International Journal of Preventive Medicine
Year:2019 | Volume:10 | Issue:-|Papers Count:38

Introduction: Iran’ s western provinces have higher suicide rate compared to the other provinces of the country. Although suicide rates fluctuate over time, suitable statistical models can describe their underlying stochastic dynamics. Methods: This study was conducted to explore the fluctuations of the monthly suicide rates in the most populated western province of Iran using exponential smoothing state space model to compute the forecasts. For this reason, the monthly frequencies of completed suicides were converted to rates per 100, 000 and a state‑ space approach was identified and fitted to the monthly suicide rates. Diagnostic checks were performed to determine the adequacy of the fitted model. Results: A significant seasonal variation was detected in completed suicide with a peak in August. Diagnostic checks and the time series graph of the observed monthly suicide rates against predicted values from the fitted model showed that in the study period (from March 2006 to September 2013), the observed and predicted values were in agreement. Thus, the model was used to obtain the short‑ term forecasts of the monthly suicide rates. Conclusions: In this study, we had no significant trend but seasonal variations in the suicide rates that were identified. However, additional data from other parts of the country with longer duration are needed to visualize the reliable trend of suicide and identify seasonality of suicide across the country.

Background: Previous studies indicated the effect of fat on autoimmune diseases. The present study was aimed to investigate the association between fat intake and vitiligo. Methods: This case– control study was conducted in the Skin and Leishmania Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. Intakes of fatty acids were examined for their relation to risk of vitiligo among 100 cases and 110 controls. We included patients who suffered from generalized or localized vitiligo for <5 years that was approved by a dermatologist via the Vitiligo European Task Force criteria and the vitiligo area scoring index. Fat intake was assessed through individual interviews by a standardized food frequency questionnaire. Results: Vitiligo group consumed more saturated fatty acid (SFA) and less eicosapentaenoic acid and docosahexaenoic acid than control group, while other fatty acids were not significantly different among two groups (P > 0. 05). Crude analysis showed that total fat (odds ratio [OR] = 3. 33, 95% confidence interval [CI]: 1. 46– 7. 58) and SFA (OR = 2. 22, 95% CI: 1. 04– 4. 90) intakes were associated with an increased risk of vitiligo (for highest quartile vs. lowest quartile). Results demonstrated a decrease in the risk of vitiligo for those within the highest quartile of monounsaturated fatty acids intake (OR = 0. 41, 95% CI: 0. 18– 0. 92). However, this relationship disappeared after adjustment for confounders as energy, age, sex, and body mass index, except for total fat (OR = 2. 84, 95% CI: 1. 63– 5. 44). Crude and adjusted analyses for polyunsaturated fatty acids and cholesterol intake were not statistically significant. Conclusions: Total‑ fat content of the diet had more impressive role than the specific subclasses of fats on the incidence risk of vitiligo. High‑ fat diet escalated the vitiligo risk. Regarding the role of fats on skin autoimmune diseases especially vitiligo, future studies are crucial.

Celery (Apium graveolens) is a popular medicinal herb that used conventionally for the treatment of different diseases. This report aimed to demonstrate celery would induce hyperthyroidism after oral celery extract consumption for weight loss. A 36‑ year‑ old female patient came to our clinic with blurred vision, palpitation, and nausea. Dietary history showed that she used 8 g/day of celery extract in powder form for weight reduction. Weight loss during 78 days of celery extract consumption was 26 kg. Thyroid function test showed that serum level of thyroid‑ stimulating hormone (TSH) and T4 were 0. 001 mIU/L and 23 ng/dl, respectively). Grave’ s and thyrotoxicosis ruled out by other laboratory evaluations. Methimazole 10 mg/day was prescribed. Serum level of TSH was evaluated. The celery extraction intake was discontinued when started treatment with methimazole. Not found any thyroid stimulator (thyroxin and other) in celery extraction. We concluded that observed hyperthyroidism and allergic reaction may be induced by celery extract consumption. Therefore, it is possible that hyperthyroidism may be a side effect of frequent celery extract consumption.

Background: Currently, in low‑ and middle‑ income countries, the problem of overweight and obesity is increasing at alarming rate. Along with well‑ known factors, psychosocial factors such as low self‑ efficacy highly associated with these problems. Hence, it is necessary to assess individual self‑ efficacy in weight management consultations using valid instrument. The aim of this study was to determine psychometric properties of the Persian version of the Weight Efficacy Lifestyle Questionnaire‑ Short Form (WEL‑ SF). Methods: A cross‑ sectional study carried out on 400 women referring to urban community health centers in Kerman Province, Iran. Data collected using a questionnaire contained demographic data and Persian version of WEL‑ SF. The reliability of the questionnaire determined using Cronbach’ s alpha. The construct validity evaluated by exploratory principal component analysis (PCA) and confirmatory factor analysis. Data were analyzed by SPSS version 19 and Lisrel 8. 8. Results: Internal consistency of WEL‑ SF was 0. 83 using Cronbach’ s alpha. In the PCA, two factors were extracted with the total amount of 62. 6% explained variance. In confirmatory factor analysis, the model had acceptable goodness of fit indices. Conclusions: The Persian version of WEL‑ SF had excellent psychometric properties.

Background: Women are the first victims in most of social damages and corruptions. However, due to some social and cultural reasons, the most of the drug addiction studies in Iran target male population. Hence, this study aimed to investigate the pattern of substance abuse and prevalence of HIV and hepatitis risk factors among addicted women. Methods: This is a cross‑ sectional study conducted on women referred to methadone maintenance treatment centers of Western Iran (Kermanshah province). Data were collected through interview by a psychologist who is working full time in the centers. Results: A total of 138 addicted women were studied. Among whom, 50 individuals were aged >45 years old (36. 2%), 135 individuals (97. 8%) had a history of substance abuse in their family, and 66 individuals (40. 5%) initiated drug use before age 20. The most common substances were opium and crack with a proportion of 76. 8% and 9. 4%, respectively. Prevalence of positive HIV and hepatitis B among addicted women were 18. 8% (26 persons) and 5. 0% (7persons), respectively. Three (2. 1%) of addicted women with HIV also had HBV. The most commonly HIV transmission were drug injections (30. 7%) and unprotected sex (11. 5%). Conclusions: Although women do not constitute a significant part of substance abuse, increasing trend of women addiction, on one hand, and high prevalence of risk factors related to HIV or hepatitis in women, on the other hand; show that officials and experts are required to seriously consider prevention and harm reduction programs for women.

Dear Editor, Globally, consumption of tobacco in any form accounts for the deaths of >7 million people each year and results in a significant financial burden on the nation in terms of health‑ care expenditures and loss of productivity. [1] It has been anticipated that by ensuring tobacco control, almost 33% of deaths attributed to noncommunicable diseases can be minimized by 2030...

Background: Data on the effects of omega‑ 3 fatty acid supplementation on clinical symptoms and metabolic profiles in patients with endometrial hyperplasia (EH) are limited. This intervention was performed to assess the effects of omega‑ 3 fatty acid supplementation on clinical symptoms and metabolic profiles in patients with endometrial hyperplasia (EH). Methods: This randomized, double‑ blind, placebo‑ controlled trial was conducted among 40 women diagnosed with simple endometrial hyperplasia (EH). EH diagnosis was performed based on specific diagnostic procedures of biopsy. Participants were randomised into two groups to intake 1, 000 mg omega‑ 3 fatty acid supplements from flaxseed oil (n = 20) or placebo (n = 20), twice a day for 12 weeks. Fasting blood samples were taken at baseline and after the 12‑ week intervention to determine related markers. Results: Compared with the placebo, omega‑ 3 fatty acid supplementation significantly decreased fasting plasma glucose (FPG) (‑ 7. 1 ± 9. 6 vs. +2. 0 ± 4. 9 mg/dL, P = 0. 001), serum insulin levels (‑ 1. 5 ± 4. 6 vs. +1. 6 ± 3. 9 μ IU/mL, P = 0. 02) and homeostasis model of assessment‑ insulin resistance (HOMA‑ IR) (‑ 0. 4 ± 1. 1 vs. +0. 4 ± 1. 0, P = 0. 02). In addition, a significant increase in plasma total antioxidant capacity (TAC) (+102. 6 ± 69. 6 vs. +5. 0 ± 37. 1 mmol/L, P < 0. 001) and total glutathione (GSH) levels (+63. 6 ± 84. 9 vs. ‑ 3. 0 ± 69. 4 μ mol/L, P = 0. 01) were seen following the supplementation of omega‑ 3 fatty acid compared with the placebo. Omega‑ 3 fatty acid supplementation had no significant effect on regression, lipid profiles, and other biomarkers of inflammation and oxidative. Conclusions: In conclusion, we found that omega‑ 3 fatty acid administration for 12 weeks to subjects with EH significantly improved FPG, insulin, HOMA‑ IR, TAC and GSH levels, but did not influence regression, lipid profiles, and other biomarkers of inflammatory and oxidative stress.

Dear Editor, Formaldehyde or formalin is a toxic substance that can induce cancer if one chronically exposed to it. The formaldehyde contamination becomes an interesting health problem. [1] In developing countries, where there is poor legal control, the contamination of formaldehyde in food is a common problem, and this is a big public health hazard to the local people. [2] Here, the authors report an interesting case of a patient presenting with abnormal finger and nail lesion. This patient noted that she got the problem for many months. She gave the history that she had practiced as a worker in vegetable preparation for wholesale to markets for 1 year and had to use her hands for dipping of the vegetables in the formaldehyde solution every day before the vegetables are delivered to the markets. She noted that the lesion occurred 1 month after she started her work...

Background: Urinary tract infection (UTI) is a common reason for referral to the emergency department (ED) especially in unwell infants. Upper UTIs are particularly at risk of significant complications later in life. Rapid dipstick urinalysis and microscopy are often used in unwell children as a screening tool to guide early diagnosis and treatment. This study aims to evaluate the sensitivity of dipstick urinalysis and microscopy in the diagnosis of UTI. Methods: A retrospective review of children aged 16 years and below with positive urine culture (UC) over a 3‑ year period was done. The results of urine dipstick and microscopy were compared with the positive UC and sensitivities calculated. Results: Dipstick urinalysis and microscopy of 262 children were studied. Female-to-male ratio of 1. 8: 1. Median age was 0. 79 (range: 0. 02– 15. 95) years. The sensitivity of nitrite, blood, and leukocyte esterase (LE) were 0. 54, 0. 74, and 0. 86 (95% confidence interval [CI] = 0. 46– 0. 62, 0. 68– 0. 80, and 0. 82– 0. 91), respectively. The sensitivity of pyuria of ≥ 100 cells/mm3 was 0. 92 (95% CI = 0. 89– 0. 95). The presence of any of the 3 dipstick parameters increased the sensitivity to 0. 97 (95% CI = 0. 95– 0. 99). The lowest sensitivity 0. 49 (95% CI = 0. 40– 0. 58) was found with combined positive LE and nitrite. There was a significant comparison between positive LE dipstick test and pyuria (P = 0. 000004). Conclusions: Dipstick urinalysis may not be reliable in ruling out UTI in children. However, considering both positive dipstick and pyuria will be more useful in making the diagnosis.

Background: This study aimed to examine nurses’ job stress based on Karasek’ s demand-controlsupport model and assess its relationship with different aspects of fatigue. Methods: This cross-sectional study was conducted on 522 nurses working in educational hospitals. Job stress dimensions and fatigue were measured by the Persian version of Job Content Questionnaire (JCQ) and Multidimensional Fatigue Inventory (MFI), respectively. Results: The results showed that psychological and physical job demands obtained high scores, but social support and decision latitude got low scores. MFI results indicated that the highest score was related to the general fatigue. Moreover, the results showed a significant positive relationship between psychological job demands and general fatigue, but a significant negative correlation to reduced activity. Conclusions: Considering the effects of job stress on nurses’ fatigue, it is necessary to develop a suitable interventional program for nurses in healthcare centers, especially hospitals, to decrease job stress and improve working conditions.

Background: There is evidence that cessation programs can be effective for hospital inpatients. Hence, the aim of this study was to investigate the effects of such programs and factors that may affect success. Methods: This study was carried out on in‑ patient users of tobacco in Shiraz Hospital, Iran in 2015. After implementing the inclusion criteria, a study population was selected using a convenience sampling method. Participants were contacted monthly by study personnel concerning certain aspects of their tobacco cessation program. The study lasted 6 months. Data analyses involved survival analysis using Kaplan– Meier analysis, log‑ rank test, and multivariate Cox regression modeling. Results: The study included 425 in‑ patient smokers of which 328 (77. 2%) were male. Median follow‑ up time was 96 days (interquartile range: 20– 150). Cessation survival rates were 76% at 1 month, 63% at 2 months, and 61% at 3 months. From the 4th month onward rates remained unchanged at 60%. Univariate analyses with variables such as time since last smoking, consumption type, interval between wake‑ up and consumption, the severity of dependence and interest in smoking cessation were statistically significant as to cessation survival rate (P ˂ 0. 05). After adjusting the confounding variables based on multivariable analyses, results indicated that consumption type, the severity of dependence and interest in smoking cessation were the most important predictors of cessation survival rates among in‑ patient smokers. Conclusions: Findings indicated that application of the cessation program among our group of inpatients appears to have been an effective intervention that produced an extended period of no smoking.

Background: The aim is to investigate the association between diet quality and daily price of foods consumed among Iranian diabetic patients. Methods: This cross‑ sectional study was conducted among 200 patients with type 2 diabetes mellitus (T2DM) aged 30– 70 years. General information, socioeconomic status, anthropometric and biochemical characteristics, and food prices were collected by pretested questionnaires. Dietary intakes were assessed using a semi‑ quantitative reliable and valid food frequency questionnaire. Modified nutritionist IV and SPSS software were used for analyses. Results: The results of the present study indicated a direct relationship between total daily price of diet and nutrient adequacy ratio of Vitamin D, Vitamin B1, selenium, zinc, magnesium, potassium, and mean adequacy ratio of 11 micronutrients (Vitamin C, Vitamin E, Vitamin D, Vitamin B1, Vitamin B6, Vitamin B12, selenium, zinc, calcium, magnesium, and potassium) (P < 0. 05). Furthermore, the total daily price of diet had a positive association with dietary intakes of protein, Vitamin D, Vitamin B1, selenium, zinc, magnesium and potassium among type 2 diabetic patients (P < 0. 05). However, no significant relationship was observed between the total daily price of diet and anthropometric indices, biochemical characteristics, and socioeconomic status of participants in the present study (P > 0. 05). Conclusions: This study showed that dietary quality and dietary intakes of energy, protein, and micronutrients were directly associated with the total daily price of foods among Iranian patients with type 2 diabetes.

Background: Zinc (Zn) knows as essential microelement which prevents oxidative stress. The effect of Zn supplement on renal function parameters in rats subjected to renal ischemia‑ reperfusion (IR) injury was investigated. Methods: Male and female rats were subjected to renal IR with and without Zn sulfate (10 mg/kg/day for 5 days) supplementation. The kidney function markers and histology findings in Zn‑ treated group were compared with sham and control groups. Results: The serum levels of blood urea nitrogen and creatinine (Cr) and kidney tissue damage score were increased significantly after renal injury (P < 0. 05) gender dependently, but no alterations were observed for these markers in Zn‑ treated animals after renal IR injury. Cr clearance was significantly different between genders (P < 0. 05); however, Zn supplementation increased the Cr clearance and kidney nitrite level significantly in male rats (P < 0. 05). Zn also increased urine flow in female (P < 0. 05), but it did not alter urine load of Na (UNaV) and percentage of Na excretion (ENa%). Conclusions: Zn may improve renal function after IR injury gender dependently.

Background: Poor retention in the prevention of women in prevention of vertical transmission programs remains a formidable common setback in elimination of HIV/AIDS. It creates new problems such as poor health outcomes and increased incidence of vertical transmission of HIV. There is a dearth of qualitative information to explain poor retention of women in prevention of mother‑ to‑ child transmission (PMTCT) programs in Zimbabwe. The purpose of the study was to explore the enablers and barriers of retention of women in PMTCT programs. Methods: This was a basic qualitative study conducted at four health centers in Zimbabwe. Four audiotaped focus group discussions were conducted with 34 pregnant or breastfeeding women coming for PMTCT services at the health centers. Descriptive statistics was used for sample demographics. Transcripts were analyzed through latent content analysis based on the Graneheim and Lundman method. Results: Maternal determination, a four‑ tier support system, and an inspiring health package were enablers to retention in the PMTCT program while uninspired individual engagement, paternalism, and undesirable PMTCT‑ related events were barriers to retention of women in the PMTCT program. Conclusions: Reinforcing hope for the women and their children, active management of side effects of antiretroviral medicine, consistent peer support, enhancing confidentiality among community cadres, and commitment from community or religious leaders may improve retention of women in PMTCT programs; for women with HIV during pregnancy, delivery and post-natal care.

Background: Recently, it has been found that Vitamin D can affect cardiometabolic risk factors. However, these findings have not been confirmed in younger population. We aimed to assess the associations of serum 25‑ hydroxyvitamin D (25(OH)D) and metabolic syndrome (MetS) components in Iranian children. Methods: This cross‑ sectional study was conducted on 240 children aged 6– 9 years old. Anthropometric indices (weight, height, waist circumference, and body fat), biochemical parameters (low‑ density lipoprotein, high‑ density lipoprotein, triglyceride [TG], fasting blood sugar, and serum 25(OH)D), systolic blood pressure (SBP) and diastolic blood pressure (DBP) blood pressure, and dietary intake and physical activity were measured. Multivariate linear regression analysis was used to assess the association of MetS components and serum 25(OH)D. Results: Mean age of children was 7. 8 ± 1. 06 year. Mean serum 25(OH)D concentration was 14. 6 ± 10. 64 ng/ml, and the prevalence of Vitamin D deficiency (serum 25(OH)D lower than 10 ng/ml) was 41. 66%. Dietary intake of Vitamin D was 1. 91 ± 1. 8 mcg/day. Serum 25(OH)D was inversely associated with TG (β = − 0. 16; CI: − 0. 27, − 0. 04) after adjusting by age, gender, body mass index, physical activity, and some dietary components. Serum 25(OH)D was negatively associated with SBP (β = − 0. 02; CI: (− 0. 05, − 0. 004), and DBP (β = − 0. 02; CI: − 0. 05, − 0. 003); however, it was not significant anymore after adjustment for sodium, potassium, and fiber. Conclusions: Vitamin D deficiency is alarming among Iranian children. Among the components of MetS, lower serum Vitamin D concentration was only associated with TG that could contribute in onset and progression of cardiometabolic disorders later in life.

Dear Editor, The publication on prevention of Zika virus (ZIKV) disease is very interesting. [1] Passi et al. noted that “ Basic preventive measures for infection primarily revolve around traditional methods of checking mosquito populations, reducing breeding sites, and avoiding mosquito bites. [1]” The above‑ mentioned preventive measure is important. Nevertheless, the extension of the prevention to cover other possible modes of ZIKV transmission is needed. At least, safe sex and use of contraception are generally recommended during the highly epidemic situation. [2] Family planning is recommended for any women in the endemic area during the outbreak period...

Background: Low physical activity (PA) is increasing public health problem. The present study aimed to determine socioeconomic inequality in PA among children aged 10– 12 years old in Kurdistan, west of Iran in 2015. Methods: The present cross‑ sectional study was conducted on 2506 children aged 10– 12 in Sanandaj, Iran, in 2015. Data on the children’ s level of PA were collected using the Modifiable Activity Questionnaire. The concentration index was used to measure inequality and the Oaxaca decomposition to examine the different determinants of the inequality. The data were analyzed in Stata 13 and SPSS 20. Results: Of the 2506 participants, 40. 90% (38. 97– 42. 82) had insufficient PA. Girls had a lower level of PA than boys (odds ratio [OR] = 0. 34; 95% confidence intervals [CI]: 0. 28– 0. 41) and it is directly related to maternal education (OR = 1. 71; 95% CI: 1. 18– 2. 47), the family’ s Socioeconomic status (SES) (OR = 2. 18; 95% CI: 1. 56– 3. 05), and the place of residence (OR = 1. 68; 95% CI: 1. 16– 2. 44). The concentration index for insufficient PA was − 0. 25 (95 CI: − 0. 30 to − 0. 21), revealing an insufficient PA in the group with a low SES. The prevalence of insufficient PA is 51. 38% (95% CI: 48. 45– 54. 31) in poor group and 28. 40% (95% CI: 22. 80– 33. 99) in the wealthier group. The Oaxaca decomposition showed maternal education and the place of residence was the most important determinants of inequality. Conclusions: According to the findings, most of the children especially in the poor groups didn’ t have sufficient PA and socioeconomic factors could have the important role.

Polycystic ovary syndrome (PCOS) is one of the most common hormonal disorders, occurring in 5– 10% women in reproductive ages. Despite a long history of studies on PCOS, its etiology is still unknown. Oxidative stress is now recognized to play a central role in the pathophysiology of many different disorders, including PCOS. Although intracellular reactive oxygen species (ROS) production and propagation are controlled by highly complex antioxidant enzymatic and non‑ enzymatic systems, understanding of mechanisms that oxidative stress is important to develop strategies for prevention and therapy of PCOS. This article reviews the literature data related to the mechanisms of oxidative stress in PCOS.

Background: Magnesium is the calcium natural physiological antagonist; it also antagonizes N‑ Methyl‑ D‑ aspartate receptors, therefore, providing antinociceptive properties. The reason for effective role of treatment with magnesium on decreasing opioid usage, less dissatisfaction, and good sleep quality is proposed theoretically yet. This study aimed to evaluate the effect of magnesium sulfate on decreasing opioids requirement after surgery of the lower limbs fracture by spinal anesthesia. Methods: A total of 60 patients aged from 45 to 75 years with the lower limb fractures (femur and hip) candidate for surgery by spinal anesthesia. In a randomized double‑ blind method, patients were divided into two groups as Magnesium Group (M) and Control Group (C). Group M received a bolus of 5 mg/kg magnesium sulfate plus (250 CC) normal saline and Group C received (250 CC) normal saline in the same condition. Results: Pain score and the physical dissatisfaction were reduced at 12, 24, and 48 h after surgery in Group M as compared with Group C (P = 0. 000). Total opioid requirement at the end of 48 h and at the first 24 h after surgery were reduced in Group M as compared with Group C (P = 0. 001). The endurance of spinal block was increased in Group M as compared with Group C (P = 0. 000). Conclusions: A low dose of magnesium sulfate reduced the pain score, opioid requirement, and physical dissatisfaction while increased endurance of spinal block.

Background: Interest in using peritoneal dialysis (PD) shows global and national increase. However, it remains a challenge to prevent the progression of PD‑ associated fibrosis in clinical practice. Here, we assessed the status of scientific publications in prevention and management of PD‑ associated fibrosis in a scientometric study. Methods: We retrieved the bibliometric data by search terms “ encapsulating peritoneal fibrosis, ” “ treatment or prevention, ” and their synonyms in the Scopus databases until December 2, 2017. Data were analyzed using Scopus analysis tools, SPSS version 15 and Visualizing Scientific Landscapes viewer version 1. 6. 5. Results: Number of publications showed a steady significant increase (P < 0. 001) reaching to 390 documents. Japan had the highest share (21. 3%) followed by United Kingdom. Coauthorship network assessment assigned “ Ikeda M. ” from Japan as the top author. The top source of documents was “ Peritoneal Dialysis International. ” Most of documents were original articles focusing on prevention and management of malignant fibrosis of peritoneum (72. 6%). The documents were cited totally 5636 times with average citations per article of 14. 45, and relatively high H‑ index of 38. Conclusions: Despite the global increasing trend in scientific output in this field, contribution of our country is very small. Perhaps more national and international collaboration is required to encourage our researchers for producing more scientific products.

Background: This study was designed to evaluate the effect of the size of plate, spoon, and fork on food and energy intake during a meal in obese or overweight staff. Methods: This was a crossover randomized controlled trial that was conducted on 40 obese or overweight clerical staff of the university. The staff was invited to have lunch randomly, receiving either a large or a small set of plate, spoon, and fork. Washout period was 3 weeks, and the participants were then invited to have lunch in a second intervention period and received opposite sizes of dishes compared to the first period sizes. The meal was composed of roasted chicken (kebab), cooked rice, vegetable salad, dairy drink, and soda. Changes in food intake between large and small utensils (plate, spoon, and fork) were analyzed with paired t‑ test. Results: Rice intake using small or large eating utensils was different (P = 0. 02). But total energy intake was not different. The Pearson correlation test demonstrated a positive and significant correlation between rice consumption and waist‑ to‑ hip ratio (P = 0. 02). Soda (P = 0. 02), carbohydrate (P = 0. 01), and total energy intake (P = 0. 03) were negatively correlated with the age of the participant. Conclusions: It seems that only the amount of grain products consumption changes with changing in dishware size with no significant effect on total energy intake. It is recommended that the independent effect of visual cues on food intake for foods with different textures be investigated in future studies.

Background: Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorders with significant impact on quality of life (QOL). Considering the role of stress in the clinical course of IBS, we investigated associations between stress coping skills and symptoms and QOL in IBS patient. Methods: A cross‑ sectional study was conducted on 95 IBS patients referring to tertiary care centers. Coping skills (Jalowiec coping scale), IBS symptom severity scale, disease‑ specific QOL (IBS‑ QOL), and symptoms of depression and anxiety (Hospital Anxiety and Depression Scale [HADS]) were evaluated by questionnaires. Bivariate and multivariate analyses were performed to investigate association among these parameters. Results: Disease severity was positively correlated with emotive (r = 0. 30) and fatalistic (r = 0. 41) and negatively correlated with optimistic (r = − 0. 25) and confrontive (r = − 0. 24) coping strategies. Psychological dysfunction (total HADS score, B [95% (confidence interval) CI] = 2. 61 [0. 001– 5. 21]) and fatalistic coping (B [95% CI] = 35. 27 [0. 42– 70. 13]) were significant predictors of IBS severity. Conclusions: However, IBS patients involved in this study utilized adaptive coping strategies more frequently. Our study showed that use of maladaptive coping strategies had positive correlation with symptom severity and degree of anxiety and depression among patients, while implementation of optimistic strategies were found to be negatively correlated to severity of symptoms and also utilization of adaptive coping styles was associated with lesser degree of anxiety and depression.

Background: Recurrences are common in neurally mediated syncope. The aim of this study is the evaluation of the effectiveness of nonpharmacologic treatments alone in preventing of syncope relapse. Methods: 70 patients (age 5– 20 years) with neurally mediated syncope were enrolled. Thirty patients received pharmacologic therapies along with nonpharmacological methods, and 40 patients received just nonpharmacological treatments then followed them for 36 months. The incidences of different outcomes were analyzed with descriptive statistics using percentages. Results: The recurrence rate of syncope was significantly higher in pharmacological group than in nonpharmacological group in each period of the follow‑ up (P < 0. 001). Conclusions: Nonpharmacologic treatment is very effective in the prevention of syncope relapses and can be a substitute for pharmacologic drugs in the initiation of treatment and if done correctly.

Background: Breast cancer (BC) is the most common cancer among women globally and also in India. Early detection by screening is likely to reduce mortality and improve survival. To study the determinants of compliance to BC screening and referral by women in a community based BC screening programme in urban India. Methods: A community‑ based one‑ time cancer screening programme, implemented in the urban slums of Mumbai, India. The programme involves screening for breast cancer by Clinical Breast Examination (CBE) performed by trained primary health workers (PHWs), referral of screen‑ positive women to the nodal hospital for further investigations, confirmation of diagnosis and treatment. Univariate and multivariate logistic regression analysis in SPSS version 16 was used. Results: The compliance to screening, referral and treatment were 90. 58%, 74. 22% and 100% respectively. The results of multivariate logistic regression analysis demonstrate literate women, having family history of cancer, with tobacco habit, being treated for breast abnormalities, being ever pregnant and having history of contraceptive use were positive predictors while, women belonging to Muslim religion or speaking mother‑ tongue other than Marathi or Hindi were negative predictors of participation to screening. Educational status was the only significant predictor of compliance to referral. Screen‑ positive women with education of secondary school level or more were more likely to comply with referral. Conclusions: The programme ensured good compliance with screening, referral and treatment indicating feasibility and acceptability of CBE based BC screening programme by the community.

Background: Gestational diabetes mellitus (GDM) is defined by World Health Organization as glucose intolerance diagnosed for the first time during pregnancy; GDM affects 7% of pregnancies. Women with earlier GDM have higher risk to develop type 2 diabetes (T2D). The aim of our study was to evaluate the outcomes of GDM and to assess the impact of recalling patients in the postpartum stage by phone, the target was to assess T2D or impaired glucose tolerance in women with a history of GDM. Methods: This prospective study included 200 patients with GDM that have received education sessions regarding the major interest of screen T2D using 75 g of oral glucose tolerance testing in the 3rd month after birth. Results: Only 22. 5% (n = 45) women spontaneously complied to assess T2D. About 15% have had developed T2D and 28% prediabetes. Risk factors of T2D onset were younger gestational age at the occurrence GD, higher fasting blood glucose, and frequent use of insulin. Conclusions: Women with GD history demonstrated high risk of developing T2D. Simple changes of lifestyle were shown to be an efficient prevention protocol. Despite therapeutical education, few women spontaneously complied with T2D screening. The telephone reminders could improve the screening observance therefore patient’ s outcome.

Background: Chronic kidney disease associated with serious morbidity and mortality rate while it is affected by renin‑ angiotensin system. The effects of losartan as angiotensin II Type 1 receptor antagonist on renal functional in 4/6 nephrectomized rats was evaluated. Methods: Twenty‑ six male and female Wistar rats underwent 4/6 nephrectomy, and the animals from each gender were randomly divided into two groups which treated with vehicle and losartan (10 mg/kg/day for 1 week). The parameters related to kidney function were measured. Results: Creatinine (Cr) clearance and urine flow were improved in losartan‑ treated group significantly (P < 0. 05). The serum level of blood urea nitrogen and Cr and kidney tissue damage score and sodium urinary output (UNaV) did not alter. However, losartan decreased percentage of sodium excretion (ENa %) in both genders insignificantly. Conclusions: Losartan may improve renal function in 4/6 nephrectomized male rats.

Background: The objective of this study was to analyze the effects of strength training on plasma homocysteine levels and cardiovascular risk factors in patients with type 2 diabetes. Methods: The sample consisted of 14 diabetic women with a mean age of 68 ± 6 years. Biochemical evaluations and anthropometric measurements were taken before and after training. Training sessions lasted 50 min and comprised three sets of 8– 12 repetitions each. The established load was 60% of 1 repetition maximum. Results: After the training program, it was observed that the levels of homocysteine (average before 13. 4 ± 2. 9 and after 12. 8 ± 3. 3, P = 0. 40), very low‑ density lipoprotein (LDL) (average before 41. 9 ± 17. 0 and after 36. 2 ± 11. 8, P = 0. 47), total cholesterol (average before 214. 4 ± 60. 6 and after 190. 2 ± 62. 3, P = 0. 09), triglycerides (average before 209. 3 ± 85. 4 and after 181. 5 ± 59. 2, P = 0. 47), and blood glucose (average before 123. 5 ± 30. 4 and after 110. 1 ± 24. 7, P = 0. 26) showed no significant changes, but the LDL (average before 129. 1 ± 63. 4 and after 95. 7 ± 53. 3, P = 0. 04), high‑ density lipoprotein (average before 43. 2 ± 12. 0 and after 58. 2 ± 15. 6, P = 0. 01), lean mass (average before 41. 1 ± 5. 7 and after 42. 8 ± 5. 4, P = 0. 008), fat mass (average before 31. 4 ± 8. 8 and after 29. 7 ± 8. 5, P = 0. 001), and percentage fat (average before 42. 6 ± 4. 0 and after 40. 3 ± 4. 6, P = 0. 000) showed significant changes. Conclusions: This study concluded that strength training does not improve homocysteine levels, but help to improve the lipoprotein profile in type 2 diabetic patients.

Background: Gastric cancer (GC) is the first and the third prevalent cancer among males and females in Iran, respectively. The aim of this study was mainly to identify high‑ risk areas of GC by assessing the spatial and temporal pattern of incidence, and second, to explore some risk factors of GC in ecological setting. Methods: In this cross‑ sectional ecological study we used Bayesian hierarchical space‑ time model to measure the relative risk and temporal trends of GC in Iran from 2005 to 2010 based on available data. Data analysis was done by the use of integrated nested Laplace approximation Bayesian approach in R software. Results: Overall trend of GC was significantly decreasing during the study period. Ardabil, Khorasan Razavi, West Azarbaijan, Zanjan, and Mazandaran provinces had the highest risk of incidence. Overweight and smoking were directly and significantly associated with GC risk. Conclusions: During the study period, GC has decreased in Iran. Nevertheless, GC risk was generally high in Northern and Northwestern provinces of Iran. Different health policies according to GC risk and trend are required for each province. Improvements in screening and education programs and conducting further epidemiological studies could help to reduce the incidence of GC in high risk provinces.

Background: High prevalence of malnutrition across India poses a significant obstacle to achieving desirable child health outcomes. For addressing childhood malnutrition, the government of Chhattisgarh during 2010– 2014 established Nutrition Rehabilitation Centers (NRCs) in selected health units for the timely, adequate, and appropriate feeding of children, and for improving skills of mothers and caregivers on age‑ appropriate caring, counseling, and growth monitoring. This study examined the functioning of NRCs in three districts; assessed perception of mothers and carers of children admitted in the NRC; and assessed the perspectives of service providers. Methods: Four out of 46 NRCs were purposively chosen. Monthly performance reports of 2012– 2014 were reviewed. Fifty mothers/carers of under‑ five children were interviewed; and ten in‑ depth interviews were conducted with the service providers. Descriptive statistics, co‑ relational, and regression models were used for data analysis; qualitative data were analyzed thematically. Results: Vacancy of staff ranged from 7. 4% to 70%. The mean age of children during admission was 23. 8 ± 6. 2 months. The mean percentage weight gain was 11. 6%, whereas the mean duration of stay in the NRC was 10. 7 ± 3. 5 days. Weight gain was directly related to the weight during admission. Follow‑ up visit and follow‑ up card issuing, counseling to mothers, special diet preparation, timely receipt of incentives, and training on diet preparation needed immediate attention. Conclusions: Regular review and supportive supervision could play a crucial role in improving the quality of services. The awareness level and expectation of mothers could be improved through NRC‑ based education and outreach services.

Background: Fatigue is a common symptom in office workers. The purpose of this study was to assess the psychometric properties of the Persian version of the Multidimensional Assessment of Fatigue (P‑ MAF) scale and its association with productivity among Iranian office workers. Methods: In order to validate the MAF scale, using “ forward‑ backward” translation, cognitive debriefing, and cultural adaptation procedure, the English version of the MAF was translated into Farsi. A total of 129 Iranian office workers with at least 1‑ year job experience were included in the study. The Persian version of the Health and Work Questionnaire was used for assessment of the productivity in the participants. Results: Internal consistency for all subscales of the P‑ MAF scale was acceptable ( ≥ 0. 854). The correlation of convergent validity and the correlation of discriminant validity for all subscales ranged from 0. 466 to 0. 948 and 0. 121 to 0. 5, respectively. Internal consistency of each subscale of P‑ MAF for sex, marital status, job tenure, and daily working hours was high (0. 810– 0. 952). Factor analysis of the P‑ MAF scale revealed that its items were related to severity, distress, timing of fatigue, interference with activity at home, and interference with activity away from home. The results showed significant correlations between the score of fatigue and some subscales of P‑ MAF, including concentration/focus (r = 0. 649, P < 0. 001) and impatience/irritability (r = 0. 334, P = 0. 001). Conclusions: The P‑ MAF had appropriate structural characteristics, was a valid and reliable instrument, and could be used for measuring fatigue among Iranian office workers.

Background: The aim of the study was to highlight the importance of adequate anticoagulant therapy and the correlation of higher risk of stroke. Methods: This study analyzed data obtained from 103 patients with diagnosis of atrial fibrillation (AF) (39 of them had a stroke). Patients were divided into groups according to the CHADS2, CHA2DS2‑ VASc, and HASBLED scores. Results: An analysis showed that anticoagulant drugs were more often prescribed to subjects <75 years of age (P = 0. 001). Patients with a higher CHADS2 score had a higher CHA2DS2‑ VASc score and vice versa (rho = 0. 513; P = 0. 0001). According to the CHA2DS2‑ VASc, 91. 3% of the patients examined were prescribed an anticoagulant medication as a therapy at discharge from the hospital. The result was statistically significant compared to the practice where an anticoagulant was prescribed to 55. 9% of high‑ risk subjects as estimated by the CHA2DS2‑ VASc score (P < 0. 05). Our results also show that rivaroxaban is more commonly prescribed as a discharge therapy than warfarin (χ 2 = 12. 401; P = 0. 0001). Furthermore, a significantly higher number of patients who were being prescribed aspirin (38. 5%) had a stroke compared to 12. 8% of patients who were being prescribed warfarin (χ 2 = 12. 259; P = 0. 0001). Conclusions: Novel oral anticoagulants (NOACs) seem to be a better choice as a pharmacological therapy in the treatment of AF, due to a lack of adequate monitoring of patients’ international normalized ratio (INR) values. CHA2DS2‑ VASc and HASBLED scores must be used as a part of routine clinical diagnostics when dealing with patients with AF.

Background: Few scientific studies have been conducted about the effect of yoga on biochemical variables such as total cholesterol (TC), high‑ density lipoprotein cholesterol (HDL‑ C), low‑ density lipoprotein cholesterol (LDL‑ C), triglyceride (TG), and C‑ reactive protein (CRP) to lay a scientific foundation regarding benefits of yoga, but its effect is not clearly detected yet. This study was conducted to assess the effect of yoga on lipid profile and CRP in women. Methods: This research was designed as an interventional study. After reviewing inclusion and exclusion criteria, selected biochemical variables such as TC, HDL‑ C, LDL‑ C, TG, and CRP were measured for each participant. Yoga instruction was done three times a week for 26 weeks by an experienced yoga instructor. After 26 weeks of yoga intervention, the above‑ mentioned dependent variables were assessed. SPSS Ver. 16 was used for data analysis. Results: After a 26‑ week follow‑ up for participants, only 24 women had the necessary criteria to be included in the study. The mean TG was 157. 33 ± 68. 416 mg/dL and 134. 33 ± 58. 80 mg/dL before and after the intervention (P = 0. 108), respectively. The mean TC was 234. 83 ± 48. 47 mg/dL and 183. 33 ± 55. 09 mg/dL before and after the intervention (P = 0. 014), respectively. The mean HDL‑ C was 31. 58 ± 14. 22 mg/dL and 38. 25 ± 13. 5 mg/dL before and after the intervention (P = 0. 118), respectively. The mean LDL‑ C was 171. 75 ± 42. 69 mg/dL and 142. 91 ± 36. 4 mg/dL before and after the intervention (P = 0. 030), respectively. The mean CRP was 0. 57 ± 0. 22 mg/L and 0. 71 ± 0. 77 mg/L before and after the intervention (P = 0. 779), respectively. Conclusions: The result showed that yoga reduced TC and LDL‑ C significantly, but had no significant effect on TG, HDL‑ C, and CRP.

Background: The purpose of this study was to assess socioeconomic status (SES) inequality in life satisfaction (LS) and good self-perceived health (SPH) in Iranian children and adolescents. Methods: This nationwide study was conducted as part of a fourth national school-based surveillance program performed on 14880 students aged 6– 18 years who were living in urban and rural areas of 30 provinces of Iran between 2011 and 2012. Using principle component analysis, the SES of participants was constructed as single variable. SES inequality in LS and good SPH across the SES quintiles was assessed using the concentration index (C) and slope index of inequality (SII). The determinants of this inequality are investigated by the Oaxaca Blinder decomposition method. Results: Frequency of LS along with the SES quintiles shifted significantly from 73. 28% (95% CI: 71. 49, 75. 08) in the lowest quintile to 86. 57% (95% CI: 85. 20, 87. 93) in the highest SES quintile. Frequency of favorable SPH linearly increased from lowest SES quintile (76. 18% (95% CI: 74. 45, 77. 92)) to highest SES quintile (83. 39% (95% CI: 81. 89, 84. 89)). C index for LS and good SPH was negative, which suggests inequality was in favor of high SES group. SII for LS and SPH was 15. 73 (95% CI: 12. 10, 19. 35) and 8. 21 (95% CI: 5. 46, 10. 96)]. Living area and passive smoking were the most contributed factors in SES inequality of LS. Also passive smoking and physical activity were the most contributed factors in SES inequality of SPH. Conclusions: SES inequality in LS and good SPH was in favor of high SES group. These findings are useful for health policies, better programming and future complementary analyses.

Background: Spread of multidrug‑ resistant tuberculosis (TB) is a threat to India’ s TB control program. We conducted this study with the objective to determine the risk factors for the development of secondary multidrug‑ resistant TB. Methods: We conducted an unmatched case– control study involving 247 multidrug‑ resistant TB patients as “ cases” and 494 individuals who were declared as “ cured” after category I DOTS treatment as “ controls. ” Data were collected through face‑ to‑ face interviews and review of treatment records. Multivariable logistic regressions were used to analyze the collected data. Results: The mean duration for which cases took first‑ line anti‑ TB drug was 19. 7 months. The mean duration between initial diagnosis of TB and diagnosis of multi‑ drug resistant TB (MDR‑ TB) was 28. 3 months. In our study, 26. 7%, 50. 2%, and 23. 1% of MDR‑ TB cases had one, two, or more previous episodes of TB before being diagnosed as MDR‑ TB. In multivariable analysis, low or no formal education (album‑ oriented rock [AOR] =1. 63 [confidence interval (CI) = 1. 03– 3. 11]), labor occupation (AOR = 2. 15 [CI = 1. 18– 3. 90]), smoking (AOR = 2. 56 [CI = 1. 19– 3. 26]), having HIV (AOR = 9. 45 [CI = 6. 80– 15. 9]), migration for job (AOR = 3. 70 [CI = 1. 96– 5. 67]), stopping TB treatment due to comorbid conditions (AOR = 8. 86 [CI = 5. 45– 11. 2]), and having type 2 diabetes (AOR = 3. 4 [CI = 1. 96– 5. 16]) were associated with MDR‑ TB. Conclusions: Government of India should devise strategy to prevent interruption of treatment to stop the emergence and spread of MDR‑ TB. We need to better integrate TB control activities with diabetes and tobacco control programs for better health outcome among patients.

Background: Diabetes as a chronic and progressive disease leads to multiple complications. Therefore, it is important to control and treat it. More effective control of this condition and the provision of therapeutic approaches require awareness and active participation of patients in self‑ care. In this regard, a smartphone that is accessible to most people at anytime and anywhere and is easily applicable can be useful in self‑ care diabetes, with the ability to install various applications. This study aimed to develop a diabetes self‑ care mobile application as a suitable solution for self‑ managing diabetes for Iranians. Methods: We conducted a mixed methods study in three Phases: (1) comparative study of existing mobile applications; (2) developed its object‑ oriented conceptual model; and (3) developed the initial version of “ Aryan” that was approved for production. Results: This application was designed for the appropriate diabetes self‑ care, with following functionalities: The user ID and his/her personal page setting; generating self‑ care reports such as blood glucose, nutrition, physiological indicators, physical activities, and patient history reports; care setting; providing patient training materials; nutrition control; insulin and other medications control; blood glucose and key tests control; and other paraclinical tests. Conclusions: “ Aryan” has been designed in compliance with Iranian experts’ opinions. It is expected “ Aryan” plays an effective role in self‑ care of patients with diabetes.

Sir, I went through with considerable interest the article by Bener which highlights the health problems in migrant workers of South Asian origin who work in Qatar. [1] The process of migration can entail several health risks because of lifestyle and environmental changes apart from stressors related to adjusting in a different sociocultural environment. [2] The World Health Organization therefore recognizes avoiding disparities in health status and access to health services to be a major public health goal...

Background: The prevalence of mental diseases is 23. 6% in Iran. Taking intersectoral measures is said to be effective in promoting mental health and reducing the burden of the diseases caused by social determinants. The aim of this study was to determine the role of national organizations in promoting mental health in Iran. Methods: An applied descriptive qualitative method was used. The data were collected by reviewing the literature, interviewing with experts, and holding focus group discussions. To identify the roles of organization, a two‑ dimensional matrix was drawn. Results: The roles of 31 national organizations in five groups were determined. Then, the intersectoral organizational expectations in two key areas were extracted. The key roles determined were mostly related to the Ministry of Education, Islamic Republic of Iran Broadcasting, Ministry of Labor and Social Welfare, and the Ministry of Sports and Youth. Conclusions: Due to the growing burden of mental disorders in the country, informing national organizations and attracting their active participation based on intersectoral expectations and developing interaction mechanisms among them can be an effective step in promoting mental health and reducing the environmental factors threatening mental health.

Background: Quality of life (QoL) is an important tool for evaluating the effect of a disease as well as effects of treatment interventions. The present study is aimed to investigate QoL of the patients with various prevalent chronic diseases in Iran. Methods: In a cross‑ sectional study, 625 patients with one of the prevalent chronic diseases were assessed. Participants were recruited via convenient sampling method in special clinics of chronic diseases in three educational hospitals in Qazvin, Iran, from May to December 2016. Data were collected using WHOQOL‑ BREF and demographic questionnaire through interview. Data were analyzed using independent t‑ test, ANOVA, Pearson’ s correlation coefficient, and multiple linear regression method. Results: Significant difference in QoL scores was found in different chronic disease; patients with diabetes and hypertension had higher scores and patients with asthma and chronic obstructive pulmonary disease (COPD) had the lowest scores. Multivariate analysis showed that age, economic status, and type of disease were among the significant variables in predicting the QoL of the patients with chronic diseases. Conclusions: Some patients, such as those with asthma and COPD, had less QoL than other patients and should be prioritized while planning for the promotion of healthcare services. Due to the negative effects of economic status on QoL, the financial support programs should be among the major priorities of the patients’ QoL improvement programs.