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Yousef Alimohamadi,1,2 Kourosh Holakouie-Naieni,2 Mojtaba Sepandi,3,4 Maryam Taghdir3 1Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran; 2Department of Epidemiology & Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; 3Health Research Center, Lifestyle Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran; 4Department of Epidemiology & Biostatistics, Faculty of Health, Baqiyatallah University of Medical Sciences, Tehran, IranCorrespondence: Mojtaba SepandiHealth Research Center, Lifestyle Institute, Baqiyatallah University of Medical Sciences, Nosrati Alley, South Sheykhbahaee Ave, Tehran 143591-13189, IranTel +982187555521Email msepandi@bmsu.ac.irBackground and Objective: Numerous actions have been taken to control the COVID-19 pandemic and reduce their morbidity and mortality. One of the most important measures in this regard is social distancing. However, there is limited evidence on the effectiveness of social distancing on COVID-19 incidence and mortality. Thus, the current study aimed to assess the effectiveness of social distancing measures on the COVID-19 incidence and mortality in Iran.Materials and Methods: In the current quasi-experimental study, we evaluated the daily incidence cases and the number of deaths of COVID-19 in Iran before and after the implementation of social distancing measures. The segmented regression model was used to analyze the data. We also performed the interrupted time series (ITS) analysis using Newey ordinary least squares (OLS) regression-based methods.Results: After the implementation of social distancing, the trend of both daily new cases and deaths due to COVID-19 was decreasing [(ß = − 1.70 (95% CI = [− 2.30 – − 1.10; P < 0.001])) and (ß = − 0.07 (95% CI = [− 0.10 − − 0.05; P < 0.001], respectively))].Conclusion: Social distancing along with other public health interventions could reduce the morbidity and mortality of COVID-19 to some degrees, and it seems to be crucial to control the pandemic.Keywords: COVID-19, social distancing, Iran, mortality, incidence

Mojtaba Sepandi,1 Simindokht Esmailzadeh,2 Mahboobeh Sadat Hosseini,1 Seyedeh Razieh Hashemi,3 Sepideh Abbaszadeh,1 Yousef Alimohamadi,4,5 Maryam Taghdir1,2 1Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran; 2Department of Nutrition and Food Hygiene, Faculty of Health, Baqiyatallah University of Medical Sciences, Tehran, Iran; 3Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran; 4Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran; 5Department of Epidemiology & Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, IranCorrespondence: Maryam TaghdirHealth Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, IranEmail mtaghdir@bmsu.ac.irBackground: Vitamin D deficiency (VDD) is a common concern. A high prevalence of VDD has been reported among pregnant women in different countries. The aim of this study was to assess the prevalence of VDD in the first trimester of pregnancy.Methods: This cross-sectional study was conducted on 267 pregnant women (before 14 weeks of gestation). The level of 25-hydroxyvitamin D (25(OH)D) was measured. Demographic data (age, educational level, season of blood sampling, and vitamin D supplementation intake) were collected using a questionnaire.Results: Based on the results of the study, 205 out of 267 subjects (76.8%) had deficient vitamin D levels (< 20 ng/mL), 39 (14.6%) had insufficient levels (20– 29 ng/mL), and 23 (8.6%) had sufficient levels (≥ 30 ng/mL). In addition, 133 women (49.8%) had severe VDD. VDD was more prevalent in autumn/winter than in spring/summer (P=0.03). The prevalence of VDD was higher among the younger age group than in the older group (P=0.04). In multivariate analysis, the only variable that was significantly associated with low vitamin D status was taking supplements. Those who were not receiving vitamin D supplements had higher odds of VDD status (adjusted odds ratio=77.3, 95% CI 23.9– 249.6).Conclusion: VDD is a public health problem in the first trimester of pregnancy. Greater awareness among healthcare providers and the community is required for prevention and appropriate treatment.Keywords: pregnancy, vitamin D deficiency, vitamin D insufficiency

Maryam Taghdir,1 Naser Honar,2 Seyed Mohammad Mazloomi,3 Mojtaba Sepandi,4 Mahkameh Ashourpour,1 Musa Salehi5 1Student Research Committee, Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; 2Department of Pediatric Gastroenterology and Hepatology, Shiraz University of Medical Sciences, Shiraz, Iran; 3Nutrition Research Center, Department of Food Hygiene and Quality Control, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; 4Department of Epidemiology and Biostatistics, Baqyiatallah University of Medical Sciences, Tehran, Iran; 5Nutrition Research Center, Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran Introduction: Celiac disease (CD) is caused due to intake of gluten, a protein component in wheat, barley, and rye. The only treatment currently available for CD is strict lifetime adherence to a gluten-free diet (GFD) which is a diet that excludes wheat, barley, and rye. There is limited information on barriers to following a GFD. The present study aimed to investigate the compliance with a GFD, barriers to compliance, and the impact of compliance on the quality of life (QOL) in Iranian children and adolescents suffering from CD.Methods: In this cross-sectional study, a total of 65 known cases of CD (both males and females), diagnosed in Namazi Hospital, a large referral center in south of Iran, selected by census were studied in 2014. Dietary compliance was assessed using a questionnaire. A disease-specific QOL questionnaire for children with CD (the celiac disease DUX [CDDUX]) was used. Comparisons between categorical variables were performed using chi-square test.Results: Sixty-five patients, 38 females (58.5%) and 27 (41.5%) males, were surveyed. Mean (± standard deviation [SD]) age of the respondents was 11.3 (±3.8) years. Dietary compliance was reported by 35 (53.8%) patients. The mean (± SD) CDDUX score was higher in dietary-compliant patients (33.5 [±19.4] vs 26.7 [±13.6], respectively, P=0.23). The score of CDDUX in parents of patients in dietary-compliant group was more than the noncompliant patients (28.1 [±13.5] vs 22.1 [±14], respectively, P=0.1). Barriers to noncompliance were poor or unavailability (100%), high cost (96.9%), insufficient labeling (84.6%), poor palatability (76.9%), and no information (69.23%).Conclusion: Approximately half of the patients with CD reported dietary compliance. Poor or unavailability was found to be the most important barrier contributing to noncompliance. The QOL was better in compliant patients. Proposed strategies to improve compliance are greater availability of gluten-free products, better food labeling, and better education about the diet and condition. Keywords: child, gluten enteropathy, adherence, gluten-free diet, quality of life

Neuropathic pain, a chronic pain condition caused by nerve damage either of the peripheral or central nervous system, responds poorly to current drug treatments. The present study aimed to investigate the analgesic and anxiolytic effect of Fe2+ nanoparticles on chronic constriction injury of sciatic nerve (CCI)-induced neuropathic pain in rats. We also assessed the effects of Fe2+ nanoparticles on brain rhythmical oscillation in rats with neuropathic pain. The CCI model was induced by four loose ligations of the left sciatic nerve. Male Wistar rats were divided into four groups: control, sham, CCI, and CCI+Fe2+ nanoparticle (1 mg/kg). The Fe2+ nanoparticle was administered by gavage on the day of CCI surgery (day 0) and daily (once a day) for 21 consecutive days after CCI surgery. Behavioral studies were conducted on days -1, 3, 7, 14, and 21 after CCI. An acetone test and elevated plus maze were performed to evaluate cold allodynia and induced anxiety-like responses, respectively. A field test was conducted to evaluate innate anxiety-like behaviors. In addition, an electrophysiological study was carried out on day 21 after CCI to assess the effects of drugs on brain wave power. Application of Fe2+ significantly reduced cold allodynia in all tested days after CCI, compared to the CCI group. The obtained data demonstrated that Fe2+ nanoparticle gavage caused analgesic and anxiolytic effects on all experimental days after CCI, compared to the CCI group. The CCI surgery significantly disturbed theta, alpha, and beta power in the brain. The application of Fe2+ nanoparticles could not significantly change brain wave power. It is suggested that Fe2+ nanoparticle has analgesic and anxiolytic effects during chronic neuropathic pain in rats. Furthermore, the CCI surgery effectively disturbed brain theta, alpha, and beta power. Nonetheless, the application of Fe2+ nanoparticles could not change deregulated brain oscillation in rats. [ABSTRACT FROM AUTHOR]

Background and Aim: The prevalence of congenital hypothyroidism (CH), one of the main causes of preventable mental handicap in neonates, is much higher in Iran than the global average. The objective of this study was to identify risk factors for congenital hypothyroidism (CH) by using the screening program in Fars Province, Iran, during the period 2003-2006. Methods and Materials: A case-control study was carried out, the samples being 126 cases and 401 controls. The neonates were those born between 2003 and 2006, under coverage of the National Congenital Hypothyroidism Program. The data were analyzed using the univariate and multivariate analysis tests. Results: An increased risk for CH was detected in infants with consanguine parents, by a multivariate analysis test (odds ratio (OR) = 2.9, 95% confidence interval (CI):1.8-4.8). The test also confirmed previously reported statistically significant associations with additional birth defects OR = 2.2 (1-4.6), birth defects in first-degree relatives OR = 4.7 (1.6-4.8), female gender OR = 1.9 (1.1-3), and twin births. Although not significant, an increased risk for CH was observed among infants with gestational age<30 weeks (preterm delivery) (OR = 1.7(0.9-1.3)). Conclusion: This study identified risk factors contributing to the etiology of CH. In particular, our results suggest a multifactorial origin of CH, in which both genetic and environmental factors play a role. [ABSTRACT FROM AUTHOR]

Objective: Public health surveillance is an important aspect of outbreak early warning based on prediction models. The present study compares a hybrid model based on discrete wavelet transform (DWT) and ARIMA (Autoregressive Integrated Moving Average) for predicting incidence cases due to COVID-19., Methods: In the current cross-sectional stuady based on time-series data, the incidence data for confirmed daily cases of COVID-19 from February 26, 2019, to April 25, 2022, were used. A hybrid model based on DWT and ARIMA and a pure ARIMA model were used to predict the trend. All analyzes were performed by MATLAB 2018, stata 2015, and Excel 2013 computer software., Results: Compared to the ARIMA model, the prediction results of the hybrid model were closer to the actual number of incident cases. The correlation between predicted values by the hybrid model with real data was higher than the correlation between predicted values by the ARIMA model with actual data., Conclusions: Discreet Wavelet decomposition of the dataset was combined with an ARIMA model and showed better performance in predicting the future trend., Competing Interests: None of the authors have any conflict of interest to declare., (© 2024 The Authors. Published by Elsevier Ltd.)

Introduction: Proper nutrition can play an important role in preventing and improving disease progression in patients with COVID-19. The Healthy Eating Index-2015 (HEI-2015) is one of the most common measures used to assess overall nutritional quality. This research aimed to identify the relationship between the HEI-2015 score and disease severity in hospitalised military patients with COVID-19., Methods: This cross-sectional study was conducted in 295 hospitalised military patients (retired military and military reserve) with COVID-19. A validated food frequency questionnaire was used to assess food intake. To evaluate the quality of the diet, the HEI-2015 score was calculated. A multiple logistic regression analysis was performed to measure the association between HEI-2015 scores and disease severity (intensive care unit (ICU) admission and length of hospital stay greater than 4 days) in hospitalised military patients with COVID-19., Results: The mean HEI-2015 score was significantly higher in non-ICU patients than in ICU patients (58.39±15.02 vs 53.54±15.65, p=0.01). After adjusting for possible confounding factors including age, sex, comorbidities, calorie intake, body mass index and physical activity, adherence to HEI-2015 inversely related to ICU admission (OR 0.98; 95% CI 0.95 to 1.00) and length of hospital stay of more than 4 days (OR 0.99; 95% CI 0.97 to 1.00) in hospitalised military patients with COVID-19, although statistically not significant., Conclusions: According to the results of the study, adherence to HEI-2015 inversely related to both ICU admission and length of hospital stay in hospitalised military patients with COVID-19, although it was not statistically significant., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Neuropathic pain, a chronic pain condition caused by nerve damage either of the peripheral or central nervous system, responds poorly to current drug treatments. The present study aimed to investigate the analgesic and anxiolytic effect of Fe 2+ nanoparticles on chronic constriction injury of sciatic nerve (CCI)-induced neuropathic pain in rats. We also assessed the effects of Fe 2+ nanoparticles on brain rhythmical oscillation in rats with neuropathic pain. The CCI model was induced by four loose ligations of the left sciatic nerve. Male Wistar rats were divided into four groups: control, sham, CCI, and CCI+Fe 2+ nanoparticle (1 mg/kg). The Fe 2+ nanoparticle was administered by gavage on the day of CCI surgery (day 0) and daily (once a day) for 21 consecutive days after CCI surgery. Behavioral studies were conducted on days -1, 3, 7, 14, and 21 after CCI. An acetone test and elevated plus maze were performed to evaluate cold allodynia and induced anxiety-like responses, respectively. A field test was conducted to evaluate innate anxiety-like behaviors. In addition, an electrophysiological study was carried out on day 21 after CCI to assess the effects of drugs on brain wave power. Application of Fe 2+ significantly reduced cold allodynia in all tested days after CCI, compared to the CCI group. The obtained data demonstrated that Fe 2+ nanoparticle gavage caused analgesic and anxiolytic effects on all experimental days after CCI, compared to the CCI group. The CCI surgery significantly disturbed theta, alpha, and beta power in the brain. The application of Fe 2+ nanoparticles could not significantly change brain wave power. It is suggested that Fe 2+ nanoparticle has analgesic and anxiolytic effects during chronic neuropathic pain in rats. Furthermore, the CCI surgery effectively disturbed brain theta, alpha, and beta power. Nonetheless, the application of Fe 2+ nanoparticles could not change deregulated brain oscillation in rats., Competing Interests: The authors declare that they have no conflict of interest.

Aim: Healthcare workers (HCWs) are always at risk of experiencing occupational needle stick injuries (NSIs). The primary aim of this study was to assess the prevalence of NSIs among Iranian HCWs in military hospitals in Tehran., Design: This cross-sectional study was conducted in four military hospitals in the summer of 2019 in Tehran., Method: By Census, 802 HCWs were included. Data were collected through a questionnaire consisting of vaccination history, safety equipment, use of safety box, history of NSIs and demographic variables. The logistics regression was used to estimate the odds ratios (OR) and 95% confidence interval (CI). The statistical significance level was set at 5%. The data were analysed using the SPSS software version 23., Results: A total of 203 (25.3%, CI: 22.3-28.4) of the participants reported a history of NSIs at least once during the past year. Single HCWs had a higher risk of NSIs compared to married HCWs (OR: 1.59, 95% CI (1.09, 2.30)). Also, the night shift working (OR: 1.91, 95% CI (1.18, 3.12)), higher educational degree (OR: 2.25, 95% CI (1.21, 4.20)), working overtime (OR: 1.50, 95% CI: (1.07, 2.12)), older age (OR: 1.02, 95% CI (1.01, 1.04)) and needle recapping (OR: 2.90, 95% CI: (1.98, 4.22)) were identified as significant associated factors. The study draws attention to a relatively high prevalence of NSIs as well as high-risk activities among military HCWs. The primary source of NSIs is needle recapping. Measures such as setting up training courses for the military HCWs are needed to be planned., (© 2023 The Authors. Nursing Open published by John Wiley & Sons Ltd.)

Background and Aim: Measles is an acute viral infectious disease usually characterized by erythematous maculopapular rash and sometimes pneumonia, diarrhea, and Central Nervous System disturbance. The current study aimed to describe the trend of measles in Iran before and after the 1978 revolution and COVID-19 pandemic., Methods: In the current quasi-experimental study, we used annual data on confirmed cases of measles in Iran, from 1974 to 2021. Data were extracted from the World Health Organization website. An interrupted time series model was used to assess the effect of different events on the incidence of measles., Results: The trend of new cases increase every year until 1980 according to the preintervention slope of 2040 (95% confidence interval [CI] = -1965-2045; p  < 0.31). After Iran's revolution, the occurrence of new cases significantly decreased (-845 [95% CI = -1262 to -432; p  = 0.001]). After the COVID-19 pandemic, the trend of new cases significantly increased (41 [95% CI = 12-70; p  = 0.006])., Conclusion: It seems that social or health-related events are among the effective factors on the incidence of measles. But with maintaining vaccination coverage in the community and vaccination of immigrants, this fluctuation in the disease trend can be decreased., Competing Interests: The authors declare no conflict of interest., (© 2023 The Authors. Health Science Reports published by Wiley Periodicals LLC.)

Diabetes mellitus is a widespread endocrine disorder globally. Due to its antioxidant and anti-inflammatory properties, ellagic acid has the potential to improve the metabolic effects of chronic non-communicable diseases. This systematic review summarizes current evidence about the potential effects of ellagic acid on metabolic variables in diabetes mellitus. A comprehensive systematic literature search was conducted in databases such as PubMed, Scopus, EMBASE, ProQuest and Google Scholar from inception until March 2022. All animal studies and clinical trials were eligible for inclusion. Studies using in vitro models or published in a non-English language were excluded. Of 1320 articles, 23 were selected for assessment, including 21 animal studies and two randomized controlled trial studies. Following ellagic acid administration, findings reported improvement in FBS, HbA1c, insulin (20, 8 and 12 studies, respectively), TG, TC, HDL-C (13, 10 and 5 studies, respectively), MDA, GSH, CAT, SOD (11, 6, 3 and 4 studies, respectively), and TNF-α and IL-6 (6 and 3 studies, respectively). In conclusion, ellagic acid may improve glycaemic indicators, dyslipidaemia, oxidative stress and inflammation in diabetes mellitus. However, further clinical trials are needed to explore the mechanisms more precisely and to observe the applied consequences., (© 2022 John Wiley & Sons Australia, Ltd.)

Competing Interests: The authors declare no conflict of interest in this study.

Background: Chronic low back pain is one of the most common musculoskeletal disorders in different countries., Aims: This study aimed to predict the chronicity of nonspecific acute and nonspecific low back pain (LBP) and related risk factors among cases referred to physiotherapy clinics., Design: A case-control and cross-sectional study., Settings: Two physiotherapy centers in Tehran, Iran., Participants: This study included 502 patients with acute, subacute and chronic LBP., Method: This study included 502 patients with acute, subacute and chronic LBP. Data were obtained using the Fear-Avoidance Beliefs Questionnaire, Patient Health Questionnaire, Pain Catastrophic Scale, Tampa Scale for Kinesiophobia, Pittsburgh Sleep Quality Index, Walker's Health-Promoting Lifestyle Questionnaire, Roland Morris Disability Questionnaire, and Numerical Pain Rating Scale. Data analysis was performed by applying independent sample t test, χ 2 , and multiple logistic regression in SPSS software version 25. IBM Amos version 22 was used for path analysis., Results: It was found that some demographic parameters (i.e., weight, BMI, job, type of occupational task performance, history of low back pain, work shift, underlying diseases and income), some cognitive parameters (i.e., fear-avoidance beliefs, kinesiophobia, catastrophic pain, and depression), some lifestyle parameters (i.e., health responsibility, physical activity, and interpersonal relationships), sleep quality and pain related disability were among the most critical risk factors in the chronicity of acute and subacute LBP (p < .05)., Conclusions: Personal, psychological, and psychosocial parameters can be among the most critical predictors in the chronicity of acute and subacute nonspecific LBP. Hence, paying attention to all the mentioned factors at the beginning of patients' treatment to create a targeted treatment algorithm and prevent the conversion of acute and subacute into chronic LBP has particular importance., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflict of interest., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Metabolic syndrome (MetS) as a cluster of conditions including hyperlipidemia, hypertension, hyperglycemia, insulin resistance, and abdominal obesity is linked to cardiovascular diseases and type 2 diabetes. Evidence suggested that intake of curcumin and coenzyme Q10 may have therapeutic effects in the management of MetS., Aims: We investigated the effects of curcumin and/or coenzyme Q10 supplementation on metabolic syndrome components including systolic blood pressure (SBP), diastolic blood pressure (DBP), waist circumference (WC), triglyceride (TG), high density lipoprotein-cholesterol (HDL-c) and fasting plasma glucose (FPG) as primary outcomes, and total cholesterol (TC), low density lipoprotein-cholesterol (LDL-c) and body mass index (BMI) as secondary outcomes in subjects with MetS., Methods: In this 2 × 2 factorial, randomized, double-blinded, placebo-controlled study, 88 subjects with MetS were randomly assigned into four groups including curcumin plus placebo (CP), or coenzyme Q10 plus placebo (QP), or curcumin plus coenzyme Q10 (CQ), or double placebo (DP) for 12 weeks., Results: The CP group compared with the three other groups showed a significant reduction in HDL-c (P = 0.001), TG (P <  0.001), TC (P <  0.001), and LDL-c (P <  0.001). No significant differences were seen between the four groups in terms of SBP, DBP, FPG, WC, BMI and weight., Conclusion: Curcumin improved dyslipidemia, but had no effect on body composition, hypertension and glycemic control. Furthermore, coenzyme Q10 as well as the combination of curcumin and coenzyme Q10 showed no therapeutic effects in subjects with MetS. The trial was registered on 09/21/2018 at the Iranian clinical trials website (IRCT20180201038585N2), URL: https://www.irct.ir/trial/32518 ., (© 2022. The Author(s).)

Objective: Identifying the epidemiological characteristics of COVID-19 could help to control the pandemic. The aim of this study was to characterize the epidemiological features of hospitalized COVID-19 patients in Iran., Methods: Data were collected on patients admitted to a military referral hospital in Tehran, Iran, from February 8, 2020 to July 28, 2021. Sex, age, clinical symptoms, outcome, type of comorbidities, level of blood Spo 2 , time of admission, and time of discharge were investigated. Sex ratio, case fatality rate (CFR), and daily trends of hospital admissions and deaths were also determined. Descriptive statistics and multiple logistic regression with 95% confidence intervals were used for data analysis. The statistical significance level was set at 0.05. STATA16.0 and Excel 2010 were used for data analysis., Results: The median hospital length of stay (LOS) was 6 days. The following symptoms were most common: cough (63.5%), fever (50%), respiratory distress (46.1%), and muscular pain (40.8%). Hypertension (29.5%), diabetes (24.7%), and cardiovascular diseases (21.8%) were the most prevalent comorbidities. The CFR was calculated at 8.30%. Respiratory symptoms increased the odds of death by 45% (OR 1.45, 95% CI 1.03-2.06). Gastrointestinal symptoms were associated with a reduction in the mortality of COVID-19 cases, but this association was not statistically significant (OR 0.94, 95% CI 0.73-1.21)., Conclusions: The results of this study emphasize higher mortality rates among older age groups, male patients, and patients with underlying diseases., (© 2022 [The Author/The Authors].)

Introduction: Metabolic syndrome comprises a set of risk factors for chronic diseases including abdominal obesity, increased fasting blood glucose (FBG), altered lipid profile and elevated blood pressure (BP). Due to high prevalence of metabolic syndrome and its complications in the military personnel, the relevant problems should be identified and controlled. Therefore, the present study was conducted to determine the effect of synbiotic supplements on the components of metabolic syndrome in the military personnel with metabolic syndrome., Methodology: Sixty military personnel with metabolic syndrome were included in this double-blind randomised controlled clinical trial. During the intervention, they were asked to consume one capsule of synbiotic supplement or placebo per day for 8 weeks. Body Mass Index (BMI), waist circumference, BP, FBG and lipid profile were measured before and after the intervention., Results: The results of the study showed that the synbiotic supplementation had a large significant adjusted effect on the BMI (Cohen's d=0.82 (95% CI 0.29 to 1.34)). It also had a medium significant adjusted effect on the FBG (Cohen's d=0.52 (95% CI 0.004 to 1.03)) as well as triglyceride (Cohen's d=0.65 (95% CI 0.13 to 1.17))., Conclusion: Findings of the study revealed that synbiotic supplementation may lead to a significant improvement in the BMI, triglyceride and FBG levels in the military personnel. Thus, consumption of synbiotic supplements is recommended as an adjuvant therapy in the military personnel with metabolic syndrome., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Aim: Achieving high COVID-19 vaccination coverage rates is essential as soon as a vaccine is available to deal with and end this pandemic. Due to the different amounts of COVID-19 vaccine acceptance rates in different regions, the pooled estimation of this rate is essential. Therefore, we conducted a systematic review and meta-analysis to investigate worldwide COVID-19 vaccine acceptance rates., Subject and Methods: International databases (including, Web of sciences, PubMed, and Scopus) were searched to identify related studies. The heterogeneity among studies was assessed using the I 2 index, the Cochran Q test, and T 2 . A random-effects model was used to pool estimate vaccine acceptance rates., Results: The overall pooled estimate of COVID-19 vaccine acceptance rate was 65.1 (95% CI 60.1-70.1; P  < 0.001, I 2  = 99.8). The vaccine acceptance rate in the general population was 68.5 (95% CI 62.5-74.5; P  < 0.001, I 2  = 99.8) and among healthcare workers (HCWs) was 55.9 (95% CI 47.8-64.1; P  < 0.001, I 2  = 99.6). The lowest COVID-19 vaccine acceptance rate was in the Middle East (46.1% (35.1-57.0)), and the highest coverage rate was (85% (71-99.1)) in South America., Conclusion: COVID-19 vaccine acceptance rate among HCWs is lower than the general population. More studies are recommended to identify related factors to the COVID-19 vaccine acceptance rate., Competing Interests: Conflicts of interestThe authors declare that they do not have any conflict of interest., (© The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2022, Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

The length of stay in the hospital for COVID-19 can aid in understanding the disease's prognosis. Thus, the goal of this study was to collectively estimate the hospital length of stay (LoS) in COVID-19 hospitalized individuals. To locate related studies, international databases (including Google Scholar, Science Direct, PubMed, and Scopus) were searched. The I 2 index, the Cochran Q test, and T 2 were used to analyze study heterogeneity. The mean LoS in COVID- 19 hospitalized patients was estimated using a random-effects model. COVID-19's total pooled estimated hospital LoS was 15.35, 95%CI:13.47-17.23; p<0.001, I 2 = 80.0). South America had the highest pooled estimated hospital LoS of COVID-19 among the continents, at 20.85 (95%CI: 14.80-26.91; p<0.001, I 2 = 0.01), whereas Africa had the lowest at 8.56 8 (95%CI: 1.00-22.76). The >60 age group had the highest pooled estimated COVID-19 hospital LoS of 16.60 (95%CI: 12.94-20.25; p<0.001, I 2 = 82.6), while the 40 age group had the lowest hospital LoS of 10.15 (95% CI: 4.90-15.39, p<0.001, I 2 = 22.1). The metanalysis revealed that COVID-19's hospital LoS was more than 10 days. However, it appears that this duration varies depending on a number of factors, including the patient's age and the availability of resources., (©Copyright: the Author(s).)

Background: Dietary quality indices are practical as an instrument to investigate the extent of adhering to a special diet to prevent cardiovascular disease (CVD) in type 2 diabetes mellitus (T2DM). Considering the lack of any systematic review with regards to this issue, our aim was to examine observational studies to test the relationship between dietary quality indices and CVD risk factors in T2DM., Methods: Systematic search was performed in Web of knowledge, PubMed, Cochrane, Science direct, Google Scholar and Scopus databases from January 1990 to July 2020. The studies exploring the relationship between dietary quality indices (diet quality score (DQS), dietary diversity score (DDS), healthy diet indicator (HDI), healthy eating index (HEI), diet quality index (DQI), Mediterranean diet score (MDS)) and lipid profile, anthropometric indices, glucose profile as well as blood pressure were eligible to be included in this review. Overall, mean changes, odd ratio (RR), correlation coefficients, and beta coefficient of outcomes were extracted, with the quality assessment of studies performed applying The Newcastle-Ottawa scale., Results: From among 1627 papers, 10 articles were included: Eight cross-sectional and two prospective (cohort) studies. The association between HEI as well as MDS and CVD risk factors was more evident in the included studies. Fasting blood sugar, hemoglobin A1c, body mass index, and waist circumference revealed the greatest inverse significant relationship with dietary quality indices in adults with T2DM., Conclusion: Overall, the findings of this study suggest that the level of CVD risk factors in T2DM decreases significantly with increase in the score of dietary quality indices. Further studies in future are required to confirm these findings., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 International Journal of Preventive Medicine.)

Background & Aim: Whey protein (WP) is one of the well-known dairy driven products to help people to change their weight and body composition (BC). This study aimed to investigate the effect of WP on weight and BC on every published RCT on all populations., Methods: A systematic review of the literature was undertaken to identify RCTs that examined the effect of WP on weight, body fat, lean body mass, fat-free mass, and waist circumference. To create weighted-group-mean differences for within- and between-group comparisons, random effects models were used. Subgroup analyses were also done to determine the effect of potential sources of heterogeneity., Results: Thirty-five RCTs, with a total of 1902 adult participants were included in pooled analysis. The effect of WP supplementation on BMI (-0.156, 95% CI: -0.31, 0.00, P < 0.05), body fat mass (-0.144, 95% CI: -0.28, 0.00, P < 0.05), and waist circumference (-0.448, 95% CI: -0.86, -0.03, P < 0.05) in within group analysis, and BMI (-0.769, 95% CI: -1.54, 0.00, P < 0.05) and lean body mass (0.741, 95% CI: 0.07, 1.41, P < 0.05) in the between group analysis was indicated. Resistance training, WP dosage, sex, age group, the type of control group (placebo, different proteins, etc.), the control group dosage, and energy intake before and during the trial, as well as between the WP and control groups, were recognized as the main sources of heterogeneity., Conclusion: The data from trials currently available supports the use of WP to improve BC indicators. The benefits of WP on BC are expected to be greatest when combined with resistance training and a reduction in overall calorie consumption., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2022 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

Microwave-assisted extraction was optimized to prepare Satureja bachtiarica leaf (SBL) extract based on antimicrobial (IZD) and antioxidant activities (DPPH) and extraction yield (EY). At optimum condition, i.e., 800 W power and 8 min, the best extraction results with EY = 16%, IZD = 73.56 mm, and DPPH = 24.2% were obtained. To develop a novel Feta-cheese, the influence of SBL extract, rennet, and starter concentrations were evaluated in terms of rheological, textural, and sensorial properties. At the optimized condition, the acceptance, taste, the strength of the network ( A ), and the distance between sequential cross-linking points ( ξ ) were 8.13, 8.07, 34,036.12 Pa·s 1/z , and 5.41 nm, respectively. At the 60th day of storage time, the lowest z value (the network extensity parameter) of the cheese samples was observed. SEM image texture indices showed a good correlation with the studied instrumental texture parameters during 60 days of storage. The mold and yeast counts and their growth rate in the SBL extract-added cheese were lower than those for control one; whereas, the former cheese showed a greater LAB population between the 80th and 120th days. The antimicrobial and antioxidant qualities of SBL extract showed a significant influence on cheese properties.

Background: Globally, several measures have been taken to decrease COVID-19 mortality. However, the effectiveness of preventive measures on the mortality related to COVID-19 has not been fully assessed. Thus, the present study aimed the present study aimed to assess the success of COVID-19 epidemic management and control plan on the mortality associated with COVID-19 in Iran from February 19, 2020, to February 5, 2021., Methods: In the current quasi experimental study an interrupted time series analysis of daily collected data on confirmed deaths of COVID-19 occurred in Iran and in the world, were performed using Newey ordinary least squares regression-based methods., Results: In Iran, the trend of new deaths increased significantly every day until 24 November 2020 according to pre-intervention slope of [(OR 1.14, 95% CI 0.96-1.32,); P < 0.001]. The occurrence of new deaths had a decreasing trend after November 24, 2020, with a coefficient of [(OR -5.12, 95% CI -6.04 - -4.20), P < 0.001)]. But in the global level daily new deaths was increasing before [(OR 18.66, 95% CI 14.41-2292; P < 0.001)] and after the 24 November 2020 [(OR 57.14, 95% CI 20.80-93.49); P: 0.002]., Conclusions: Iranian COVID-19 epidemic management and control plan effectively reduced the mortality associated to COVID-19. Therefore, it is essential to continue these measures to prevent the increase in the number of deaths., Competing Interests: Conflict of interest statement The authors declare that there is no conflict of interests., (©2022 Pacini Editore SRL, Pisa, Italy.)

Objective: This study aimed to evaluate the effect of magnesium supplementation on anxiety, depression and sleep quality of patients after openheart surgery., Materials and Methods: Based on a clinical trial, 60 candidates for open-heart surgery were separated into control and intervention groups. In the intervention group, 500 mg of magnesium was administered daily in the form of two 250-mg magnesium oxide tablets for five days, and routine care was performed in the control group. Patients’ demographic information and assessment based on the Hospital Anxiety and Depression Scale (HADS) and Petersburg Sleep Quality Inventory (PSQI) were documented at the beginning of the study, after surgery and endotracheal intubation, and at the end of the study. Data were statistically analysed using Stata software version 13., Results: After the intervention, the mean level of magnesium in the intervention group was significantly higher (p=0.001). At the end of the study, the mean level of anxiety and depression was significantly lower in the intervention group than the control group (p=0.007), moreover, mean sleep quality improved in the intervention group (8.3 ± 2.1) compared to the control group (10.3 ± 2.0) (p=0.001)., Conclusion: Due to the effects of magnesium supplementation in patients after heart surgery, it is recommended that this supplement be included in the treatment plan in order to prevent anxiety and depression in these patients after surgery and improve their quality of sleep.

Background and Aim: The approach of food storage, especially cereals and basic human food sources, has long been considered as a problem to combat storage pests. the use of plant compounds has been suggested by researchers as an alternative to phosphine in the fight against pests.In this study, four plants such as Aesculushippocastanum, Thymus daenensis, Artemisia abrotanum and Chrozophoratinctoria were evaluated based on their deadly and repellent properties of pests and insectsconsidering Iranian medicine sources., Materials and Methods: First, plant extracts were prepared by ethanol solvent method and then, their lethal and Anti-feeding experiments were performed on rice insects (Sitophylusoryzae) in standard laboratory conditions., Results: Extracts of Thymus daenensis, Aesculushippocastanum, Artemisia abrotanum  and  Chrozophoratinctoria were estimated to be 553.2, 753.6, 878.3 and 987.3 mg / ml effective dose, respectively.The results showed that Thymus daenensis extract with 90.33% with lower concentration compared to Aesculushippocastanum, Artemisia abrotanum  and  Chrozophoratinctoria extracts has the highest lethal effect against S. oryzae . Also in Anti-feedingtest, Thymus daenensis  extract showed the highest Anti-feedingeffect in comparison with  Aesculushippocastanum, Artemisia abrotanum  and  Chrozophoratinctoria extracts, respectively., Conclusions: The use of plants in the control against storage pests such as rice weevils will have favorable environmental results, human health and less storage is dangerous., Competing Interests: Conflict of interestThere are no conflicts of interest to declare., (© Springer Nature Switzerland AG 2021.)

The basolateral nucleus of the amygdala (BLA) is responsible for memory retrieval after stress. It regulates hippocampal long-term potentiation (LTP) during stress. Although β-adrenoceptors of the BLA have a critical role in memory, few studies have addressed this question in the BLA, and the results still have been contradictory. The present study was designed to investigate the involvement of β-adrenoceptors of the BLA on hippocampus memory, anxiety, and plasticity in intact and stressed rats. Male Wistar rats were submitted to the electrical foot-shock stress for four consecutive days. Over four consecutive days, animals received bilateral micro-injections of either vehicle or propranolol (4 µg in 1 µl/side) into the BLA (5 min before foot-shock stress). Behavioral (memory, as well as anxiety-like behaviors), electrophysiological, and histological (neural arborization in the hippocampal CA1 pyramidal neurons) studies were performed. Results showed that inhibition of β-adrenoceptors of BLA by propranolol significantly further impaired fear and spatial memory in stressed rats. Similarly, propranolol effectively impaired both memories in the intact animals. Propranolol significantly amplified the slope and amplitude of fEPSP in the CA1 area of the hippocampus only in stressed rats. Foot-shock stress significantly increased the number of dendritic branches in the hippocampus, and propranolol suppressed this effect of stress. It is suggested that β-adrenoceptors in the BLA promote memory and reduce anxiety-like behaviors under tonic and stress conditions. Propranolol dysregulated LTP parameters and reduced dendritic branches, resulting in memory impairment. Probably β-adrenoceptors of BLA regulate evoked responses of CA1 neurons only in stress- and not the tonic condition., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: Given the wide range of depressive disorders, suicidal ideation and suicide attempts in various military studies around the world, determining the exact prevalence of these disorders in line with health planning as well as care and treatment service designing for military forces can be useful. The aim of the present meta-analysis was to determine the pooled prevalence of depressive disorders, suicide thoughts, and attempts in the military., Methods: The present systematic review and meta-analysis study was performed based on PRISMA criteria in 5 steps of the search strategy, screening and selection of articles, data extraction, evaluation of article quality and meta-analysis. International databases (PubMed (Medline), Scopus, Web of science, Embase (Elsevier), PsycInfo (Ovid), Cochrane CENTRAL (Ovid)) were searched using related keywords extracted from Mesh and Emtree. After screening and final selection of articles, data were extracted and qualitative evaluation was performed using the NOS checklist., Results: The results of meta-analysis showed that the prevalence of depression in active military forces and veterans was 23% (%95 CI: 20-26%) and 20% (%95 CI: 18-22%), respectively. In addition, the prevalence of suicidal ideation and attempts in the military was 11% (%95 CI: 10-13%) and 11% (%95 CI: 9-13%), respectively. The prevalence of suicide ideation and attempts in drug-using military was 18% (%95 CI: 7-33%) and 30% (%95 CI: 23-36%), respectively. The prevalence of suicidal ideation and attempts in military consuming alcohol were 9% (%95 CI: 4-13%) and 8% (%95 CI: 7-10%), respectively. In militaries with AIDS / HIV, the prevalence of suicide attempts was 5% (%95 CI: 4-8%)., Conclusion: Therefore, it is necessary to develop and design training and intervention programs in order to increase the awareness of the military, especially veterans, to prevent the occurrence of suicide and depression., (© 2021. The Author(s).)

Background: Epidemiological studies indicate increased prevalence of cardiovascular disease (CVD) among military personnel. Accordingly, identification of at-risk individuals and lifestyle modification such as improving diet quality can potentially inhibits the increasing trend of CVD mortality. The aim of this study was predicting the 10-year risk of CVD and its association with healthy diet indicator (HDI) among military personnel., Methods: In this cross-sectional study, 400 male military personnel within the age range of 30-75 years were included. HDI score was calculated based on food frequency questionnaire, and the 10-year risk of CVD was evaluated using Framingham risk score (FRS). The FRS items include age, gender, total cholesterol, high density lipoprotein cholesterol (HDL-C), systolic blood pressure, status of diabetes and smoking. Partial correlation test was employed to investigate the relationship between Framingham risk score and HDI score., Results: The mean age and body mass index (BMI) of participants were 38.67 ± 5.3 year and 25.28 ± 3.22 kg/m 2 , respectively. Prediction of FRS was as follows: 96.5% were low risk, 2% were moderate risk, and 1.5% were high risk. The mean HDI score of participants in this study was 5.98 ± 1.36. While HDI score did not show a significant correlation with FRS (r: - 0.009, p:0.860), increased dietary sodium intake had a significant positive correlation with FRS (r: 0.114, p:0.026)., Conclusion: The most of participants (96.5%) had in low risk of CVD development in the next 10 years. Meanwhile, the FRS showed no significant relationship with HDI score. Further researches are required to confirm the results of the present study., (© 2021. The Author(s).)

Objective: The ongoing novel coronavirus disease 2019 (COVID-19) is the leading cause of morbidity and mortality due to its contagious nature and absence of vaccine and treatment. Although numerous primary studies reported extremely variable case fatality rate (CFR) of COVID-19, no review study attempted to estimate the CFR of COVID-19. The current systematic review and meta-analysis were aimed to assess the pooled CFR of COVID-19., Methods: Electronic databases: PubMed, Science Direct, Scopus, and Google Scholar were searched to retrieve the eligible primary studies that reported CFR of COVID-19. Keywords: ("COVID-19"OR "COVID-2019" OR "severe acute respiratory syndrome coronavirus 2"OR "severe acute respiratory syndrome coronavirus 2" OR "2019-nCoV" OR "SARS-CoV-2" OR "2019nCoV" OR (("Wuhan" AND ("coronavirus" OR "coronavirus")) AND (2019/12[PDAT] OR 2020[PDAT]))) AND ("mortality "OR "mortality" OR ("case" AND "fatality" AND "rate") OR "case fatality rate") were used as free text and MeSH term in searching process. A random-effects model was used to estimate the CFR in this study. I 2 statistics, Cochran's Q test, and T 2 were used to assess the functional heterogeneity between included studies., Results: The overall pooled CFR of COVID 19 was 10.0%(95% CI: 8.0-11.0); P < 0.001; I 2 = 99.7). The pooled CFR of COVID-19 in general population was 1.0% (95% CI: 1.0-3.0); P < 0.001; I 2 = 94.3), while in hospitalized patients was 13.0% (95% CI: 9.0-17.0); P < 0.001, I 2 = 95.6). The pooled CFR in patients admitted in intensive care unit (ICU) was 37.0% (95% CI: 24.0-51.0); P < 0.001, I 2 = 97.8) and in patients older than 50 years was 19.0% (95% CI: 13.0-24.0); P < 0.001; I 2 = 99.8)., Conclusion: The present review results highlighted the need for transparency in testing and reporting policies and denominators used in CFR estimation. It is also necessary to report the case's age, sex, and the comorbidity distribution of all patients, which essential in comparing the CFR among different segments of the population., Competing Interests: Conflict of interest statement The authors declare no conflict of interest., (©2021 Pacini Editore SRL, Pisa, Italy.)

The burden of five main air pollutants, including CO, O3, NO2, SO2, and PM2.5, on the emergency department visits (EDVs) during January 2016-December 2019 due to all cardiovascular diseases was assessed in Tehran by using a time-series model. The pollutants data were collected from Iran Department of Environment including 10 air pollution monitoring stations for the period of our study. Cumulative relative risk and attributable number/fraction were calculated for each pollutants by a Quasi-Poisson time-series regression and distributed lag non-linear model (DLNM). The maximum lag was set to 14 days because harvesting effect is more likely happened during few days. We used percentile 25 as reference value in order to calculate cumulative relative risk and attributable fraction. About 69,000 patients with cardiovascular symptoms have been admitted into the hospital during 4 years. The cumulative relative risk during the 14 days was 1.13 (1.01, 1.26), 1.15 (1.02, 1.29), and 1.08 (1.01, 1.18) for CO, NO2, and PM2.5, respectively. The numbers attributed to all values of CO were more than others; about 3800 EDVs were significantly attributed to CO, of which over 3000 were significantly attributed to high values of the pollutant. Low values of all pollutants were, not surprisingly, responsible for low number of EDVs. PM2.5, CO, and NO2 were responsible to considerable attributable number of EDVs. Our study emphasizes the need for local authorities to establish a program to reduce the air pollution in Tehran., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Occupational contact with blood and body fluids poses a significant risk to healthcare workers. The aim of this systematic review is to investigate the epidemiology and risk factors affecting needlestick injuries (NSI) in healthcare personnel in Iran., Methods: In March 2020, researchers studied six international databases such as Medline/PubMed, ProQuest, ISI/WOS, Scopus, Embase, and Google Scholar for English papers and two Iranian databases (MagIran and SID) for Persian papers. Joanna Briggs Institute (JBI) Critical Appraisal Checklist was used to assess quality of studies. The method of reporting was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement., Results: A total of 43 articles were included in the analysis. Results showed that females (OR = 1.30, 95 % CI 1.06-1.58, P value = 0.009), younger age (OR = 2.75, 95 % CI 2.27-3.33, P value < 0.001, rotated shift workers (OR = 2.16, 95 % CI 1.47-3.15, P value < 0.001), not attending training courses (OR = 1.30, 95 % CI 1.07-1.56, P value = 0.006), working in the surgery ward (OR = 1.83, 95 % CI 1.33-2.50, P value < 0.001), less work experience (OR = 1.43, 95 % CI 1.04-1.95, P value = 0.025) apposed a greater risk factors for NSI among healthcare workers., Conclusion: Based on the results of this review, factors such as young age, less work experience, work shift, and female gender are considered as strong risk factors for NSI injury in Iran. Preventive measures including education programs can reduce the burden of NSI among healthcare personnel.

This study aimed to investigate the potential ability of simultaneously used L. acidophilus(LA-5), L.rhamnosus(LGG), and L.casei(LC-01) in encapsulated (E) and nonencapsulated (NE) forms in mycelial growth of Aspergillus spp and aflatoxin production by A. flavus . In order to assess the zone of fungal growth inhibition by E and NE lactic acid bacteria, the agar well diffusion method was applied. Quantification of aflatoxin was performed using a high-performance liquid chromatography technique. Lactic acid bacteria exhibited high antifungal activity and significantly reduced AFB1, AFB2, AFG1, and AFG2 production in both E and NE forms compared to the control group. The percentage of reduction in total AFs production in treated samples with E and NE lactic acid bacteria was 94.1% and 95.5%, respectively. These results suggested that simultaneously used lactic acid bacteria in E and NE forms can prevent growth and decrease aflatoxin production of toxigenic aspergilla., (© 2021 The Authors. Food Science & Nutrition published by Wiley Periodicals LLC.)

Introduction: Colorectal cancer (CRC) is one of the most prevalent cancers among Iranian people. The study of spatio-temporal distribution of disease has an important role in the design of disease prevention programmes. The purpose of the current study was to describe the spatio-temporal distribution of CRC in the Iranian military community as a sample of the Iranian population., Methods: In the current ecological study, all registered cancer cases in the Iranian military community during the period 2007-2016 were considered. To identify hotspots, Getis-Ord Gi statistics were used. All analyses were performed using ArcGIS 10.5 and Excel 2010., Results: The highest incidences of CRC in 2007-2008, 2009-2010 and 2011-2012 were recorded in Kermanshah province. The highest incidences of CRC in 2013-2014 were seen in Kermanshah, Ghilan, Tehran and North Khorasan. In 2007-2008 and 2009-2010, hotspots were detected in West Azarbayjan. In 2011-2012, hotspots were detected in Zanjan and Qazvin. In 2013-2014, a hotspot was detected in Qazvin. Finally, West Azerbaijan was the hotspot for CRC in 2015-2016., Conclusions: The incidence of CRC in men was higher than in women. Also it appeared that North and North West Iran were risk areas for this disease, and so these areas should be considered in the design of disease prevention programme for this cancer type. Additionally, the determination of individual risk factors in the aforementioned geographical areas can play an important role in the prevention of this type of cancer., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: This study aims to determine the alarm thresholds in influenza outbreaks and aberration detection in the influenza trend in Iran by using cumulative sum control chart (CUSUM) and period regression., Methods: We used the weekly reported influenza-positive (types A and B) cases from Iran between January 2015 and November 2019. The period regression model and CUSUM chart were used as detection algorithms to figure out the alarm thresholds., Results: The mean ± SD and the median (95% CI) of the determined threshold per week were 34.85 ± 15.29 and 28.30 (17.67-64.62). According to the period regression, there were nine epidemic periods of influenza from 2015 to 2019. By using the CUSUM and considering a different h (h is an appropriate value that leads to the desired estimation for upper control limit) for the calculation of the upper control limit, 88, 84, 73 and 67 weeks were determined as the epidemic period., Conclusion: According to the current study, the incidence of influenza showed a cyclic pattern and the epidemic recurred each year. Understanding this cyclical pattern can help health policymakers launch prevention programs such as vaccination during certain months of the year., (© 2020 The Authors.)

Introduction: COVID-19 is an emerging infectious disease. The study about features of this infection could be very helpful in better knowledge about this infectious disease. The current systematic review and meta-analysis were aimed to estimate the prevalence of clinical symptoms of COVID-19 in a systematic review and meta-analysis., Methods: A systematic review using Medline/PubMed, Scopus, and Google scholar has been conducted. In the current systematic review and meta-analysis, the articles published in the period January 1, 2020, to April 2, 2020, written in English and reporting clinical symptoms of COVID-19 was reviewed. To assess, the presence of heterogeneity, the Cochran's Q statistic, the I 2 index, and the tau-squared test were used. Because of significant heterogeneity between the studies the random-effects model with 95% CI was used to calculate the pooled estimation of each symptom prevalence., Results: The most common symptoms in COVID-19 patients include: Fever 81.2% (95% CI: 77.9-84.4); Cough: 58.5% (95% CI: 54.2-62.8); Fatigue 38.5% (95% CI: 30.6-45.3); Dyspnea: 26.1% (95% CI: 20.4-31.8); and the Sputum: 25.8% (95% CI: 21.1-30.4). Based on the meta-regression results, the sample size used in different studies did not have a significant effect on the final estimate value (P > 0.05)., Conclusions: Considering the main symptoms of COVID-19 such as Fever, Cough, Fatigue, and Dyspnea can have a key role in early detection of this disease and prevent the transmission of the disease to other people., (©2020 Pacini Editore SRL, Pisa, Italy.)

Background: The aim of this study was to determine the relationship between parity and obesity in Iranian women., Methods: In a cross-sectional study, a total of 6447 urban women aged 40-65 were studied. Parity(number of full-term births), age at menarche, menopausal status, age, height, weight, marital status, education level and occupation were gathered by a checklist. Body Mass Index (BMI) was calculated. Statistical associations between parity and obesity using multiple logistic regression model were examined., Results: The mean age of the enrolled women was 48.40 ± 6.13 years. The mean BMI was 27.55 ± 4.47 kg/m 2 . Of the total participants enrolled, 3517 (54.55%) had < 3 parities, while 2930 (45.44%) had ≥ 3 parities. The prevalence of obesity (BMI ≥ 30 kg/m 2 ) and overweight (30 > BMI ≥ 25) was 27.50 % (95% CI 26.85-28.15) and 43.70% (95% CI 42.98-44.42), respectively. After adjustment for potential confounders, women with ≥ 3 parities were at higher risk of being obese (OR 1.19, 95% CI 1.05-1.35)., Conclusion: There was a statistically significant positive association between higher parity and obesity. It is recommended that health policymakers plan appropriate weight loss programs for postpartum., (©2020 Pacini Editore SRL, Pisa, Italy.)

Oral health problems are common among pregnant women. The objective of this study was to examine the effectiveness of motivational interviewing (MI) as a behavior-change technique to enhance self-efficacy and oral health among pregnant women. A randomized controlled trial was conducted with 112 pregnant Iranian women. Women in the intervention group received an education program on oral health using MI during two face-to-face sessions, along with routine health education (two 1-h lectures on oral health changes and needs during pregnancy presented as a lecture by an oral health technician over a 2-wk period). Those in the control group received two 1-h lectures on oral health changes and needs during pregnancy. Oral health behaviors, oral health self-efficacy, and general self-efficacy, were assessed, along with gingival and dental health from baseline to the 3-month follow-up. Analysis of covariance was used to determine differences between intervention and control groups. Scores for both general and specific self-efficacy and for healthy behaviors increased in the intervention group, whereas there was no significant change within controls from baseline to follow-up. Between-group analyses also indicated a significant difference in the scores for self-efficacy and behavior favoring the intervention group. Scores on the gingival inflammation index decreased, as did the number of decayed teeth in the intervention group relative to the control group. The number of filled teeth increased significantly in the intervention group. Health education interventions using MI techniques may help to improve oral health-related self-efficacy and behaviors among pregnant women., (© 2020 Eur J Oral Sci.)

Background: The current study aimed to identify effective factors on the death among COVID-19 patients., Methods: All articles published in the period Jan 1, 2020, to Mar 23, 2020, written in English and reporting factors associated with COVID-19 mortality were reviewed. The random-effects model with 95% CI was used to calculate the pooled Odds Ratio (OR) and Hazard Ratio (HR). Data were analyzed using Stata ver.11.0., Results: The older age OR: 1.21(1.10-1.33) and male gender OR: 1.41(1.04-1.89) were most prone to death due to COVID-19. The Comorbidity with some chronic diseases such as Diabetes type2 OR: 2.42(1.06-5.52), Hypertension OR: 2.54(1.21-5.32), Kidney disorder OR: 2.61(1.22-5.60), Respiratory disorder 3.09 (1.39-6.88) and Heart diseases OR: 4.37 (1.13-16.90) can increase the risk of COVID19 mortality., Conclusion: Infection with COVID-19 is associated with substantial mortality mainly in older patients with comorbidities. We found the significant effect of age, gender and comorbidities such as Diabetes Mellitus, Hypertension, Kidney disorders and Heart diseases on the risk of death in patients with COVID-19. The factors associated with mortality found in this research can help to recognize patients with COVID-19 who are at higher risk of a poor prognosis. Monitoring these factors can serve to give early warning for the appropriate interventions., 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.)

Objectives: Police officers may be at a greater risk for cardiovascular disease (CVD) than the general population due to their highstress occupation. This study evaluated how an educational program based on the health belief model (HBM) may protect police officers from developing CVD., Methods: In this single-group experimental study, 58 police officers in Iran participated in a 5-week intervention based on HBM principles. Outcomes included changes in scores on an HBM scale, time spent on moderate to vigorous physical activity (International Physical Activity Questionnaire), body mass index (BMI), blood lipid profile, blood glucose, and blood pressure. The intervention consisted of 5 HBM-based educational sessions. Follow-up was conducted at 3 months post-intervention. The paired t-test was used to examine differences between baseline and follow-up scores., Results: All aspects of the HBM scale improved between baseline and follow-up (p<0.05), except the cues to action subscale. Self-efficacy and preventive behaviors improved the most. BMI decreased from 26.7±2.9 kg/m2 at baseline to 25.8±2.4 kg/m2 at follow-up. All components of the lipid profile, including triglycerides, cholesterol, high-density lipoprotein, and low-density lipoprotein, showed significant improvements post-intervention. Blood glucose and blood pressure also decreased, but not significantly. Nearly 25% of participants who were not physically active at baseline increased their physical activity above or beyond the healthy threshold., Conclusions: A relatively brief educational intervention based on HBM principles led to a significant improvement in CVD risk factors among police officers. Further research is needed to corroborate the effectiveness of this intervention.