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Background: Toxoplasmosis could lead to serious outcomes during pregnancy. The aim of this study was to investigate serologic toxoplasmosis in three groups of women according to number of sexual partners. Methods: The frequency of anti-Toxoplasma IgG from 471 women (101 virgin girls, 240 married women and 130 multi partner women) were determined by ELISA method from referred participant to medical centers of Tehran, Iran in 2020. The results were analyzed by chi-square and logistic regression tests. Results: Prevalence of toxoplasmosis was significant with the number of sexual partner according to chi square test (P

Background: The bagging (BG) and random forest (RF) are famous supervised statistical learning methods based on classification and regression trees. The BG and RF can deal with different types of responses such as categorical, continuous, etc. There are curves, time series, functional data, or observations that are related to each other based on their domain in many statistical applications. The RF methods are extended to some cases for functional data as covariates or responses in many pieces of literature. Among them, random-splitting is used to summarize the functional data to the multiple related summary statistics such as average, etc. Methods: This research article extends this method and introduces the mixed data BG (MD-BG) and RF (MD-RF) algorithm for multiple functional and non-functional, or mixed and hybrid data, covariates and it calculates the variable importance plot (VIP) for each covariate. Results: The main differences between MD-BG and MD-RF are in choosing the covariates that in the first, all covariates remain in the model but the second uses a random sample of covariates. The MD-RF helps to unmask the most important parts of functional covariates and the most important non-functional covariates. Conclusions: We apply our methods on the two datasets of DTI and Tecator and compare their performances for continuous and categorical responses with the developed R package (“RSRF”) in the GitHub.

Abstract Background The objective of this health system interventional study was to determine the effect of delivering newborn-care-oriented education and encouragement on newborn care utilization. Methods This study was performed in the urban health centers of the catchment area of Tehran Defined Population, which covered 10 of the 22 municipality districts of Tehran. The two catchment areas included 10,000 families in the intervention and 20,000 families in the control areas. As many as 4837 newborns (intervention = 1544, control = 3293) were enrolled and followed until the end of the second month of life. The utilization of the three newborn care visits, as recommended by national guidelines, was compared among the intervention and control groups. Results As many as 877 (56.8%) newborns in the intervention group and 1214 (36.9%) in the control group received all their three newborn care visits. The mean number of newborn care visits was higher in the intervention group compared to the control group: 2.26 (0.99) versus 1.84 (1.07), p

Objectives: Insufficient evidence exists regarding factors that affect screening adherence among people with a family history of diabetes, who comprise roughly half of all patients with diabetes. Therefore, we aimed to identify the determinants of diabetes screening adherence in adults with a family history of diabetes who had not yet been diagnosed with diabetes. Methods: This cross-sectional study was conducted at selected urban primary healthcare facilities in Tehran, Iran. The study population was clinically non-diabetic adults above 20 years of age with a family history of diabetes in at least 1 first-degree relative. All eligible people identified on randomly-selected days of the month were invited to join the study. Results: Among 408 participants, 128 (31.4%) had received a fasting blood glucose check during the last year. Using binary logistic regression, the independent predictors of screening adherence were knowledge of adverse effects of diabetes such as sexual disorders (odds ratio [OR], 3.05) and renal failure (OR, 2.73), the impact of family members’ advice on receiving diabetes screening (OR, 2.03), recommendation from a healthcare provider to have a fasting blood glucose check (OR, 2.61), and intention to have a fasting blood glucose check within the next 6 months (OR, 2.85). Other variables that predicted screening adherence were age (OR, 1.05), job (being a housekeeper; OR, 3.39), and having a college degree (OR, 3.55). Conclusions: Knowledge of the adverse effects of diabetes, physicians’ and healthcare providers’ advice about the benefits of early disease detection, and family members’ advice were independent predictors of screening adherence.

Background: Statistical models are used to investigate the relationship between variables in statistical studies. Considering the variety of statistical models, finding the most suitable model is a complex work. This study aimed to compare different models in the treatment of infantschr('39') colic and the misspecification of specificity. Methods: This randomized clinical trial was conducted on 100 infants with colic in the pediatric clinic of Amir Kabir Hospital in Arak, the intervention and control groups were randomly divided into two groups. The collection and analysis of the data was performed in 2016. After teaching massage to mothers of the intervention group, they were asked to perform massage on infants three times a day during the week. In the control group, mothers can relieve the symptoms of colic by shaking the infant. Parents recorded the number and severity of crying daily in the checklist. Finally, by using different models, R software, SAS, and goodness of fit, the best model was introduced. Results: In the massage group, the mean crying intensity of infants with colic decreased from 5.01 units on the first day to 2.47 units on the seventh day. On the other hand, the difference in mean sleep time changed from 1.81 hours in favor of the shaking group on the first day to 1.26 hours in favor of the massage group on the seventh day. Also, the severity of crying in the infants of the massage group was significantly higher than the impulse group. Regarding the grace of marginal models, the first-order self-return correlation structure was the best grace and for some variables, the model had random effects with a gamma distribution for the random component. Conclusion: Massage can reduce infantschr('39') colic. Statistically, in the case of a nonlinear model, the variance of estimates is more than estimated to be influenced by the misspecification of the correlation structure.

Background and Objective: Inappropriate gestational weight gain (GWG) may increase risk of adverse pregnancy outcomes. To prevent these risks, determining optimal weight gain is a priority in prenatal care. The objective of this study was to determine the GWG of women referring to health centers for their prenatal care visits in Tehran in 2016. Materials and Methods: This cross-sectional study was conducted in Tehran, Iran. The study population included all pregnant women receiving prenatal care visits from April 2016 to March 2017 in 12 health centers affiliated to Shahid Beheshti and Iran Universities of Medical Sciences. The sampling method was census and a total of 232 people were surveyed. Data were analyzed by SPSS software version 23 using statistics of frequency, mean and standard deviation. To investigate the relationship between variables, correlation method was used by using Pearson's correlation coefficient at a significance level of 0.05. Results: The mean (SD) of age of women was 28.6 (5.4) with a range of 18 to 40 years. According to the pre-pregnancy body mass index, among 220 pregnant women, 6 (2.7%) were underweight, 112 (50.9%) were normal, 78 (35.4%) were overweight, and 24 (11%) people were obese. The mean (SD) of GWG was 11.7 (4.3) kilograms and among 177 pregnant women, 76 (42.9%) had GWG within, 55 (31.1%) had GWG below and 46 (26) had GWG above guidelines. Conclusion: The prevalence of GWG above guidelines was higher in overweight and obese women than underweight and normal women in this study. Therefore, achieving the appropriate weight before pregnancy and close monitoring of weight gain during pregnancy is recommended.

Objective(s): It has been proposed that lipid markers may predict cardiovascular events; however, their effect may vary depending on the type of cardiovascular disease. The purpose of this study was to investigate the effects of lipid markers on death from coronary heart disease (CHD) and stroke in competing risks setting.Materials and Methods: Participants included 2502 women and 2020 men, age 40 years or older from Tehran Lipid and Glucose Study. The association between total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triglyceride (TG), and high-density lipoprotein cholesterol (HDL-C) with hazard and cumulative incidence of CHD and stroke was investigated using cause-specific hazard and sub-distribution hazard models. Statistical analyses were performed using “risk regression” and “cmprsk” package in R 3.3.2.Results: One standard deviation (SD) increase in TC and LDL-C increased the hazard of CHD death by 1.42 (CI=1.07,1.89) and 1.41 (CI=1.04,1.93), respectively. 1-SD increase in TG increased the cumulative incidence of CHD death increased by 1.94 (CI=1.02,3.75) in women. Other risk factors were not associated with the hazard and cumulative incidence of CHD in women, men and the total sample. In addition, none of lipids had a significant effect on the hazard and cumulative incidence of stroke in men, women and the total sample.Conclusion: The associations of lipid components on CHD death were modified by gender. TC, LDL-C and TG were independent predictors of CHD mortality in women. Furthermore, death due to stroke changes the association of lipid markers with CHD mortality.

Background: The transtheoretical model (TTM) is used as a framework to implement smoking cessation programs. This model has some subscales based on which the smoking temptation scale is proposed as stages movement factor. This study aimed to translate and validate the temptation subscales of the TTM questionnaire in the Iranian population. Methods:This cross-sectional study was conducted on 387 smokers. The participants were selected using convenience sampling method. First, the smoking temptation scale designed by Velicer et al. was translated into Persian, and then, factorial validity of the hierarchical three-factor structure for this subscale was studied using factor analysis and measurement invariance (MI) methods. All analyses were performed using Mplus software. Findings: It was observed that the hierarchical three-factor structure model had a good fit to the data [confirmatory fit index (CFI) = 0.944, Tucker-Lewis index (TLI) = 0.915, Root Mean Square Error of Approximation (RMSEA) = 0.067, standardized root mean square residual (SRMR) = 0.042]. This study showed that this factorial structure had an identical measurement and structural model in subgroups of the population such as rural and urban residence, highly educated and low educated, high income and low income, three stages of quitting, and across the three ethnicities. Conclusion: Given the validity and reliability of the hierarchical three-factor structure for smokingtemptation scale, this measure can be used in interventional programs for smoking cessation in the Iranian male population.

Background: Identification of risk factors involved in road traffic deaths (RTDs) could help policymakers and road traffic managers to adopt effective strategies and approaches for the prevention and control of these incidents, while the lack of accurate data on the risk factors of RTDs causes the problem to persist. This systematic review aimed at assessing the national studies regarding the risk factors of RTDs in the regions covered by the World Health Organization (WHO). Methods: This review study was conducted during 2008–2018 via searching in databases of PubMed, Science Direct, Scopus, Cochrane, Thomson Reuters, Web of Science, EMBASE, ProQuest, and Trip databases. Initially, a literature review was performed to find similar systematic reviews, followed by another literature review to retrieve the published or registered protocols. At the next stage, PECOTS was developed for the search strategy, followed by the quality assessment. The eligibility criteria in this study were the national-level studies about the risk factors related to RTDs, English-language studies, and studies published during 2008–2018. Results: In total, 169 articles were included in this study, with the highest and lowest number of the published articles in the United States and African countries, respectively. According to the reviewed studies, human factors accounted for the most common risk factors involved in RTDs. In the southeastern regions of Asia, the main road-related risk factor for RTDs was reported to be the type of roads. Furthermore, roadside departure to the right side and long roads were denoted in the national data of the Western Pacific region on the incidence of RTDs. Differences were observed between the six regions covered by the WHO in terms of the time-related risk factors for RTDs. Conclusions: Several risk factors have been reported for RTDs in the countries covered by the WHO, and each risk factor is considered to have various subcategories. Therefore, it could be concluded that there are different epidemiological patterns for road traffic accidents and RTDs.

Purpose: The purpose of this study is estimating and comparing the three different dimensions of the EEG and studying the trials variability for two auditory and visually oddball tasks in the healthy subjects. They include regional as the region of the brain, longitudinal as the repetition of the stimuli, and functional as whole curve of Evoked Related Potential (ERP), dimensions. Materials and Methods: The sample size is seventeen, with six females, in this three-trial study with standard and target stimuli per task. The dataset was downloaded from the internet and preprocessed. The Hybrid Principal Component Analysis (HPCA) decomposed the ERPs and estimated eigen components of three dimensions. The 95% Bayesian credible sets and trial effects as random effects of the first eigen component of each dimensions studied with the Generalized Additive Mixed Model (GAMM). Results: The p-values of the interaction effects between time and stimuli, repeats and stimuli and regions and stimuli are 0.05. The p-value of trial effects are

Background: Among the achievements of modern fertility technologies available to contemporary humans, we could mention the freezing technique to fertility preservation, and subsequently, unmarried childbearing. The only way for having children was having sexual intercourse with the opposite gender in the past years; however, with the advent of this technology, even without such a relationship, it is possible to have a child. This process could be termed unmarried childbearing or single-status fertilities. This is one of the resent subjects in medical fertility; however, there is no research in this field, in Iran. Methods: This was an applied and theoretical research in the theology field; thus, no research material was implemented. The main method of this research was the bookcase approach. Results: In countries such as the USA, UK, and Australia, where there are more coherent laws about employing modern fertility techniques, this issue is addressed and specific laws exist in this regard. However, despite widespread use of this technique in Iran, we have no law in this respect except for the Fetal Donation Act of 2003, which only covers the general issues. In other words, the social fertility mandate has remained silent given permission, prohibition, and its conditions and effects on the child lineage in Iran’s laws. Freezing gametes is practiced in our country for a wide range. Besides, single-status fertility is occurring worldwide. Accordingly, this seems to be among the problems facing our society, and may also be illegally conducted in some cases, in Iran. In Islamic law, the permissible instances of reproductive rights include births through marriage, not otherwise, as well as births employing reproductive aids in terms of meeting the Islamic law. On the other hand, some individuals believe that this case can be regarded as some kind of inoculation with the involvement of a donor agency, and some jurists have voted to allow it. Therefore, these jurists explicitly accepted the use of donor gamete in the form of marital relations. The legislature of the Islamic Republic of Iran also emphasizes on donation to lawful couples in the law of donation approach. Therefore, using donated gametes for childbearing is excluded in singles. Additionally, Judaism and all branches of Christianity, except for the liberal protestant denomination prohibit unmarried childbearing. While the approach to the issue differs from one country to another, the USA Supreme Court has recognized and protected free relationships, family formation, and decisions on births, as freedom rights. The UK law has subjected the provision of services to single women to the welfare of children resulting from the process. However, in France, the provision of infertility treatment services to single individuals is prohibited. According to Australia law, any single or heterosexual individual without receiving medically-assessed services, i.e., referred to as ‘‘clinically infertile’’ cannot use this technology for having children. Conclusion: In some countries, like the USA, bearing a child at a single status is legal; however, in some other regions, like the UK and Australia, it is permitted under special conditions. In some countries, like France, this action is prohibited. There is no law about this matter in Iran. The 167 article of the constitution addresses considering the Islamic verses and narrations on preserving the destination of the generation or acquiring the benefits and disposing of the corruption. In conclusion, the only way to have a child and to realize the principle of reproduction is permitted in the framework of religious marriage; thus, bearing a child at a single status is illegal and prohibited, in Iran.

Background and Objectives: Health reform plan is designed to improve health care in Iran. Since job dissatisfaction of health care providers can affect quality of services, the current study aimed to evaluate the views of physicians and residents working in governmental hospitals of Shahid Beheshti University of Medical sciences, regarding the health reform program Material and Methods: This study was a descriptive- cross sectional study. A questionnaire was developed for assessing attending physicians and resident’s views regarding health reform plan. Construct and content validity and reliability of the instrument had been evaluated by experts in the fild. The study population consisted of physicians and residents who worked in governmental hospitals affiiated to Shahid Beheshti University of Medical Sciences. Data was analyzed using descriptive statistic and the Chi square test in SPSS-16 (SPSS Inc, Chicago, IL, USA). Results: One hundred and fity attending physicians and 232 residents participated in the current study. 94% of physicians desired to continue working in their current position. 46.7% of physicians and 42.4% of residents were fairly satisfid with increasing number of clients and Sixty six percent of physicians were moderately satisfid with an income increase. Of all physicians of current study, 41.6% had a relative agreement with implementation of the reform plan and 21.3% believed that diagnostic and treatment facilities had been improved. Relative satisfaction of physicians and residents was 27% and 70% respectively. Conclusion: The highest dissatisfaction rate related the work place and the highest satisfaction rate referred to increase in the number of clients. Since health care provider’s job satisfaction affects the quality of care, paying attention to increase in physician’s satisfaction in all aspects seems necessary

Background & objectives: Ilam province is one of the oldest known endemic foci of zoonotic cutaneous leishmani- asis (CL) in Iran; and the recent studies have shown an increasing trend in the number of cases from the region. This study was aimed to investigate the parasite species and genetic diversity of isolates obtained from CL patients based on the N-acetylglucosamine-1-phosphate transferase (nagt) gene. Methods: Exudate materials were collected from the swollen margin of the skin lesions of the patients suspected with CL who were referred to health centers laboratory of Mehran, Dehloran, Ilam and Malekshahi cities in the Ilam province. Demographic data were collected through a questionnaire. Smears were stained and examined microscopically. In total, 62 parasitologically positive samples were subjected to PCR-RFLP of nagt gene for identification of Leishmania species, in addition to genetic diversity investigation. Results: Nearly, half of the positive cases were referred from Mehran followed by Dehloran City (40.4%). These included people from different age groups (1 to 73 yr), with majority being male (66.1%). The common site of lesions was hand (48.4%). Half of the patients had multiple lesions; most of them were wet ulcerative type. A 1450-60 bp band of the nagt gene was amplified from all the samples. Digestion patterns of acetyl-coenzyme A carboxylase 1 (ACC1) enzyme were similar to what expected for Leishmania major. No difference was observed at the nucleotide acid level or resulting amino acid in nine sequenced samples on the basis of phylogenetic analyses. However, intra- species differences (0.0015) were observed amongst the L. major isolates of present study and the other parts of Iran. Interpretation & conclusion: The findings of this study demonstrated that the main causative agent of CL in Ilam Province is L. major, and there is no considerable heterogeneity among the L. major isolates. Moreover, nagt gene proved to be an efficient marker for differentiating Leishmania species. Further studies with more samples need to be carried out to achieve a more comprehensive result on the genetic variation of L. major isolates.

Background: Imbalanced diet, as it may cause micronutrient malnutrition has been known as a causal factor for several chronic diseases. Several studies in Iran have shown that some micro-nutrient deficiencies are prevalent and of high concern. Minerals such as calcium and iron can supply physical and mental health as well as survival, and growth development. In this study, Nutrient density analysis was used to display Iranian households' diet quality. Methods: In this descriptive-analytical study, the diet quality of seven provinces, namely Eastern Azarbaijan, Isfahan, Tehran, Khorasan, Khouzestan, Sistan Balochestan and Fars was assessed in terms of calcium and iron. To do so, the data were obtained through national household food consumption survey conducted by National Nutrition & Food Technology Research Institute, 2000-02, in Iran. Results: Generally, 80% of households' calcium density was less than the standard value and this rate was 40-70% for iron. Index of nutrition quality (INQ) for calcium and iron were respectively almost 1/2 and 1/3 of requirements in all provinces. Conclusions: There were significant differences in calcium intake density between the rural and urban households however; there were no differences between the selective provinces and all over the country

Background and Objective: To achieve overall human health, social health in recent decades has been considered as one of the main health dimensions. Defining and measurement social health of any society varies according to its situation. By determining and measuring its characteristics, social health status of society is determined to make evidence-based interventions.Materials and Methods: This study was conducted in two phases of qualitative and quantitative. In qualitative phase, framework and indicators were extracted by literature review. In quantitative phase, the information of provinces was obtained from official sources. The final indicators were extracted by expert's opinions about the importance and accuracy of the information respectively. Through standardization of individual indicators and using additive model, total score of social health is calculated and then provinces were ranked. Using ArcGIs software, geographical view of social health was constructed.Results: Based on composite index including 39 indicators, the most important characteristics of a healthy society is a society where there are no drug use, child labor, divorce, unemployment academics, discipline and inadequate care for children and smoking. Yazd had highest social health and "Sistan and Baluchestan" Province won the last rank.Conclusion: This study draws a complete view of the province's social health as an important tool for evidence based policy making. It is suggested that for monitoring future trends, similar studies should be conducted every 3-5 years.

Introduction: The largest proportion of road traffic deaths (RTDs) happen in Low and Middle Income Countries (LMICs). The efforts for decreasing RTDs can be successful if there is precise information about its related risk factors. This study aimed to determine economic, population, road, and vehicle factors with the highest impacts on RTDs in Iran. Methods: This is an ecological study, which has been done using covariates including: the population density, economic growth, urbanization, distance traveled (km) in 100 thousand people, the length of urban roads, the length of rural roads and the Vehicle per 1000 population for each province of Iran in 2015. The covariates considered had been gathered from different sources and to determine which one of the covariates has an effect on RTDs, the Negative Binomial (NB) regression model was used. Results: The mean number of RTDs per 100000 population was 474 ± 70.59 in 2015. The highest and lowest rates of death belonged to Fars and Qom provinces, respectively. The results of the univariate model showed the population density as the only covariate of RTDs (p=0.001). Also, among other covariates, GDP was the only variable with a p-value equal to 0.2. In the multivariate NB model, it was seen that the population density (p=0.001), and GDP (p=0.02) significantly correlated with RTDs. For a unit (Million Rial) increase in the GDP of the province, the number of deaths decreased by as much as 0.0014. In addition, for a unit increase in population density, the number of deaths went up by as much as 30. Conclusion: Population density and GDP had positive and negative effects on the number of fatal road traffic injuries, respectively. By considering these factors in presentational and controlling programs on road traffic injuries, it is possible to decrease the RTDs.  Â

Background: The first duty of any government is to ensure the health of its children and neonates. Today's countries are classified as declining mortality in this group. To increase neonatal survival rate, classified causes of newborn mortality are the core strategy and policies. This study was aimed to determine the classification of causes of neonatal death in Iran. Methods: Neonatal mortality refers to deaths of young children. It is measured by the neonatal mortality rate (NMR), which is the number of deaths of neonates per 1000 live births. This study was used data from 11693 neonatal deaths (from 22 weeks gestational age to neonatal death less than 30 days), in Iran's hospitals in 2012 that registered in the perinatal mortality surveillance system (hospital-based system). Demographic characteristics and other factors associated with neonatal death were investigated. To aid in cause of death analysis, burden of disease analysis, and comparative risk assessment we classified the causes of death according to international statistical classification of diseases version 10 (ICD 10), divided into three cause mortality strata. Results: Results showed the most common cause of neonatal mortality was "certain conditions originating in the perinatal period" (77.92%) with the highest incidence of "disorders related to length of gestation and fetal growth" (37.7%) in this group. Also it shows that 20.82% of deaths caused by "congenital malformations, deformations and chromosomal abnormalities" and 1.26% cases had occurred as a result of "accidents and injuries". The greatest cause of death in the neonates with weight over one thousand grams was "certain conditions originating in the perinatal period" (71.29%), with the highest percentage in the disorders related to "length of gestation and fetal growth" (29.65%). Conclusion: According to this study the "certain conditions originating in the perinatal period" special "disorders related to length of gestation and fetal growth" was the main cause of neonatal mortality. Also "congenital malformations, deformations and chromosomal abnormalities" was the second cause of neonatal mortality.

Background and aim: Neonatal hypothermia is a major risk factor for mortality after delivery. This study aims to identify the risk factors associated with transition in hypothermia state with new definition of hypothermia states.Methods: Four hundred and seventy nine (479) neonates hospitalized in NICU of Valiasr in Tehran, Iran in 2005 participated in this study. The rectal temperature of neonatal was measured immediately after delivery and every 30 min afterwards, until neonates became normal.Results: The mean weight of neonatal was 2580±882.9 g and mean of delivery room temperature was 29.2±1.45 °C. Most of the neonatal were mild hypothermia. There were significant associations between weight of neonatal, cardiopulmonary resuscitation (CPR) and Apgar score with hypothermia state (PConclusion: The findings of this study indicated that a major risk factor for hypothermia was low weight of neonatal.

Background and Objective: Conduct disorder is characterized with aggressive behaviors, deceitfulness or theft, destruction of property and serious violations of rules, prior to age 18 years. Attachment to God is a relationship with God that reveals aspects of individual thought. Secure attachment is associated with an increased ability to forgive. Various studies indicated the association between insecure attachment and delinquency and criminal behavior. The aim of this study was to evaluate the attachment to God and forgiveness in adolescents with conduct disorder at Tehran reformatory.Materials and Methods: This study is a cross-sectional study. The attachment to God and Transgression-Related Interpersonal Motivations Scale--12-Item Form (TRIM-12), were completed by 60 adolescents between 14 -18 years old with conduct disorder, with or without substance abuse disorders, and ADHD, at Tehran reformatory. Descriptive statistics and linear regression methods was used to analyze the data in SPSS-16.Results: The results showed that anxiety and avoidant attachments to God and avoidance and revenge motivations in adolescents with conduct disorder are high. A history of addiction, criminality, and mental disorders among family members predicted increasing avoidant attachment to God among this group of adolescents in the univariate model. Also, parental divorce and attention deficit-hyperactivity variables predicted increased revenge motivation in the univariate model, and unemployed father predicted avoidance motivation, in the multivariate model.Conclusion: There is a defect in the ability to forgive in adolescents with insecure attachment and conduct disorder, there are basic requirements for the design of interventions and spiritual treatment programs specifically for this group of adolescents.

Background: We need a defined population for determining prevalence and incidence of diseases, as well as conducting interventional, cohort and longitudinal studies, calculating correct and timely public health indicators, assessing actual health needs of community, performing educational programs and interventions to promote healthy lifestyle, and enhancing quality of primary health services.The objective of this project was to determine a defined population which is representative of Tehran, the Capital of Iran. This article reports the methodology and establishment of the research network of Tehran defined population.Methods: This project started by selecting two urban health centers from each of the five district health centers affiliated to Shahid Beheshti University of Medical Sciences in 2012. Inside each selected urban health center, one defined population research station was established. Two new centers have been added during 2013 and 2014. For the time being, the number of the covered population of the network has reached 40000 individuals. The most important criterion for the defined population has been to be representative of the population of Tehran. For this, we selected two urban health centers from 12 of 22 municipality districts and from each of the five different socioeconomic of Greater Tehran. Merely 80000 individuals in neighborhoods of each defined population research station were considered as control group of the project.Findings: Totally we selected 12 defined population research stations and their under-covered population developed a defined population which is representative of Tehran population.Conclusion: a population lab is ready now in metropolitan of Tehran.

Background & Aim: In survival studies, incidence of competing risks causes that the time of event of interest to be unknown. Analysis of competing risk data, often implemented using hazard-based method under proportional hazard assumption. In this study, we interpreted covariate effect under accelerated failure time model and cause-specific survival function. Methods & Materials: We considered weibull hazard and survival function as cause-specific hazard and survival function and explored the relation between these function. Estimation of parameters performed using Bayesian methods with non-informative priors that implemented in R2WinBUGS package of R software. Results: Simulation study showed that, the relation between hazard and survival parameters for weibull distribution is also established between parameters of cause-specific hazard and cause-specific survival function. This relation also verified in PBC data set for logarithm of serum bilirubin and D-penicillamine effect. Conclusion: Although in competing risk studies, most of the analysis performed under PH assumption, analysis based on AFT models will also be applicable for these data. In these setting, coefficients can be interpreted as effects of covariate on time to each event.

Purpose TTM pattern has widely been used in smoking cessation interventions. This study was aimed to investigate the compatibility of a hierarchical factor structure of short form questionnaire developed by Velicer et al regarding situational temptation construct among smokers in Golestan province. Methods A cross-sectional study was conducted on 387 smokers that were included using inconvenient sampling method. At first, internal validity and reliability of the short-form questionnaire were examined. At second, invariance of hierarchical structure was tested in sub-groups of ethnicity, residence, education, stage of quit, starting age, and income. Measurement invariance (including five invariances) and structural invariance (including three invariances) were explored in each sub-group. Results Chi-square test for confirmatory factor analysis of hierarchical factor structure was statistically significant for all samples [χ^2 (24)=66.3,p

Background: Neonatal mortality is the major proportion of children mortality under five years and it is considered as the main health indicator in the first year of life. This paper has aimed to review the neonatal mortality in the numbers recorded at the Iranian Perinatal Mortality Surveillance System (IPMSS) by Iran Ministry of Health and Medical Education. Methods: A descriptive study was done in 2014. For assessment of sampling quality and quantity, 24 hospitals randomly were selected. Recorded information, related to perinatal mortality (deaths from 22 completed weeks of gestation until 30 completed days after birth inclusive of stillbirths and neonatal mortality) from selected hospitals, was compared with recorded data in IPMSS. Results: Results showed that, out of 1,725 perinatal deaths occurred in hospitals, 1,480 (85.80%) deaths were recorded in IPMSS. Of 1,041 neonatal deaths that occurred in hospitals (in hospital wards and delivery rooms), 875 (84.05%) were in IPMSS. It shows that a correction coefficient for hospital neonatal mortality was 1.1904. Based on analyzing process, correction coefficients for stillbirth reported by hospitals, stillbirth for all over the country and perinatal death were 1.130, 1.1775 and 1.2443, respectively. Considering these correction coefficients – that enabled to calculate 15,130 neonatal deaths – and 1,421,689 live births (according to Statistics Center) in 2012, neonatal mortality rate was 10.64 in 1,000 live births. Conclusion: Our data showed some problems in the registration system. Although implementation and supervision of such Surveillance System are not easy, they are essential and provide valuable data in perinatal audit and neonatal health care practices.

Background & Objective: Inability to measure exact exposure in epidemiological studies is a common problem in many studies, especially cross-sectional studies. Depending on the extent of misclassification, results may be affected. Existing methods for solving this problem require a lot of time and money and it is not practical for some of the exposures. Recently, new methods have been proposed in 1:1 matched case–control studies that have solved these problems to some extent. In the present study we have aimed to extend the existing Bayesian method to adjust for misclassification in matched case–control Studies with 1:2 matching. Methods: Here, the standard Dirichlet prior distribution for a multinomial model was extended to allow the data of exposure–disease (OR) parameter to be imported into the model excluding other parameters. Information that exist in literature about association between exposure and disease were used as prior information about OR. In order to correct the misclassification Sensitivity Analysis was accomplished and the results were obtained under three Bayesian Methods. Results: The results of naïve Bayesian model were similar to the classic model. The second Bayesian model by employing prior information about the OR, was heavily affected by these information. The third proposed model provides maximum bias adjustment for the risk of heavy metals, smoking and drug abuse. This model showed that heavy metals are not an important risk factor although raw model (logistic regression Classic) detected this exposure as an influencing factor on the incidence of lung cancer. Sensitivity analysis showed that third model is robust regarding to different levels of Sensitivity and Specificity. Conclusion: The present study showed that although in most of exposures the results of the second and third model were similar but the proposed model would be able to correct the misclassification to some extent.

Background and Objectives: According to the available evidence, consumption of milk and other dairy products among Iranians is far less than recommendations. The share of different milks (i.e., traditionally vs. industrially processed) and its associated variables are, however, neither consistent nor fully known in different Provinces.Materials and Methods: This cross-sectional study was conducted to determine household milk consumption and its association with selected socio-demographic factors in West Azarbayejan Province, North-west Iran. A total of 650 households were selected from urban and rural areas in three major Azeri and Kurdish districts (i.e. Urmia, Khoy and Mahabad) using a multi-stage cluster sampling method. Data were collected using socio-economic and milk frequency questionnaires. Results: The findings indicated that traditionally-processed milk (bulk) was the most common milk consumed at household level (62.5%). Mean of bulk milk consumption in urban and rural areas was 479±23 and 730±64 ml/wk per capita, respectively. It was also shown that establishment of the new food subsidization policy has decreased the mean of household milk consumption by approximately 3 l/wk in urban areas. Factor analysis detected a significant decrease in the higher tertiles of family size/ethnicity score consumption of both bulk and pasteurized milk, which resulted in decreased consumption of total milk. Conclusions: Designing and implementation of alternative approaches, such as targeted milk subsidies for poor households or vulnerable age-groups should be considered. Keywords: Household milk consumption, Milk processing method, Socio-economic variables, Iran.

Background and Objective: The lack of a proper sewage collection & disposal system, the water and sewerage project, in the city of Rasht, became a priority by Guilan province Urban Water and Sewerage Company with the government partnership and World Bank financial support. The objective of this research was to complete the first phase of a two-phase study, to determine the impact of using an urban sewerage system on acute diarrhea in children under five years old, in Rasht city in the Guilan province.Materials and Methods: The study is a concurrent control before and after field trial which is carried out in two phases: before (phase I) and after (phase II). Sampling for phase I was performed in the middle month of each season, November and February 2009 and May and August 2010. The incidence of acute Diarrhea was measured with the participation of 1560 mothers of children under 5 years old. This was done in two groups: the intervention group (inside the sewerage system project perimeters) and the control group (outside the project perimeters). Data was collected by local female general practitioners and medical students by door-to-door interviews with mothers. Data was analyzed using the SPSS 11.5 software package. The Pearson Chi-Square was used to compare qualitative variables between groups, whilst the t-test and One-Way ANOVA was used to compare quantitative variables.Results: The average annual incidence of acute diarrhea in children under five years old was 10.4% (9.4% in the intervention group and 11.4% in the control group). The seasonal pattern of acute diarrhea incidence was 10.5% (9.3% in the intervention group and 11.7% in the control group) in May, 12.5% (11.5% in the intervention group and 13.4% in the control group) in August, 9.3% (8.1% in the intervention group and 10.5% in the control group) in November, and 9.1% (8.5% in the intervention group and 9.8% in the control group) in February respectively.Conclusion: The study showed the incidence of acute diarrhea in children under five years old in Rasht city is moderate and it follows a seasonal pattern. The highest rate was seen in summer and the lowest rate in winter. It is expected to decrease with the initiation of the sewerage system program.Keywords: Acute Diarrhea, Children, Incidence rate, Epidemiology, Sewerage, Rasht

Background and Purpose: Patients with Bipolar I Disorder recurrence experiences mood variation between manic and depression during the time. Hence, that is need to the longitudinal study on Bipolar Disorder patients. This study aims to evaluate the effective factors on Bipolar I Disorder frequent recurrence in 5 years longitudinal study using generalized estimation equations (GEE) method. Materials and Methods: Data were collected with repeated measurements on 255 Bipolar I Disorder patients in mazandaran, Iran, in a longitudinal study between 2007 and 2011. The outcome variable is Bipolar I Disorder recurrence, and the predictor variables are as follows: sex, age of onset, family history (Grade 1), economic status and education level. In this paper, SAS PROC GENMOD was used to apply GEE regression to the assessment of parameters corresponding to the factors causing recurrence. Results: The age was among 13-55 years and the average of age of onset was 24.1 years. Almost of patients were male and had economic status with (upper/middle) deciles and also had a diploma and under diploma education level. The results of GEE method showed that the covariate of family history (Grade 1) increased the odds of recurrence (odds ratio [OR] >1; P < 0.0500); and age of onset decreased the odds of recurrence in patients with Bipolar I Disorder (OR

Background: Cutaneous leishmaniasis (CL) is one of the most important neglected tropical diseases and a major public health challenge in Iran caused by Leishmania spp and transmitted by phlebotomine sand flies. The number of CL cases has shown an increasing pattern all over the country, including the district of Varamin, southeast of Tehran, Iran. This study aimed to identify the Leishmania spp isolated from CL patients using molecular methods in Varamin during 2012–2013. Methods: Exudate materials collected from the swollen edge of the skin lesions of 44 parasitological positive CL patients by disposable lancet. They were referred to Varamin Health Center by physician. The samples were sub­jected to molecular method for Leishmania species identification. Results: The digestion pattern of restriction enzyme revealed that 37 (84.1%) CL patients were infected with L. ma­jor and 7 (15.9%) were infected with L. tropica. They were mostly male than female. More than half of the patients (58%) had multiple lesions, and they were mostly observed on extremities, 34.1% on legs and 29.5% on hands. Le­sions were mostly of wet ulcerative type. Conclusion: Dominancy of L. major provides more evidence that Varamin District probably could be considered as Zoonotic Cutaneous Leishmaniasis (ZCL) areas. More investigation on other epidemiological aspects of disease is needed.

Background: Obesity and metabolic syndrome are serious public health problems. It is suggested that high calcium diet can improve lipid profile, blood pressure and insulin resistance.Methods: In this clinical trial, 75 healthy overweight or obese premenopausal women were randomly allocated to one of the following dietary regimens for 8 weeks: 1) a control diet 2) a calcium-supplemented diet containing 800mg/d calcium carbonate 3) a high milk diet containing three servings of low fat milk (all of them providing a 500kcal/day deficit). At baseline and after 8 weeks, waist circumference (WC), blood pressure, serum triglyceride (TG), fasting blood sugar (FBS), and high density lipoprotein cholesterol (HDL-C) were measured.Results: After 8 weeks, WC, FBS and HDL-C decreased in all groups (P

Background: The present study was aimed to determine the effect of Ger-minated Barley Foodstuff (GBF) administration on serum C-reactive pro-tein (CRP) levels and clinical signs in patients with Ulcerative Colitis (UC). Methods: Forty-six patients were randomly allocated into GBF group and control group. Subjects in control group received only conventional drug therapy, while the GBF group received 30g GBF per day (3 times a day) by oral administration during 2 month along with routine medications. Results: The mean serum CRP in the GBF group decreased significantly (P=0.017) compared with the baseline. Although the frequency of clinical signs including the number of episodes diarrhea, degree of visible blood in stool, degree of abdominal pain or cramping, nausea, vomiting, and anorex-ia decreased in the GBF group but it was statistically significant only in the case of abdominal pain and cramping. However, this reduction was only significant in the case of abdominal pain and cramping (P=0.016) Conclusions: The consumption of GBF along with the current medication may be efficient in attenuating the inflammation and clinical signs of UC patients.

Background- CD24 is a cell adhesion molecule that has been implicated in metastatic tumor progression cells. Our aim was clarify correlation between CD24 expression and cAMP:cGMP ratio in murine colorectal cancer cell line (CT26) after using cholera toxin.Materials and Methods- The CT26 cells were cultured in microtubes for assaying cAMP and cGMP; also the cells were cultured in flasks for assaying cytoplasmic and membranous CD24 expression. The Real-Time PCR was done for cDNA that was synthesized from CT26 cells’ mRNA. Also, expression CD24 marker of cells was determined by Anti-CD24 antibody and Goat Anti-Rabbit IgG-FITC (flow cytometry).Results- The cholera toxin grew cAMP:cGMP ratio and it influenced cytoplasmic and membrane CD24 expression.Conclusion- There are indirect correlation between cAMP:cGMP ratio and CD24 expression.

Background: Trichomonas vaginalis causes trichomoniasis and metronidazole is its chosen drug for treatment. Ferredoxin has role in electron transport and carbohydrate metabolism and the conversion of an inactive form of metronidazole (CO) to its active form (CPR). Ferredoxin gene mutations reduce gene expression and increase its resistance to metronidazole. In this study, the frequency of ferredoxin gene mutations in clinical isolates of T.vaginalis in Tehran has been studied.Methods: Forty six clinical T. vaginalis isolates of vaginal secretions and urine sediment were collected from Tehran Province since 2011 till 2012. DNA was extracted and ferredoxin gene was amplified by PCR technique. The ferredoxin gene PCR products were sequenced to determine gene mutations.Results: In four isolates (8.69%) point mutation at nucleotide position -239 (the translation start codon) of the ferredoxin gene were detected in which adenosine were converted to thymine.Conclusion: Mutation at nucleotide -239 ferredoxin gene reduces translational regulatory protein’s binding affinity which concludes reduction of ferredoxin expression. For this reduction, decrease in activity and decrease in metronidazole drug delivery into the cells occur. Mutations in these four isolates may lead to resistance of them to metronidazole.

Background and Objectives: Postpartum depression is one of most important health problems in women. This study was performed with the purpose of comparing the frequency of postpartum depression in pregnant women with emotion and problem-focused coping strategies. Methods: This study was conducted as a prospective cohort study on 200 pregnant women with stress (low and high levels). The samples were pregnant women referred to all health-treatment, centers of Ardabil, which were selected using a multi-stage sampling method; and according to coping strategy, they were divided into two groups: emotion-focused and problem-focused. Low-risk pregnant women completed questionnaires about demographic characteristics, perceived stress, and Billings and Moos coping strategies in the 38th to 42th week of their pregnancy, and completed the Edinburgh depression scale in the 3th to 4th weeks after childbirth. Data were analyzed using chi 2 and t tests. p

Objective: To understand different dimensions of quality of life in low income people of 4th estate of Tehran in comparisons with the general public at the same age in order to improve health related quality of life and provide more help for these people.Methods: Methods: This was a cohort study with a sample of 200 people in poverty and 200 people selected as a control group. Quality of life was assessed using SF-36 questionnaire .Data on age, sex, marriage state, educational level and occupational level collected.Results: Comparing quality of between low- income people and control group showed that low- income people had worse conditions in physical functioning, role physical, bodily pain, vitality, role emotional, physical and mental component scores. Both men and women in poverty group had worse condition in all dimensions except for general health and mental health.Conclusion: The finding showed that people in poverty status suffered from a poor health and quality of life.

Background: The goal of this study is to extend the applications of parametric survival models so that they include cases in which accelerated failure time (AFT) assumption is not satisfied, and examine parametric and semiparametric models under different proportional hazards (PH) and AFT assumptions. Methods: The data for 12,531 women diagnosed with breast cancer in British Columbia, Canada, during 1990-1999 were divided into eight groups according to patients′ ages and stage of disease, and each group was assumed to have different AFT and PH assumptions. For parametric models, we fitted the saturated generalized gamma (GG) distribution, and compared this with the conventional AFT model. Using a likelihood ratio statistic, both models were compared to the simpler forms including the Weibull and lognormal. For semiparametric models, either Cox′s PH model or stratified Cox model was fitted according to the PH assumption and tested using Schoenfeld residuals. The GG family was compared to the log-logistic model using Akaike information criterion (AIC) and Baysian information criterion (BIC). Results: When PH and AFT assumptions were satisfied, semiparametric and parametric models both provided valid descriptions of breast cancer patient survival. When PH assumption was not satisfied but AFT condition held, the parametric models performed better than the stratified Cox model. When neither the PH nor the AFT assumptions were met, the log normal distribution provided a reasonable fit. Conclusions: When both the PH and AFT assumptions are satisfied, the parametric and semiparametric models provide complementary information. When PH assumption is not satisfied, the parametric models should be considered, whether the AFT assumption is met or not.

Background: More than one third of energy intake in Iran is provided from bread. Therefore, improving bread mineral bioavailability through dephytinization can play an important role in decreasing the prevalence of many mineral deficiencies. In this study, effect of phytase supplementation on zinc, iron and calcium status in growing rats fed with a diet containing high phytate Iranian bread (Sangak) was assessed. Methods: Thirty weanling Wistar male rats were assigned to phytase (Aspergillus niger) or control group for 6 weeks. The diet was designed based on Iranian′s food pattern and 34.2% of the energy was supplied from Sangak bread. Food intake, body and organ weight and body height were measured. Zinc was measured in blood, liver and femur. Iron was assessed in blood and liver and calcium was titrated from femur bone. Statistical analyses were performed using SPSS software. Paired sample t-test, Wilcoxon signed-rank test and repeated measurement ANOVA were used for proper analysis of data. Results: Although weekly weight gain was not different between groups, final weight was in favor of control group. Food intakes, liver and femur bone weight did not differ between the two groups. However, the blood zinc was higher in the phytase group (26.2 ± 7.4 vs. 19.2 ± 5.2, P = 0.03). Thus positive effects of phytase supplementation on zinc, independent of growth was found. Other variables did not show any differences between groups. Conclusion: Addition of phytase to diet containing high phytate Iranian bread can improve blood zinc status in growing rats.

BackgroundTo determine the level of plasma homocysteine in patients with polycystic ovary syndrome (PCOS) compared with healthy controls. Materials and MethodsIn this prospective case-control study on 85 PCOS women and 83 controls matched by body mass index (BMI), homocysteine levels were assessed. ResultsThe mean level of homocysteine was 16.25 ± 11.94 μmol/L in patients with PCOS and 11.58 ± 3.82 μmol/L in controls (p=0.002). Patients with PCOS had a significantly higher risk for hyperhomocysteinemia compared with BMI-matched control women. Conclusion These data suggest that homocysteine levels are elevated in the PCOS population. Further studies are needed to characterize this relationship.

Background: Evidence exists for reciprocal effects of insulin and desacyl-ghrelin (DAG) concentration, but the association between different fatty acid saturation in high fat diet (HFD) and these hormones remain to be established. To evaluate the impact of different sources of dietary fat and the level of fatty acid saturation on plasma insulin and DAG levels and also the association of DAG with insulin action this study was carried out. Methods: Male weaning Wistar rats were randomly divided into four groups of HFDs, high fat butter (HF-B), high fat soy (HF-S), high fat olive (HF-O), high fat fish (HF-F), and a group of standard diet (SD). Blood samples were collected after 8 weeks and after they were fasted for 24 h. Body weight, food intake, plasma glucose, insulin, DAG and insulin resistance (HOMA-IR) were measured. Results: Plasma insulin levels at fed and fasted status, were significantly higher in rats on HF-B compared to those on SD, HF-F and HF-O diets (P

Background and Objective: Gastric cancer is one of the most common cancers in the world. Although its incidence is decreasing, it rarely is detected early, and the prognosis remains poor. The aim of this study was to evaluate prognostic factors in gastric cancer using log-normal regression model. Materials and Methods: This retrospective study was done on 746 patients with gastric adenocarcinoma from February 2003 through January 2007. Gender, age at diagnosis, family history of cancer, tumor size and pathologic distant of metastasis were entered to a log-normal model. Relative risk (RR) was employed to interpret the risk of death. Results: Results indicated that patients who were upper than 45 years at diagnosis had an increased risk for death (RR=1.01 95% CI, 1.01-1.03), followed by greater tumor size (RR=1.64, 95% CI, 1.07-2.25) and pathologic distant metastasis (RR=2.14, 95% CI, 1.60-2.86) and similar results in multivariate analysis for greater tumor size (RR=2.04, 95% CI, 1.23-3.33) and pathologic distant metastasis (RR=2.01, 95% CI, 1.13-3.56). Conclusion: This study showed that the early detection of patients in younger and in primary stages and grade of tumor is important to decrease the risk of death in patients with gastric cancer and increase the survival rate.

Background: Postpartum home care plays an important role in prevention of postpartum complications. Regular visits of mothers during this period are imperative. This study aimed to provide postpartum home care for mothers to assess its effects on mothers' health in Iran. Materials and Methods: This study was carried out in two phases. First, a comprehensive postpartum home care program was compiled by performing a comparative study, using the available guidelines in this regard in different countries and based on the opinions of the experts. Next, a clinical trial was carried out on 276 women who gave birth in the university hospitals affiliated to Shahid Beheshti University of Medical Sciences. There were 92 mothers in the intervention and 184 in the control group. The intervention group mothers were provided with postpartum home care service while the control group did not receive such a service. Results: Outcome assessment at 60 days' postpartum revealed a significant difference between the two groups in terms of the use of supplements, birth control methods, postpartum depression, breastfeeding problems, constipation, and fatigue (P < 0.05). No significant differences were noted between the two groups with regard to hospitalization, hemorrhoids, backache and lumbar pain (P > 0.05). Conclusion: The postpartum home care program had a positive effect on some aspects of the mothers' health status and their satisfaction in our society.

Background: The first duty of any government is to ensure the health of its children and neonates. Today's countries are classified as declining mortality in this group. To increase neonatal survival rate, classified causes of newborn mortality are the Core Strategy and Policies. This study was aimed to determine the classification of causes of neonatal death in Iran. Methods: Neonatal mortality refers to deaths of young children, typically those less than 28 days of age. It is measured by the neonatal mortality rate (NMR), which is the number of deaths of neonates per 1000 live births.This study was used data from 11693 neonatal deaths (from 22 weeks gestational age to neonatal death less than 30 days), in IRAN's hospitals in 2012 that registered in the Perinatal Mortality Surveillance System (hospital-based system). Demographic characteristics and other factors associated with neonatal death were investigated. To aid in cause of death analyses, burden of disease analyses, and comparative risk assessment we classified the causes of death according to International statistical classification of diseases version 10 (ICD 10), divided into three cause mortality strata. Results: The most common cause of neonatal mortality was "certain conditions originating in the perinatal period" (77.92%) with the highest incidence of "disorders related to length of gestation and fetal growth" (37.7%) in this group. Also 2419 (20/82%) of deaths caused by "Congenital malformations, deformations and chromosomal abnormalities" and 147 (1/26%) cases had occurred as a result of "accidents and injuries". The greatest cause of death in the neonates with weight over one thousand grams was "certain conditions originating in the perinatal period" (71/29%), with the highest percentage in the disorders related to "length of gestation and fetal growth" (29/65%). Conclusion: Policies and interventions should be in line with the priority given to the most common causes of death in prenatal care, prevention and treatment of complications of pregnancy and delivery.

Abstract INTRODUCTION: Diabetes control is one of the main conflict issues in diabetes management. Scientists, recently, recommend [increasing low glycemic index (LGI) foods in dietary regimen. The effects of cooked lentil as a low glycemic index food on serum blood glucose and lipid profile among type 2 diabetic patients has been investigated in this study. METHODS: In a randomized cross-over clinical trial which was performed on 30 patients with type II diabetes mellitus, subjects were randomly divided into 2 groups. Group A followed the normal diet and Group B followed normal diet with 50gm cooked lentil and 6gm canula oil substitute of 30gm bread and 20gm cheese. After 6 weeks, groups stopped their diets and put on wash out period for 3 weeks and later the diets where switched between the them. Diet continued for another 6 weeks. Anthropometric measurements, dietary intakes, serum lipids and glucose levels were determined at the beginning and the end of each test period. Data were analyzed by Food Processor II and SPSS-13. RESULTS: BMI, LDL_C, HDL_C, TG and serum Fructozamine were not significantly affected by dietary regimens. But Total cholesterol and fasting blood glucose decreased significantly in regimen containing lentil (P CONCLUSION: Consumption of cooked lentil as a LGI food in breakfast led to reduction of FBS and TC and improvement of glycemic control in type 2 diabetic patients. Keywords: Diabetes Mellitus, Lentil, Lipid profiles, Blood glucose, Glycemic index, Clinical Trial.