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Hassan Mahmoodi,1 Fatemah Jalalizad Nahand,2 Abdolreza Shaghaghi,2 Shahin Shooshtari,3 Mohammad Asghari Jafarabadi,4 Hamid Allahverdipour2 1Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran; 2Department of Health Education and Health Promotion, School of Public Health, Tabriz University of Medical Sciences, Tabriz, Iran; 3Departments of Family Social Sciences and Community Health Sciences, University of Manitoba; St. Amant Research Centre, Winnipeg, Manitoba, Canada; 4Department of Epidemiology and Biostatistics, School of Public Health, School of Public Health, Tabriz University of Medical Sciences, Tabriz, Islamic Republic of IranCorrespondence: Hamid AllahverdipourDepartment of Health Education & Promotion, Faculty of Health Sciences, Tabriz University of Medical Sciences, Attar-e-Neyshabouri Street, Golgasht Street, Tabriz 5165665931, IranTel +98 41 333 44 731Email allahverdipour@gmail.comBackground: Life course gender-role traits and social stereotypes could affect the pattern of medication adherence in old age.Objectives: The main purpose of this study was to investigate gender based cognitive determinants of medication adherence in a sample of older adults who suffer from at least a chronic condition.Methods: In this cross-sectional design, 455 older adults participated from five health centers in Tabriz city, Iran from June to August 2017 using a random sampling method. Next, required data about medication adherence, knowledge and beliefs about prescribed medications, perceived self-efficacy in medication adherence, illness perception, and reasons for medication non-adherence were gathered using a structured written questionnaire through face-to-face interviews with the attendees.Results: Low medication adherence was reported by 54.5% of the study participants. Perceived self-efficacy for medication adherence (OR = 1.04; 95% CI: 1.00, 1.08) and medication adherence reason (OR = 0.96; 95% CI: 0.92, 0.99) were two identified strong predictors of medication adherence among the studied older men. Illness perception (OR = 1.02; 95% CI: 1.00, 1.02) and beliefs toward prescribed medication (OR = 0.95; 95% CI: 0.93, 0.98) were both recognized as the significant predictors of medication adherence in the older women subgroup.Conclusion: Gender based variations were noted regarding the medication adherence in the studied sample and attributes of cognitive function were the main pinpointed elucidating parameters for the non-conformity. The explicit cognitive processes must be considered in care provision or interventional programs that target medication adherence in older adults.Keywords: chronic disease, Iran, medication regimen adherence, older adults

Background: Breast cancer is a prevalent cancer characterized by its aggressive nature and potential to cause mortality among women. The rising mortality rates and women's inadequate perception of the disease's severity in developing countries highlight the importance of screening using conventional methods and reliable scales. Since the validity and reliability of the breast cancer perception scale (BCPS) have not been established in the Iranian context. Therefore, this study aimed to determine the measurement properties of the BCPS in women residing in Tabriz, Iran., Methods: The present study comprised a cross-sectional design, encompassing a sample of 372 Iranian women. The participants were selected through a multi-stage cluster random sampling technique conducted over a period spanning from November 2022 to February 2023. The measurement properties of the Iranian version of BCPS were assessed following the guidelines outlined in the COSMIN checklist. This involved conducting various steps, including the translation process, reliability testing (internal consistency, test-retest reliability, and measurement error), and methodological tests for validity (content validity, face validity, construct validity, and hypothesis testing). The study also investigated the factors of responsiveness and interpretability. The presence of floor and ceiling effects was assessed., Results: The internal consistency of the scale was assessed using Cronbach's alpha, yielding a satisfactory value of 0.68. Additionally, McDonald's omega (95% CI) was computed, resulting in a value of 0.70 (0.66 to 0.74). Furthermore, the test-retest reliability was evaluated, revealing a high intraclass correlation coefficient (ICC) of 0.97 (95% CI: 0.94 to 0.99). The CVI, CVR, and impact scores of the BCPS were determined to be 0.98, 0.95, and 3.70, respectively, indicating favorable levels of content and face validity. To assess construct validity, an examination of the Exploratory Factor Analysis (EFA) was conducted on a set of 24 items. This analysis revealed the presence of six distinct factors, which collectively accounted for 52% of the cumulative variance. The fit indices of the validity model (CFI = 0.91, NFI = 0.96, RFI = 0.94, TLI = 0.90, χ 2 /df = 2.03, RMSEA = 0.055 and SRMR = 0.055) were confirmed during the confirmatory factor analysis (CFA). The overall score of BCPS exhibited a ceiling effect of 0.3%. The floor effect observed in the overall score (BCPS) was found to be 0.5%. Concerning the validation of the hypothesis, Spearman's correlation coefficient of 0.55 was obtained between the BCPS and the QLICP-BR V2.0. This correlation value signifies a statistically significant association. Furthermore, it is worth noting that the minimum important change (MIC) of 3.92 exhibited a higher value compared to the smallest detectable change (SDC) of 3.70, thus suggesting a satisfactory level of response., Conclusions: The obtained findings suggest that the Iranian version of the BCPS demonstrates satisfactory psychometric properties for assessing the perception of breast cancer among Iranian women. Furthermore, it exhibits favorable responsiveness to clinical variations. Consequently, it can serve as a screening instrument for healthcare professionals to comprehend breast cancer and as a reliable tool in research endeavors., (© 2024. The Author(s).)

Background: Establishing cost-effective informal care services for lonely older adults living at home in developing countries can be an innovative approach for improving their well-being. This study investigated the effectiveness of an informal home care support intervention program (HoSIP) reducing the loneliness and improving quality of life of lonely community-dwelling older adults., Methods: This quasi-experimental pre-post study employed a non-randomized control group design with a 12-week intervention period and three follow-up points at the end of the HoSIP. Questionnaires were used to measure feelings of loneliness (20-item UCLA Loneliness Scale), quality of life (Control, Autonomy, Self-Realization and Pleasure Scale), general health (12-item General Health Questionnaire), social network (six-item Lubben Social Network Scale), social support (12-item Multidimensional Scale of Perceived Social Support), and self-care ability (17-item Self-care Ability Scale for the Elderly). Repeated-measures analysis of variance was used to gauge the effect of the intervention program over time and in comparison to the control group. Data analyses were performed using the IBM SPSS Statistics software (IBM Corp., USA)., Results: We found a significant relationship between the outcome variables, including feelings of loneliness (P<0.001) and quality of life (P<0.001), at different stages of measurement. Despite the positive feasibility results, the implementation of the HoSIP faced challenges due to a lack of facilities (e.g., place restriction for holding educational classes, educational facilities like computers, video projector, and whiteboard at daycare center) and the absence of supporting organizations., Conclusion: Utilizing the existing capabilities of older adults to provide online and face-to-face care services can be a cost-effective way to improve their quality of life and reduce loneliness. The process of facilitating such informal care services for lonely older adults should be managed by either governmental or non-governmental organizations to reduce the rate of social isolation among this vulnerable population.

Purpose: Heart failure (HF) is a widespread ailment and is a primary contributor to hospital admissions. The focus of this study was to identify factors affecting the extended-term survival of patients with HF, anticipate patient outcomes through cause-of-death analysis, and identify risk elements for preventive measures., Methods: A total of 435 HF patients were enrolled from the medical records of the Rajaie Cardiovascular Medical and Research Center, covering data collected between March and August 2018. After a five-year follow-up (July 2023), patient outcomes were assessed based on the cause of death. The survival analysis was performed with the AFT method with the Bayesian approach in the presence of competing risks., Results: Based on the results of the best model for HF-related mortality, age [time ratio = 0.98, confidence interval 95%: 0.96-0.99] and ADHF [TR = 0.11, 95% (CI): 0.01-0.44] were associated with a lower survival time. Chest pain in HF-related mortality [TR = 0.41, 95% (CI): 0.10-0.96] and in non-HF-related mortality [TR = 0.38, 95% (CI): 0.12-0.86] was associated with a lower survival time. The next significant variable in HF-related mortality was hyperlipidemia (yes): [TR = 0.34, 95% (CI): 0.13-0.64], and in non-HF-related mortality hyperlipidemia (yes): [TR = 0.60, 95% (CI): 0.37-0.90]. CAD [TR = 0.65, 95% (CI): 0.38-0.98], CKD [TR = 0.52, 95% (CI): 0.28-0.87], and AF [TR = 0.53, 95% (CI): 0.32-0.81] were other variables that were directly related to the reduction in survival time of patients with non-HF-related mortality., Conclusion: The study identified distinct predictive factors for overall survival among patients with HF-related mortality or non-HF-related mortality. This differentiated approach based on the cause of death contributes to the estimation of patient survival time and provides valuable insights for clinical decision-making., (© 2024. The Author(s).)

Background: The exclusive breastfeeding (EBF) is undeniably proven significant in mothers' health and infants' growth and survival. Its persistence has many familial, social, and economical benefits. Social support is known to be an effective factor in EBF's success and sustainability. However, Exclusive breastfeeding social support (EBFSS) scale validity and reliability is not evaluated in Iran. This study aimed to determine the psychometric properties of EBFSS during postpartum period in Tabriz city, Iran., Methods: It is a cross-sectional study with descriptive survey method performed between March 2021 and August 2022. Psychometric properties were determined for the Persian version of EBFSS in six stages: translation process, evaluating content validity, face validity, construct validity, discriminant validity, and reliability. A group of experts (n = 10), followed by a group of women with EBF (n = 10), evaluated the instrument's items based on content and face validities, respectively. A cross-sectional study using the multi-stage cluster random sampling method on 348 women with EBF in the first four months after delivery was conducted to determine the construct validity. The internal consistency and repeatability (test-retest on 30 women, 2 weeks apart) were used to find out the reliability., Results: Content validity ratio (CVR), content validity index (CVI), and impact score were 0.98, 0.98, and 3.54 for EBFSS, respectively. This indicates a good content and face validity. Exploratory factor analysis (EFA) was performed on 16 items to examine the construct validity identified emotional, instrumental, and informational factors. These factors explained 59.26% of the cumulative variance. The fit indices (CFI = 0.98، TLI = 0.95، χ 2 /df = 4.20، RMSEA = 0.07 and SRMSEA = 0.05) confirmed the validity of the model in a confirmatory factor analysis (CFA). The internal consistency was examined through Cronbach's alpha and McDonald's omega coefficients that were 0.90 and 0.92, respectively. Finally, Repeatability and reproducibility were found 0.97 (95% CI: 0.92 to 0.99) using Intra-class correlation. This shows an appropriate reliability of the instrument., Conclusions: The research findings indicate that the Persian version of the EBFSS has appropriate psychometric properties for evaluating the social support in Iranian women with EBF. This means healthcare providers can use it for screening social support in EBF. Researchers also can use it as a valid instrument., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: The increasing prevalence of postpartum anxiety as a common psychological problem affects a large part of women's lives. Despite the existence of tools in this field, but due to the lack of specificity in reflecting postpartum anxiety, it is necessary to have a specific tool to screen it. Since the psychometric evaluation of the Postpartum Specific Anxiety Scale-Research Short-Form (PSAS-RSF) among Iranian women has not been assessed in Iran until now, so we decided to conduct this study with the aim of psychometric evaluation of the PSAS-IR-RSF., Methods: We included 180 women (six weeks to six months postpartum) in the study by random sampling during the period from December 2021 to June 2022. We examined the validity of the PSAS-IR-RSF tool in terms of face, content and construct (through exploratory and confirmatory factor analyses). We used internal consistency and test-retest reliability to determine the reliability of the scale., Results: In the present study, content validity index (CVI) and content validity ratio (CVR) of the PSAS-IR-RSF tool were equal to 0.91 and 0.97, respectively. We extracted a four-factor structure through the process of exploratory factor analysis. The values of fitting indices confirmed the validity of the model. Cronbach's alpha coefficient was equal to 0.72 and intra-class correlation coefficient (with 95% confidence interval) was 0.97 (0.98 to 0.93)., Conclusions: The Persian version of the PSAS-IR-RSF is a valid and reliable tool for the specific evaluation of postpartum anxiety among Iranian women., (© 2023. The Author(s).)

Background: Due to its high pervasiveness and adversarial consequences, postpartum anxiety has been one of the most worrying public health concerns in the last decade. According to previous research, the occurrence of mental disorders among women in the postpartum period upsurges significantly in the course of universal disasters. The Postpartum Specific Anxiety Scale - Research Short Form - for use in global Crises [PSAS-IR-RSF-C] has not been used in Iran for postpartum women during a health system shock. Consequently, this study was conducted to determine the validity and reliability of the Persian version (PSAS-IR-RSF-C) during the COVID-19 pandemic., Methods: This cross-sectional study was performed with 180 women who were between six weeks and six months after delivery, by random sampling method from December 2021 to June 2022. The validity of the PSAS-RSF-C in terms of face, content, was analyzed, and the construct validity was assessed using exploratory and confirmatory factor analyses. Internal consistency and test-retest reliability of the questionnaire were measured using (Cronbach's alpha, McDonald's ω) and intraclass correlation coefficient (ICC), respectively., Results: The content validity index and content validity ratio of the Persian version of the PSAS-IR-RSF-C were 0.96 and 0.98, respectively. A three-factor structure was extracted during the exploratory factor analysis process, and model validity was confirmed by the values of fit indices. Cronbach's alpha coefficient, McDonald's ω and intra-cluster correlation coefficient (95% confidence interval) were 0.74, 0.92 (0.78 to 0.93) and 0.97 (0.93 to 0.98), respectively., Conclusions: For the specific assessment of postpartum anxiety among Iranian women during crises, the Persian version of the PSAS-IR-RSF-C is a valid and reliable tool., (© 2023. The Author(s).)

Background: Diabetes management in hemodialysis patients with end-stage renal disease needs precision to avoid complications. The study aimed to investigate the effect of ginger supplementation on prooxidant-antioxidant balance, glycemic management, and renal function in diabetic hemodialysis patients., Trial Design and Methods: Forty-four patients were randomly allocated to either the ginger or the placebo group in this randomized, double blind, placebo-controlled study. Patients in the ginger group received 2000 mg/d ginger for eight weeks, whereas those in the placebo group received equivalent placebos. After a 12- to 14-h fast, serum levels of fasting blood glucose (FBG), insulin, urea, creatinine, and prooxidant-antioxidant balance (PAB) were measured at baseline and at the end of the study. The homeostatic model evaluation of insulin resistance was used to determine insulin resistance (HOMA-IR)., Results: Serum levels of FBG (p = 0.001), HOMA-IR (p = 0.001), and urea (p = 0.017) were considerably lower in the ginger group compared to baseline, and the difference was significant when compared to the placebo group (p < 0.05). Moreover, ginger supplementation decreased serum levels of creatinine (p = 0.034) and PAB (p = 0.013) within the group, but the effect was insignificant between groups (p > 0.05). On the other hand, insulin levels did not vary significantly across and among the groups (p > 0.05)., Conclusion: In summary, this study indicated that in diabetic hemodialysis patients, ginger could result to lower blood glucose levels, enhanced insulin sensitivity, and lower serum urea levels. Further studies with a more extended intervention period and various doses and forms of ginger are needed., Trial Registration: IRCT20191109045382N2. (06/07/2020), Retrospectively registered, https://www.irct.ir/trial/48467., (© 2023. The Author(s).)

Background: Disrespect and abuse during childbirth is regarded as harassment of women and a violation of their rights. The aim of this study was to assess the psychometric properties of the disrespect and abuse questionnaire in Iranian parturient women., Materials and Methods: This cross-sectional study was conducted on 265 postpartum women in both private and public hospitals in Tabriz, Iran. The scale was translated from English into Farsi. In the quantitative face validity, the impact score was determined for each item. Moreover, in the quantitative content validity, the Content Validity Ratio (CVR) and Content Validity Index (CVI) were assessed based on the comments of experts on the relevance, clarity, and simplicity of items (CVI) and the necessity of items (CVR). Construct validity was assessed through exploratory and confirmatory factor analyses., Results: In the face validity assessment, all items received a minimum impact score of 1.5. In assessing the content validity, all the items attained the minimum acceptable value of CVR (>0.69) and CVI (>0.79). According to the exploratory factor analysis, the Disrespect and Abuse Questionnaire has 23 items and five factors, including abandoning the mother, improper care, mother's immobility, not talking to the mother, and mother's deprivation. The construct validity of the scale was confirmed by the confirmatory factor analysis, in which X 2 /df <5 and root mean square error of approximation <0.08., Conclusions: The Farsi version of the disrespect and abuse questionnaire can be used as a valid tool for assessing instances of lack of respectful maternity care in the postpartum period., Competing Interests: Nothing to declare., (Copyright: © 2023 Iranian Journal of Nursing and Midwifery Research.)

Background: The prevalence of cesarean birth in Iran is very high. Having a negative childbirth experience is one of the reasons that primiparous women provide to prefer caesarean birth over a vaginal birth. This study is aimed to understand women's perspective on what determines a positive or negative birth experience for them., Methods: This qualitative study is a part a mixed method study that was conducted among primiparous women with a previous vaginal birth experience. The purpose of the main study was to develop a guideline based on Iranian primiparous women's birth experiences. The quantitative phase of the study was a cross-sectional study where women's childbirth experiences was measured in a survey via the Childbirth Experience Questionnaire-2. In the qualitative part of the study, women were invited for an in-depth interview via a random stratified sampling method based on their childbirth mean score (women with 10% of the upper bound score which indicated a positive birth experience and 10% of the lower bound indicating negative birth experience, n = 17). Conventional content analysis was used for data analysis., Results: We extracted three main themes: (a) "Internal control", (b) "External control", and (c) "Support". Possessing internal control, having a balanced external control to feel cared and feeling supported were the main reasons for women to feel positive about their birth experiences. Whereas, loss of internal control, imbalanced external control and unsupportive environment were related to their negative childbirth experiences., Conclusion: Considering that women's sense of control, the care and support that they receive can influence their childbirth experiences, there is a need for changing maternity policies and practices to highlight the importance of a woman-centred care to create a pleasant, respectful and positive memory for primirparous women who experience normal vaginal births., (© 2022. The Author(s).)

Introduction: Mild cognitive impairment (MCI) is a progressive age-related condition caused by physiological and structural changes in the brain, such as neurodegeneration and hypometabolism. Transcranial photobiomodulation (tPBM) is a neuromodulation technique that improves brain metabolism and oxygenation by irradiating red to near-infrared light on a specific area of the head. This study aimed to investigate the effect of multi-session tPBM on the cognitive capacities and attentional function of older women with MCI., Material and Methods: In this randomized controlled trial, 42 older women with MCI were randomly assigned to 2 equal groups: real and sham. The mini-mental state examination (MMSE) and the attentional Go/No-Go task were used to examine the patients. On the right frontal-pole of the cortex, 5 sessions of 850 nm tPBM were given. Re-examinations were conducted on the participants. For the Go/No-Go task, the reaction time to the target (RTT), the percentage of correct trials (PCT), and the efficiency score (ES) were measured., Results: The findings revealed a significant interaction between group × time for MMSE ( F (1, 40) = 20, p < 0.001, h 2 = 0.33), and the post-hoc paired-samples t -tests revealed a substantial rise in the mean MMSE in the real group ( t = 15.9; p = 0.001; d = 9.3). Additionally, for ES ( F (1, 40) = 19, p < 0.001, h 2 = 0.32), RTT ( F (1, 40) = 17, p < 0.001, h 2 = 0.38), and PCT ( F (1, 40) = 13, p < 0.001, h 2 = 0.31), a significant group × time interaction was discovered, and post-hoc paired-samples t -tests revealed a significant improvement in attention performance of the real group for increases in the mean of ES ( F (1,40) = 20, p < 0.001, h 2 = 0.33), ( t = 5.3, p < 0.001, d = 0.034), decreases in the mean of RTT ( t = 4.8; p = 0.001; d = -37.4), and increases in the mean of PCT ( t = 2.67; p = 0.015; d = 6.3)., Conclusions: According to the findings of this study, tPBM had a positive effect on older people's attention and cognitive abilities., Competing Interests: The authors report no conflict of interests., (Copyright © 2022 Termedia.)

Introduction: Isolation and self-quarantine can expose individuals, particularly older people, to cognitive and physical decline. Due to a reduction in their musculoskeletal and neural flexibility, older adults are more likely to be affected by quarantine limitations. This study aimed to investigate the effect of self-quarantine on cognitive and balance performance of older women during the COVID-19 outbreak., Material and Methods: In a convenience sampling method, a total of 75 older adult women were recruited in this ex post facto study. The mini-mental state exam, single leg stance test, and timed up and go test were used to assess cognitive functions, static, and dynamic balance, respectively. Fall risk was measured by the Johns Hopkins assessment tool. Evaluations were performed before and after 7 months of quarantine due to the COVID-19 outbreak (November 2019 - June 2020), in which volunteers were at the lowest level of physical and social interaction., Results: No significant difference was observed in the mean static balance performance of the older adult women between the baseline and quarantine phases [ p = 0.095, t (df) = -1.69]. The dynamic balance performance [ p < 0.001, t (df) = 5.6] and cognitive status ( p < 0.001, t = -7.4) decreased and the fall rate increased [ p < 0.001, t (df) = 7.35] after 7 months of quarantine., Conclusions: It seems that self-quarantine can cause a decline in cognitive functions and dynamic balance performance of older women. It implies that the decrease in social interactions and physical activities caused by the limitations of self-quarantine put individuals at greater risk of cognitive impairment and increase their falling rate by impairing dynamic balance., Competing Interests: The authors report no conflict of interest., (Copyright © 2022 Termedia.)

Background: Today, cardiovascular disease (CVD) is the leading cause of mortality in both sexes. There are several risk factors for heart diseases; some controllable, others not. However, socioeconomic, technological, and environmental factors can impact CVD as well as exclusive risk factors. Accurate identification and assessment of these factors are often difficult. In the present systematic review, we aimed to explore factors affecting CVD., Methods: Multiple databases (MEDLINE, Scopus, ISI Web of Science, and Cochrane) and gray literature were searched. The included studies described at least one determinant of CVD. The framework method was applied to analyze the qualitative data., Results: A total of 64 studies from 26 countries were included. The contextual determinants of CVD were categorized into 45 determinants, 15 factors, and 4 main social, economic, technological, and environmental categories. The 15 potentially reversible factors were identified as sociodemographic, violence, smoking, occupation, positive childhood experience, social inequalities, psychological distress, eating habits, neighborhood, family income, rapid technology, environmental pollution, living environments, noise, and disaster., Conclusions: Devolution and more efficient health policies are required to achieve further sustained reduction in CVD mortality, increase life expectancy, and reduce its associated risk factors. Policymakers should fully address the value of social, economic, technological, and environmental factors. In fact, a prevention agenda should be developed and updated collaboratively in terms of the determinant factors., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 International Journal of Preventive Medicine.)

Nonalcoholic fatty liver disease (NAFLD) is commonly associated with obesity. This randomized, double-blind, placebo-controlled trial aimed to evaluate the effects of turmeric on serum adiponectin and sirtuin 1 (SIRT1) levels, blood pressure, and body mass index (BMI) in patients with NAFLD. A total of 46 eligible patients with NAFLD (BMI, 25.0∼39.9 kg/m 2 ) were randomly allocated to turmeric and placebo groups using block randomization. The turmeric group (n=23) was administered 3,000 mg/d turmeric powder in six 500-mg capsules for 12 weeks, whereas the placebo group (n=23) was administered six placebo capsules/d for 12 weeks. Body weight, BMI, serum SIRT1 and adiponectin levels, and systolic and diastolic blood pressures were measured at baseline and 12 weeks after intervention. Serum SIRT1 levels increased significantly in the turmeric group compared with the placebo group. Additionally, participants in the turmeric group exhibited lower weight, BMI, and systolic blood pressure after 12 weeks of intervention compared with the baseline. Turmeric effectively improved SIRT1 levels in patients with NAFLD compared with the placebo. The efficacy of turmeric might increase with long-term use at higher doses., Competing Interests: AUTHOR DISCLOSURE STATEMENT The authors declare no conflicts of interest., (Copyright © 2022 by The Korean Society of Food Science and Nutrition. All rights Reserved.)

Background: Colorectal cancer (CRC) is the third most common cancer and the second leading cause of death worldwide. However, CRC is considered as one of the most preventable cancers by which the mortality rates reduce about 60% through implementing the screening programmes. The present study aimed to evaluate the main barriers of CRC screening in a defined population., Method: Healthy individuals from all regions of the state were invited to participate in different healthcare centres. They were assessed by a provided online risk assessment tool, which was completed for all recruited subjects, and has been developed to assess the CRC risk based on personal and family history of adenoma, CRC, and other high-risk diseases. Research team staff assessed all individuals by this tool and then eligible people according to their lifetime risk of CRC were included in the study. There was not any age restriction in this study. Colonoscopy and three stool-based tests including faecal occult blood test, faecal immunochemical test and stool DNA tests were performed., Results: Overall, 725 cases including 425 (58.6%) males and 300 (41.4%) females participated in the study. Lack of knowledge and attitude about screening programmes was the most common barrier, especially among women (68% for women versus 58% for men) and those from rural areas (88% in rural versus 55% in urban areas). Fear of colonoscopy and procedure complications and pain (48%), discomfort and anxiety from inserting a tube into the bowel (65% among females versus 43% among males) were reported commonly. Embarrassment and dignity were other complaints, especially in women (62% in females versus 35% in males)., Conclusion: Increasing knowledge and attitude about the aims and benefits of screening programmes, acceptable and convenient communication of health systems with the general population are considered to be the key elements in the success and implementation of any screening programme., Competing Interests: The authors report no conflicts of interest in this work., (© the authors; licensee ecancermedicalscience.)

Particulate air pollutants are known contributors to global cardiorespiratory mortality through several pathways. We examined the effects of varied exposure to PM 2.5 and trace metals on biological markers of airway inflammation, oxidative stress, and hemodynamic function of young individuals living in two different exposure settings. We enrolled and followed a panel of 97 healthy nonsmoking participants aged 15-18 years living in a highly polluted metropolitan city of Tabriz (TBZ) and a much less polluted semi-urban town of Hadishahr (HDS). For five consecutive months, the subjects were examined by a physician, and fractional exhaled nitric oxide levels (FE NO ) were measured. Samples of exhaled breath condensation (EBC) were obtained for measuring interleukin 6 (IL-6), tumor necrosis factor α (TNF-α), and total nitric oxide (NO x ). We measured daily outdoor PM 2.5 mass concentration in a fixed station in each location for all this period. The PM-metal content was analyzed by ICP-MS. The linear mixed-effects regression models were applied for data analysis. The averages of PM 2.5 mass and total metals in TBZ were nearly two and four times higher than in HDS, respectively. In TBZ, an increased IQR of PM 2.5 mass during 0-5 days was -correlated with a significant rise in diastolic blood pressure, heart rate, TNF-α, FE NO , and NO x and reduction of IL-6. Moreover, exposure to low PM 2.5 concentration is significantly -correlated with an elevation in diastolic blood pressure in HDS. We also observed that exposure to metal constituents in the highly polluted region is correlated with increased TNF-α and IL-6 with 131.80% (95% CI: 56.01, 244.39) and 47.51% (95% CI: 33.01, 62.05) per IQR of Hg, respectively. This study suggests that exposure to ambient PM 2.5 and their metal contents in highly polluted areas may incite significant changes in airway inflammation, oxidative stress, and hemodynamic parameters in healthy subjects., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Adolescence is a period of transition for developmental and social domains that may also be accompanied by behavioral problems. Aggressive behavior may be a mental health concern for young teens and is defined as a behavioral and emotional trait that may be distressing for others. This study aimed to understand the factors associated with aggressiveness among young teenage girls. A cross-sectional study was conducted among a sample of 707 female middle school-aged students using multistage random sampling in Tabriz, Iran. The variables of interest were aggressiveness, general health status, happiness, social acceptance, and feelings of loneliness. Structural equation modeling was employed to analyze the data. Low parental support, low satisfaction with body image, high sense of loneliness, and lower perceived social acceptance were found to be the factors influencing aggressiveness. The current study found that the school environment, home environment, individual and interpersonal factors all play a part in aggressiveness. As a result, the contributing elements must be considered when creating and executing successful interventions to improve this population's psychological well-being.

Background: There is a lack of scientific literature on the application of fear appeals theories to evaluate lung cancer risk perception among smokers. The aim of the present study is to apply the Extended Parallel Process Model (EPPM) to discover the perception of the smokers about their lifetime risk of developing lung cancer (perceived susceptibility), their perception of lung cancer survival (perceived severity), response efficacy, self-efficacy, and readiness to quit., Methods: In this cross-sectional study, 215 eligible smokers (aged 45 years and over who have smoked at least 1 pack per day in the last 5 years) were recruited. The data collection tool was designed using validate self-report questionnaires and it was contained items on the perceived risk of a smoker contracting lung cancer and perceived lung cancer survival rate. It also had questions to measure the main constructs of the EPPM and Readiness to quit ("Low&#95;Readiness", and "High&#95;Readiness"). To test how the data support conceptual EPPM to data, Generalized Structural Equation Modeling (GSEM) was used., Results: Findings showed a significant relationship between Perceived&#95;Susceptibility and Perceived&#95;Response Efficacy; (B = 1.16, P < 0.001); between Perceived&#95;Susceptibility and Perceived&#95;Self Efficacy, (B = -0.93, P < 0.001), Perceived&#95;Severity, and Perceived&#95;Response Efficacy (B = 1.07, P < 0.001). There was also a significant relationship between Perceived&#95;Threat and Perceived&#95;Response Efficacy; between Perceived&#95;Threat and Perceived&#95;Self Efficacy. The relationship between High&#95;Readiness and Perceived&#95;Self Efficacy, and between High&#95;Readiness and Perceived&#95;Severity also were significant. However, the relationships between High&#95;Readiness and Perceived&#95;Threat were not significant (P > 0.05)., Conclusion: Perceived&#95;threat and Perceived&#95;efficacy were important for smokers with low readiness to quit, while Perceived&#95;efficacy was most important for smokers with high readiness to quit. These findings could be used in promoting lung cancer awareness and designing smoking cessation programs based on smokers' stages of change., (© 2021. The Author(s).)

Background: The aim of this study was to compare fear of childbirth, state and trait anxiety, and childbirth self-efficacy among primiparous and multiparous women in Ahvaz, southwest of Iran., Methods: This cross-sectional study was conducted with 200 pregnant women (100 primiparous and 100 multiparous women) who had been admitted to the maternity ward of hospitals affiliated to Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. The instruments used for data collection in this study included a demographic questionnaire, Delivery Fear Scale (DFS), Spielberger's State-Trait Anxiety Inventory (STAI), and Childbirth Self-Efficacy Inventory (CBSEI). The data were analyzed by chi-square test and independent t-test. Also, the univariate general linear model was used by adjusting for the socio-demographic and obstetric characteristics that were considered as possible confounding variables., Results: The mean score of DFS in primiparous women was significantly higher than that of multiparous women. The mean of the overall score of childbirth self-efficacy of primiparous women was significantly lower than that of multiparous women. The mean score of the outcome expectancies and self-efficacy expectancies was significantly lower in primiparous women compared with multiparous women. There was no statistically significant difference between the two groups in terms of the mean score of STAI. After adjusting for possible confounding variables, the differences between the two groups in terms of fear of childbirth scores, overall childbirth self-efficacy score and self-efficacy expectancies remained significant., Conclusion: Given the high fear of childbirth and low childbirth self-efficacy in primiparous women compared to the multiparous women, appropriate interventions should be adopted by health care providers in order to reduce fear and improve childbirth self-efficacy in primiparous women., (© 2021. The Author(s).)

One of the major smoking prevention strategies has been to educate the public and increase people's awareness, using health-warning messages. However, many young people continue smoking without paying attention to health risk messages on cigarette packets in Iran. Hence, this study was conducted to examine the processing route of anti-smoking messages and influencing cognitive factors based on the Elaboration Likelihood Model. This cross-sectional study was correlational in nature. The non-probability sample consisted of 387 tobacco smokers in the age range of 18 to 30 years old. The study was conducted between July and November of 2018 in Tabriz, Iran. A researcher-designed questionnaire was used for the purpose of data collection. No causal inferences were drawn due to the non-experimental nature of the investigation. It was found that tobacco smokers often processed the health warning messages through the central route. Perceived severity, smoking abstinence self-efficacy, and psychological dependence were predictors of message processing through the central route. The results supported the conceptual model of cognitional predictors of the processing route. To design and execute effective health warning messages to quit smoking, it is recommended to consider cognitive factors as a means to enhance critical thinking about the content of the health-warning message., Competing Interests: Conflict of interest statement The authors declare no conflict of interest., (©2021 Pacini Editore SRL, Pisa, Italy.)

Background: Anxiety is one of the most prevalent mental health disorders among mothers during the postpartum period, which can lead to maternal and infant physical and psychological consequences. The Postpartum Specific Anxiety Scale (PSAS) predicts unique variance in postnatal outcomes over and above general anxiety tools. It has never been used in Iran and its validity and reliability have not been assessed either. Therefore, the present study aimed to translate and investigate the psychometric properties of the PSAS-IR., Methods: 510 women, from six weeks to six months postpartum, were selected through random sampling in 2020. After forward and back-translation, the face validity, content validity, and construct validity of PSAS (through confirmatory factor analysis) were examined. The reliability of the scale was assessed using both internal consistency (Cronbach's alpha) and test-retest stability methods., Results: CVI and CVR values of the PSAS tool were 0.89 and 0.88, respectively. The good fit indices confirmed the validity of four-factor structure. Cronbach's alpha coefficient and Intra Correlation Coefficient (ICC) equaled 0.93 and 0.92, respectively., Conclusion: The Persian version of PSAS is a valid and reliable four-factor scale, it will improve the measurement of postpartum anxiety in an Iranian setting. This will improve the measurement of postpartum anxiety in an Iranian setting., (© 2021. The Author(s).)

(1) Background: The older adult population of society is exposed to multiple stressors daily, such as the loss of loved ones, dysfunctional mobility, financial dependence, and suffering from numerous chronic illnesses. The present study aimed to assess the psychometric properties of the Anxiety about Aging Scale among older adults in Iran. (2) Methods: A sample of 703 community-dwelling older adults was recruited and screened using a standardized tool. The mean age of participants was 69.4 ± 8.1 years. The majority of participants were male (59.2%), married (66.6%), and illiterate (79.7%). A 'forward-backward' translation method was used in developing the Iranian version of the AAS for assessing the psychometric properties among older adults. Confirmatory factor analysis (CFA) and the Rasch model were used for construct validity. (3) Results: Applying CFA indicated that the model's four original factors are the best solution, representing 55% of the total variance. The result of the CFA showed that this four-factor model had a good fit for the data. The findings were also confirmed by Rasch analysis. (4) Conclusions: The Persian version of the AAS is valid and reliable for measuring aging anxiety among Iranian older adults.

Background: Women's satisfaction with childbirth experience is considered as one of the quality indicators of the maternity services across the world. However, there is no guideline for improving the experience of childbirth in Iran that is suitable for women with different cultural, economic, and social statuses. The aim of this study is to make recommendations for practice and propose a clinical guideline for improving the experience of women with vaginal births., Methods/design: The study design was a mixed method study with a sequential explanatory approach consisting of three phases. The first phase of the study was a cross-sectional study to identify the predictors of traumatic vaginal childbirth experience among 800 primiparous women from Tabriz health centers who had vaginal birth. Data collection tools in this phase were Childbirth Experience Questionnaire (CEQ) and Support and Control in Birth (SCIB). Both tools were validated for Farsi language. The second phase was a qualitative study with 17 in-depth individual interviews among women who took part in the first phase to better understand their reasons that influenced their childbirth experience either positively or negatively. The third phase of the study was to develop recommendations for a proposed clinical guideline through a Delphi study where maternal health experts were selected and invited to take part in the panel. They first rated the proposed recommendations individually and provided written responses on their own agreement or disagreement with each statement in terms of its impact on childbirth experience, feasibility, acceptability, and cost-effectiveness. After three confirmation rounds, the final conscience was reached by the panel members., Results: The results of the quantitative phase showed that the probability of negative experience of childbirth was increased when physical exercise was not implemented during pregnancy, lacking pain relief options, having fear of childbirth, lacking skin to skin contact with the newborn and being unable to initiate breastfeeding in the first hour after birth (P < 0.05). The analysis of qualitative data revealed 13 major theme categories which were related to women's sense of internal control, external control and support. In the third phase of the study, culturally appropriate recommendations were made and an evidence-based clinical guideline was proposed. The proposed guideline was based on the combination of the quantitative and qualitative phases, a review of the literature, and the opinions of Iranian experts using the Delphi technique., Conclusion: Given the high prevalence of negative childbirth experience among Iranian primiparous women, the present study may be of great interest for managers, leaders, policymakers, and care providers to improve the quality of the maternity services. However, further studies are required to translate the recommendations into practice and identify enablers and barriers during the implementation of the proposed guideline. To adopt the recommendations at national level, there is a need to further studies to assess the effectiveness of the proposed guideline within different communities across the region and the country.

Purpose: The slow coronary flow (SCF) was identified as delayed opacification of epicardial coronary arteries in the absence of stenotic lesion. Metabolic syndrome (MetS), oxidative stress, and inflammation may be possible known insulting factors for the pathogenesis of SCF. This investigation aimed to assess the relationship between some inflammatory markers, oxidative stress parameters and MetS components with SCF phenomenon., Methods: A total of 35 patients with SCF and 35 subjects with normal coronary flow (NCF) were included in the study. We assessed some inflammatory markers (IL-1β, IL-18, TNF-α, and NF-κB mRNA expression in peripheral blood mononuclear cells (PBMCs)). Moreover, blood samples of the participants were tested for total antioxidant capacity (TAC), glutathione peroxidase (GPX) and nitric oxide (NO) levels using enzyme-linked immunosorbent assay (ELISA). Diagnosis of MetS was based on the National Cholesterol Education Program's Adult Treatment Panel III report (ATPIII) criteria, 2005. Diagnostic criteria for coronary flow rates of all subjects were documented by thrombolysis in myocardial infarction (TIMI) frame count method., Results: SCF patients had significantly higher prevalence of MetS (46%, p = 0.048).We found that the level of TAC was significantly higher in the NCF group (p = 0.006). Furthermore, the NO concentration was significantly lower in SCF groups (p = 0.001). A significant incremental difference was detected in IL-1β (fold change 2.82 ± 0.31, p < 0.05) and NF-κB (fold change 4.62 ± 0.32, p < 0.05) mRNA expression in the SCF group when compared with its level in the NCF group. Furthermore, according to logistic regression analysis, there were significant associations between IL-1β, NF-κB expression levels and the incidence of SCF (p < 0.05)., Conclusion: Based on the findings of this study, the pathogenesis of the SCF phenomenon may be closely associated with metabolic syndrome and inflammation. The NF-κB/IL-1β/nitric oxide & MetS signaling pathway might be considered as potential therapeutic targets in the management of SCF patients but further researches is required to guarantee these findings., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Purpose: The present study was performed to develop the Persian version of food craving inventory (FCI) (FCI-P) and to assess food craving in Iranian adult population. In addition, individual differences, including sex and body mass index (BMI) in food craving were assessed., Methods: Eight hundred and twenty subjects who participated in the same study Hill (Proc Nutr Soc 66: 277-285, 2007) were studied (540 women and 280 men). The FCI-P, International Physical Activity Questionnaire (IPAQ), Three-Factor Eating Questionnaire (TFEQ), and a questionnaire pertaining to demographic characteristics were completed for all participants., Results: Good content, construct, and convergent validity was observed for the FCI-P. A good reliability was found for both aggregate scores of the FCI-P and scores of its five factors. Exploratory factor analysis showed a five-factor model including "sweets," "high-fat foods," "fast food fats," "carbohydrates/starches" and "high-fat meats". These five factors accounted for 47.31% of the total variance. The scores of "uncontrolled eating" and "emotional eating" of the TFEQ were significantly correlated with the scores of the FCI-P factors and its total score. A significant correlation was found between BMI and the FCI-P score (r = 0.199). Significant differences were observed in the mean age and physical activity score among normal weight, overweight, and obese participants. Normal weight and overweight groups were more active than obese group. Obese participants had higher FCI-P score (P < 0.001) than the normal and overweight groups. FCI-P score was significantly higher in women than men., Conclusions: FCI-P can be used as a valid and reliable measure to assess food craving in Iranian populations. Obese individuals experienced food craving more than normal weight subjects. Similarly, women may experience food craving more than men., Level of Evidence: Level V, cross sectional study.

Background: Socioeconomic disparities in health and healthcare are global issues that affect both adults as well as children. Children with exceptional healthcare needs, especially those with developmental impairments, including Autism Spectrum Disorders (ASD), encounter major disparities in access to and quality of health services. However, disparities in the population of children are rarely studied. The main aim of this paper is to study the socioeconomic disparities in children with ASD by examining the association between their Social Determinants of Health (SDH) status and access to and the quality of services., Methods: This is a cross-sectional study on 202 children with ASD conducted in 2019 in two provinces including Ardabil and East-Azerbaijan, in the North-West of Iran. A structured, valid questionnaire was used to collect data on demographic, SDH status, quality of services, and access to services in a population of children with ASD aged 2-16-year-old. Around 77% participants were male and the mean age of children was 2 years and 6 months. Structural Equation Modeling (SEM) were used to assess the relationship., Results: Based on the results of this study, the overall mean scores of the quality of services, access to services, and SDH status were 61.23 (30.01), 65.91 (21.89), and 29.50 (22.32) out of 100, respectively. All the associations between the quality and access dimensions and quality (B: 0.464-0.704) and access (B: 0.265-0.726) scales were statistically significant (P < 0.001). By adjusting to covariates, the access was also significantly related to service quality (P = 0.004). Finally, the associations between SDH score with service quality (P = 0.039) and access (P < 0.001) were positively significant., Conclusions: There are socioeconomic disparities in the quality of and access to services among children with ASD, who use ASD services, in the North-West of Iran. We recommend health/medical centers, where children are diagnosed with ASD, conducting SDH screening and providing families of low-SDH status with specific information about the quality of and access to services for children with ASD. Additionally, medical universities must have a plan to routinely monitor the quality of and access to services provided for the children with low SDH.

Background: Education by smartphone-based software is a new method among the world's educational practices. Due to the lack of studies on the effect of this education on promoting knowledge and self-care behaviors of students' reproductive health this study aimed to determine the effect of smartphone-based software education on knowledge and self-care behaviors in the field of reproductive health., Materials and Methods: This RCT with 164 married female students (82 in each group) conducted from October 2019 to January 2020, in Tabriz University and Tabriz medical University. Participants were randomly allocated to two groups of educational intervention and control. Smartphone-based software education designed in four areas of reproductive health. Intervention group was trained for 4 weeks. The score of knowledge and self-care behaviors of participants in both groups were compared at baseline and 8 weeks after intervention. Data were analyzed by SPSS-23 software using Chi-square, independent t -tests, and analysis of covariance tests., Results: Eight weeks after the intervention, a significant increase was observed in the mean (standard deviation [SD]) score of overall knowledge for reproductive health and all its subdomains ( P < 0.001), as well as in in the mean (SD) self-care score of reproductive health and all subdomains ( P < 0.05), except for the family planning in the education group compared to the control group., Conclusion: The findings indicate a significant effect of smartphone-based software on increasing students' knowledge and self-care in all areas of reproductive health except for family planning subdomain of self-care., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Education and Health Promotion.)

Background: The aim of the present study was to evaluate the psychometric properties of the Persian version of delivery fear scale (DFS) among Iranian women population., Methods: This is a methodological study that was conducted to evaluate the psychometric properties of DFS. Convenience sampling was used to select 200 pregnant women from the maternity ward of Razi Hospital in Ahvaz, Iran. In the first step, the scale was translated into Persian using backward-forward translation method. Afterwards, the following types of validity were examined: face validity based on impact score, construct validity based on confirmatory factor analysis (CFA), and concurrent validity. The Pearson correlation test was used to determine the correlation of DFS with pregnancy-related anxiety questionnaire (PRAQ), Childbirth Attitude Questionnaire (CAQ), Spielberger's state-trait anxiety inventory (STAI), and the short form of Lowe's childbirth self-efficacy inventory. Reliability of DFS was assessed by determining internal consistency (Cronbach's alpha) and split-half method., Results: CFA had satisfactory validity considering x 2 ⁄df < 5 and the RMSEA < 0.08. /the obtained Cronbach's alpha coefficient was 0.77. The split-half coefficient of the questionnaire was 0.83, indicating an acceptable reliability for the questionnaire. The results showed that DFS had a direct significant correlation with the CAQ (r = 0.72), PRAQ (r = 0.74), STAI-Y1 (r = 0.71) and STAI-Y1 (r = 0.63) and a reverse significant correlation with subscales of the short form of Lowe's childbirth self-efficacy inventory including outcome expectancy (r= -0.75) and self-efficacy expectancy (r= -0.76)., Conclusions: The findings of the present study confirm the validity and reliability of the Persian version of DFS as an instrument for measuring fear of childbirth (FOC) in Iranian women population.

Objectives: After heart disease, brain stroke (BS) is the second most common cause of death worldwide, underscoring the importance of understanding preventable and treatable risk factors for the outcomes of BS. This study aimed to model the survival of patients with BS in the presence of competing risks., Methods: This longitudinal study was conducted on 332 patients with a definitive diagnosis of BS. Demographic characteristics and risk factors were collected by a validated checklist. Patients' mortality status was investigated by telephone follow-up to identify deaths that may be have been caused by stroke or other factors (heart disease, diabetes, high cholesterol, etc.). Data were analyzed by the Lunn-McNeil approach at alpha=0.1., Results: Older age at diagnosis (59-68 years: adjusted hazard ratio [aHR], 2.19; 90% confidence interval [CI], 1.38 to 3.48; 69-75 years: aHR, 5.04; 90% CI, 3.25 to 7.80; ≥76 years: aHR, 5.30; 90% CI, 3.40 to 8.44), having heart disease (aHR, 1.65; 90% CI, 1.23 to 2.23), oral contraceptive pill use (women only) (aHR, 0.44; 90% CI, 0.24 to 0.78) and ischemic stroke (aHR, 0.52; 90% CI, 0.36 to 0.74) were directly related to death from BS. Older age at diagnosis (59-68 years: aHR, 21.42; 90% CI, 3.52 to 130.39; 75-69 years: aHR, 16.48; 90% CI, 2.75 to 98.69; ≥76 years: aHR, 26.03; 90% CI, 4.06 to 166.93) and rural residence (aHR, 2.30; 90% CI, 1.15 to 4.60) were directly related to death from other causes. Significant risk factors were found for both causes of death., Conclusions: BS-specific and non-BS-specific mortality had different risk factors. These findings could be utilized to prescribe optimal and specific treatment.

Background: Given the importance of the childbirth experience, its effects on women's life and society, and the need for its assessment by accurate instruments, this study aimed to determine the psychometric properties of the Questionnaire for Assessing the Childbirth Experience (QACE) in an Iranian women population., Methods: The validity of the Farsi edition of the questionnaire was assessed using the opinions of eight experts. Its construct validity was assessed by studying 530 mothers, at 1-4-month postpartum, who delivered in health centers of Tabriz, Iran. The exploratory factor analysis (EFA) was performed to identify its factors. Then, the confirmatory factor analysis (CFA) was performed for the structural assessment of the extracted factors. Spearman's correlation coefficient was used to investigate the correlation between factors. Cronbach's alpha and intraclass correlation coefficient (ICC) were used to obtain the internal consistency and test-retest reliability., Results: In total, four factors were extracted from the EFA: "relationship with staff" (4 questions), "first moments with the newborn" (3 questions), "feelings at one-month postpartum" (3 questions), and "emotional status" (3 questions). According to the CFA, the model achieved desired fit level (RMSEA < 0.08, GFI, CFI, IFI > 0.90, and x 2 /df < 5.0). Cronbach's alpha (0.77-0.82) and intraclass correlation coefficient index (0.83-0.98) were desirable for all factors., Conclusion: The short edition of the QACE, as a standard tool, can be used by future studies to measure the experience of Iranian women.

As there is limited and inconsistent evidence in potential role of vitamin D on insulin resistance and matrix metalloproteinases, this study aimed to examine the effect of vitamin D supplementation on glucose homeostasis, insulin resistance, and matrix metalloproteinases in obese subjects with vitamin D deficiency. A total of 44 participants with serum 25-hydroxyvitamin D (25(OH)D) level ≤ 50 nmol/L and body mass index (BMI) 30-40 kg / m 2 were randomly allocated into receiving weight reduction diet with either 50 000 IU vitamin D 3 pearl ( n = 22) or placebo ( n = 22) once weekly for 12 weeks. Primary outcomes were changes in fasting serum glucose (FSG), homeostasis model assessment of insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), and matrix metalloproteinases (MMPs). Secondary outcomes were changes in weight, BMI, 25(OH)D, calcium, phosphorous and parathyroid hormone (PTH). Sun exposure and dietary intakes were also assessed. Serum levels of 25(OH)D3 increased significantly with a simultaneous decrease in serum concentration of PTH in the vitamin D group. Weight, BMI, FSG, and MMP-9 decreased significantly in both groups, and there were significant differences in changes in weight, serum 25(OH)D3, PTH, and MMP-9 levels between the groups. Within- and between-groups analysis revealed no significant differences in serum calcium, phosphorous, serum insulin, HOMA-IR, QUICKI, and MMP-2 after intervention. Our results indicated that improvement in vitamin D status resulted in greater reductions in weight and MMP-9 during weight loss. These preliminary results are sufficient to warrant a bigger study group.

It has been suggested that abdominal obesity might be a better cardiovascular diseases (CVDs) discriminator than overall obesity. The most appropriate obesity measures for estimating CVD events in Kurdish populations have not been well-recognized. The objective of the present study was, therefore, to determine the cutoff points of BMI, waist circumference (WC), waist-to-hip ratio (WHR), and waist to height ratio (WHtR) as the diagnostic cut-offs to discriminate the prevalent cardiovascular diseases. The data collected from Ravansar Non-Communicable Disease (RaNCD) cohort, the first Kurdish population-based study, was analyzed. The information related to BMI, WC, WHR and WHtR of 10,065 adult participants in the age range of 35-65 was analyzed in this study. Receiver operating characteristic (ROC) analyses were conducted to evaluate the optimum cut-off values and to predict the incidence of cardiac events. The results showed that WHtR had the largest areas under the ROC curve for cardiac events in both male and female participants, and this was followed by WHR, WC, and BMI. The optimal cut-off values for determining the cardiac events in the Kurdish population were BMI = 27.02 kg/m 2 for men and BMI = 27.60 kg/m 2 for women, WC = 96.05 cm in men and 99.5 cm for women, WHRs = 0.96 in both sexes, and WHtR = 0.56 for men and 0.65 for women. The current study, therefore, showed that WHtR might serve as a better index of prevalent cardiac event than BMI, WHR and WC.

Background: Protocolized ventilator weaning (PW) strategies utilizing spontaneous breathing trials (SBTs) result in shorter intubation duration and intensive care unit (ICU) length of stay (LOS). We compared respiratory therapy (RT)-driven PW versus usual care (UC) as it pertains to physiologic respiratory parameters, intubation duration, extubation success/reintubation rates, and ICU LOS., Methods: prospective, multicentric, randomized controlled trial was performed in closed medical and surgical ICUs with 24/7 in-house intensivist coverage at six academic medical centers in a resource-limited setting from October 18, 2007, to May 03, 2014. Extubation readiness was determined by the attending physician (UC) or the respiratory therapist (PW) using predefined criteria and SBT. Physiologic variables, serial blood gas measurements, and weaning indices were assessed including the Rapid Shallow Breathing Index (RSBI), negative inspiratory force (NIF), occlusion pressure (P0.1), and dynamic and static compliance (C dyn and C s )., Results: total of 5502 patients were randomized (PW 2787; UC 2715), of which 167 patients died without ventilator weaning (PW 90; UC 77) and 645 patients were excluded (PW 365; UC 280). Finally, a total of 4200 patients were analyzed (PW 2075; UC 2125). The PW group displayed improvements in minute ventilation ( P < 0.001), C s and C dyn (both P < 0.05), P0.1 ( P < 0.001), NIF ( P < 0.001), and RSBI ( P < 0.001). Early re-intubation (≤48 h) rates were lower in the PW group (16.7% vs. 24.8%; P < 0.0001), as were late re-intubation rates (5.2% vs. 25.8%; P < 0.0001). Intubation duration was longer in the PW group ( P < 0.001), however, hospital LOS was shorter ( P < 0.001). Mortality was unchanged ( P = 0.19)., Conclusion: PW with RT-driven extubation decisions is safe, effective, and associated with decreased re-intubation (early and late), shorter hospital stays, increased intubation duration (statistically but not clinically significant), and unchanged in-patient mortality., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 International Journal of Critical Illness and Injury Science.)

Background: Poor mental health is common among adolescents. Given the increasing burden of poor mental health among adolescents in developing countries, it seems necessary to identify the effective interventions. The main purpose of this study was to investigate the effects of a school-based mental health promotion program (SMHPP) on mental health parameters among female adolescents in Tabriz, Iran., Method: In this experimental study, a random sample of female high-school students of grade nine was recruited. The subjects were then randomly allocated to intervention (n = 145) and control (n = 139) groups. The three-stage SMHPP was designed based on the shortages and unmet needs of the students as reported in the pretest stage. All subjects in the intervention group were provided with a stress management skill training program of six sessions using McNamara Model. Coincided with making environmental changes, a joyful intervention program was carried out. After 2 months, post-test data were collected., Results: A total of 284 students completed their participation in the study. The groups did not differ in none of socio-demographic characteristics and mental health parameters, at baseline. The number of subjects reporting medium-level of happiness was increased by 32.6% among intervention group. Moreover, upon sign test and pre-post comparison, the group-wise distribution changed between the intervention and control groups for the parameters of life satisfaction (p ≤ 0.001) and psychological well-being (p ≤ 0.01)., Conclusion: The implementation of SMHPP as a low-cost, needs-based and multifaceted program, showed promise in promoting adolescents' mental health, particularly in the parameters of happiness, life satisfaction and psychological well-being. This was an important evidence for the development and implementation of interventions and policies in the field of mental health promotion among adolescents. Our work provided means for reducing burden of poor mental health among adolescents in a non-western cultural context. Further larger studies are required to evaluate the effectiveness of such school-based mental health promotion interventions in students., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s) 2020.)

Background and Aim: The association with obesity of a common variant near the melanocortin-4 receptor (MC4R) gene (rs17782313) has been indicated in various studies. Adherence to dietary quality indices also have shown to have potential favorable effects on obesity-related health outcomes. However, no study has examined the interaction between rs17782313 and the Dietary Approach to Stop Hypertension (DASH) score and the Mediterranean Dietary Score (MDS) on cardio-metabolic risk factors and hypothalamic hormones. Therefore, the purpose of the current study was to examine whether adherence to these dietary quality indices modifies the association of the MC4R rs17782313 polymorphism with cardio-metabolic risk factors and hypothalamic hormones among obese adults., Method: Two hundred eighty-eight healthy obese adults were recruited in this cross-sectional study. Diet quality indices, including DASH score and MDS, were calculated from a validated 147-item food frequency questionnaire (FFQ). MC4R s17782313 genotypes were determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). An ANCOVA multivariate interaction model was used to assess the gene-diet interaction., Results: Significant interactions were detected between DASH score and MC4R rs17782313 genotypes on systolic blood pressure (SBP), atherogenic index of plasma (AIP), and serum glucose and triglyceride (TG) among the female group (p Interaction < 0.05). In the male group, there were gene-DASH and gene-MDS interactions in relation to serum glucose concentration and plasma α-melanocyte stimulating hormone (MSH) levels, but these were found only in multi-adjusted interaction models (p Interaction < 0.05). In addition, there was a significant interaction between MC4R rs17782313 polymorphism and DASH score on plasma agouti-related peptide (AgRP) concentrations in the female group in a multivariate interaction model (p Interaction < 0.05). An inverse association between DASH score and chance of having the CC genotype in a multivariate-adjusted model among women was also revealed., Conclusion: MC4R rs17782313 interacts with healthy dietary pattern (DASH score and MDS) to influence cardio-metabolic risk factors and hypothalamic hormones in obese individuals. Prospective cohort studies are needed to further assess these findings.

Purpose: Pyroptosis, a form of inflammatory programmed cell death, is activated in diabetic patients. This study was conducted to investigate the effects of daily consumption of sodium butyrate (NaBut) and high-performance (HP) inulin supplementation, individually or in combination, on the expression of pyroptosis-related genes, microRNA (miR) 146a-5p, miR-9-5p and biomarkers of oxidative stress in patients with type 2 diabetes (T2DM)., Methods: In this study, we conducted a randomized, double-blinded, placebo-controlled clinical involving sixty patients with type 2 diabetes. Participants received 600 mg/d of NaBut (group A), 10 g/d of HP inulin (group B), 600 mg/d of NaBut + 10 g/d of HP inulin (group C) or placebo (group D) for 45 consecutive days. We assessed the pyroptosis-related genes mRNA expression in peripheral blood mononuclear cells (PBMCs), as well as the plasmatic levels of miR-146a and miR-9 before and after the intervention. Moreover, blood samples of the patients at baseline and following the intervention were tested for total antioxidant capacity (TAC), superoxide dismutase (SOD) and catalase levels using enzyme-linked immunosorbent assay (ELISA). This study was registered on the Iranian Registry of Clinical Trials website (identifier: IRCT201605262017N29; https://www.irct.ir/)., Results: Following butyrate supplementation, the relative expression levels of TLR2/4, NF-κB1, Caspase-1, NLRP3, IL-1β & IL-18 were significantly downregulated (p < 0.05). Furthermore, butyrate and concomitant use of butyrate and inulin caused a significant increase in the fold change of miR-146a and miR-9 compared with the placebo group (p < 0.05). Interestingly, the changes in total antioxidant capacity (p = 0.047) and superoxide dismutase (p = 0.006) were significantly increased after butyrate and concomitant use of butyrate and inulin supplement, respectively., Conclusion: In summary, the change in expression level of miR-146a-5p and miR-9-5p due to butyrate supplementation may have a pivotal role in alleviating of diabetes via inhibiting pyroptosis by targeting TLR2 and NF-κB1. These microRNAs might be considered as potential therapeutic targets in the treatment of type 2 diabetes but further researches is required to prove the link., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Methods: Data were obtained from East Azerbaijan cancer registry database for the 10-year period between 2007 and 2016. Survival analysis was performed to calculate the breast cancer-specific survival proportions and mortality rates. Joinpoint trend analysis was performed to estimate the incidence trend of the cancer., Results: A total number of 4989 patients were recorded with primary diagnosis of breast cancer. Of them, we collected follow-up data for 1335 (1309 female and 26 male). The 10-year crude mortality rate was 3.34 (per 100,000). The one-, two-, three-, five-, and ten-year breast cancer-specific survival proportions were 0.92 (95% CI 0.91-0.93), 0.88 (95% CI 0.86-0.90), 0.84 (95% CI 0.83-0.86), 0.77 (95% CI 0.74-0.80), and 0.65 (95% CI 0.60-0.70), respectively. Over the study period, the age-standardized incidence rates increased from 21.68 to 36.99 (per 100,000) with an annual percentage change of 5.5 percent. Older individuals and males patients had significantly worse survival, and patients with high-grade tumors had significantly higher risk of mortality., Conclusion: A relatively better survival for breast cancer in East Azerbaijan, Iran, was observed compared to the overall breast cancer-specific survival proportions and mortality rates in the country. However, it is still poor compared to the developed countries indicating that inappropriate treatment modalities might have played a role on this., Competing Interests: The authors have no conflicts of interest., (Copyright © 2020 Roya Dolatkhah et al.)

Background: Although the Melanocortin-4 Receptor (MC4R) gene rs17782313 C/T has been consistently related to obesity risk, the interaction between MC4R polymorphism and diet quality indices on cardio-metabolic risk factors has not yet investigated. Therefore we aimed to test this hypothesis., Methods: This cross-sectional study recruited 188 (96 males and 92 females) healthy obese adults aged 20-50 years. Diet quality indices including Healthy Eating Index-2015 (HEI-2015) and Diet Quality Index-International (DQI-I) were constructed using data from a validated food frequency questionnaire. MC4R s17782313 were genotyped by Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP). The interaction between MC4R polymorphism and diet quality indices was tested by Analysis of covariance (ANCOVA) multivariate interaction model., Results: There were significant gene-diet interactions between rs17782313 and HEI-2015 (P Interaction  < 0.05) in modulating low-density lipoprotein cholesterol (LDL-C) levels among female group; rare allele heterozygotes of rs17782313 had highest mean of LDL-C concentration when placed in second tertile of HEI (P < 0.05). Moreover, rs17782313 and both indices (HEI and DQI-I) had significant interaction on serum glucose concentrations, systolic and diastolic blood pressure (SBP, DBP) in males (P Interaction  < 0.05); when adherence to these indices was low, the obesity risk allele was associated with serum glucose concentrations, SBP and DBP. These gene-diet interactions remained significant even after adjustment for potential confounders., Conclusion: Our study showed that MC4R rs17782313 interacts with adherence to the dietary quality indices (HEI and DQI-I) to influence several cardio-metabolic risk factors in obese male and females. Further large prospective studies are warranted to confirm our findings.

Background: Polymorphisms in the interleukin-10 (IL-10) gene have been studied in various ethnic groups for possible association with Behçet's disease (BD). This study aimed to perform a meta-analysis of eligible studies to calculate the association of IL-10 polymorphisms with BD.A systematic literature search was carried out in PubMed, Embase, Web of Science, and Scopus databases to identify relevant publications, and extracted the respective results. Pooled odds ratio (OR) with 95% confidence interval (CI) was used to evaluate the power of association with a random-effects model., Results: A total of 19 articles, consisting of 10,626 patients and 13,592 controls were included in the meta-analysis. The meta-analysis revealed significant associations in allelic and genotypic test models of - 819 (C vs. T: OR = 0.691, P  < 0.001; CC vs. TT: OR = 0.466, P  < 0.001; CC + CT vs. TT: OR = 0.692, P  < 0.001; and CC vs. CT + TT: OR = 0.557, P  < 0.001), - 592 (C vs. A: OR = 0.779, P  = 0.002; CC + AA vs. AA: OR = 0.713, P  = 0.021; and CA vs. AA: OR = 0.716, P  = 0.016), rs1518111 (G vs. A: OR = 0.738, P  < 0.001; GG vs. AA: OR = 0.570, P  < 0.001; GG + AG vs. AA: OR = 0.697, P  < 0.001; GG vs. GA + AA: OR = 0.701, P  < 0.001; and AG vs. GG: OR = 0.786, P  = 0.004) and rs1554286 (C vs. T: OR = 0.582, P  < 0.001; CC vs. TT: OR = 0.508, P  < 0.001; CC + CT vs. TT: OR = 0.605, P  < 0.001; CC vs. CT + TT: OR = 0.665, P  = 0.012; and CT vs. TT: OR = 0.646, P  = 0.001). However, we failed to find any association between - 1082 polymorphism and susceptibility of BD., Conclusion: This meta-analysis demonstrated that the interleukin-10 -819, - 596, rs1518111 and rs1554286 polymorphisms could be responsible against BD susceptibility, and should probably be regarded as a protective factor for Behçet's disease., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s). 2019.)

Background: Mothers' capability for childcare and compatibility with the maternal role represent important challenges in postpartum care. Given the significance of evaluating maternal functioning, and the lack of adequate standard instruments in Iran for this purpose, the present study was aimed at translating and conducting a psychometric assessment of the Barkin Index of Maternal Functioning (BIMF) for Iranian women., Methods: The instrument was translated into Persian using the Backward Forward method. The study included 530 women in the postpartum period admitted to healthcare centers in Tabriz, Iran; they were selected through the cluster sampling method. Face, content, and construct (through exploratory and confirmatory analyses) validity were presently examined. Reliability of the questionnaire was determined using the internal consistency and test-retest reliability methods., Results: Two factors (mom's needs and competency), emerged based on exploratory factor analysis. The x 2 /df ratio was less than 5, and the values of the Root Mean Square Error of Approximation (RMSEA) and the Root Mean Square Residual (RMR) were less than 0.08 and 0.1, respectively, verifying the model validity. Cronbach's alpha coefficient and Intra-class Correlation Coefficient (ICC) were calculated as 0.88 and 0.85, respectively, indicating reliability., Conclusion: The Persian version of the BIMF is a valid and reliable instrument for measuring the postpartum functioning of Iranian mothers.