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Background: Breast cancer is still a major contributing factor to the burden of the disease worldwide. A single-stage implant-based reconstruction (IBR) lowers tissue morbidity, thus increasing overall aesthetic outcome and patient satisfaction. Objectives: Because of the high price of ADM and the lack of insurance coverage in Iran, we aimed at examining the results of using TIGR® mesh in patients with breast cancer. Methods: This quasi-experimental study was conducted in Iran (Tehran) from 2016 to 2018. About 140 eligible patients with breast cancer were included and their information was collected and analyzed prospectively during the 3 years that they were referred to the surgery center in Tehran. The reconstruction was performed, as either direct-single staged, Implant + TIGR MESH, or delayed-multistage. Patient satisfaction was calculated after 1 year of follow-up, using Body Checking Questionnaire (BCQ) by applying the VAS scale. All statistical analyses were performed at a 95% significance level, using SPSS statistical software version. (Evidence-based medicine level: Level III, a prospective cohort). Results: The results of our study showed slightly more short-term complications than other studies due to the surgical team’s first experience in the surgery. Complications were infection (7.1%), epidermal necrosis (15.9%), and severe capsular contracture (14.2%). Seven patients (6.2%) had full-thickness skin necrosis, and the prosthesis was finally removed. The use of the TIGR Mesh did not increase the rate of complications, and only 5 implant losses in this group and 2 in the tissue expander group were reported. The levels of patients’ satisfaction in IBR and delayed-multistage groups were 44.4% and 12.7%, respectively. Conclusions: Our results showed that placement of TIGR MESH for lower pole support during IBR does not increase the complication rate. Additionally, patients’ satisfaction levels increased compared to traditional methods of reconstruction.

BACKGROUND Introduction: Currently, diabetes is known as one of the major health problems and the most important issue in the medical profession which has a high prevalence in children and adults. On the other hand, machine learning has been introduced as a developing, reliable, and supportive technology in the field of health, and one of the interesting techniques for analyzing interventions, diseases, and conditions of the health system is the use of data mining. In fact, data mining is the process of selecting, exploring, and modeling large amounts of data. OBJECTIVE The present study was performed in order to predict fasting blood sugar status using machine learning and data mining. METHODS The data used in this study was from a diabetes screening program in Tehran. 3376 participants over 30 years old in 16 comprehensive health service centers participated in this screening program to check the prevalence of diabetes and its related risk factors. The dataset was not balanced according to the output variable. Therefore, the random sampling method and SMOTE technique were used for making a balance. Four different machine learning algorithms including CatBoost, Random Forest, XGBoost, and logistic regression were used to model the dataset. Also, the Shapley technique was used to select the most important features. Accuracy, sensitivity, specificity, accuracy, F1- Score, and AUC criteria were used to evaluate the model. RESULTS The results of the Shapely technique in selecting the most important features showed that the characteristics of age, waist-to-hip ratio, body mass index, and systolic blood pressure were the most important factors in predicting fasting blood sugar status. Also, the modeling results showed that the CatBoost algorithm gave the best results. For the CatBoost algorithm, various evaluation criteria including accuracy, sensitivity, specificity, and AUC were obtained as 65.98%, 71.32%, 64.54%, and 0.74% respectively. CONCLUSIONS In this study, a predictive model was developed using gradient-improved decision tree algorithms to identify the most important risk factors related to diabetes. Age, waist-to-hip ratio, body mass index, and systolic blood pressure were the most important risk factors for diabetes, respectively. This model can be used in the planning for diabetes management.

Background: In recent decades, the significant increase in the prevalence of obesity, both in developing and developed countries, suggests that obesity is a complex health problem. Environmental factors such as lack of physical activity, excessive TV watching and sedentary lifestyle, consumption of high-calorie foods, and side effects of different drugs, can cause overweight and obesity. Obesity is associated with severe health problems such as diabetes, hypertension, hyperlipidemia, asthma, arthritis, and even reduced life expectancy. Obesity also has a profound effect on people's mental health. Methods: After ethics committee approval from the Iran University of Medical Sciences (IR.IUMS.FMD.REC.1399.457), 395 healthy women between 20 to 50 years old entered the study. Questionnaires related to general information and assessment of individuals' status in terms of eating behaviors were completed on women from 20 to 50 years old who worked at the Iran University of Medical Sciences. Anthropometric variables including height, weight, body fat percentage, waist circumference, and hip circumference were measured and body mass index (BMI) and waist to hip ratio (WHR) were calculated. Then, a questionnaire related to perceived stress was completed by each participant. The 24-hour food recall questionnaire and the physical activity questionnaire were also conducted. Results: In contrast to other studies, anthropometric indices (weight, height, BMI, waist circumference, and hip circumference) were reported higher in people who ate breakfast than in those who did not. There is no significant relationship between eating behaviors (speed rate, eating breakfast or not eating breakfast, and eating with or without a screen) and perceived stress levels. Anthropometric indices increase with increasing food intake and decreasing physical activity, while there is no relationship between dietary intake and physical activity with perceived stress levels. Conclusion: Dietary behaviors and physical activity affect anthropometric indices, while, perceived stress levels do not affect dietary behaviors or anthropometric indices.

There is scattered evidence of the impact of workplace interventions in improving employees' physical activity. This systematic review was performed to evaluate the strategies of workplace interventions and their effectiveness, as reported in primary studies.Primary experimental trials, both randomized controlled trials (RCTs) and non-RCTs, which examined interventions to increase healthy adult employees' physical activity were included in this review. Studies in English or Persian published between 2009 and 2019 with access to full text of resources were considered. Google Scholar, PubMed, Web of Science, Scopus and Cochrane Library, ProQuest (Thesis) and World Health Organization Clinical Trial Registration Databases and Persian databases such as SID, Magiran, IranMedex, Irandoc were searched. All the stages of review were conducted based on PRISMA. RoB and ROBINS-I were used to assess the risk of bias of the primary studies.Thirty-nine studies, with a total of 18 494 participants, met the inclusion criteria. Of these, 22 were RCTs, 17 were non-RCTs. Effective interventions were reported in 15 RCTs and 14 non-RCTs. Four main strategies of interventions were identified, consisting of motivation and support; monitoring and feedback; information and education; and activity. Thirteen different behavior change techniques (BCT) were identified with self-determination theory (SDT) being the most frequent behavior change theory used.It seems that a multi-strategy intervention that one of the strategies of which is physical activity in the workplace (Activity), the use of behavioral change theories, especially SDT, may be indicative of a more effective intervention. It is recommended that BCTs be considered when designing physical activity interventions.

Background: Metabolic syndrome (MetS) is associated with an increased risk of cardiovascular disease and all-cause mortality. Zinc (Zn) is an essential trace element for the synthesis, storage, and release of insulin. The relationship between serum Zn and MetS is controversial. In this study we have evaluated whether serum Zn levels are associated with hsCRP level according to MetS phenotypes. Method: A total of 9493 individuals (3768 men and 5635 women) were recruited as part of the Mashhad Stroke and Heart Association Disorder (MASHAD) study. We measured the concentration of serum Zn by flame atomic absorption (Varian AA240FS) and we divided the subjects into quartile of serum Zn. We used SPSS version 18 statistical analyses for all. GraphPad Prism 6 for figures was used.Results: In this study there were significant differences between quartiles of Zn according to sex. The results showed that the level of serum hs-CRP were higher in subjects with metabolic syndrome who also had a serum Zn >95 µg/dl. In subjects with serum Zn Conclusion: Serum hs-CRP concentrations were related to MetS phenotypes. This relationship was modified by serum Zn level. According to the number of MetS components serum Zn levels decreased as the number of MetS component increased, and low serum zinc levels (Q1) showed an overall greater prevalence of MetS.

Background: The low physical activity is a challenge in adults. A majority of adults spend many hours each week at work, so the workplace is a suitable site for health promotion and implementation of physical activity programs. This qualitative study was implemented to identify worksite physical activity barriers and facilitators from the perspective of the employees of the Iran University of Medical Science. Methods: In the present qualitative content analysis, five focus group discussions were held with the participation of 68 personnel of Iran University of Medical Sciences. Purposive sampling with maximum diversity was carried out for the study. Results: The analysis of the data led to the identification of three general themes, including challenges and barriers, strategies, and incentives (facilitators). The four main categories of challenges and barriers included policy-making and legislation, organizational factors, structural factors, and personal factors. Most barriers identified by the participants were placed in the personal factors and organizational factors categories. The strategies for increasing physical activity were identified in the following three categories: Policy-making and legislation, organizational factors, and environmental factors. The majority of the strategies proposed were placed in the organizational factors and policy-making and legislation categories.Conclusions: Increasing physical activity in the workplace as a strategy for the general promotion of physical activity in people requires interventions in different areas, especially with regard to organizational factors and policy-making and legislation.

Background Low physical activity in adulthood is a major public health challenge. The majority of adults spend many hours each week at work, and workplace thus becomes a suitable location in which to promote health and implement physical activity programs. This qualitative study was conducted to identify the barriers and facilitators of worksite physical activity from the perspective of the employees of Iran University of Medical Sciences. Methods In this qualitative thematic analysis, five focus group discussions were held with the participation of 68 staff members of Iran University of Medical Sciences who had been selected by purposive sampling with maximum diversity. Results The analysis of the data led to the identification of three general themes, including challenges and barriers, strategies, and incentives (facilitators). The four main categories of challenges and barriers included policy-making and legislation, organizational factors, structural factors, and personal factors. Most barriers identified by the participants were placed in the personal factors and organizational factors categories. The strategies for increasing physical activity were identified in the following three categories: Policy-making and legislation, organizational factors, and environmental factors. The majority of the strategies proposed were placed in the organizational factors and policy-making and legislation categories. Conclusions Increasing physical activity in the workplace as a strategy for the general promotion of physical activity in people requires interventions in different areas, especially with regard to organizational factors and policy-making and legislation.

Cardiovascular disease (CVD), one of the main mortality causes worldwide is considered to be affected by general oxidative stress and inadequacy antioxidant system. Superoxide dismutase 1 (SOD1), a cytosolic antioxidant enzyme has a key role in neutralizing the excessive prooxidant by scavenging the super oxide anions. SOD1 polymorphic variants exhibit the altered activity properties. In the current study, we are aimed to investigate the association between the SOD1 polymorphism and CVD prevalence. A 6-years case control follow up study was designed to genotype the 526 participants (311 controls and 215 cases) for studying the 50 bp INS/DEL polymorphism at SOD1 promoter gene and analyze their blood lipid profile and anthropometric characteristics. Among the two possible alleles of the SOD1 gene (Wild [W] and Mutant [M]) the meaningful association was detected between the Mutants' frequency and the prevalence of CVD patients (p-value

Objective Postmenopausal women are at an increased risk of Cardiovascular Disease. We aimed to investigate whether this risk differed between individuals with a naturally occurring and other reasons for menopause within a large population-based Iranian sample. Study Design A total number of 1763 postmenopausal women (defined by amenorrhea for more than a year, or FSH > 30-40 mIU/ml), 900 of them with a natural menopause and 863 of them with other reasons for menopause caused by (hysterectomy without oophorectomy or one side oophorectomy, hysterectomy with oophorectomy or two side oophorectomy without hysterectomy) were recruited as part of the Mashhad Stroke and Heart Atherosclerotic Disorders (MASHAD) cohort study. Biochemical and hematological risk factors were measured in all the subjects and the data were analyzed by SPSS software version 20 Results There was a significant difference in the presence of cardiovascular disease in the natural menopause group compared with other reasons for menopause group (p

Background Normal weight obesity (NWO) is defined by a normal body mass index (BMI) but a high percentage body fat (%BF) composition. We aimed to examine the hypothesis that subjects having NWO are at higher risk for cardio metabolic abnormalities compared to normal body weight subjects with low body fat content. Method In this cross sectional study 2439 adults' normal body Mass Index were recruited as part of the Mashhad Stroke and Heart Atherosclerotic Disorders (MASHAD) cohort study. We measured 6 cardio-metabolic risk factors: Low-density lipoprotein cholesterol (LDL-C), triglycerides (TGs), and high-density lipoprotein cholesterol (HDL-C), fasting blood glucose (FBG), systolic and diastolic blood pressure, and serum C-reactive protein (hs-CRP). Two models were evaluated: in model A, the categorization of individuals utilized cut off values of BMI: 18.5–25 and %BF: > 25 in men and >30 in women; in model B, the cut off values used were BMI: 18.5–25 and BF% with cut-offs depending on age: 20–39 years, >19% and >32%; 40–59 years, >21% and 33% and 60–79 years, > 24% and 35% for men and women were used, respectively. Cardiovascular risk estimates were made using QRISK2. SPSS version 18(SPSS Inc. Chicago, IL, USA) was used for all statistical analyses. GraphPad Prism 6 for figures was used. Result Of the 2439 individuals with a normal BMI, 38.5% were found to be in high group and 61.5% were placed in normal weight groups for %BF in model A. In model B, 53.8% and 46.2% were found to be in the normal and high groups for %BF. The odds ratio for the presence of a metabolic abnormality for the high %BF group was 1.82 (95% CI, 1.42–2.34) and for high QRISK was 5.79 (95%CI, 4.17–8.02) after adjusted for age, in model A. In model B, the odds ratio for the presence of a metabolic abnormality for the high %BF group was 2.02 (95% CI, 1.68–2.42) and for high QRISK was 6.03 (95%CI, 4.45–8.08) after adjusted for sex. Conclusion It can be stated that if body fat analysis among normal weight individuals can have an important contribution to the prevention of cardiovascular disease and other obesity-related conditions.

Background Neonatal mortality accounts for more than 47% of deaths among children under five globally but proper care at and around the time of birth could prevent about two-thirds of these deaths. The Every Newborn Action Plan (ENAP) offers a plan and vision to improve and achieve equitable and high-quality care for mothers and newborns. We applied the bottleneck analysis tool offered by ENAP to identify obstacles and bottlenecks hindering the scale-up of newborn care across seven health system building blocks. Methods We applied the every newborn bottleneck analysis tool to identify obstacles hindering the scale-up of newborn care across seven health system building blocks. We used qualitative methods to collect data from five medical universities and their corresponding hospitals in three provinces. We also interviewed other national experts, key informants, and stakeholders in neonatal care. In addition, we reviewed and qualitatively analyzed the performance report of neonatal care and services from 16 medical universities around the country. Results We identified many challenges and bottlenecks in the scale-up of newborn care in Iran. The major obstacles included but were not limited to the lack of a single leading and governing entity for newborn care, insufficient financial resources for neonatal care services, insufficient number of skilled health professionals, and inadequate patient transfer. Conclusions To address identified bottlenecks in neonatal health care in Iran, some of our recommendations were as follows: establishing a single national authorizing and leading entity, allocating specific budget to newborn care, matching high-quality neonatal health care providers to the needs of all urban and rural areas, maintaining clear policies on the distribution of NICUs to minimize the need for patient transfer, and using the available and reliable private sector NICU ambulances for safe patient transfer.

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BackgroundThe prevalence of depression increased about 18% during a 10-year period between 2005 and 2015. The aim of the present study was to investigate the association between serum zinc and copper, PAB, SOD and hsCRP in men with depression.MethodsIn this study, 3768 men, were recruited as part of MASHAD study. Demographic, anthropometric and metabolic data measured and recorded for all subjects. The Beck Depression Inventory (BDI) was used for assessing depression in all participants. Serum zinc and copper concentration, hs-CRP, PAB (Pro-oxidant- Antioxidant Balance), and SOD (Superoxide dismutase) were measured in all subjects.Results:The mean level of copper in males with depression is significantly lower than normal males (p 0.05). The median of hs-CRP and mean of PAB were significantly higher in depressed subjects (p Conclusion:Inflammation and copper status, not zinc concentration, are two factors that may play a role in depression in male patients.

Background: Under Every Newborn Action Plan (ENAP), stillbirth rate in every country should be reduced by 12 or fewer per 1000 total births by 2030. The aims of this study were to determine stillbirth rate at national and subnational levels and to investigate its associated risk factors in Iran. Methods: Using all data from Iranian Maternal and Neonatal Network (IMaN), we calculated stillbirth rate of Iran from 2014-2016. This network registers information of almost all births across the country. The logistic regression was used to estimate the adjusted odds ratio (aOR) with 95% confidence intervals (CIs) for stillbirth. Results: In 2014, still birth rate was 7.40 per 1000 births. In 2015 and 2016, stillbirth rates were 7.22 per 1000 births and 7.63 per 1000 births, respectively. The most important related factors of stillbirth were preterm birth (aOR= 62.53, 95% CI; 60.77-64.34), sexual ambiguity (aOR= 14.51, 95% CI; 12.76-16.50), and post term birth (aOR= 3.31, 95% CI; 2.66-4.13). Conclusion: Under Every Newborn Action Plan (ENAP), stillbirth rate in every country should be reduced by 12 or fewer per 1000 total births by 2030. Iran has achieved stillbirth target of ENAP at national level. It is important for the health care system to establish and improve specific and focused policies, interventions, and programs for achieving this target even in the most deprived areas.

Obesity is an important feature of the metabolic syndrome and is associated with an increased risk of type 2 diabetes mellitus, cardiovascular disease, and some cancers. The aim of this study was to determine the relationship between body fat percentage and an imbalance of the prooxidant/antioxidant balance (PAB), serum superoxide dismutase (SOD1) and inflammation (serum hs-CRP) and increase risk of metabolic syndrome and diabetes mellitus. In this study, 9154 individuals were recruited as part of the Mashhad Stroke and Heart Association Disorder (MASHAD) study. Subjects were categorized into two groups according to body fat percentage as defined >25% in male and > 30% in female, according to gender. Biochemical factors, including serum PAB, SOD1, and hs-CRP were measured in all subjects. SPSS version 18 was used for statistical analyses for all. GraphPad Prism 6 for figures was used. Of total number of subjects (9154), 6748 (73.7%) were found to have a high body fat (BF) percentage. Serum hs-CRP and PAB were significantly higher in individuals with a high BF percentage (P 0.05). BF percentage, serum PAB and serum hs-CRP were significantly higher in individuals with metabolic syndrome and diabetes versus those without metabolic syndrome and diabetes mellitus (P < 0.05), however serum SOD1 was significantly lower in individuals with metabolic syndrome (P < 0.005). Oxidative stress and inflammation are two factors that may link the presence of high BF percentage with the development of metabolic syndrome, diabetes, and cardiovascular disease. © 2018 BioFactors, 45(1):35-42, 2019.

Metabolically obese normal weight (MONW) individuals are potentially at increased risk of developing metabolic syndrome. Serum zinc and copper concentrations were assessed in individuals with MONW to determine whether MONW is associated with altered serum zinc and/or copper status. Normal weight subjects (total n = 2419; 1298 men and 1121 women), were recruited as part of Mashhad Stroke and Heart Association Disorder (MASHAD) Study cohort. They were divided into two groups according to the presence or absence of MetS, defined using IDF criteria. Serum zinc and copper concentrations were determined by atomic absorption. Of the 2419 normal weight adults, 377 had MetS. Of this group, 53.7% and 49.7% had a serum zinc 131 µg/dl (Q4) (p = 0.034), and 18.8% had a serum zinc >95 µg/dl (Q4). Logistic regression analysis was performed to determine the odds ratio (OR) for an association of serum zinc, copper and zinc to copper ratio with MetS in normal weight subjects. The subjects with a serum zinc >95 µg/dl (Q4) had 0.386 [OR: 0.614(95%CI 0.457–0.823)] lower chance of MetS (p = 0.001) and the subjects with a serum copper >131 (Q4) had OR 1.423 (95% CI: 1.09–1.857) higher chance of MetS (p = 0.009). These data remained significant after adjustment for age and sex, for serum zinc and copper, respectively. Furthermore, our results strongly suggested that zinc and copper were the independent risk factor for metabolic syndrome in normal weight subjects. There is an imbalance between serum copper and zinc concentrations among individuals with MONW when compared with normal BMI individuals without MetS. This may increase the risk of individuals with MONW developing conditions associated with this imbalance, such as diabetes and cardiovascular disease.

The primary objective of the present study was to compare the mental health status of Iranian medical vs other health sciences students and to examine how demographic factors relate to their mental health problems. A total of 560 medical and other health sciences students (250 (44.6%) males and 310 (55.4%) females) were recruited from Iran University of Medical Sciences. Data were obtained by self-administered questionnaire, including questions on socio-demographic characteristics. The Beck Depression Inventory, Beck Anxiety Inventory, General Health Questionnaire, and WHO well-being index were used to assess mental health status of students. Ten percent of students had BDI scores consistent with clinically significant depression (6.6% mild, 1.8% moderate, 1.6% severe), and 28.7% had BAI scores consistent with clinically significant anxiety (20.7% mild, 7.1% moderate, 0.9% severe). Kurdish students had an odds ratio (OR) of 2.71 (95% CL, 1.22–6.02) for mild to severe depression symptoms when compared to Persian students. The prevalence of distressed health sciences students and poor psychological well-being was 13.4% and 14.1%, respectively. Maternal education gave an OR of 0.57 (0.35–0.93) for anxiety symptoms, after adjustment for all other factors. The possibility of general psychiatric morbidity was significantly lower in students who studied medicine (OR, 0.40 (0.21–0.71)). Being born in the capital city was associated with better psychological well-being (OR, 0.48 (0.26–0.86)). Ethnicity, birthplace, discipline, and maternal educational level were major determinants of mental health status among health sciences students. Further research should be undertaken to determine the prevalence of psychological disorders using more reliable diagnostic interview.

Background: Attention deficit hyperactivity disorder (ADHD) is among the most common neurodevelopmental disorders in children and adolescents. There is a controversy over the true prevalence of ADHD in Iran, the knowledge of which is crucial for allocating health care resources and identifying research priorities. This is an updated systematic review of the prevalence of ADHD in Iranian children and adolescents. Methods: For this systematic review, PubMed/Medline, Web of Science, Scopus, PsycINFO, IranPsych, IranMedex, Irandoc, Google Scholar, and grey literature were reached for publications between January 1990 and December 2018 that reported prevalence estimates of ADHD in Iran. Parallel independent assessments were conducted. The Quality Assessment Checklist for Prevalence Studies was used to assess the overall quality of studies. Results: A total of 34 original studies covering 33 621 Iranian children, adolescents, and adults were included. The included studies were mostly conducted on the population of preschool, elementary, middle, and high school-aged children as well as adolescents. Also, 6 studies addressed university students. Prevalence estimates of ADHD reported varied substantially across the studies and offered a range of heterogeneous data. Conclusion: Overall, making exact comparisons among studies was not easy because the assessment method and the type of sampling could impact prevalence estimates. These factors need to be considered when comparing data from different studies.

Depression and Anxiety are two important public health problems that are known to be associated with viral infections. The association between the intake of nutrients such as zinc and copper with symptoms of depression has been studied previously. The aim of the current study was to investigate the association between depression with human T cell lymphotropic virus type 1 (HTLV-1) infection and serum content of zinc and copper in a large Iranian population cohort. The study population consisted of 279 HTLV-1-positive patients who were identified after recruitment as part of a large cohort study: the Mashhad Stroke and Heart Association Disorder (MASHAD) study. They were divided into two groups of diagnosed with or without depression based on their symptoms. Serum zinc and copper levels of all subjects were measured using the flame atomic absorption spectrometry. The population sample comprised of 279 individuals infected with HTLV-1 of whom 192 (68.8%) were women. The mean serum zinc in the group with and without depression was 78.69 ± 13.79 μg/dl and 86.87 ± 19.44 μg/dl, respectively (p

Obesity is an important feature of the metabolic syndrome and is associated with an increased risk of type 2 diabetes mellitus, cardiovascular disease, and some cancers. The aim of this study was to determine the relationship between body fat percentage and an imbalance of the prooxidant/antioxidant balance (PAB), serum superoxide dismutase (SOD1) and inflammation (serum hs-CRP) and increase risk of metabolic syndrome and diabetes mellitus. In this study, 9154 individuals were recruited as part of the Mashhad Stroke and Heart Association Disorder (MASHAD) study. Subjects were categorized into two groups according to body fat percentage as defined25% in male and30% in female, according to gender. Biochemical factors, including serum PAB, SOD1, and hs-CRP were measured in all subjects. SPSS version 18 was used for statistical analyses for all. GraphPad Prism 6 for figures was used. Of total number of subjects (9154), 6748 (73.7%) were found to have a high body fat (BF) percentage. Serum hs-CRP and PAB were significantly higher in individuals with a high BF percentage (P0.05) but SOD1 was not significantly different between the two groups (P0.05). BF percentage, serum PAB and serum hs-CRP were significantly higher in individuals with metabolic syndrome and diabetes versus those without metabolic syndrome and diabetes mellitus (P0.05), however serum SOD1 was significantly lower in individuals with metabolic syndrome (P0.005). Oxidative stress and inflammation are two factors that may link the presence of high BF percentage with the development of metabolic syndrome, diabetes, and cardiovascular disease. © 2018 BioFactors, 45(1):35-42, 2019.

The prevalence of hypertension (HTN) is increasing globally. It has been shown that there is an association between micronutrient deficiency and HTN. In the current study, we aimed to assess the association between HTN with serum copper and zinc concentrations in a large representative Iranian population. The participants were enrolled into the Mashhad stroke and heart atherosclerotic disorders study (MASHAD study), a cohort study that was initiated in 2010. Anthropometric indices were assessed using standard procedures. Systolic (SBP) and diastolic (DBP) blood pressures were measured using a standard mercury sphygmomanometer. Fasting blood glucose (FBG), lipid profile, uric acid and blood urea nitrogen (BUN), and hs-CRP were measured using routine methods. HTN defined as persons who had SBP ≥ 130 mmHg and/or DBP ≥ 85 mmHg and/or medication use. Flame atomic absorption (Varian AA240FS) was used to measure serum Zn and Cu concentrations. SPSS software was used for all statistical analyses. A total of 9588 participants were recruited into the MASHAD study project. Participants were divided into two groups; 5695 healthy (non-hypertensive) (mean age 45.85 ± 7.5 years) and 3893 hypertensive participants (mean age 51.18 ± 7.67 years). Systolic (p 0.001) and diastolic blood pressure (p 0.001) were significantly different for different serum copper quartiles. The participants with serum copper levels 80 μg/dl had 1.33 times greater risk of an increased blood pressure than other participants. Participants with serum copper levels 130 μg/dl had a 1.94-fold higher risk of raised blood pressure. Serum zinc was not associated with systolic blood pressure, but individuals in the first quartile level of serum zinc had a diastolic blood pressure that was significantly higher than other quartiles (p = 0.035). Serum copper is associated with blood pressure status in adults in a U-shaped relationship, with a range of serum copper between 80 and 130 μg/dl being associated with normal blood pressure.

Although diabetes control and prevention program has been initiated in Tehran, Iran and five other large cities in the country since 2010, patients' satisfaction with the services provided by this program has not been evaluated yet. The aim of this study was to determine the patient satisfaction with this program in Tehran.This cross-sectional study, were conducted in 15 primary health care centers in Tehran, Iran in 2013. We enrolled 386 people aged older than 30 yr referred to primary health care centers. A questionnaire was used to evaluate the degree of patients' satisfaction with the services (the questionnaire included six domains: access to services, continuity of care, the humanness of staff, provision of health education materials, effectiveness of services, comprehensiveness of care). The chi-square test, independent t test and one-way ANOVA were used for data analysis.Overall, 239 patients (62%) were female. The mean age (SD) of the patients was 51±11 yr. Overall, 263 patients (68%) were highly satisfied with providing services. The highest levels of patients' satisfaction were in the domains of continuity of care, the humanness of staff, and effectiveness of services. The lowest level of satisfaction was in the domain of provision of health education materials.Diabetes control and prevention program seems to be a suitable program in health care centers in Tehran, however, it is necessary to make further plans to improve the level of training materials provided to patients and comprehensiveness of care.

Estimating burden of disease, injuries and risk factors is crucial for health policy decision making. The Burden of Diseases (BoD) studies provide data about the magnitude and distribution of health problems among the population at national and sub-national levels. The BoD studies are designed to use secondary data for estimating prevalence and incidence of diseases, injuries and risk factors. However, due to the scarcity of data sometimes it becomes unavoidable to collect data from medical records. Among all needed source of data, including surveys, registries, censuses, inpatient and outpatient data, hospital data are an essential source for BoD studies. Hospital Data Survey (HDS) aims to estimate the prevalence and incidence of diseases and injuries that led to admission to hospitals. This paper aims to describe the required steps for data gathering, sampling, analytical methods, and other needed procedures for HDS.The designed questionnaire includes demographic data, current health status, diseases, injuries and co-morbidities with their ICD10 codes, curative procedures, and treatment. A pilot study was conducted on 302 medical records from 6 hospitals to evaluate the validity and reliability of the questionnaire. Sampling frame was designed and probability proportional was used after being tested in the pilot study. In the next step, we will collect 367500 medical files from 863 hospitals (0.5% of all inpatient records in hospitals from1996 - 2013). The HDS is the first national study in Iran that is gathering data through an online-offline web-based system based on electronic version of the questionnaire which makes the process of data cleaning and analyses more comfortable.