Background: National Nutrition and Food Security Policy of Iran was developed and ordered by Office of Community Nutrition Improvement, in cooperation with National Nutrition and Food Technology Research Institute and National Institute of Health Research in 2012. This study was aimed at evaluating the success of the operationalization of the Policy between 2012 and 2015 and using the lessons learned in future policies. Methods: The participatory evaluation was conducted by taking part of all main partners including trustee organizations involved in implementation of the document, specialists and academic researchers, people's deputies, health service, headquarters experts at Ministry of Health. Three qualitative methods including reviewing evidences, interviews, and focus group discussions have been used to gather information. The degree of achievement of the document's strategic objectives, as well as the degree of adaptation of the document implementation to the desired state, has been determined. Results: The mean percentage of progress in achieving outcomes and adaptation of the deployment method to ideal criteria (for 2016) of the National Document on Food and Nutrition Security from 2013 to 2017 are 52.6% and 41%, respectively. The best success was found in the existence of an evidence-based program (70%), a coalition of policy implementation (66.1%), and indicators for monitoring the progress of the document (61.1%). The least success was related to the weakness of public justification and public participation (20%) and lack of ranking and encouraging partners' function (24%). Lack of approval of the national document at the High Council for Health and Food Security of the country (HCHFS) was the important factor which led to less progress of the document. Conclusions: It is recommended to target avoiding structural changes while saving time, strengthening intersectoral capacity for collaboration, encouraging partners, and empowering the environment of the provinces in the coming years.

Introduction: Outsourcing is one of the major strategies for keeping competitive gain in today's highly varying markets, especially in health systems. This study endeavored to identify operational challenges of outsourcing health facilities affiliated to Isfahan University of Medical Sciences in the academic year 2019. Methods: This qualitative study was conducted with content analysis approach. To conduct the interview, key informants were from the managers of health facilities and decision makers of health deputy and managers from private sector were selected through purposive sampling. The saturation point was reached at 12 semi-structured interviewees; this way, data were collected through interviews with experts. A thematic analysis was employed to analyze the transcriptions by MAX QDA10. Results: According to the results of thematic analysis, seven major themes identified as operational challenges of outsourcing health services in health facilities with 40 sub-themes. Conclusions: Outsourcing health services in health facilities needs to be done more scientifically and logically. Decision makers must predict the challenges and apply solutions before outsourcing, supervise, and evaluate the impacts of outsourcing after at least 1 year.

Pressure ulcer is a health problem worldwide that is common among inpatients and elderly people with physical-motor limitations. To deliver nursing care and prevent the development of pressure ulcers, it is essential to identify the factors that affect it. This global systematic review and meta-analysis was conducted with the aim of evaluating the incidence of pressure ulcers in observational studies. In this study, databases including Web of Science, Embase, PubMed, Scopus, and Google Scholar were searched to collect data. Articles published from 1997 to 2017 about the factors influencing the incidence of pressure ulcers were retrieved and their results were analyzed using meta-analysis according to the Random-Effects Model. The heterogeneity of studies was investigated using the I² statistic. Data were analyzed using the R and Stata software (version 14). In this study, 35 studies were included in the final analysis. The results showed that the pooled estimate of the incidence rate of pressure ulcer was 12% (95% CI: 10–14). The incidence rates of the pressure ulcers of the first, second, third, and fourth stages were 45% (95% CI: 34–56), 45% (95% CI: 34–56), 4% (95% CI: 3–5), and 4% (95% CI: 2–6), respectively. The highest incidence of pressure ulcers was observed among inpatients in orthopedic surgery ward (18.5%) (95% CI: 11.5–25). According to the final results, better conditions should be provided to decrease the incidence of pressure ulcers in different wards, especially orthopedics, and in patients with diabetes.

Background: Nowadays, the use of green tea supplements has increased. Studies have shown that green tea can have positive effects on anti-inflammatory and antioxidative factors, as well as improve aerobic performance capacity. Therefore, in this study, we investigate the effects of this supplement on inflammatory factors, total antioxidant capacity responses, and maximum oxygen uptake (VO₂Max) of healthy young men in summer. Methods: This study is a double-blind randomized controlled trial (RCT) in which 15 young men (age 25.06 ± 2.1) were randomly assigned into the green tea (GT) and placebo groups. Subjects performed maximum aerobic exercises (shuttle run 20 m) in separate workouts (14 days) in summer. They consumed 640 mg green tea extracts or maltodextrin 90 min before exercise in a double-blind design. Blood samples were collected before and after the exercise and then evaluated in the biochemistry laboratory. In this study, one way analysis of variance (ANOVA) tests were used for the statistical analysis. Results: The results of this study show that green tea supplement significantly slowed down the increasing tumor necrosis factor alpha (TNF-α) (GT: 15.03 ± 4.31 [pg/ml], placebo: 31.38 ± 7.18 [pg/ml], [P = 0.000]); increased the total antioxidant capacity (GT: 1.04 ± 0.06 [mm], placebo group: 0.72 ± 0.04 [mm], [P = 0.001 VO₂]); and Max (GT: 44.43 ± 3.06 [ml/kg/min], placebo group: 34.88 ± 1.30 [ml/kg/min], [P = 0.001]) in the supplement group than placebo. In addition, no significant differences in interleukin 1 beta (IL-1β) was observed between thee groups (GT: 26.86 ± 5.05 [pg/ml], placebo group: 23.47 ± 3.16 [pg/ml], [P = 0.251]). Conclusions: The consumption of green tea supplements 90 min before aerobic exercise may decrease inflammation and oxidative stress factors and improve VO₂Max in summer.

Background: Congenital hypothyroidism (CH) is an important and preventable cause of intellectual disability. This study determined the incidence of CH and its related factors in Semnan city in Iran. Methods: All neonates born in Semnan from 2011 to 2016 who participated in a screening program for CH were evaluated to estimate the incidence of CH. In a nested case-control study, all diagnosed CH cases were compared with a control group of healthy newborns. Statistical analysis used conditional logistic regression model with STATA-14. Results: 106 out of 17,507 neonates born in Semnan during 2011–2016 were diagnosed with CH (6.05 cases per 1,000 live births). Maternal parity (odds ratio [OR] =1.78, P = 0.044), birth weight (OR = 0.29, P = 0.001), parental history of thyroid disease (OR = 3.43, P = 0.001), father's education (OR = 0.71, P = 0.003), father's occupation (nonworker) (OR = 2.97, P = 0.001), and the presence of other anomalies (OR = 4.14, P = 0.037) were related to the incidence of CH. Conclusions: The cumulative incidence of CH in Semnan was higher than in both the global and national statistics. Aside from well-known medical determinants, some important social factors such as father's occupation and education have a significant and independent relationship with occurrence of CH; rational attention should be given to them in health care programs to increase the effectiveness of preventative measures for CH.

Background: Chronic back pain is one of the most challenging medical problems worldwide that results in disability, physical problems, and high costs for the family and society. Therefore, it can be very beneficial to find an appropriate treatment with minimum side-effects for this disease. The present study attempted to compare the effects of different water gait protocols on the endurance and electrical activity of spine extensor muscles in men with nonspecific chronic back pain. Methods: The study adopted an experimental design in which 30 men with non-specific chronic back pain were selected through convenience sampling and using simple randomization method assigned into three groups of forward walking, backward walking, and sideways walking. Walking exercises were performed for 8 weeks, three sessions per week for 30 min. Twenty-four hours before and 48 h after the intervention, the endurance of spine extensor muscles and electrical activities were measured using the Ito test and electromyography, respectively. Data were analyzed in SPSS 23 using paired sample t-test and analysis of variance. Results: The results showed that backward walking in water significantly increases endurance and electromyography activities of spine extensor muscles (P < 0.05), while forward and sideways walking had no significant effect on these variables (P > 0.05). The results obtained from Bonferroni post-hoc test showed a significant difference between the strength of trunk extensor muscles and EMG of spinal cord extensor muscles in forward and backward water gait groups (P = 0.001, 0.006). Conclusions: According to the findings of this study, it seems that walking backward can be an effective therapeutic method for patients with chronic back pain.

Background: Nowadays, tobacco consumption has become one of the major public health problems and is the leading cause of escapable illness and death. A significant role is played by dental professionals in the identification of smokers; they are, thus, in a better position to offer preventive care. The aim of the present study was to systemically review the knowledge and attitude of dental practitioners toward tobacco cessation. Methods: A literature search was performed in PubMed Central and Cochrane Library, Medline—PubMed, Embase, Google Scholar up to 2018 to identify appropriate studies. Full-text original research articles of the cross-sectional design were only included in the study. Our target was to systemically review the knowledge and attitude of dental practitioners toward tobacco cessation. Results: The present review included a total of nine articles (studies) that fulfilled the eligibility criteria. Two articles which were hand searched and one article which was obtained through contact with experts were included. The results of the review revealed that the dental practitioners in most of the included studies lack satisfactory knowledge and were unaware of existing referral pathways to specialist smoking cessation services. At the same time, most of the dentists have a positive attitude toward tobacco cessation. Conclusions: Dental professionals are aware of their obligations toward smoking cessation counseling for patients but certain barriers including lack of time, confidence, and training prevent them from practicing the same in their daily routine. The dental professionals should obtain appropriate training and attain knowledge along with quantifiable skills for the prevention and cessation of tobacco use.

Bisphosphonates (BPs) are a commonly used class of drugs for the treatment of bone disorders. An extensive review of BPs with their clinical efficacy and safety profile is unavailable. This study aimed to review the available literature on BPs, summarize their role in clinical therapy, and emphasize their safety profile. Authors reviewed the existing literature using the Google Scholar, PubMed, and Micromedex databases and analyzed the collected articles. BPs are the preferred medication for osteoporosis and other similar conditions owing to their efficient antiosteoclastic activity. Few of them are available in oral dosage forms; hence, they are patient-friendly. The mechanism of action, common adverse effects and their clinical applications, precautions and warnings pertaining to the route of administration, and safety profiles have been discussed in this manuscript. The common adverse effects are majorly related to the gastrointestinal, cardiovascular, and endocrine system. Upon chronic usage, patients may experience serious problems like osteonecrosis of the jaw and atypical bone fractures. Although BPs are effective and safe, they may cause GI adverse effects and rare cases of osteonecrosis. Patient counseling could prove beneficial in early identification and prevention of the adverse effects associated with BPs.

Background: This study was conducted to synthesize the evidence on the dimensions of performance appraisal of the public health and primary care system through a scoping review and meta-synthesis. Methods: The review conducted systematically in 2018 with a scoping review approach. To identify pertinent studies, the following electronic databases were systematically searched until December 20, 2017: Cochrane, ISI Web of Science, PubMed, Scopus, Science Direct, and Embase. Reviewing the studies found on the search bases was carried out in three stages by two persons individually. According to refined studies, the data were extracted to meet the objectives and respond to the research questions. The thematic analysis was used to identify and categorize the dimensions of performance measurement. Results: Using this process, 20 studies were eligible for our research. The critical points in measuring the performance of the public health field were classified into eight main domains including leadership and stewardship, funding, resource generation, service delivery, quality, accessibility, efficiency/productivity, and community health status. The differences in measurement frameworks are inevitable. One reason for the differences in the health system performance measurement framework is the differences in the data or data collection, analysis, and reporting. Performance measurement in the field of health, especially primary care, was a multidimensional issue. Conclusions: Each of the main dimensions had several sub-criteria, indicating the broadness and complexity of the performance of first-level care providers. Single-dimensional performance measurement could underpin incorrect policies and decisions.

Background: Studies have shown that one of the most important complications of exposure to ionizing radiation is the emergence of cancer tumors, as a result of oxidative DNA. Since different radiography groups have high rate of exposure to ionizing radiation, examining the susceptibility rate of cancer in these groups is of prime importance. Therefore, the present study was conducted to measure the level of 8-hydroxy2-deoxyguanosine(8-OHdG) in the radiographers' urine as a biomarker of oxidative damage while comparing it with the nonradiography staff. Methods: Samples of two groups were selected for this case-control study, wherein 35 subjects were selected from different radiography groups (including nuclear medicine, radiology, radiotherapy, and CT scan) while the other 35 subjects were staffs who had no exposure to radiation. Later, urine samples were collected at the end of the working shift to determine the 8-OHdG concentration. The samples were obtained via SPE (solid-phase extraction) method. Subsequently, the 8-OHdG concentration was measured by the GC-MS analyzer. Results: The results confirmed that, the average concentration of 8-OHdG in the radiographers' urine (253.4 ± 31.2 ng/mg of creatinine) had a significant difference as compared to the nonradiographers' urine (141.1 ± 21.9 ng/mg of creatinine) (P = 0.004). Conclusions: In conclusion, due to elimination of interfering factors, ionizing radiation affects the increase in 8-OHdG levels and acts as a potential biomarker for the damaged oxidative DNA.

Background: Hemoconcentration (HC) has been suggested to be a useful biomarker for determination of optimum diuretic therapy in acute heart failure (HF), but role of this factor in rehospitalization and death was still controversial. In this study, we aimed to define relation between HC and readmission and mortality rate among Iranian patients with acute HF. Methods: This was a prospective cohort study done from March 2017 to March 2018 using data of a HF section of Persian Registry Of cardioVascular diseasE. From a total number of 390 registered HF individuals aged 18 years or older, 69 ones showed alterations in hemoglobin (Hb) levels. Hb levels were measured at admission and discharge time. HC was defined as any increased level in Hb during hospitalization. The relation of HC with readmission and death rate was done using multiple logistic regression and Cox proportional hazard model, respectively. Results: The mean age of study population was 70.5 ± 11.9 years with the dominant percentage of male participants (66.9%). Patients showing HC during admission did not reveal any significant decreased likelihood of rehospitalization compared to negative ones. In comparison to HC negative patients, those showing increments in Hb levels had a borderline significant lower likelihood of mortality (hazard ratio: 0.82, 95% confidence interval, CI = 0.07–1.18, P = 0.08). Conclusions: Our data suggested that HC was associated marginally with reduced mortality rate 6 months post HF attack and could be utilized as a useful biomarker for risk stratification of HF patients. Several prospective longitudinal population-based studies are necessary proving these associations.

Background: Prehypertension increases the likelihood of hypertension, cardiovascular diseases, and renal failure, and it is amenable to control if it is detected early. The burden of prehypertension prevalent in the community is not much explored. This study aimed to estimate the prevalence and to identify the socio-behavioral and dietary factors related to prehypertension in South India. Methods: A community-based cross-sectional study was carried out where data related to socio-demographic status, substance use, dietary patterns, physical activity, and associated comorbidities were assessed using the WHO STEPwise survey tool. Adults aged >=18 years who were not previously diagnosed and treated for hypertension were assessed for prehypertension. Prevalence of prehypertension is reported as percentage with 95% CI. Association was reported as adjusted prevalence ratio obtained through multivariable log binomial regression adjusted for potential confounders. Results: Among 2399 participants, 2213 underwent screening. Among 2213 adults, 810 (36.6%, 95% CI: 34.6–38.6%) were in the prehypertension range. The adjusted prevalence for prehypertension was 36.2% among males and 37.2% among females, respectively. Being in the age group of 45–54 years aPR-1.36, body mass index (BMI) >23 Kg/m² aPR-1.25, consumption of more than 6 grams of salt per day aPR-1.15 times were more likely to be associated with prehypertension. The comorbid conditions such as diabetes are less likely to be associated with prehypertension aPR-0.54 (0.41–0.72). Conclusions: This community-based surveillance showed 36% of prehypertension among adults which would have been missed if we were to follow the routine cares such as opportunistic and high-risk-based screening. Since prehypertension increases the risk for various end organ failures, there is an impending need to focus on screening and promote healthy lifestyles.

Background: Craving is one of the diagnostic criteria for nicotine dependence. The aim of this study was Translating and Validating of Tobacco Craving Questionnaire-Short Form (TCQ-SF) on Persian. Methods: Fifty smokers aged 15–65 years participated through a public invitation. The forward and backward translation was done according to Beaton's guideline, then all smokers completed questionnaire, in non-deprived and deprived states with a 1-week interval. After expert committee confirmed forward and backward translation, construct validity evaluated by confirmatory factor analysis (CFA), mean craving scores Independent sample T-tests between high and low Fagerstrom Test for Nicotine Dependent (FTND), and also, deprived and non-deprived smokers. The reliability assessment was done by Intraclass coefficient (ICC) and mean craving scores paired sample t test between two deprived states. The Cronbach's alpha was conducted for internal consistency. Results: The consensus Persian version of the questionnaire was obtained. The CFA indicated a significant (P < 0.001) association of four latent variables with questionnaire structure. The significant (P < 0.001) difference between craving scores in Independent sample t tests indicated the construct validity as concurrent validity. There was no significant difference (P = 0.063) between two deprived states' scores and ICC = 0.97, indicated questionnaire reliability. The Cronbach's alpha was 0.89, shows good internal consistency. Conclusions: The results confirmed the validity and reliability of the Persian version of the Tobacco Craving Questionnaire-Short Form.

Background: The relationship between dietary fat quality (DFQ) indices and pre-diabetes has not been well studied. This study aimed to determine the association of DFQ indices and fatty acid intake with pre-diabetes. Methods: This case-control study included 150 subjects with normal fasting blood glucose (FBG) and 147 pre-diabetic subjects. Dietary intake was assessed by a validated food-frequency questionnaire. DFQ indices including atherogenicity (AI) and thrombogenicity (TI), the ratios of hypo- and hypercholesterolemic (h:H), polyunsaturated:saturated (P:S) and n-3:n-6 polyunsaturated fatty acids were calculated. FBG test and 2-hour oral glucose tolerance test (OGTT) were measured. Results: After adjustment for some confounding variables, a positive association was found between intake of total saturated fatty acids (SFA), myristic acid, palmitic acid, and pre-diabetes, and a negative association was observed among n-3 polyunsaturated fatty acids, eicosapentaenoic, docosahexaenoic and arachidonic acids intake and pre-diabetes. AI was found to be positively associated with pre-diabetes (OR 6.68, 95% CI 2.57-17.34). An inverse relationship was observed between n-3:n-6 (OR 0.37, 95% CI 0.14-0.93) and h:H (OR 0.20, 95% CI 0.07-0.52) ratios with pre-diabetes. Conclusions: Higher intake of dietary n-3 fatty acids was adversely, whereas SFA intake was positively related to pre-diabetes morbidity. DFQ indices may be a useful measure to investigate fat intakes and blood glucose disturbances.

Background: The body image is a complex concept that influences various factors, one of these factors is the quality of life. The present study aimed to investigate the relationship between quality of life and body image perception in the medical students of Shahid Beheshti University of Medical Sciences. Methods: This descriptive study was carried out on 400 students of Shahid Beheshti University of Medical Sciences using a stratified random sampling method and the samples were selected from each faculty in 2017 using simple random sampling Questionnaires (PSDQ) and (SF-12) were used. Data were analyzed using mean and standard deviation and t-test, Mann-Whitney U, ANOVA, kelmogrouf smirnouf test and Spearman Correlation to SPSS 16 software and structural equation modeling (SEM) was to test the relationships between the three parameters (quality of life, body image, and demographic characteristics) using AMOS24 software. Results: The findings show Quality of life significantly correlated with two demographic variables: location and exercising of students. Body image perception significantly correlated merely with the body mass index and exercising. The Structural Equation Modeling (SEM) results confirmed a positive and direct relationship between the quality of life and body image perception. Conclusions: The results showed that there is a significant relationship between body image perception and quality of life. Therefore, by modifying and improving the students' quality of life in the dormitories, the level of students' self-concept can be raised in order to prevent the physical and psychological complications of this group of community.