Background: Few studies have evaluated the continuity of primary care in universal health care systems, especially in underserved areas. Methods: This was a cross-sectional study with 4,001 adults (≥18 years old) living in the Manaus Metropolitan Region in 2015. Interviews were conducted in households selected with probabilistic sampling. City and neighborhood variables were collected from databanks. Prevalence ratios (PR) of the continuity of care (defined as using a primary care service and having been previously registered in the Family Health Strategy program) and 95% confidence intervals (CIs) were calculated with multilevel Poisson regression analysis. Results: A total of 20.6% (95%CI 19.4-21.9%) of the participants reported continuity of primary care. Women (PR = 1.38; 95%CI 1.18-1.61), nonwhite individuals (PR = 1.13; 95%CI 1.05-1.21), and poorer people (PR = 1.55; 95%CI 1.19-2.02) had higher levels of continuity, whereas health insurance holders had lower levels of continuity (PR = 0.46; 95%CI 0.34-0.62). Individuals with continuity of care had more physician consultations (PR = 1.06; 95%CI 1.02-1.10), dentist consultations (PR = 1.16; 95%CI 1.05-1.28), fewer depressive (PR = 0.59; 95%CI 0.44-0.79) and anxiety symptoms (PR = 0.64; 95%CI 0.48-0.85), and a higher quality of life (β = 0.033; 95%CI 0.011-0.054) than those without continuity. Conclusions: Continuity of care was attained by two-tenths of the population and the level of continuity was high among socioeconomically disadvantaged people. Good outcomes and health services usage increased with continuity of care.

Background: A correlation between type 2 diabetes and refined carbohydrates has been proven, while several studies have indicated that Iranian daily diets are poor in term of proper carbohydrates. It was thus considered absolutely critical to conduct a qualitative study in terms of people's attitudes toward whole grains, and the feasibility of their replacing existing refined carbohydrates in their diets. The aim of this study is to probe Iranian awareness of whole grains, to explore barriers to refined-grain substitution with whole grains and legumes, and to assess whole-grain sensory perceptions. Methods: Focus group discussions (FGDs) and taste tests conducted between July 2016 and March 2017 in urban and rural areas of Kurdistan, Yazd, and Tehran provinces in Iran. A total of 96 healthy men and women (aged 40-65, BMI ≥25 kg/m²) were selected through purposive sampling with maximum variation. FGDs were categorized by content analysis method. As for taste test, ANOVA analysis with Bonferroni post-hoc was used to determine significant differences (P < 0.05). Results: Four themes and 11 sub-themes emerged. Cultural beliefs, traditional eating patterns, sensory properties, and familial acceptance were the most influential factors in choosing the type of bread and rice. Simultaneously they are the most prominent barriers to consuming whole grains and legumes. Plain cooked brown rice had the lowest mean sensory attribute score and traditional whole-wheat flatbread was the highest. Conclusions: There was a higher acceptance tendency toward using traditional whole-wheat flatbread rather than refined grains, as it was consistent with preference and priority. However, low availability was the largest substitution problem.

Background: Noncommunicable diseases are on the rise in India. Hypertension is one of the major risk factors for cardiovascular diseases and also labeled as a chronic lifestyle disorder. Hence, non-pharmacological interventions leading to lifestyle modifications are of utmost importance to control and prevent hypertension. This trial aims to implement yoga intervention to the experimental group in addition to medicines, advice on diet and physical activity and to compare blood pressure and perceived stress scores with the control group. Methods: It was an open-label, two-armed, non-randomized controlled trial, conducted at a tertiary care center on 145 patients with hypertension: 73 in the intervention group and 72 in the control group. The intervention group received yoga intervention for a period of 4 months on a weekly basis along with advice on physical activity, diet, and routine medicines. The control group did not receive yoga intervention. Results: The mean age of the participants was 51.3 ± 9.4, females (58.2%) outnumbered males (41.3%). Following the intervention, perceived stress score and blood pressure showed a significant reduction between two groups (P < 0.001). Also, perceived stress and blood pressure were found to be reduced significantly within both groups (P < 0.001). Conclusions: Yoga proves to be an effective, safe, and less expensive adjunct therapy for hypertension management. Yoga was also found to be effective in reducing the level of stress. Diet modification and physical activity have got an important role to play in the control and prevention of hypertension.

Background: Figures from Iranian cancer registries indicate that Isfahan ranks first in female breast cancer incidence. Although few previous studies have examined whether the breast cancer incidence trend in Isfahan province has increased over a given period of time, this study employed a joint point regression analysis to answer the same question. Moreover, it compared the data of Isfahan province, from a developing country, with those of England, as a representative of developed countries, and tried to explain the causes of the differences observed between the trends. Methods: This repeated cross-sectional study was conducted on the data of 6057 women in Isfahan province and of 141,011 women in England with breast cancer over the years 2001–2013. The incidence rates were calculated using direct standardization method and based on the 2013 standard European population. For an analysis of the trends in breast cancer incidence rates, Joint Point Regression program, version 4.3.1.0, released in April 2016, was employed. Results: The mean age-standardized incidence rate (ASR) was calculated to be 34.7 per100,000 population over the years 2001 to 2013, which indicated an increase from 22 to 68 in Isfahan province. The corresponding mean ASR for England has also risen from 147.5 to 170.1 per 100,000 women during the same time period. The average annual percentage changes (AAPCs) for Isfahan and England were also calculated to be 9.6 and 1.1, respectively. This indicated an increasing trend in breast cancer incidence rates for Isfahan province over the period in question. Conclusions: The drastic discrepancy in breast cancer incidence rates between these two regions may be attributed to differences in an improved cancer registry system in Iran and women's developing awareness of the cancer over time.

Background: Congenital hypothyroidism (CH) is one of the most prevalent preventable causes of mental retardation. Studies show that the incidence rate of CH is very high in Iran. Disease mapping is a tool for visually expressing the frequency, incidence, or relative risk of illness. The present study aimed to model CH counts considering the effects of the neighborhood in towns and perform mapping based on the relative risk. Methods: In this historical cohort study, data of all neonates diagnosed with CH with TSH level ≥5 mIU/L between March 21, 2017, and March 20, 2018, in health centers in Guilan, Iran were used. The number of neonates with CH was zero in most towns of Guilan Province. The Bayesian spatial zero-inflated Poisson (ZIP) regression model was employed to investigate the effect of the town's neighborhood on the relative risk of CH incidence. Then, the map of the posterior mean of the relative risk for CH incidence was provided. The analysis was performed using OpenBUGS and Arc GIS software programs. Results: The relative risk of CH incidence was high in the West of Guilan. Moreover, the goodness-of-fit criterion indicated that it is more appropriate to fit the Bayesian spatial ZIP model to these data than the common model. Conclusions: Considering the high relative risk of CH in the Western towns of Guilan Province, it is better to check important risk factors in this region.

Background: Dyslipidemia is often associated with obesity and contributes to the increased risk of atherosclerosis, heart disease, and stroke. This study was designed to evaluate the independent or combined effect of calcium and vitamin D (Ca + Vit D) supplementation on blood lipid profile in overweight or obese premenopausal women. Methods: This study is a triple-blind, randomized, parallel, placebo-controlled trial. About 100 overweight or obese (body mass index (BMI) of 25–40 kg/m²) premenopausal (aged 30–50 years) women, recruited from Shiraz University of Medical Sciences (SUMS) clinics, were allocated into 4 groups: (1) calcium (Ca) supplementation (2 tablets per day; each containing 500 mg calcium carbonate), (2) vitamin D (Vit D) supplementation (2 tablets per day; each containing 200 IU vitamin D3), (3) Ca + Vit D supplementation (2 tablets per day; each containing 500 mg calcium carbonate plus 200 IU vitamin D3), (4) placebo supplementation (2 tablets per day, containing micro-cellulose). All participants received a 500 kcal energy-restricted diet. Blood lipids, serum vitamin D, and anthropometric indices were measured at baseline and after 8 weeks. Physical activity and 3-day dietary records were taken at baseline and every 4 weeks during the intervention. Results: At 8 weeks, triglyceride levels were significantly decreased in the Ca group (P = 0.002). Low-density lipoprotein (LDL) levels were decreased in the Ca + Vit D group (P = 0.04) and high-density lipoprotein (HDL) levels decreased in both the Ca and Ca + Vit D groups (P = 0.006, P = 0.004, respectively). The results of one-way ANOVA indicated that changes in the serum lipid profile levels were not significantly different among the four groups (P = 0.90, P = 0.86, P = 0.61, P = 0.27, and P = 0.19, respectively for TG, TC, LDL, HDL, and LDL/HDL). The results were not significant even after adjusting for potential covariates. Conclusions: Although the results were not significantly different among the four treated groups at 8 weeks, within-group changes like the reduction in triglyceride and LDL levels, respectively in the Ca group and Ca + Vit D group, and HDL levels in both the Ca and Ca + Vit D groups were significant. These changes may have potentially significant public health implications.

Background: Assessing children's early development can help health and social policymakers to improve children's well-being. This study aims to develop an early childhood composite index for measuring early childhood care and education among Iranian children considering each child's geographical area, socioeconomic status and gender. Methods: In this cross-sectional secondary study, the data come from Iran's Multiple Indicator Demographic and Health Survey 2010. Of the 9,345 eligible children whose information had been collected, 3,532 fulfilled the inclusion criterion of being 3 or 4 years old at the time of the interview. We examined a composite index and three subscales of early childhood development including “Quality of Care”, “Early Childhood Care and Education”, and “Overall Developmental Status”. Factor analysis and latent class analysis were used for analyzing the data. Results: The results indicate that of the children in the sample, 47.3% were in the “low early child development” class, 6% were in the “middle early child development” class, and 46.7% were in the “high early child development” class. The means of the three subscales and the composite index were significantly different across geographical areas (P < 0.01) and between the socioeconomic classes (P < 0.0001), with children from poorer families having lower scores. The composite index was significantly higher for girls (M = 11.28, SD = 3.96) than boys (M = 10.99, SD = 3.87, P = 0.029). Conclusions: The study presents significant differences in childhood development based on geographical divisions, quartile classes and gender. We suggest that future research is needed to explore the robustness of findings in this study over time and diversity between and within various Iranian populations.

Background: Patients with multiple sclerosis (MS) suffer from a wide range of psychological problems. Application of a valid and reliable tool for psychosocial assessment is required for Iranian patients. The aim of this study is to determine the psychometric properties of the Persian version of the PARADISE-24 questionnaire in Iranian patients with multiple sclerosis. Methods: One hundred and thirteen multiple sclerosis cases were enrolled in this study. Participants were asked to answer the valid and reliable Persian version of the fatigue severity scale, social support scale, Pittsburg sleep quality index, and hospital anxiety and depression scale and translated version of the PARADISE-24 questionnaire. Twenty cases filed the questionnaire 2 weeks later to assess reliability. The intraclass correlation coefficient, Cronbach's alpha, correlation coefficients, and multiple regression analysis were used. Results: Mean age and mean duration of the disease were 35.8 ± 9.9 and 8.7 ± 5.6 years, respectively. The intraclass correlation coefficients ranged from 0.8 to 0.94 and Cronbach's alpha values (Cronbach's alpha was calculated as 0.91 for the whole questionnaire) were also significant. There were significant correlations between PARADISE-24 score and expanded disability status scale (r = 0.42, P < 0.001), fatigue severity scale (r = 0.62, P < 0.001), anxiety (r = 0.43, P < 0.001) and Pittsburg sleep quality index scores (r = 0.46, P < 0.001). Regression analysis by considering PARADISE-24 as dependent and other variables as independent showed that expanded disability status scale, fatigue severity scale, anxiety score, and Pittsburg sleep quality index were positive predictors of PARADISE-24 score. Conclusions: Persian version of PARADISE-24 questionnaire is a valid and reliable instrument for evaluating psychosocial aspects in patients with multiple sclerosis.

Background: Patent ductus arteriosus (PDA) is one of the more common congenital heart defects in preterm neonates. The closure of PDA can be done with ibuprofen; however, this drug is associated with many contraindications and potential side-effects. In the past years, paracetamol has been proposed for the treatment of PDA. This study was designed to evaluate the efficacy and gastrointestinal complications of paracetamol and ibuprofen for the pharmacological closure of PDA in preterm infants. Methods: In a clinical trial study, 40 preterm infants with echocardiographically confirmed PDA were randomly assigned to receive either paracetamol (n = 23; 15 mg/kg every 6 h for 2 days) or ibuprofen (n = 17; initial dose of 10 mg/kg, followed by 5 mg/kg every 12 h for 2 days). The neonates matched for gestational age and weight. We used t-test for parametric, Chi-square for categorial, and Wilcoxson for nonparametric variables. Significant level was considered less than 0.05. Results: Platelet count, BUN and creatinine levels, and closure of PDA had not significant difference between two groups (P > 0.05). Incidence and severity of GI bleeding, feeding intolerance, and NEC were significantly more in infants who received paracetamol than ibuprofen (P < 0.05). Conclusions: There were no differences in the rate of PDA closure between the two drugs, but with respect to complications, rate and severity of GI bleeding, feeding intolerance, and NEC were significantly more in infants who received paracetamol than ibuprofen. Therefore, paracetamol could not be used as a proper alternative agent for ibuprofen in the treatment of PDA in preterm infants.

Background: The cardiovascular mortality rate in Iran has been reported 65% of all death recently. Despite the high prevalence of cardiovascular diseases (CVD) risk factors and its burden in developing countries, public awareness of CVD symptoms and its risk factors are very low, leading to poor control of these risk factors. Methods: Our study is a cross-sectional study that was conducted in an undefined sample of 163 individuals who participated in a public health campaign. We used a validated questionnaire containing demographic, cardiovascular history, family history, lifestyle (exercise, smoking, alcohol, and environment), stress, sleep, bowel toxicity, blood sugar, inflammation/pain, and diet parts for estimating total cardiovascular risk factor. Results: 52.7% of our participants were male. The mean age of our participants was 42.6 ± 47.27 years. Half of our participants (50.3%) were between 30 and 60 years. 12.3% of the participants were diagnosed with CVD. 12.8% were smokers and 25.8% were passive smokers. 73% of our participants had a high level of stress in their individual and work life. 35.5% of participants sleep less than 6 h per night. Half of them complained of initial or intermittent insomnia. 51.5% of our participants were at high or very high risk for CVD with three or more relative risks. There was a significant association between total cardiovascular risk and blood pressure, weight, sleep, and lifestyle in our population. Conclusions: More than half of our participants were on high or very high risk for CVD. The most common risk of CVD events in our participants is attributed to hypertension. Weight, sleep, and lifestyle were other modifiable risks that had a significant association with CVD in our study.

Background: It is known that some elements are needed for normal thyroid gland functions. Iodine and selenium are the most well-known trace elements necessary for thyroid metabolism. Selenium is involved in the formation of thyroid hormones and the structure of the deiodinases associated with the development of the thyroid gland. While the role of zinc in thyroid metabolism is at the T3 receptor level, the role of copper is yet not clear. Objective: To compare the levels of serum trace elements such as selenium, zinc, and copper between the patients with euthyroid nodular goiter and healthy participants. Methods: This cross-sectional study included 98 patients with euthyroid multinodular goiter and 83 healthy subjects without thyroid disease. The demographics, thyroid hormone levels, and thyroid ultrasonography of the participants were recorded. Venous blood samples were centrifuged and sera samples were stored at -80°C until analysis of selenium, zinc, and copper levels. The levels of trace elements were determined by inductively coupled plasma-mass spectrometry (ICP-MS). Results: While serum, zinc, and selenium levels were significantly higher in the control group than the nodular goiter group, the copper levels were similar in the two groups. Trace elements were not correlated with thyroid hormone levels and thyroid volumes. Patients in the nodular goiter group were analyzed according to their solitary and multiple nodule status. The solitary and multiple nodular goiter groups were similar in terms of copper, zinc, and selenium levels. Conclusions: Deficiency of selenium and zinc may be associated with nodular goiter. Replacement of these trace elements may be useful for the prevention of nodular goiter, especially in deficient regions.

Background: Glycation, inflammation, and oxidative stress are the cardinal motivators of diabetes vascular complications. Here, we studied the effect of eucalyptol (EUC) on the formation of atheromatous lesions, glycation, oxidative stress, and inflammatory markers as well as insulin resistance, lipid profile, and activity of glyoxalase-1 (GLO-I) in the atherosclerotic rat model. Methods: Diabetic-atherosclerosis induced in rats with a combination of streptozotocin and atherogenic diet. Two groups of rats, normal and diabetic-atherosclerotic, were treated intragastrically with EUC (200 mg/kg) once daily for 3 months. Fasting blood sugar (FBS), insulin, insulin resistance index, lipid profile, the activity of GLO-I, low-density lipoprotein (LDL) glycation and oxidation markers, inflammatory markers, creatinine in the serum, and proteinuria in the urine of all rats were determined. Results: EUC inhibited the formation of any atheromatous lesions in atherosclerotic rats. Further, EUC displayed the lowering effect on glycemia, insulin resistance, LDL glycation, and oxidation products, and tumor necrosis factor (TNF)-α as well as it exhibited the improving effect on lipid profile, the activity of GLO-I, and renal function in the diabetic rat (P < 0.001). Conclusions: EUC prevented the formation of the atheromatous lesions and improved renal function in the atherosclerotic rat model due to a reduction of glycation, oxidative stress, and inflammatory mediators.

Background: The fruits of Apiaceae family have been widely used in traditional medicine for the treatment of pain and inflammation. In this study, we evaluated the analgesic and anti-inflammatory effects of wild celery (Smyrniopsis aucheri) seeds, as a member of the Apiaceae family. Methods: Hydroalcoholic and hexane extracts of seeds were prepared and for the evaluation of analgesic activity, acetic acid, formalin, and hotplate tests in male mice (20–30 g) and for anti-inflammatory assessment carrageenan-induced paw edema in rats and croton oil-induced ear edema in mice were used. Results: Hydroalcoholic and hexane extracts (100–400 mg/kg) significantly reduced abdominal spasms in the acetic acid test. In the formalin test, the hydroalcoholic extract at doses of 200 and 400 mg/kg reduced the pain of the chronic phase while hexane extract was effective in both acute and chronic phases. In the hot plate test, both extracts were ineffective. In the carrageenan and croton tests, both extracts at a dose of 400 mg/kg significantly reduced edema. Conclusions: The results revealed the analgesic and anti-inflammatory effects of plant seed extracts. Due to the lack of response of the extracts in the hot plate test, it seems that the plant mainly has a peripheral analgesic effect.

Background: To determine the relationship between serum protein electrophoresis (SPE) and serum immunoglobulin profiles of patients with multiple myeloma (MM). Methods: This is a retrospective study conducted at the Eric Williams Medical Sciences Complex, focusing on patients over 18 years who received diagnostic blood tests for MM. Results for SPE and serum immunoglobulin profiles were obtained using lab logbooks. Descriptive and inferential statistics techniques were used to analyze the data. Results: The median age of MM patients in Trinidad and Tobago is of 69 years. The ratio of male and female patients with the MM is 50:50. Out of 131 patients, 24 (18.32%) had M bands present, 60 (45.80%) had an increase in gamma globulin, and 16 (12.21%) had a decrease in albumin. In cases of M band presence and raised gamma, there was noticeable increase in IgG concentration and a slight increase in IgM concentration. There was also an increase in IgA concentration in patients with the M-band but a decrease in concentration in those with raised gamma. Patients with an elevated gamma had a significant increase in IgG diameter and IgG concentration. Conclusions: This study showed a relationship between the presence of M bands and serum immunoglobulins. It has proven the significance of SPE and immunoglobulins, like IgG and IGM, in the detection of MM in the early and advanced stages. Therefore, it is recommended that SPE be used, along with other laboratory tests, in the diagnosis of MM.