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Background & Aims of the Study: Beta-Endorphin (β-EP), as the main stress hormone, is secreted during delivery and labor and modifies the pain threshold and sensation. This study aimed to determine the umbilical cord blood level of β-EP and its related factors in two groups of nulliparous women with Natural Vaginal Delivery (NVD) and Elective Cesarean Section (ECS). Materials and Methods: This case-control study was conducted on 80 pregnant women (40 cases & 40 control) at 38-42 weeks of gestation. Besides, the study subjects presented no history of chronic diseases, pregnancy complications, abortion, stillbirth, or infertility. The explored cases were women with NVD and the control were women with ECS. After delivery, a 3-mL blood sample was collected from the placental umbilical cord. After separating the blood serum, the β-EP level was examined using a standardized β-EP kit (Glory Co., USA). Data analysis was performed in SPSS using the Chi-squared test, t-test, and Fisher’s Exact test (P≤0.05). Results: The study groups were matched on individual, social, and obstetric characteristics, such as age, educational level, occupational status, gestational age, body mass index, and the frequency of prenatal care. The obtained results indicated that the umbilical cord blood levels of β-EP were significantly higher in the NVD group, compared to the ECS group (P=0.03). Conclusion: The present research results suggested that NVD provides greater effects on the release of β-EP, in comparison with ECS.

Objective:Community responses are important for the management of early-phase outbreaks of coronavirus disease 2019 (COVID-19). Perceived susceptibility and severity are considered key elements that motivate people to adopt nonpharmaceutical interventions. This study aimed to (i) explore perceived susceptibility and severity of the COVID-19 pandemic, (ii) examine the practice of nonpharmaceutical interventions, and (iii) assess the potential association of perceived COVID-19 susceptibility and severity with the practice of nonpharmaceutical interventions among people living in Afghanistan.Methods:A cross-sectional design was used, using online surveys disseminated from April to May 2020. Convenience sampling was used to recruit the participants of this study. The previously developed scales were used to assess the participants’ demographic information, perceived risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and perceived severity of COVID-19. Multivariate analyses were conducted to assess the potential association of perceived COVID-19 susceptibility and severity with the practice of nonpharmaceutical interventions.Results:The Internet was the main source for obtaining COVID-19 information among participants in this study. While 45.8% of the participants believed it was “very unlikely” for them to get infected with COVID-19, 76.7% perceived COVID-19 as a severe disease. Similarly, 37.5% believed the chance of being cured if infected with COVID-19 is “unlikely/very unlikely.” The majority of participants (95.6%) perceived their health to be in “good” and “very good” status. Overall, 74.2% mentioned that they stopped visiting public places, 49.7% started using gloves, and 70.4% started wearing a mask. Participants who believed they have a low probability of survival if infected with COVID-19 were more likely to wear masks and practice hand washing.Conclusions:It appears that communities’ psychological and behavioral responses were affected by the early phase of the COVID-19 pandemic in Afghanistan, especially among young Internet users. The findings gained from a timely behavioral assessment of the community might be useful to develop interventions and risk communication strategies in epidemics within and beyond COVID-19.

During the last few decades painstaking efforts have been made to eliminate iodine deficiency throughout the world. Todays in regions where dietary iodine intake is adequate or borderline, the main focus is increasing dietary iodine supply in the target population during pregnancy and the first years of life. Objective: The aim of this study was to obtain longitudinal data on urinary iodine excretion and the changes of maternal thyroid parameters in two groups of healthy women with mild-to-moderate iodine deficiency and iodine sufficiency residing in an iodine replete area of Tehran capital city of IR Iran, for more than one decade. Research designs and methods: The present study is part of a cohort study, investigating the relative influences of iodine intake on thyroid size and function of mothers and their infants during and after pregnancy. A total of 500 pregnant women enrolled from two mother-child health care centers and was divided into group I, with median urinary iodine excretion (MUIE) < 150 µg/L, and group II with MUIE ≥ 150 µg/L. Sonographic thyroid volume measurement, urinary iodine excretion and thyroid function tests were measured sequentially in all pregnant women during the three trimesters (T) of pregnancy. Results: The mean ± SD age of the participants was 25.1 ± 5.1 years. The MUIE in group I and II in the first, second and third trimester were 123 and 250 µg/L, 127 and 166 µg/L, 120 and 150 µg/L, respectively. The MUIE in the third trimester of pregnancy in group I did not differ significantly from the values in the first and second trimesters (p = 0.67), but it did decline significantly in group II (p < 0.001). The median thyroid volume of subjects, in the first, second and third trimesters were 7.8, 8.2 and 8.1 ml in group I and 7.5, 8.0 and 8.4 ml in group II, respectively. No difference in thyroid volume was found between two groups in each of the three trimesters of pregnancy (p > 0.05). The mean (± SD) TSH concentration of subjects in first, second and third trimester was 2.3(± 2.6), 2.1(± 1.8), 2.3(± 1.7) mIU/L in group I and 2.1(± 3.1), 2.1(± 1.8) and 2.0(± 1.3) mIU/L in group II, respectively. The trend of TSH rising in group I was 26.7% and in group II it was 13.3%. The mean TSH value in three trimesters did not differ significantly in either groups (p > 0.05). The mean (± SD) total T4 concentrations of subjects in first, second and third trimesters were 13.2(± 3.4), 13.8(± 3.3), 13.0(± 2.9) µg/dl in group I and 13.1(± 3.2), 13.7(± 2.9), 13.4(± 3.2) µg/dl in group II, respectively. The mean total T4 value in three trimesters did not differ significantly in either groups (p > 0.05). There was no correlation between the thyroid volume and three observed parameters (UIE, total T4 and TSH) during the pregnancy in either groups. Conclusion: Even in areas with well-established universal salt iodization program, pregnancy could be a risk of having iodine deficiency and systematic dietary fortification needs to be implemented in this vulnerable group.

Background: Coronavirus is a viral disease with a fast-spreading rate. It has become a pandemic. For preventing the covid-19 infection, respect for health protocols is necessary. The level of adherence to the protocols depends on one’s risk perception. To measure the level of risk perception, a valid and reliable measurement tool is needed. The present study is an attempt to evaluate the psychometric properties of the coronavirus infection risk perception (CIRP) questionnaire, with a working life approach. Methods: The article concentrated on the generation, translation, cross-cultural adaptation, and psychometric properties of the CIRP questionnaire. In this cross-sectional study, authors generated an item pool, extracted from the literature relating to risk perception in COVID-19 disease. 228 people participated in the study. The initial scale, consisting of 41 Items, was produced from literature. A scale, containing 26 Items, appeared as a result of Exploratory Factor Analysis (EFA). Cronbach’s alpha was used to measure the internal consistency. Data analysis was conducted at a 95% confidence level. Data were analyzed using the SPSS statistical version (V. 21). Results: Exploratory factor analysis of the scale, explained 45.3% of the variance observed. In addition to the analyses indicated, satisfactory results for internal consistency (Cronbach's alpha ranging from 0.72 to 0.87) and intra-class correlation (ranging from 0.79 to 0.94) were obtained. Conclusion: This study generated the Persian-language version of the CIRP, for Iranian individuals through psychometric testing, to measure risk perception. This questionnaire is reliable for measuring people's CIRP.

Introduction: Nowadays many physicians have focused their attention on using low invasive methods for the treatment of disc protrusion. Thus, the current study was carried out to evaluate the effect and therapeutic outcomes of clinical percutaneous laser disc decompression (PLDD) in the treatment of chronic low back pain caused by disc protrusion during a two-year follow-up. Methods: This historical cohort study was conducted on 40 patients, who were suffering from chronic low back pain caused by disc protrusion diagnosed, and referred to the pain clinic of Akhtar Hospital from March to August 2016 were treated with PLDD and were followed up for at least two years after performing PLDD (from 2018 to 2019). All the information has been extracted using medical records and patient interview. The severity of pain was measured by the Numeric Rating Scale (NRS), and the Oswestry disability index (ODI) was measured before and two years after the treatment. Results: The most common sites for two-level PLDD were L4-S1 and L3-L5, and the most common sites for one-level PLDD were L5-S1 and L4-L5. Overall, the levels of pain and functional disability two years after PLDD showed significant improvements (P =0.0001). The results revealed no statistically significant differences in NRS and ODI scores between the two groups of men and women two years after PLDD (P >0.05). Furthermore, they indicated no statistically significant differences in NRS and ODI scores between the different disc protrusion levels two years after PLDD (P >0.05). Conclusion: It seems that the PLDD is a low-invasive, safe, and effective method that can be used in patients with chronic low back pain caused by a disc protrusion. Therefore, it can be considered as a suitable choice in treating patients with chronic low back pain caused by a disc protrusion.

Background: Thyroid disorders such as subclinical hypothyroidism and isolated maternal hypothyroxinemia are understudied in pregnant women, despite their possible adverse effects on the health of m...

Background: Physical activity affects office employees in achieving a healthy lifestyle and preventing diseases such as Musculoskeletal Diseases (MSDS). Combining sports such as stretching exercises in healthy lifestyle programs is one of the most important decisions to prevent such disease.Purpose: This study aimed to predict factors of interpersonal and situational influences for stretching exercise (SE) among office employees at Shahid Beheshti University of Medical Sciences.Methods: A cross-sectional study was conducted among 420 office employees recruited by multi-stage cluster sampling. Self-administered questionnaires of SE and interpersonal and situational influences based on Pender’s Health Promotion Model, as well as socio-demographic data, were used in this study. The collected data were analyzed using Spearman correlation and logistic regression tests.Results: Results showed that among 420 participants, the scores of interpersonal and situational influences, and SE were 4.6±11.52, 4.5±14.21, and 2.48±17.64, respectively. There was a significant relationship between interpersonal influence and SE (r=0.54; p0.05), and interpersonal influences were a strong predictor for SE behavior.Conclusion: This study showed that the office employees who were more interpersonal influencers were more likely to do stretching exercise behavior. Therefore, interpersonal factors could be used as an educational principle in facilitating admission behavior of SE regarding Pender’s Model.

BACKGROUND: Breakthrough pain (BTP) is an important challenge in treatment and requires a rapid onset of action for pain control. BTP should be adequately controlled with a stable dose of a short-acting oral opioid. So far, no drug is available for the treatment of BTP in cancer patients in Iran, so we designed the first study in Iran to investigate the effect of sublingual fentanyl in relief of pain episodes in these patients. OBJECTIVE: The purpose of this study was to evaluate the efficacy and safety of sublingual fentanyl in the treatment of breakthrough pain in cancer patients. METHOD: This study was a randomized double-blind placebo-controlled clinical trial in cancer patients with breakthrough pain (at least 1–4 episodes of acute pain with moderate to severe pain daily) referred to the pain clinic of Akhtar and Masih Daneshvari hospitals in 2019. The study consisted of two stages: 100 patients were selected by simple, non-random sampling and entered the open-label titration phase. The primary efficacy endpoint was the sum of pain intensity difference over 30 min post-administration. Secondary efficacy endpoints included pain intensity difference (PID) and pain relief (PR) throughout the 60-min post-dose assessment period. In the double-blind study, patients were randomly divided into two groups of placebo (n=50) and intervention (sublingual fentanyl tablet) (n=50). For evaluation of efficacy, 10 episodes were treated in each group and the results were recorded by the patient. (Clinical trial registration: IRCT20131124015515N8). RESULTS: A total of 100 patients entered the titration phase, primary efficacy of sublingual fentanyl was 3.5±0.6 and secondary efficacy of sublingual fentanyl (60 min, after treatment) was 0.3±0.6 which was statistically significant. In the titration phase, the treatment success rate was 100%. In the double-blind phase of the study, the pain intensity in multiple episodes showed a significant improvement at 15, 30, 45, and 60 min after drug administration (P=0.0001). The intensity of pain in each episode was significantly decreased compared to the next episode (P=0.0001). The mean frequency of pain episodes in the sublingual fentanyl group showed a significant decrease (P=0.0001). The most common adverse drug events in the titration phase were drowsiness (20%), dizziness (7%), and nausea 4%, and in the double-blind phase only drowsiness (12%). (Cancer Research Center, Shahid Beheshti University of Medical Sciences, Survey). CONCLUSION: Sublingual fentanyl appears to be effective for patients with rapid-onset analgesia, has short-acting duration, is effective medication, safe, and well tolerated. It is a suitable choice in Iranian patients with chronic cancer-related pain controlled suffering from acute pain episodes related to cancer.

Background: This aim of this study was examining the application of the Health Action Process Approach Model (HAPA) in predicting diagnostic mammography among women over 40 years old in Iran.Methods: This was a cross-sectional study that was performed on four hundred women over 40 years old in health centers in Tehran between May to September 2017. The multi-stage cluster sampling were selected for sample research. The instrument was designed on based literature review about Health Action Process Approach (HAPA). Data were collected by self-report questionnaires and analyzed using statistical tests, t-test, correlation regression analysis. The predictors of diagnostic mammography were determined by the structures of the HAPA model.Results: The result regression analysis showed the diagnostic mammography behavior prediction rate, using the structures of the HAPA model was generally 60%.Conclusions: This study showed the effectiveness of the HAPA to predict diagnostic mammography in women over 40 years old. So, it seems examining mammography behavior and individuals' beliefs about breast cancer based on HAPA model is important in order to development of training programs and effectiveness interventions for breast cancer prevention.

Although Iran has been considered iodine replete since 2000, the first national survey of iodine intake among Iranian pregnant women in 2014 indicated that despite the adequate intake of iodine by the general population, this vulnerable group has moderate iodine deficiency. Therefore, in this national cross-sectional interventional study, we aimed to assess the iodine intake and thyroid function of Iranian pregnant women 2 years after implementing national iodine supplementation for this vulnerable group. In this cross-sectional study, we conducted a national interventional survey of pregnant women. A total of 1200 pregnant women (400 women from each trimester) from 12 provinces of Iran were recruited from the antenatal care clinics from October 2018 to March 2019. The median urinary iodine concentration (MUIC), as an indicator of iodine status in three spot urine samples, was measured, along with the serum total T4 (TT4), thyrotropin (TSH), thyroglobulin (Tg), thyroid peroxidase antibody (TPO-Ab), and iodine content of household salt. The mean age of the cohort was 28 ± 6.2 years, with the mean gestational age of 22.7 ± 13.0 weeks. The overall MUIC (IQR) of pregnant women was 188 µg/L (124.2–263 µg/L). Also, the MUICs in the three trimesters of pregnancy were 174 µg/L (110–254), 175 µg/L (116–251), and 165 µg/L (114–235), respectively. The MUICs ≥ 150, 100–149, and

Context: Thyroid hormones can affect the development and function of the central nervous system and various other organs. As such, the pathologic excess of these hormones, known as thyrotoxicosis, can be the source of significant damage during childhood and adolescence. The objective of this study was to review the management of Graves’ disease (GD) in the pediatric age group, especially concerning long-term antithyroid drug (ATD) treatment. Evidence Acquisition: A thorough search of literature published from 1980 to 2019 was performed in PubMed only for English language literature. The following key terms were used: “Graves’ disease, hyperthyroidism, thyrotoxicosis in children, thyrotoxicosis remission, thyrotoxicosis relapse, definite therapy, radioactive iodine, thyroidectomy, anti-thyroid drugs, propylthiouracil, methimazole, and carbimazole”. We also did a thorough search in review articles, observational studies, open-label/controlled randomized/non-randomized trials, and meta-analyses, as well as the articles cited by textbooks, chapters, and review articles, which led us to locate older sources of information on the topic. Results: More than 90% of thyrotoxicosis in the pediatric age group is attributable to GD. A host of strategies, including ATDs, radioiodine therapy, and surgery, are employed to treat this entity. However, there is still significant controversy regarding the most optimal strategy. Current evidence suggests that ATDs are the best initial treatment in pediatric patients with GD. Although ATDs are widely used, the duration of their administration is controversial and varies significantly between protocols. A major problem is the high relapse rate (up to 70%), but extending the duration of such treatment could potentially bring the remission rate up to 88%. Indications for using radioactive iodine treatment include the lack of remission following years of receiving ATDs, poor compliance, and the emergence of a major side effect. In pediatric patients aged five-years-old or younger who suffer from very large goiter, severe ophthalmopathy, and persistent hyperthyroidism, as well as those with the lack of response to or showing adverse effects of ATDs, it is advisable to consider total or near-total thyroidectomy. Conclusions: Antithyroid drugs are the mainstay of treatment of juvenile GD, and long-term methimazole therapy increases the remission rate in pediatric GD.

Background: Breast cancer is a major public health problem in both developed and developing countries. The mortality rates of this disease are due to the lack of awareness about screening methods and late detection of breast cancer, which is high in Iran. Objectives: The aim of this study was to determine breast self-examination (BSE) behaviors applying protection motivation theory (PMT). Methods: In this cross-sectional study, the multi-stage cluster sampling method was used to 410 women aged 40-65 years old in Tehran, Iran. The questionnaire was completed through self-reported for each of the participants. PMT theoretical variables and BSE behavior are the basis of the data collection procedure. All analyses were performed using SPSS 20 for the windows. One-way ANOVA, chi-Square test, Independent Samples t-test, logistic regression, and Pearson correlation coefficient were applied. We set 0.05 as a criterion for statistical significance. Results: The results indicated there were significant and positive correlations between the knowledge about breast cancer and selfefficacy of practicing BSE (r = 0.43, P < 0.001), response efficacy (r = 0.20, P < 0.001), and protection motivation (r = 0.25, P = 0.003). Conclusions: Healthcare providers may consider PMT as a framework for developing educational interventions aiming at improving women’s BSE behavior. © 2020, Author(s).

Background: Hepatitis B virus (HBV) infection is a major public health problem worldwide. Health care workers are at high risk of obtaining HBV infection due to direct interaction with HBV-infected blood and body fluids in their workplace.Objective: The purpose of this research was to assess KAP of Health care workers towards Hepatitis B infection in Kabul.Methods: this cross-sectional study was conducted between November, 2018 and January; 2019 among 502 health care workers using simple random sampling method. The tool for data collection was a self-administered structured questionnaire. The collected data were analyzed using SPSS 16.00.Results: The overall knowledge, attitude and practice score of HCWs were 86.58%, 34.73% and 61.22% respectively. Most of participants correctly identified HBV transmissions. Health care workers with higher education level, showed good knowledge than those with low educational level (p < 0.0001). The majority of the participants had a poor attitude towards HBV prevention (53.98%). only 77.45% of participants had been screened for HBV and 56.37% of participants had been vaccinated against HBV, only 5.17% had completed three doses of vaccine.Conclusion: The finding of our study shows that health care workers in Kabul, are at higher risk of acquiring HBV infection due to low vaccination coverage and poor preventive practice. We recommend that free and compulsory vaccination, awareness and encouraging programs should be provided for all health care workers in order to increase favorable attitude and effective preventive measures for HBV infections.

Introduction: The purpose of this study was to find, the prevalence of self-medication with antibiotics, and antibiotics used for self-treated disease.Methods: this cross-sectional study was carried out among 385 participants in 12 community pharmacies located in 4 different regions of Kabul from May to November 2017. Standard questionnaire based on similar studies was designed and distributed among participants. Data was collected and analyzed in SPSS 16.0.Results: out of 385 participants (61.29% male and 38.70% female) 282 persons (73.25%) had practiced antibiotic self-medication during last year. The common reasons for antibiotic self-medication was economic problems (26.95%), lack of time (22.69%), comfortability (21.63%), lack of confidence on health care system (17.37%), and poor access to health care facilities (11.34%). Conditions like cough (28.01%), common cold (14.89%), respiratory infections (13.47%), sore throat (12.41%) and diarrhea (7.44%) were commonly self-medicated with antibiotics. penicillins (25.17%), metronidazole (15.60%), ceftriaxone (14.18%), tetracycline (10.28%), Azithromycin (9.21%), cefixime (7.09%), ciprofloxacin (6.73%) were mostly used for self-medication. 93 (32.97%) respondents had experienced side effects during antibiotic self-medication. Conclusions: The prevalence of antibiotic self-medication is very high (75.53%) in Kabul and this widespread antibiotic use has increased the risk of antibiotic resistance. Awareness and Strict rules for selling antibiotics without prescription should be developed and implemented to improve the rational use of antibiotics. Only pharmacists or professional peoples should be permitted to work in pharmacies. The quality, accessibility and cost of health care services should be enhanced in order to improve patient’ satisfaction in health care system.

Background: The outbreak of corona virus diseases (COVID-19) has rabidly spread all over the world. Community responses are important for outbreak management during the early phase when preventive interventions are the major options. Therefore, this study aimed to investigate perceived susceptibility and severity and behavioral responses at the early phase of the COVID-19 epidemic in Afghanistan population. Methods: A cross-sectional online survey was performed after confirmed COVID-19 in Afghanistan. The population of the study was 500 residents of the in provinces of Afghanistan that were randomly surveyed. The research tool was demographic and perceived threat questionnaire. The data analyzed using the SPSS statistical version (V.20). Findings: The means of age participants was 26.44± 7.64. Many respondents reported their health status were very good or good (95.6 %; 430/450). About 12.4 (n- 56) participants had respiratory symptoms in the past 14 days and 16.2 % had a history of travelled outside their city where they live. The means of perceived susceptibility and Perceived severity was 4.09±2.21 and 11.02±1.82 respectively. Interpretation: Perceived susceptibility the research community was very low and perceived severity toward COVID-19 in the community of Afghanistan Provinces was very high. Most participants are alert to disease progression. It seems that psychological and behavioral outcomes to COVID-19 had been considered during the phase of the outbreak. This study suggested timely behavioral assessment of the community is beneficial and effective to inform the next intervention, and risk communication strategies in at epidemic disease. Funding Statement: No funding. Declaration of Interests: All authors stated that there is no conflict of interest for this manuscript. Ethics Approval Statement: This study has been approved by the Ethics Committee of Afghanistan National Charity Organization for Special Diseases (ANCOSD) (ID: AF. ANCOSD. HREC. 016, 25/04/2020).

Aim: The purpose of this examination is determining predictors to oral health behaviors predict in Iranian students in district 1 Tehran based on the health belief model with added commitment to plan construct. Methods: This cross-sectional study were randomly selected conducted on 351 eligible four grade female students in the first district of Tehran, Iran in 2017. The random Multi‑stage random cluster sampling method was used to recruit students. The inclusion criteria were being graded, four female students (aged 9-11 years), or education at the fourth grade of one of the elementary schools studied in the first district of Tehran and, The health of the student from a physical and psychological of view. Logistic regression analysis was used to identify the variables that predict oral health behaviors. To assess the predictors of oral health behaviors, all the expanded Health Belief Model constructs with the construct of “Commitment to Plan of Action” from “Health Promotion Model were examined as risk factors to see if they influence on the probability of brushing behavior and dental floss behavior occurrence and were interpreted through odds ratio (OR). SPSS version 19 was used to analyze the data. Results: Totally 308 four grade female students with mean age of 9.32 ± 0.81 years old took part in the study. The total 31.8% of the students reported that they were brushing behavior less than twice a day and 55.2% students claimed, use of dental floss behavior once a week or less than once a day. The results indicated that perceived self-efficacy (OR=1.46, 95% CI=0.57-3.78, P

Iodine is a micronutrient used by the thyroid gland to produce thyroid hormones, which manage different aspects of body metabolism. Humans depend on exogenous sources of iodine to maintain the normal concentration of thyroid hormones. Pregnancy alters iodine turnover and is associated with significant changes in thyroid function. Daily iodine requirement during pregnancy increases to 250 μg, compared with 150 μg for nonpregnant women. According to recent guidelines of scientific organizations, to improve maternal thyroid status and to prevent child neurocognitive defects, all pregnant and breastfeeding women should take 150 μg of iodine supplementation, not only in iodine-deficient regions but also in iodine-sufficient areas. However, some recent studies have confirmed that iodine supplementation of mildly iodine-deficient pregnant women has no clear benefits as concerns maternal thyroid function or child neurodevelopment.

espanolAntecedentes: los empleados de oficina de todas las edades corren el riesgo de contraer enfermedades no transmisibles, como los trastornos musculoesqueleticos (TME) debido a la inactividad fisica. El comportamiento del ejercicio de estiramiento (SE) podria ayudar a los empleados de oficina a prevenir los TME. Esta investigacion tuvo como objetivo estudiar los predictores de SE entre los empleados de oficina que trabajan en la Universidad de Ciencias Medicas Shahid Beheshti (SBUMS) de Iran a traves de un modelo de promocion de la salud (HPM). Metodos: en el presente estudio, 430 empleados de oficina elegibles fueron seleccionados al azar. Para evaluar los predictores de SE, todos los constructos de HPM se examinaron como factores de riesgo para determinar si influyen en la probabilidad de ocurrencia de comportamiento de SE y se interpretaron a traves de odds ratio (OR). SPSS version 19 se utilizo para analizar los datos. Resultados: un total de 420 empleados de oficina con una edad media de 37,1 ± 8,03 anos participaron en el estudio. Este estudio demostro que las barreras percibidas para la accion podrian evitar que los participantes se involucren en SE (OR [IC 95%]: 0.875 [0.815-0.939], p Conclusiones: Este estudio mostro que los empleados de la oficina que tenian mas confianza y estaban comprometidos con un plan de accion, y percibian menos barreras, tenian mas probabilidades de participar en el comportamiento de SE. EnglishBackground: Office employees of all ages are at risk for non-communicable diseases such as musculoskeletal disorders (MSDs) due to physical inactivity. Stretching exercise (SE) behavior could help office employees prevent MSDs. This research aimed to study the predictors of SE among office employees working in Shahid Beheshti University of Medical Sciences (SBUMS) of Iran through a health promotion model (HPM). Methods: In the present study, 430 eligible office employees were randomly selected. To assess the predictors of SE, all the HPM constructs were examined as risk factors to determine whether they influence the probability of SE behavior occurrence and were interpreted through odds ratio (OR). SPSS version 19 was used to analyze the data. Results: A total of 420 office employees with mean age of 37.1 ± 8.03 years took part in the study. This study showed that perceived barriers to action could prevent participants from engaging in SE (OR [95% CI]: 0.875 [0.815-0.939], p 2019;71:178-85)

I deficiency can lead to detrimental effects, particularly in neonates and young infants. The aim of this study was to explore whether postpartum maternal urinary I can be used to estimate the I status of newborns. In this cross-sectional study conducted in Tehran, lactating mothers and newborns, within 3–5 d postpartum, were randomly selected. Urine samples were collected from each mother and newborn, and a heel-prick blood sample was obtained from all newborns as part of the routine national newborn screening programme. According to the WHO criteria, median urinary I concentration (UIC) 5 mIU/l was considered as I insufficiency. A total of 147 postpartum women and neonates, aged 27·8 (sd5·3) years and 4·2 (sd0·6) d, respectively, completed this study. The median UIC was 68·0 (interquartile range (IQR) 39·4–133·5) and 212·5 (IQR 92·3–307·3) µg/l in postpartum mothers and newborns, respectively. The median neonatal TSH was 1·00 (IQR 0·50–1·70) mIU/l. There was no significant difference in the neonatal UIC and TSH of infants whose mothers had deficient and sufficient urinary I. In the multiple linear regression, neonatal UIC value was associated with maternal urinary I (P=0·048) and parity (P=0·039); a significant association was observed between neonatal TSH and infant sex (P=0·038) and birth weight (P=0·049). The findings of our study demonstrate that, despite postpartum mothers being mildly I deficient, I status of their infants was adequate as assessed by UIC and TSH values. It seems factors other than maternal urinary I may influence the I status in newborns.

The aim of this community-based study is to ascertain the effect of different obesity phenotypes on the incidence of chronic kidney disease in Iranian adults.A prospective cohort study, the Tehran Lipid Glucose Study (TLGS).Adults aged ≥ 20 years with a mean age of 40.38 years (54.8% female) who were free from chronic kidney disease (CKD) at baseline (phase 1) and were followed up at 3 time stages (phases 2, 3, and 4) for a mean duration of 9.4 years to assess the risk for CKD.Obesity phenotypes.Incidence of chronic kidney disease.Glomerular filtration rate (GFR) was estimated from the simplified equation developed using data from the Modification of Diet in Renal Disease (MDRD) Study.CKD events occurred in 1162 participants. The prevalence of the 2 known obesity phenotypes (metabolically obese normal weight [MONW] and metabolically healthy but obese [MHO]) in the overall population was 3.5% and 8.8%, respectively. According to Kaplan-Meier curves, rates of freedom from CKD in the MHO and MONW obesity phenotypes were 75.3% and 60.6%, respectively (p0.0001). Age- and sex-adjusted (model 1) hazard ratios for participants with MHO or MONW obesity phenotype were 1.14 (95% confidence interval [CI], 0.91-1.43) and 1.43 (95% CI, 1.09-1.88), respectively. After further adjustment for confounder variables (model 2), multivariate-adjusted hazard ratios for CKD for participants with MHO or MONW obesity phenotypes were 1.23 (95% CI, 0.93-1.62) and 1.43 (95% CI, 1.08-1.90), respectively.Adults with the MONW obesity phenotype compared to those with MHO obesity phenotype have a higher risk for incidence of CKD. The results indicate that having a normal weight is not the only factor to protect against incidence of CKD.

The PRECEDE-PROCEED model is an adaptable planning model that could be served in public health issues. The purpose of this study is to investigate the effects of an educational program based on Precede-Proceed model on promoting Low Back Pain (LBP) behaviors among health care workers (HCWs). This Double-blinded randomized trial study was conducted on 112 from 120 HCWs aged from 30 to 55 years The eligible HCWs were randomly divided to intervention group 1 (N = 38), respectively intervention group 2 and control group (N = 37) for which the Precede-Proceed - based educational program was implemented and control group (N = 37). The random multi-stage cluster sampling method was used to recruit HCWs. HCWs completed a self-reported questionnaire on their Low Back Pain Behaviors assessment questionnaire based on the Precede-Proceed Model and a visual analogue scale (VAS) was also used. The data were gathered at initial of the study, 6 and 12 months follow-ups from three groups and were analyzed through SPSS version 19. There was a significant interaction between the factors “group” and “test time” (p < 0.05, p < 0.001) of knowledge, perceived self-efficacy, and attitude, reinforcing factors, enabling factors, public health, quality of life and LBP preventive behaviors of the intervention group., although, no significant alternate became located in the mean score of above structures of the control group. The findings of the present study confirmed the effectiveness of the PRECEDE-PROCEED model-based educational program on preventing LBP by enhancing scores of model constructs. However, these results should be repeated in further studies to be able to apply this program in health system., Occupational health; Health profession; Rehabilitation; Physical activity; Public health; Quality of Lifel PRECEDE-PROCEED model; LBP, Preventive behavior, Attitude, Enabling factors, Reinforcing factors.

Hemophilia is a rare inherited disorder associated with abnormal repeated bleeding and debilitating joint pain due to deficiency in coagulating factors VIII and IX. This study aimed to provide an updated account on the health-related quality of life (HRQoL) in children with hemophilia in Afghanistan.This cross-sectional study included 65 randomly selected hemophiliacs out of 350 children registered with the Afghanistan Hemophilia Patient Association (AHPA). The patients were 8-16 years old and voluntarily entered the study. Data were collected through a demographic questionnaire and a Persian version of Haemo-QoL Questionnaire (short version) for children aged 8-16 years.The patients' age averaged 12.9 ± 3.9 years with a mean QoL score of 75.9 ± 17.4. The patients were suffering from hemophilia A, mostly the severe type (80%). They were born to low income families (95 %) with high illiteracy rates (50%) and hemophilia family history (90%). Spearman test showed a significant correlation between age and QoL scores (r = 0.8, P = 0.02). One-way ANOVA indicated no significant difference between QoL scores of patients categorized based on hemophilia severity (P = 0.2, F = 1.3), family incomes (P = 0.9, F = 0.01) and parents' levels of education (P = 0.2-0.4, F = 0.82-1.3). The Cronbach alpha for the instrument was 0.82.Regardless of hemophilia severity, Family and Sports were the most impaired domains of QoL. Herein, we have presented the first reliable and updated data on hemophiliacs' demographic characteristics and their quality of life in Kabul.

Secondary and tertiary preventions are concerned with the recognition of the disease process in a very early stage and delay in progression to complete disease and minimization of complications and the impact of illness.All articles related to secondary and tertiary prevention of thyroid diseases were reviewed. Using related key words, articles published between 2001 and 2015 were evaluated, categorized, and analyzed.In secondary prevention, congenital hypothyroidism and subclinical hypo and hyperthyroidism are equally important. Routine screening of patients with multinodular goiter by either ultrasonography or calcitonin is a controversial issue, while calcitonin assessments in medullary cancer and RET in family members are recommended. Screening of thyroid disease in pregnancy is limited to those with risk factors. Views regarding the importance of thyroid autoimmunity in secondary prevention are also presented. In tertiary prevention, prescribing excessive doses of levothyroxine, in the elderly in particular and appropriate care of all patients to avoid progression and complications are the key issues.Optimization of management of thyroid diseases requires timely screening, prevention of progression to more sever disease, optimal medical care, and avoidance of iatrogenic conditions.

Background Primordial and primary preventions of thyroid diseases are concerned with avoiding the appearance of risk factors, delaying the progression to overt disease, and minimizing the impact of illness. Summary Using related key words, 446 articles related to primordial and primary, preventions of thyroid diseases published between 2001-2015 were evaluated, categorized and analyzed. Prevention and elimination of iodine deficiency are major steps that have been successfully achieved and maintained in many countries of the world in last 2 decades. Recent investigations related to the effect of cigarette smoking, alcohol consumption, and autoimmunity in the prevention of thyroid disorders have been reviewed. Conclusions The cornerstone for successful prevention of thyroid disease entails timely implementation of its primordial and primary preventions, which must be highly prioritized in related health strategies by health authorities.

Background Iodine deficiency and related disorders were very common in Iran prior to 1996, when universal salt iodization (USI) was implemented and in 2000 Iran was declared iodine deficiency disorders (IDD) free. The aim of this study was to evaluate the adequacy of iodine intake by Iranian households in all 30 provinces of Iran, a quarter of a century after the intervention. Methods A total of 18,000 school-aged children (8–10 years with mean 8.7 ± 1 year) were included in this study. Urine samples were collected from all children for measurement of urinary iodine excretion and 1800, 210 and 3000 salt samples were randomly collected from the family kitchen, production site of 73 salt factories and distribution circles of 30 provinces, respectively. Results The median urinary iodine concentration (UIC) of participants was 161 μg/L. The proportion of children with UIC of, 20–49, 50–99 and ≥ 100 μg/L were 10.3, 15.9 and 73.7%, respectively. The mean (± SD) and median salt iodine values were 28.2 (± 12.6) and 31.7 ppm, at the production site, and 31.5 (± 13.6) and 29.6 ppm at the distribution circles, respectively. About 80% of factory salts had more than 20 ppm iodine. 98% of households consumed iodized salt, 80% had appropriate salt storage, and 83% of the household salts contained ≥ 20 ppm. Conclusions Based on the results of this study, Iranian populations are consuming adequate iodine. The well-maintained and monitored USI program has improved the dietary iodine intakes of the population, and the country has achieved all criteria of a well-controlled IDD program.

ObjectiveTo evaluate the newborn screening programme for congenital hypothyroidism (CH) in Iran from diagnosis to management and follow-up for 3 years from 2011 to 2014.DesignRetrospective cohort.Setting and patientsSeventeen university districts were randomly selected from 30 provinces. Central data in each district were gathered and collectively analysed. Congenital hypothyroid subjects were followed for 3 years.Main outcome measuresProgramme coverage, screening and treatment age, recall rate, compliance to follow-ups.ResultsThe total number of births in 2011 was 501 726, of which 452 918 neonates (90.3%) were screened and 15 671 (3.46%) were recalled; 1085 (1:462, 0.22%) were confirmed as having CH (57.1%: permanent, 42.9%: transient) and followed for 3 years. Positive predictive value (PPV) for the first screening test was 6.9%. After the second screening, recall rate was reduced to 0.69% and PPV increased to 31.3%. Median age at screening was 6 (3–9) days and for 90.6% of patients treatment was initiated before 40 days of age with a median levothyroxine dosage of 25 µg/day; 131 (13.4%) were lost to follow-up. Mean number of follow-up visits over 3 years was 5.7 (95% CI 5.5 to 5.9) and 23% (n=225) had total compliance to all follow-ups. Median time for thyroid stimulating hormone normalisation was 45 days, 95% CI (41.1 to 48.8).ConclusionIn Iran, despite well-established protocols of screening and detecting CH subjects, stricter implementation of a structured system for monitoring and surveillance is needed to promote the management of patients and to reduce rates of loss to follow-up. Determining and addressing the causes of high false positive rates must be prioritised.

Iodine deficiency during the first two years of life may cause irreversible brain damage and mental retardation. The aim of the present study was to investigate, for the first time, the effect of iodine fortified milk on the iodine status of lactating mothers and their infants. In this multicenter randomized controlled trial, 84 lactating mother-infant pairs from health care centers were randomly selected. After meeting the inclusion criteria, lactating mothers were randomly assigned to two groups: the iodine fortified milk group and the control group (n = 42 each). Maternal and infant urine and breast milk samples were collected at 3–5 (baseline), 7, 10, 14 days, and 1 month postpartum, for a measurement of the iodine concentration. A total of 84 lactating mothers, with a mean age of 28.2 ± 4.5 years, and 84 infants, with a mean age of 4.2 ± 0.7 days, were included in the study. Compared to mothers of the control group, mothers receiving iodine fortified milk had higher urinary (p < 0.001) and breast milk (p < 0.001) iodine concentrations. Urinary iodine levels in infants revealed no significant differences between the two groups. The findings of this study indicate that supplementation with daily iodine fortified milk provides iodine nutrition adequacy among lactating mothers. However, it had no effect on the iodine status of infants, who were previously iodine sufficient.

Context Iodine deficiency is one of the most important health problems worldwide. The overall aim of this study was a narrative review of the past and present status of iodine nutrition in the Iranian population to gather and provide valuable background data in this field for future studies. Evidence acquisition For this narrative literature review study, published internal (SID, Iran doc, Iran medex) and international (Web of knowledge, Pubmed, SCOPUS) source studies were searched using the following medical subject heading terms: Iodine, IDD (iodine deficiency disorders), UIC (urinary iodine concentration), Goiter, IQ (intelligence quotient), thyroid hormone, Iodine and pregnancy, Iodine and breast feeding, as well as Iodized salt, reporting the prevalence of iodine deficiency and iodine nutrition status of different target populations in Iran over 25 years, between 1988 - 2014, were assessed. We found 185 abstracts by literature search, of which, 161 papers that were as case reports, animal study, with lack of regional or national data were excluded after full text evaluation. Finally 24 full papers covering regional or national data on iodine nutrition of the study population were eligible for our review. Results Iodine deficiency, as a nutritional problem, had been identified in Iran since 1968. In the years 1987 - 1989, a few studies were done to define the prevalence of iodine deficiency in the country. The first nation-wide survey was performed in 14 provinces. Based on this survey all provinces were suffering of endemic goiter. In 1989, iodine deficiency was recognized as a major problem for community health. In 1990, salt factories began to produce iodized salt and in 1996, the second national survey was performed in 26 provinces. This survey indicated that 40% of boys and 50% of girls have goiter, with a median urinary iodine excretion of 205 µg/L. The 3rd national survey in 2001 showed that the total goiter rate is 9.8% and median UIC of 165 μg/L. In 2007, the 3th national survey was conducted 17 years after iodized salt consumption by Iranian households. In this study the total goiter rate and median urinary iodine was 5.7% and 145 μg/L, respectively. The 5th national survey conducted in 2013, showed household consumption of iodized salt for all provinces was 98% and the median urinary iodine of school children was 161 μg/L. Following the 5th national survey, the 1st national survey of the iodine status and thyroid function of pregnant women, conducted in 10 provinces in the different region of the country, documented a median UIC for pregnant women of 87.3 µg/L, results of this national survey clarified that despite iodine sufficiency of school children in Iran, pregnant women have moderate iodine deficiency and need iodine supplementation. Conclusions The success of iodine deficiency control program depends on well designed programmatic steps and mandatory iodized salt consumption in certain situations. The iodine intake of school children is sufficient, however, Iranian pregnant women are suffering from moderate iodine deficiency and need iodine supplementation.

Objectives This study aimed to assess the prevalence and incidence and predictive factors of thyroid disorders (TD) in patients with impaired glucose metabolism. Methods Prevalence of TD was calculated in patients with impaired glucose metabolism compared to healthy controls, aged over 30 years in phase 1 of the Tehran Thyroid Study (TTS). Follow up assessments were conducted every 3 yrs, after which incidence of TD was calculated and its correlations with age, sex, smoking, blood pressure, body mass index (BMI), thyroid peroxidase antibody (TPOAb), thyrotropin (TSH), insulin resistance index, triglycerides and cholesterol were assessed. Results Incidence of TD among 435 diabetics, 286 prediabetics, and 989 healthy controls at baseline was 14, 18, and 21 per 1000 patients per year, respectively, being significantly lower in diabetics than that in healthy controls, a difference however that was not significant after adjusting for the variables mentioned (OR:0.64, 95% CI: 0.39–1.01). The incidence of TD in subjects with baseline serum TSH>1.94 mU/L or TPOAb≥40 IU/ml in all three groups was higher than that in patients with TSH≤1.94 mU/L or TPOAb1.94 mU/L was predictive of TD with 70% sensitivity and specificity. Baseline serum TSH (ROC area: 0.73, 95% CI: 0.68–0.77) had better predictive value than TPOAb (ROC area: 0.65, 95% CI: 0.61–0.69) for developing TD. Conclusion Incidence of TD in type 2 diabetics or prediabetics is not higher than healthy controls. It is however necessary to conduct thyroid tests in patients with TPOAb≥40 IU/ml or TSH>1.94 mU/L.