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The first step to reducing the growing burden of cardiovascular disease (CVD) is to find modifiable risk factors with the highest burden in each population. Urban and rural citizens may have different priorities in this regard. This study aimed to compare the 10-year incidence probability of CVD events and its associated risk factors between rural and urban areas in Iran. Data was extracted from two big cohorts, Fasa Adults Cohort Study (FACS) and Shiraz Heart Study (SHS), with participation of over 12,000 general population. Linear regression models were used to test the difference in CVD risk between two populations. Totally, 6,258 FACS and 6,101 SHS participants entered the study. Urban participants had a significantly higher mean ASCVD score (4.43% vs. 5.51%, p-value < 0.001). Also, they significantly showed higher body mass index, waist circumference, cholesterol level, fasting blood glucose level, systolic blood pressure, educational attainment, and occupational status. However, the prevalence of smoking was higher in rural areas. Notably, socioeconomic parameters including marital, occupational, and educational statuses seem to have strong impact on cardiovascular risk factors. After adjustment for all confounders, living in the urban areas seemed to be associated with higher atherosclerotic CVD risk (β = 0.78, 95%CI: [0.69-1.05]), which was consistent across both sexes. Given the higher risk of cardiovascular events in urban areas and different profiles of risk factors between these two regions, preventive strategies should be precisely and separately designed for each population by the health authorities and policymakers in order to reduce the CVD toll efficiently., Competing Interests: Declarations. Ethics: The present study was conducted considering the Helsinki Declaration and approved by the Ethical Committee of Shiraz University of Medical Sciences (ethical code: IR.SUMS.REC.1400.413). All of the participants were aware of the aims, benefits, and risks of the study by a written informed consent. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Obesity is increasingly recognized as a leading cause of death and is associated with various comorbidities. This study evaluates the relationship between protein score, characterized by the plant-to-animal protein ratio (PAR) and total protein per calorie (Pro%), and body composition: fat percentage (FATP), fat mass (FATM), and fat-free mass (FFM). We categorized 4512 individuals (55.2% female) into tertiles based on their protein score and its components. Male participants in the highest and middle protein score tertiles exhibited significantly greater FFM in both adjusted and crude models, and lower FATP and FATM in adjusted model 2. FFM was elevated in the top (P < 0.001) and middle (P = 0.002) Pro% tertiles in males in both adjusted models and only in the top tertile of all models in females (P = 0.003). The analysis of male participants revealed significantly lower FATP and FATM in the highest tertiles of Pro% in adjusted models. Among female participants, only the highest PAR tertile was associated with significantly lower FATM in adjusted model 1 (P = 0.042). Our findings indicate that protein score and its components are associated with favorable body composition differences. Health administrators may leverage these insights to refine dietary guidelines., Competing Interests: Declarations Ethics approval The study followed the Declaration of Helsinki guidelines and received approval from the IRB (Institutional Review Board) of Fasa University of Medical Sciences (Code: IR.FUMS.REC.1395.177). Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Many factors can lead to an increase in the prevalence of metabolic syndrome (MetS) in different populations. Using an advanced structural equation model (SEM), this study is aimed to determine the most important risk factors of MetS, as a continuous latent variable, using a large number of males and females. We also aimed to evaluate the interrelations among the associated factors involved in the development of MetS. This study used data derived from the Fasa PERSIAN cohort study, a branch of the PERSIAN cohort study, for participants aged 35 to 70 years with 10,138 males and females. SEM was used to evaluate the direct and indirect effects, as well as gender effects of influencing factors. Results from the SEM showed that in females most changes in MetS are described by waist circumference (WC), followed by hypertension (HP) and triglyceride (TG), while in males most changes in MetS are described by WC, followed by TG then fasting blood glucose (FBG). Results from the SEM confirmed the gender effects of social status on MetS, mediated by sleep and controlled by age, BMI, ethnicity and physical activity. This study also shows that the integration of TG and WC within genders could be useful as a screening criterion for MetS in our study population., (© 2023. Springer Nature Limited.)

Nurses play a key role in medication safety and, by extension, patient safety. Evaluation of medication safety competence in nurses requires valid, specific, and comprehensive instruments. The present study was conducted to translate and psychometric assessment a Persian version of medication safety competence scale (MSCS) for clinical nurses in Iran. This is a cross-sectional and multi-centric work of research with a methodological design. A total of 1080 clinical nurses were selected from 5 cities located in Iran. The original version of the MSCS was translated into Persian and the psychometric properties of MSCS were assessed using COSMIN criteria. The exploratory factor analysis (EFA) showed that the factor loading of the 36 items was between 0.72-0.87, all of which were significant. The confirmatory factor analysis (CFA) fitted the data well (χ 2 /df = 7, RMSEA = 0.01, CFI = 0.96, NFI = 0.95, and TLI = 0.97). The reliability of the instrument was assessed in terms of its internal homogeneity where the Cronbach's alpha of the whole instrument was found to be 0.96. The Persian version of MSCS for nurses possesses satisfactory validity and reliability. Thus, nurse managers can use this instrument to measure medication safety competence in nurses., (© 2023. The Author(s).)

Multiple sclerosis is an inflammatory disease of the spinal cord and brain. Receptor for advanced glycation end products and Apolipoprotein A1 (Apo-AI) have been recommended to have a pathogenic role in the neuroinflammatory disorder as multiple sclerosis. The purpose of this research was to measure the plasma levels of S100A12 and Apo-A1 in the first-degree family of relapsing-remitting multiple sclerosis (RRMS) patients. Plasma levels of S100A12 & Apo-A1 were evaluated via enzyme-linked immunosorbent assay in the thirty-five new cases of untreated patients with deterministic RRMS according to the McDonald criteria, twenty-four healthy controls, and twenty-six first-degree members of untreated RRMS patients (called them as high-risk group). The main findings of this study were as follows: the plasma level of S100A12 was significantly lower in the new cases of untreated RRMS (P ≤ 0.05; 0.045) and high-risk (P ≤ 0.05; 0.001) groups. Although the plasma protein level of Apo-A1 was reduced significantly in the high-risk group (P < 0.05, P = 0.003) as compared to the healthy control group, there was no significant difference in the untreated RRMS patients (P = 0.379). The plasma level of vitamin D3 in both RRMS patients and high-risk groups displayed significance reduction, although, there was no significant association between vitamin D and S100A12 & Apo-A1 levels. Given the role of S100A12 and Apo-A1 in the inflammatory process performed in the first-degree family members of the RRMS patients, which revealed a significant decrease in this group, we concluded that they can be considered as one of the contributing factors in the pathogenesis of MS, though more research is needed before assuming them as predictive biomarkers., (© 2022. The Author(s).)

Recent decades have seen a dramatic rise in the prevalence of obesity. While genetic factors can influence obesity, environmental factors and lifestyle may play important roles as well. Sleep can be regarded as one of these factors. This study aimed to examine sleep duration, as a potential risk factor for obesity in an Iranian population. In this cross-sectional study, the Fasa PERSIAN cohort study data was used and 10,136 subjects aged 35-70 were entered. Anthropometrics indices have been measured and the total body fat percentage (BFP) was obtained by Bio-Impedance Analysis. Also, physical activity and dietary intake have been recorded. Sleep duration was obtained and individuals categorized into two groups of "< 8" and "≥ 8" h of sleep. The mean age and sleep duration of the participants were 48.63 ± 9.57 years and 6.92 ± 1.62 h in the total population, respectively. All of the anthropometric indices were significantly higher in the "< 8 h of sleep" group than in the "≥ 8 h of sleep" group. Regarding BFP and fat mass index (FMI) the same results was seen (p-value < 0.05). Body mass index (BMI), Waist and hip circumferences (WC, HC), and waist-to-height ratio (WHtR) were in a significant negative association with night time sleep (p-value < 0.001), while these associations with daytime napping were positive (p-value < 0.001). After multi-variable adjusting, BMI, WC, HC, WHtR, and wrist circumference showed significant negative associations with 24-h sleep duration (p-value < 0.05). This study established the association between nocturnal, daytime napping, 24-h sleep duration and obesity parameters. Daytime napping was positively associated with obesity parameters and short 24-h sleep duration was associated with higher risk of overweight/obesity. These results indicate that insufficient sleep can be a screening indicator for an unhealthy lifestyle and poor health outcomes., (© 2021. The Author(s).)

One of the main health problems in many societies is the increased opium abuse, which was found to be correlated with many problems like cardiovascular disease. This study aimed to evaluate the correlation of opium use with blood lipoproteins as the risk factor of CVD. This was a cross-sectional study conducted on participants of the first phase of the PERSIAN Cohort study who were aged between 35 and 70 years old. Demographic characteristics; history of smoking, alcohol, and opium consumption; medical history; and medications were asked and the related checklists were filled out. The levels of physical activity and fat intake were also registered. As well, lipoprotein profiles were investigated by blood sampling. The linear and logistic regression was used to analyze the relationship between opium and lipid profile and the statistical significant level was considered as < 0.05. Among 9300 participants with a mean age of 48.06 ± 9.44 years old, 49.6% of them were men. About 24.1% of the participants used opium. In the linear regression models, unlike TG (β = 2.2, p = 0.36), total cholesterol (β = - 2.5, p = 0.02), LDL (β = - 2.0, p = 0.04), and HDL (β = - 1.0, p = 0.04) were significantly lower in people who used opium compared to the others. In the logistic regression models, abnormal level of LDL (OR = 0.78, p = 0.003) and total cholesterol (OR = 0.82, p = 0.008) were less in people who used opium compared to the others. This study showed that there is a correlation between opium usage and lower levels of total cholesterol and LDL; however, the lower level of HDL in normal range was seen in opium users. Considering the current evidences, most of them showed the increased risks of ischemic heart disease, heart attack, hypertension, cerebrovascular disease, and cancer in opium users. Therefore, Healthcare providers and patients should be noticed about the deleterious effects of opium consumption on various vascular events. In addition, it is necessary for managers and policy makers of the health care system to take the necessary measures to raise the level of awareness and health literacy of the general public about the high-risk side effects of opium use and to take necessary and effective strategies to prevent and reduce its use.

Metabolic syndrome (MetS) is one of the risk factors for all causes of mortality. Inflammation is an important risk factor for MetS. The present cross-sectional study aimed to investigate the relationship between MetS and pro-inflammatory diet by using the food inflammation index (DII). This study consists of 10,017 participants with an age range of 35 to 70 years. The Fasa Cohort Study (FACS) population (Fars Province, Iran) was used to collect data. The DII was estimated according to Shivappa et al. method using a validated 125-item FFQ. To determine the association between MetS components and DII Logistic regression was used (P > 0.05). The overall mean of DII was - 0.89 ± 1.74. However, adjusted multinomial logistic regression indicates each unit increase in waist circumference (WC) (OR 0.98, 95% CI 0.96-0.99) and HDL-C (OR 0.99, 95% CI 0.98-0.99) was associated with significantly decreased odds of being in the 4th DII quartile in men and all participations respectively, there is no statistically significant relationship between MetS and DII. Overall, although people in the highest quartile of inflammatory food consumption had more likely to develop MetS, this relationship was not statistically significant among males and females.

Cardiovascular disease (CVD) is the leading cause of death worldwide. One common factor that may affect CVD risk factors is sleep disturbance. The factors influencing an individual's sleep may vary among different cultures. The current study investigated sleep quality and quantity in the Fasa cohort population as an Iranian population. In a cross-sectional study using the Fasa PERSIAN cohort study data, 10,129 subjects aged 35-70 were entered. Self-reported sleep duration and cardiovascular events were recorded. The Framingham risk score (FRS) is used to predict cardiovascular events. Adjusted logistic regression showed significant odds ratios in subjects who sleep less than 6 hours for CVD (OR = 1.23; 95% CI:1.03-1.48), coronary heart disease (CHD) (OR = 1.21; 95% CI:1.009-1.46), and hypertension (HTN) (OR = 1.37; 95% CI:1.16-1.62). Higher risk profiles were also seen in the FRS for short sleepers. The highest significant odds ratios in FRS profiles in the intermediate high-risk group compared with the low-risk group were (1.44; 95% CI:1.18-1.75) in CVD and (1.48; 95% CI:1.16-1.88) in CHD risk score profiles. It can be suggested that participants with short durations of sleep had significantly higher CVD, HTN prevalence, and 10-year FRS. Participants with long sleep durations had no increase in CVD, CHD, myocardial infarction (MI), or HTN prevalence. MI prevalence was at the lowest level in subjects who got 8 to 8.9 hours of sleep.