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Summary: Background: Although the beneficial role of ginger consumption on peptic ulcer disease (PUD) has been shown in experimental studies, there is no clinical trial on patients with PUD. Methods: The current study was performed as a randomized, double blind, placebo-controlled, clinical trial on patients with PUD. Patients were randomized to take either ginger (2000mg/day) or placebo as a supplement after the standard treatment for 6 weeks. At the beginning and the week 8, all participants underwent endoscopic exam, and gastric ulcers were evaluated and biopsied for pathologic assessment. Serum high-sensitive C-reactive protein (hs-CRP), IL-8, and total anti-oxidant capacity (TAC) were measured at the baseline, and the end of the study. Results: There was no significant difference in the number of ulcers at baseline and ending point of the study in the control group (P-value=0.772). Meanwhile, the number of ulcers were significantly lower in the intervention group after 6 weeks of ginger supplementation compared to the baseline (P-value=0.01). Moreover, higher reduction in mean dyspepsia scores was found in the intervention group compared to the control group (P=0.04). As another finding, the mean TAC increase in the intervention group (1.12±0.44 U/ml) was significantly higher than the control group (0.09±0.16 U/ml) (P

Abstract Cardiovascular disease (CVD) can often lead to serious consequences such as death or disability. This study aims to identify a tree-based machine learning method with the best performance criteria for the detection of CVD. This study analyzed data collected from 9,499 participants, with a focus on 38 different variables. The target variable was the presence of cardiovascular disease (CVD) and the villages were considered as the cluster variable. The standard tree, random forest, Generalized Linear Mixed Model tree (GLMM tree), and Generalized Mixed Effect random forest (GMERF) were fitted to the data and the estimated prediction power indices were compared to identify the best approach. According to the analysis of important variables in all models, five variables (age, LDL, history of cardiac disease in first-degree relatives, physical activity level, and presence of hypertension) were identified as the most influential in predicting CVD. Fitting the decision tree, random forest, GLMM tree, and GMERF, respectively, resulted in an area under the ROC curve of 0.56, 0.73, 0.78, and 0.80. The GMERF model demonstrated the best predictive performance among the fitted models based on evaluation criteria. Regarding the clustered structure of the data, using relevant machine-learning approaches that account for this clustering may result in more accurate predicting indices and targeted prevention frameworks.

Abstract Background Providing safe care in a sensitive and high-risk unit such as the ICU is one of the most crucial tasks for nurses. One way to establish the criteria for safe care is by creating a instrument to assess it. Therefore, this study was conducted with the aim of designing and psychometrically evaluating an instrument for safe nursing care in the ICU. Methods The current study employed a sequential-exploratory mixed-method approach with two qualitative and quantitative phases. Based on the results of qualitative phase and the literature review, the primary instrument was designed. In the quantitative phase, the designed instrument underwent psychometric evaluation. Face, content and construct validity were assessed. Face validity was assessed by 20 nurses, and content validity was assessed by 26 experts. In the construct validity stage, the sample size for the exploratory factor analysis (EFA) included 300 nurses, and for the confirmatory factor analysis (CFA) included 200 nurses who work full-time in the ICUs of hospitals affiliated with Kermanshah University of Medical Sciences in western Iran. EFA sampling was conducted in three hospitals, encompassing six ICUs, while CFA sampling was carried out in two hospitals, covering four ICUs. Sampling was done using the convenience method. The reliability of the instrument was also assessed. Finally, the interpretability, feasibility, weighting, and scoring of the instrument were evaluated. Results The qualitative phase identified three themes, including professional behavior (with categories: Implementation of policies, organizing communication, professional ethics), holistic care (with categories: systematic care, comprehensive care of all systems), and safety-oriented organization (with categories: human resource management and safe environment). The primary instrument was designed with 107 items rated on a five-point Likert scale. In the quantitative phase, the psychometrics of the instrument were conducted. First, the face and content validity were assessed, and the average scale content validity index (S-CVI) was 0.94. Then, a preliminary test was conducted to assess the initial reliability (α = 0.92) and the correlation of each item with the total score. After completing these steps, the number of items in the instrument was reduced to 52. The results of the EFA explained 58% of the total variance, with 4 factors identified: professional behavior by following guidelines, comprehensive care, accurate documentation, and pressure ulcer care. At the CFA stage, the results of the calculation of indices and goodness of fit showed that the model had a good fit. The reliability of the relative stability by examining the intraclass correlation coefficient (ICC) for the whole instrument in 20 samples was 0.92 with a confidence interval of 0.97 − 0.81. To measure absolute stability and determine the responsiveness of the instrument, the standard error of measurement (SEM) was 4.39 and the minimum detectable change (MDC) was 12.13. Conclusion The instrument for safe nursing care in the ICU has favorable psychometric properties.

Objective (s): In a situation where the vaccine was not completely accurate and up-to-date against different strains of the virus in all people of the world, compliance with health guidelines was the main key to prevent transmission. But what is clear is that compliance with health protocols is not the same among all communities and depends on factors. This article examines the effects and attitudes of health protocols. Methods: This research was a descriptive-quantitative cross-sectional study, which was conducted among 385 students of Shahid Beheshti University of Medical Sciences, Iran in the last week of May 2022. Factors affecting the adherence to water hygiene behaviors due to covid-19 were investigated using a questionnaire and the results were analyzed and reported in ordinal regression with SPSS 25 software. Results: The ratio of the average score of compliance (19.08) from the total of eight health behaviors to the maximum score (25) was reported as 76%. It was reported that the score of awareness was very high, 94%, and the average score of attitude was about 75%. In the ordinal regression, it was found that having knowledge was not effective in following all health protocols and only two behaviors of avoiding attending gatherings and avoiding losing when meeting acquaintances showed a statistically significant relationship. In other words, with the increase of each score of awareness, the chance of having higher compliance scores in these two behaviors increased by about 1.5 times. On the other hand, the attitude score had a statistically significant relationship with most of the behaviors, except the compliance of coughing and sneezing into a handkerchief or the corner of the arm, and it had a positive simultaneous effect on the compliance of the behaviors. Conclusion: The high level of awareness among the studied community can partially indicate the effectiveness of interventions in increasing awareness, but the gap between awareness, attitude and behavior indicates the need to pay attention to other factors affecting attitude and behavior.

Abstract Background The relationship between the dietary insulin index (DII) and the disease’s risk is unknown, despite the fact that hyperinsulinemia is presumed to contribute to osteoporosis. The insulin response of various diets determines the DII. This study aimed to investigate the connection between postmenopausal Iranian women’s adherence to a diet with a higher insulinemic potential and osteoporosis. Methods A total of 380 postmenopausal women were included in the current case-control study. A 168-item food frequency questionnaire (FFQ) with established validity and reliability was used to evaluate individuals’ daily calorie intake. The standard formula was employed to determine the dietary insulin load of each product. Subsequently, the calculation of DII was performed by dividing the dietary insulin load by the total energy consumed for each individual. In order to investigate the relationship between osteoporosis and DII, logistic regression was implemented. Results The results of the current study demonstrated a substantial inverse relationship between osteoporosis and the DII, even after accounting for confounding variables (OR = 0.927; 95% CI = 0.888–0.967). The mean scores of DII (P

Background A child health-friendly neighbourhood is defined as a neighbourhood where the child’s health is provided, protected and promoted. Designing and validation of an assessment tool is required to identify the deficits and strengths of neighbourhoods within the context of each country. This study aimed to design and validate a child health-friendly neighbourhood assessment tool in Tehran.Methods A mixed-methods approach using semistructured interviews with 31 participants (15 mothers of children under 6 years old and 16 experts) conducted in Tehran between 2021 and 2022. Face validity, content validity and reliability of the checklist were calculated. Highly influenced by the Child Friendly City framework, designing and validation of the checklist was carried out through three phases: (a) identifying the child health-friendly neighbourhood domains and subdomains, (b) drafting the Iranian Child Health-Friendly Neighbourhood checklist and (c) validation of the designed checklist.Results Following three phases of study, the final version of the checklist consisted of six dimensions, namely green space and park, recreational centre, passage and street, healthcare centre, cultural centre and kindergarten. Each dimension encompassed five domains of facilities and services, accessibility, security, safety and aesthetics and view, with 42 indicators, 77 subindicators and 273 items.Conclusions The child health-friendly neighbourhood checklist has a more health focus on neighbourhood level and is more contextually specific, relevant and appropriate compared with UNICEF’s Child Friendly City framework. It also showed acceptable validity and reliability; therefore, the checklist could be a feasible tool to assess child health-friendly neighbourhoods.

Abstract Background Men experiencing infertility encounter numerous problems at the individual, family, and social levels as well as quality of life (QOL). This study was designed to investigate the QOL of men experiencing infertility through a systematic review. Materials and methods This systematic review was conducted without any time limitation (Retrieval date: July 1, 2023) in international databases such as Scopus, Web of Science, PubMed, and Google Scholar. The search was performed by two reviewers separately using keywords such as QOL, infertility, and men. Studies were selected based on inclusion and exclusion criteria. The quality of the articles were evaluated based on the Newcastle-Ottawa Scale. In the initial search, 308 studies were reviewed, and after removing duplicates and checking the title and abstract, the full text of 87 studies were evaluated. Results Finally, 24 studies were included in the final review based on the research objectives. Based on the results, men’s QOL scores in different studies varied from 55.15 ± 13.52 to 91.45 ± 13.66%. Of the total reviewed articles, the lowest and highest scores were related to mental health problems and physical dimensions, respectively. Conclusion The reported findings vary across various studies conducted in different countries. Analysis of the factors affecting these differences is necessary, and it is recommended to design a standard tool for assessing the quality of life of infertile men. Given the importance of the QOL in men experiencing infertility, it is crucial to consider it in the health system. Moreover, a plan should be designed, implemented and evaluated according to each country’s contex to improve the quality of life of infertile men.

Abstract Background Food and nutrition insecurity is a major health issue in developing countries. Homestead food production (HFP) programs are strategies for improving food and nutrition security of a country. Iran implemented a HFP program entitled “Nutrition Improvement of Rural and Nomadic Women” in its villages for a five-year period from 2017. The current study assessed the outcomes of this mentioned program and its determinants among rural women in Tehran province. Methods The population of this cross-sectional study comprised a group covered by the program (n = 143) and a non-covered group (n = 160). The participants were selected randomly from 32 villages of five counties in Tehran province. Data was collected using five questionnaires: (1) General information, (2) Women’s empowerment, (3) Nutritional knowledge, (4) Dietary diversity, and (5) Household Food Insecurity Access Scale (HFIAS). Data was analyzed using the IBM SPSS version 21 and the IBM Amos SPSS version 22 software. Results The results of the study showed no significant improvement in the expected indicators, such as frequency of home gardening, nutritional knowledge, dietary diversity, women’s empowerment, and household food insecurity status among women covered by the program (p > 0.05). The structural equation modelling (SEM) results indicated that women’s empowerment from the dimension of decision-making power (r = 0.151) and nutritional knowledge (r = 0.135) were the significant positive predictors of dietary diversity (p

IntroductionEarly permanent dental caries can pose a serious threat to oral health in the coming years. This study aimed to investigate the key factors influencing early dental caries in permanent teeth among first-grade Iranian children.MethodsA cross-sectional study involving 778 randomly selected first-grade children from public schools in Tehran, Iran, was conducted between November 2017 and January 2018. The oral health of the children, evaluated by two trained dentists, was recorded based on the DMFT index. Information on maternal education, gender, dmft index, brushing frequency, dental visits, flossing, and sweet consumption was also collected. The Random Forest method was employed to identify factors associated with early permanent dental caries, and its performance was compared with logistic regression using the Area Under the Curve (AUC) index.ResultsLogistic regression, represented by odds ratios (OR), revealed a significant association between early permanent dental caries and dmft index [OR = 1.13, 95% CI (1.07, 1.20), p-value

Background: Pregnant women have poor knowledge of oral hygiene during pregnancy. One problem with the follow-up of dental caries in this group is zero accumulation in the decayed, missing, and filled teeth (DMFT) index, for which some models must be used to achieve valid results. The studied population may be heterogeneous in longitudinal studies, leading to biased estimates. We aimed to assess the impact of oral health education on dental caries in pregnant women using a suitable model in a longitudinal experimental study with heterogeneous random effects. Materials and Methods: This longitudinal, experimental research was carried out on pregnant women who visited medical centers in Tehran. The educational group (236 cases) received education for three sessions. The control group (200 cases) received only standard training. The DMFT index assessed oral and dental health at baseline, 6 months, and 24 months after delivery. The Chi-square test was used for comparing nominal variables and the Mann–Whitney U test for ordinal variables. The zero-inflated Poisson (ZIP) model was applied under heterogeneous and homogeneous random effects using R 4.2.1, SPSS 26, and SAS 9.4. The level of significance was set at 0.05. Results: Data from 436 women aged 15 years and older were analyzed. Zero accumulation in the DMFT was mainly related to the filled teeth (51%). The heterogeneous ZIP model fitted better to the data. On average, the intervention group exhibited a higher rate of change in filled teeth over time than the control group (P = 0.021). Conclusion: The proposed ZIP model is a suitable model for predicting filled teeth in pregnant women. An educational intervention during pregnancy can improve oral health in the long-term follow-up.

Objective(s): Family members of patients hospitalized in intensive care unit experience high levels of depression, anxiety and stress. Therefore, the present study was conducted with the aim of assessing depression, anxiety and stress in the family members of patients hospitalized in the intensive care units of selected hospitals in Tehran, Iran Methods: This was a cross-sectional study in which depression, anxiety and stress of 160 family members of patients hospitalized in the intensive care units were examined. The samples were selected using a multi-stage cluster sampling method (from February to December 2022). The data were collected using the Persian version of DASS-21 and were analyzed with descriptive statistics and linear regression model. Results: The results of the present study showed that the mean anxiety score of family members was 17.84(SD = 7.92), the average depression score was 17.49(SD = 8.34), and the average stress score was 18.35(SD = 7.50). The linear regression model simultaneously showed that for an increase of one year in age, the anxiety score of family members decreased by 0.11, and this decrease was significant (P

Abstract Background & Aims Education and counseling during marriage is an opportunity to raise some issues needed by couples on the verge of marriage. This study was conducted with the aim of improving reproductive and sexual health literacy of couples on the verge of marriage. Methods This study was a mixed‐methods participatory action research conducted based on the Find, Organize, Clarify, Understand, Select‐Plan, Do, Check, Act (FOCUS‐PDCA) model in nine steps during 2019−2020 in the city of Bandar Abbas. The Reproductive Health Literacy Scale and the Service Quality (SERVQUAL) Questionnaire were used to evaluate the interventions. Data were analyzed by SPSS version 26. A significance level of less than 0.05 was considered. Results The mean age of women and men participating in the quantitative part of the study was 21 ± 5 and 25.84 ± 3.9 years, respectively, which was similar to their counterparts in this part of the study, and the difference in the mean scores of reproductive health literacy before and after the changes in the program showed a significant difference (p > 0.001). The study results showed that, except for the understanding dimension, most participants were at an insufficient level in other dimensions of reproductive health literacy. The result of measuring the satisfaction of service recipients indicated good satisfaction in the two dimensions of warranty and accountability, and there was a gap in empathy, assurance, and tangibility dimensions, which the biggest gap was related to the empathy dimension. Conclusion The changes made in improving the reproductive health literacy of couples were effective, which can be taken into consideration based on the added items in the current program of providing educational services in marriage preparation classes for couples.

IntroductionNutrition-sensitive agriculture (NSA) is a comprehensive, inter-sectoral approach to improve food security and nutrition. In Iran, “National Nutrition Improvement Program in Rural and Nomadic Women” has been developed and implemented as a NSA program. The main purpose of this study was analysis of this program using the Policy Triangle Framework.MethodsThis was a qualitative policy analysis study, which was conducted retrospectively. The study population included policymakers and executors at macro (Tehran Province) and micro levels (County and village) from the two involved ministries, as well as rural women in Tehran province. The collected data included the program document (N = 210), in-depth semi-structured interviews (N = 40), as well as focus group discussions (N = 8). Data was analyzed using MAXQDA 2010 software with a deductive approach.ResultsThe findings of this study indicated that the underlying factors including social, economic and cultural status, health, structural-environmental and political are associated to the development of the program. The current program is a multi-faceted, in accordance with the existing needs, which provides opportunities to improve nutrition and community health, empower women, strengthen socio-economic status at the micro and macro levels and pave the way for other projects, by connecting the nutrition sector to agriculture. The analysis has also shown that the content of this program requires more consideration in budget and motivational measures. Although developing an NSA program based on inter-sectoral collaboration is a valuable step, it needs to be improved in the areas of sustainability, inter-sectoral collaboration, resources and facilities, monitoring and evaluation, as well as needs assessment.ConclusionThe findings of the present study can be used as evidence by policymakers and planners in redesigning and implementing the program, or developing other NSA programs.

Abstract Background Infertility is a major challenge in the life of women which affects their quality of life. Infertile women's quality of life is a relatively new field of research that has recently been considered by health researchers. However, there has been no standard tool for measuring different aspects of infertile women's quality of life with female factors, and general and specific tools of infertile couples have been used to assess their quality of life. This study, thus, aimed to analyze different aspects of the quality of life of infertile women. Methods This descriptive cross-sectional study was conducted on 320 infertile women referred to a teaching hospital affiliated with Mazandaran University of Medical Sciences and private infertility treatment centers in Sari, Iran. Demographic and fertility characteristics and the quality of life questionnaire for infertile women questionnaire (a 25-item tool was designed which measured 7 factors of psychological effects, sexual life with infertility family and social effects, infertility-related concerns, physical effects, adaptive approaches and factors preventing infertility adaptation), were recruited for data gathering. Data were analyzed using SPSS version 22. Descriptive statistics (percentage, mean, standard deviation), correlation coefficient, independent sample t-test, and multiple linear regression were used. P-values less than 0.05 were considered statistically significant. Results The total mean score of infertile women's quality of life was 65.68 ± 8.91%. Findings were indicative of infertile women's quality of life in the dimensions of adaptive approach (70.48 ± 15.02%), psychological (67.88 ± 12.06%), family and social (64.63 ± 10.76%), physical, 63.42 ± 11.36%), inhibitory factors/ factors preventing adaptation (60.98 ± 8.24%), related concerns (51.52 ± 10.21%) and sexual life (40.12 ± 14.28%). According to the final multiple linear regression model, women's education (B = 2.57, p

Abstract Background Primary ovarian insufficiency is menopause before the age of 40. It can affect the quality of life of afflicted women. Because there is no instrument available for measuring the quality of life of these women, the present study was carried out to develop and assess the psychometric properties of the quality of life scale for women with primary ovarian insufficiency. Methods This exploratory sequential mixed method study was performed in two phases. In the qualitative phase (item generation), semi-structured in-depth interviews were conducted with 16 women having primary ovarian insufficiency, and a literature review was performed to generate initial items pool. In the quantitative phase (psychometric evaluation), the face, content, and construct validity (exploratory factor analysis), as well as reliability (internal consistency and test–retest methods), were evaluated. Besides, the responsiveness and interpretability were investigated. Results During the first phase of the study, the initial item pool was generated with 132 items. After the face and content validity, the number of items was reduced to 40. The results of exploratory factor analysis yielded a 28 item scale with six factors. These factors explained 58.55% of the total variance. The Cronbach’s alpha for each factor was more than 0.7. Furthermore, the intraclass correlation coefficient for the entire scale was 0.95. Conclusions The primary ovarian insufficiency quality of life scale (POIQOLS) is a valid and reliable tool for accessing the quality of life of women with primary ovarian insufficiency.

Abstract Background Body dissatisfaction has been known as an important public health concern that can influence the physical and psycho-social health of adolescents. Hence, health professionals need a valid and reliable tool to assess this problem and its related factors in youth. This study aims to develop and assess the psychometric properties of an indigenous scale for the evaluation of body image and to investigate its association with body weight status among Iranian adolescents. Methods This study was conducted on 857 adolescents who completed the body image scale for Youth (BISY) and self-reported their body weight and height. Face, content, and construct validity methods were used to assess the validity of the BISY. Exploratory factor analysis (EFA) was used to assess construct validity. Moreover, the internal consistency of the scale was assessed by calculating Cronbach’s alpha coefficient (α), and test–retest reliability was examined using the intra-class correlation coefficient (ICC). To compare the BISY scores across sex and body weight status groups, the Independent samples t-test and the analysis of variance (ANOVA) or Welch tests were used, respectively. Results Mean age and body mass index (BMI) of participants were 16.5 ± 1.1 years and 22.4 ± 4.5 kg/m2, respectively. The EFA showed a 10-factor construct which explained 57% of the variance. The Cronbach’s alpha coefficient for overall items of the scale was 0.896 and ranged from 0.42 to 0.92 for subscales. The test–retest reliability result was acceptable for the BISY (ICC = 0.805). The ICC values ranged from 0.753 to 0.990 for BISY subscales. The BISY total score was significantly higher in girls compared to boys (34.8 ± 12.7 vs. 31.3 ± 10.2; p

Introduction: The mixed effects logistic regression model is a common model for analysing correlated binary data as longitudinal data. The between and within subject variances are typically considered to be homogeneous but longitudinal data often show heterogeneity in these variances. This study proposes a Bayesian mixed effects location scale model to accommodate heteroscedasticity in binary data analysis. Methods: This study was carried out in two stages; first, the simulation study was used to evaluate the accuracy of the proposed model with the Bayesian approach and then the proposed model was applied to a real data. In simulation study, the data were generated from the mixed effects location scale model with different correlations between the random location effect and random scale effect and different sample sizes. In order to evaluate the accuracy of the estimations, the Root Mean Square Error, bias and Coverage Probability were calculated and the deviance information criterion was used to select the appropriate model. At the end we utilized this model to analyse uric acid levels of patients with haematological disorders. Results: The simulation results show the accuracy of model parameter estimates as well as the correlation between random location and scale effects. They also display that if a random scale effect is present in the data, it should be accounted for in model. Otherwise, the model is forced to assign the within subject variation due to these subject random effects to the error term. The results of real data are also in line with this. The odds of having normal UA levels increases by a factor of 26% per week. Due to the positive value of the covariance parameter, patients with higher mean of UA levels show higher variation in UA levels. Furthermore, the significance of the covariates in the between subject and within subject variances model, as well as the significance of the random scale variance determines the heterogeneity across subjects. Conclusion: Bayesian mixed effects location scale model provides a useful tool for analysing correlated binary data with heteroscedasticity because it considers data correlation and modelling mean and variance simultaneously. Furthermore, it improves the accuracy of statistical inference in longitudinal studies compared to classic mixed effects models.

Objectives: The focused question of this systematic review was “does hyaluronic acid (HA) injection in areas of interdental papillary deficiency reduce black triangles?” Materials and Methods: A systematic literature search was performed to find clinical studies on human patients with a minimum of 6-month follow-up, published in English from 2005 to May 2020. There were two outcome variables: black triangle area (BTA) change after treatment at different measurement time points compared with baseline, and patient reported outcome measures (PROMs), when available. Results: Of eight eligible articles (2 randomized clinical trials (RCTs) and 6 non-randomized, non-placebo controlled clinical studies), seven reported that HA injections had a positive impact on reduction of BTA and subsequent papillary augmentation. Six studies were included in meta-analysis and showed that the intervention led to a pooled reduction percentage of 57.7% in BTA after 6 months. Although there were clinical diversities between the studies, all the studies applied the same concentration of HA (approximately 2%), 2-3 mm apical to the papilla tip in several intervals. Some degrees of relapse were reported in some studies. Conclusion: Within the limits of this study, this systematic review and meta-analysis showed that HA injection can serve as an efficient minimally-invasive treatment for small interdental papillary deficiencies. It is essential to conduct further randomized clinical studies with prolonged follow-ups in order to support this conclusion.

Introduction: A cure rate survival model was developed based on the assumption that the number of competing reasons for the event of interest has the Geometric distribution and the time allocated to the event of interest follows the Generalized Birnbaum-Saunders distribution. Methods: The Geometric GB-S distribution was defined and two useful representations were represented for its density function which contributes to the creation of some mathematical properties. Furthermore, the parameters of the model with cure rate were estimated by using the maximum likelihood method. Results: Several simulations were performed and a real data set was analyzed from the medical area for different sample sizes and censoring percentages. Conclusion: By considering the advantages of the GGB-S model, the model can be implemented as an appropriate alternative to explain or predict the survival time for long-term individuals.

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

Abstract Background Schools provide an opportunity for developing strategies to create healthy food environments for children. The present study aimed to analyze the Healthy School Canteen (HSC) policy and identify challenges of its implementation to improve the school food environment in Iran. Methods This mixed method study included two qualitative and quantitative phases. In the qualitative phase, triangulation approach was applied by using semi-structured interviews with key informants, documents review and direct observation. Data content analysis was conducted through policy analysis triangle framework. In the quantitative phase, food items available in 64 canteens of primary schools of Tehran province were gathered. The food’s nutrient data were evaluated using their nutrition facts label. The number and proportion of foods that met the criteria based on Iran’s HSC guideline and the World Health Organization nutrient profile model for the Eastern Mediterranean Region (WHO-EMR) were determined. Results The main contextual factors that affected adoption of HSC policy included health (nutritional transition, high prevalence of non-communicable diseases and unhealthy food environment in and around the schools), political (upstream supportive policies and joint memorandums about health children between the Ministry of Health and Medical Education and Ministry of Education), structural (the lack of unified stewardship, inadequate human resource capacity, poor inter-sectional cooperation), economic (school financial problems, poor fiscal supportive of food policies), and socio-cultural (mothers working outside the home, the role of children’s peer group, low nutrition knowledge of school principals) factors. Assessment of the school canteens showed that a large proportion of available foods did not comply with the national guidelines (54.7 ± 2.54%) and WHO-EMR model (85.6 ± 2.34%). The main reasons identified for incomplete implementation of the policy were inadequate physical and economic infrastructure to set up standard school canteens, lack of scientific criteria for food categorization, poor monitoring, high price of healthy foods, and conflict of interest among the actors. Conclusion The majority of foods and beverages available in the school canteens did not comply with national and regional standards. Iran HSC policy needs to be improved by using an evidence-based approach and active interaction between all key actors.

Objective Recent studies have shown a possible association between vitamin D deficiency and the severity of primary dysmenorrhea. The present study aimed to investigate the effect of vitamin D supplementation on pain and systemic symptoms in patients with primary dysmenorrhea. Methods This double-blind, randomized, placebo-controlled trial was conducted on female students aged 18 to 32 years with primary dysmenorrhea and vitamin D deficiency (25 [OH]D

Abstract Age is a known predictor of blood pressure (BP); however, the literature mostly includes cross‐sectional investigations. This prospective cohort study aimed to decompose the cross‐sectional and longitudinal age effects on BP. The secondary data were obtained from the Tehran lipid and glucose study, which comprised six repeated measurements of participants, with median follow‐up of 15.8 (interquartile range of 14.2‐16.9) years. The sample is representative of the metropolitan area of Tehran, Iran, containing 7,460 participants aged 20‐70. The cross‐sectional and longitudinal effects of age (age at baseline and aging, respectively) were fitted in the mixed effects models, taking systolic, diastolic, and pulse BPs as response, adjusting for adiposity, smoking, diabetes, and antihypertensive medication, and stratifying for sex and 10‐year age‐groups. The mean age at baseline was 41.3 (SD = 12.9) years, and 41.7% of the participants were male. Age at baseline and aging were directly associated with BP, aging owned the weaker effect, and the largest distinction were for systolic blood pressure of men aged 40‐49 years (0.75 vs 0.10, p‐value

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

Abstract Aim To assess needs for a gender‐sensitive perimarital counselling services in Iran. Design A descriptive cross‐sectional study. Methods This was a study on all 236 premarital counselling providers in 37 health centres in Shiraz‐Iran. The tools for data collection included the following: (a) a demographic information questionnaire and; (b) a valid and reliable Needs Assessment questionnaire for Gender‐Sensitive Perimarital Counseling Services (GSPCS) in 3 sections of needs for process, structure and policy making of the perimarital counselling services. Data were analysed using SPSS 21. Results All health providers with average working experience of 8.63 (SD 5.35) years participated in the study. Results demonstrated highest scores for needs related to facilities as the structure of the services (90.09 SD 13.70 per cent) and community empowerment (89.50 SD 16.67 per cent) as the necessary policy for the gender‐sensitive services. We concluded that providing gender‐sensitive perimarital counselling healthcare services needs to reform the process, structure and policies of the services.

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.

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

Abstract Aim The current work investigated the issues that cause apprehension in infertile women, the effects of this disquiet on their quality of life and the strategies that they adopt in dealing with their concerns. Design The qualitative research. Method This qualitative research sampled participants from a training centre in Mazandaran University of Medical Sciences and a privately owned infertility centre in Mazandaran Province, north of Iran. Purposive sampling continued until data saturation was reached. We conducted a conventional content analysis of the responses of 30 individuals (15 women with female infertility and 15 key informants) to in‐depth and semi‐structured in‐person interviews on May to November 2019 . Results The results uncovered two themes subsuming four categories of issues: The first theme revolves around “infertility concerns,” under which “concerns” and “the difficulty and vagueness of treatment” belonged. The second theme was “dealing with infertility,” which covered “adaptive strategies” and “inhibitors of reconciliation with perceived infertility.”

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

Abstract Background and Aim Providing gender‐sensitive health services is emphasized by the World Health Organization. This study aimed to assess and prioritize the needs for the gender‐sensitive sexually transmitted infections/human immunodeficiency viruses (STIs/HIV) prevention services by a valid and reliable questionnaire. Methods This was an exploratory mixed methods sequential study in Shiraz Iran 2019. The first phase was a qualitative study on 37 providers and managers of the services who were recruited using the purposive and then snowball sampling method. In the second phase, following the content analysis of the qualitative data and a review of related literature, a questionnaire was developed and its psychometric properties were evaluated. Then, in the third phase, the questionnaire was used to assess and prioritize the needs through a quantitative descriptive cross‐sectional study on all 290 providers of STI/HIV prevention services affiliated with Shiraz University of Medical Sciences. Results The finding of the qualitative phase showed gender‐sensitive STI/HIV prevention services should provide gender‐sensitive care and education by the trained personnel and manages with appropriate facilities and equipment. Providing these services also requires supportive policies, intersectoral cooperation, and community capacitation. In the second phase, a questionnaire was developed with 63 items. Assessment of psychometric properties of the questionnaire demonstrated the scale content validity index and ratio (S‐CVI = 0.98 and S‐CVR = 0.87, respectively), as well as the reliability of the questionnaire (internal consistency = 0.972 and intracluster correlation coefficient = 0.910). Results of the third descriptive phase of the study demonstrated the highest priorities for gender‐sensitive education (92.01 ± 11.76%) and care services (92.11 ± 12.04%), respectively. Conclusions To improve the quality of the services, a gender‐based education and care process, as well as a gender‐sensitive structure, including gender‐sensitive personnel, facilities, and management are necessary. Recognizing and meeting the needs for gender‐sensitive services will improve the quality of the services.

Abstract Background Infertility is one of the most important issues that negatively influences women’s quality of life, especially when the cause is associated with females. Given that no instruments have been designed to assess quality of life among infertile women with focus on female factors, this study was conducted to develop and evaluate the psychometric properties of a female-centric quality of life questionnaire for infertile women. Method This sequential exploratory study was conducted in two stages. First, the concept of quality of life and its dimensions as they relate to infertile women were elucidated through a qualitative inquiry accompanied with a content analysis. Accordingly, infertile women and key informants from a teaching hospital affiliated with the Mazandaran University of Medical Sciences and a private center for infertility treatment in Sari (north of Iran) were screened through purposive sampling until data saturation. Those who satisfied the inclusion criteria and exhibited maximum variance in terms of age, educational level, employment status, infertility duration, treatment type, and social class were recruited. The conventional content analysis was carried out in accordance with the steps proposed by Graneheim and Lundman, and the accuracy and robustness of the data were verified using Lincoln and Guba’s criteria (credibility, transferability, dependability, confirmability and authenticity). Second, the psychometric properties of the instrument developed in the qualitative stage were evaluated using a quantitative method and on the basis of the results of a literature review. The content, face, and construct validity of the instrument was determined, and its test–retest reliability and stability were ascertained using internal correlation and Cronbach’s alpha. The collected data were entered into the Statistical Package for the Social Sciences (version 22) for analysis, and descriptive statistics were calculated. Discussion Developing and evaluating the psychometric properties of a valid and reliable female factor-centric instrument that measures quality of life among infertile women will be very useful in the assessment of their future status.

Abstract Background Providing gender sensitive reproductive health service is recently emphasized by health organizations. This study aims to develop and assess psychometric properties of a questionnaire to assess gender sensitivity of perinatal care services (GS-PNCS) to be used by managers of perinatal services. Methods This study is a mixed sequential (Qualitative-Quantitative) exploratory study. In the qualitative phase, 34 participants were interviewed and the items were generated. To evaluate the validity; face, content and construct validity were assessed. The reliability was assessed by internal consistency and stability calculation. Results The content validity and reliability were demonstrated by S-CVR = 0.92 and S-CVI = 0.98, Cronbach’s α = 0.880 and the ICC = 0.980 to 0.947. Exploratory factor analysis showed 8 factors which explained more than 52.53% of the variance. Conclusion GS-PNCS is a valid and reliable questionnaire, with 49 items to assess gender sensitivity of perinatal care services and helps health care managers and planners to improve the quality of the services.

Abstract Background Gestational diabetes mellitus (GDM) is associated with adverse diabetic complications for both mother and child during pregnancy. The common Gold Standard (GS) for diagnosis of GDM is 75 g oral glucose tolerance test (OGTT) during 24–28 gestational weeks which seems a little late for any proper intervention. This study aimed to employ the Bayesian latent class models (LCMs) for estimating the early diagnostic power of combination of serum multiple marker in detecting GDM during 14–17 weeks of gestation. Methods Data from a sample of 523 pregnant women who participated in gestational diabetes screening tests at health centers affiliated to Shahid Beheshti University of Medical Sciences in Tehran, Iran from 2017 to 2018 were used. The beta-human chorionic gonadotropin (β-hCG), unconjugated estriol (uE3), and alfa-fetoprotein (AFP) values were extracted from case records for all participants. The Bayesian LCMs were applied for estimating sensitivity, specificity, and area under receiver operating characteristic curve (AUC) of combining the three biomarkers’ results in the absence of GS, adjusting for maternal age and body mass index. Results The mean (standard deviation) maternal age of the participants was 28.76 (±5.33) years. Additionally, the mean (standard deviation) BMI was 24.57 (±3.22) kg/m2. According to the Bayesian model, the cSensitivity, cSpecificity, and cAUC for the optimal composite diagnostic test were estimated as 94% (95% credible interval (CrI) [0.91–0.99]), 86% (95% CrI [0.80–0.92]), and 0.92 (95% CrI [0.87–0.98]), respectively. Conclusions Overall, the findings revealed that the combination of uE3, AFP, and β-hCG results might be considered as an acceptable predictor for detecting GDM with a rather high level of accuracy in the early second trimester of pregnancy without a GS.

Abstract Background Visually impaired children encounter some challenges for their oral health. We aimed to compare the effectiveness of oral health education using Audio Tactile Performance (ATP) technique alone, ATP combined with oral health education for mothers, and ATP along with art package on the oral health status of visually impaired children. Materials and methods This cluster, randomized trial, included visually impaired children from preschool to 10th grade (32 classes, n = 200), in Tehran, Iran, in 2018–2019. A questionnaire was filled out through face to face interviews at baseline regarding age, gender, status of visual impairment, and place of residence. The Simplified Oral Hygiene Index (OHI-S) and Bleeding on Probing (BOP) were examined afterward. Classes were randomly assigned to three groups through simple randomization: 1. Art group (ATP, game-based, and music-based education (11 classes, n = 66); 2. Mothers group (children received ATP and their mothers received education by telephone (10 classes, n = 73); and 3. Control group (children received ATP (11 classes, n = 61). Children received reinforcement after 1 and 2 weeks. Follow-up oral examinations were performed after 1 and 2 months by a blind calibrated examiner. Descriptive statistics were performed using Chi-Square, and ANOVA tests by SPSS (version 22). In analytic statistics, two-level mixed-effects models for BOP and OHI-S were fitted using the Statistical Analysis Software (SAS) version 9.4. Both models fitted with the grouping variable and time (baseline, 1, and 2 months after interventions) as the fixed effects. Results The mean age (SD) of the children was 12.29 (3.45) years (range: 6–17). Male children (67%) more than female children (33%) participated in the study. Also, 35.5% were blind, and 12% resided at the dormitory. The art and mothers groups had no statistically significant difference compared with the control group, in terms of OHI-S (P = 0.92, and 0.39, respectively) and BOP (OR = 0.64, and 0.66, respectively). The time effect was statistically significant in both BOP and OHI-S models (P

Abstract Background Data available on the association between physical activity (PA) and body mass index (BMI) in different periods of life is controversial. Using a parallel latent growth curve modeling (LGCM) approach, the current study aimed to investigate the influence of daily PA on adolescents’ BMI over a 12 year follow-up, taking into account their parental risk. Method Participants comprised 1323 adolescents (53.5% girls), aged 12–18 years who had participated in the baseline phase of Tehran Lipid and Glucose Study (TLGS) (2001–2003), and were followed for an average period of 12 years. Physical activity, including leisure time and occupational activities, was assessed using the reliable and validated Iranian version of the Modifiable Activity Questionnaire (MAQ). Weight and height were objectively measured in order to calculateBMI.Atwo-step cluster analysis was conducted to classify parents into two high- and low-risk clusters. Parallel LGCM was fitted to estimate cross-sectional, prospective and parallel associations, which assessed the longitudinal association between simultaneous changes in PA and BMI during the study period. Analyses were stratified by gender and parental clusters. Results A rising trend of BMI per 3 years was observed in boys 1.39 kg.m2(95% CI; 1.32, 1.48) and girls 0.9 kg.m2(95% CI; 0.82, 0.98), as well as in the low risk 1.11 kg.m2(95% CI; 1.03, 1.18) and high-risk 1.12 kg.m2(95% CI; 1.03, 1.22) clusters. Moreover, a positive prospective association between PA at baseline and BMI change over the 12 year follow-up, was observed in adolescents in the low-risk parental cluster 0.27(95% CI; 0.14, 0.41) indicating that higher levels of PA at baseline may lead to greater BMI in adolescents over time. However, examining longitudinal parallel association between simultaneous changes of PA and BMI per 3 years revealed adverse associations for adolescents in the low-risk parental cluster − 0.07 (95% CI; − 0.13, − 0.01) and in boys − 0.06 (95% CI; − 0.11, − 0.01). Conclusion Despite a positive prospective association between BMI and PA at baseline, there was a weak inverse parallel association between these variables over time, particularly in boys and adolescents with low parental risk. These findings imply the potential role of other influential factors indetermining adolescents’ weight status which need to be considered in the future plannings.

Abstract Background Women’s empowerment is a process wherein females are afforded power over their own lives as well as their participation in the communities and larger societies to which they belong. An important aspect of such empowerment is the right to make decisions regarding fertility—an entitlement affected by the social health determinants that contribute to the social conditions under which humans live and work throughout their lives. As one such determinant, psychosocial factors play an essential role in the development of women’s empowerment. Correspondingly, this study conducted a structural equation modeling of these determinants to examine the empowerment of Iranian women in reproductive decision making. Methods This cross-sectional study involved 400 women who were referred to clinical centers of the Shahid Beheshti University of Medical Sciences in Tehran, Iran. Data were collected using six questionnaires, namely, demographic, socioeconomic, and social support questionnaires, the Rosenberg self-esteem scale, a marital satisfaction questionnaire, and an empowerment survey. The data were analyzed using SPSS software version 17, and the structural equation modeling was carried out using EQS software version 6.1. Results The Iranian women had an average level of empowerment with respect to reproductive decision making, and such empowerment was related to all the psychosocial factors examined (p = 0.001). The final model appropriately fit the data (comparative fit index = 0.92, root mean square error of approximation = 0.06). The psychosocial factors served as intermediate social determinants of the women’s empowerment in reproductive decision making (β = 0.78, p = 0.001). This empowerment was indirectly affected by socioeconomic situation as a structural factor (β = 0.44, p = 0.001). Conclusions Socioeconomic factors, through the mechanism of psychosocial determinants, may significantly affect women’s empowerment in making decisions regarding reproductive health. Conditions associated with these factors should be improved to ensure that women claim and exercise their right to have mastery over their reproductive health.

Background and Objective: Overweight and obesity are public health concerns in adolescence that can be affected by socio-cultural factors. The aim of this study was to determine and compare overweight and obesity among female adolescents of Azeri and Kurd ethnicity living in Urmia city. Materials and Methods: This cross-sectional study was conducted among 350 female students (Azeri=219; Kurd=131) aged 16-18 years old. Schools were selected by stratified cluster random sampling and in each school; students were selected through simple random sampling. Socio-economic and demographic data were collected by face-to-face interview. Adolescents’ weight and height were measured using standard techniques. Center for Disease Control and Prevention (CDC) and World Health Organization (WHO) cutoffs were used for determining overweight and obesity. Data were analyzed using SPSS software version 23 and independent-samples t-test and chi-square test were used to compare quantitative and qualitative data among Azeri and Kurd groups. Results: The mean) SD) age was 16.8 (0.8) among Kurd and 16.7 (0.7) Azeri participants. Among Azeri participants, the prevalence of obesity was 49 (22.4) based on CDC cutoff and the prevalence of overweight was 65 (29.7) based on WHO cutoff. Among Kurd participants, the prevalence of obesity was 14 (10.7) based on CDC cutoff and the prevalence of overweight was 16 (12.2) based on WHO cutoff. The prevalence of both obesity and overweight was higher among Azeri participants than Kurd participants (P

Background: Osteoporosis, a prevalent bone malady, is prevalent in Iran. Several studies have represented the role of dietary antioxidants on osteoporosis. The dietary antioxidant index (DAI) is a valid and reliable index, which indicates a comprehensive view of dietary antioxidant capacity. This study aimed to survey the relationship of the DAI with the risk of osteoporosis in postmenopausal women in Iran. This research aimed to examine the association between the DAI and the risk of osteoporosis among postmenopausal women in Iran. Materials and Methods: In this case–control study, 440 postmenopausal women (220 cases and 220 controls) were enrolled. The dietary intake of contributors was evaluated using a 147-item food frequency questionnaire. To estimate the DAI, the amount of six antioxidant micronutrients such as Vitamins A, C, and E, selenium, manganese, and zinc was standardized. Then, the DAI was estimated by collecting the standardized consumption of these antioxidant micronutrients. Results: Our findings represented the participants in the first (crude odds ratio [OR] = 1.79, 95% confidence interval [CI]: 1.13–2.85, P = 0.013) and second (crude OR = 1.60, 95% CI: 1.01–2.55, P = 0.043) tertiles of the DAI scores had significantly higher odds of osteoporosis compared to those in the third one; while after modifying for confounding factors, this significant reverse relationship was observed just between women in the first and third tertiles of the DAI scores (adjusted OR = 1.90, 95% CI: 1.34–3.18, P = 0.015). Conclusion: The consequence of this study suggested that adherence to a diet rich in antioxidant compounds may have protective effects against osteoporosis.

Abstract Background Risk perception is an effective factor in the determining of the incidence of unsafe behaviors and the occurrence of occupational accidents in the workplace. Objective The purpose of this study is to determine the relationship between risk perception and occupational accidents among foundry workers in Tehran, Iran. Methods In this cross-sectional study, all male workers in a foundry unit were initially selected (n = 245). After applying the study criteria and dismissing incomplete returned questionnaires, only 109 workers were included in the study. The General Health Questionnaire and the Flynn et al. Risk Perception Questionnaire were used to assess the mental health and risk perception of workers, respectively. Data regarding the occupational accidents of workers were also extracted from the accidents’ records of the foundry. Workers with a record of occupational accidents during 2013–2016 were compared with workers without an occupational accident record. Results Findings showed that a one-unit increase in the risk perception score resulted into an increase of approximately 33% in the odds of the occurrence of occupational accidents, but this rate was not significant (p = 0.695). In addition, the study found no significant relation between the risk perception score and the frequency of occupational accidents (Spearman’s r = 0.003, p = 0.977). Conclusion There is no statistically significant relationship between risk perception and occupational accidents among foundry workers in Tehran, Iran.

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.

Objectives: Biological alterations throughout the lives of women make them highly vulnerable compared to men. Thus, being empowered to make better reproductive decisions is an important and valuable aspect of women’s lives. One of the Millennium Development Goals was women’s empowerment. The present study aimed to investigate the relationship between marital satisfaction and women’s empowerment in progenitive decision-making. Materials and Methods: This explanatory correlational study was conducted on 400 women who had referred to medical centers associated to Shahid Beheshti University of Medical Sciences, Tehran, Iran. Data were collected using a questionnaire encompassing the participants’ demographic information, the indices of marital satisfaction and women’s empowerment in reproductive decisions. The gathered data were evaluated via the SPSS software version 21.0. Results: The results indicated that there was a significant relationship between female marital satisfaction and relevant reproductive empowerment (r = 0.34; P

Background: Primary ovarian insufficiency is known as menopause before the age of 40 years. The afflicted women face both physical complications and various psychosocial problems capable of reducing their quality of life. The present study aimed to investigate the way Iranian women coped with the disease. Methods: This was a qualitative study using in-depth semi-structured interviews with 16 women with primary ovarian insufficiency selected via purposive sampling method. The data from interviews were then analyzed using content analysis method. Findings: Four main categories emerged for the way Iranian women with primary ovarian insufficiency confronted the disease: resilience (adaptation to life, spirituality, posttraumatic growth, and obtaining information), attitude towards the disease (wrong beliefs vs. positivism), attempts to manage health (life style modification, risk reduction, preventive measures, and non-genetic motherhood), and seeking support (from spouse, family, friends, healthcare team, and the government). Conclusion: There is a strong need to provide these women with effective and supportive relationships, as well as accurate information and consultation services. Moreover, creating websites for accurate information provision and forming virtual support groups helps them get adapted. Besides, the government can facilitate their adaptation with the disease through fertility insurance coverage.

Introduction: Primary dysmenorrhea is defined as painful menses with cramping sensation in the lower abdomen with normal ovulatory cycles which has no pelvic pathology. This study aimed to evaluate the effect of inhalation of Lavandula angustifolia (lavender) essential oil on alleviating primary dysmenorrhea.Methods: This randomized double-blinded clinical trial included 96 students (48 in lavender and 48 in placebo groups) from Tehran University of Medical Sciences, Tehran, Iran. Single students with regular menstrual cycles suffering from primary dysmenorrhea regarding the verbal multi-dimensional scoring system were included. The intervention group was administered to inhale lavender essential oil (diluted in sesame oil in 2:1 ratio). The control group only inhaled sesame essential oil. The visual analogue scale (VAS) was used to assess the pain score at the baseline and 1, 2, 4, and 48 hours after intervention. Generalized estimation equations method was used for data analysis.Results: The students’ mean ± standard deviation (SD) age was 20.32±1.38 years. No significant difference was found in demographic and menstrual characteristics between groups. The mean VAS was not significantly different between groups at the baseline. Lavender inhalation reduced the mean±SD primary dysmenorrhea score of 2.92±0.2 according to VAS significantly during 48 first hours adjusted for baseline VAS (P < 0.001).Conclusion: It could be concluded that lavender inhalation can decrease primary dysmenorrhea. The observed effectiveness of lavender inhalation as an inexpensive therapy without evidence of adverse event supports the interest for potential application of this therapy.

Introduction: Some studies have shown the relationship between vitamin D3 deficiency, with primary dysmenorrhea and associated systemic symptoms. However, the relationship between pain severity and serum vitamin D level is not known. Therefore, this study was performed with aim to investigate the relationship between the severity of primary dysmenorrhea and associated systemic symptoms with serum levels of vitamin D. Methods: This cross-sectional study was performed on 143 students with primary dysmenorrhea in dormitories of Shahid Beheshti University of Medical Sciences in 2018. Data related to menstruation cycle and severity of primary dysmenorrhea were collected using demographic questionnaire, menstrual status and pain index. The serum level of 25-hydroxyvitamin D3 was determined by LIASON device, by Chemiluiminescence method and was analyzed in DiaSorin kit. Data were analyzed by SPSS software (version 24) and Mann-Whitney test and independent t-test. PResults: No significant relationship was found between the mean score of primary dysmenorrhea and serum vitamin D levels (P>0.05). There was a significant relationship between severity of headache, fatigue, nausea and vomiting with serum vitamin D levels (P 0.05). Conclusion: There is no significant relationship between severity of primary dysmenorrhea and serum vitamin D levels, but significant relationship was found with severity of headache, fatigue, nausea and vomiting. Performing larger studies in a non-homogeneous society is suggested for closer evaluation of this relationship.

Background: The Multi state Markov models have extensively application with categorization of laboratory marker of CD4 cells for evaluation of HIV disease progression. These models with different states result in different effects of covariates and prediction of HIV disease trend. The main purpose of this study was comparison of four and five states models with the three- state in order to select the model with better prediction ability of occurrence of HIV and finally death in HIV positive people. Methods: A total of 305 HIV positive people were included in this cohort study in the Iran AIDS center in Imam Khomeini Hospital in Tehran that entered during March 1995 to January 2005 and then fallowed up to October 2014. The three continuous- time Markov models of three-, four- and five- state models were fitted to data to describe the evolution of a HIV disease Trend over different states. For comparison of models, two criteria of modification of Akaike’s criterion (DRAIC) and likelihood cross-validation criterion (DRLCV) along with their 95% tracking interval was used. For fitting of these models and estimation of transition matrix and the hazard ratio of gender and treatment independent variables, the msm package of R project for statistical computing, version R 3.2.4 (www.r-project.org) was used. Results: The results showed that the four- state model has more prediction ability than five-state model for evaluation of HIV disease Trend. In the four-state model, the progression hazard ratio to death for people who received highly active antiretroviral therapy (HAART) was 0.64 lower than who didn’t get this therapy. Moreover, the progression hazard ratio for men was 2.33 fold in comparison to women. The disease progression hazard ratio to death was 4.9 fold for men in comparison to women. Conclusion: The (DRAIC) and (DRLCV) criterions showed that the four-state model has more predictive ability of the progression trend of HIV disease in comparison of five-state model.

Considering the advancement of medical sciences, diagnostic tests have been developed to distinguish patients from healthy population. Therefore, Determining and evaluation of the diagnostic accuracy tests is of great importance. The accuracy of a test under evaluation is determined through the amount of agreement between its results with the results of the gold standard, and this test accuracy can be defined based on sensitivity, specificity, positive predictive value, negative predictive value and the area under the receiver operative characteristic curve (AUC). Gold standard is an accurate and error- free method to determine the presence or absence of disease of interest and classify patients, which is not available in some diseases and situations as this method is costly or invasive. In these cases, reference standard is a best available replacement method to be used by physicians to diagnostic disease. However, in some situation, the acceptable reference standard is invasive or costly and does not exist or unreliable. It can be imperfect and results of the reference standard method are not necessarily error- free and cannot be applied to everyone in the study; all these cases point to the conditions in which the gold standard is not available. The use of reference standard including error causes to incorrect separation of patients from healthy population and thus, it cannot be a comparing measure for other diagnostic tests and its results are inaccurate. Therefore, other alternatives methods are needed for evaluation and determine the diagnostic accuracy tests when the gold standard does not exist. Imputation method, correct imperfect reference standard method, the construct reference standard method, latent class models, differential verification, composite reference standard and discrepant analysis are of these alternative methods. Each of these methods, considering its features, advantages, and limitations can be used to evaluate the accuracy of diagnostic test in the absence of gold standard. The present study gave an overview of methods to evaluation of diagnostic accuracy tests when there is no gold standard and the focus of this study was on explain the concept of these solutions, review and compare them and their strengths and weaknesses.

Background: Dietary intake of Vitamin D is an effective public health strategy to improve the current low Vitamin D status of populations. This research aimed to identify subpopulations at greater risk for Vitamin D deficiency. We studied the sociodemographic factors that are potentially associated with dietary intake of Vitamin D in the Iranian population. To do so, we used a marginalised two-part (MTP) model to control for the substantial proportion of zero Vitamin D intake. Methods: Data from 180 cross-sectional random samples were recorded. Dietary intake of Vitamin D was assessed using a 168-item validated food frequency questionnaire. Sociodemographic factors associated with intake of Vitamin D were explored using MTP-Weibull. Results: Mean (standard deviation) daily dietary Vitamin D intake was 0.54 (0.70) μg/day which was below the standard recommended level for all participants. The 'fish, milk and eggs' food group contributed 50% of total dietary intake of Vitamin D. Higher intake was associated with higher levels of education (P = 0.003). Furthermore, the odds of Vitamin D intake was associated with smoking status (odds ratio = 0.613, confidence interval: 0.407–0.914); where smoking decreases the chance of having a non-zero Vitamin D intake by 38.7%. Conclusion: Dietary intake of Vitamin D is below the recommended levels in our study in Iran, a developing country. We identified that education level and smoking status are associated with low intake. This result could lead to the straightforward recommendation for smokers and less-educated individuals to increase their intake of Vitamin D-rich foods.

Background: Chronic lymphoid leukemia (CLL) is one of the most prevalent types of leukemia, which is responsible for a remarkable mortality rate in the world. This study aimed to investigate the global trend of this cancer from 1990 to 2015 and to determine the relationship between trend of CLL mortality rate and Human Development Index (HDI) throughout the world. Methods: The age-standardized mortality rate data of all countries of the world (per 100,000) were extracted from the GBD database. In addition, the HDI values for the studied countries in different years were obtained from the UNDP database. The statistical analysis was performed using the mixed-effects location-scale model in the SAS software, version 9.4. Results: The findings of the statistical modeling showed a downward slope for CLL Age Standardized Mortality Rate (ASMR) for total world countries ( ). We also find a significant association between CLL ASMR and HDI. Countries with higher HDI had higher level of CLL ASMR in years 1990 to 2015 with a negative slope. Furthermore, countries with lower HDI had Lower level of CLL ASMR with rather fixed rates in this period. Conclusion: These findings showed a decreasing trend of global CLL ASMR in the previous decades, although, the fixed trend of CLL ASMR in countries with low HDI is worrisome. The health policymakers should make more efforts to decrease the mortality due to this cancer in these countries.

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

Background: Survival time is one of the indicators used for evaluation of the quality of care in different types of malignancies, including breast cancer. The present study aimed to estimate the survival rate of breast cancer and its related factors among Iranian patients. Methods: Overall, 3148 cases of breast cancer who referred to the Cancer Research Center in Shahid Beheshti University of Medical Sciences, Tehran, Iran during 1994-2017 participated in this longitudinal study. Survival estimates were calculated using the Kaplan-Meier method and the Bayesian generalized Birnbaum–Saunders model with cure rate from geometric distribution. Clinical, pathological, and biological variables as potential prognostic factors were entered in univariate and multivariate analyses. In order to identify the significant prognostic factors, 95% highest posterior density (HPD) intervals were used. Results: The overall 1, 5, 10, 15, 20 and 25-year survival rate were 95%, 75%, 60%, 47%, 46% and 46%, respectively. A significant relation was observed between survival time and the variables such as age, size of tumor, number of lymph nodes, stage, histological grade, estrogen receptor, progesterone receptor, and lymphovascular invasion. Conclusion: The findings of this study might help the health managers to plan long-term programs considering regional determinants, public education, and screening for early detection of breast cancer cases which can eventually influence the overall survival rate of these patients.