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Abstract Objectives The objective of this study was to specifically investigate Separation Anxiety Disorder (SAD), as one of the noteworthy disorders within the spectrum of anxiety disorders, among children and adolescents, after overcoming the crises caused by the Coronavirus Disease 2019 (COVID-19) pandemic. Efforts were also made to identify socio-demographic factors that could be associated with changes in SAD level and also to assess the effect of different constituting dimensions of SAD on the severity of this disorder. Methods In this cross-sectional study, face-to-face interviews were conducted with the parents of 317 (7-13-year-old) Iranian students, who were selected through a multi-stage random sampling method in the city of Shiraz. During the interviews, socio-demographic data were collected, and subsequently, SAD symptoms and dimensions were assessed using the Separation Anxiety Assessment Scale (Parent Version) (SAAS-P) questionnaire. Later, employing the Partition Around Medoids (PAM) statistical method, the participants were categorized into two groups with low and high levels of SAD. Also, to understand the interaction between the different dimensions of SAD, the network analysis method was employed. Finally, univariate analysis and logistic regression were utilized, with a significance level of 0.05, to determine potential associating factors with the level of SAD. Results The sample included 128 girls and 189 boys with a mean age of 9.63 ± 2.63 and 9.63 ± 1.95 years respectively. Based on the PAM method, 51.1% of the participants presented a high level of SAD. According to network analysis, it was demonstrated that the “fear of abandonment” dimension plays a central role in high levels of SAD. Based on logistic regression, female gender, age ≥ 10 years, parents’ unacademic educational background, mother’s employment, and child’s history of physical/mental problems were significantly associated with the high level of SAD. Conclusions A considerable number of the participants in this study presented a high level of SAD with the “fear of abandonment” being a key influential dimension of elevated levels of this disorder. Maternal employment, female gender, child’s history of health issues, and low parental education were identified as important contributors to the high SAD level. Considering these factors allows for more effective diagnostic and therapeutic interventions. However, the need for further studies remains crucial.

Abstract Utilizing a novel microsimulation approach, this study evaluates the impact of fixed and average point-to-point Speed Enforcement Cameras (SEC) on driving safety. Using the SUMO software, agent-based models for a 6-km highway without exits or obstacles were created. Telematics data from 93,160 trips were used to determine the desired free-flow speed. A total of 13,860 scenarios were simulated with 30 random seeds. The ratio of unsafe driving (RUD) is the spatial division of the total distance travelled at an unsafe speed by the total travel distance. The study compared different SEC implementations under different road traffic and community behaviours using the Power Model and calculated crash risk changes. Results showed that adding one or two fixed SECs reduced RUD by 0.20% (0.18–0.23) and 0.57% (0.54–0.59), respectively. However, average SECs significantly lowered RUD by 10.97% (10.95–10.99). Furthermore, a 1% increase in telematics enforcement decreased RUD by 0.22% (0.21–0.22). Point-to-point cameras effectively reduced crash risk in all implementation scenarios, with reductions ranging from − 3.44 to − 11.27%, pointing to their superiority as speed enforcement across various scenarios. Our cost-conscious and replicable approach can provide interim assessments of SEC effectiveness, even in low-income countries.

Background: A decade after the implementation of the Urban Family Physician Program (UFFP) in Fars province, southern Iran, we aimed to reveal people’s opinions regarding the strengths and challenges of this program, which help policymakers for evidence-based improvement of this program. Methods: In this thematic content analysis qualitative study, which was performed in 2023, one adult individual of each family under the coverage of UFPP was selected using a purposeful sampling method. Then, an in-depth and semi-structured phone interview was conducted with each participant. Interviews were continued until the achievement of data saturation. The trustworthiness of data was checked according to Guba and Lincoln criteria. Data analysis was accomplished using MAXQDA software version 10. Results: A total of 25 participants with a mean age of 41 ± 12 years old were interviewed. Extracted strengths points of UFPP consisted of 390 meaning units, 41 open codes, 16 subcategories, 9 categories, and 3 themes, of which the main themes consisted of proper governance, adequate service provision, and promoting community health. In contrast, the challenges of this program comprised 127 meaning units, 54 open codes, 17 subcategories, 7 categories, and 3 themes, the main themes of which included weak governance, inefficient service provision, and limitation of resources. Conclusions: After a decade of implementation, people demonstrated contradictory opinions about many aspects of UFPP. Strength points should encourage policymakers to advocate more for this program and extend it to the other provinces of Iran, whereas weak points should be used for its revisions and improvement.

Abstract Background Intimate partner violence (IPV) against pregnant women can cause several complications for the mother and her baby, which are life-threatening. Thus, we aimed to find the prevalence of IPV and its associated factors in pregnant women in Shiraz, Iran. Methods This cross-sectional study was conducted among pregnant mothers in Shiraz between July 2020 and January 2021. The questionnaire consisted of four parts: demographic data, socio-economic status (SES), obstetric and medical history, and questions about IPV. Univariate analysis was performed using Chi-square, McNemar, or Fisher’s exact test, and variables with p-value

Abstract Introduction The antiinflammatory and antioxidative effects of melatonin have been established in recent years. Several studies indicate that oxidative stress and inflammation are key drivers of post-coronary artery bypass graft (CABG) surgery complications. In the present study, we aimed to investigate the effects of melatonin on cardiac injury and inflammatory biomarkers in CABG candidates. Methods Embase, Medline/PubMed, Web of Science, Scopus, and the Cochrane library were searched up to 5 June 2022. All randomized controlled trials examining cardiac injury and inflammatory biomarkers of CABG patients who received melatonin were included. The random-effects model was utilized to perform the analysis. Results A total of 947 citations were retrieved through database searches. Finally, five articles (six trials with 342 patients) were included after the screening. Melatonin supplementation led to a significant reduction in cardiac troponin I (CTnI) [weighted mean difference(WMD): −2.28 ng/ml; 95% CI −2.87, −1.69; P

Background. The impact of COVID-19 on the neonatal population is still mysterious. This study is aimed at reporting the prevalence of COVID-19 and its clinical characteristics and outcomes among neonates in Iran. Methods. We conducted a retrospective cohort including 25 neonates who had COVID-19 infection confirmed by reverse transcription polymerase chain reaction (RT-PCR). Based on neonates’ hospitalization records, data regarding neonatal and maternal characteristics and clinical and paraclinical findings were extracted. Results. In Fars Province, the incidence of COVID-19 among neonates was 47.5 per 100000 living births in one year. From 25 neonates, 20 cases (80%) were recovered, while five cases (20%) died, and all of them were symptomatic. Nine cases (37.5%) were preterm, and two cases (22.2%) belonged to deceased neonates. Four out of five deceased neonates (80%) suffered from congenital abnormalities, and all required respiratory support in the course of their disease progression. Also, 18 neonates (72%) were admitted to NICU. Moreover, the COVID-19 RT-PCR test of nine mothers (43.7%) became positive. Conclusions. This study showed that the incidence of confirmed and symptomatic SARS-CoV-2 infection among neonates in the Fars Province of Iran over one year was 47.5 per 100000 living births. Thoroughly evaluating the epidemiological factors associated with COVID-19, such as underlying health conditions and family history of COVID-19, is crucial in properly managing neonates during the pandemic and increasing awareness.

Objective: This systematic review and meta-analysis was undertaken to estimate the effectiveness of motorcycle safety campaigns for increasing helmet use among motorcycle riders and passengers. Methods: PubMed, Scopus, EMBASE, and the Web of Science (WOS) databases were systematically searched up June 2020 for all relevant studies. The National Institute of Health (NIH) tool was used to assess the quality of all included studies. Inter-study heterogeneity was measured using the Chi-Squared and I2 statistics, with the odds ratio (OR) being used as a measure of the pooled effect size. Results: Out of the 561 records identified from the literature searches, eight articles (or 11 studies) were eligible for inclusion in the present meta-analysis. Using a random effects model, the results of the meta-analysis demonstrated statistically significant increases in helmet use among motorcycle riders (OR = 4.52, 95% CI: 1.01–20.14, I2 = 99.9%) and passengers (OR = 6.57, 95% CI: 1.41–30.56, I2 = 99.9%). The findings of sensitivity analyses, based on alternative levels of r for imputing the standard error (SE) of the ORs, showed the pooled OR of helmet use among motorcycle riders (r = 0.7; 3.49; 95% CI: 0.78, 16.44; r = 0.9; 3.49; 95% CI: 0.76, 16.11) was sensitive to different levels of r. However, no significant effect was detected on the pooled effect size for different correlation coefficients for motorcycle passengers (r = 0.7; 6.56; 95% CI: 1.59, 27.00; r = 0.9; 6.56; 95% CI: 2.25, 19.13). Increases in helmet use among motorcycle passengers were found in studies that: monitored pre and post campaign periods for longer than one year and were conducted in Thailand or Vietnam. However, the effect of motorcycle safety campaigns on helmet use among motorcycle riders remained significant for all of the different strata included. Conclusion: The present meta-analysis found that motorcycle safety campaigns can lead to a significant increase in helmet use among both motorcycle riders and passengers. Due to the high degree of inter study heterogeneity, these findings should be interpreted with some caution. Despite the apparent favourable influence of motorcycle safety campaigns, more robust research is required.

BackgroundThe adherence to speed limits can reduce deaths associated with road traffic injuries (RTIs) by more than a quarter. This study aimed to evaluate the effective factors on the speeding behavior of Iranian taxi drivers around fixed speed cameras.MethodTelematics devices used in this study collected the location and speed of the vehicles. The units of analysis in this study were trips per camera, including 2.5 km before and after each camera. Linear regression analysis was used to identify kangaroo driving (KD), defined as trips with a significant V-shape in speed distribution around the camera. In the clustered camera zones, cameras were placed at regular intervals of approximately 3.5 km.FindingsA total of 93,160 trips were recorded from 13,857,443 data points. There was an inverse association between drivers' age and KD with an odds ratio (OR) of 0.98 (95% confidence interval: 0.98–0.98). The intercity trips had a substantially higher probability of KD than urban trips (OR: 4.94 [4.73–5.16]). The tendency of drivers toward KD during the daylight hours vs. nighttime was significant for both urban (OR: 1.15 [1.06–1.25]) and intercity (OR: 1.18 [1.14–1.22]) trips. The 4 −8 a.m. period had the highest chance of KD in both urban (10.71% [7.41–14.53]) and intercity (44.13% [41.18–47.09]) trips. There was a significant decrease in the odds of KD inside the clustered camera zones (OR: 0.22 [0.20–0.25]).ConclusionThe heterogeneous occurrence of KD in different locations and times indicates the necessity of evidence-based decision-making in urban planning to improve safe driving behaviors. The lower occurrence of KD in clustered camera zones could be a practical key to the effective control of speeding behaviors by helping in the efficient placement of cameras through sustainable development of cities and roads.

Abstract Background and Aims COVID‐19 has adversely impacted the public's mental health. One of the causes of psychopathology during the present pandemic is death anxiety and fear of COVID‐19. The present study aimed to determine the prevalence and risk factors of death anxiety and fear of COVID‐19 in Shiraz city, south of Iran. Methods This cross‐sectional study was conducted among 982 participants in Shiraz from October to November 2021. Data were collected using Templer's Death Anxiety Scale and the Fear of COVID‐19 Scale. Trained interviewers collected data throughout different city districts. A data‐driven approach (latent class analysis) was applied to categorize the participants and determine the risk factors. Results Among the participants, 507 (51.6%) were female, and 475 (48.4%) were male. The participants’ mean age was 38.26 ± 15.16 years. Based on the analysis, 259 (26.4%), 512 (52.1%), and 211 (21.5%) participants had low, moderate, and severe levels of death anxiety. Also, 393 (40.06%) and 588 (59.94%) of the participants had low and high levels of fear, respectively. Higher death anxiety was significantly associated with being female, having an associate degree, being retired, share of medical expenditure from total expenditure of more than 10%, having a history of hospital admission due to COVID‐19, history of COVID‐19 in relatives, and having fear of COVID‐19. Also, being female, expenses equal to income, history of hospital admission due to COVID‐19, death in relatives, and higher death anxiety were linked to higher levels of fear of COVID‐19. Conclusions Death anxiety and fear of COVID‐19 are closely associated with each other and affected by various sociodemographic and economic factors. Given this pandemic's unpredictable nature and chronicity, interventions at the community level to support high‐risk groups are crucial.

Plain English summary Children of mothers who experience high psychological distress during pregnancy are more susceptible to cognitive and behavioral problems. Few studies have reported the psychological distress of pregnant mothers during the COVID-19 pandemic, and it may be considered as a risk factor for child developmental disorders. In total, 540 out of 920 registered pregnant mothers in maternity clinics affiliated with Shiraz University of Medical Sciences answered the online questionnaire and were included in this study. An online self-administered data gathering tool was used so that the respondents felt more secure. The data gathering tool had three main parts: socio-demographic, obstetric and medical histories, and the short form of the Depression Anxiety Stress Scales (DASS-21) which consisting of 21 questions, 7 in each subscale; depression (DASS-D), anxiety (DASS-A) and stress (DASS-S). Pregnant mothers who had two or more comorbidities or those with lower self-rated health (SRH) had a higher chance of having an abnormal anxiety level. Depression levels were higher in pregnant mothers who had no insurance. Additionally, depression symptoms were more prevalent in pregnant mothers who had low health status than in those with good or intermediated SRH. In conclusion, the COVID-19 pandemic contributes to a significant increase in depression and anxiety symptoms among pregnant mothers. Moreover, lack of insurance, poor SRH, and having comorbidities are significantly associated with increasing depressive and anxiety scores.

Abstract Background Iranians face being overweight as one of the most common health problems, which is more prevalent among women. This study aimed to identify gender differences in determinants of being overweight in 40- to 70-year-old participants from Kharameh, Iran. Methods This cross-sectional study was conducted during 2015–2016. The total 10,663 inhabitants of Kharameh, Iran, aged 40–70 years old, were target population. Those with a body mass index (BMI) 29.9 were excluded. A checklist composed of socio-demographic, lifestyle, and BMI items was used; a p-value

Abstract Background People with HIV have always faced stigma and discrimination. Given the numerous papers that have addressed the psychological and social risk factors in spreading HIV, a pressing question is whether individuals’ mere careless and behavioural flaws can still account for the spread of HIV. Barriers and opposing politic made a hard position for HIV and sex education in Iran. Methods The present study investigated the causes of contracting HIV/AIDS from the perspective of HIV-infected patients. To accomplish this, 150 patients referring to the voluntary counseling and testing Center, Shiraz were convenient selected based on the convenient sampling method and responded to a researcher-made questionnaire From June to August 2019. The data were analyzed through descriptive statistics (mean, SD, frequency tables) and inferential statistics (chi-square). Results Results revealed that the main cause of HIV infection amongst males was the injection of narcotics, and in the females it was sexual intercourse with an infected individual. Meanwhile, 57% of the females and 66% of the males blamed themselves for contracting and transmitting the disease. The patients stated that if they could return to pre-infection period, they would use one of the following ways to prevent the disease: (a) they would pay attention to hygienic/sanitary principles; (b) they would not get married; and (c) they would prevent drug addiction. Also only 44% of the individuals had successful siblings (those who were neither addicts nor HIV/AIDS-infected individuals), which was an observation that emphasizes on the epidemic of high-risk behaviors in the patients’ families. Conclusions According to participants' statements collected in our study, weakness in governmental public health education, along with family-related and individual factors, are important causes of HIV spread

Abstract Background More severe cases of COVID- 19 are more likely to be hospitalized and around one-fifth, needing ICU admission. Understanding the common laboratory features of COVID-19 in more severe cases versus non-severe patients could be quite useful for clinicians and might help to predict the model of disease progression. This systematic review and meta-analysis aimed to compare the laboratory test findings in severe vs. non-severe confirmed infected cases of COVID-19. Methods Electronic databases were systematically searched in PubMed, EMBASE, Scopus, Web of Science, and Google Scholar from the beginning of 2019 to 3rd of March 2020. Heterogeneity across included studies was determined using Cochrane’s Q test and the I 2 statistic. We used the fixed or random-effect models to pool the weighted mean differences (WMDs) or standardized mean differences and 95% confidence intervals (CIs). Findings Out of a total of 3009 citations, 17 articles (22 studies, 21 from China and one study from Singapore) with 3396 ranging from 12 to1099 patients were included. Our meta-analyses showed a significant decrease in lymphocyte, monocyte, and eosinophil, hemoglobin, platelet, albumin, serum sodium, lymphocyte to C-reactive protein ratio (LCR), leukocyte to C-reactive protein ratio (LeCR), leukocyte to IL-6 ratio (LeIR), and an increase in the neutrophil, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, blood urea nitrogen (BUN), creatinine (Cr), erythrocyte Sedimentation Rate (ESR), C-reactive protein (CRP), Procalcitonin (PCT), lactate dehydrogenase (LDH), fibrinogen, prothrombin time (PT), D-dimer, glucose level, and neutrophil to lymphocyte ratio (NLR) in the severe group compared with the non-severe group. No significant changes in white blood cells (WBC), Creatine Kinase (CK), troponin I, myoglobin, IL-6 and K between the two groups were observed. Interpretation This meta-analysis provides evidence for the differentiation of severe cases of COVID-19 based on laboratory test results at the time of ICU admission. Future well-methodologically designed studies from other populations are strongly recommended.

Abstract Background There are current trials investigating the effect of resveratrol supplementation on lipid profiles and liver enzymes among patients with metabolic syndrome (MetS) and related disorders; however, their findings are controversial. This systematic review and meta-analysis were aimed to determine the effects of resveratrol supplementation on lipid profiles and liver enzymes among patients with MetS and related disorders. Methods We performed a comprehensive search of the following online databases up to November 2018: Cochrane Library, PubMed, Embase, and Web of Science. The relevant articles were assessed for quality of studies using the Cochrane risk of bias tool. Results Out of 2459 citations, 31 articles were appropriate for including to the current meta-analysis. The pooled results indicated that resveratrol use significantly decreased total cholesterol [weighted mean difference (WMD) = − 7.65 mg/dL; 95% CI, − 12.93, − 2.37; P

Mental health is one of the most important of health components.Mental and behavioral diseases are major disease burdens. Women make up half of the world's population and raise the other half. While women are an integral part of societies, their diverse roles put them at a higher risk of psychological issues The 8th conference on women's health was the collaboration of Health Policy Research Center, affiliated with Shiraz University of Medical sciences, and Health Promotion and Women’s Health workgroup affiliated with the Academy of Medical Sciences. It is believed that we must move towards promoting and broadening women's health issues beyond the sole reproductive and sexual rights. Through a coordinated action, which has involved all concerned stakeholders including governmental health, social, and economic sectors, local authorities and stakeholders, industries, NGOs, volunteers, and the media aiming to enhance women’s mental health, the conference had three priorities: 1) family cohesion and lifestyle, 2) vulnerable women, and 3) resilience.

Abstract Background and objective The current systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to summarize the effect of vitamin D supplementation on endothelial activation among patients with metabolic syndrome and related disorders. Methods Cochrane library, Embase, PubMed, and Web of Science database were searched to identify related RCTs published before 30th April 2018. The heterogeneity among the included studies was assessed using Cochran’s Q test and I-square (I2) statistic. Data were pooled by using the random-effect model and standardized mean difference (SMD) was considered as summary effect size. Results Fourteen clinical trials that contained a total of 1253 participants were included in the current meta-analysis. Vitamin D supplementation significantly decreased von willebrand factor (vWF) (SMD -0.27; 95% CI, − 0.46, − 0.08; P = 0.006; I2:40.5%). However, we found no significant impact of vitamin D supplementation on intercellular adhesion molecule 1(ICAM-1) (SMD -1.96; 95% CI, − 4.02, 0.09; P = 0.06; I2:97.4%), vascular celladhesion molecule 1 (VCAM-1) (SMD -0.50; 95% CI, − 1.19, 0.19; P = 0.15; I2:91.2%), on E-selectin (SMD -0.04; 95% CI, − 0.36, 0.28; P = 0.81; I2:78.8%) and endothelin (SMD -0.49; 95% CI, − 1.18, 0.19; P = 0.15; I2:90.5%). The pooled data from trials of vitamin D supplementation with dosage of ≤4000 IU/day (− 0.37, 95% CI: -0.65, − 0.10, I2: 73.5%) significantly reduced vWF concentrations, while there was no effect of vitamin D supplementation on vWF concentrations among trials with the dosage of intervention > 4000 IU/day (− 0.17, 95% CI: -0.43, 0.10, I2: 0.0%). VWF concentrations significantly reduced in pooled data from trials with duration study ≤8 weeks (− 0.37, 95% CI: -0.67, − 0.07, I2: 60.6%), but there was no effect of vitamin D supplementation on vWF concentrations among trials with > 8 weeks (− 0.20, 95% CI: -0.45, 0.05, I2: 0.0%). While there was no effect of vitamin D supplementation on vWF concentrations among trials with total sample size of ≤60 patients (− 0.03, 95% CI: -0.42, 0.36, I2: 0.0%), vWF concentrations in trials with more than 60 patients decreased significantly (− 0.34, 95% CI: -0.56, − 0.12, I2: 60.9%). Conclusions Overall, the current meta-analysis demonstrated that vitamin D supplementation to patients with metabolic syndrome and related disorders resulted in an improvement in vWF, but did not affect ICAM-1, VCAM-1, E-selectin and endothelin levels.

Abstract Background Chronic inflammation and increased oxidative stress significantly contribute in developing coronary artery disease (CAD). Hence, antioxidant supplementation might be an appropriate approach to decrease the incidence of CAD. This systematic review and meta-analysis was aimed to determine the effects of coenzyme Q10 (CoQ10) supplementation on lipid profile, as one of the major triggers for CAD, among patients diagnosed with coronary artery disease. Methods EMBASE, Scopus, PubMed, Cochrane Library, and Web of Science were searched for studies prior to May 20th, 2018. Cochrane Collaboration risk of bias tool was applied to assess the methodological quality of included trials. I-square and Q-tests were used to measure the existing heterogeneity across included studies. Considering heterogeneity among studies, fixed- or random-effect models were applied to pool standardized mean differences (SMD) as overall effect size. Results A total of eight trials (267 participants in the intervention group and 259 in placebo group) were included in the current meta-analysis. The findings showed that taking CoQ10 by patients with CAD significantly decreased total-cholesterol (SMD -1.07; 95% CI, − 1.94, − 0.21, P = 0.01) and increased HDL-cholesterol levels (SMD 1.30; 95% CI, 0.20, 2.41, P = 0.02). We found no significant effects of CoQ10 supplementation on LDL-cholesterol (SMD -0.37; 95% CI, − 0.87, 0.13, P = 0.14), lipoprotein (a) [Lp(a)] levels (SMD -1.12; 95% CI, − 2.84, 0.61, P = 0.20) and triglycerides levels (SMD 0.01; 95% CI, − 0.22, 0.24, P = 0.94). Conclusions This meta-analysis demonstrated the promising effects of CoQ10 supplementation on lowering lipid levels among patients with CAD, though it did not affect triglycerides, LDL-cholesterol and Lp(a) levels.

BACKGROUND After the introduction of the Rome IV criteria for the diagnosis of irritable bowel syndrome (IBS), studies on the clinical significance of the new criteria in the settings of a large study has been scarce. Objective: Herein we used the infrastructures provided by one the largest cohort studies in Iran to evaluate the epidemiological features related to IBS. METHODS A total of 9264 participants, were enrolled in the initial registry. Diagnosis of IBS was done using the Rome IV criteria. Individuals with IBS were compared with a control group. Since the study included a large sample size of patients, we used the penalized smoothly clipped absolute deviation (SCAD) regression analysis to construct a model for the evaluation of factors associated with IBS. RESULTS Overall, data of 9163 participants entered the final analysis. In total, 1067 (11.6%) individuals were diagnosed with IBS, among which 57 (5.3%) were diarrhea dominant (IBS-D), 380 (35.6%) were constipation dominant (IBS-C), and 630 (59%) did not mention having any of the two (IBS-U). In the regression model, back pain/arthralgia (OR: 1.98, 95% CI: 1.65 - 2.40), insomnia (OR:1.65, 95% CI: 1.40 - 1.93), depression (OR: 1.64, 95% CI: 1.38 - 1.95), female sex (OR: 1.58, 95% CI: 1.27 - 1.96), anxiety (OR: 1.43, 95% CI: 1.21 - 1.69), and being married (OR: 1.23, 95% CI: 1.03 - 1.48), were associated with higher rates of IBS. We found that IBS prevalence displays a peak at the age of 41 years for both men and women. CONCLUSION The present study provides a background for follow-up studies to be conducted in order to evaluate causality between IBS and some major diseases such as liver disease. We also found that opium use, although not statistically significant, in addition to sex, education, back/joint pain, depression, insomnia, anxiety, and marital status might be a contributing factor in IBS.

Background: Exclusive breastfeeding (EBF) in the first six months of the life can significantly improve maternal and children health, and it is especially important in low- and middle-income countries. We aimed to determine the factors affecting EBF duration in a sample of Iranian infants. Methods: This prospective study was conducted between April 2012 and October 2014 in Fars, Iran. Women (N=2640), who had given birth to healthy term infants were categorized into EBF versus non-EBF groups. Demographic information from mothers and infants, medical and drug history, and pregnancy related factors were compared between the two groups. Multivariable analysis was performed using Adaptive Lasso regression. P

Abstract Objective This systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to determine the effect of alpha-lipoic acid (ALA) supplementation on the inflammatory markers among patients with metabolic syndrome (MetS) and related disorders. Methods We searched the following databases until November 2017: PubMed, MEDLINE, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials. Three reviewers independently assessed study eligibility, extracted data, and evaluated risk of bias of included primary studies. Statistical heterogeneity was assessed using Cochran’s Q test and I-square (I2) statistic. Data were pooled by using the random-effect model and standardized mean difference (SMD) was considered as the summary effect size. Results Eighteen trials out of 912 potential citations were found to be eligible for our meta-analysis. The findings indicated that ALA supplementation significantly decreased C-reactive protein (CRP) (SMD = − 1.52; 95% CI, − 2.25, − 0.80; P

Abstract Background Several studies have evaluated the effect of inositol supplementation on lipid profiles among population with metabolic diseases; however, the findings are controversial. This review of randomized controlled trials (RCTs) was performed to summarize the evidence of the effects of inositol supplementation on lipid profiles among population with metabolic diseases. Methods Relevant RCTs studies were searched in Cochrane Library, EMBASE, MEDLINE, and Web of Science until October 2017. Two researchers assessed study eligibility, extracted data, and evaluated risk of bias of included primary studies, independently. To check for the heterogeneity among included studies Q-test and I2 statistics were used. Data were pooled by using the random-effect model and standardized mean difference (SMD) was considered as summary of the effect size. Results Overall, 14 RCTs were included into meta-analysis. Pooled results showed that inositol supplementation among patients with metabolic diseases significantly decreased triglycerides (SMD − 1.24; 95% CI, − 1.84, − 0.64; P

Objective: The aim of this study was to investigate changes in physical activities during pregnancy and the relationship between physical activity and unplanned caesarean sections (CSs). Materials and methods: A cohort study design was carried out. A cohort of 2029 pregnant women was established when they received prenatal care at 18–22 weeks of gestation in a medical center in southwest Iran. Participants were asked to recall their levels of physical activity during pre-pregnancy. The data were processed using Statistics/Data Analysis. To compare activities the chi-square was used to identify significant differences between the groups. A multiple logistic regressian was used to identify the association between activities and delivery mode as well as controlling potential confounding variables. In the analyses, the level of significance was set at P

Purpose: Unsafe behaviors are an important cause of accidents in adolescent age groups. This study was designed to examine the behaviors of adolescent pedestrians in southern Iran. Methods: This is a descriptive analytical cross-sectional study. The study population consisted of high school students in Shiraz, capital city of Fars Province, Iran. Five hundred and sixteen students were selected by multi-stage sampling. Data were collected by the use of three questionnaires, which included Persian copies of adolescent road user behavior questionnaire (ARBQ), Duke University Religious Index (DUREL), as well as the context and independent variables questionnaire. Results: The results showed that a decrease in dangerous behaviors on the road resulted in an increase in respondents' intrinsic religiosity. Also, engagement in unsafe crossing behavior in the road decreased with increasing respondents' intrinsic religiosity. Another finding showed that female students were less involved in dangerous play and planned protective behaviors on the road. Conclusion: Findings clearly indicate that intrinsic religiosity has a significant role in reducing the risky road behaviors of students. Hence, religion may improve road safety in school students' road behavior in Iran. Keywords: Religion, Traffic accidents, Road behaviors, Students

Background: The users’ satisfaction is a method for evaluating the efficacy of healthcare system. We aimed to evaluate the association between the users’ socioeconomic status (SES) and satisfaction with the healthcare system in Shiraz, Iran. Methods: This cross-sectional study was conducted from December, 2013 to March, 2014, in Shiraz, Iran. 3400 households were recruited by multi-stage cluster random sampling. Information about demographic, insurance status, and users’ satisfaction was derived from face-to-face interviews. Satisfaction with healthcare system was assessed by using 5-point Likert scale statements, which ranged from “very dissatisfied” to “very satisfied”. All statistical analyses were performed using SPSS-21. Results: Overall, 1.6% (55) of the respondents were very satisfied, while 6% (203) were very dissatisfied with healthcare system. Participants were classified into high SES (26.3%), middle SES (47.9%) and low SES (25.8%). It was discovered that the better the SES, the more frequent were the respondents dissatisfied with healthcare system (P

OBJECTIVES Child development is a significant issue in global public health, and maternal mental health (MMH) can have a remarkable effect on children’s development of communication skills. We aimed to investigate the association between MMH and communication skills in a sample of Iranian children. METHODS This study was conducted in Shiraz, Iran during 2016. In total, 640 mothers who lived in Shiraz and were registered in the Fars Birth Cohort (FBC) study were invited to attend the FBC clinic with their children. A trained physician evaluated MMH using the General Health Questionnaire (GHQ). Additionally, a trained nurse assessed the children’s communication development status using the Ages and Stages Questionnaire for 60-month old children. RESULTS The majority of the mothers were homemakers (82.8%) and had high school diplomas (38.9%). The mothers’ mean age was 33.7±4.6 years. Seventy-nine (12.3%) children had delayed communication skills, but no significant association was found between children’s communication skills and the mothers’ total GHQ score (p=0.43). In total, 493 mothers (77.0%) had abnormal somatic symptoms, 497 (77.7%) had abnormal anxiety/insomnia, 337 (52.7%) had social dysfunction, and 232 (36.3%) suffered from depression. Logistic regression indicated that after adjusting for confounders, the odds of delayed communication skills were 3-fold higher among the children of mothers with abnormal somatic symptoms than among other children (p=0.01). CONCLUSIONS The study results confirmed that MMH had a significant impact on children’s communication skills. Moreover, maternal abnormal somatic symptoms exerted the strongest impact on the development of communication skills in 5-yearold children.

Background and objective: The current systematic review and meta-analysis of randomized controlled trials (RCTs) was carried out to assess the influence of curcumin intake on weight among patients with metabolic syndrome and related disorders.Methods: We searched the following databases up until January 2018: MEDLINE, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials. The relevant data were extracted and evaluated for quality of the studies in accordance with the Cochrane risk of bias tool. Data were pooled using the inverse variance method and expressed as standardized mean difference (SMD) with 95% confidence intervals (95% CI).Results: Eighteen articles (21 studies) that comprised a total of 1,604 individuals were finally included in the meta-analysis. Curcumin intake significantly reduced body mass index (BMI) (SMD −0.37; 95% CI, −0.61, −0.13; P < 0.01), weight (SMD −0.23; 95% CI, −0.39, −0.06; P < 0.01), waist-circumference (WC) (SMD −0.25; 95% CI, −0.44, −0.05; P = 0.01), leptin levels (SMD −0.97; 95% CI, −1.18, −0.75; P < 0.001) and increased adiponectin levels (SMD 1.05; 95% CI, 0.23, 1.87; P = 0.01). We found no significant effect of curcumin intake on hip ratio (HR) (SMD −0.17; 95% CI, −0.42, 0.08; P = 0.18).Conclusions: Overall, we have found that curcumin intake among patients with metabolic syndrome and related disorders was correlated with a significant reduction in BMI, weight, WC, and leptin, and a significant increase in adiponectin levels, but did not affect HR.

Objective. Fatty liver is a rising global health concern, significantly increasing the burden of health care cost. Nonalcoholic fatty liver disease (NAFLD) has a correlation with metabolic syndrome and its complications. Method. We reviewed the literature regarding the mechanisms of developing NAFLD through AGE-RAGE signaling. Results. NAFLD, metabolic syndrome, and production of advanced glycation end-products (AGEs) share many common risk factors and appear to be connected. AGE induces production of the receptor for AGE (RAGE). AGE-RAGE interaction contributes to fat accumulation in the liver leading to inflammation, fibrosis, insulin resistance, and other complications of the fatty liver disease. The immune system, especially macrophages, has an important defense mechanism against RAGE pathway activities. Conclusion. Soluble form of RAGE (sRAGE) has the capability to reduce inflammation by blocking the interaction of AGE with RAGE. However, sRAGE has some limitations, and the best method of usage is probably autotransplantation of transfected stem cells or monocytes, as a precursor of macrophages and Kupffer cells, with a virus that carries sRAGE to alleviate the harmful effects of AGE-RAGE signaling in the settings of fatty liver disease.

Hepatocellular carcinoma is the third leading cause of cancer-related death worldwide and late diagnosis is the main cause of death in HCC patients. In this study expression patterns of HSP70, GPC3 and GS and their relationships with pathogenesis of HCC in Iranian patients were investigated. The expression of HSP70, GPC3 and GS were determined by immunohistochemistry and quantitative real-time PCR (q-PCR) methods, using 121 cases from patients with HBV alone, HCC without HBV, HBV+HCC and 30 normal tissues as control group. HSP70, GPC3 and GS were expressed in higher levels in HBV-related HCC samples compared to HBV alone group. The results showed that the labeling index of HSP70, GPC3 and GS are correlated with immunohistochemical and molecular expressions of HSP70, GPC3 and GS. The sensitivity and specificity for HCC diagnosis were 43.4% and 89.7% for HSP70, 64.3% and 90.4% for GPC3, and 60.7% and 94.3% for GS, respectively. The sensitivity and specificity of the panels with 3, 2 and 1 positive markers, regardless of which one, were 21.6% and 100%, 51.3% and 100% and 93.4% and 80.5% respectively. The current study demonstrated an association between HSP70, GPC3 and GS expressions and HBV-related HCC in our population. It was concluded that HSP70, GPC3 and GS expressions could be useful biomarkers for increasing the specificity and sensitivity of HCC diagnosis to acceptable level. Also, proper combinations of these 3 markers could improve diagnostic accuracy.

Background: This study evaluated the role of family history of cancer and gynecologic factors in relation to the etiology of ovarian cancer in a low socioeconomic population in Iran. Methods: From 2007-2009 we conducted a screening program on women with insurance coverage provided by the Imam Khomeini Relief Foundation. A total of 26788 women participated in this study of whom 76 cases had ovarian cancer and 26712 were considered as controls. We used rare event logistic (ReLogit) regression analysis with a prior correction method that used the Zelig package in R to obtain odds ratio estimates and confidence intervals. Results: Ovarian cancer was more frequent among postmenopausal than premenopausal (odds ratio: 2.30; confidence interval: 1.17-4.49) women. We observed increased risk for this disease in women with histories of hormone replacement therapy compared to those with no history (odds ratio: 2.36; confidence interval: 1.13-4.91). A greater increase in ovarian cancer was observed in women with family histories of breast (odds ratio: 2.88; confidence interval: 1.44-5.77), ovarian (odds ratio: 11.27; confidence interval: 5.63-22.54) and all cancer sites (odds ratio: 2.95; confidence interval: 1.71-5.08). However, the use of oral contraceptive pills was significantly associated with lower risk for ovarian cancer (odds ratio: 0.47; confidence interval: 0.28-0.79). There was no association between ovarian cancer and age, marital status, occupation, education level, age at menarche, age at first pregnancy and number of pregnancies. Conclusion: Ovarian cancer was considered a rare event. Thus we deemed it necessary to explore the associated risk factors using ReLogit with a prior correction method. The risk factors for ovarian cancer were menopause, history of hormone replacement therapy and family history of cancer of the breast, ovaries and other sites. Oral use of contraceptive pills showed a protective effect on risk for ovarian cancer.

Women’s health is increasing identified as a global health priority. Women’s health is affected by many factors, such as the economy, environment, society, culture, religion, and biology. For this reason, the Health Policy Research Center, Shiraz, Iran decided to hold The First Iranian International Conference on Women’s Health. The aim of this conference was to provide up-to-date information on different aspects of women’s health, including healthy aging, non-communicable and communicable diseases, psycho-social aspects, health promotion, reproductive health, and nutrition. Finally, the attending specialists and experts provided recommendations to be put into practice which reinforced the recommendations for additional clinical preventive services for women, mobilizing health professionals within practice, education, and research to address the national health goals, encouraging the adoption of ongoing evidence-based prevention guidelines, gender-sensitive, and culturally appropriate, persuading all stakeholders to harmonize their endeavors on women’s health, changing the viewpoint to the women as a workforce alliance as with like men, along with considering the major role of women as the basis of the family, and improving the coverage, accessibility, and quality of women-oriented health services.