Background: Nutrient deficiency such as antioxidants is a common problem in the elderly; it can result in different diseases such as cancer. Accordingly, assessment of the dietary intake of antioxidants is necessary to design a specific plan for solving this problem. Methods: This case–control study was conducted on 152 old people (≥60 years) with and without nursing care in nursing care centers in Isfahan, Iran, in 2017. Nutritional assessment was performed by an expert nutritionist using semi-quantitative validated Food Frequency Questionnaire. Nutrition IV software was used as food analyzer. Analysis of covariance and independent t-test were used for data analysis. Results: The mean age of the participants was 68.6 ± 4.9 and 68.9 ± 6.1 years in case and control groups, respectively, and the percentage of male/females in these groups was 46.3%/53.7% and 51.4%/48.6%, respectively. Dietary intake of energy, vitamin E, and selenium was significantly higher (P = 0.041; 0.007; 0.017) while beta-carotene intake was significantly lower in the elderly under nursing care than in the control (P = 0.002). Conclusions: The findings indicated that nursing care leads to improved intake of energy, vitamin E, and selenium, while diminished beta-carotene intake in the elderly. Intake of vitamin E, A, C, zinc, and selenium was high among elderly people with and without care, compared with the dietary reference intake. It seems that further studies are required to confirm these findings.

Background: Inflammatory bowel disease (IBD) incidence has been increased in Iran as a developing country. Surveillance is a standard method for accessing valid data about disease epidemiology to make relevant decisions for disease control, prevention, and management. We designed Isfahan IBD Surveillance Project (IISP) to make a surveillance system in this area. Methods: The project is designed in 3 phases. At the first phase, a model of step-wise approach (core, expanded core, and optional variables) for IBD surveillance was designed and implemented among IBD patients registered at a major referral gastrointestinal diseases clinic in Isfahan. Data bank program and its software were designed with suitable and multifunctional features. A total of 352 IBD cases were registered to data bank and analyzed as a pilot study of IISP. Results: A total of 352 IBD patients, including 245 ulcerative colitis (UC), 80 Crohn's disease (CD), and 27 indeterminate colitis, were registered to the data bank. Bloody stool and abdominal cramp were the most common presentation symptom among UC and CD, respectively. Extensive pancolitis was the most prevalent phenotype (40%) of UC. Over two-thirds of our IBD patients were in remission states. Biologic agents had been prescribed in about 10% of patients during disease. Primary sclerosing cholangitis was detected in about 7% and 10% of CD and UC patients, respectively. Conclusions: Valid data from a standard surveillance system are a relevant, trustworthy tool for making decision by health policy-makers. Integrated comprehensive interventional programs for disease control and management is the second phase of IISP.

Introduction: Childhood obesity has become a global endemic public health problem. Emotional distress has been proposed to be a strong mediator of unhealthy lifestyle behaviors among youth. The aim of this study was to explore the sources and role of stress on developing unhealthy lifestyle practices pertaining to diet and physical activity among overweight and obese adolescents. Methods: This qualitative study was conducted in 2016–2017 in two large cities of Iran, Mashhad and Isfahan. Fifty-two overweight and obese adolescents were selected through purposeful sampling. In-depth semi-structured interviews and focus group discussions were conducted to obtain perceptions and experiences regarding underlying factors of obesity and the sources and role of stress in inducing unhealthy lifestyle. Ten parents were also interviewed. Data were analyzed using conventional content analysis with MAXQDA software. Study rigor was verified using criteria proposed by Lincoln and Guba. Results: After analyzing the data, two main categories which triggered emotional overeating and physical inactivity among adolescents were: “school originated stress” and “family originated stress.” Three subcategories of school originated stress were “Too much homework,” “Frequent exams” and “Priority for studying at both school and home” and family originated stress subcategories were “Parental destructive conflicts,” “Divorce” and “Socio-familial issues.” Conclusions: Our findings highlighted the sources and role of stress in emerging unhealthy lifestyle practices including emotional overeating and physical inactivity among adolescents which could lead to weight gain. Therefore, to improve lifestyle behaviors of students and prevent childhood obesity, addressing school, and family stressors is a crucial subject.

Background: Associations between smoking and health-related quality of life (HRQoL) in the general population remain unclear. The aim of the study was to quantify the independent associations between smoking and HRQoL. Methods: A cross-sectional population-based study was conducted on a total sample of 2197 participants obtained by multistage sampling to investigate the associations between smoking and HRQoL in the general population of southeast and southwest of Iran, aged 18–100 years in 2012–2013. Data were collected using a self-administrated of the 36-Item Short Form Survey (SF-36) questionnaire. Linear regression analyses were used to evaluate the associations between HRQoL and smoking while adjusting for various socioeconomic variables. In this study, P < 0.05 was considered a significant difference. Results: Out of the total of 2197 participants, current smokers and never smokers accounted for 13% and 87%, respectively. The mean HRQoL indices were for the current smokers 66.66 ± 17.86, and never smokers 71.35 ± 18.47 (P < 0.001). Independent associations between smoking and HRQoL were found, including negative associations (P < 0.001). The multivariate associations between smoking status and HRQoL, male smokers had a lower physical functioning, mental health, and total SF-36 score. Conclusions: Smoking was independently related to HRQoL, with large differences according to the gender. This study showed that there is a significant difference in the quality of life related to health in male smokers compared to male nonsmokers.

Background: Polycystic ovary syndrome (PCOS) is a polygenic endocrine disorder in women of reproductive ages which will lead to infertility. This study is aimed to determine changes in levels of hyperandrogenism, hirsutism and menstrual regulation after a period of aquatic high intensity interval training (AHIIT) in women with PCOS. Methods: Thirty patients with PCOS having age between 20 and 35 and body mass index (BMI) ≥30 kg/m² in obstetrics and gynaecology clinics in Isfahan were selected based on Rotterdam Diagnostic Criteria. They were randomly divided into experimental (AHIIT + metformin, N = 15) and control groups (metformin, N = 15). The exercises were done for 12 weeks, three sessions of 20 minutes. Metformin (1500 mg) was taken daily for 3 consecutive days for 12 weeks. Kolmogorov–Smirnov test, t-test, Covariance and Wilcoxon were applied (P value < 0.05). Results: After 12 weeks, no significant difference was observed in waist-to-hip ratio (WHR), but in AHIIT, the BMI and fat mass significantly decreased and levels of follicle-stimulating hormone (FSH), free testosterone (FT) and sex hormone binding globulin (SHBG) increased compared to control group (P < 0.05). While levels of improvement of total testosterone (TT), dehydroepiandrosterone sulphate (DHEAS), FT, luteinising hormone (LH) and free androgen index (FAI) were not significant between the two groups (P > 0.05). Furthermore, there was a significant decrease in homeostatic assessment of insulin resistance (HOMA-IR) and hirsutism severity in experimental group (P < 0.05). In both groups, the order of menstrual cycles improved significantly (P < 0.05). Conclusions: Doing AHIIT besides drug therapy can be effective for PCOS patients.

Background: The growing supply and prevalence of waterpipe (WP) smoking among Iranian adolescents have become a concern for both families and policymakers. The aim of this study was to determine the factors underlying WP use and also to design an intervention program based on social cognitive theory (SCT) aimed to reduce the demand for WP smoking among male adolescents. Methods: This quasi-experimental study involved 189 high-school students in Kerman, Iran, who were split into two groups, an intervention group and a control group. A validated questionnaire based on SCT constructs was used to collect data. The intervention was performed over four sessions with a focus on preventing WP smoking. Results: Before intervention, the lifetime and current-use prevalence of WP smoking across both groups was 48.5% and 20.2%, respectively. In the intervention group, the most change was related to knowledge score from 10.70 ± 4.38 to 16.52 ± 3.89 (P < 0.0001) and outcome values score from 12.40 ± 3.81 to 13.53 ± 4.23 (P = 0.007); however, in the control group, no significant changes were seen in posttest scores. The scores for self-efficacy (P = 0.21), outcome expectations (P = 0.09), and environment constructs (P = 0.06) did not show any statistically significant changes after the intervention in both groups. Overall, there was no significant difference in the rate of WP smoking after the intervention. Conclusions: Based on the results of this study, although some construct scores showed significant differences after the intervention, there was no significant change in the prevalence of WP smoking. More effective educational interventions based on this theory but with a greater focus on self-efficacy and environmental influences may be warranted.

Background: Depression and obesity are among the increasingly publicized health problems, both being related to critical complications, and increasing the risk of substantial morbidity and mortality. An increasing number of documents indicate that obesity affects mental status, low serum cholesterol levels, and is related to depressive symptoms. The purpose of the present study was to evaluate the possible significant difference in lipid profile levels, body mass index (BMI), waist circumference (WC), and blood pressure (BP), between depressive and nondepressive older adults. Methods: This was a case–control study where 107 patients, over 65-year-old, were enrolled in this study. Serum total cholesterol, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol (LDL-C), triglycerides (TG), BP, and fasting blood sugar were measured. Data were analyzed using the statistical SPSS software version 22. Independent t-test was used to compare the results between the two groups and the Chi-square test was used to compare categorical variables. In addition, nonparametric Mann–Whitney test was used to evaluate the data. Results: The depressive group showed significant lower BMI, WC, LDL-C, and TG (P < 0.001, P < 0.001,P < 0.016, and P < 0.014). Furthermore, the findings showed significantly higher systolic and diastolic BP in participants who had shown depressive symptoms (P < 0.035 and P < 0.024). Conclusions: The findings suggest that a low BMI, serum LDL-C, and TG are related to depressive symptoms the Iranian elderly.

Background: Health literacy is a major factor for health promotion and well-being. In spite of several researches on health literacy, information on the subject of the status of health literacy in Asian countries such as Iran is inadequate. Therefore, this study aimed to assess the inequality of health literacy in an Iranian population and its influencing factors. Methods: In this cross-sectional study, 736 families were selected by cluster random sampling. A validated questionnaire was used to measure the health literacy of participants. Socioeconomic status (SES) was calculated by asset-based approach, and principal component analysis (PCA) was performed to estimate the families' SES. Concentration index and curve were used to measure SES inequality in health literacy, and after that decomposed into its determinants. The data were analyzed by Stata software. Results: The mean age of the participants was 34.81 years (standard deviation = 5.98 years). The value of concentration index for health literacy equals 0.2292 (95% confidence interval = 0.168–0.283), and this value indicates that there is inequality in distribution of health literacy in Iran and the inequality disfavors the poor. Conclusions: The results of this study revealed that there is inequality in distribution of health literacy in Iran, and people of higher economic status in Iran enjoy from better health literacy levels.

Background: To test whether gender moderates the effects of baseline depressive symptoms and chronic medical conditions (CMCs) on risk of receiving subsequent psychiatric diagnosis among older adults. Methods: Data came from ten waves of the Health and Retirement Study, a nationally representative longitudinal study. We followed 9794 individuals older than 52 years without any diagnosed psychiatric disorder at baseline for up to 18 years. Baseline depressive symptoms and CMC were the predictors, time to receiving an emotional diagnosis was the outcome, baseline demographics and socioeconomics were controls, and gender was the moderator. We used Cox proportional hazards models for data analysis. Results: In the pooled sample, female gender increased the effect of baseline depressive symptoms (hazard ratio [HR], 1.58; 95% confidence interval [CI], 1.26–2.00) and reduced the effect of baseline CMC (HR, 0.78; 95% CI, 0.63–0.97) on time to receiving a psychiatric diagnosis. Among men, baseline depressive symptoms (HR, 2.36; 95% CI, 1.87–2.97) increased and baseline CMC (HR, 0.81; 95% CI, 0.69–0.95) decreased time to receiving a psychiatric diagnosis. Among women, depressive symptoms (HR, 1.49; 95% CI, 1.21–1.83) but not CMC (HR, 1.06; 95% CI, 0.91–1.23) were associated with time to receiving a psychiatric diagnosis over time. Conclusions: Men and women differ in how depressive symptoms and CMC influence their risk of receiving a psychiatric diagnosis over time. Depressive symptoms are more salient promotor for men than women while CMC is only a barrier for men.

Introduction: Cisplatin is a widely used anti-cancer drug that is commonly administered for the treatment of various cancers. However, nephrotoxicity is the most important side effect of this drug which limits its use. This study aimed to investigate the protective effect of Cystone against nephrotoxicity induced by Cisplatin in patients with cancer. Methods: This pilot clinical trial study was conducted on 43 cancer patients treated with Cisplatin (75 mg/m2 for a period of six months). The subjects were divided into treatment group (receiving Cystone, two per 8 hours; n = 21) and control group (n = 22). The two groups were compared with each other in terms of demographic and laboratory variables. Results: In the intervention group receiving Cystone, serum creatinine-based GFR level (P = 0.453) and 24-hour urine creatinine-based GFR level (P = 0.397) did not change significantly during the studied period, but in the control group, serum creatinine-based GFR level (P = 0.013) and 24-hour urine creatinine-based GFR level (P = 0.016) significantly changed. Serum creatinine-based GFR level increased by 2.3 units in the intervention group and 10.5 units in the control group (P = 0.005) in the six months of the study. At the end of the sixth month, 24-hour urine creatinine-based GFR level increased by 2.2 units in the intervention group and 0.8 unit in the control group (P = 0.008). Conclusions: The use of Cystone resulted in more stable kidney function indices in the intervention group, as compared with the control group. Therefore, Cystone seems to have a protective effect against nephrotoxicity induced by Cisplatin in cancer patients.

Background: Trichomoniasis is a common sexually transmitted disease that is caused by infection with protozoan parasite called Trichomonasvaginalis. Metronidazole is the drug of choice for the treatment of this infection. In this study, design, formulation, and physicochemical evaluation of vaginal cream containing Eucalyptus camaldulensis, Viola odorata, and Mentha piperita extracts for the prevention and treatment of trichomoniasis has been investigated. Methods: Ethyl acetate extract of E. camaldulensis leaves, water fraction of V. odorata root, and hydroalcoholic extract of M. piperita leaves was prepared and used for anti-trichomonas experiments. Then, based on results, different formulations of vaginal cream containing mixed extracts were prepared and physicochemical evaluation was conducted. In the next step, anti-trichomonas effect of selective formulation was tested in vitro. Results: The mixed concentrates containing 2.5 mg/ml E. camaldulensis, 0.06 mg/ml V. odorata, and 1 mg/ml M. piperita showed 100% growth inhibition (GI) during 24 h. Furthermore, the mixture containing 1.25 mg/ml E. camaldulensis, 0.03 mg/ml V. odorata, and 0.5 mg/ml M. piperita showed 92% GI in the first 24 h. The selective formulation passed all of physicochemical test and also showed 100% GI for in vitro anti-trichomonas experiments in the first 24 h. Conclusions: The mixed concentrates containing 2.5 mg/ml E. camaldulensis, 0.06 mg/ml of V. odorata, and 1 mg/ml of M. piperita are the mixture which showed the highest percentage of GI (100%) after 24 h. The selective formulation of vaginal cream containing this mixture of extracts was detected 100% GI in the first 24 h.

Background: Anabolic-androgenic steroids (AASs), when taken in supraphysiologic doses, increase muscle strength and athletic performance. Evidence suggests that long-term use of AAS in supraphysiologic doses have adverse effects on health. Therefore, the study was conducted to find crude estimate of the prevalence of AAS use among attendees of the gymnasium, the factors that could have influenced them for AAS abuse and to assess the short- and long-term side effects as perceived by them. Methods: A cross-sectional study was conducted in selected gymnasiums of a smart city of India using a predesigned and pretested questionnaire. Snowball sampling method was undertaken. The study was from July 2015 to June 2016. Informed written consent was taken. The analysis was done using SPSS v. 20.0. Results: Of 84 bodybuilders approached, 74 participants used AAS. All users were male with mean age of 26.5 + 0.55 years. The mean age of initiation of AAS abuse was 23 years, and 66.2% (49) were unmarried. Eighty-five percent (63) preferred injectable. Seventy percent (52) abusers were influenced by trainers for abuse. Most commonly abused was Nandrolone decanoate (55.4%). Seventy-three percent were not aware of any legal ban on steroids. Reported benefits include increased strength, muscle size, and power, while harms were increased acne, deepening of voice, swelling of feet, increased irritability, depressive thoughts, impaired judgment, panic disorder, and withdrawal effect. Conclusions: Frequency of ASS use was substantial among young bodybuilders. Awareness about side effects was not a deterrent factor. Abusers were highly influenced by coaches. Efforts should be made for preventing easy access to AAS.

Background: Diagnosis of prediabetic stage is very important for prevention of diabetes and complications. This stage may be associated with some oral lesions. Only a few studies are available on the oral status of prediabetic patients and incidence of oral lesions in this population. This study aimed to compare some oral complications between prediabetic and healthy control groups. Methods: The present two-group cross-sectional study was carried out on 302 prediabetic and non-diabetic (healthy) 20- to 60-year-old subjects. In this study, data on age, gender, educational level, medications use, smoking, and some other variables were extracted through history taking. In addition, orodental examination was carried out by an oral medicine specialist to diagnose oral lesions including candidiasis, lichen planus, periodontitis, gingivitis, xerostomia, delayed wound healing, geographic tongue, fissured tongue, and burning mouth sensation. Data entry and analysis was performed by SPSS version 22 software, and P value and odds ratio (OR) were calculated to show statistical relationship between variables. Results: The most common oral lesion in prediabetic subjects was periodontitis (27.2%), followed by gingivitis (14.7%) and xerostomia (11.3%). In the control group, gingivitis (20.5%) followed by periodontitis (11.3%) are common oral lesions. Candidiasis (P = 0.036), periodontitis (P < 0.001), and xerostomia (P < 0.001) in prediabetic subjects were higher than control group that is statistically significant. Regression analysis showed that in the prediabetic group, periodontitis [OR = 2.91, confidence interval (CI): 1.54–5.49] and xerostomia (OR = 18.51, CI = 2.42–141.45) were significantly more prevalent than healthy subjects. Conclusion: Based on the results, glucose intolerance stage exhibited a significantly higher oral problems such as periodontitis and xerostomia than healthy euglycemic stage.

Background: We investigated the effect of thioctic acid (TA) on kidney function, oxidative stress, and inflammatory status in serum and kidney homogenates of a rat subjected to ischemia–reperfusion injury (IRI). Materials and Methods: Thirty male Wistar rats were randomly divided into three equal groups: sham, IR, and IR + TA in 50 mg/kg once-daily intraperitoneal injection for 2 weeks, before IR induction. The levels of urea and creatinine (Cr) in the serum of rats were measured. Malondialdehyde and nitric oxide (NO) as stress oxidative markers; tumor necrosis factor-α, interleukin-6, and myeloperoxidase as inflammatory markers, as well as activities of superoxide dismutase, glutathione peroxidase and catalase, and glutathione (GSH) level in both serum and kidney homogenates were determined. Results: Cr and urea increased in serum of IR group. Furthermore, levels of oxidative stress and inflammatory markers in serum and kidney homogenates of the cited group were higher than the sham group. TA not only decreased the levels of Cr, urea, oxidative stress, and inflammation but also elevated the level of GSH and activities of antioxidant enzymes (P < 0.001). Conclusions: The findings showed that TA protected IR rat against kidney dysfunction and IRI due to reinforcing endogenous antioxidant and subtracting of inflammatory markers.

Background: Incidence and prevalence of type 2 diabetes are one of the major challenges of Iran health system. Despite policies on diabetes prevention and control, Iran is faced with many problems in prevention and control of this disease at the executive level. This study seeks to identify the problems of Type 2 diabetes prevention and control program in Iran. Methods: In this qualitative study, 17 participants were interviewed purposefully. The semi-structured interview guide was designed based on literature review and four initial in-depth interviews. Framework analysis method was used for the analysis of qualitative data. Results: Six themes and 29 subthemes explaining the problems of type 2 diabetes prevention and control program were identified: Referral system, human resources, infrastructure, cultural problems, access, and intersectoral coordination issues. Conclusions: Despite the well-developed policy of type 2 diabetes prevention and control, the implementation is faced with some problems which endangers the effectiveness of the plan. Any attempt to improve the successful implementation of the type 2 diabetes prevention and control program requires effective measures, deep understanding of the problems and solving them.

Background: The aim is to determine the incidence rate of unintentional injuries and its associated factors and determine the pattern of these injuries among laboratory staff in three reference laboratories in Sana'a, Yemen. Methods: A cross-sectional study was conducted among laboratory staff in the three reference laboratories in Sana'a, Yemen. A pretested structured questionnaire was used to collect data on the unintentional injuries during the past 12 months including the type of injury. Results: A total of 93 technicians responded and filled the questionnaires. Of the 93 technicians, 51 (54.8%) technicians reported that they had been injured in the past 12 months. Of all injuries, 38% of technicians were caused by needle sticks, 21% by sharp materials other than needles, 15% by hot materials, 15% by exposure to chemicals, and 11% of them by other exposures. Only 18% of injuries were reported to safety officer in the laboratory. Those who had an experience of <5 years were more likely to experience injury in the past 12 months than those who had 5 years of experience or more (odds ratio = 8.3; 95% confidence interval: 2.2, 27.4; P < 0.005). Conclusions: About half of laboratory technicians in Yemen reported that they had been injured in the past 12 months, with the needle stick being the most common cause of injury. Therefore, there is a need for targeted interventions to laboratory technicians to increase their awareness on the risk of injuries in the laboratory. Bio-safety training among laboratory technicians deemed very necessary.

Introduction: Child nutrition status is very important in all societies, which is influenced by the interaction of multiple factors including food security and socioeconomic status in both genders. The aim of this study was to examine the relationship between food security and socioeconomic status with anthropometric indices among 2–5-year-old urban children in eight different cities in Iran. Materials and Methods: In this cross-sectional study, anthropometric Z scores of 7028 children of urban area were measured by using World Health Organization (WHO) Anthro software based on WHO 2007 standards. Family food security was assessed by using HFIAS 9-item questionnaire. Socioeconomic status as well as health factors were analyzed using the SPSS. Results: Based on the present study, significant correlation was observed between sleep time, birth weight, and food security (P < 0.05) with body mass index (BMI), while the rest of the variables including age, family size, number of children, parents' education, breastfeeding duration, watching TV, playing computer games, playing outdoors, number of main eating, and number of snacks showed no significant relation (P > 0.05). Conclusion: It was shown that 2–5 years old children's life are the most vital and vulnerable to the hazards of undernutrition or overweight and obesity, which could affect the whole health of the person. As food security affects BMI, it is important to focus more on this issue in order to improve child's health status.

Background: Delay in diagnosis of diabetes mellitus (DM) in older adults is more catastrophic than other age groups. This study investigated the prevalence of pre-diabetes, DM, and glycemic control in the elderly. Methods: In this cross-sectional study, a sample of 412 older adults >60 years from Shiraz, Iran, were recruited through a multistage cluster random sampling. Demographic, clinical, and laboratory information were collected by interview, physical examination, and reviewing the medical records. Data were analyzed using SPSS 20. Results: Mean age was 68.1 ± 6.2 years and female-to-male ratio was 1.1. Out of all, 137 (33.2%) were diagnosed as diabetic including 128 (31%) as known cases and 9 (2.2%) as new cases of DM, whereas 275 (66.7%) were diagnosed as new cases of pre-diabetes. Multivariable analysis showed that low level of education (OR = 5.2, 95% CI: 1.5–16.6), hyperlipidemia (OR = 3.5, 95% CI: 2.1–5.8), liver disease (OR = 3.1, 95% CI: 1.4–6.9), and hypertension (HTN) (OR = 1.9, 95% CI: 1.1-3.2) were the most common predictors of DM in the elderly, respectively. Out of all diabetics, 33.6% had FBS >130 mg/dL and 25.5% had HbA1c >8%, whereas these figures were ≥100 mg/dL and ≥5.7% in 36.7% and 21.4% of pre-diabetics, respectively. Conclusions: The pre-diabetic elderly were mostly undiagnosed, while one-third to one-fourth of DMs had poor glycemic indices. These figures show the need for pre-diabetes and diabetes screening in the elderly, especially in those with low level of education, hyperlipidemia, liver disease, or HTN. Furthermore, regular monitoring of glycemic indices in the diabetic and pre-diabetic elderly is recommended.

Background: Based on the World Health Organization definition, mental health is the absence of mental disorders and presence of positive mental health (PMH). As the social determinants of mental disorders and PMH are not the same in different cultures and in order to promote community mental health, social determinants of PMH should be identified, which is the aim of this study. Methods: This was a qualitative study conducted in Tehran. Data were collected through eight focus group discussions with the general population aged between 30 and 60 years and ten semi-structured interviews with mental health professionals from Tehran. Data were analyzed through directional content analysis using Dedoose software. Results: Fifty-one lay people and ten mental health professionals participated in this study. The process of content analysis resulted in two main themes: (a) structural determinants of PMH which consist of socioeconomic and political context and socioeconomic position and (b) intermediary determinants of PMH which consist of working condition, living condition, family factors, lifestyle, psychosocial factors, and health system. Conclusions: Improvement of living conditions, with emphasis on working conditions as one of the intermediary social determinants, will play an important role in promoting PMH.

Background: The aim was to determine validity, reliability, and cutoff of full-mini nutritional assessment (MNA) and MNA-short form (SF) also which one was better for the screening of malnutrition in the Iranian hospitalized elderly. Methods: In this cross-sectional validation study, 96 hospitalized elderly ≥60 years selected from two hospitals in Tehran. Anthropometric measures (body mass index [BMI], mid-arm circumference [MAC], calf circumference [CC], abdomen, and waist skinfold thickness) and laboratory tests (albumin and hemoglobin levels, and red blood cell count were performed. Nutrition tools (full-MNA and MNA-SF), cognition tool (mini-mental state examination, depression scale (Geriatric Depression Scale15 and activities of daily living (ADL) index (Modified Barthel-ADL) were administered. Results: The full-MNA scores were significantly correlated to measures of MAC, BMI, waist, and CC. The MNS-SF scores were significantly related to measures of MAC, waist, and CC. Serum albumin showed a poor correlation with both tools. At cutoff 24 in full-MNA had a sensitivity 75% and specificity 77.8% and the MNA-SF considered 62.5% sensitivity and 65.3% specificity at cutoff 10.50 to detect well-nourished from malnourished subjects. The internal consistencies of both tools were >90%. In exploratory factor analysis, six components found for full-MNA and two components for MNA-SF. Known group validity of full-MNA was reflected significant differences between geriatric patients with expected higher full-MNA scores and patients with expected lower scores (BMI ≥24 vs. BMI <24 or bed ulcer or assisted food intake). Conclusions: It seems the Persian version of full-MNA is more appropriate in comparison to MNA-SF for screening malnutrition in the Iranian hospitalized elderly patients.

Background: Since women's readiness for dietary behavioral change can be one of the most effective fundamental measures for reducing dietary salt intake in line with preventing chronic diseases in developing countries, the present study is aimed to determine the readiness for behavioral change in discretionary salt intake among women living in Tehran. Methods: The present cross-sectional study was conducted on 561 women referring to the women care units across city of Tehran. The self-administered questionnaire included assessment of nutrition-related knowledge on salt intake and its association with diseases, discretionary salt intake, stages of change, and self-efficacy of women. In addition, the logistic regression test was used to determine the predictors of women's readiness for behavioral change in discretionary salt intake. Results: 40% women had someone in the family who had such a limitation (salt intake-limited exposure group), while 81.6% always or often added salt to their foods. Moreover, one-third of the participants were in the stage of pre-contemplation and 41.2% were in the stage of preparation for reducing salt intake. Self-efficacy and salt intake-limited exposure were the two most important determinants of the women's readiness for behavioral change in discretionary salt intake, respectively: (OR = 1.1 95% CI: 1.06--1.14 P < 0.001; OR = 1.58, 95% CI: 1.03--2.42 P < 0.03). Conclusions: Results of the present study showed that increased self-efficacy is associated with higher levels of behavioral change among women. Since self-efficacy is very important for initiating and maintaining the behavioral change, women's empowerment for reducing salt intake necessitates putting the emphasis on increased self-efficacy as well as community-based nutritional interventions.

Background: The aim of this study was to compare the PID with bare skin (without PID) regarding bacterial recolonization and bacterial regrowth of the adjacent skin of surgical incision in lumbar spine surgery patients. Methods: This quasi-experimental study was conducted from February to May 2018 on 88 patients who were candidate for lumbar spine surgery. Patients were assigned to one of two groups, treatment (with PID) and control (without PID). Skin sampling (adjacent of surgical incision) for bacterial culture was done in two steps, immediately after surgical skin prep (IASSP) and immediately after surgical wound closure (IASWC) by researcher. Finally, samples were sent to the laboratory. Results: The mean total bacterial count of patient's skin in stage IASSP was not significantly different between treatment and control groups (0.34 vs 0.27, P = 0.68). However, mean total bacterial count in stage IASWC in treatment group was significantly higher than control group (2.2 vs 0.93, P = 0.03). The frequency distribution of S. aureus (P = 0.04) and S. epidermidis (P = 0.02) was significantly higher in treatment group compared with control group in stage IASWC. Conclusions: The results showed that using PID is unable to reduce recolonization and regrowth of bacteria on patients' skin adjacent to surgical wound in clean lumbar spine surgeries. However, making a definite decision about using or not using of PID requires further studies.

Background: The incidence of breast cancer is on rise in low- and middle-income countries as populations increasingly adopt western lifestyles. Studies on risk factors of cancers including breast cancer are lacking in Yemen. Therefore, this study aimed to determine the risk factors of breast cancer among women registered at Hadramout Valley and Desert Oncology Center (HVDOC). Methods: A case–control study was conducted at HVDOC, Yemen. All women who were registered in HVDOC and diagnosed with breast cancer and confirmed by histopathology during 2011–2015 were selected as cases. Age-matched controls were selected from women who underwent mammography in HVDOC during 2011–2015 and were confirmed to be free of breast cancer. Data were collected using semi-structured questionnaire and clinical data were abstracted from the medical records. Results: A total of 105 patients and 210 controls were included in this study. About 70.5% of cases and 72.4% of control were 50 years old or younger. Compared with married women, divorced women had higher odds of breast cancer [odds ratio (OR) = 2.2]. The odds of breast cancer was higher for women who had never breastfed a child (OR = 1.7). Having hypertension (OR = 2.5), family history of malignancy (OR = 2.4), and postmenopausal status (OR = 2.0) were significantly associated with higher odds of breast cancer in multivariate analysis. Conclusions: The main risk factors for breast cancer among women in Yemen are divorced marital status, never breastfed a child, having hypertension, family history of malignancy, and postmenopause. Regular screening especially among women with high risk is needed.

Background: Disposal and release of plastic bags in the environment can cause environmental, economic, and social problems. The aim of this study was to explore the determinants of the behavior of plastic bag use (BPBU) among residents using socioecological approach (SEA). Methods: In this cross-sectional study, multistage random sampling was employed to enroll 400 residents in Hadishahr County, North West of Iran. A valid and reliable instrument based on SEA variables was used. Results: Hierarchical multiple linear regressions were performed with SEA and BPBU as outcome variables. Predictors of outcome variables were classified into four different blocks. Demographic characteristics and SEA constructs explained 50% of the observed variance in BPBU. In the first block, age (P = 0.03) and purchase frequency (P = 0.902) were significant predictors of BPBU (R² = 0.34), and in the third block, access to alternatives in environment (P = 0.01) was significant predictor for BPBU (R² = 0.49). The majority of residents (47%) were taking home 6 to 10 plastic bags and more than 10 freezer bags after their shopping per week. Conclusions: Health-care providers may consider purchase frequency and SEA as a framework for developing educational, environmental, and social interventions aiming at reducing the consumption of plastic bags.

Background: Overweight, obesity, and underweight are common child health problems in Iran. Child-feeding practices are one of the major factors affecting children's weight through eating behavior and dietary intake. The Comprehensive Feeding Practices Questionnaire (CFPQ), a 49-item measure comprising 12 subscales, assesses parental child-feeding practices. It is used to determine factors that may affect the development of overweight, obesity, and underweight and therefore, helps us plan appropriate preventive action. The aim of this study was to revise and adapt CFPQ to be used for 2–5-year-old children. Methods: This study including, 300 mothers selected by simple systematic random sampling, was conducted in the rural and urban areas of Birjand city, Iran. Health workers interviewed the mothers and completed questionnaire according to the standard protocol. Exploratory factor analysis (EFA), tests for internal consistency, and test–retest reliability were conducted. Results: EFA resulted in a final questionnaire with 39 items distributed over seven factors, including Healthy Eating Guidance, Modeling, Parent Pressure, Monitoring, Emotion Regulation, Child Control, and Restriction. The internal consistency reliability for the proposal scales was acceptable for five out of the seven factors and all of the seven factors demonstrated excellent test–retest reliability. Conclusions: The revised CFPQ is a valid tool for determining the various aspects of parental feeding practices aiming to prevent overweight, obesity, and underweight among 2–5-year-old children.

Background: Primary healthcare system in Iran has played an extensive role in promoting people health in the past decades. However, regarding universal developments in the different global aspects effective on health, the performance of this system has been influenced significantly. The aim of the present research is to identify the future trends of the primary health care in Iran. Methods: The participants of this qualitative case study were experts in primary healthcare, which were selected and interviewed through purposive sampling method. The interview process was saturated after 25 interviews, so we stopped the process at this point. Framework analysis based on STEEP model used to analysis the interviews. Results: The most important social/value, technological, economic, environmental, and political future trends of primary healthcare in Iran included demographic transition, epidemiological transition, social and cultural changes, emergence of modern and advanced technologies, internet and cyberspace, budgeting limitations, resource management, changing paradigm from volume to value in providing health services, environmental pollutions, natural disasters, health governance, intellectual paradigm of senior officials, regional security, international development, and other internal factors of the health system. Conclusions: The identified factors can be turned into opportunities for Iran primary healthcare system if health planners and policymakers have a deep and accurate look at these influential factors and manage them properly.

Background: Osteoporosis and obesity are two major public health problems worldwide. Considering the conflicting results about the association between anthropometric measurement and bone mineral density (BMD) and also differences between various races, this study was designed to examine the relationship between anthropometric measurements and BMD in a sample of Iranian adults. Methods: This cross-sectional population-based study was conducted on 2625 Iranian adults aged 18 and above who were selected using multistage, cluster sampling method from Sanandaj and Arak (two cities of Iran). The evaluated variables included age, sex, height, weight, body mass index (BMI), BMD, and waist and hip circumferences. The correlations between anthropometric measures and BMD in three bone areas (total hip, femoral neck, and spine) were observed in four sex/age groups (men <50 years, men ≥50 years, and pre- and postmenopausal women). Results: Of all the 2625 participants in the Iranian Multicenter Osteoporosis Study, 2022 (1303 women and 719 men) entered into our survey and were stratified into four sex/age groups. According to the results, increasing BMI was directly associated with BMD increase, while an inverse association was observed between waist-to-hip ratio (WHR) and total hip BMD. In a similar analysis on the femoral neck and WHR, the correlation coefficients in premenopausal women and men ≥50 years were reported as being the highest and the lowest, respectively, among the four groups. Conclusions: Our results showed that high BMI is a protective factor (positive correlation), and high WHR is a risk factor for osteoporosis, although it should be reminded that we could not specifically define which factors including lean tissue mass, fat mass, and total weight are really affecting BMD increase in the overweight/obese participants.

Background: One of the most effective parameters in the progression of the prostate cancer is interleukin (IL)-6 through affecting pSTAT3, pERK1/2, and pAKT cell signaling proteins. Carvacrol is an herbal antioxidant with antitumor effects. The purpose of this study was to investigate the effects of carvacrol on IL-6 gene expression, pSTAT3, pAKT, pERK1/2 cellular signaling proteins, and invasion in human prostate cancer PC3 cells. Methods: PC3 cell viability was evaluated by MTT assay with different concentrations of carvacrol (0–800 μM). IL-6 gene expression and cellular concentration of pSTAT3, pERK1/2, and pAKT were investigated using the real-time reverse transcription quantitative polymerase chain reaction (RT-qPCR) and western blotting technic, respectively. PC3 cell invasion was determined by invasion assay test. Results: Carvacrol IC₅₀for PC3 prostate cancer cells was 360 μM. Carvacrol led to a significant reduction (P < 0.05) for IL-6 gene expression in a dose-dependent manner compared to control. IL-6 protein reduced 41.5% and 52.7% when compared with control cells at 360 and 420 μM of carvacrol, respectively. Carvacrol led to a decline in pSTAT3, pAKT, and pERK1/2 above 360 μM compared to control. PC3 potential invasion was significantly reduced after treatment with carvacrol in a dose-dependent manner. Conclusions: Decreased IL-6 protein level by carvacrol resulted in diminishing of pSTAT3, pERK1/2, and pAKT signaling proteins, which leads to the reduction of the cell survival, proliferation, and invasion in PC3 cells.

Background: To address the disproportionate burden of poor mental health among women, we present a community based participatory research (CBPR) model used to develop a women's mental health promotion program for Iranian women. Methods: This is a multi-phase interventional study using a CBPR approach among married women age 18–65 living in Tehran. First, participants described the process of women's mental health. Subsequent steps involved participatory needs assessment, priority setting, intervention design, and evaluation. Finally, a conceptual model of women's mental health promotion was developed. Results: “Seeking comfort” emerged as the core process in women's mental health. To promote mental health, women prioritized training on coping mechanisms to deal with stress. Women receiving this training used more problem-based coping methods and reported a higher quality of life than the comparison group. Conclusions: The resulting conceptual model illustrates the utility of using a CBPR approach to develop women's mental health promotion programs.