Background: To explore the essence of game changing on applying joint venture (JV) approach for healthcare system improvement in developing countries. Methods: This is cross-sectional study exploring the factors influencing the successful implementation of JV for the healthcare services in low- and middle-income countries (LMICs). The study included: Qatar Statistical Authority, CIA fact book, Ministry of Health Annual Report, Hamad Medical Corporation Annual Report, Organization for Economic Cooperation and Development information, and Qatar's healthcare system history. Results: The research indicated that the LMIC healthcare system would benefit from affiliation with leading technology partner for healthcare reform. The findings support the view of LMIC healthcare systems' needs to incorporate joint venture approach in implementing JV concept for process improvement and knowledge transfer to contribute in country economic growth, development, and stability. Current study explored evidence supporting decision maker and management control of JV trends in different ways in comparison with developed countries. JV can also help the organization to share the risk and cost of large capital investment. Conclusions: The present study supports observations on expending the use of JVs as approach for improvement in LMIC healthcare system. The current study confirmed the advantages of JV which include helping businesses grow faster, increasing productivity, and generating greater profits, both parties sharing the risks and costs, accessing new markets and distribution networks.

Background: Chronic diseases such as diabetes have an adverse effect on the quality of life (QOL) of patients. It has been shown physical activity can improve the quality of life. Aims: The aim of current study was to determine the effectiveness of Physical activity package (PAP) on the quality of life (QOL) of individuals with type 2 diabetes. Methods: Using a randomized controlled trial, 100 individuals with type 2 diabetes were studied. The patients were selected from endocrine clinic of a teaching hospital of Iran University of Medical Sciences. Subjects were randomly assigned to intervention (PAP and routine care), and control (just education and routine care) groups. The WHO Quality of Life- brief (WHOQOL - BREF) Questionnaire was completed by all patients at the beginning and after three months. The IPAQ (long form) physical activity questionnaire was completed at the beginning, 1.5 and 3 months follow-up for all subjects. The Mann-Whitney U, Chi-square and repeated measure of analysis of variance (ANOVA) tests were used to analysis of data. The significant level was considered as 0.05. Results: Average of age was 46.22 ± 6.10 years. The scores of physical, psychological and environmental domains of WHOQOL - BREF were 27.42 ± 3.34, 21.44 ± 3.24 and 27.02 ± 4.68 in intervention group versus 22.58 ± 3.71, 17.29 ± 3.46, and 24.41 ± 3.92, in control group respectively. These differences were statistically significant (P < 0.0001). There was not any significant difference for social relations domain across two groups. Conclusions: Physical activity package had a significant effect on all aspects of QOL just social relations of individuals with type 2 diabetes. It seems social relations activities needs more time to change.

Background: There is some separate evidence that probiotic soy milk and Cuminum cyminum (C. cyminum) have positive effects on the prevention and reduction of diabetic complications. While the impact of probiotic soymilk mixed with herbal essential oils has not been investigated so far, the objective of this study is to examine the effects of probiotic soy milk using Lactobacillus plantarum A7 (KC 355240) added with essential oil of C. cyminum on diabetic rats. Methods: 50 streptozotocin-nicotinamide (STZ-NA) induced diabetic Wistar rats were divided into five groups: Control group (C group), soy milk group (SM group), probiotic soy milk group (PSM group), soy milk containing essential oil of C. cyminum group (SMC group) and probiotic soy milk containing essential oil of C. cyminum group (PSMC group). The animals consumed these products (1 ml/day) for 30 days. The fasting blood glucose (FBS), the serum lipid levels, and body weight variation were analyzed in 10-day intervals. Results: FBS, total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) decreased significantly, whereas high-density lipoprotein cholesterol (HDL-C) increased in the PSMC group compared with that of other groups (P < 0.05). This product also led to weight gain (P < 0.05). Conclusions: A mixture of probiotic soy milk and herbal essential oil consumption could impose a positive effect on reducing FBS as well as serum lipid profile in STZ- NA diabetes-induced rat. Also, it results in an increase in their weight gain.

Background: Coronary artery disease (CAD) has been the leading cause of morbidity and mortality worldwide. Studies indicate that patients with CAD show higher degree of pulp calcifications. Localized pulp calcifications are microscopically apparent in more than half of the teeth in young adolescents. However, pulp stones extending to the entire dentition are infrequent and need further evaluation to predict the risk of other probabilities of associated diseases. The present study was planned to estimate the prevalence of pulp stones in patients diagnosed with or, undergoing treatment for CAD. Methods: The present study consisted of 300 subjects within an age range of 20-55 years who were divided into the study group consisting of 150 patients including 108 males and 42 females as well as 150 age- and sex-matched healthy controls. Pulp stones were imaged using bitewing radiographs using paralleling technique under standard conditions. Statistical Analysis Used: The statistical analysis was performed using IBM SPSS statistics 20 Core system software (SPSS Inc., Chicago, IL, USA) while Chi-square test was used to check the prevalence of pulp stones in patients with CAD in addition to their arch-wise and region-wise distribution. P value <0.05 was considered statistically significant. Results: The present study revealed 100% prevalence of pulp stones in the study group while 90% of the subjects in the control group were also afflicted with pulp stones, though the total number of pulp calcifications observed were lesser in number in the control group compared to the study group (P < 0.05). No significant difference was found, although in the gender predilection for the development of pulp stones in the study group while the control group revealed a definite male predilection with around 96.24% of the males afflicted with pulp stones (P < 0.05). Furthermore, maxillary teeth had a statistically significant predilection for the development of pulp stones in both the study as well as the control groups (P < 0.05). Conclusions: The patients with CAD have high chance of being affected with pulp stones. Higher prevalence of this entity in multiple teeth may warrant such an individual, in the presence of other compounding risk factors, as a candidate for CAD to be ruled out.

Background: The study evaluates the changes of pre and post stages of behavioral change, motivation level, and smoking status among cardiovascular disease patients, participating in the new smoking cessation program in Hospital Tengku Ampuan Afzan, Kuantan. Methods: A total of 65 adult cardiac patients were randomly distributed into two groups, i.e., intervention and control group, who were baseline smokers and assessed in three phases. Initially, the first, second, and third phase collected the information about their demographic details, their smoking status, and smoking status using cotinine amylase strip, respectively. Results: It showed that behavioral change was significant for the control group (P value = 0.031), while motivation level improved for both groups (i.e., control, P value = 0.000 and intervention group, P value = 0.001). The smoke quitting status percentage was higher for intervention group 41.9% and lower for control group 20.6%; however, the P value was insignificant for both control group (1.000) and intervention group (0.250). Conclusions: This study suggests a need for more personal testimonial videos to focus on other smoking-related diseases.

Background: Burnout is characterized by the presence of emotional exhaustion, depersonalization, and low personal accomplishment, and manifests itself in difficulties in the handling of the psychological aspects of personal relationships with patients, by taking a negative attitude toward them. The objective was to evaluate the associated factors and describe the prevalence of burnout in Colombian anesthesiologists. Methods: A cross-sectional observational study. The classification of burnout was carried out using two criteria: the first related to high emotional exhaustion, accompanied by either high depersonalization or low personal accomplishment; the second associated with high emotional exhaustion in conjunction with both high depersonalization and low personal accomplishment. The prevalence and the variables associated with the presence of Burnout were described according to each criterion. Results: 19.2% of the respondents were categorized as having burnout according to the first criterion and 9.2% according to the second criterion. The results are consistent regardless of the criterion used to define burnout; the associated factors were the presence of depression, anxiety, the degree of satisfaction with the profession, more than 200 hours worked per month and being an at-risk drinker. Anxiety was found to be associated with increased risk of both criteria 1 and 2 burnout. Conclusions: In line with other studies, the prevalence of burnout among Colombian anesthesiologists varies depending on the burnout criteria. However, a strong correlation was noted with depression, anxiety, low satisfaction with professional career and high number of working hours per month.

Background: Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by the three main symptom domains including inattention, hyperactivity, and impulsivity. Recent findings suggested that nutrients might play an important role in the pathology of ADHD. The present study aimed to examine the effects of Vitamin D and magnesium supplementation on behavior problems in children with ADHD. Methods: This double-blind, randomized controlled clinical trial study was conducted on 66 children with ADHD in Clinic of Noor and Ali Asghar Hospital in Isfahan, Iran, in 2016. Children were randomly allocated to receive both Vitamin D (50,000 IU/week) and magnesium (6 mg/kg/day) supplements (n = 33) or placebos (n = 33) for 8 weeks. Conners' Parent Rating Scale was used to evaluate children's behavior at baseline and at the end of the study. Results: After 8 weeks of Vitamin D consumption as well as magnesium, the serum levels of 25-hydroxy-Vitamin D3 and magnesium increased significantly in the intervention group compared with placebo group. Supplementation with Vitamin D and magnesium caused a significant decrease in conduct problems, social problems, and anxiety/shy scores; but it had no significant effect on psychosomatic problems score. Conclusions: Vitamin D and magnesium supplementation in children with ADHD was effective on conduct problems, social problems, and anxiety/shy scores compared with placebo intake, but it did not affect psychosomatic problem scores, significantly.

Background: In addition to its short-term effects, low birth weight increases the risk of noncommunicable diseases (NCDs) in adult life. The quality of maternal diet including the macronutrient intake is very important in this regard. This study aims to evaluate the possible associations between maternal zinc and neonatal anthropometric measures. Method: This cross-sectional study was conducted on 226 pairs of mothers-neonates in Isfahan, Iran. Maternal characteristics including the history of the disease, age, preconceptional weight, weight gain during pregnancy, as well as, anthropometric characteristics of neonates such as weight, height, length, and circumferences of head, belly, chest, and thigh were documented. Cord blood zinc was measured by atomic absorption spectrophotometer in three groups of neonates depending on their weights. Results: The gestational age of neonates was 35 to 38 weeks with a mean weight of 3.13 ± 0.42 kg. The mean of zinc concentration was 0.81 ± 0.18 and it was higher in neonates with appropriate weight than in those with high or low birth weight (0.82 ± 0.18, 0.75 ± 0.19, and 0.65 ± 0.12 ng/ml, respectively). Bivariate correlation analysis showed significant weak correlation between cord blood zinc and neonatal weight (r = 0.16, P = 0.04). Conclusions: The cord blood zinc concentration of normal-weight neonates was higher than others. Our findings suggest that maternal zinc may influence neonatal birth weight, and it should be considered in the primordial prevention of NCDs.

The dietary requirement for an essential trace element is an intake level which meets a specified criterion for adequacy and thereby minimizes risk of nutrient deficiency or excess. Disturbances in trace element homeostasis may result in the development of pathologic states and diseases. This article is an update of a review article “Trace Elements in Human Nutrition-A Review” previously published in 2013. The previous review was updated to emphasis in detail the importance of known trace elements so far in humans' physiology and nutrition and also to implement the detailed information for practical and effective management of trace elements' status in clinical diagnosis and health care situations. Although various classifications for trace elements have been proposed and may be controversial, this review will use World Health Organization( WHO) classification as previously done. For this review a traditional integrated review format was chosen and many recent medical and scientific literatures for the new findings on bioavailability, functions, and state of excess/deficiency of trace elements were assessed. The results indicated that for the known essential elements, essentiality and toxicity are unrelated and toxicity is a matter of dose or exposure. Little is known about the essentiality of some of the probably essential elements. In regard to toxic heavy metals, a toxic element may nevertheless be essential. In addition, the early pathological manifestations of trace elements deficiency or excess are difficult to detect until more specific pathologically relevant indicators become available. Discoveries and many refinements in the development of new techniques and continual improvement in laboratory methods have enabled researchers to detect the early pathological consequences of deficiency or excess of trace elements. They all are promises to fulfill the gaps in the present and future research and clinical diagnosis of trace elements deficiencies or intoxications. However, further investigations are needed to complete the important gaps in our knowledge on trace elements, especially probably essential trace elements' role in health and disease status.

Background: The aim of this study is to identify the information and communication technologies used by health professionals to assist in training and updating of technical and scientific knowledge about crack, exchange of experiences, and development of programs to prevent consumption and treatment of addicts. Methods: The qualitative methodology was used, constructed an intentional sample by criteria and applied research techniques through semi-structured interviews, triangulation of the analysis, and key informants. The study resulted in the presentation of differences between the way key informants and health professionals sought information. Results: Internet was the preferred source; however, key informants sought information on sites of scientific journals and reference centers, while health professionals did free searches on the internet to consume information. Conclusions: The literature does not reflect a broad scope of the specific area, but relates the problem of access to health information to other characteristics. The sources of information about crack are focused on digital technologies, the internet and its specific tools. It also finds that health professionals are not being capacitate solidly on the subject of study.