombin G20210A were 0.4% and 0%, respectively, in cases compared to controls (P = 0.02). The prothrombin mutation was significantly higher in cases compared to the control group (odds ratio 8.81; 95% confidence interval: 1.16–66.62). There was no significant difference between the FVL mutation and pregnancy loss. Conclusions: The results indicated a significant higher frequency of prothrombin G20210A in women with RPL in comparison with controls. Our data suggest that the prothrombin G20210A mutation, but not the FVL mutation, may be an unrecognized cause of RPL in our population.

Background: One of the main causes of mortality is hepatocellular carcinoma (HCC) which accounts for the third leading cause of deaths and one in forty deaths worldwide. The flavonoids, natural antioxidant compounds, account for a major group of polyphenolic compounds. One of the major isoflavones in soybean is genistein (GE) which can inhibit proliferation and induce apoptosis. Isoflavones, major type of phenolic materials, derived from dietary plants and medicinal herbs play a significant role in cancer prevention and treatment. Correlation between dietary habits and cancer risk including breast, prostate, and colon cancer has been reported. Various bioactivities of these compounds such as anticarcinogenic and antioxidant are responsible for their chemopreventive activities by which induce migration, proliferation, cell cycle arrest, and apoptosis. GE, one of the major isoflavones, is considered as a potent chemopreventive agent against cancer. The aim of this study was to investigate the inhibitory and apoptotic effects of GE on HCC Hepa1-6 cell line. Methods: Cell viability assay and cell cycle analysis with flow cytometry were used to evaluate proliferative and apoptotic effect GE. Results: GE inhibited the growth of Hepa1-6 cells and induced apoptosis with a concentration and time-dependent fashion. During GE treatment for 24, the half maximal inhibitory concentration (IC50) was 20 μM, and the maximum inhibition of cell growth was 52% (P < 0.01). The percentage of apoptotic cells with a concentration of 20 μM of GE after 24, 48, and 72 h was 35, 42, and 65%, respectively (P < 0.01). Conclusions: Our finding clearly indicated that GE can significantly inhibit proliferation of hepatocellular carcinoma Hepa 1-6 cell line and induce apoptosis in this cell line.

Background: The presence of air pollutants such as CO, NO₂, SO₂, O₃, and PM in the ambient air mainly emitted from fossil fuels combustion has become a major health concern. The aims of this study were to estimate the attribution of NO₂, SO₂, and O₃ in the premature deaths and prevalence of cardiovascular and respiratory diseases in Isfahan in 2013–2014. Methods: In this study, short-term health effects (total mortality, cardiovascular and respiratory mortality, chronic obstructive pulmonary disease, and acute myocardial infarction) of exposure NO₂, SO₂, and O₃ on the population of Isfahan were assessed using AirQ 2.2.3 software suggested by the World Health Organization (WHO). Results: The result showed that from nonaccident total mortality in 2013–2014 in Isfahan, the attributable proportion related to NO₂, SO₂, and O₃ were 1.03% (109 cases), 3.46% (365 cases), and 1.29% (136 cases), respectively. The percentage of days that people were exposed to the highest concentration of NO₂ (40–49 μg/m³), SO₂ (60–69 μg/m³), and O₃ (40–49 μg/m³) was 34.46%, 16.85%, and 42.74% of a year, respectively. Total mortality attributed to NO₂, SO₂, and O₃exposure was 0.36%, 0.79%, and 0.83%, respectively. Conclusions: The concentrations of NO₂and SO₂were upper than the WHO guidelines. The Air-Q software in spite of its limitations can provide useful information regarding the health outcome of the air pollutants. The results estimated in this study were considerable. This information can help the health authorities and policy makers to draw suitable strategies and fulfill effective emission control programs.

Background: The investigation of personality characteristics and emotional experiences of the people suffering from anxiety disorders is one of the most important issues which are considered by researchers and clinicians. Perfectionism, sensitivity to interpersonal rejection, and anger are personality traits related to social anxiety. In social anxiety disorder, it has also been focused on anger as a personality characteristic and as an emotional condition. The main purpose of this work is to investigate the role of these variables in predicting social anxiety among a nonclinical group of Iranian students. Methods: In this cross-sectional study, 131 students completed the self-report version of Liebowitz Social Anxiety Scale Self-Report version (LSAS-SR), Frost Multidimensional Perfectionism Scale (FMPS), Interpersonal Sensitivity Measure (IPSM), and State and Trait Anger Expression Inventory. Multiple linear regressions were conducted to examine the concurrent associations between perfectionism, interpersonal sensitivity and quality of emotional experience, and expression of anger with severity of self-report social anxiety. Results: Greater levels of FMPS total were significantly associated with a greater level of LSAS total, fear, and avoidance of social and functional situations (P = 0.022, P = 0.024, and P = 0.006). Moreover, a significant positive correlation between IPSM total (P = 0.015) with fear and also between anger expression index (P = 0.009) with avoidance subscale were found. Conclusions: In accordance to the previous researches, we found that perfectionism, interpersonal sensitivity, anger experience, and anger expression skills are related to social anxiety. How these personality traits are related to fear and avoidance of social situations and their concurrent effects on predicting social anxiety were discussed.

Background: Factors affecting lifestyle become one of the most priorities of the research field, especially in adolescents and youth. Using a qualitative approach, this study aimed to understand what factors are affecting young people's healthy lifestyle. Methods: Using the conventional content analysis, and used the semi-structured in-depth interviews, we conducted a qualitative study to elicit the youth opinion considering their lifestyle affecting factors. Initially, purposeful sampling method was considered for data collection. Participants were selected from volunteered youths 18–30 years whom were selected from the Tehran city. Inclusion criteria for the participants were; (a) willingness to participate in the study, and (b) ability to express experiences. Results: According to findings, although the majority of participants agreed on the important role of lifestyle related behaviors in their healthy life, the lack of essential motivation and the pressure of educational assignments remove it from their daily program priorities. The most important barrier to observing the healthy lifestyle was expressed as; the acceptance of the concept by the individual and the social and economic potential of the individual. It was also suggested that practical interventions should focus on improving more participator engagement of all of the related stakeholders. Conclusions: We proposed the participatory strategies for youth healthy lifestyle promotion. Through which based on a specific needs the assessment of different target groups, designing, development, and implementation of health programs led to more effective interventions.