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Abstract Background Limited information exists linking food habits, diet quality, and lifestyle scores with anthropometric indices and happiness levels. Our aim was to examine the association between food habits, diet quality, and lifestyle scores with anthropometric indices and happiness levels in the Iranian population. Methods This cross-sectional study included 200 students randomly selected from a university in Iran. Dietary intakes, physical activity (PA), and happiness levels of study participants were assessed using validated questionnaires. The anthropometric indices examined in this study included the body shape index (ABSI), body roundness index (BRI), and abdominal volume index (AVI). Multiple logistic regression models were used to examine the association between food habits, diet quality, and lifestyle scores with anthropometric indices and happiness levels. Results The mean age and body mass index (BMI) of study participants were 23.5 years ± 4.52 and 23.8 kg/m2 ± 3.17, respectively. In the study population, no significant association was seen between ABSI, BRI, AVI and happiness with food habits, diet quality, and lifestyle scores respectively. After adjusting for potential confounders (age, energy intake, marital status, education, smoking, physical activity, gender, and BMI), the association remained not significant for ABSI and food habits, diet quality, and lifestyle scores respectively (OR: 0.56, 95% CI (0.25–1.34), P = 0.193; OR: 0.59, 95% CI (0.22–1.57), P = 0.413; OR:1.19, 95%CI (0.54–2.63), P = 0.652), BRI and food habits, diet quality, and lifestyle scores respectively (OR:1.98, 95% CI (0.41–9.49), P = 0.381; OR: 0.57, 95%CI (0.12–2.74), P = 0.512; OR: 1.19, 95% CI (0.3–4.71), P = 0.811), AVI and food habits, diet quality, and lifestyle scores (OR:1.15, 95% CI (0.53–2.48), P = 0.743, OR:1.01, 95% CI (0.47–2.18), P = 0.965; OR: 1.3, 95% CI (0.64–2.65), P = 0.465) and happiness and food habits, diet quality, and lifestyle scores respectively (OR:0.3, 95%CI (0.07–1.25), P = 0.972; OR: 0.77, 95%CI (0.18–3.19), P = 0.724, OR: 0.3, 95% CI (0.07–1.25), P = 0.083). Conclusions No significant association was detected between food habits, diet quality, and lifestyle scores with anthropometric indices and happiness levels. However, longitudinal studies are required to confirm these findings.

As the editor of the Journal of Case Report in Clinical Practice and someone who has been teaching scientific writing in Iran and the Middle East for many years, I always emphasize two points regarding the case report. 1. Generally, your case report should be rare and not commonly seen. In the history of the last two centuries, which war do you think would kill more than 40,000 defenseless people in a few months with the weapons provided by the three member countries of the Security Council, and create more than two million refugees [1-4]? All the people of the West, including academics, protest, but with the efforts of the same three members of the Security Council, the United States, United Kingdom, and France, not a single resolution against the Zionist regime is passed. In my opinion, as the editor of the Journal, this is definitely a case report. 2. The purpose of writing a case report is for the medical doctor to do the best work with his/her practice in medicine, which in the case of killing the people of Gaza and documenting it as a tragic event unique in history, will probably cause the free people of the world in the future, to elect rulers who believe in human rights and respect for human life. Anyway, what is important is that despite the support and at best, indifference of the Western countries, this killing has offended the conscience of the free people of the West so much that after the Vietnam war, almost all the academics of the American universities have protested and this protest movement of the universities America has developed to other Western universities. The cruel killing of infants who needed NICU or were in NICU and died due to lack of electricity and oxygen will be written in the history of modern medicine [5, 6].

Abstract Background Previous researches conducted in both developed and developing countries have demonstrated a rising trend in the utilization of complementary and alternative medicine. The World Health Organization has underscored the importance of studying the prevalence and determinants of such alternative practices. This study delves into the knowledge, attitudes, and practices of Iranian adults towards Persian medicine, a distinct form of complementary and alternative medicine, through a national survey for the first time. Methods A total of 2882 Iranian adults (aged ≥ 15 years) were randomly chosen from all regions. Data were gathered through structured door-to-door interviews using a survey questionnaire, wherein cases were selected randomly based on postal codes, and interviewers completed the forms at the participants’ residences. Results Approximately 46% of the subjects exhibited familiarity with Persian Medicine. The study revealed that the primary sources of knowledge about Persian Medicine were family, relatives, and friends, with only 2.9% indicating medical staff as their source of information. Furthermore, the study indicated that 21% of participants expressed a strong interest in using Persian Medicine, while 30.3% did not. When comparing Persian medicine to modern medicine, respondents indicated that Persian medicine is more cost-effective and has fewer side effects, yet modern medicine is more widely used globally; although, the majority responded “I don’t know” to other questions. The results also demonstrated that approximately 37% of the participants had a history of Persian Medicine utilization in their lifetime. Conclusion This study revealed that Iranian adults have low reliable knowledge (from medical staff, Persian medicine books and other publications) and limited familiarity with Persian medicine, with about one third of the participants expressing disinterest (attitude) and over half of them having not utilized this form of medicine (practice).

Objective: Saffron is a spice derived from the Crocus sativus L. with antioxidant, anti-inflammatory, and neuroprotective effects. This study aims to systematically review the systematic reviews (SRs) investigating the clinical neuropsychotropic effects of saffron.Materials and Methods: The protocol of this SR was registered in PROSPERO (CRD42021268446). Scopus, ISI Web of Science, Embase, MEDLINE, PubMed, CINAHL, Cochrane Library, Google Scholar, and PROSPERO were searched up to June 6, 2021, to find SRs investigating the neuropsychotropic effects of saffron. The primary outcome was a report on whether or not saffron was effective in each study. AMSTAR was checked for the included reviews.Results: Twenty-three studies were reviewed with a mean AMSTAR score of 6.08 (ranging from 1 to 10). Thirteen SRs investigated the effects of saffron on depression. Six of the SRs studied its impact on sexual dysfunction. Each of the anxiety and cognitive disorders was discussed in three distinct reviews. Furthermore, possible effects of saffron on some other disorders, like premenstrual syndrome, postpartum depression, sleep disorders, and snacking behavior, have been reported.Conclusion: Saffron is beneficial, safe, and tolerable in treating the mentioned neurological and psychiatric disorders. Further high-quality, large-scale studies are recommended to rectify the shortcomings.

Background and Objective Co-morbidity of obesity, sleep disturbance, and depression is common, especially among women. We aimed to evaluate the effects of melatonin on body weight, depression symptoms and sleep among women with co-morbidities of obesity, mild and moderate depression, and sleep disturbances seeking weight reduction compared with the placebo. Methods This double-blind, randomized clinical trial was performed on 43 patients with comorbidity of mild and moderate depression, overweight/obesity (body mass index ≥ 25) and sleep disturbance. After obtaining the informed consent forms they were randomly assigned to receive 3 mg melatonin or placebo at bed-time. We performed body composition assessments, Beck Depression Inventory, Spielberger State-Trait Anxiety Inventory and Pittsburgh Sleep Quality Index at the baseline, and 2, 4, 8, and 12 weeks after initiating of the study. We analyzed the data using analysis of variance repeated measures. Results Melatonin significantly reduced depression symptoms compared with the placebo, F = (1, 34) = 6.2, p = 0.017. Also, melatonin significantly improved sleep quality, F = (1, 33) = 8.0, p = 0.008. Besides, subjects on the melatonin reduced more weight compared with the placebo but difference between groups was not significant, F = (1, 41) = 0.2, p = 0.650. Patients in the melatonin group did not show significantly more side effects compared to placebo. Conclusions Based on our findings, melatonin was not able to significantly reduce the body weight more than placebo, but as a safe over-the-counter supplement, it may be helpful in patients with co-morbidities of sleep disturbance, mild and moderate depression, and obesity in reducing the symptoms of depression and insomnia.

Objective: One of the traditional aphrodisiacs used in various cultures is Crocus sativus, commonly called saffron. Previous studies have pointed to the possible applicability of saffron for sexual dysfunction in both men and women. This study investigates the effects of saffron capsules on female sexual dysfunction.Materials and Methods: This study was a parallel-group, double-blind, randomized, placebo-controlled clinical trial. Participants, who were married women between 18 and 55 years of age suffering from severe sexual dysfunction, were randomized to receive either 15 mg Crocus sativus capsules twice daily or placebo. The treatment continued for 6 weeks, and patients were evaluated every 2 weeks. The primary outcome was the change in the female sexual function index score. Other outcomes included the female sexual function index sub-domains.Results: Seventy-four patients were equally randomized to each group, and 34 in each group completed the trial. Participants in both groups experienced improved total scores at each visit. However, a repeated-measures ANOVA revealed that time ´ treatment differed between groups in favor of the saffron group (p=0.050). During the 6th week follow-up, the saffron group had a 62% score improvement from baseline. Desire, lubrication, and satisfaction were female sexual function index domains in which saffron demonstrated superiority over placebo. The adverse event profile was similar for the groups, and no participant discontinued treatment.Conclusion: Findings of this study suggest that saffron might be a safe and effective option to ameliorate female sexual dysfunction. Further robust research is warranted.

Background: Gender differences in scientometric indicators among medical faculty members in Iran was investigated. Methods: The Research performance of the faculty at all universities and institutes of medical sciences in Iran was assessed using the Iranian Scientometric Information Database (ISID) on June 12, 2021. Selected variables in our study were name, gender, university, degree, academic rank, type of faculty, the total number of articles, the total number of citations, self-citation percentage, h-index, citation per article, international cooperation percentage, and the number of research collaborators. The Kruskal-Wallis test was used. The extracted data were analyzed using R v4.0.1 statistical software. Results: A total of 21064 faculty members in 77 universities and institutes of medical sciences were registered in the ISID database, of which 12093 (57.4%) were men. Men faculty members outnumbered women in all academic ranks, except for the “instructor” rank (1134 female instructors against 835 male). In both sexes, most faculty members were assistant professors. There were more articles (346837 vs. 146024) and citations (5177060 vs. 1639246) by men than women. Among the 1789 faculty members with zero articles, 902 (50.4%) were men. One-hundred-and-fifty-four people were among ESIchr('39')s top researcherschr('39') list, with a majority of men (124 people equal to 80.5%). The medians of all the scientometric indicators were higher in men than women. Men had a higher number of articles, the number of citations, h-index, citation per article, percentage of international articles, and co-authors, however, women had lower self-citations (1.56% vs. 2.51%). In all academic ranks, men had higher scientometric indicators. The only exception was the associate professors’ self-citation, in which women’s citations were higher than that of men (3.5 vs. 3.3). The highest mean h-index was in men with a Ph.D. in Pharmacy (13), men with a Ph.D. by Research (12) and women with a Ph.D. by Research (8.5), respectively. Conclusion: Gender differences were evident in research performance in Iran. Women faculty members of medical sciences in Iran generally had lower scientometric indicators.

Parkinson’s disease (PD) is one of the most common neurodegenerative diseases. There is a wide range of sleep disturbances in patients with PD, such as insomnia and rapid eye movement (REM) sleep behavior disorder (or REM behavior disorder (RBD)). RBD is a sleep disorder in which a patient acts out his/her dreams and includes abnormal behaviors during the REM phase of sleep. On the other hand, melatonin is the principal hormone that is secreted by the pineal gland and significantly modulates the circadian clock and mood state. Furthermore, melatonin has a wide range of regulatory effects and is a safe treatment for sleep disturbances such as RBD in PD. However, the molecular mechanisms of melatonin involved in the treatment or control of RBD are unknown. In this study, we reviewed the pathophysiology of PD and sleep disturbances, including RBD. We also discussed the potential molecular mechanisms of melatonin involved in its therapeutic effect. It was concluded that disruption of crucial neurotransmitter systems that mediate sleep, including norepinephrine, serotonin, dopamine, and GABA, and important neurotransmitter systems that mediate the REM phase, including acetylcholine, serotonin, and norepinephrine, are significantly involved in the induction of sleep disturbances, including RBD in PD. It was also concluded that accumulation of α-synuclein in sleep-related brain regions can disrupt sleep processes and the circadian rhythm. We suggested that new treatment strategies for sleep disturbances in PD may focus on the modulation of α-synuclein aggregation or expression.

Introduction: A major cause of injury and the second cause of death worldwide is stroke. Among several infectious agents considered as the risk factor of stroke, some pathogens demonstrated stronger robust associations with stroke. Proposing an accurate correlation between infectious microorganisms and stroke provides valuable information for early intervention and control of the infections. Methods: In this study, we searched the literature using the Web of Science, PMC/Medline via PubMed, and Scopus databases up to July 2018 without time and language restrictions. After quality assessment, 16 articles were included in the study. The whole data extraction process was independently conducted by two reviewers. Results: Based on the results of the studies, viruses, such as Hepatitis C virus (HCV), Hepatitis B virus (HBV), Human Immunodeficiency Virus (HIV), Herpes Simplex Virus Type-1, 2 (HSV-1, 2), Varicella-Zoster Virus (VZV or Chickenpox), and West Nile virus (WNV) seem to be common causes of ischemic stroke. Moreover, the association of other microbial categories, such as Streptococcus mutans (in bacteria), Toxocara spp. and Toxoplasma gondii (in parasites), and Rhizopus sp. (in fungi) with stroke was reported. Conclusion: Considering the adverse role of the above-mentioned microorganisms, it is necessary to implement some preventive measures for stroke treatment.

Objective: Available treatments of depression have limited efficacy and unsatisfactory remission rates. This study aims to review randomized controlled trials (RCTs) investigating effects of glutamate receptor modulators in treating patients with resistant depression. Method: The study protocol was registered in PROSPERO (CRD42021225516). Scopus, ISI Web of Science, Embase, Cochrane Library, Google Scholar, and three trial registries were searched up to September 2020 to find RCTs evaluating glutamate receptor modulators for resistant depression. The difference between intervention and control groups in changing depression scores from baseline to endpoint was considered the primary outcome. Version 2 of the Cochrane risk-of-bias tool for randomized trials was used to assess the quality of the RCTs. No funding was received. Results: Thirty-eight RCTs were included. Based on the included studies, compelling evidence was found for ketamine (with or without electroconvulsive therapy, intravenous or other forms), nitrous oxide, amantadine, and rislenemdaz (MK-0657); the results for MK-0657, amantadine, and nitrous oxide were only based on one study for each. Lithium, lanicemine, D-cycloserine, and decoglurant showed mixed results for efficacy, and, riluzole, and 7-chlorokynurenic acid were mostly comparable to placebo. A limited number of studies were available that addressed drugs other than ketamine. Conclusion: The study cannot determine the difference between statistical and clinical significance between the agents and placebo due to high heterogeneity among the RCTs. Nevertheless, ketamine could be used as an efficacious drug in TRD; still, additional studies are needed to delineate the optimum dosage, duration of efficacy, and intervals. Further studies are also recommended on the effectiveness of glutamatergic system modulators other than ketamine on treatment-resistant depression.

Background and Aim: According to the WHO Commission on social determinants of health, identification of social determinants of health and collection of scientific evidence in this domain is essential for reducing health inequity. This is considered one of the main missions of social determinants of health research centers. The aim of this study was to evaluate the status of knowledge production in the county SDH research centers in Iran. Materials and Methods: In this 5-year cross-sectional study (2014 – 2018) 33 SDH research centers were assessed in regard to knowledge production indicators such as published articles, citation, H index, the high-quality publication (Q1), and international collaborations. Results: We found 4229 indexed articles which have been published by 334 faculty members/researchers of these research centers from 2014 to 2018. 11.9 percent of these articles have been published in high-quality research journals and 488 articles were produced with international collaboration. In 2018, the total number of citations to these articles published by these research centers from 2014 to 2018, was 4427 and the highest five-year H index was 26. According to the results of the research rankings, social determinants of health research centers of Kermanshah, Kurdistan, and Qazvin were ranked first to third, respectively. Conclusion: The trend of knowledge production in Iranian social determinants of health research centers has paralleled the trend of their citations and it is necessary to pay more attention to high-quality journals for publication of articles and expansion of international collaboration. Obviously, producing scientific documentation can be an effective source in health promotion policies and reduction of access gradients

Transcranial magnetic stimulation (TMS) has become a promising strategy for bipolar disorder (BD). This study reviews neuroimaging findings, indicating functional, structural, and metabolic brain changes associated with TMS in BD. Web of Science, Embase, Medline, and Google Scholar were searched without any restrictions for studies investigating neuroimaging biomarkers, through structural magnetic resonance imaging (MRI), diffusion tensor imaging (DTI), functional MRI (fMRI), magnetic resonance spectroscopy (MRS), positron emission tomography (PET), and single photon emission computed tomography (SPECT), in association with response to TMS in patients with BD. Eleven studies were included (fMRI = 4, MRI = 1, PET = 3, SPECT = 2, and MRS = 1). Important fMRI predictors of response to repetitive TMS (rTMS) included higher connectivity of emotion regulation and executive control regions. Prominent MRI predictors included lower ventromedial prefrontal cortex connectivity and lower superior frontal and caudal middle frontal volumes. SPECT studies found hypoconnectivity of the uncus/parahippocampal cortex and right thalamus in non-responders. The post-rTMS changes using fMRI mostly showed increased connectivity among the areas neighboring the coil. Increased blood perfusion was reported post-rTMS in PET and SPECT studies. Treatment response comparison between unipolar depression and BD revealed almost equal responses. Neuroimaging evidence suggests various correlates of response to rTMS in BD, which needs to be further replicated in future studies.

BackgroundResearch on perceived school safety has been largely limited to studies conducted in Western countries and there has been a lack of large-scale cross-national studies on the topic.MethodsThe present study examined the occurrence of adolescents who felt unsafe at school and the associated factors of perceived school safety in 13 Asian and European countries. The data were based on 21,688 adolescents aged 13-15 (11,028 girls, 10,660 boys) who completed self-administered surveys between 2011 and 2017. Logistic regression analyses were used to estimate odds ratios and 95% confidence intervals.FindingsThe number of adolescents who felt unsafe at school varied widely across countries, with a mean occurrence of 31.4% for the total sample: 31.3% for girls, and 31.1% for boys. The findings revealed strong independent associations between feeling unsafe and individual and school-related factors, such as being bullied, emotional and behavioral problems and feeling that teachers did not care. The study also found large variations in perceived school safety between schools in many countries.ConclusionThe findings emphasize the need to create safe educational environments for all students, based on positive relationships with teachers and peers. School-based interventions to prevent bullying and promote mental health should be a natural part of school safety promotion.

BackgroundToday, academic social network sites' role in improving the quality of education and how investigators conduct their research has become more critical. ObjectiveThis study aimed to investigate Iranian health researchers' requirements for academic social network sites from a low-income country perspective. MethodsThis qualitative study with a phenomenological approach was done in 2020. In this study, 23 researchers in the health system were selected by purposive sampling. Semistructured interviews were used to collect data. Data were analyzed by MaxQDA-10 software and the content analysis method. ResultsWe identified 2 categories of functional and technical characteristics in the study participants' expectations. Functional characteristics included facilitating communication and team activities, managing scientific publications, enhancing the process of conducting research, being informative, and sharing and trading laboratory materials and equipment. Technical characteristics of an academic social network include user management capabilities, high security and privacy, being user-friendly, and other technical features. ConclusionsHealth researchers emphasized 2 functional and technical characteristics required to meet academic social network sites' expectations.

Objective: Spironolactone (C24H32O4S), a potent mineralocorticoid receptor (MR) inhibitor, is a potassium-sparing diuretic that is traditionally used to treat fluid build-up in the body or for its anti-androgenic properties. This study is a double-blind, placebo-controlled, randomized clinical trial assessing the beneficial effects of spironolactone in addition to risperidone in improving negative symptoms of schizophrenia. Method: 40 patients with chronic schizophrenia, aged 18–60 years, were assigned to two groups: risperidone + spironolactone or risperidone + placebo. Risperidone was administered to both the spironolactone and placebo groups with a dose up to 6 mg/day throughout the trial. Spironolactone (C24H32O4S) was ordered 100 mg/day for the full 8-week course of the study. Patients were rated on the Positive and Negative Syndrome Scale (PANSS) at four time points: baseline, weeks two, four, and eight. The PANSS negative subscale score was the main objective. Results: PANSS negative, positive, and total scores showed significantly greater improvements in the spironolactone relative to the placebo group from baseline to the trial endpoint (P (Cohen’s d): 0.004 (0.96), 0.007 (0.90), and 0.042 (0.66), respectively). Similarly, ANOVA also presented significant time × treatment interaction effect for spironolactone on PANSS negative (F = 9.04; ηp2 = 0.19; df = 1.38; P = 0.002), positive (F = 3.43; ηp2 = 0.08; df = 2.72; P = 0.023), and total (F = 3.94; ηp2 = 0.09; df = 2.05; P = 0.022) scores. However, spironolactone did not cause significant decrease in the general psychiatric pathology score of PANSS. Conclusion: Our findings suggest the efficacy and safety of spironolactone as an adjunctive therapy to risperidone in improving the symptoms of schizophrenia.

Abstract Objective Vitamin B6 has been linked to a variety of probable roles, including anti‐inflammatory, homocysteine‐lowering, serotonin‐regulating, and dopamine‐lowering. In this study, we investigated the possible effect of vitamin B6 on bipolar disorder in manic episode with psychotic feature in a placebo‐controlled double‐blind clinical trial in a psychiatric hospital. Methods This study was performed on 50 patients who were equally divided into two groups (each group included 25 patients) using 80 mg of vitamin B6 daily or placebo. At the beginning and end of the study, they were evaluated for lab tests, inflammatory biomarkers and level of blood homocysteine. Also, at the baseline and in weeks 2, 4, and 8, they were evaluated based on the anthropometric measurements, score obtained from the Young Mania Questionnaire, Mini‐Mental State Examination (MMSE), and the Pittsburgh Sleep Questionnaire. Results Accordingly, based on Yang Mania scoring scale, no significant difference was observed between the two groups receiving vitamin B6 and placebo (22.68 ± 5.39 vs. 21.80 ± 5.39 [p‐value = .51]). Based on MMSE, significant improvement in cognitive status was obtained in group placebo compared to vitamin B6 group (25.24 ± 1.96 vs. 24.40 ± 3.25, respectively [p‐value = .01]). At the Pittsburg scale (total, there was no statistically significant difference between the two groups receiving vitamin B6 and placebo (1.04 ± 0.20 vs. 0.48 ± 0.50 [p‐value = .23]). Additionally, no significant difference was observed between the two groups regarding the anthropometric status. Conclusions According to this study, the daily dose of 80 mg of vitamin B6 for 8 weeks in patients with bipolar disorder in the manic episode with psychotic feature treated daily with lithium, was not associated with a significant improvement in mood status compared to the control–placebo group. It is recommended to perform similar studies in a multi‐center manner with a larger sample size and longer duration.

Background: Despite the reduced quality of life in patients with recurrent vasovagal syncope (VVS), pharmacologic treatment options remain limited. Studies indicate that norepinephrine reuptake inhibition reduces tilt-induced syncope/pre-syncope. This study aimed to evaluate the effects of atomoxetine on syncopal/pre-syncopal episodes in patients with recurrent VVS. Methods: In a placebo-controlled trial, we randomized patients with newly diagnosed VVS who experienced ≥3 syncopal episodes in the past three months to receive either atomoxetine (20 mg daily for two weeks followed by 40 mg daily for two weeks) or placebo. The primary endpoint was the combined number of syncopal and pre-syncopal episodes. Results: Among 843 patients initially screened, 46 were randomized (N = 23 in each group) and reevaluated at one and three months. Compared to placebo, atomoxetine significantly reduced the primary endpoint after three months (P

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Objective: Major depressive disorder (MDD) is predicted to be the first cause of burden of disease. The antidepressant activity of gemfibrozil has been recently considered. This study was designed to evaluate the effectiveness of gemfibrozil as a sertraline adjunct in treating patients with MDD. Method: A total of 46 patients with MDD based on the DSM-V criteria with a minimum score of 22 on the 17-item Hamilton Rating Scale for Depression (HAM-D) were randomized to receive either 300 mg daily gemfibrozil or placebo in addition to 100 mg sertraline for 8 weeks in a randomized, double-blind placebo-controlled trial. Patients were evaluated for response to treatment using the HAM-D score at baseline and weeks 2, 4, and 8. Results: Forty-five patients completed the study and took part in all follow-up visits. Repeated measure ANOVA with a Greenhouse-Geisser correction showed a significant difference for time×treatment interaction on within-subjects HAM-D scores [p–value= 0.026]. A significant difference was seen in time [p–value < 0.001]. The test of between-subject effects also showed a significant effect of treatment on HAM-D scores at weeks 2, 4, and 8 [p–value = 0.07]. Using Kaplan-Meier estimate curves, time to remission periods were significantly different between the 2 trial arms [Log-Rank p–value = 0.003]. Conclusion: Gemfibrozil is an effective adjunctive treatment in MDD and can be used to reduce depression symptoms.

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Background: Drug addiction is known as one of the health, medical and social problems of the present century. Beyond the harmful physical and mental consequences for addicts, drug abuse can cause serious social problems. The aim of this study was to evaluate drug and alcohol abuse in individuals aged 15 yr and over in Iran in 2015. Methods: This descriptive cross-sectional study was done on individuals aged 15 yr and older who lived in urban and rural areas of Iran. Overall, 36,600 individuals were selected by systematic and cluster random sampling. The postal code was used to access the samples in 31 provinces of Iran. In each province 1200 individuals (50% men, 50% women) were evaluated. The used instrument was the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), and data were analyzed using SPSS software. Results: The results showed 4.6% of individuals used Opium and its derivatives, 0.4% used Cannabis, 0.4% used Amphetamine stimulants, 6.1% used Sedative drugs, and 2.6% used Alcoholic beverages on a regular basis. Within the last 12 months, 3.9% of individuals used Opium and its derivatives, 0.4% used Cannabis, 0.3% used Amphetamine stimulants, 5.8% used Sedative drugs, and 1.9% used Alcoholic beverages. With the exception of Sedatives drugs men used more drugs than women and residents of rural areas used more opium and its derivatives than other groups of drugs. Based on the provincial distribution, Kerman and Qom used the highest and lowest prevalence percentage of Opium and its derivatives respectively. Conclusion: Overall, 2340000 individuals were addicts used Opium and its derivatives in 2015, therefore, medical and health officials should take all necessary measures to deal with these serious social problems.

The population with emerging diseases such as COVID-19, which is used to calculate the basic reproduction number of epidemic outbreak (R0) cannot be simply observed. In this article, we have proposed a method for estimating the hidden population of people with COVID-19 disease. Knowing the number of people with COVID-19 disease is very important for health policy. The provision of medical equipment (e.g., masks, alcohol, ventilators, medication, etc.), the reopening of schools and universities, the start of tourism and public gatherings, the provision of medical staff and preventive planning depend on the number of patients with the disease. Therefore, it is very important to estimate the number of patients. Key words: • Corona virus • Covid-19 • Epidemiology • Hidden population • Attack rate Copyright © 2020 Soltanian et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial (CC BY-NC 4.0) License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial.

Background: Health research networks (HRNs) are critical components of large-scale systems of production and validation of scientific evidence. As evaluation of research systems is a reliable process to measure efficiency and effectiveness of their activities, we aimed to report the processes of development of evaluation indicators’ for Iranian health research networks and the results of conducted assessment. Methods: In 2017, for the first time, aim to develop the evaluation framework for national HRNs, following the qualitative approach to assess the quality of research we designed the peer review method as one of the most important tools. This qualitative method was conducted according to experts’ views in specific fields. Key policy makers and stakeholders collaboratively developed a number of criteria for evaluation of research performance of Iranian HRNs. Following the review of conducted studies, benefitting from published guide line, these indicators were defined under 4 main axes of governance and leadership; infrastructures; research products and research impact. Results: Based on requirements of developed protocol for evaluation of HRNs in Iran, 18 HRNs completed the processes of evaluation. Results show a progressive need for more attention to precise planning of HRNs for achieving to goals. Another point to consider is the attention to documenting processes. The observational system for researches for detection of latest research priority was the most important issues that need to be more addressed by all of networks. Conclusion: Research evaluation of Iranian HRNs more over creating of constructive positive competition provide an overview of the shortcomings and research challenges could be used for better planning and promotion of the health research system.

Objective: Saffron was found efficient and safe in treatment of neuropsychiatric disorders, in particular depression. We compared the efficacy of saffron with duloxetine in treatment of patients with fibromyalgia. Materials and Methods: In this double-blind parallel-group clinical trial, outpatients with fibromyalgia were randomized to receive either saffron 15 mg or duloxetine 30 mg starting with 1 capsule per day in the first week followed by 2 capsules per day from week 2 until the end of week 8. Participants were men and women aged 18-60 years diagnosed with fibromyalgia based on the American College of Rheumatology 2010 criteria who also had a pain score ≥40 based on visual analogue scale. Participants were excluded in case they had rheumatologic diseases, inflammatory/infectious/autoimmune arthritis, comorbid neuropsychiatric disorders except depressive disorders, pain due to traumatic injuries, drug history of duloxetine or saffron use, current use of psychoactive medications, recent use of muscle relaxants, steroids, opioid analgesics, benzodiazepines, anti-epileptics, or injective analgesics. Primary outcomes included differences in mean score changes from baseline to endpoint between the treatment arms for Hamilton Rating Scale for Depression, Fibromyalgia Impact Questionnaire, and Brief Pain Inventory. Results: Socio-demographic characteristics and baseline scores were similarly distributed between the two treatment arms (2n=46). No significant difference was detected for any of the scales neither in terms of score changes from baseline to endpoint between the two treatment arms (Mean score changes: -4.26 to 2.37; p-values: 0.182-0.900) nor in terms of time´treatment interactions (p-values: 0.209-0.964). Conclusions: Saffron and duloxetine demonstrated comparable efficacy in treatment of fibromyalgia symptoms.

Introduction: Food Craving Questionnaire (FCQ) is a popular tool in assessing food craving which consisted of a trait (FCQ-T) and state (FCQ-S). The aim of the current study was to provide reliability and validity of the Persian version of FCQ-Trait-reduced (FCQ-T-r 15-items) in overweight and obese women. Material and methods: The subjects were 168 overweight and obese women who were consented to participate. The subjects completed the FCQ-T-r and subsequently, anthropometric, body composition and psychometric assessments performed to assess the inter-correlations and concurrent validity. The confirmatory factor analysis was done to derive the potential factors and internal consistency of the questionnaire was assessed. Two weeks later, FCQ-T-r repeated for 126 subjects to assess test-retest reliability. Results: The confirmatory factor analysis of by varimax rotation, show that three principal components were loaded on expected factors. The Cronbach’s alpha coefficient was 0.90. (0.91, 0.78, and 0.71, for factors). The test–retest analysis shows an acceptable level of reliability ( P=0.001) and Pearson correlation coefficient of 0.92 between the two administrations. In split-half reliability analysis the Cronbach’s alpha coefficient of the part 1 was 0.80 and for the part 2 was 0.86. The correlation coefficient between part 1 and part 2 was 0.81. Conclusion: This preliminary study provides evidences in favor of reliability and validity of the Persian version of the FCQ-T-r. In general, the results showed a high level of internal consistency for FCQ-T-r, and none of the 15 items had to be deleted to improve α.

Background and aim: Uncontrolled diabetes causes liver and renal dysfunctions. Since, saffron may improve diabetes control and indicate renal and liver protection, this study purposed to illustrate for the first time the effects of saffron extract on some liver and renal functional parameters among diabetic patients. Materials and methods: In this double-blind clinical trial, 54 type 2 diabetic patients were randomly recruited to consume either 15 mg saffron extract (n = 27) or placebo capsules (n = 27) twice a day for 8 weeks. Alkaline phosphatase, aspartate and alanine amino transferase, uric acid, blood urea nitrogen, and creatinine of the patients as well as their physical activity, dietary intakes, anthropometric measures and blood pressure were measured. Data were analyzed by SPSS.18 software. Results: Uric acid and blood urea nitrogen were significantly decreased in the saffron group (P

Objective: Bullying and victimization are common and serious problems in schools resulting in development of emotional and behavioral disorders in adolescents. This study aimed at examining the prevalence of bullying behavior and some of its associated factors among students. Method: This was a cross sectional analytic study involving junior high schoolers in grades seven, eight and nine. This study was part of an international study that used a questionnaire as a tool for data collection. The questionnaire investigated some of the characteristics and qualities possessed by most juveniles and some occasional problems which they may experience. Also, it was used to examine participants’ experiences with bullying and victimization. This questionnaire comprised of 15 sections on demographic characteristics, individual health, family status and types of bullying experiences at school and outside of school, along with the Strengths and Difficulties Questionnaire (SDQ), which is an instrument for screening emotional and behavioral problems in children and adolescents. A multistage cluster sampling from five regions, consisting of the north, south, west, east, and central regions of Tehran, was conducted and 1456 questionnaires were completed by the students. Results: According to the results of this study, prevalence rate for bullying and victimization was 17.4% and 25.8%, respectively. The results indicated that gender had a significant relationship with bullying and victimization, with boys being more likely to be bullies and also more prone to victimization than girls (p < 0.001). Other parameters such as emotional, behavioral, and environmental influence also had a significant relationship with bullying and victimization. Conclusion: Bullying is more prevalent in boys than in girls, and boys are more likely to be victimized as well. Emotional and behavioral problems are identified as risk factors, and future interventions should focus on these risk factors to develop preventive measures.

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Introduction:lthough herbal medicine have been used by traditional healers and physicians for thousands of years, these herbs are still being probed by researchers hoping to unlock their full therapeutic potentials. There is still much to learn about the biochemical and clinical effects of the individual constituents and of the various parts (petals, stigmas, leaves, and roots) of these plants. Many of today’s synthetic drugs originated in the plant kingdom, and less than two hundred years ago, the major pharmacopoeias of the world were dominated by herbal drugs-

Objective: Although the pathogenesis of schizophrenia is still uncertain, a variety of predisposing mechanisms have been implicated including inflammatory cascades. The present study was conducted to investigate the effectiveness of acetaminophen as a cyclooxygenase inhibitor in treating patients with schizophrenia. Method: A double-blind clinical trial was performed on 52 patients with chronic schizophrenia. Patients received risperidone (up to 6 mg/day) plus either acetaminophen (975mg/day) or placebo. Psychotic symptoms were assessed by the Positive and Negative Syndrome Scale (PANSS) at the onset of the trial, and at 2, 4, 6, and 8 weeks post therapy. Results: Compared to the placebo group, the acetaminophen group showed no significant difference in any subtypes of PANSS. Moreover, the side effect profiles of the 2treatment regimens were not significantly different. Conclusion: Acetaminophen adjuvant to risperidone showed no significant effect in ameliorating symptoms of schizophrenia. Trial Registration: The trial was registered at the Iranian Registry of Clinical Trials (registration number: IRCT201410251556N67).

Objective: Frequent use of opioids produces reactive oxygen species, upregulates inflammatory factors, and contributes to opiate dependence. In this study, we examined perturbations of plasma oxidative and inflammatory markers in patients with opioid use disorder in two phases. In the first phase, we compared the oxidative status in patients with opioid use disorders and in healthy controls; and in the second phase, we examined oxidative changes before and after methadone maintenance treatment. Method: To explore whether oxidative changes were associated with opioid use disorder, we compared plasma oxidative and inflammatory markers in patients with opioid use disorder and in smoking and non-smoking healthy participants. All participants completed measures of catalase (CAT), glutathione (GSH), malondialdehyde (MDA), superoxide dismutase (SOD), matrix metalloproteinase (MMP-9), and TNF-α at baseline. Baseline measures were compared using Kruskal-Wallis test. In the second phase, to explore oxidative changes during transition from opium use to methadone, blood and urine samples of patients with opioid use disorder were re-evaluated on Days 3, 7, and 14 after methadone therapy. Repeated measures analysis was used to determine the relative contribution of intervention to changes in CAT, GSH, MDA, SOD, MMP-9, and TNF-α level over time. Results: We observed lower SOD and catalase activities, and higher TNF-α and MMP-9 level in patients compared to the two comparison groups. Opioids exacerbated the oxidative imbalance and superimposed the underlying oxidative injury in smoker comparison group. Methadone therapy was associated with lower MMP-9 and TNF-α level, and higher SOD and catalase activities two weeks after therapy; showing an improvement in oxidative profile. Conclusion: This was an investigation indicating an oxidative imbalance before methadone therapy and during early days of transition from opium use to methadone. Being aware of redox status is crucial for determining an appropriate antioxidant therapy in opioid use disorder.

Dysmenorrhea is called "primary" when there is no specific abnormality and "secondary" when the pain is caused by an underlying gynecological problem. It is believed that primary dysmenorrhea occurs when hormone-like substances called "prostaglandins" produced by uterine tissue trigger strong muscle contractions in the uterus during menstruation. However, the level of prostaglandins does not seem to have anything to do with how strong a womanchr('39')s cramps are. Some women have high levels of prostaglandins and no cramps, whereas other women with low levels have severe cramps. This is why experts assume that cramps must also be related to other things (such as genetics, stress, and different body types) in addition to prostaglandins. Secondary dysmenorrhea may be caused by endometriosis, fibroid tumors, or an infection in the pelvis. In this article we focus on herbal medicine in the treatment of primary dysmenorrheal

Objective: There are different pathophysiological mechanisms for obsessive- compulsive disorder (OCD) as suggested by the serotonergic, dopaminergic, and glutamatergic hypotheses. The present study aimed at comparing the efficacy and safety of saffron (stigma of Crocus sativus) and fluvoxamine in the treatment of mild to moderate obsessive- compulsive disorder. Method: In this study, 50 males and females, aged 18 to 60 years, with mild to moderate OCD, participated. The patients were randomly assigned to receive either saffron (30 mg/day, 15 mg twice a day) or fluvoxamine (100 mg/day) for 10 weeks. Using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Adverse Event Checklist, we assessed the patients at baseline, and at the second, fourth, sixth, eighth, and tenth week. Finally, the data were analyzed using general linear repeated measures. Results: In this study, 46 patients completed the trial. General linear repeated measures demonstrated no significant effect for time-treatment interaction on the Y-BOCS total scores [F (2.42, 106.87) = 0.70, P = 0.52], obsession Y-BOCS subscale scores [F (2.47, 108.87) = 0.77, p = 0.49], and compulsion Y-BOCS subscale scores [F (2.18, 96.06) = 0.25, P = 0.79]. Frequency of adverse events was not significantly different between the 2 groups. Conclusion: Our findings suggest that saffron is as effective as fluvoxamine in the treatment of patients with mild to moderate OCD.

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Objective: The Three-Factor Eating Questionnaire Reduced (TFEQ-R18) is one of the most widely used instruments for assessing eating behavior worldwide. The present study aimed at confirming the reliability and validity of the Persian version of TFEQ-R18 among overweight and obese females in Iran. Material and Methods: In the present study, 168 overweight and obese females consented to participate. We estimated the anthropometric indices and asked the participants to complete the TFEQ-R18. Beck Depression Inventory (BDI), Spielberger Anxiety Scale, Appetite Visual Analogue Rating Scale, Food Craving Questionnaire (FCQ), Compulsive Eating Scale (CES), and Restraint Eating Visual Analogue Rating Scale were performed simultaneously to assess concurrent validity. Two weeks later, TFEQ-R18 was repeated for 126 participants to assess test-retest reliability. Moreover, we reported the internal consistency and factor analysis of this questionnaire. Results: Using the results of the reliability analysis and exploratory factor analysis of the principal component by varimax rotation, we extracted 3 factors: hunger, cognitive restraint, and emotional eating. After removing the Items 16 and 18, the Cronbach’s alpha was increased to 0.73 (The Cronbach’s alpha of the factors was 0.84, 0.64, and 0.7, respectively). The results of the Pearson correlation revealed a consistency of 0.87 between the test and retest administrations (p = 0.001). Significant positive correlations were observed between TFEQ-R18 and BDI, Spielberger Anxiety Scale, FCQ, CES, appetite, body weight, fat percentage, and calorie intake. Moreover, a negative correlation was observed in Restraint Eating Visual Analogue Rating Scale and muscle percentage. Conclusions: This study aimed at presenting preliminary support for the reliability and validity of the Persian version of TFEQ-R18 and its psychometric characteristics. This instrument may be helpful in clinical practice and research studies of obesity, appetite, and eating behavior.

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Background: Governance is one of the main functions of Health Research System (HRS) that consist of four essential elements such as setting up evaluation system. The goal of this study was to introduce a new web based research evaluation model in Iran. Methods: Based on main elements of governance, research indicators have been clarified and with cooperation of technical team, appropriate software was designed. Three main steps in this study consist of developing of mission-oriented program, creating enabling environment and set up Iran Research Medical Portal as a center for research evaluation. Results: Fifty-two universities of medical sciences in three types have been participated. After training the evaluation focal points in all of medical universities, access to data entry and uploading all of documents were provided. Regarding to mission – based program, the contribution of medical universities in knowledge production was 60% for type one, 31% for type two and 9% for type three. The research priorities based on Essential National Health Research (ENHR) approach and mosaic model were gathered from universities of medical sciences and aggregated to nine main areas as national health research priorities. Ethical committees were established in all of medical universities. Conclusion: Web based research evaluation model is a comprehensive and integrated system for data collection in research. This system is appropriate tool to national health research ranking.

Objective: Compulsive or binge eating is a kind of disturbed eating behavior, which is mostly observed among dieting women, and is integrated with appetite disorder, and uncontrolled eating of plenty of junk food. The Compulsive Eating Scale (CES) created first by Kagan & Squires in 1984, is an eight-item self-reporting instrument that is made to measure the severity of binge eating disorder. The aim of this study was to provide the reliability and validity of the Persian version of Compulsive Eating Scale (CES) among overweight and obese women in Iran. Method: One hundred and twenty six (N = 126) overweight and obese women consented to participate in this study. We estimated the anthropometric indices, including body weight, height, waist and hip circumferences, a total body fat percentage, and visceral fat level with body analyzer all in standard situations. Then, the participants completed the CES. Next, to assess concurrent validity, Beck Depression Inventory, Spielberger anxiety scale, appetite visual analogue rating scale, Food Craving questionnaire, Three-Factor Eating Questionnaire-R18, and Restraint eating visual analogue rating scale were performed simultaneously. To assess test-retest reliability, CES was repeated for all the participants two weeks later. Moreover, we reported the internal consistency and factor analysis of this questionnaire. Furthermore, we estimated the concurrent correlation of CES with logically relevant questionnaires and body composition and anthropometric indices. Results: Based on the reliability analysis and factor analysis of the principal component by Varimax rotation, we extracted two factors: eating because of negative feelings, and overeating. Internal consistency (Cronbach's alpha) of the CES was 0.85 (Cronbach alpha of the factors was 0.85, and 0.74, respectively). The test-retest correlation of the CES was 0.89. Also, the split-half reliability of the questionnaire was established with the correlation coefficient between Sets I and II. The correlation was 0.85. Conclusion: This study provides preliminary support for the reliability and validity of the Persian version of the CES. This instrument would be helpful in measuring the clinical practice and research studies of obesity, appetite and eating disorders reliably and validly.

Saffron is a natural compound that has been used for centuries in many parts of the world as a food colorant and additive. It was shown to have the ability to mitigate various disorders through its known anti-inflammatory and anti-oxidant properties. Several studies have shown the effectiveness of saffron in the treatment of various chronic diseases like inflammatory bowel diseases, Alzheimer’s, rheumatoid arthritis as well as common malignancies of the colon, stomach, lung, breast, and skin. Modern day drugs generally have unwanted side effects, which led to the current trend to use naturally occurring products with therapeutic properties. In the present review, the objective is to systematically analyze the wealth of information regarding the potential mechanisms of action and the medical use of saffron, the “golden spice”, especially in digestive diseases. We summarized saffron influence on microbiome, molecular pathways, and inflammation in gastric, colon, liver cancers, and associated inflammations.

The aim of this study was to evaluate knowledge, attitude and practice of herbal remedies (HRs) in infertile patients. This was a cross sectional study in a referral infertility care center. Three hundred and six outpatients, both women and men, presenting for the first time with complaint of infertility at Arash hospital, were recruited. Verbal consent for participation was received. A self administered questionnaire was used. Main outcome measure was knowledge, attitude and practice of patients toward herbal medications. 47.3% of participants were knowledgeable of HRs with female gender and lower educational background being the associated factors in knowledge. 43.4% of patients with significant female dominancy had positive attitude toward HRs. 31% of participants were using HRs. Only 3.2% of those using HRs informed their physician. The most common health condition promoting herbal use was psychological (33.3%) and gastrointestinal (30.8%) disorders. 3.5% of participants used HRs as fertility treatment which was significantly observed in women and those with lower levels of formal education. A considerable proportion of our population had used HRs without sufficient knowledge and had positive attitude toward HRs. More importantly, patients did not disclose their use of HRs to physicians. Therefore, physicians should inquire about the use of alternative remedies and provide patients with appropriate information

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Anxiety may negatively affect the course of coronary artery disease (CAD). The aim of this study was to assess which factors are associated with anxiety in young adults with CAD. A cohort of individuals with premature coronary artery disease was formed between 2004-2011, as the Tehran Heart Center's Premature Coronary Atherosclerosis Cohort (THC-PAC) study. Patients (men≤45-year-old, and women≤55-year-old) were visited between March 2013 and February 2014. All participants were examined, and their demographic, clinical, and laboratory data were collected. Then, all participants filled in the Beck Anxiety Inventory. Logistic regression models were used to identifying factors related to anxiety in both sexes. During the study, 708 patients (mean [SD] age: 45.3 [5.8] y, men:48.2%) were visited. Anxiety was present in 53.0% of participants (66.0% of women and 39.0% of men). The logistic regressions model showed that the associated factors for anxiety in men were opium usage (OR=1.89, 95% CI: 1.09-3.27), positive family history (OR=1.49, 95% CI:0.94-2.35), and creatinine serum level (OR=1.17, 95% CI:1.05-1.303); and in women were major adverse cardiac events (MACE) during follow-up (OR=2.30, 95% CI:1.25-4.23), hypertension (OR=1.71, 95% CI:1.07-2.73) and the duration of CAD (OR=0.99, 95% CI:0.98-1.00). In premature CAD patients, the determinants of anxiety seem to be different in each sex. Opium usage, positive family history of CAD, and creatinine serum levels in men, and MACE, hypertension, and duration of CAD in women appear the relevant factors in this regard.

Objectives: The aim of this randomized clinical trial was to assess the efficacy of memantine versus methylphenidate in the treatment of children with attention deficit hyperactivity disorder. Method: Forty participants (34 boys and 6 girls) aged 6-11 who were diagnosed with attention deficit hyperactivity disorder based on (DSM-IV-TR) criteria were selected for this study. The participants were randomly assigned to two groups: group one (n = 22) received memantine and the other group (n = 18) received methylphenidate for six weeks. Treatment outcomes were assessed using the Attention Deficit Hyperactivity Rating Scale and Clinical Global Impression- Severity Scale administered at baseline and at weeks 3 and 6 following the treatment. Also, a two-way repeated measures analysis of variance (time- treatment interaction) was used. Results: At 6 weeks, methylphenidate produced a significantly better outcome on the Parent Rating Scale scores and Clinical Global Impression- Severity than memantine. Side effects were observed more often in the memantine group. However, with respect to the frequency of side effects, the difference between the memantine and methylphenidate groups was not significant. The most common side effects associated with memantine are appetite suppression, headache, vomiting, nausea and fatigue. Conclusion: The results of this study revealed that although memantine was less effective than methylphenidate in the treatment of attention deficit hyperactivity disorder, it may be considered as an alternative treatment.

Objective: Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most common behavioral ‎disorders in children effecting the families and society. This systematic review examined ‎the literature on the role of lead exposure in children with ADHD‏ ‏symptoms. Articles were ‎analytically compared, focusing on the methodology used to assess exposure and‏ ‏adverse ‎effects‏ ‏on children with ADHD. ‎ Method: Using the search strategy from six databases (Pub Med, PsycINFO, Web of Science, SID, ‎IRAN Medex, IRAN DOC), hand searching in key journals, list of references of selected ‎articles and gray literature, without time and language limitation, articles up to May 2014 ‎were entered into this review. In this review, 1,387 articles were acquired at the primary ‎search. Study selection and quality assessment processes were done based on Cochrane ‎library guidelines. After assessing the quality and inclusion and exclusion criteria, 18 articles ‎were selected and entered into the data synthesis.‎ Results: Blood Lead level (BLL) of less than 10µg/dL in children has been attributed to at least one ‎type of ADHD i.e., Combined / Inattentive / Hyperactive-Impulsive. The results of this ‎study revealed that in 16 out of the 18 studies, a significant association was found between ‎BLL and one of the types of ADHD.‎ Conclusion: Based on the findings of this study, even the BLL of less than the action level of 10µg/dL, ‎chosen by Centers for Disease Control and Prevention (CDC), may affect children with ‎ADHD.‎

A recent randomized clinical trial showed buspirone efficacy in the treatment of attention-deficit/hyperactivity disorder (ADHD) in children. However, results from a recent multi-site controlled clinical trial of transdermal buspirone failed to separate it from placebo in a large sample of children with ADHD. Therefore, due to these inconsistent findings, this study was designed to assess the efficacy of buspirone in the treatment of children with ADHD compared to methylphenidate in a double blind randomized clinical trial. Forty outpatients with a DSM-IV-TR diagnosis of ADHD were study population of this trial. Subjects were recruited from an outpatient child and adolescent clinic for a 6 week double blind, randomized clinical trial. All study subjects were randomly assigned to receive treatment using tablet of buspirone at a dose of 20-30 mg/day depending on weight (20 mg/day for < 30kg and 30 mg/day for > 30kg) (group 1) or methylphenidate at a dose of 20-30 mg/day depending on weight (20 mg/day for < 30kg and 30 mg/day for > 30kg (group 2) for a 6 week double blind, randomized clinical trial. The principal measure of outcome was the Teacher and Parent ADHD Rating Scale IV. Patients were assessed at baseline and at 21 and 42 days after the medication started. Significant differences were observed between the two groups on the Parent and Teacher Rating Scale scores. The changes at the endpoint compared to baseline were: -8.95±8.73 (mean±SD) and -15.60±7.81 (mean±SD) for buspirone and methyphenidate, for Parent ADHD Rating Scale. The changes at the endpoint compared to baseline were: -9.80 ±7.06 (mean±SD) and -22.40±9.90 (mean±SD) for buspirone and methyphenidate, respectively for Teacher ADHD Rating Scale. The difference between the buspirone and methylphenidate groups in the frequency of side effects was not significant except for decreased appetite, headache and insomnia that were observed more frequently in the methylphenidate group. The results of this study suggest that administration of buspirone was less effective than methylphenidate in the treatment of ADHD.

Objective: It is postulated that ritalin may adversely affect sleep, appetite, weight and growth of some children with ADHD. Therefore, we aimed to evaluate melatonin supplementation effects on dietary intake, growth and development of children with ADHD treated with ritalin through circadian cycle modification and appetite mechanisms.Method: After obtaining consent from parents, 50 children aged 7-12 with combined form of AD/HD were randomly divided into two groups based on gender blocks: one received melatonin (3 or 6 mg based on weight) combined with ritalin (1mg/kg) and the other took placebo combined with ritalin (1mg/kg) in a double blind randomized clinical trial. Three-day food record, and standard weight and height of children were evaluated prior to the treatment and 8 weeks after the treatment. Children’s appetite and sleep were evaluated in weeks 0, 2, 4 and 8. Hypotheses were then analyzed using SPSS17.Results: Paired sample t-test showed significant changes in sleep latency (23.15±15.25 vs. 17.96±11.66; p=0.047) and total sleep disturbance score (48.84±13.42 vs. 41.30±9.67; p=0.000) before and after melatonin administration, respectively. However, appetite and food intake did not change significantly during the study. Sleep duration and appetite were significantly correlated in melatonin group (Pearson r=0.971, p=0.029). Mean height (138.28±16.24 vs. 141.35±16.78; P=0.000) and weight (36.73±17.82 vs. 38.97±17.93; P=0.005) were significantly increased in melatonin treated children before and after the trial.Conclusion: Administration of melatonin along with ritalin improves height and weight growth of children. These effects may be attributed to circadian cycle modification, increasing sleep duration and the consequent more growth hormone release during sleep.

Objective: The aim of this study was to determine melatonin effects on sleep patterns, symptoms of hyperactivity and attention deficiency in children with attention-deficit hyperactivity disorder (ADHD).Methods: Children with age range of 7-12 years who had a combined form of ADHD were randomly divided in to 2 groups according to gender blocks. One group took melatonin (3 or 6mg) combined with methylphenidate (Ritalin) (1mg/kg), and the other group took placebo combined with methylphenidate (1mg/kg). ADHD rating scale and sleep patterns questionnaires were completed. Research hypotheses were assessed at the baseline, the second, fourth and eighth weeks after the treatment.Results: The mean sleep latency and total sleep disturbance scores were reduced in melatonin group, while the scores increased in the placebo group (p≥0.05). Data analysis, using ANOVA with repeated measures, did not show any statistically significant differences between the two groups in ADHD scores.Conclusion: Administration of melatonin along with methylphenidate can partially improve symptoms of sleep disturbance. However, it does not seem to reduce attention deficiency and hyperactivity behavior of children with ADHD.

Objective: Mental health is one of the evaluating factors of community indicators, and physical activity is considered an important tool for the importance of public health. Previous studies have demonstrated associations between physical activity and mental health, but these studies did not include those populations in which training children have some traditional and religious aspects.Methods: Multiple logistic regression analyses were used to compare the prevalence of mental health among those who had inactive, minimally and HEPA activity in a representative sample of adolescents aged 15-19 in South of Iran using data from the Mental Health Survey (n = 2584). The GHQ-28 and IPAQ-short forms were used to evaluate the mental health and physical activity, respectively .Results: A total of 2584 adolescents (1401 male and 1178 female) participated in the study. The observed odds of psychological symptoms in boys compared to girls is 1.2 times (p=0.018). We observed that HEPA-activity decreases odds of somatic distress and social dysfunction compared with inactivity (p=0.031 and 0.001, respectively); minimally activity decreases odds of anxiety compared with inactivity (p=0.038); but physical activity rate was not affected on odds of adolescents' depression (p>0.05).Conclusion: Physical activity decreases mental health subscales except for depression among adolescents in Boushehr, southern city of Iran.

Attention-deficit/hyperactivity disorder (ADHD) is a highly heritable neuropsychiatric disorder associated with significant impairments in occu¬pational, academic, neuropsychological, and social functioning. Central nervous system (CNS) stimulants are recommended as first-line medication therapy for children. CNS stimulants include formulations of methylphenidate and amphetamine derivatives and are available in a large variety of immediate- and extended-release preparations. Extended-release preparations are often preferred to limit drug administration during school or work and may help to limit side effects associated with rapid fluctuations in serum concentration. Stimulant medication is by far the most commonly used treatment in managing children with ADHD, 10-20% of those who take such medication do now show clinically significant improvements in their primary ADHD symptom. Even when a favorable response is obtained, some children experience side effects that are of sufficient occurrence and severity to prevent continued use of stimulant medication. In such instances or when families are unwilling to consider a stimulant, non-stimulant medications may be appealing. This review focuses on etiology, assessment and treatment of ADHD with various stimulant and non-stimulant agents.