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Abstract The Internet of Things (IoT) is a growing technology that remotely connects multiple devices (ranging across many fields and applications) over the Internet. The scalability of an IoT network mandates a reliable transport infrastructure. Traditional transport control protocol (TCP) control protocol is unsuitable for such domain, mainly due to energy and power consumption reasons. A lighter version of TCP, light weight IP (lwIP) provides a promising solution for current and projected future scalable IoT infrastructures. However, the original lwIP is just a simple mapping of the protocol, without insight into the IoT specific requirements. This paper examines the lwIP congestion control mechanism and addresses its shortcomings. In particular, a detailed examination is devoted to the various metrics such as retransmission time‐outs and its back‐off epochs, the congestion window behaviour and progress in the absence (and presence) of congestion. In particular, we propose a set of novel algorithms to address both the IoT constraints nature (light‐weight) as well as keeping up with scalability in IoT network size and performance. A detailed simulation study has been conducted to endorse the viability of our proposed set of algorithms for next‐generation IoT networks.

Advances in data collection, storage, and processing in e-Health systems have recently increased the importance and popularity of data mining in the health care field. However, the high sensitivity of the handled and shared data, brings a high risk of information disclosure and exposure. It is therefore important to hide sensitive relationships by modifying the shared data. This major information security threat has, therefore, mandated the requirement of hiding/securing sensitive relationships of shared data. As a large number of data mining activities that attempt to identify interesting patterns from databases depend on locating frequent item sets, further investigation of frequent item sets requires privacy-preserving techniques. To solve many difficult combinatorial problems, such as data distribution problem, exact and heuristic algorithms have been used. Exact algorithms are studied and considered optimal for such problems, however they suffer scalability bottleneck, as they are limited to medium-sized instances only. Heuristic algorithms, on the other hand, are scalable, however, they perform poor on security and privacy preservation. This paper proposes a novel heuristic approach based on Formal Concept Analysis (FCA) for enhancing security and privacy preservation of sensitive e-Health information using itemset hiding techniques. Our approach, named FACHS (FCA Hiding Sensitive-itemsets) uses constraints to minimise side effects and asymmetry between the original database and the clean database (minimal distortion on the database). Moreover, our approach does not require frequent itemset extraction before the masking process. This gives the proposed approach an advantage in terms of total availability. We tested our FCAHS heuristic on various reference datasets. Extensive experimental results showed the effectiveness of the proposed masking approach and the time efficiency of itemset extraction, making it very promising for e-Health sensitive data security and privacy.

The paper focuses on the importance of prompt and efficient process fault detection in contemporary manufacturing industries, where product quality and safety protocols are critical. The study compares the efficiencies of two techniques for process fault detection: Kernel Principal Component Analysis (KPCA) and the observer method. Both techniques are applied to observe water volume variation within a hydraulic system comprising three tanks. PCA is an unsupervised learning technique used for dimensionality reduction and pattern recognition. It is an extension of Principal Component Analysis (PCA) that utilizes kernel functions to transform data into higher-dimensional spaces, where it becomes easier to separate classes or identify patterns. In this paper, KPCA is applied to detect faults in the hydraulic system by analyzing the variation in water volume. The observer method originates from control theory and is utilized to estimate the internal states of a system based on its output measurements. It is commonly used in control systems to estimate the unmeasurable or hidden states of a system, which is crucial for ensuring proper control and fault detection. In this study, the observer method is applied to the hydraulic system to estimate the water volume variations within the three tanks. The paper presents a comparative study of these two techniques applied to the hydraulic system. The results show that both KPCA and the observer method perform similarly in detecting faults within the system. This similarity in performance highlights the efficacy of these techniques and their potential adaptability in various fault diagnosis scenarios within modern manufacturing processes.

The electrocardiogram (ECG) provides essential information about various human cardiac conditions. Several studies have investigated this topic in order to detect cardiac abnormalities for prevention purposes. Nowadays, there is an expansion of new smart signal processing methods, such as machine learning and its sub-branches, such as deep learning. These popular techniques help analyze and classify the ECG signal in an efficient way. Our study aims to develop algorithmic models to analyze ECG tracings to predict cardiovascular diseases. The direct impact of this work is to save lives and improve medical care with less expense. As health care and health insurance costs increase in the world, the direct impact of this work is saving lives and improving medical care. We conducted numerous experiments to optimize deep-learning parameters. We found the same validation accuracy value of about 0.95 for both MobileNetV2 and VGG16 algorithms. After implementation on Raspberry Pi, our results showed a small decrease in accuracy (0.94 and 0.90 for MobileNetV2 and VGG16 algorithms, respectively). Therefore, the main purpose of the present research work is to improve, in an easy and cheaper way, real-time monitoring using smart mobile tools (mobile phones, smart watches, connected T-shirts, etc.).

Background: One of the most significant demographic challenges over the past three decades has been the substantial reduction in fertility rates, worldwidely. As a developing country, Iran has also experienced a rapid decline in fertility over the past decades. Understanding factors influencing fertility is essential for development programs. Moreover, it's crucial to study the parameters that affect the intention for childbearing in any society. Therefore, through a systematic scoping review, the present study investigates the factors influencing couples' decisions toward childbearing., Methods: This study was a systematic scoping review conducted in 2023. To design and conduct this scoping review, Joanna Briggs Institute's Protocol (Institute TJB, The Joanna Briggs Institute Reviewers ' manual 2015; methodology for JBI scoping reviews, 2015) was used and the framework presented by Levac et al. (2010) was also used as a guide for conducting this review. Studies were searched in three main databases including ISI Web of Sciences, PubMed, and Scopus, using a predefined search strategy. Google Scholar was also used for complementary search. The search period was from 2002 to 2022., Results: A total of 18,454 studies were identified across three primary databases. After evaluating articles in three distinct phases based on title, abstract, and full-text, 46 articles were deemed eligible for inclusion in the scoping review. The qualitative analysis of the collected data from the selected studies through the scoping review led to classifying factors influencing households' desire for childbearing into eight main themes and 101 sub-themes. The main themes associated with factors impacting households' intention for childbearing encompass individual determinants, demographic and familial influencing factors, cultural elements, social factors, health-related aspects, economic considerations, insurance-related variables, and government support/incentive policies., Conclusions: Comprehensive and holistic attention from governments and officials toward the various factors affecting households' intention and behavior regarding childbearing appears beneficial and effective. Furthermore, given the relative ineffectiveness of some of the current government's supportive/incentive policies to increase couples' desire for childbearing, it seems necessary to review and amend these policies. This review should address the most significant challenges and factors contributing to couples' reluctance to childbearing or strengthen factors that can play a substantial role in fostering fertility and childbearing desires., (© 2024. The Author(s).)

Background: Causal directed acyclic graphs (cDAGs) are frequently used to identify confounding and collider bias. We demonstrate how to use causal directed acyclic graphs to adjust for collider bias in the hospitalized Covid-19 setting., Materials and Methods: According to the cDAGs, three types of modeling have been performed. In model 1, only vaccination is entered as an independent variable. In model 2, in addition to vaccination, age is entered the model to adjust for collider bias due to the conditioning of hospitalization. In model 3, comorbidities are also included for adjustment of collider bias due to the conditioning of hospitalization in different biasing paths intercepting age and comorbidities., Results: There was no evidence of the effect of vaccination on preventing death due to Covid-19 in model 1. In the second model, where age was included as a covariate, a protective role for vaccination became evident. In model 3, after including chronic diseases as other covariates, the protective effect was slightly strengthened., Conclusion: Studying hospitalized patients is subject to collider-stratification bias. Like confounding, this type of selection bias can be adjusted for by inclusion of the risk factors of the outcome which also affect hospitalization in the regression model., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

This study was designed and implemented to analyze and establish documents related to the above cases in the first to third COVID-19 epidemic waves for the use of researchers and doctors during and after the epidemic. The current case series study was conducted on 24,563 thousand hospitalized COVID-19 patients by examining their clinical characteristics within a one-year period from the beginning of the pandemic on 02.22.2020 to 02.14.2021, which included the first to the third waves, based on gender and severity of COVID-19. The mean age of the participants was 56 ± 20.71, and 51.8% were male. Out of a total of 24,563 thousand hospitalized COVID-19 patients until February 2021, there were 2185 mortalities (9.8%) and 2559 cases of severe COVID-19 (13.1%). The median length of hospitalization from the time of admission to discharge or death in the hospital (IQR: 13-41) was estimated to be 21 days. The rate of hospital mortality was higher in severe (37.8%) than in non-severe (4.8%) cases of COVID-19, While the risk of severe cases increased significantly in the third (HR = 1.65, 95% CI: 1.46-1.87, P < 0.001) and early fourth waves (HR = 2.145, 95% CI: 1.7-2.71, P < 0.001). Also, the risk of contracting severe COVID-19 increased significantly in patients aged ≥ 65 years old (HR = 2.1, 95% CI 1.1.93-2.72, P < 0.001). As shown by the results, the rates of hospital mortality (9.3% vs. 8.5%) and severe cases of COVID-19 (13.6% vs. 12.5%) were higher among men than women (P < 0.01). In our study, the mortality rate and severity of COVID-19 were within the scope of global studies. Men experienced higher severity and mortality than women. The was a significantly higher prevalence of old age and underlying diseases in individuals with severe COVID-19. Our data also showed that patients with a previous history of COVID-19 had a more severe experience of COVID-19, while most of these patients were also significantly older and had an underlying disease., (© 2023. The Author(s).)

Background: The present study aimed at investigating the topical effect of the combination of Plantago ovata and vinegar on the improvement of rural cutaneous leishmaniasis lesions., Materials and Methods: The present randomized double-blind controlled clinical trial was performed on 42 patients with rural skin leishmaniasis. In the case group, in addition to injecting glucantime into the lesion according to the latest national instructions, a combination of P. ovata and vinegar was applied topically twice a day for 8 weeks. In the control group, only glucantime injection into the lesion was performed for 8 weeks according to the latest national guidelines. At the end of the 1 st , 2 nd , 3 rd , 4 th , 8 th , and 12 th weeks after the intervention, the lesion area and improvement were evaluated and recorded., Results: The results of the present study indicated the lesion area in the case group with the mean of 0.35 ± 0.39 cm and 0.18 ± 0.27 cm in the 8 th and 12 th weeks, respectively was significantly less than that of the control group with the mean of 0.64 ± 0.78 cm and 0.56 ± 0.44, respectively ( P < 0.05). Twelve weeks after the intervention, 84.1% of the lesions in the case group and 65.9% of the lesions in the control group were completely improved ( P < 0.05)., Conclusion: According to the results of the present study, the improvement of leishmaniasis lesion with the topical application of the combination of P. ovata and vinegar was significantly more than that of the control group in the 8 th and 12 th weeks after the intervention., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Advanced Biomedical Research.)

Background: Prevention of smoking is very important at a young age and during the student period. Because of the lack of a questionnaire based on the prevention of smoking behavior, this study was conducted to design and standardize a tool according to the protection motivation theory (PMT)., Materials and Methods: This was an analytical cross-sectional study where information and opinions of experts and then designing tools and assessing the face validity in the first phase and content validity, construct validity, test-retest reliability, and internal consistency of questions in the second phase were examined. The initial themes and structures were determined based on the literature Review and the opinion of experts. Three hundred students of Yazd Universities were selected by cluster sampling and included in the study. All analyses were performed in SPSS and AMOS software version 24 with a significance level of less than 5%., Results: The final version of the scale had 39 questions in eight dimensions. The overall Cronbach's alpha value was 0.89, and for each dimension, it was more than 0.7. The content validity ratio and content validity index for the whole tool were 0.87 and 0.94, respectively. The results of confirmatory factor analysis showed that the latent construct model had good fit (X2/df = 4.31; RMSEA = 0.07; CFI = 0.94; NFI = 0.92; TLI = 0.91, P < 0.001)., Conclusion: In this study, a valid and reliable tool based on PMT to predict smoking behavior in students was introduced. This tool can be used in interventional and etiological studies. It also has questions related to the coronavirus disease 2019 (Covid 19) virus and can be used in the coronavirus pandemic., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Journal of Education and Health Promotion.)

Background: Starting vaccination in pregnant women; numerous theories have been proposed that the vaccine might affect the mother or the fetus., Objective: The goal of this research was to see whether there was a link between the Sinopharm vaccination and certain pregnancy outcomes in COVID-19-vaccinated women., Study Design: This is a retrospective cohort study., Method: This study was conducted on pregnant women who delivered from 1 August 2021 to 1 January 2022 in Yazd city. We have followed the STROBE Guidelines when preparing the manuscript. In this period time, all pregnant women were 5787 people in which 5666 were in the second and third trimester. Among these women, 1222 women were randomly selected., Results: Among 1222 pregnant women, 558 (45.6%) women had received one dose vaccine, 162 (13.3%) people had received two doses, and 502 (41.1%) women had not been vaccinated. On crude analysis, there was no significant difference between vaccinated and non-vaccinated groups. After adjusting for maternal age, maternal body mass index, parity, stillbirth history, abortion history, and gestational diabetes in multivariate analysis, no differences were found between the groups in pregnancy as well., Conclusion: Vaccinations during pregnancy seem to have no negative effects on the mother or the baby. This finding may aid pregnant women in deciding whether or not to take the vaccination.

Introduction: COVID-19 pandemic has had mixed reactions from nations, people and governments about ways to cope with, prevent and control the disease. The current study identifies social, cultural and policy factors affecting the incidence and control of Coronavirus disease in Iran., Methods: A qualitative study consists of content analysis as well as the views of 20 experienced and knowledgeable subjects specialized in social and cultural health management. The data were gathered using three semi-structured interviews and then continued by 17 semi-structured interviews. Data analysis was done using Graneheim approach. After each interview, the recorded audio files transcript and reviewed. Then codes extracted and divided to categories and sub-categories., Results: There are distinct social and cultural factors in coping with Coronavirus disease. These consisted of three categories of governance, individual and community related factors. A total of 17 subcategories and 215 primary codes that were extracted from the text of interviews as variables of the study and in relation to the research question. Ten subdomains of governance including vaccination, political issues, knowledge, support services, administrative services, transportation, health and treatment, culturalization, legislation and, managerial and financial policies impacted the spread and mitigation of the pandemic at various levels., Conclusion: The management of pandemics requires a comprehensive capacity for identifying and determining social and cultural criteria. A healthy partnership between governments and the community may be required to remove unnecessary obstacles that hinder public health attempt to alleviate the risk. The obtained criteria and indicators from this study may be utilized by policy makers in an attempt to strengthen protocols for mitigating pandemics. Further studies may be warranted to confirm these findings., (© 2022. The Author(s).)

Introduction: Social factors can affect the vulnerability of disaster-prone communities. This review aimed to identify and categorize social vulnerability indicators in the COVID-19 pandemic., Methods: This systematic review was conducted in February 2021. Bibliographies, citation databases, and other available records were investigated based on the aim of the study. The Joanna Briggs Institute (JBI) critical appraisal tools were applied for assessing the included articles retrieved through the comprehensive and systematic literature search. Descriptive and thematic analyses were done to extract the indicators affecting social vulnerability in the COVID-19 pandemic., Results: Thirty-one eligible articles were included and 85 indicators of social vulnerability were extracted. The indicators were categorized in seven main categories, including; Household, community composition; Race, minority status and language; Socioeconomic status; Community health status; Public health infra-structures; Education; Information, technology and communication., Conclusion: Regions with higher social vulnerability experienced greater mortality rates during the COVID-19 pandemic. Additional research is needed to measure the social vulnerability index in pandemics to prioritize distribution of scarce resources and ensure effectiveness and equity for all regions of countries., (© 2022 Wiley Periodicals LLC.)

Background: Breast cancer is one of the most common cancers in Iran and round the globe. Seroma formation is the most common primary complication after mastectomy (partial/radical). Nowadays, drainage is used as a routine method to reduce seroma formation after mastectomy, although there is no consensus about the appropriate time to perform drainage after this surgery. This study evaluated the effects of short-term and long-term drainage after mastectomy along with removal of axillary lymph nodes., Methods: This randomized clinical trial was performed on 88 women who underwent mastectomy with ALND in hospitals in Yazd (were randomly divided into two groups). Suction drains were inserted for all patients at completion of surgery. The data collection tool was a researcher-made form based on variables. In the first group, the drain was removed 24 hours after surgery and the patients were discharged, but the second group was discharged with the drain in place after 24 hours and the drain was removed 5 days after surgery. Data were analyzed with SPSS18 using T-Test, Chi square, and Mann-Whitney U test., Results: The results showed that 28 (31.8%) participants had formed seroma, of whom 22 (50%) were in the 1-day drainage group and 6 (13.6%) were in the 5-day drainage group. There was a statistically significant correlation among seroma frequency, mean aspiration volume, mean number of aspirations, mean seroma volume in sonography one week after surgery, and mean seroma volume in sonography between the two groups three weeks after surgery (P<0.05)., Conclusion: Based on the results, it can be concluded that long-term drainage reduces the risk of seroma formation after mastectomy with removal of axillary lymph nodes compared to short-term drainage. Complementary study be performed by considering other underlying factors such as comorbidities to obtain the best drain removal time in breast cancer patients.

Background: The aim of this study was to evaluate the predictors of osteoporosis in women in Yazd, Iran., Methods: This hospital-based case-control study was performed on 270 women 35-65 yr old (135 case and 135 control) from Mar 2016 to Mar 2017. Case and control were matched in terms of age ± 2 (year) as a group matching. Osteoporosis is defined as a T-score of bone mineral density (BMD) below -2.5 SD. Data were analyzed using SPSS 20 software. Statistical tests included chi-square, student t test and Mann Whitney test .Multiple logistic regression (MLR) which forward method was used for modeling., Results: Odds ratio (OR) of osteoprosis were menarche age>12 yr (OR=3.37, CI:2.29-15.89), history of hysterectomy (OR=13, CI:3.81-44.82), rheumatoid arthritis (RA) (OR=6.58, CI:2.29-18.91) calcium supplements (OR=0.14, CI:0.04-0.41), menopause age <40 (OR=11.84, CI:1.54-90), second smoking (OR=3.38, CI:1.16-9.81) and increase of weight (OR=0.86, CI:0.80-0.94)., Conclusion: Predictors of osteoporosis was menarche age >12 yr (3 times), history of hysterectomy (13 times), RA (6.5 times), menopause age <40 (12 times), second smoking (more than 3 times), calcium supplements and weight (protective)., Competing Interests: Conflict of interest The authors declare that there is no conflict of interests., (Copyright © 2022 Askari et al. Published by Tehran University of Medical Sciences.)

The outbreak of COVID-19 disease is an international public health concern. Therefore, the analysis of information related to mortality and disability due to COVID-19 is considered important, so the present study was designed and conducted with the aim of assessing COVID-19 Disability-Adjusted Life Years (DALYs) in Yazd. In Yazd province, all suspected cases of COVID-19 that would be referred to central hospitals in order to get confirmed through PCR or CT scan test, were recruited to our study. The fatality data of COVID-19 was gathered from the forensic medicine organization. The Disability-Adjusted Life Years (DALYs) combines in one measure years of life lost (YLL), the loss of healthy life due to premature mortality and years of life lived with disability (YLD), the loss of healthy life because of disease and disability. The total burden of COVID-19 was 23,472 years. The number of years lost due to premature death was 23385 and the number of years of life with disability due to COVID-19 was estimated to be 87 years. The disease burden was 12992 years for men and 10480 years for women. The overall incidence of COVID-19 was 1411 per 100,000, of which 1419 in men and 1402 in women per 100,000. The outbreak of COVID-19 pandemic affected a large population and the residents of Yazd Province lost many years of their lives due to this disease., Competing Interests: None., (IJMEG Copyright © 2021.)

Background: Todays, human lifestyle has faced significant changes, and this lifestyle has caused health problems. The increase of smoking, among young people, is one of the risk factors and incorrect lifestyle factors. The present study will design an educational campaign intervention based on the protection motivation theory (PMT) on smoking preventive behaviors in students., Materials and Methods: In designing this study, five phases are considered. (1) needs assessment and determination of the current situation are considered. In this phase, the required communication is established to form a planning team with key and influential people and experts, (2) tool design, (3) educational intervention (educational campaign) is designed. Some individuals will be selected and trained as facilitators to start entering the target population, have a better access to the target group, and implement the interventions in the target group. (4) the implementation of the educational plan, in which the designed educational intervention (educational campaign) will be implemented on the students of the studied universities. (5) the educational evaluation, which will be conducted 2 months after the intervention of the educational campaign. The posttest will be based on before and after the implementation of the educational campaign. In the prevention of the second type in smoking students, the salivary cotinine levels of smoking students will be measured and comparisons will be made before and after educational using appropriate statistical tests., Results: The present study addresses the needs and strategies for smoking prevention using a training campaign based on the PMT and web ., Conclusion: Designing a campaign which will lead to smoking preventive behaviors causes lifestyle changes, prevent health problems such as cancer, cardiovascular diseases, and other chronic diseases, reduce treatment costs, and increase life expectancy., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Education and Health Promotion.)

Introduction: One of the most important environmental factors affecting academic achievement and performance is the family especially mothers. The purpose of this study was to determine the relationship between quality of life (QOL) and the academic achievement of pupils with the employment status of their mothers., Methods: This cross-sectional study was conducted on 9th-grade students in Shiraz. A sample of 400 individuals was selected through a multi-stage sampling method from among the 9th-grade students and a questionnaire on academic achievement and quality of life was completed for them. Then data was entered into spss23 software and analyzed. The value of P < 0.05 was considered a significant statistical level., Results: There was no significant difference between students who have employed and Housewife mothers about the student's academic achievements ant QOL score (P > 0.05). According to the results of multivariate analysis, none of the variables was a significant predictor of the QOL and academic achievement in the students., Conclusion: In spite of lack of association between the quality of life and academic achievement of students with their mothers' occupation but it should be regarded that more attention to students and spent more time by students can be very helpful in the academic achievement of students., Competing Interests: Conflicts of interest statement The authors declare no conflict of interest., (©2021 Pacini Editore SRL, Pisa, Italy.)

Prosopis cineraria is locally grown which scientific literature present evidence for its anti-inflammatory effect. Monitoring the content of toxic elements is one of the most important aspects to consider medicinal plants' safety before evaluating the pharmaceutical use. The aim of present study was to investigate the level of essential and toxic elements in the leaves, branches, and stem of Prosopis cineraria to assess its health risk. Samples were collected around Bandar Abbas, washed several times, and dried in air for 2 weeks. The dried samples were chopped with stainless steel knife to small pieces and powdered by electrical mortar. Some physical and chemical properties of samples were investigated by chemical methods. Samples were ashed by a programmable electric furnace at 650 °C for 6 h. Then samples were dissolved in 30% HNO 3 , and the content elements of each sample were determined by inductive coupled plasma optical emission spectrometer (ICP-OES). The tests quality control and the measurement uncertainty were checked through the analysis of certified reference materials of SRM 1515 from NIST and solution standards. Correlation analysis of the obtained results showed a significant difference between leaves, branches, and stem of Prosopis cineraria so that the stem had the high essential and low toxic elements ones in comparison to other parts. The results revealed that the Prosopis cineraria stem is meeting health standards regarding the studied toxic metals.

Background: It is suggested that combining a healthy diet with physical activity during and before pregnancy have a significant effect on insulin sensitivity. This study aimed to investigate the relationship between physical activity and diet before and during pregnancy with the risk of gestational diabetes mellitus (GDM). Methods: A case-control study was conducted on 173 women with GDM diagnosed during the pregnancy as the case group and 168 women with a negative test for GDM as controls. Weight and height were measured and BMI was calculated. Dietary intake and physical activity data during pregnancy were collected using 24-hour food recall questionnaire and international physical activity questionnaire (IPAQ). Results: Body mass index and the intake of refined sugars, high fat dairy products, and fried foods were significantly higher and the intake of fruit and animal oil intake were significantly lower in the case group compared to the control group (All p  < .05). However, there was not any significant association between the level of physical activity, vegetable intake, and total energy intake with the risk of GDM. Conclusions: According to the results of this study, dietary intake before and during the pregnancy have a critical effect on the risk of GDM. Appropriate dietary planning for pregnant women can reduce the risk of GDM.

Background: Insulin resistance and hyperinsulinemia are involved in the etiology of metabolic syndrome (MetS) and its components., Objective: The current study assessed the association of dietary insulin load (DIL) and dietary insulin index (DII) with the odds of having MetS among a large population of Iranian adults., Design: This study was a cross-sectional analysis of the Shahedieh cohort study, which began in 2015-2016 and continues to the present day., Participants/setting: A total of 5,954 Iranian adults, aged 35 to 70 years, were included in the current analysis. To collect dietary data, the validated block-format 120-item semiquantitative Food Frequency Questionnaire was used. MetS was defined using the criteria belonging to the Iranian-modified National Cholesterol Education Program for Adults., Main Outcome Measures: Enzymatic colorimetric tests were used to measure fasting blood glucose, triglyceride, and high-density lipoprotein cholesterol concentrations; blood pressure and waist circumference were measured using the standard protocols., Statistical Analysis: Binary logistic regression with adjusted models was used to examine the association of DIL and DII with MetS., Results: After taking potential confounders into account, moderate DIL was associated with increased odds of MetS in men, meaning that men in the third quartile of DIL had 61% greater odds for having MetS compared with those in the first quartile (odds ratio [OR]: 1.61, 95% confidence interval [CI]: 1.02-2.54). Such a significant association was not seen for DII. In women, DIL was significantly associated with increased odds of developing MetS. After controlling for potential confounders, women in the top quartile of DIL had 77% greater odds for having MetS compared with women in the bottom quartile (OR: 1.77; 95% CI: 1.08-2.91). This significant positive association was also seen for DII, such that a higher score of DII was associated with 41% greater odds of MetS (OR: 1.41, 95% CI: 1.08-1.83)., Conclusions: Adherence to a diet with a high DIL and DII is associated with greater odds of having MetS in women. Also, moderate DIL was associated with increased odds of MetS in men., (Copyright © 2020 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Background: The current study aimed to measure and decompose socioeconomic-related inequalities in DMFT (decayed, missing, and filled teeth) index among adults in Iran., Methods: The study data were extracted from the adult component of Prospective Epidemiological Research Studies in IrAN (PERSIAN) from 17 centers in 14 different provinces of Iran. DMFT score was used as a measure of dental caries among adults in Iran. The concentration curve and relative concentration index (RC) was used to quantify and decompose socioeconomic-related inequalities in DMFT., Results: A total of 128,813 adults aged 35 and older were included in the study. The mean (Standard Deviation [SD]) score of D, M, F and DMFT of the adults was 3.3 (4.6), 12.6 (10.5), 2.1 (3.4) and 18.0 (9.5), respectively. The findings suggested that DMFT was mainly concentrated among the socioeconomically disadvantaged adults (RC = - 0.064; 95% confidence interval [CI), - 0.066 to - 0.063). Socioeconomic status, being male, older age and being a widow or divorced were identified as the main factors contributing to the concentration of DMFT among the worse-off adults., Conclusions: It is recommended to focus on the dental caries status of socioeconomically disadvantaged groups in order to reduce socioeconomic-related inequality in oral health among Iranian adults. Reducing socioeconomic-related inequalities in dental caries should be accompanied by appropriate health promotion policies that focus actions on the fundamental socioeconomic causes of dental disease., Competing Interests: Competing interestsThe authors declare that they have no conflict of interest., (© The Author(s) 2020.)

Background: Cutaneous Leishmaniasis (CL) is a major health problem in many parts of Iran. Many methods have been introduced for detection and identification of Cutaneous Leishmaniasis. The purpose of this study was isolation and molecular identification of Leishmania spp. agents in patients with CL from endemic region of central Iran. In this study, one of the main loci of central Iran named Yazd will be assessed CL identification using PCR-RFLP., Methods: For this cross-sectional study, sampling was done from 372 suspicious patients with CL who referred to Health Centers of Yazd Province from 2016 to 2017. After collection samples of patients, DNA extraction was done from samples on slides. Genus detection was done using specific primers by PCR. RFLP analysis was done for species identification., Results: Out of 372 samples, 159 samples were positive using PCR based method. Out of 159 samples, 87 (54.7%) L. major and 72 (45.3%) L. tropica were identified using RFLP analysis. The number of lesions in each patient was different but 119 (74.8%) patients showed the number of 1-3 lesions, and more lesions (more than 10 lesions) was showed in 4 (2.5%) person., Conclusion: The CL found in Yazd province resulted from L. major and L. tropica as the agents of rural and urban types, respectively. The prevalence of L. major and L. tropica was almost the same . This indicated that control programs could be designed for treatment and vector and reservoir control., Competing Interests: Conflict of interest The authors declare that there is no conflict of interest., (Copyright© Iranian Public Health Association & Tehran University of Medical Sciences.)

Background and Aims: Many countries lack resources to identify patients at risk of developing Type 2 diabetes mellitus (diabetes). We aimed to develop and validate a diabetes risk score based on easily accessible clinical data., Methods: Prospective study including 5277 participants (55.0% women, 51.8±10.5 years) free of diabetes at baseline. Comparison with two other published diabetes risk scores (Balkau and Kahn clinical, respectively 5 and 8 variables) and validation on three cohorts (Europe, Iran and Mexico) was performed., Results: After a mean follow-up of 10.9 years, 405 participants (7.7%) developed diabetes. Our score was based on age, gender, waist circumference, diabetes family history, hypertension and physical activity. The area under the curve (AUC) was 0.772 for our score, vs. 0.748 (p<0.001) and 0.774 (p = 0.668) for the other two. Using a 13-point threshold, sensitivity, specificity, positive and negative predictive values (95% CI) of our score were 60.5 (55.5-65.3), 77.1 (75.8-78.2), 18.0 (16.0-20.1) and 95.9 (95.2-96.5) percent, respectively. Our score performed equally well or better than the other two in the Iranian [AUC 0.542 vs. 0.564 (p = 0.476) and 0.513 (p = 0.300)] and Mexican [AUC 0.791 vs. 0.672 (p<0.001) and 0.778 (p = 0.575)] cohorts. In the European cohort, it performed similarly to the Balkau score but worse than the Kahn clinical [AUC 0.788 vs. 0.793 (p = 0.091) and 0.816 (p<0.001)]. Diagnostic capacity of our score was better than the Balkau score and comparable to the Kahn clinical one., Conclusion: Our clinically-based score shows encouraging results compared to other scores and can be used in populations with differing diabetes prevalence., Competing Interests: The baseline CoLaus/PsyCoLaus study (2003-2006) was supported by an unrestricted research grant from GlaxoSmithKline. The funding source had no involvement in the study design, data collection, analysis and interpretation, writing of the report, or decision to submit the article for publication. This does not alter our adherence to PLoS One policies on sharing data and materials. The Tlalpan 2020 study received funding from AstraZeneca Mexico (no grant number). The funding source had no involvement in our study design, data collection, analysis and interpretation, writing of the report or decision to submit the article for publication. This does not alter our adherence to PLoS One policies on sharing data and materials.

Objective: Demonstrating the risk factors of diabetes can help to plan for prevention of this disease. This study aimed at quantification of the impact of physical activity, hypertension, general obesity, central obesity, high cholesterol, HDL, LDL, triglyceride, smoking, hookah, drug use, alcohol consumption on the incidence of type 2 diabetes at a population level in Yazd, Iran. And this study calculated population attributable risk (PAR) of them., Methods: For this study, data from the first phase of the cohort study of chronic diseases in the adults of Yazd city were used, which began in 2016. Data was recorded through a cohort trained team. To calculate PAR and its the Bayesian confidence interval were performed using software R (version 3.4.3)., Results: Of the 9967 subjects studied, age ≥30, 14.67% (n = 1432) has type 2 diabetes. The most common risk factors for diabetes were Inadequate physical activity and central obesity (WHR). The PAR for Inadequate physical activity of diabetes in women was 17.92%, in men 18.53, And PAR for WHR in women was 57.62%, in men 43.03., Conclusions: In this study, age was the strongest determinant of diabetes. And then type 2 diabetes is mainly attributable to WHR, significantly more so in women than men. Therefore, central obesity probably should be considered as a major strategy for reducing incidence of type 2 diabetes., (Copyright © 2019. Published by Elsevier Ltd.)

Biomarkers are promising indicators to evaluate human exposure to air pollutants and to predict the health outcomes. Area of Airway macrophages that is occupied by Black Carbon could be used as a biomarker of personal long term exposure to traffic related air pollution. Association of airway macrophages carbon load with weighted average distance and environmental and subject-specific behavior are considered in this study. Sputum samples were taken from 160 healthy adult women and airway macrophages carbon load (AMCL) were determined in 93 subjects, which represent a success rate of 62% in sputum induction. Nearest distance of the subjects to major roads and average weighted distance were calculated for each subject. A questionnaire was field according to general and behavioral characteristics of the participants. There was not any significant difference (P-value >0.05) between induced and non-induced subjects. Subjects with indoor kitchen without separation wall, passive smokers and those with longer presence time in high traffic streets showed higher carbon area. Weighted average distance had a better association (β = -0.186, 95%CI: -0.139, -0.230, P-value = 0.00) with AMCL than nearest distance to major roads (β = -0.155, 95%CI: -0.109, -0.201, P-value = 0.19). Association of Weighted average distance with AMCL was interrupted in subjects with a garage connected to house environment, those with IK kitchen, those with a hood above the stove and passive smokers. The findings indicated that more generation and distribution of indoor air pollutants can completely enhance the internal exposure and indoor pollution has the same importance as outdoor pollution., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Telomere length (TL) has been suggested to be a surrogate for cellular ageing, and a record of cumulative inflammation and oxidative stress over life. An emerging body of evidence has associated exposure to air pollution to changes in TL. To date there is no available systematic review of literature on this association. We aimed to systematically review and conduct meta-analysis of published studies on the relationship between air pollution and TL in adults. Electronic databases were systematically searched for available English language studies on the association between air pollution and TL published up to 1 July 2018. Meta-analyses were conducted following MOOSE guidelines. The heterogeneity in the reported associations was assessed using Cochran's Q test and quantified as I 2 index. Publication bias was assessed using Egger's regression. Our search identified 19 eligible studies including 11 retrospective and eight prospective studies of which, four had excellent quality, ten had good quality and five had fair quality. Meta-analysis result of two studies on long-term exposure to PM 2.5 showed an inverse association between these exposures and TL (for 5 μg/m 3 PM 2.5 -0.03 95% CI; -0.05, -0.01). Meta-analysis of short-term exposure to PM 2.5 with three studies and Polychlorinated Biphenyls (PCBs) with two studies revealed a direct association between these exposures and TL (0.03 95% CI; 0.02, 0.04 and 0.10 95% CI; 0.06, 0.15 respectively). No statistically significant relationship between exposure to PM 10 and polycyclic aromatic hydrocarbons (PAHs) exposure and TL were observed. We observed suggestive evidence for associations between air pollution and TL with potentially different direction of associations for short- and long-term exposures., (Copyright © 2018. Published by Elsevier Ltd.)

The aim of this study was to investigate spatial variation and health risk of the exposure to PM 2.5 (particulate matter with a diameter of 2.5 µm or less) and PM 10 (particulate matter with a diameter of 10 µm or less) in Sabzevar, Iran. PM 2.5 and PM 10 were measured during three campaigns from April to November 2017, in 26 sampling points. Spatial analysis was performed using kriging and autocorrelations (Moran's index) model in Arc GIS software. Relationship between exposure to the PM 2.5 and PM 10 and their health impacts were investigated by AirQ 2.2.3 software. The mean concentrations (and standard deviation) of PM 2.5 and PM 10 over the entire study period were 32.54 (37.28) and 42.61 (47.76) μg/m 3 , respectively, which were higher than the guideline of World Health Organization. According to the spatial analysis, the maximum concentrations of PM 2.5 and PM 10 were around the main highway (beltway) which placed all over the south of Sabzevar. According to the Moran's index, the emission patterns for PM 2.5 (Z-score = 2.53; P-value = 0.011) and PM 10 (Z-score = 2.82; P-value = 0.004) were clustered. The attributable percentage (AP) of total mortality related to PM 2.5 and PM 10 were 3.544% (95% confidence interval (CI): 2.623-4.447%) and 2.055% (95% CI: 1.379-2.721%) per increasing each 10 μg/m 3 of these pollutants, respectively. According to observed results, it is suggested that the beltway and other pollution sources, such as industries, should be placed at a greater distance from the city, to reduce PM amounts in residential areas., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Gestational diabetes mellitus (GDM) has occurred in Fourteen percent of all pregnancies in the world. Epidemiological evidences about risk factors of GDM may be different from region to region and are unknown, exactly. This study examines the role of clinical factors in the association of gestational diabetes in Yazd, Iran., Methods: This study was carried out on 168 women with gestational diabetes and 168 women as controls after matching for age and place of residence. Each participant was interviewed about her pregnancy history and tobacco consumption. Information including BMI, weight before pregnancy and background of underlying diseases were recorded from information system in Health Centers. Finally, data were analyzed by using chi-square test, logistic regression and multiple correspondence analyze(MCA)., Results: History of gestational diabetes in past pregnancy OR = 3.2[95%CI:1.1, 9.7], a family history of gestational diabetes OR = 3.7 [95%CI:1.1, 11.5], a history of hookah smoking OR = 3.6 [95%CI:1.06, 12.3], being obese before pregnancy OR = 1.9[95%CI:1.01, 3.5], and weight gain during pregnancy OR = 0.5[95%CI:0.2, 0.9], were the most important determinants of gestational diabetes. There were not significant relation between GDM and underlying diseases, history of stillbirth, abortion, twinning, cigarette smoking, alcohol and drug abuse., Conclusions: In this research modifiable risk factors for gestational diabetes were high BMI before pregnancy, weight gain during pregnancy and history of hookah consumption. We advise that appropriate education, avoiding sedentary lifestyle, diet improvement and advertising which focus on tobacco consumption is playing as an important role in developing the chronic diseases, including GDM., (Copyright © 2018 Diabetes India. Published by Elsevier Ltd. All rights reserved.)

The aim of this study was to assess the potential health risk of exposure to polycyclic aromatic hydrocarbons (PAHs) at home and kindergarten for pre-school children. The urine samples were taken from 200 pre-school children aged 5-7 years and analyzed for 1-OHP as a biomarker of PAHs. Mixed effect models were applied to investigate the association between effective environmental parameters (mode of transport, distance to major roads, traffic density, greenness, tobacco exposure, home ventilation, and grill foods) and urinary 1-OHP levels. A Monte-Carlo simulation technique was applied to calculate the risk of exposure to PAHs and to check the uncertainty of input variables and the sensitivity of the estimated risk. The median and inter quartile range (IQR) of 1-OHP was 257 (188.5) ng L -1 . There was a positive significant association between distance from the kindergartens to the green space with surface area ≥5000 m 2 and 1-OHP concentration (β = 0.844, 95% CI: 0.223, 1.46, P-value = 0.009). Also, urinary 1-OHP was found to be inversely associated with the time the window was open at the home (β = -12.56, 95% CI: -23.52, -1.596, P-value = 0.025) and normalized difference vegetation index (NDVI) in a 100 m buffer around the homes. The mean (9.76 E-3) and 95th percentile (3.28 E-2) of the hazard quotient (HQ) indicated that the concentration of urinary 1-OHP is at a safe level for the target population (HQ < 1). According to the sensitivity analysis results, the concentration of 1-OHP is the most influential variable in the estimated risk. Our findings indicated that the proximity of homes and kindergartens to green space areas and their remoteness from the main streets and heavy traffic areas are associated with reduced exposure to PAHs., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: This study was conducted in Yazd Province, Central Iran aimed to investigate the relationship between adverse events and breast cancer during 2012-2014., Methods: Hospital-based case-control study of 150 women with breast cancer and 150 healthy women (did not have breast cancer) was conducted. Sampling was performed in the form of accessibility. Data collection was conducted using questionnaire through interview. The collected data were entered into SPSS for statistical analysis., Results: The mean age of participants was 51.58 yr. Eight percent of cases and 1.3% of the controls had experienced the sister's death over the past 5 yr, this difference was statistically significant ( P =0.03). Factors such as disability due to illness, divorce, unemployment, the second marriage, addiction, ill spouse, child's problems (such as conflict, unemployment, addiction, legal troubles, illness), taking care of their own parents or their husband's parents, migration, change of habitat, loss of home, communication problems, job-relevant factors were not significantly different between the two groups ( P >0.05). Mean of severity of adverse events in both groups was significantly different (8.92±8.29 in the case group, 5.72±5.6 in the control group) ( P =0.000)., Conclusion: There was no significant relationship between adverse events in the last 5 yr and the risk of breast cancer. Factors such as personality and ability to cope with problems may positively influence this relationship., Competing Interests: Conflict of interest The authors declare that there is no conflict of interest.

Biological Aerated Filter (BAF) reactors due to their plentiful biomass, high shockability, high efficiency, good filtration, availability and lack of need for large land areas, are enjoying from great importance in advanced wastewater treatment. Therefore, in this study, Polystyrene Coated by Sand (PCS) was produced as a novel media and its application in a modified down-flow BAF structure for advanced wastewater treatment was assessed in two steps. In step one, the backwash effluent did not return to the system, while in step two backwash effluent returned to increase the water reuse efficiency. The backwash process was also studied through three methods of Top Backwashing (TB), Bottom Backwashing (BB), as well as Top and Bottom Backwashing Simultaneously (TBBS). The results showed that return of backwash effluent had no significant effect on the BAF effluent quality. In the second step similar to the first one with slight differences, the residual average concentrations of TSS, BOD 5 , and COD at the effluent were about 2.5, 8.2, and 25.5 mg/L, respectively. Additionally, in step two, the mean volume of disposal sludge/volume of treated water (v ds /v tw ) decreased a large extent to about 0.088%. In other words, the water reuse has increased to more than 99.91%. The backwash time in methods of TB and BB were 65 and 35 min, respectively; however, it decreased in TBBS methods to 25 min. The concentrations of most effluent parameters in this system are in concordance with the 2012 EPA Agriculture Standards, even for irrigation of Non-processed agricultural crops and livestock water consumption., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: Bladder cancer is the most common cancer of the urinary tract, with known occupational causes. The most effective way to prevent occupational cancers of the urinary tract is to prevent exposure to known carcinogens., Objective: To examine the relationship between occupation and the risk of bladder cancer., Methods: This case-control study was performed on 200 patients with bladder cancer and 200 healthy individuals in Yazd. Data were collected using a researcher-made questionnaire and based on interviews with patients and controls., Results: The mean age of cases and controls were 61.5 (SD 13.6) and 61.5 (13.3) years, respectively. Level of education, type of occupation, family history of bladder cancer in the first-degree relatives, and history of chronic and recurrent urinary tract infection, kidney and bladder stones, and using hair dye, were considered the main predictors for bladder cancer., Conclusion: There was a significant difference between cases and controls in terms of type of occupation. The risk of bladder cancer was higher among those working in high-risk occupations-metal working, textile, driving, farming, and construction.

Background: Rheum ribes L. is a plant native to China, Iran, Turkey, India, and a few other countries. Antidiarrheal activity is considered to be one of its important properties according to various systems of traditional medicine. An increasing rate of bacterial resistance to antibiotics has led to treatment failure in some cases of shigellosis in children, and underlines a need for safe, efficient and valid options., Objective: The purpose of this study is to evaluate the efficacy of R. ribes syrup as a complementary medicine for treatment of shigellosis in children., Design, Setting, Participants and Interventions: This randomized, double-blind, placebo-controlled trial started with a group of 150 children aged between 12-72 months with suspected Shigella dysentery. R. ribes syrup or placebo syrup was administered to the intervention and control groups, respectively for 5 days. In addition, the standard antibiotic treatment (ceftriaxone for the first 3 days and cefixime syrup for 2 further days) was administered to both groups., Main Outcome Measures: Body temperature, abdominal pain, need for antipyretics, defecation frequency, stool volume and consistency and microscopic stool examination were recorded as outcome measures. Any observed adverse effects were also recorded., Results: Mean duration of fever and diarrhea in the R. ribes group was significantly lower than that in the placebo group (P = 0.016 and 0.001, respectively). In addition, patients in the R. ribes group showed shorter duration of need for antipyretics and shorter duration of abdominal pain (P = 0.012 and 0.001, respectively). However, there were no significant differences between the two groups regarding the microscopic stool analyses. Furthermore, no adverse effect was reported., Conclusion: R. ribes syrup can be recommended as a complementary treatment for children with Shigella dysentery., Trial Registration: Iranian Registry of Clinical Trial: IRCT2014070518356N1.

Background: Occult hepatitis B infection is characterized by negative hepatitis B surface antigen (HBsAg) and also detectable hepatitis B virus (HBV) -DNA, with or without hepatitis B core antibody (anti-HBc). HBV reactivation in individuals under immunosuppressive therapy is critical, occurring in occult HBV., Objective: In this study, we aimed to determine the prevalence of occult HBV infection among hepatitis B surface antigen negative in cancer patients before receiving chemotherapy., Methods: Sera from 204 cancer patients who were negative for HBsAg, were tested for anti-HBc antibodies. The samples that were negative for HBsAg but positive for anti-HBc also examined for HBV-DNA by polymerase chain reaction (PCR)., Results: Of the 204 HBsAg negative blood samples, 11 (5.4%) samples were positive for anti-HBc antibodies. HBV-DNA was detected in 9/11 (81%) of anti-HBc positive samples. Occult HBV infection in hematological cancers was more than solid cancers, 4.8% and 4.3% respectively. There was no significant difference in HBc antibody positivity based on vaccination, previous blood transfusions, history of familial hepatitis or biochemical parameters (ALT, AST, total and direct bilirubin levels) (P>0.05)., Conclusion: Screening of occult HBV infection by HBsAg, HBV DNA and anti HB core antibody should be suggested as a routine investigation in cancer patients before receiving chemotherapy.

Background: The aim of this study was to directly compare efficacy of atomoxetine and methylphenidate in treatment of children and adolescents 6- 18 years., Methods: All published, randomized, open label or double blind trials, comparing the efficacy of methylphenidate with atomoxetine in treatment of children diagnosed with ADHD, using DSM-IV criteria were included in this study; ADHD Rating Scale-IV-Parent Version: Investigator Administered and Scored (ADHDRS) scores was used. The standardized mean difference (SMD) was used as a measure of effect size., Results: Eleven studies were included with a total of 2,772 participants. The meta-analysis did not find a significant difference in the efficacy between methylphenidate and atomoxetine (SMD= 0.09, 95% CI -0.06, 0.25) (Z= 1.18, p= 0.24). Sub group analysis showed a significant standardized mean difference favoring OROS methylphenidate (SMD= 0.31, 95% CI 0.16, 0.47 (Z= 3.91, p< 0.0001); immediate release methylphenidate was not superior to atomoxetine (SMD= -0.05, 95% CI -0.20, 0.10) (Z= 0.68, p= 0.49). Open label trials did not make a difference in the standardized mean difference (SMD= 0.10, 95% CI -0.02, 0.23) (Z= 1.17, p= 0.09). There was significant heterogeneity among the studies (p= 0.003, I2= 63%). Subgroup analysis demonstrated that heterogeneity was because of the open label trials (p= 0.009, I2= 79%)., Conclusion: Atomoxetine and methylphenidate showed comparable efficacy in the treatment of children and adolescents with ADHD. However, Osmotic (Controlled) Release Oral (Delivery) System (OROS) methylphenidate is more effective than atomoxetine in treatment of ADHD in children and adolescents that is suggested as a first-line treatment in ADHD. Moreover, comparing the immediate release (IR) methylphenidate to atomoxetine did not lead to the benefit of IR methylphenidate.

There is some evidence to suggest that a benefit might be derived from a program that incorporated both annual physical examination of the breast (BPx) and the teaching of breast self-examination (BSE). Current investigation presents the profile of a multicenter community based intervention for evaluating the effect of BSE+BPx on the reduction of morbidity and mortality due to breast cancer amongst women residing in urban areas of Yazd (Iran) from 2008 to 2018. There were three distinctive phases in this trial with 10 years duration: pilot phase with the duration of 1 year, active intervention phase with 4 rounds of annual screening of BPx+BSE and follow up phase with 5 years duration. Tools of enquiry included a pre-tested questionnaire, repeated annual physical examination of the breast and more importantly mammography, sonography, and fine needle aspiration (FNA). Data were analyzed using descriptive statistics such as frequencies, percent, mean (SD), tests of chi-square and student t-test with 95% confidence level. Comparison of socio-demographic and socio-economic factors such as age, age at marriage, family size, number of live births, occupation, education level, total family income and marital status showed that no significant difference was seen between the groups (P>0.05). A response rate of 84.5% was seen by participants of the experiment group visiting the health centers for the first BPx. Our results showed that except for the education and marital status, the difference in other main demographic and socio-economic factors between the groups were not significant, and the response rate of individuals in the experiment group was at an acceptable level.

Background: Polycystic ovary syndrome (PCOS) is a multifactorial, metabolic disorder. Characteristics are chronic anovulation, polycystic ovaries and hyperandrogenism. The aim of this study was to determine the effect of omega-3 supplementation on visfatin, adiponectin, and anthropometric indices in PCOS women., Methods: The study was a randomized double blind placebo-controlled clinical trial. It was conducted on 84 women with polycystic ovary syndrome (26.92±5.05 years, BMI=31.69 Kg/m (2)) who referred to the fertility and infertility research center and Shahid Sadoughi hospital in Yazd. After the examination, evaluation and para-medical assessment by obstetrician, they were recruited. They took 3 capsules of omega-3 (each one contained 180 mg EPA and 120 mg DHA) or placebo (each contained 1 g paraffin) daily for 8 weeks. Statistical analysis was paired T-test and student T-test, and a p<0.05 was considered statistically significant., Results: After the intervention, visfatin concentration did not change in neither groups. But, at the end of the study, the mean of adiponectin concentration increased (p<0.001) in omega-3 group. Moreover, the mean of changes in this factor was significantly different between groups (p<0.005). FSH did not change in two groups of the study. However, the mean of LH decreased about 1.74 mlU/ml in omega-3 group (p<0.005). The mean of change of LH/FSH ratio between groups was significant (p<0.05). After the intervention, prolactin did not meaningfully change in both groups., Conclusion: Our results showed that 8 weeks of supplementation of omega-3 may have some beneficial effects on PCOS biochemical characteristics such as LH, LH/FSH, and adiponectin.

Introduction: The aim of this study was to determine self-care predictors in diabetic patients based on health belief model., Materials & Methods: The cross-sectional study was conducted on 110 diabetic patients referred to health service centers in Ardakan city, Yazd, Iran. The data was collected by a questionnaire including perceived benefits, barriers, severity, susceptibility, self-efficacy, social support, self-care behaviors and demographic variables., Results: Regularly medicine use (mean=6.48 times per week) and shoes checking (mean=1.17 times per week) were reported as the highest and the lowest self-care behaviors respectively. Health belief model constructs including perceived benefits, barriers, severity, susceptibility, self-efficacy and social support predicted 33.5% of the observed variance of self-care behaviors. Perceived susceptibility and self-efficacy had positive effect on self-care behavior; whereas perceived barrier's has negative effect. Self-efficacy, perceived susceptibility and barriers were most powerful predictor respectively., Conclusion: The findings approved the efficiency of health belief model in prediction of self-care behaviors among diabetic patients. The findings realized the health belief model structure; therefore, it can be used as a framework for designing and implementing educational interventions in diabetes control plans.

Background: Among the non-communicable diseases, diabetes mellitus has an important ranking and with annually increasing rate where it is expected the number of people suffering from the disease will reach to 300 million up to 2025 in all of world. The prevalence of type 2 diabetes in Iran is 4-4.5% and in population aged above 30 years is greater than 14%. The present study is attempting to find out the prevalence rate of the disease and its risk factors in Yazd Province, central Iran., Methods: This cross-sectional study was carried out in 2012.  A total of 14993 subjects were randomly selected and enquired by a pretested questionnaire. Data were analyzed by descriptive statistics and appropriate statistical tests such as chi-square, and multiple logistic regressions., Results: The prevalence rate of known diabetes and impaired fasting glucose was 16.3% & 11.9% respectively. Age, sex, family history of diabetes, high blood pressure, BMI, and history of gestational diabetes were significantly associated with diabetes disease (P=0.001)., Conclusions: The prevalence rate of diabetes is higher than other parts of the world and living in the city. Female gender, increasing age, high blood pressure, increased BMI and positive family history, are independent risk factor for diabetes, therefore performing prevention programs and controlling these high risk groups should be considered as a priority.

Background: There is some evidence regarding the effect of poly unsaturated fatty acid intake on androgen levels and gonadal function in polycystic ovary syndrome (PCOS)., Objective: This study was conducted to determine the effect of omega-3 supplementation on sex hormone-binding protein (SHBG), testosterone, free androgen index (FAI) and menstrual status in women with PCOS., Materials and Methods: This double-blind randomized clinical trial was conducted on 78 overweight/obese women with PCOS. Participants were randomized to receive omega-3 (3gr/day) or placebo for 8 weeks. Data about weight, height and nutrient intake as well as blood samples were collected before and after intervention. Serum concentrations of testosterone (nmol/L) and SHBG (nmol/L) were measured. FAI was also calculated as the ratio of testosterone to SHBG., Results: Seventy eight patients (age: 26.92±5.46 yrs, Body Mass Index: 31.69±4.84 Kg/m(2)) completed the study. There was no significant difference in mean age, weight, height, Body Mass Index and intake of energy, and macronutrients between 2 study groups before and after treatment. All the participants had irregular periods. After the trial the percentage of regular menstruation in the omega-3 group was more than the placebo group (47.2% vs. 22.9%, p=0.049). Furthermore, testosterone concentration was significantly lower in the omega-3 group compared with placebo, after supplementation (p=0.04). SHBG and FAI did not change in either group., Conclusion: Omega-3 supplementation could reduce serum concentrations of testosterone and regulate menstrual cycle without significant effect on SHBG and FAI. Future studies with longer period of supplementation are warranted. This article extracted from M.Sc. thesis. (Niloufar Vaziri) Registretion ID in IRCT: IRCT201112318564N1.

Aim: The purpose of the present study was to evaluate the shear bond strength of orthodontic brackets bonded to porcelain following etching with erbium-doped yttrium aluminum garnet (Er:YAG) laser compared with 9.6% hydrofluoric acid (HF)., Methods: A total of 100 porcelain disk samples were divided into four groups, and after removing their glazed layer, the first group was etched with 9.6% HF, and the other three groups were etched with Er:YAG lasers of 1.6, 2, and 3.2 W, respectively. After application of silane on the disk surfaces, central incisor brackets were bonded with composite on the disks. The disks were mounted on an acrylic stand for measuring the shear bond strengths. The shear bond strengths were measured by a testing machine., Results: The mean shear bond strength in the laser group with power of 1.6 W (7.88 MPa) was more than that of the HF (7.4MPa), 2-W power (7.52 MPa), and 3.2-W power (7.45 MPa) groups, but this difference was not statistically significant. Examination with an electron microscope showed different patterns of etching by HF and laser. Also, etching by laser and HF had not resulted in cracks on the porcelain surface., Conclusion: Er:YAG laser can be a suitable method for bonding of orthodontic brackets to porcelain surfaces.

Objective: To assess the growth pattern of children in Yazd, and compare it with standards outlined by the World Health Organisation., Methods: The cross-sectional study, which was conducted in 2009, involved 20 guidance schools of Yazd city. A total of 1921 children were chosen by simple cluster method and general demographic and anthropometric information regarding the subjects was extracted from students' health identification booklets. Data was analysed through SPSS., Results: The mean values of height in 7th and 12th years of age were 119 +/- 8.8cm and 150 +/- 6.6cm in boys and 117 +/- 5.97cm and 152 +/- 7.3cm in girls respectively. The mean values of weight in 7th and 12th years of age were 20 +/- 3.39kg and 39 +/- 1kg in boys and 20 +/- 3.78kg and 41 +/- 1.07kg in girls respectively. These values generally were below the values set by the World Health Organisation till the 9th year of age, and above them beyond the 9th year., Conclusion: The growth pattern among children in Yazd is better than some of the other provinces in Iran. Larger studies are needed for generating Iran-specific standard for better assessment of the growth and nutritional status of Iranian children.

Background and Objective: Pulmonary function tests play an important role in the management of pulmonary diseases. One of the tests that are widely used is spirometry. Performing an acceptable spirometry manoeuvre according to the standards set by the American Thoracic Society/European Respiratory Society is difficult. The aim of this study was to compare forced expiratory volume in 3 s (FEV(3)) and forced expiratory volume in 6 s (FEV(6)) with forced vital capacity (FVC), and forced expiratory volume in 1 s FEV(1)/FEV(3) and FEV(1)/FEV(6) with FEV(1)/FVC, in order to substitute the usual spirometric manoeuvres with manoeuvres that are easier to perform., Methods: In a cross-sectional study, spirometry was performed for 588 subjects who were referred for occupational health evaluations. The accuracy of FEV(3), FEV(6), FEV(1)/FEV(3) and FEV(1)/FEV(6) was compared with that of FVC and FEV(1)/FVC. Chi-square tests and kappa tests were used to analyse the data., Results: Individuals with normal (n = 297) and abnormal spirometry (n = 291) were evaluated. The sensitivity, specificity, positive predictive value and negative predictive value of FEV(1) /FEV(6) , as compared with that of FEV(1)/FVC for detecting obstruction, were 93.56, 99.32, 98.95 and 96.09, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of FEV(6), as compared with that of FVC for detecting restriction, were 96.68, 98.65, 96.68 and 98.65, respectively., Conclusions: FEV(6) and FEV(1)/FEV(6) can be used as surrogates for FVC and FEV(1)/FVC, respectively, and these parameters showed acceptable sensitivity, specificity, positive predictive value and negative predictive value for occupational health evaluations., (© 2012 The Authors. Respirology © 2012 Asian Pacific Society of Respirology.)

Background: Coronary artery disease (CAD) is a major cause of mortality and morbidity with high health care cost in both developed and developing countries. CAD accounts for nearly 50% of all yearly deaths in Iran., Objective: The aim of this study is to explore the main CAD risk factors in the urban areas of Yazd in the Islamic Republic of Iran., Methods: A hospital-based case-control study was conducted to investigate the role of the important CAD risk factors in urban area of Yazd city from December 2007 to June 2008. A total of 436 subjects in the age group of 30 to 75 years (218 cases and 218 controls) were included in this study. The tools of enquiry were a pretested and precoded questionnaire, physical examination, and laboratory findings. A confidence level of 95% and study power of 80% were considered for the interpretation of possible significant findings. Gender-wise stratified analysis was separately done for men and women using multiple conditional logistic regression., Results: A total of 75.5% of the participants were men and 24.5% were women. Five variables, including unskilled jobs, physical inactivity, giving positive history of hypertension, high levels of waist/hip ratio, and low levels of high-density lipoprotein (HDL) were the factors that could account for significant predictors of CAD in males on the logistic model (P < .05). No such significant CAD predictors were found for women., Conclusion: The findings showed that categories of nonprofessional, physical inactivity, positive history of hypertension, wais/hip ratio ≥0.9 and HDL levels ≤40 mg/dL are the significant risk factors that can predict CAD in male residents of Yazd.

Vitamin D is an essential hormone for growth and development of bones in children. There is a lot of evidence for deficiency of this vitamin in Middle East females. This study conduct to find a way to combat deficiency in girls during rapid growth phase of puberty in academic year. One hundred and two Middle School girls who had not consumed any vitamins supplement have been participated in this randomized clinical trial. They allocated randomly in two case groups who received 50,000 or 100,000 IU vitamin D3 in October and three months later in January or in control group who received vitamin E. At the end of winter blood samples for 25-hydroxyvitamin D were checked. The mean of 25-hydroxyvitamin D were 5.5±1.5 ng/ml, 15.2±6 ng/ml, 23.0±6.8 ng/ml in control, 50,000 and 100,000 IU vitamin D groups respectively (P<0.05). Neither dosage of vitamin D could raise 25-hydroxyvitamin D above 20 ng/ml in all cases. However, none of the students in 100,000 IU of vitamin D3 had severe deficiency in winter. Headache, dizziness, and weakness were the most common complain after vitamin D consumption, but no difference between groups detected (P>0.05). Urine calcium/creatinin ratio was equal in case and control groups (P>0.05). 100,000 IU of vitamin D3 every three months (equal to 800 IU/day) can raise 25-hydroxyvitamin D above 12 ng/ml in all cases but for area with high prevalence of sever deficiency, dosage more than 100,000 IU every three months or shorter interval recommended to achieve optimal level.