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Introduction: Tooth extraction initiates a cascade of homeostatic and structural modifications within the periodontal tissues, culminating in alveolar ridge resorption. To prevent ridge resorption following extraction and facilitate successful placement of an implant-supported prosthesis, alveolar ridge preservation was performed. Methods: In this study, the biocompatibility of a nanocomposite consisting of self-assembling peptide nanofibers (organic phase) and tri-calcium phosphate-nano hydroxyapatite (mineral phase), was evaluated in rabbits. Subsequently, the nanocomposite was grafted onto a model of alveolar bone repair in patients. Results: The in vivo findings revealed no significant differences in the irritation ranking score and average thickness of the reaction zone between the nanocomposite and control groups. Furthermore, there were no significant differences in the appearance of necrosis, granulation tissue, fibroplasia, neovascularization, and hemorrhage as well as in the number of neutrophils, mast cells, lymphocytes, macrophages, and giant cells between the two groups. The defect area was completely filled with newly formed bone trabeculae and cavities containing bone marrow, indicating angiogenesis, while remnants of the scaffold were observed in the deeper region of the defects, adjacent to the bone marrow, considered osteoinductive. The clinical trial findings (TRN: IR.IUMS.REC.1401.355) demonstrated robust bone regeneration after 3.5 months of socket preservation, whereas the bone in the control group experienced atrophy. The nanocomposite facilitated soft tissue healing without any signs of infection or other periodontal malfunction. Conclusion: The application of nanotechnology has enhanced the bio-functionality of alloplastic materials, positioning this nanocomposite a promising alternative to autografts and allografts in alveolar bone repair.

Abstract Alzheimer’s Disease and Related Dementias (ADRD) affect millions of people worldwide, with mortality rates influenced by several risk factors and exhibiting significant heterogeneity across geographical regions. This study aimed to investigate the impact of risk factors on global ADRD mortality patterns from 1990 to 2021, utilizing clustering and modeling techniques. Data on ADRD mortality rates, cardiovascular disease, and diabetes prevalence were obtained for 204 countries from the GBD platform. Additional variables such as HDI, life expectancy, alcohol consumption, and tobacco use prevalence were sourced from the UNDP and WHO. All the data were extracted for men, women, and the overall population. Longitudinal k-means clustering and generalized estimating equations were applied for data analysis. The findings revealed that cardiovascular disease had significant positive effects of 1.84, 3.94, and 4.70 on men, women, and the overall ADRD mortality rates, respectively. Tobacco showed positive effects of 0.92, 0.13, and 0.39, while alcohol consumption had negative effects of − 0.59, − 9.92, and − 2.32, on men, women, and the overall ADRD mortality rates, respectively. The countries were classified into five distinct subgroups. Overall, cardiovascular disease and tobacco use were associated with increased ADRD mortality rates, while moderate alcohol consumption exhibited a protective effect. Notably, tobacco use showed a protective effect in cluster A, as did alcohol consumption in cluster B. The effects of risk factors on ADRD mortality rates varied among the clusters, highlighting the need for further investigation into the underlying causal factors.

IntroductionLow socioeconomic status (SES) is identified as a pivotal risk factor for mental health. Objective socioeconomic status (OSS) is measured by tangible resources, whereas subjective social status (SSS) reflects an individual’s perception of their OSS. A paucity of literature exists that elucidates the specific psychosocial mechanisms or pathways linking OSS with mental illness via SSS. This research aimed to explore the mediating role of SSS in the OSS-mental health association, utilizing data from the Iranian Mental Health Survey (IranMHS).MethodsThis study is a secondary analysis of data from IranMHS, a national survey conducted in 2011 through face-to-face interviews with 7,886 Iranian adults aged 15-64. As part of the original survey, the General Health Questionnaire-28 (GHQ-28) was randomly administered to half of these participants. We focused our analysis on data from 3,759 participants who completed all items of the GHQ-28. OSS was evaluated using education, occupation, wealth, and a combined OSS index, while SSS was measured using the MacArthur Scale. We examined how SSS mediates the associations between OSS factors and GHQ scores, including its four dimensions—somatic symptoms, anxiety and insomnia, social dysfunction, and severe depression— while adjusting for demographic variables and conducting gender-stratified analyses.ResultsAmong the 3759 respondents, 2157 (57.4%) were women, 2110 (56.1%) lived in urban areas, with an average age of 33.1 years (SD=12.1). SSS mediated the associations between wealth and the overall GHQ score (mediation percentage: 92.3%), education (75.4%), OSS index (66.7%), and occupation (34.0%) on the GHQ score. The most significant mediation effects were observed for wealth on the somatic symptoms, social dysfunction, and depression dimensions, with SSS accounting for more than 80% of these associations.ConclusionThe findings indicate a significant mediating role of SSS in the relationship between OSS and mental health. Enhancing our comprehension of the social determinants that moderate the relationship between objective and subjective socioeconomic status may contribute to a more nuanced understanding of the impact of SES on mental health outcomes.

Abstract Background and objectives Due to an increased rate of inflammation in generalized anxiety disorder (GAD), insight into the mediating factors in the onset and recurrence of the inflammatory response can help to achieve novel treatments for alleviating the risk of GAD. In the current study, we aimed to evaluate the possible relationship between visceral adipose tissue (VAT) as an important intermediary in inflammation pathways and GAD in participants of the Employees’ Health Cohort Study of Iran (EHCSIR). Method We analyzed the data from 3889 included participants aged > 18 years in the EHCSIR study, which were collected from 2017 to 2020. Lifetime and 12-month GAD were assessed using the Composite International Diagnostic Interview (CIDI-2.1) questionnaire. The adjusted prevalence ratio was computed to evaluate the association between GAD and visceral adiposity index (VAI), GAD and visceral fat area (VFA), GAD and body mass index (BMI) and ultimately GAD and waist circumference (WC) in males and females using STATA software. Results Log-binomial analysis showed a higher prevalence ratio of 12-month GAD associated with VFA in women [PR: 1.42, CI: 1.07–1.87, P: 0.015]. The prevalence of lifetime GAD was higher in obese women (BM1 > 30) [PR: 2.35, CI: 1.07–5.13, P:0.03] than in women with normal BMI. Women with higher VAI were also significantly more likely to suffer lifetime GAD [PR: 1.25, CI: 1.05]. 1.48, P:0.01]. In males, the prevalence of lifetime diagnosed GAD per 1 standard deviation increase in VFA was 0.65 [CI: 0.46–0.91, P: 0.01]. Conclusion Visceral adiposity as a positive agent was associated with GAD prevalence in women. The presence of GAD symptoms showed no relationship to VFA in men.

There are concerns about the health of nail salon technicians due to the inherently harmful agents such as volatile organic compounds (VOCs) and released particles in the salons. For this reason, this study was conducted to investigate the occupational exposure of nail salon technicians to VOCs and particulate matters (PMs) in the nail salons in Tehran, Iran. In this cross-sectional study, indoor air quality and measurement continually Total VOCs and PMs in the various size of PM1-PM10 using PhoCheck Tiger and particle counter device investigated, respectively. site observation, and an interview with the manager in 49 salons in Tehran. Data was analyzed using SPSS software (version 22). Mean concentrations of PM1 with 2.56 μɡ/m3 was the lowest amount and PM10 with 346.86μɡ/m3 had the highest concentration. Also, the mean concentration of TVOCs was equal 2.61 ppm. The results of the regression model showed that there is a statistically significant between the number of services with airborne PMs (PM2.5), (p-Value≤0.050). In salons only with nail activities, the concentration of PM4 was less than the others, although this correlation was statistically significant just for PM1 (p-Value = 0.010). By implementing effective local exhaust ventilation systems equipped with dust collectors and utilizing safe products, the emission of particles and chemical compounds within salons can be significantly reduced.

BackgroundMultiple sclerosis (MS) is a chronic autoimmune disease. Ellagic acid is a natural polyphenol and affects the fate of neurons through its anti-inflammatory and antioxidant properties. The present study aimed to investigate ellagic acid effects on disease severity, the expression of involved genes in the pathogenesis of MS, and the levels of related cytokines.MethodsThe present study was a triple-blind clinical trial. Eligible patients were randomly assigned to two groups: Ellagic acid (25 subjects) for 12 weeks, receiving 180 mg of Ellagic acid (Axenic, Australia) and the control group (25 subjects) receiving a placebo, before the main meals. Before and after the study, the data including general information, foods intake, physical activity, anthropometric data, expanded disability status scale (EDSS), general health questionnaire (GHQ) and pain rating index (PRI), fatigue severity scale (FSS) were assessed, as well as serum levels of interferon-gamma (IFNγ), interleukin-17 (IL-17), interleukin-4 (IL-4) and transforming growth factor-beta (TGF-β), nitric-oxide (NO) using enzyme-linked immunoassay (ELISA) method and expression of T-box transcription factor (Tbet), GATA Binding Protein 3 (GATA3), retinoic acid-related orphan receptor-γt (RORγt) and Glyceraldehyde-3-phosphate dehydrogenase (GAPDH) genes were determined using Real-Time Quantitative Reverse Transcription PCR (RT-qPCR) method.FindingsEllagic acid supplementation led to a reduction in IFNγ, IL-17, NO and increased IL-4 in the ellagic acid group, however in the placebo group no such changes were observed (−24.52 ± 3.79 vs. -0.05 ± 0.02, p 0.05). Also, the Tbet and RORγt genes expression decreased, and the GATA3 gene expression in the group receiving ellagic acid compared to control group significantly increased (0.52 ± 0.29 vs. 1.51 ± 0.18, p 0.05).ConclusionEllagic acid supplementation can improve the health status of MS patients by reduction of the inflammatory cytokines and Tbet and RORγt gene expression, and increment of anti-inflammatory cytokines and GATA3 gene expression.Clinical trial registration: (https://en.irct.ir/trial/53020), IRCT20120415009472N22.

Abstract Background Chitosan is one of dietary fiber that has received great attention in improving obesity-related markers, but little is known on its effects on adolescents. Objectives To analyze the effects of chitosan supplementation on obesity-related cardiometabolic markers and appetite-related hormones in adolescents with overweight or obesity. Methods and analysis A randomized clinical trial was performed on 64 adolescents with overweight and obesity, who were randomly allocated to receive chitosan supplementation (n = 32) or placebo as control (n = 32) for 12 weeks. Anthropometric measures, lipid and glycemic profiles, and appetite-related hormones were examined. Results Sixty-one participants completed study (chitosan = 31, placebo = 30). Chitosan supplementation significantly improved anthropometric indicators of obesity (body weight: − 3.58 ± 2.17 kg, waist circumference: − 5.00 ± 3.11 cm, and body mass index: − 1.61 ± 0.99 kg/m2 and − 0.28 ± 0.19 Z-score), lipid (triglycerides: − 5.67 ± 9.24, total cholesterol: − 14.12 ± 13.34, LDL-C: − 7.18 ± 10.16, and HDL-C: 1.83 ± 4.64 mg/dL) and glycemic markers (insulin: − 5.51 ± 7.52 μIU/mL, fasting blood glucose: − 5.77 ± 6.93 mg/dL, and homeostasis model assessment of insulin resistance: − 0.24 ± 0.44), and appetite-related hormones (adiponectin: 1.69 ± 2.13 ng/dL, leptin − 19.40 ± 16.89, and neuropeptide Y: − 41.96 ± 79.34 ng/dL). When compared with the placebo group, chitosan supplementation had greater improvement in body weight, body mass index (kg/m2 and Z-score), waist circumference, as well as insulin, adiponectin, and leptin levels. Differences were significant according to P-value

The nail salon industry has grown considerably, but there are serious concerns about the health risks associated with working in this field. Therefore, the purpose of this study was to investigate the exposure of nail technicians to BTEX. A cross-sectional study was conducted on 49 salons, and NIOSH Method 1501 was used to measure the concentration of BTEX in the breathing zone of technicians. The EPA method was used to assess health risks. Statistical analysis was conducted using SPSS software. The mean concentrations of toluene were (82.65 ± 198.84µg/m3)µg/m3, followed by benzene (10.58 ± 9.62µg/m3), p-xylenes (20.77 ± 37.79µg/m3), o-xylene (13.79 ± 25.70µg/m3), and ethylbenzene (29.35 ± 58.26µg/m3) , that lower than the permissible exposure limits suggested by NIOSH. Among the BTEX, toluene (82.65 ± 198.84µg/m3) has the most concentration in the nail salons. It was also discovered through multiple linear regression analysis that humidity had a significant effect on increasing the concentration of toluene (Beta = 0.50, P-value = 0.001) and ethylbenzene (Beta = 0.16, P = 0.049), while there was a considerable association between the number of services performed and benzene concentration (Beta = 0.34, P = 0.010).The average inhalation lifetime cancer risk for benzene (4.9 × 10 −5±4.5 × 10−5) was higher than the recommended value set by the US EPA. Although the concentrations of BTEX were lower than the maximum permissible limits, the results of the cancer risk assessment for benzene showed that working in nail salons with poor ventilation is hazardous. Therefore, exposure can be minimized by ensuring appropriate ventilation in the workplace and using safe products.

Abstract Background Gestational Diabetes Mellitus (GDM) is an underlying cause of maternal and newborn morbidity and mortality all around the world. Timely diagnosis of GDM plays an important role in reducing its adverse consequences and burden. This study aimed to determine diagnostic accuracy of multiple indicators in complete blood count (CBC) test for early prediction of GDM. Methods In this prospective cohort study, the data from 600 pregnant women was analyzed. In the study sample, the two-step approach was utilized for the diagnosis of GDM at 24–28 weeks of gestation. We also used the repeated measures of hemoglobin (Hb), hematocrit (Hct), fasting blood sugar (FBS) and red blood cell count (RBC) in the first and early second trimesters of pregnancy as the longitudinal multiple indicators for early diagnosis of GDM. The classification of pregnant women to GDM and non-GDM groups was performed using a statistical technique based on the random-effects modeling framework. Results Among the sample, 49 women (8.2%) were diagnosed with GDM. In the first and early second trimester of pregnancy, the mean HcT, Hb and FBS of women with GDM was significantly higher than non-GDMs (P

Abstract Background Type 1 diabetes is a main health burden with several related comorbidities. It has been shown that endothelial function, vascular structure, and metabolic parameters are considerably disrupted in patients with type 1 diabetes. Omega-3 as an adjuvant therapy may exert profitable effects on type 1 diabetes and its complications by improving inflammation, oxidative stress, immune responses, and metabolic status. Because no randomized clinical trial has examined the effects of omega-3 consumption in children and adolescents with type 1 diabetes; the present study aims to close this gap. Methods This investigation is a randomized clinical trial, in which sixty adolescents with type 1 diabetes will be randomly assigned to receive either omega-3 (600 mg/day) or placebo capsules for 12 weeks. Evaluation of anthropometric parameters, flow-mediated dilation (FMD) as an endothelial function marker, carotid intima-media thickness (CIMT) as a vascular structure marker, proteinuria, biochemical factors including glycemic and lipid profile, blood urea nitrogen (BUN), creatinine, high-sensitivity C-reactive protein (hs-CRP), and erythrocyte sedimentation rate (ESR), as well as blood pressure will be done at the baseline and end of the trial. Also, dietary intake and physical activity will be assessed throughout the study. Statistical analysis will be performed using the SPSS software (Version 24), and P < 0.05 will be considered statistically meaningful. Discussion It is hypothesized that omega-3 supplementation may be beneficial for the management of type 1 diabetes and its complications by reducing inflammation and oxidative stress and also modulating immune responses and glucose and lipid metabolism through various mechanisms. The present study aims to investigate any effect of omega-3 on patients with type 1 diabetes. Ethical aspects This trial received approval from Medical Ethics Committee of Iran University of Medical Sciences, Tehran, Iran (IR.IUMS.REC.1400.070). Trial registration Iranian Registry of Clinical Trials IRCT20210419051010N1 . Registered on 29 April 2021

BackgroundThe distribution of population-level real-time reverse transcription-polymerase chain reaction (RT-PCR) cycle threshold (Ct) values as a proxy of viral load may be a useful indicator for predicting COVID-19 dynamics. ObjectiveThe aim of this study was to determine the relationship between the daily trend of average Ct values and COVID-19 dynamics, calculated as the daily number of hospitalized patients with COVID-19, daily number of new positive tests, daily number of COVID-19 deaths, and number of hospitalized patients with COVID-19 by age. We further sought to determine the lag between these data series. MethodsThe samples included in this study were collected from March 21, 2021, to December 1, 2021. Daily Ct values of all patients who were referred to the Molecular Diagnostic Laboratory of Iran University of Medical Sciences in Tehran, Iran, for RT-PCR tests were recorded. The daily number of positive tests and the number of hospitalized patients by age group were extracted from the COVID-19 patient information registration system in Tehran province, Iran. An autoregressive integrated moving average (ARIMA) model was constructed for the time series of variables. Cross-correlation analysis was then performed to determine the best lag and correlations between the average daily Ct value and other COVID-19 dynamics–related variables. Finally, the best-selected lag of Ct identified through cross-correlation was incorporated as a covariate into the autoregressive integrated moving average with exogenous variables (ARIMAX) model to calculate the coefficients. ResultsDaily average Ct values showed a significant negative correlation (23-day time delay) with the daily number of newly hospitalized patients (P=.02), 30-day time delay with the daily number of new positive tests (P=.02), and daily number of COVID-19 deaths (P=.02). The daily average Ct value with a 30-day delay could impact the daily number of positive tests for COVID-19 (β=–16.87, P

Abstract Background Cardiovascular diseases (CVDs) are the number one cause of global mortality representing about one third of all deaths across the world. The objective of the present study was to model the global trend in disability-adjusted life years (DALY) and its components due to CVD over the past three decades. We also aimed to evaluate the longitudinal relationship between CVD DALY and Human Development Index (HDI) in this period of time. Methods The age-standardized rates of years lost due to disability (YLD), years of life lost (YLL) and DALY were extracted for cardiovascular diseases from the Global Burden of Disease (GBD) Study 2019 in years 1990 to 2019. Additionally, the United Nations Development Programme (UNDP) database was used to retrieve HDI values for all world countries at the same period time. The trend analysis was performed using the joinpoint regression model. Results The obtained revealed a significant downward trend for DALY and its components with the average annual percent change of − 1.0, − 0.3 and − 1.1 per 100,000 population, respectively for DALY, YLD and YLL. We also found that countries with high/very high levels of HDI have remarkably experienced steeper declining slope of trend than those in lower levels of HDI over the study period. Conclusions Although the observed decreasing trend of CVD burden is a hopeful message for all world countries, the considerable gap in slope of trend between richer and poorer parts of the world is a serious alarm for health policy makers. Regarding this, there is an urgent need to put more efforts on implementing preventive programs, improving the level of patients’ care and providing efficient treatment, especially in regions with lower levels of HDI.

BackgroundVascular dysfunction is a major complication of diabetes mellitus that leads to cardiovascular disease (CVD). This study aimed to examine the effects of omega-3 consumption on endothelial function, vascular structure, and metabolic parameters in adolescents with type 1 diabetes mellitus (T1DM).MethodsIn this randomized, double-blind, placebo-controlled clinical trial, 51 adolescents (10–18 years) with T1DM completed the study. Patients received 600 mg/day [containing 180 mg eicosapentaenoic acid (EPA) and 120 mg docosahexaenoic acid (DHA)] of omega-3 or placebo for 12 weeks. Flow-mediated dilation (FMD), carotid intima-media thickness (CIMT), high-sensitivity C-reactive protein (hs-CRP), erythrocyte sedimentation rate (ESR), triglycerides (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL), total cholesterol, blood urea nitrogen (BUN), creatinine, fasting blood sugar (FBS), hemoglobin A1C (HbA1c), homeostatic model assessment for insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), serum insulin (SI), urine albumin-creatinine ratio (uACR), blood pressure, and anthropometric indices were assessed at the baseline and after the intervention.ResultsFollowing supplementation, omega-3 significantly increased FMD (3.1 ± 4.2 vs. −0.6 ± 4%, p = 0.006) and decreased TG (−7.4 ± 10.7 vs. −0.1 ± 13.1 mg/dl, p = 0.022) in comparison with the placebo group. However, no significant difference was observed regarding CIMT (-0.005 ± 0.036 vs. 0.003 ± 0.021 mm, p = 0.33). Although hs-CRP was significantly decreased within the omega-3 group (p = 0.031); however, no significant change was observed compared to placebo group (p = 0.221). Omega-3 supplementation had no significant effect on other variables.ConclusionGiven the elevation in FMD and reduction in TG, omega-3 supplementation can improve vascular function and may reduce the risk of cardiovascular disease in adolescents with T1DM patients.

Abstract As of November 12, 2020, the mortality to incidence ratio (MIR) of COVID-19 was 5.8% in the US. A longitudinal model-based clustering system on the disease trajectories over time was used to identify “vulnerable” clusters of counties that would benefit from allocating additional resources by federal, state and county policymakers. County-level COVID-19 cases and deaths, together with a set of potential risk factors were collected for 3050 U.S. counties during the 1st wave of COVID-19 (Mar25–Jun3, 2020), followed by similar data for 1344 counties (in the “sunbelt” region of the country) during the 2nd wave (Jun4–Sep2, 2020), and finally for 1055 counties located broadly in the great plains region of the country during the 3rd wave (Sep3–Nov12, 2020). We used growth mixture models to identify clusters of counties exhibiting similar COVID-19 MIR growth trajectories and risk-factors over time. The analysis identifies “more vulnerable” clusters during the 1st, 2nd and 3rd waves of COVID-19. Further, tuberculosis (OR 1.3–2.1–3.2), drug use disorder (OR 1.1), hepatitis (OR 13.1), HIV/AIDS (OR 2.3), cardiomyopathy and myocarditis (OR 1.3), diabetes (OR 1.2), mesothelioma (OR 9.3) were significantly associated with increased odds of being in a more vulnerable cluster. Heart complications and cancer were the main risk factors increasing the COVID-19 MIR (range 0.08–0.52% MIR↑). We identified “more vulnerable” county-clusters exhibiting the highest COVID-19 MIR trajectories, indicating that enhancing the capacity and access to healthcare resources would be key to successfully manage COVID-19 in these clusters. These findings provide insights for public health policymakers on the groups of people and locations they need to pay particular attention while managing the COVID-19 epidemic.

Abstract Background Cardiovascular diseases (CVDs) are one of the global leading causes of concern due to the rising prevalence and consequence of mortality and disability with a heavy economic burden. The objective of the current study was to analyze the trend in CVD incidence, mortality, and mortality-to-incidence ratio (MIR) across the world over 28 years. Methods The age-standardized CVD mortality and incidence rates were retrieved from the Global Burden of Disease (GBD) Study 2017 for both genders and different world super regions with available data every year during the period 1990–2017. Additionally, the Human Development Index was sourced from the United Nations Development Programme (UNDP) database for all countries at the same time interval. The marginal modeling approach was implemented to evaluate the mean trend of CVD incidence, mortality, and MIR for 195 countries and separately for developing and developed countries and also clarify the relationship between the indices and Human Development Index (HDI) from 1990 to 2017. Results The obtained estimates identified that the global mean trend of CVD incidence had an ascending trend until 1996 followed by a descending trend after this year. Nearly all of the countries experienced a significant declining mortality trend from 1990 to 2017. Likewise, the global mean MIR rate had a significant trivial decrement trend with a gentle slope of 0.004 over the time interval. As such, the reduction in incidence and mortality rates for developed countries was significantly faster than developing counterparts in the period 1990–2017 (p

Background: Musculoskeletal disorder (MSD) is one of the important problems concerning the staffschr('39') health and productivity in the workplace. Nutritional status and consumption of some foods are also among the determining factors of MSD. So, this study aimed to evaluate the correlation of diet and consumed food groups with MSD. Methods: This cross-sectional study was conducted on 100 office workers. The participantschr('39') anthropometric parameters and their dietary information were collected using a semi-quantitative food frequency questionnaire. The findings were categorized into nine levels. The total scores were calculated for all the items per food group and per person. Nordic musculoskeletal questionnaire was also administered to evaluate the MSD symptoms in nine parts of body. Results: The score of consumed food groups was compared between individuals “with pain” and “without pain” in nine parts of the body. The scores of fruit intake in individuals “with pain” and “without pain” were 2.94 ± 1.27 vs. 3.29 ± 1.16 and 2.81 ± 1.10 vs. 3.49 ± 1.38 in terms of neck and wrists, respectively. The difference between the two groups were significant (P < 0.05). Furthermore, the participants with pain in the neck consumed significantly lower amounts of cereals and nuts (P = 0.03, 0.04). In the case of the shoulder pain, consuming legumes and nuts in the “without pain” group was higher than the group of participants who had pain (P = 0.01, P = 0.03). Fat intake was higher in the patients who had pain in their hips (P = 0.02). Conclusion: Less pain was reported in the musculoskeletal system by higher consumption of fruits, nuts, and legumes. It seems that plant-based dietary pattern is more effective in musculoskeletal health.

Background: Little evidence exists regarding the clinical value of synbiotics in the management of post-treatment complications of breast cancer especially breast cancer-related lymphedema (BCRL). This study aimed to investigate the effects of synbiotic supplementation along with calorie restriction on quality of life and edema volume in patients with BCRL. Methods: This randomized, placebo-controlled, clinical trial was conducted on 135 overweight and obese women with BCRL aged 18–65 years old. Participants were randomly allocated to receive a calorie-restricted diet plus 109 CFU synbiotic supplement (CRS group; n = 45) or placebo (CRP group; n = 45), daily for 10 weeks. Also, a control group (n = 45) with no intervention was included in the trial. All of the participants received Complete Decongestive Therapy for lymphedema treatment. The quality of life score, edema volume and body mass index (BMI) were measured at baseline and end of the trial. Results: A total of 121 subjects completed the trial. CRS group showed a significant decrease in the total quality of life score (P = 0.004), and it’s psychosocial (P = 0.022) and functional (P = 0.002) domain scores, as well as edema volume (P = 0.002) and BMI (P

Abstract Background Cardiovascular diseases (CADs) are the first leading cause of death across the world. World Health Organization has estimated that morality rate caused by heart diseases will mount to 23 million cases by 2030. Hence, the use of data mining algorithms could be useful in predicting coronary artery diseases. Therefore, the present study aimed to compare the positive predictive value (PPV) of CAD using artificial neural network (ANN) and SVM algorithms and their distinction in terms of predicting CAD in the selected hospitals. Methods The present study was conducted by using data mining techniques. The research sample was the medical records of the patients with coronary artery disease who were hospitalized in three hospitals affiliated to AJA University of Medical Sciences between March 2016 and March 2017 (n = 1324). The dataset and the predicting variables used in this study was the same for both data mining techniques. Totally, 25 variables affecting CAD were selected and related data were extracted. After normalizing and cleaning the data, they were entered into SPSS (V23.0) and Excel 2013. Then, R 3.3.2 was used for statistical computing. Results The SVM model had lower MAPE (112.03), higher Hosmer-Lemeshow test’s result (16.71), and higher sensitivity (92.23). Moreover, variables affecting CAD (74.42) yielded better goodness of fit in SVM model and provided more accurate result than the ANN model. On the other hand, since the area under the receiver operating characteristic (ROC) curve in the SVM algorithm was more than this area in ANN model, it could be concluded that SVM model had higher accuracy than the ANN model. Conclusion According to the results, the SVM algorithm presented higher accuracy and better performance than the ANN model and was characterized with higher power and sensitivity. Overall, it provided a better classification for the prediction of CAD. The use of other data mining algorithms are suggested to improve the positive predictive value of the disease prediction.

Background: Preterm birth is the most important in children under 5 yr mortality. In this study, we used the Global Burden of Disease Data (GBD) to evaluate the trend of preterm infant mortality rate for all countries from 1990 to 2017 and to assess the effect of development factors on this trend. Methods: The preterm infant mortality rate data from 196 countries of the world, from 1990 to 2017, were extracted from the GBD database. To study the trend of preterm infant mortality rate, a mixed-effects log-linear regression model was fitted separately for each IHME super-region. In the next step of data analysis, the development factor was included in the model to determine its effect on this trend for all countries under study. Results: The average rate mortality rate has declined about 2% per year throughout the world over the mentioned period. The highest and lowest decreasing trends were observed in high-income countries (about 4.0%) and Sub-Saharan Africa (about 1.0%), respectively. Including the effect of development factor in the mentioned model revealed that in 1990, the rate of preterm infant mortality in developed countries was 2.2 times of this rate in developing countries and this rate ratio has increased to 2.69 in year 2017. Conclusion: Although the preterm infant mortality rate were decreasing in all super regions, there is a remarkable gap in this rate between developing and developed countries yet. Therefore, preventative strategies are needed to reduce preterm birth and its burden, especially in the developing world.

Objective: National surveys revealed a high prevalence of psychiatric disorders in Iran. Province-level estimates are needed to manage the resources and focus on preventive efforts more efficiently. The objective of this study was to provide province-level estimates of psychiatric disorders. Method: In this study, Iranian Mental Health Survey (IranMHS) data (n = 7886) was used to produce province-level prevalence estimates of any psychiatric disorders among 15-64 year old males and females. Psychiatric disorders were diagnosed based on structured diagnostic interview of the Persian version of Composite International Diagnostic Interview (CIDI, version, 2.1). The Hierarchical Bayesian (HB) random effect model was used to calculate the estimates. The mental health status of half of the participants was also measured using a 28-item general health questionnaire (GHQ). Results: A wide variation in the prevalence of psychiatric disorders was found among 31 provinces of Iran. The direct estimates ranged from 3.6% to 62.6%, while the HB estimates ranged from 12.6% to 36.5%. The provincial prevalence among men ranged from 11.9% to 34.5%, while it ranged from 18.4% to 38.8% among women. The Pearson correlation coefficient between HB estimates and GHQ scores was 0.73. Conclusion: The Bayesian small area estimation provides estimation with improved precision at local levels. Detecting high-priority communities with small-area approach could lead to a better distribution of limited facilities and more effective mental health interventions.

Introduction: Cardiovascular diseases are the first leading cause of death worldwide. World health organization has estimated that the morality rate due to heart diseases will mount to 23 million cases by 2030. Hence, the use of data mining algorithms will be useful in predicting coronary artery disease. The objective of the present study was to compare the accuracy of the CAD predictions made by ANN and SVM techniques. Methods: The present study was conducted via descriptive-analytical method. The research sample included all CAD patients hospitalized in three hospitals affiliated to AJA University of Medical Sciences from March 2016 to March 2017. Totally, 1324 records with 26 characteristics affecting the disease were extracted and after normalizing, and cleaning of the data, they were entered in SPSS statistics V23.0 & IBM Excel 2013; then, R3.3.2 data mining software was used to format data. Results: SVM model with lower MAPE (112.03) and higher Hosmer-lemeshow statistic (16.71), sensitivity (92.23) and specificity (74.42) yielded better fitness of data and provides more accurate prediction than ANN model. On the other hand, since the area under the ROC curve in SVM algorithm was more than that in ANN, it could be concluded that this model had higher accuracy. Conclusion: According to the results, SVM algorithm presented higher accuracy and better performance than ANN model and showed higher sensitivity and accuracy. It is suggested that in future studies, the results of the present study be compared with the findings resulted from applying other data mining algorithms.

One of the challenges facing economic sectors is providing the required financing and liquidity for fixed investments and current capital (working capital). The current study is aimed to expand such studies in another aspect of the role of financial markets in terms of their relationship with macroeconomic variables such as economic growth rate, unemployment rate, and exchange rate as vital economic variables. Considering the position of the financial system in the allocation and efficiency of financial resources, this study deals with the impact and importance of financial repression policies and financial depth in solving the problems of the unemployment rate, exchange rate, and economic growth rate in Iran with the simultaneous equations approach from 1971 to 2017. The results showed that financial repression and depth policies significantly affect macroeconomic variables (economic growth, unemployment rate, and exchange rate). Furthermore, it is indicated that the financial repression policy does not have a negative effect on economic growth and a positive effect on the unemployment rate; however, it has a positive impact on the exchange rate. In addition, this study unravels that the financial depth policy does not negatively and significantly affect economic growth. However, it positively affects the exchange rate and unemployment rate. [ABSTRACT FROM AUTHOR]

Objectives The aim of this study was to determine the factors associated with the spatial distribution of the incidence of colorectal cancer (CRC) in the neighborhoods of Tehran, Iran using Bayesian spatial models. Methods This ecological study was implemented in Tehran on the neighborhood level. Socioeconomic variables, risk factors, and health costs were extracted from the Equity Assessment Study conducted in Tehran. The data on CRC incidence were extracted from the Iranian population-based cancer registry. The Besag-York-Mollié (BYM) model was used to identify factors associated with the spatial distribution of CRC incidence. The software programs OpenBUGS version 3.2.3, ArcGIS 10.3, and GeoDa were used for the analysis. Results The Moran index was statistically significant for all the variables studied (p

Background Multiple pregnancies are an important complication of assisted reproductive technology (ART). The present study aims to indentify the risk factors for multiple pregnancies independent of the number of transferred embryos. Materials and Methods This retrospective study reviewed the medical records of patients who underwent intracytoplasmic sperm injection (ICSI) cycles in Royan Institute between October 2011 and January 2012. We entered 12 factors that affected the number of gestational sacs into the poisson regression (PR) model. Factors were obtained from two study populations-cycles with double embryo transfer (DET) and cycles that transferred three embryos (TET). We sought to determine the factors that influenced the number of gestational sacs. These factors were entered into multivariable logistic regression (MLR) to identify risk factors for multiple pregnancies. Results A total of 1000 patients referred to Royan Institute for ART during the study period. We included 606 eligible patients in this study. PR analysis demonstrated that the quality of transferred embryos and woman’s age had a significant effect on the number of observed sacs in patients who underwent ICSI with DET. There was no significant predictive variable for multiple pregnancies according to MLR analysis. Our findings demonstrated that both regression models (PR and MLR) had the same outputs. A significant relation existed between age and fertilization rate with multiple pregnancies in patients who underwent ICSI with TET. Conclusion Single embryo transfer (SET) should be considered with the remaining embryos cryopreserved to prevent multiple pregnancies in women younger than 35 years of age who undergo ICSI cycles with high fertilization rates and good or excellent quality embryos. However, further prospective studies are necessary to evaluate whether SET in women with these risk factors can significantly decrease multiple pregnancies and improve cycle outcomes.

Introduction: Correspondence analysis method and preparation of accidents and occupational hazards pattern is able to predict and anticipate accidents and is automatically prioritize the risks and injuries. The aim of this study was to present accidents and occupational hazards pattern based on risk-injury groups, which use it to manage of occupational accidents. Material and Method: The report of occupational accidents, registered in the social security organization was collected in a period of ten years from 2005 to 2015 (222,300 accidents). Types of risk and injuries to any of the accidents specified based on International Labor Organization criteria and risk of injury were classified in a matrix (18 × 18). Risk-injury groups were separately identified using correspondence analysis and collapse process, as patterns of accidents and occupational hazards. In the mentioned patterns, the relationship between risks and damage can be identified, as it facilitates decision-making in risk assessment in companies covered by the social security organization. Result: According to the findings, three groups of occupational accidents were obtained and variables of these three groups extracted from the obtained patterns. The first group included six risks and seven injuries that the risks variables were: contact with hot materials, accidents caused by caustic and corrosive substances, contact with chemicals, accidents caused by toxic substances, contact with electrical equipment, explosion and fire, and injuries were: burns, other injuries, multiple injuries, gas poisoning, suffocation, poisoning, environmental hazards. The second group included seven risks and six injuries that the risks variables were: accidents caused by displacement, projections of fragments or particles, accidents caused by machine tools, slipping, falling people, falling objects, other accidents and injuries were: twists and sprains, dipping the objects in the body, objects in the eyes, cuts and amputations, superficial wounds, deep wounds. Finally, the third group included five risks and five injuries that risks variables were: Falling under the rubble, accident with vehicle, accidents caused by displacement, colliding of persons against objects, projections of fragments or particles, accidents caused by manual tools, trapped between objects, accidents caused by machine tools and injuries were: fractures, dislocation, back pain, hitting, contusions and crushing. It should be noted that the study of these patterns can be used to identify and prioritize of occupational accidents. Conclusion: The proposed groups make new opportunities for development of the applications to analyze, interpret and automate management of occupational accidents in order to minimize uncertainty and increase its objectivity. Its advantage over other similar analyses can be considering both the risks and injury and to obtain groups of two variables. Due to the frequency and distribution of mass of risk and injury variables in the groups, the risk and injury variables of group 3 are the most important, and the risk and injury variables of group 2 are less important and the risk and injury variables of group 1 have the least importance.

Background and aims: correspondence analysis method and preparation of accident and occupational hazards pattern enables forecasts and predictions of accidents and prioritizations of risks and injuries to be obtained automatically. The procedure for any company, regardless of its size is applicable. This study presents the first model accidents and occupational hazards as a first step to identify and predict accident in the workforces. Method: initially was collected reports of occupational accidents registered in the Social Security for a period of ten years (2005 – 2015) (222,300 accidents) and the type of risk and injury related to any of the accidents have been codified following the criteria of the International Labor Organization. In the next step, the average annual occupational accidents summarized in a contingency table, include of risk (R) as row and injury (A) as column, it called risk-injury matrix. Correspondence analysis was selected as the suitable method for optimizing the risk-injury matrix functions. Thus, we were used statistical software STATISTICA and correspondence analysis test for data analysis. Results: The obtained risk-injury group (the first pattern accidents and occupational hazards) include of six risks and seven injuries that the obtained pattern is composed of two dimensions: dimention1, with eigenvalue =0/562, dimention2, eigenvalue 0/419% is 78/6% of the total variance. The greatest affinities are contact with hot material (R11) with burn (A12); Accidents caused by burning and corrosive materials (R12) with other injuries (A18) and multiple injuries (A17); Contact with chemicals (R14) and accidents caused by toxic substances (R15) with gas shock (A14); Contact with electrical equipment (R13), explosions and fires (R17) with suffocation (A16) and poisoning (A13) and environmental hazards (A15) is the least affinity with other variables. Overall, mentioned variables have less affinity than other 23 variables. Conclusion: This obtained risk-injury group includes all the of risk and injury variables related to the appearance of historically recent technological problems, the industrial revolution and scientific and technical development. In this group the Industrial accidents are identified in this group as risks associated with the work environment, and injuries being caused by the environment. This study is the first step to anticipate accidents and occupational hazards and prioritize risks and injuries and we can use these results fully to the goals came in the later stages.

Background and objective: The women-headed households are more susceptible to social damages than other women. Such condition remarkably influences the women’s health-related life quality. The present study was aimed to investigate the effect of the educational intervention based on PRECEDE-PROCEED model on the quality of life in women-headed households covered by the Tehran Welfare Organization. Materials and methods: About 180 household-head women, from among the women under the protection of Tehran Welfare Organization, participated in this quasi experimental witnessed study. Sampling was done through multistage random sampling method. Instruments used for gathering data included life quality standard questionnaire (WHOQOL-BREF) and a researcher-made questionnaire about the structures of ecologic and educational diagnosis phase of the PRECEDE-PROCEED model whose validity and reliability were approved in the primary study. Based on the results obtained from the primary filling of the questionnaire, the appropriate educational intervention was designed and performed in the case group. One month and three months after the intervention, data were analyzed by SPSS 15 using the descriptive (the mean, SD, frequency and percentage) and analytical tests (t, Mann–Whitney, Chi Square, ANOVA with repeated measures, and Freedman tests). Results: Before intervention no significant difference was observed between the mean scores of the life quality, behavioral factors, and knowledge, enabling, and reinforcing factors among the two groups. But one month and three months after intervention a significant difference was observed between the mean score of the life quality (p = 0.001), behavioral factors (p = 0.001), and knowledge (p = 0.001), enabling (p < 0.001), and reinforcing factors (p = 0.001) in the two groups. Conclusion: Educational intervention through the PRECEDE-PROCEED model effects the women-headed households’ quality of life improvement.

Introduction: Crimean-Congo hemorrhagic fever (CCHF) is an acute viral and potentially fatal disease that is endemic in the south east of Iran, especially Sistan and Baluchestan. This study aimed to measure the serum levels of interferon-[1]r (IFN-[1]r) in the patients with CCHF, considering the disseminated intravascular coagulation (DIC) severity. The second aim was to determine the correlation between the serum levels of IFN-[1]r and DIC severity using the guidance of diagnosis and treatment of the CCHF. Methods: Thirty-seven patients with CCHF were studied. The diagnosis was made, based on the detection of viral RNA by real time-polymerase chain reaction (RT-PCR) and by positive serology. These patients, based on the severity of DIC, were divided into two groups. The serum levels of IFN-[1]r were measured by the enzyme-linked immunosorbent assay (ELISA) method and compared between these two groups. Data analysis was performed using the SPSS 20.0 and non-parametric statistical tests were used for analyses. Results: The mean serum levels of IFN-[1]r were lower in the patients with CCHF on the ­rst day compared to the ­fth day of admission (P < 0.008). There was a signi­cant relationship between the serum levels of IFN-[1]r and DIC severity, as the level of IFN-[1]r was lower in the patients with overt DIC (P < 0.001). The serum level of IFN-[1]r in the patients with the overt DIC was 1.04 pg/dL with 90% speci­city and 88% sensitivity. Conclusion: The serum levels of IFN-[1]r were lower in the patients with severe CCHF, and their evaluation may be used as a marker for the diagnosis of disease severity.

Introduction: In recent years, platelet rich plasma (PRP) has been receiving increasing attention for the treatment of soft tissue injuries. These numerous applications have raised a great deal of questions and debate about the effectiveness of this method. This study aimed to determine the efficacy of PRP in improving sports injuries and subsequently throw some light on these controversies. Methods: A systematic review of the literature and meta-analysis of results were undertaken. All related databases, such as PubMed, Cochrane Database of Systematic Reviews, DARE, and EMBASE, were searched on the use of PRP on athletes and in sports medicine. The search was conducted from June 2013 to February 2014. Results: Our search retrieved 905 studies, of which 13 randomized control trials (RCT) met our inclusion criteria for systematic review and meta-analysis. All articles were appraised by Critical Appraisal Skills Program (CASP) checklist for RCT studies. The analysis of the results of pain scores and physical activity/functions did not show any superiority for PRP as opposed to the other options. Conclusions: The meta-analysis showed no more effectiveness for PRP application in sports-related injuries in terms of physical function improvement and pain relief. Therefore, the extensive use of PRP for such injuries should be limited. Well-designed RCTs are needed to support the findings.

BACKGROUND: Financial management system acts as a driving force and the first important principle of health sector reform. This study aimed to prepare a framework for new financial management system in Iran health sector. MATERIALS AND METHODS: This qualitative study was conducted by content analysis approach and 15 key informant participants selected through purposive sampling consisted of three minsters of Ministry of Health and Medical Education (MOHME), three vice-chancellors in the Center of Resource Development and Management, Two members of the Health Assembly of the Islamic Consultative, four Medical Sciences university's presidents, and three managers in Budgeting and performance Monitoring Center of MOHME in 2017. Data were collected through semi-structured interviews and they were analyzed using Atlas T6 software. RESULTS: Six main themes were emerged as follow: “legal reform,” “removing barriers to set up accrual accounting,” “cost price calculation,” “operational planning and budgeting,” “human resources' organization, recruitment, and moderation,” and “financial system output utilization (management accounting techniques) as the base for evidence-based policymaking and decision-making practices.” CONCLUSION: Any efforts for improving the current situation and reducing of mentioned limitations could be useful in providing required space for future phases of reforms and calculation of unit cost, operational budgeting, and management of cost and productivity. This can be achieved through an integrated system of recording and producing standard and accrual financial information. Furthermore, changing the accounting process and the financial system that complies with one single encoding in the country is a key issue.