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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 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

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.

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.

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.

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.

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.

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.

Road Traffic Accidents (RTA) are a major worldwide public health problem. The aim of this study was to use the growth mixture model for clustering countries on the basis of the mortality rate patterns of RTAs from 2007 to 2013. We obtained the data on RTA death rates from World Health Organization reports and Human Development Index (HDI) of United Nations Development Programme reports for the years 2007, 2010 and 2013. Simple Latent Growth Models (LGM) in 181 countries were applied to estimate overall RTA mortality rate growth trajectories and the latent growth mixture modeling utilized to cluster them. According to non-linear LGM, the overall mortality rate of RTAs showed a decrease from 2007 to 2010 followed by an increase from 2010 to 2013. The HDI covariate had a significant negative and positive effect on intercept and slope of the LGM, respectively. The extracted mixture model appeared to have seven classes with different trends in RTA mortality rates. The worldwide countries were clustered into seven classes. Further studies on each of the seven classes are suggested to provide recommendations for reducing the mortality rate of the RTAs. Additionally, increasing HDI in some countries could have a significant effect on reducing the RTA death rates.

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.

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.

Introduction: One of the most important factors affecting the future survival of organizations is identifying and meeting the increasing needs and demands of patients in order to provide high quality health care services. The aim of this study was to identify factors affecting the selection of Milad Hospital, Iran, by patients based on combined marketing factors. Methods: The present analytical and cross-sectional study was performed in the inpatient wards of Milad Hospital in 2013. Data collection was conducted using the Yaghoubi and et al. Questionnaire. The validity of the questionnaire was approved by specialists and its reliability was approved using Cronbach’s alpha (r = 0.85). The statistical population consisted of patients referring to inpatient wards of Milad Hospital. Using the formula for determining sample volume, a sample sized of 421 patients was determined. Sampling was performed using stratified random method. Data were analyzed using one-sample Kolmogorov Smirnov, independent-samples t-test, and ANOVA in SPSS software. Results: Among the seven dimensions of marketing, the service and process dimensions with mean scores of 18.58 and 6.27, respectively, were the most and the least important reasons for selecting a hospital. Moreover, specialization, appropriate quality of services, type of insurance coverage, skilled physicians, reputation of the hospital, recommendations of relatives and physicians, and sophisticated equipment played a leading role in hospital selection. Conclusion: Patients make different choices in different situations, but multiple competitive advantages can result in an increase in frequency of patient referral to a medical center.

Objectives: This study was designed to evaluate the psychometric features of the Persian version of the Fatigue Impact Scale (FIS-P) tool when used in Iranian MS patients. Methods: 140 MS patients and the equivalent number of healthy controls completed the following assessments: FIS-P, Fatigue Severity Scale (FSS), SF-36 questionnaire and the Mini-Mental State Examination (MMSE). Results: A significant inverse correlation between FIS and the quality of life (SF-36 assessment tool), as well as a positive and significant correlation with the FSS were noted. The Intraclass Correlation Coefficient (ICC) values for the inter-rater reliability for the physical, cognitive, and social sections and the whole questionnaire were 0.89, 0.86, 0.95 and 0.98, respectively. The FIS Persian version was shown to possess a high reliability (with a Cronbach’s alpha of 0.953). Likewise, the ICC values for the test-retest reliability were 0.86, 0.87, 0.92 and 0.93 for the physical, cognitive, social subscales and the whole questionnaire, respectively. This suggested a high reliability for the FIS-P. Discussion: With a proper validity and reliability, the Persian-version of FIS retains the capability for being used in the assessment of fatigue and evaluation of the treatment and rehabilitation effects on fatigue-related symptoms among Persian-speaking patients with MS.

Abstract Background: Ferula assa-foetida is one of the common medicines that was used as antiseptic with a view to traditional uses, it can be used as a safe and effective drug to treat diseases particularly resistant bacterial infections. This study aims to product gelatin nano- capsules containing Ferula assa-foetida essential oil and investigate their antioxidant and antibacterial activities. Materials and Methods: This experimental study was performed on gelatin nano-capsules containing Ferula assa-foetida essential oil (FAO) (2, 4, 6 and 8% w/w), glycerol (25% w/w) as plasticizer and glutaraldehyde as cross-linker. The morphology, antioxidant and antibacterial activities and operation of the nano-capsules were assessed according to American Standards by Scanning Electron Microscopy, ABTS, and microbiological tests. Results: Gelatin nano-capsules exhibited low antioxidant and antibacterial activities while gelatin nano-capsules incorporated with FAO exhibited excellent antioxidant and antibacterial. The highest rates of these effects were seen merged with 8% of FAO. Conclusion: Gelatin nano-capsules merged with FAO have excellent physical form, as well as they are an appropriate antioxidant and antibacterial that have been considered to produce antoxidant and antibacterial drugs.

Background: The complications associated with spastic cerebral palsy can affect the physical ability and quality of life of individuals suffering from this motor disorder. The aim of this study was to assess the relationship between quality of life and hypertonia in adults with spastic cerebral palsy. Methods: In an analytical cross sectional study, 70 subjects with the diagnosis of spastic cerebral palsy from three Ra’ad Rehabilitation Goodwill complexes in Tehran and Karaj cities took part in this study through convenient sampling. The severity of spasticity and contracture of the knee flexors were measured by Modified Tardieu Scale. Also the quality of life was assessed through World Health Organization quality of life-BREF questionnaire. To analyze data, Pearson and spearman correlation coefficient were used. Results: Participants of this study were 42.90% male, 57.10% female with mean age 26.24±5 years. No correlation existed between quality of life with knee flexor muscles spasticity. However, psychological and environmental domains showed low correlations with knee extension range (respectively r=0.26 and r=0.28; P

BACKGROUND: Regarding lack of resources in the health-care sector, prioritization of these resources is inevitable. The objective of the current study was to elicit public preference in prioritizing and allocating health resources using a discrete choice experiment technique, which is currently the most commonly applied method in this field of researches. METHODS: In this discrete choice study, five attributes were selected through interview with 25 health experts to elicit people preferences in Tehran (Iran) in 2017. Eighteen choice tasks were arranged within 3 blocks, and this would be achieved with a sample size of 579. Choice data were modeled using generalized estimating equation method and STATA 14 software. RESULTS: Five attributes including level of emergency, severity of disease, communicable, benefit from treatment, and age are the most important attributes in the prioritizing health resources from the expert's point of view. As well as among these attributes, communicable (odds ratio = 2.81) is the most important attributes from the public's point of view. CONCLUSION: The results of this study could be very useful for prioritizing resources which is one of the most challenging measurements of the health system. By identifying the importance of each patient's characteristic, patients can be categorized in groups with different priorities, as well as the diagnosis-related group system, based on which resources are allocated.

Background: This study was designed to present and compare Iranian hospitals` performance applying ratio analysis technique.Methods: This cross-sectional survey was conducted to present an instant image of 139 Iranian hospitals` performance status applying ratio analysis as one of the non parametric technical efficiency assessment methods in 2008. Data was collected using nine dimensional questionnaires supported by world wide web to achieve main hospital ratios. Final analysis was performed applying classic statistics and relevant statistical tests on significant level of 0.05. Results: Four hospital performance indicators were estimated in the studied hospitals as follows: Bed turnover rate (BTR) was fluctuated from 64.5 to 114.8 times for hospitals located in rich and poor areas respectively. Moreover Bed Interval Rate (BIT) was calculated 1.36 versus 2.4 in the poor and rich areas. Average length of stay (ALS) was computed 1.82 for the poor regions but 3.27 for the rich ones furthermore, a positive statistical significant correlation was seen between ALS and the hospital size (P=0.001,r=0.28). Average bed occupancy rate (BOR) was 57.8% and its variation was from 31.4% to 64.5% depending on the hospital size so that there was a positive statistical significant relationship between the hospital size and BOR (P=0.006, r=0.32).Conclusion: Regarding that BOR, ALS, BTR and BIT along with mortality rates are mentioned as the most considerable performance indicators, applying analytic frameworks more than considering single and raw indicators are severely recommended.

Introduction: The family of each hearing-impaired child has its own cultural, social, educational, and financial background, and its own special needs. The objectives of our study were to explore the information and support needs of parents of children with severe-to-profound hearing impairment and to investigate the effects of the parents’ level of education and economic status on the score attained in the parents’-needs questionnaire. Materials and Methods: Fifty-one parents of children with severe-to-profound hearing loss (53% girls, 47% boys; mean age 47.96 months) who used the Auditory-Verbal Therapy approach were asked to complete the parents’-needs questionnaire. The questionnaire included demographic information and hearing-loss history and covered six domains which evaluated the information or support needs of parents. Parental needs with regard to different domains were evaluated separately in all participants. Results: Statistical analysis indicated that there was a significant decrease in the score attained in the parents’-needs questionnaire with increasing level of education of the child’s parents (P

Introduction: Consequences of cerebral palsy can cause significant influences on physical and psychological capabilities of adults with cerebral palsy and affect on their quality of life. The purpose of this study was to investigate the relationship between quality of life with hypertonia and ambulation status in young adults with spastic cerebral palsy. Materials and Methods: In an analytical cross sectional study, 70 participants (40 women ،30 men, age range 20 to 40 years, mean age + SD, 26.24 ± 5.07) with spastic cerebral palsy were recruited in this study. They were selected from three Ra’ad Rehabilitation Goodwill Complexes in Tehran and Karaj cities. Quality of life (QOL), ambulation status, knee extension, and ankle dorsi flexion range of motion were measured by World Health Organization Qualit of life questionnaire (WHOQOL- BREF), functional ambulation category and manual goniometer, respectively. To analyze the data, Pearson and spearman correlation coefficient, Mann-Whitney U test, Independent sample T test were used. Results: We found no correlation between ambulation status and ankle dorsi flexion range of motion with quality of life domains. However, psychological and environmental domains showed low correlations with knee extension range of motion (respectively r = 0.26 and r = 0.28). Also, no significant difference was found between males and females in QOL domain scores. Conclusion: Probably knee extension range of motion could affect on psychological and environmental domains in adults with spastic cerebral palsy. Also, impairments and physical limitations seems to have a less pronounced effect on health-related quality of life in adults with cerebral palsy. Keywords: Quality of life, Ambulation status, Range of motion, Cerebral palsy

Abstract Background: Consequences of cerebral palsy in adulthood can affect physical, psychological capabilities and quality of life. The purpose of this study was to investigate the relationship between quality of life with spasticity and level of motor function in Iranian young adults with spastic cerebral palsy who were community dweller. Methods: In an analytical cross sectional study, 77 participants with spastic cerebral palsy (44 women، 33 men) with age range of 20 to 40 years; (mean age 26.19±5 yr) took part in this study. They were enrolled from three Raad Rehabilitation Goodwill complexes in Tehran and Karaj cities. All subjects were recruited through convenient sampling. Severity of Spasticity for knee flexors was measured with Modified Tardieu Scale. In addition, the level of motor function, and quality of life were assessed respectively through Gross Motor Function Classification System and World Health Organization Quality of life questionnaire (WHOQOL- BREF). To analyze data, Pearson and spearman correlation coefficient was used. Results: No correlation found between quality of life with knee flexor muscles spasticity and level of motor function (p> 0.05). Conclusion: Quality of life as a multi dimensional concept has been impacted by many factors such as physical status, environmental issues and culture. Possibly, severity of spasticity and level of function have a less pronounced effect on quality of life in community dwelling adults with cerebral palsy.

Abstract Background: One third of patients with Parkinson’s disease (PD) have mentioned “dysphonia” as their most debilitating communication deficit. Patient-based measurements, such as Voice Handicap Index (VHI) add necessary supplementary information to clinical and physiological assessment. There are a few studies about relation between VHI and disease severity in PD, although none of them showed any significant correlation. The goal of this study was to find correlation between these variables in Iranian PD patients. Method: This cross-sectional, analytical and non-interventional study was done on 23 PD patients who reported a voice disorder related to their disease. They were selected from attendants of movement disorders clinic of Hazrat Rasool Akram Hospital. The relationship between disease severity (according to Hoehn and Yahr/H&Y and Unified Parkinson’s Disease Rating Scale-part3 /UPDRS-III) and VHI questionnaire (and its 3 domains) was investigated based on patients’ sex, UPDRS-III score H&Y and VHI. Results: Total VHI and its 3 domains had no relationship with disease severity (H&Y) in all patients and by sex separation. However, there was a positive correlation between VHI and disease severity (UPDRS-III) (r=0.485). There was also a relation between physical and functional domains of VHI and UPDRS (rP=0.530, rF=0.479) while no relationship observed regarding sex differences. 9 out of 18 UPDRS-III items had strong relationship with VHI (total and 3subscales). Conclusion: Iranian PD patients feel handicap according to voice disorder caused by PD. Patient satisfaction of voice decreases with the disease severity and progression. A larger sample size is necessary to find relationship in genders. VHI is an important issue could be offered to be used in PD beside other assessments.

Background and Aim: Quality of printed papers in 4 four medical journals affiliated to one of the universities of medical sciences in Iran was assessed based on methodological and statistical methods.Materials and Methods: In this cross sectional study conducted in 2010, out of all articles published between the years 2002 to 2008 in one of the universities of medical sciences for affiliated journals that were equal to 1568, a sample of 162 articles were selected with Multi-stage stratified sampling method . For data collection, standard questionnaire was used to develop an information form. One sample t-test and Kruskal-Wallis test were used to compare scores from different parts of article.Results: Cross sectional studies with 61.7% (100 papers) formed most of studies. Median of authors and number of references for each article were 3 and 19, respectively and 10% of articles had more than 35 references. Material and methods with 3.53 points from 4 points (88.2%) earned the mighest score which was of high quality and conclusion achieved the lowest score. Also p-value has been reported correctly in 102 articles (81.6%). In 95 articles (58.6%) results were not compare with the similar internal articles whereas only in 21 articles (13%) comparison was not made with similar external researches.Conclusion: The present study showed that the overall quality of the medical articles is not desirable. Hence, employing experts in research methods and statistics in various medical studies can improve the quality of articles in this branch of science.

Background and Aim : These days dental composites are very popular because they look good and are similar to human teeth regarding color. Hygroscopic expansion is one of the physical properties of dental composites. A dental composite may lose its efficiency as a restoration material because of water absorption. The objective of this study was to compare the hygroscopic expansion of three dental composites . Materials and Methods : In this experimental study, to assess the effective factors of hygroscopic expansion, we used three different dental composites (Kalore, P90 and Z250). The length of these composites in water and saliva were measured eighteen times in a three-month period. We used the marginal modeling technique, in which the correlation between response data can be included for analysis . Results : The results of marginal modeling showed that the type of composite is significantly related to hygroscopic expansion (P0.05). Conclusion : Overall, our findings showed that hygroscopic expansion is significantly related to the type of composite and time. Therefore, we should utilize the composites with lower hygroscopic expansion (such as Z250) for filling the patients’ teeth .

Background: The Motricity Index was used to measure strength in upper and lower extremities after stroke. The weighted score based on the ordinal 6 point scale of Medical Research Council was used to measure maximal isometric muscle strength. There is dearth of articles dealing with the reliability of this method. Therefore, the aim of this study was to determine the test retest reliability of Motricity Index strength assessments for paretic lower limb in 20 chronic stroke patients with one week interval. Methods: In a cross sectional study, intrarater reliability of lower extremity Motricity Index strength assessments with one week interval were measured. Result: The SPSS 18 was used for analysis of data. Two-way random-consistency model of ICC was used for assessment of test-retest reliability. The ICC values showed high reliability of strength measurement of Motricity Index (ICC=0.93). Conclusion: The Motricity Index can be a reliable instrument for measuring the strength of involved lower extremity when assessment is done by one rater following chronic stroke.

Objective: The purpose of this study was to determine the relation between parentsʼ child bearing methods parents and school anxiety, regarding to the self-concept as a variable, especially in mentally retarded school students. Materials & Methods: The study Population included all known-available educable mentally retarded students, aged 12-18 years, in Kermanshah. The other entry criteria for the above-mentioned population were the parents’ age between 30-55 years and having at least 5-year elementary education. Entire community (157 people) was applied, this way parents of students 30 to 55 years of age and at least fifth of their study, were enrolled After applying these criteria remain Number 125 remained, test your imagination on all students was conducted among 125 students, then 83 patients were available. And then by parents child rearing styles test methods and test anxiety of students by teachers of the school was completed. Obtained data with statistical tests, including tests Kolmogorov-Smirnov (for study being normal data distribution), Pearson and Spearman correlation (for relation between variables) and Covariance analysis tests were analyzed. Results: Results showed that children husbandry practices powerful father (P=0.002) and mother (P=0.001) a significant negative relationship with school anxiety. The autocratic style husbandry child's father (P=0.009) and mother (P=0.020) a significant positive relationship with school anxiety. In addition, simple husbandry practices lighter child's father (P=0.319) and mother (P=0.452) have a significant relationship with school anxiety and determined that a significant effect on anxiety self concept school students are mental (P=0.004). Conclusion: Statistical test results showed child rearing methods parents ways anxious school students are effective but moderate effect on self concept child rearing parents practices is an important than part of school anxiety. This means that students who have strong self concept less students who are weak self concept, anxiety, school experience.

Objective: The aim of this study was to survey the reliability of Intra-rater and Inter-rater with and without video camera assessment in children with spastic cerebral palsy. Materials & Methods: In this cross-sectional study, we validate the Quality of Upper Extremity Skill Test questionnaire. Fifty children with hemiplegia aged 19 to 95 months (mean age 61.31 ± 25.7 month) were enrolled in our study using non random available approach. After obtaining parents’ consent, intra-rater assessment was performed in one session and intera rater assessment with camera after 10 days. Then, the third examiner did the reassessment using film observation of 46 children from 50. Spearman correlation for survey the reliability of intra-rater & inter rater with & without video recording assessment & gross motor function classification system 66 for determined functionality of child were used. Results: Intra-rater correlation was 0.774-0.996, Inter-rater correlation was 0.663-0.998 and correlation for video camera assessment was 0.710-0.974 for the first and third evaluation and 0.652-0.938 for second and third evaluation. P value for sub scales and total score was P

Weeds are enemies to the crop plants and have harmful effects on agricultural crops due to several factors such as competition for space, light and nutrients. Allelopathic effects of weed extracts were studied on grain yield and yield components of rice. The experiment was carried out in the Rice Research Institute of Chaparsar, in 2006- 2007, in Tonekabon, Iran (latitude 36°54’ N, longitude 50° 40’E, level -20 m altitude), split plot on basis of randomized completely block design (RCBD) with 4 replications. Results showed highly significant differences suggesting substantial to moderate phenotypic variability in most parameters evaluated except number of empty grain and 1000 -grain weight. Also, most yield of single plant obtained from umbrella sedge extract (28.5 g). It seems that umbrella sedge had least minerals in water; it could be affected positively on important factors such as yield of single plant compared to other treatments. Correlation coefficient analysis revealed significant and negative correlation between number of empty grain and yield of single plant (r=-0.42***). It’s implies that grain yield magnitude of Nemat cultivar exhibiting the least number of empty grain. Although yield of single plant was not affected neither by plant height nor number of tiller. In addition, irrigation water due to existence of high mineral and chemical pesticides in upstream of station farms severely was reduced yield. Also, results of this research showed that weed extracts haven’t very allelopathic effect on rice and in end of growing season, that’s better, plant leftover return and remain in field.

Objective: The purpose of this study was to investigate development of the theory of mind (TOM) of mentally retarded students and its relationship with the number of siblings. Materials & Methods: This descriptive study was in correlation determination type, the total number of 8-14 years old mentally retarded students (59 people) who were studying in 1st to 5th degree of primary school in Mee’aad education center of Torbat-e Heidarieh (the only male education center of Torbat-e Heidarieh) in academic year 2008-09 participated. To collect data of theory of mind (TOM) Unexpected-content task and 38-item test of theory of mind were used. In order to analyze data, ANOVA, Scheffe, Pearson correlation coefficient and Chi- square were carried out. Results: The first and second level of the evolution theory of mind of the mentally retarded students ascending to 12 years (P

Objective: To translate the WHO’s quality of life questionnaire, WHOQOL-100, into Persian language and assess the validity and reliability of this translated version. Materials & Methods: To translate the questionnaire, a forward-backward procedure is used. A pilot sample of 60 university students was recruited to assess the repeatability and concurrent validity of the instrument. Then, 500 healthy and 500 disabled individuals were randomly selected using a multi-stage sampling technique. The internal consistency of the Persian version of the WHOQOL-100 was evaluated using the Cronbach’s alpha in this sample. In addition, a multiple linear regression model was utilized for assessing the discriminant validity of this instrument adjusting for different confounders. Results: The test-retest analysis of the data from the pilot sample showed that the Persian version of the WHOQOL-100 has acceptable repeatability (ICCs for all six domains were more than 0.7). Also, computing the correlation between domains of WHOQOL-100 and WHOQOL-BREF showed satisfactory concurrent validity. Analyzing the data from 500 healthy and 500 disabled persons revealed that all the domains of WHOQOL-100 met the minimum level of acceptable internal consistency. The multiple regression results showed acceptable discriminant validity for all domains of this version of the WHOQOL-100, expect for the spiritual domain. Conclusion: In general the Persian version of the WHOQOL-100 had satisfactory reliability and validity for assessing the quality of life in Iranian people. However, further research is recommended for challenging the problem of the spiritual domain.

Objective: Handwriting difficulties are a common educational problem in mentally retarded students. The aim of this survey is producing an instrument for handwriting evaluation and executing it on the mentally retarded students. Materials & Methods: In this descriptive and cross – sectional research which is a relationship and validity assessment study, one hundred and twenty six mentally- retarded students (53 girls and 73 boys) ranging from 9 to 19 years old from two exceptional children schools in Shahr-e-rey participated. A handwriting check-list made by the researcher was executed on all of the students. Data were analyzed by use of independent T test, Mann Whitney test and Spearman correlation. Results: Executing handwriting checklist on the mentally-retarded students showed that there is not a significant relationship between handwriting and laterality (P=0.196), sex (P=0.487) and age (P=0.449). There is significant relationship between handwriting and grade (r=0.448, P

Objective: The purpose of present research was the comparison of mothers irrational believes with severe or profound mentally handicapped child and mothers with normal child from 6 to14 years old in Tehran city. Materials & Methods: This study was an analytical, cross – sectional and comparative (case – control) research. From mothers with severe or profound mentally handicapped child who had refered to Tehran welfare services centers, 80 mothers were selected by regular randomized sampling from two rehabilitation centers and 80 mothers with normal child were selected for peering with the group of testimonial from schools areas of east, west, south, north and center of Tehran, through multi - stage cluster sampling in for variables of: age of mothers, educational levels, the location of living and the number of children. They answered to questionnaire of irrational believes of jons (IBT). Analysis of data was done by descriptive and infringing statistics methods (Independent T test, U Mann Whitney, Chi-square and fisher). Results: The findings showed that: there are significantly differences in total irrational believes and irrational believes of blame proneness, frustration reactive, anxious over concern, problem avoiding and dependency, perfectionism between two groups of mothers (P