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1.  A Systematic Review on Exposure to Toxic and Essential Elements through Black Tea Consumption in Iran: Could It be a Major Risk for Human Health? 
Background:
Tea is the most popular nonalcoholic beverage worldwide. In recent years, some Iranian studies have shown the occurrence of toxic elements in fresh or dried tea leaves as well as in brewed tea. The present study aimed to ascertain the health risks associated with exposure to toxic and essential element through black tea consumption in Iran by systematically reviewing the accredited articles in the field.
Methods:
In order to obtain the relevant articles and academic databases, the search engines covering the specific disciplines were searched for the keywords, including tea, elements, heavy metals and determination. Having provided the complete list of sound articles, being conducted in Iran was considered as the inclusion criteria. Exclusion criteria were established as failure to provide information on the validity parameters and accuracy in the analytical methods. Choosing well conducted, reliable studies, analytical results for the concentration of each element in black tea were utilized in the determination of the hazard quotient (HQ) for the given element and the hazard index (HI) was then determined for all of the elements in each study.
Results:
Among the total studies, two were considered to be reliable. Aluminum was found to be the most abundant element in black tea marketed in Iran. Although the HQ for manganese was the highest among the studied elements, HQ and HI values for both toxic elements and essential elements were calculated as less than 1.
Conclusions:
The hazard of excessive element intake through black tea consumption should be considered as negligible in Iran. However, related risk for manganese appeared to be more than toxic metals.
PMCID: PMC4274540  PMID: 25538829
Black tea; risk assessment; toxic and essential elements; hazard index; hazard quotient; Iran
2.  Lack of Nephroprotective Efficacy of Althaea Officinalis Flower Extract Against Gentamicin Renal Toxicity in Male Rats 
Background:
Gentamicin (GM) is used as antibiotic for Gram-negative infections, but its administration is limited due to a side-effect of nephrotoxicity. It was attempted to investigate the effect of Althaea officinalis flower extract (AOFE) against nephrotoxicity induced by GM in male rats.
Methods:
30-year-old male Wistar rats were divided into five groups. Group 1 as a negative control group received AOFE 250 mg/kg/day. Groups 2-5 received saline, AOFE 50 mg/kg/day, AOFE 250 mg/kg/day, and AOFE 500 mg/kg/day for 9 days, respectively, and GM (100 mg/kg/day) was added from the 3rd day on. At the end of the experiment, blood samples were obtained, animals were sacrificed, and the kidneys were removed immediately.
Results:
Gentamicin (in group 2) significantly increased serum levels of blood urea nitrogen and creatinine as well as the pathological damage score (P < 0.05) when compared with group 1. Low dose of AOFE did not decrease the nephrotoxicity induced by GM while the high dose of AOFE aggravated renal toxicity (P < 0.05).
Conclusions:
Although AOFE acts as an antioxidant, at the doses used in the current study did not ameliorate nephrotoxicity induced by GM.
PMCID: PMC4274541  PMID: 25538830
Gentamicin; Althaea officinalis; nephrotoxicity; rat
3.  Tobacco use, Alcohol Consumption and Self-rated Oral Health among Nigerian Prison Officials 
Background:
The oral health condition and lifestyle in term of tobacco use and alcohol consumption of custodian of prisons have been left unstudied. The purpose of this study was to determine the prevalence of tobacco use, alcohol consumption and self-rated oral health among Nigerian prison officials.
Methods:
This cross-sectional study was conducted among prison officials working in Abuja, Nassarawa and Kano prison yards between March and June 2011 using 28-item self-administered questionnaire as a tool of data collection. The questionnaire elicited information on demography, self-rated oral health, oral health behaviors, oral health conditions, tobacco use, pattern and quit attempts, alcohol consumption, type and pattern.
Results:
The participants were aged between 20 and 51 years, with a mean age of 32.25 ± 6.13 years. The majority of the participants were males (66.4%), Christians (76.7%), junior officials (78.1%) and of Northern origin (50.7%). A total of 50 (34.2%) of the participants indicated that they were tobacco users and 39 (78.0%) indulged in cigarette smoking only. Of the study participants, 67 (45.9%) indicated they consume alcohol, beer majorly and gin rarely with 23 (34.3%) consuming it excessively. The dominant tooth cleaning device utilized by the participants was toothbrush and toothpaste, and 65 (44.5%) had visited the dentists with the majority of the visit done >5 years ago. About one-third 57 (39.0%) reported experiencing one or more forms of oral disease. However, it was only 17 (11.6%) of them that rated their oral health poor/fair, and the determinants of self-rated oral health were age, rank, and oral health condition.
Conclusions:
Data from this survey revealed that the majority of the participants rated their oral health as good/excellent. The prevalence of tobacco use and alcohol consumption among prison officials was higher than reported values among the general population in Nigeria. This indicates that more surveillance and intervention studies are needed to evaluate the best way to control tobacco use and alcohol consumption among prison officials in Nigeria.
PMCID: PMC4274542  PMID: 25538831
Alcohol; prison; smoking; self-rated oral health; tobacco
4.  Geographic Health's Way to Prevention of Diseases: A Case Study on Arsenic Spatial Dispersion and Dyspnea in Isfahan Province 
Background:
As geographic science discusses the analysis of environment, human beings and their mutual relations, thus the field of medical geography consists of being inspired from the relations between these two factors, analyzing environmental factors, their identification them and the state of their effects on human health, as well as determining the location of these factors. Some hazards that threat human health are the results of environmental factors and the relevant pollutions. Some important categories of diseases including (Shortness of Breath or, Dyspnea) have considerable differences in various places, as observed in their spatial prevalence and distribution maps.
Methods:
The record of patients with Dyspnea diseases were prepared for this descriptive research, for the period of 2009-2011, from the provincial health center, with the questionnaires were excluded patients with a family history of disease and the spatial diagram for disease prevalence was drawn according to the prepared data. The arsenic geographical distribution diagram in Isfahan province was also prepared and then the relation between an element of Arsenic in the province and the Dyspnea diseases were analyzed.
Results:
The analyses showed that the highest rate of Arsenic is entered the soil via fertilizers to come eventually into the food cycle of humans. By analyzing the amount of used fertilizers in Isfahan province and the dispersion diagram of Arsenic in Isfahan province, it was found that the highest frequency of Arsenic is in places having agricultural base. The spatial dispersion of Dyspnea diseases also showed that the spreading of Dyspnea diseases is greater in places with higher scale of Arsenic.
Conclusions:
This study is a logical justification between the two diagrams to confirm the hypothesis regarding the effect of arsenic on Dyspnea.
PMCID: PMC4274543  PMID: 25538832
Arsenic; dyspnea; Isfahan province; medical geography; spatial dispersion
5.  Conversion from Radiologically Isolated Syndrome to Multiple Sclerosis 
Background:
The aim of this study was to estimate the conversion rate from radiologically isolated syndrome (RIS) to definite multiple sclerosis (MS).
Methods:
During a mean (standard deviation [SD]) follow-up period of 17.4 (5.4) (range 8-29) months, 25 subjects with RIS and without neurological symptom aged 22-45 year from a single-center have been examined for the occurrence of definite MS. The mean (SD) age of participants was 35.1 (6.2) years at first brain magnetic resonance imaging (MRI). The definite MS were assessed using the revised McDonald's criteria (2010).
Results:
Six of 25 patients developed clinical symptom consistent with criteria for definite MS. The conversion rate from RIS to definite MS was 1.5 (95% confidence interval [CI] 0.54, 3.17) per 100 person-months based on 480 person-months of follow-up. Multivariate analysis revealed that presence of contrast-enhancing lesions on the initial MRI was marginally significantly associated with MS (hazard ratio 1.83, 95% CI 0.98, 3.45, P = 0.060).
Conclusions:
This is the first estimate of conversion rate from RIS to definite MS in Iran. The conversion rates from RIS to definite MS in these participants are high and intensive follow-up and intervention strategies are recommended for these high-risk individuals. A larger study is warranted to assess this risk in greater detail.
PMCID: PMC4274544  PMID: 25538833
Conversion rate; Iran; longitudinal study; multiple sclerosis; predictors; radiologically isolated syndrome
6.  The Effect of Neutral Oligosaccharides on Reducing the Incidence of Necrotizing Enterocolitis in Preterm infants: A Randomized Clinical Trial 
Background:
Necrotizing enterocolitis (NEC) is one of the most destructive diseases associated with conditions of neonatal prematurity. Supplementation with enteral prebiotics may reduce the incidence of NEC, especially in infants who fed exclusively with breast-milk. Therefore, we compared the efficacy and safety of enteral supplementation of a prebiotic mixture (short chain galacto-oligosaccharides/long chain fructo-oligosaccharides [SCGOS/LCFOS]) versus no intervention on incidence of NEC in preterm infants.
Methods:
In a single-center randomized control trial 75 preterm infants (birth weight [BW] ≤1500 g, gestational age ≤34 weeks and were not fed with formula) on 30 ml/kg/day volume of breast-milk were randomly allocated to have enteral supplementation with a prebiotic mixture (SCGOS/LCFOS; 9:1) or not receive any prebiotic. The incidence of suspected NEC, feeding intolerance, time to full enteral feeds, duration of hospitalization were investigated.
Results:
Differences in demographic characteristics were not statistically important. SCGOS/LCFOS mixture significantly reduced the incidence of suspected NEC, (1 [4.0%] vs. 11 [22.0%]; hazard ratio: 0.49 [95% confidence interval: 0.29-0.84]; P = 0.002), and time to full enteral feeds (11 [7-21] vs. 14 [8-36] days; P - 0.02]. Also duration of hospitalization was meaningfully shorter in the prebiotic group (16 [9-45] vs. 25 [11-80]; P - 0.004]. Prebiotic oligosaccharides were well tolerated by very low BW (VLBW) infants.
Conclusions:
Enteral supplementation with prebiotic significantly reduced the incidence of NEC in VLBW infants who were fed exclusively breast-milk. This finding suggests that it might have been the complete removal of formula which caused a synergistic effect between nonhuman neutral oligosaccharides (prebiotic) and human oligosaccharides.
PMCID: PMC4274545  PMID: 25538834
Exclusive breast feeding; necrotizing enterocolitis; oligosaccharides; prebiotic; preterm neonates
7.  Dropouts and Social Determinants of Health; Policy for the Prevention of School Dropout, Qualitative Study of the Causes and Interventions 
Background:
Indicators of the level of education are the most important parameters influencing each country's development. Social indicators considered to be a determinant of one's health consists of two constituents namely; (1) Rate of students enrolled in elementary, guidance, secondary and higher education and (2) the rate of adult literacy. This study is aimed to evaluate the situation of school dropouts in Iran, their causes, and appropriate interventions.
Methods:
Data were collected through literature review (including published researches and analysis of documents), focus group discussions with the presence of experts from (Department of Community Health, Academy of Medical Sciences) and interviews with stakeholders then these data were classified and presented in three sections namely; current situation, causes and solutions.
Results:
Results showed that Iran's current situation in terms of school dropouts is unsatisfactory in comparison to developed countries and in some countries in the region. Influencing factors for school dropouts were classified into (1) Individual factors such as intellectual disability and behavioral disorders (2) group factors such as peer groups, family problems and children's reduced interests in school and (3) major factors such as educational system and the changes of value, economic, cultural, and political issues.
Conclusions:
The present study, with the presentation of statistical documents specifically of the current problem of school dropouts in all levels of the Iranian society has been determined and aside from identifying the causes and factors affecting school dropouts, provision of strategies in three levels of prevention to combat this problem has been addressed.
PMCID: PMC4274546  PMID: 25538835
Health; school dropouts; social determinants of health
8.  Effect of Low-fat Milk Consumption Compared to Apple Juice and Water on the Energy Intake Among 10-12-Year-Old Obese Boys: A Three-way Cross-over Clinical Trial 
Background:
Appetite lowering characteristics of dairy have attracted scientists to look for its effect on energy intake particularly among children. In the present study, we tried to assess the effect of low-fat milk on total and short-term energy intake among obese boys in a randomized three-way cross-over clinical trial.
Methods:
A total of 34 obese 10-12-year-old boys were randomized to consume three beverages (low-fat milk, apple juice, or water) with a fixed energy breakfast for two consecutive days, 1 week apart. Ad libitum lunch was provided for subjects 5 h later. The energy intake from breakfast till lunch and total energy intake on intervention days, and 2 days after intervention were compared. Generalized linear model repeated measures procedure in which test beverages were considered as repeated factors.
Results:
Energy intake from breakfast till lunch was lower when low-fat milk consumption was included in the breakfast compared with water and apple juice (adjusted mean ± standard error: Low-fat milk = 1484.33 ± 15.30 Kcal, apple juice = 1543.39 ± 20.70 Kcal, water = 1606.6 ± 19.94 Kcal; P < 0.05). The energy intake on a day before interventions, total energy intake on intervention days, and 2 days after intervention was not statistically different between intervention periods (P > 0.05).
Conclusions:
One serving of low-fat milk might affect the energy intake in a short-term period. The possible effect of frequent consumption of dairy products on long-term energy intake among children is needed to be examined.
PMCID: PMC4274547  PMID: 25538836
Apple juice; children; energy intake; low-fat milk; obesity
9.  Cardiovascular Risk Factors and Nutritional Intake are not Associated with Ultrasound-defined Increased Carotid Intima Media Thickness in Individuals Without a History of Cardiovascular Events 
Background:
Carotid ultrasound appears to be useful in the assessment of cardiovascular risk. In this study, we have assessed the carotid intima-media thickness (CIMT) in a group of individuals without a history of cardiovascular events.
Methods:
A sample of 431subjects (189 [43.9%] males and 242 [56.1%] females) was obtained from an urban population using a stratified-cluster method in Mashhad stroke and heart atherosclerosis disorder study. None of the subjects had a history of the cardiovascular event. Carotid artery duplex ultrasound was used to determine the CIMT in all subjects, and to identify those with an abnormal value (CIMT [+]; i.e., CIMT ≥ 0.8 mm). Dietary intake of participants was assessed using a questionnaire for 24-h dietary recall. The relationship between anthropometric, biochemical and dietary data and CIMT were assessed.
Results:
The mean age of subjects was 48.7 ± 8.0 years. Of the 431 patients, 118 (27.4%) were found to be CIMT (+). Of the cardiovascular parameters assessed, only age (odds ratio [OR] [95% confidence interval (CI)], 1.11 [0.56-4.34]; P < 0.01) and male gender (OR [95% CI], 1.14 [0.63-2.23]; P < 0.05) were significant independent predictors of ultrasound defined CIMT. Crude and total energy adjusted intake were not associated with the presence of CIMT (+).
Conclusions:
It appears that within a relatively young Iranian population of individuals without a history of cardiovascular event, the presence of CIMT (+) defined by duplex ultrasound cut-off value of ≥0.8 mm, did not associate with several modifiable cardiovascular risk factors or measures of dietary intake.
PMCID: PMC4274548  PMID: 25538837
Carotid artery atherosclerosis; duplex ultrasound; intima-media thickness; nutritional intake; risk factors
10.  Preventive Effect of Central Administration of Venlafaxine on Morphine Physical Dependence, Nociception, and Blood Cortisol Level in Rat 
Background:
Chronic abuse of opiates induces dependency, but the neurobiological mechanisms of this event remain unclear. The aim of this study was to evaluate the effects of intracerebroventricular of venlafaxine on the morphine dependence and pain perception.
Methods:
A total of 80 adult male rats were divided into two major groups: (1) 40 of them was divided into groups of positive control (morphine dependent) negative control (received saline) and morphine dependent groups under treatment by central administration of venlafaxine at various dosages (25, 50, or 100 μg), after drug treatment total withdrawal index (TWI), latency time of withdrawal syndrome expression and blood cortisol as marker of anxiety were measured and compared with positive control and negative control. (2) Forty rats were grouped in control; indometacin treated (5 mg/kg) and grouped which received central administration of venlafaxine at three doses (25, 50, or 100 μg) and then pain perception and expression was assessed in the writhing test (acetic acid induced abdominal constriction), tail flick, and hot plate test.
Results:
Central administration of three doses (25, 50, or 100 μg,) of venlafaxine attenuates TWI to 47 ± 1.2, 38 ± 1.5, and 23 ± 1.1 and decrease blood cortisol level to 14 ± 1, 13.75 ± 0.5, and 12.5 ± 0.8, this decreases was significant in comparison with the positive control group (P < 0.05). Central administration of venlafaxine at mentioned doses significantly attenuates pain response with 37%, 24%, and 20% inhibition in writhing test, 69%, 34%, and 23% inhibition in hot plate test, and 29%, 23%, and 15% inhibition in tail flick test in comparison with control group (P < 0.05).
Conclusions:
This study suggested that central administration of venlafaxine attenuated morphine withdrawal index and can be effective in modulation of pain that was induced by morphine dependency.
PMCID: PMC4274549  PMID: 25538838
Morphine; pain; venlafaxine; withdrawal syndrome
11.  The Effect of Quality of Care on Cardiovascular Risk Factors in Newly Diagnosed Diabetic Patients 
Background:
In this study, we evaluated the quality of care and control of cardiovascular risk factors in newly diagnosed diabetic patients, identified during diabetes screening program, 1 year after diagnosis.
Methods:
In this prospective study, 83 newly diagnosed diabetic patients identified at screening in Isfahan, were studied. Height, weight, blood pressure, plasma glucose, lipids, and hemoglobin A1c (HbA1c) of these patients were measured 2 times, first at the time of diagnosis and then 1 year later, and the results were compared between two groups, with and without regular course of treatment.
Results:
Nearly 46.99% and 53.1% of the studied patients have regular and irregular course of treatment. After 1 year, significant improvement in the mean of plasma glucose, cholesterol, triglyceride, low density lipoprotein (LDL), high density lipoprotein and HbA1c was seen in patients with regular course of treatment except for blood pressure (P < 0.05). Frequency of controlled cardiovascular risk factors including fasting plasma glucose, HbA1c, cholesterol and LDL was significantly improved in patients with regular course of treatment (P < 0.05). Mentioned changes were not seen in patients with irregular course of treatment.
Conclusions:
The findings of the current study demonstrated that though diabetes screening program result in earlier diagnosis of patients with type 2 diabetes, but it seems that regular follow-up and proper management of newly diagnosed patients is crucial for appropriate glycemic and metabolic control and preventing its related micro and macrovascular complication.
PMCID: PMC4274550  PMID: 25538839
Cardiovascular disease; care; screening; type 2 diabetes
12.  Burden of Obstructive Lung Disease Study in Tehran: Research Design and Lung Spirometry Protocol 
Background:
Chronic obstructive pulmonary diseases (COPD) are planned to rank fifth in burden of disease and third with respect to mortality by 2020. Carrying out research regarding different aspects of COPD is mentioned as important health priorities by academic institutions and governments. The burden of lung disease (BOLD) Initiative was designed a decade ago to develop robust models that can be used to estimate the prevalence and current and future economic burden of COPD. The goal of the present project is to describe the prevalence and determining the causes and risk factors of COPD in the population of Tehran city.
Methods:
This cross-sectional study follows a stratified cluster sampling strategy with proportional allocation within strata. The target population is all noninstitutionalized inhabitants, aged 18-40 in one group and over 40 in another, who inhabit in Tehran city. The stratification of the sample according to the 22 municipal districts of Tehran is incorporated in the sampling process. Proportional to the number of households in the 22 districts, the appropriate number of clusters is weighted according to each district. For each cluster, a team of three members approaches the index household, which is specified through the aforementioned random selection of clusters, and continues the enumeration in 10 neighbor households in a systematic manner.
Results:
As a study protocol, there are no specific results to present; our purpose is to share our design with the scientific body.
Conclusions:
We expect that findings from the BOLD study in Tehran will show the status of COPD and its causes in the community.
PMCID: PMC4274551  PMID: 25538840
Chronic bronchitis; chronic obstructive pulmonary disease; Iran; prevalence
13.  Obstructive Sleep Apnea and Postoperative Complications in Patients Undergoing Coronary Artery Bypass Graft Surgery: A Need for Preventive Strategies 
Background:
Obstructive sleep apnea (OSA) is very frequent and often unrecognized in surgical patients. OSA is associated with perioperative complications. We evaluated the effects of OSA on postoperative complications and hospital outcomes in patients undergoing coronary artery bypass graft (CABG) surgery.
Methods:
Candidates of elective CABG were evaluated by the Berlin questionnaire for OSA. After surgery, patients were assessed for postoperative complications, re-admission to the Intensive Care Unit (ICU), duration of intubation, re-intubation, days spent in the ICU and the hospital.
Results:
We studied 61 patients who underwent CABG from which 25 (40.9%) patients had OSA. Patients with OSA had higher body mass index (29.5 ± 3.9 vs. 26.0 ± 3.7 kg/m2, P = 0.003) and higher frequency of hypertension (68.0% vs. 30.5%, P = 0.003), dyslipidemia (36.0% vs. 5.5%, P = 0.004), and pulmonary disease (16.0 vs. 2.7%, P = 0.08). Regarding the surgical outcomes, OSA patients had longer intubation duration (0.75 ± 0.60 vs. 0.41 ± 0.56 days, P = 0.03).
Conclusions:
Obstructive sleep apnea is frequent, but unrecognized among patients undergoing CABG. In these patients, OSA is associated with prolonged intubation duration. Preventing these problems may be possible by early diagnosis and management of OSA in cardiac surgery patients. Further studies with larger sample of patients and longer follow-ups are required in this regard.
PMCID: PMC4274552  PMID: 25538841
Cardiac surgery; coronary artery bypass grafting; coronary artery disease; obstructive sleep apnea
14.  New Insight into Fat, Muscle and Bone Relationship in Women: Determining the Threshold at Which Body Fat Assumes Negative Relationship with Bone Mineral Density 
Background:
The aim was to investigate the relationships among lean mass (LM), fat mass (FM), and bone mineral density (BMD) in women stratified by body mass index (BMI) (BMI – normal-weight, overweight, obese) and to determine threshold at which body fat assumes negative relationship with BMD.
Methods:
This was a cross-sectional study in 471 healthy Caucasian women, aged 18-67 years. BMD, LM, and FM were measured using dual-energy X-ray absorptiometry. Analysis of variance with Bonferroni corrections was used to test the BMI group differences. Linear regression was used to examine independent contributions of LM and FM on BMD of various skeletal sites (controlling for age and height). In overweight/obese women PROC LOESS plots were used to determine the inflection points at which either LM or FM relationship with BMD changes direction. Separate analyses in pre- and post-menopausal women were conducted as well.
Results:
Spine and femoral neck BMD were not different among three BMI groups while total body, femur and radius BMD were statistically different (the highest in the obese group). Linear regression revealed that LM had significant positive association with BMD of various skeletal sites in all groups. FM showed a negative association with BMD of femoral neck and femur in normal-weight and spine in overweight women, but a positive association with radius in obese women. Inflection points showed that body fat between 33% and 38% assumed negative relationship with BMD for most skeletal sites in overweight and obese women.
Conclusions:
Although LM has strong positive relationship with BMD, FM above 33% in overweight/obese women is negatively related to BMD of most skeletal sites. Therefore, overweight/obesity after certain amount of FM, may not be a protective factor against osteoporosis in females. For clinical practice in women, it is important to maintain LM and keep FM accrual below ~30% body fat to maintain good skeletal health.
PMCID: PMC4274553  PMID: 25538842
Body mass index; bone mineral density; fat mass; lean mass; menopause
15.  Blood Glucose and Cholesterol Concentrations in a Mediterranean Rural Population of Andros Island, Greece 
Background:
This study conducted as part of a screening program for the promotion of community health in the primary care setting of Ormos Korthi in Andros, Greece. The objective of this study was to identify the levels of glucose and total cholesterol in individuals without major cardiovascular problems in order to identify cases of undetected dyslipidemia and high blood glucose levels, in a rural population located in the southern part of Andros Island, Greece.
Methods:
In total, 242 individuals (152 women, mean age 65.1 ± 12.3 and range 33-91 years) were examined for the determination of serum glucose and total cholesterol levels. Participants were arbitrarily divided into 5 age groups and statistical differences between groups investigated.
Results:
The mean serum glucose level was 125.1 ± 42.4 mg/dl and the mean total serum cholesterol level was 225.2 ± 44.9 mg/dl. Statistical differences were not observed between the age groups in either the glucose or cholesterol levels. Difference between men and women was not significant regarding glucose levels while women had significantly elevated levels of total cholesterol (P < 0.01). Age was significantly correlated with glucose, but statistical analysis did not show significant correlation between age and total cholesterol levels.
Conclusions:
The present study confirms that dyslipidemia and high blood glucose levels are prevalent among the rural populations of Greece and therefore informative campaigns and structured screening programs are required to promote preventive health care.
PMCID: PMC4274554  PMID: 25538843
Cholesterol; glucose; Greece; Mediterranean diet; rural; screening
16.  Do Medical Students Prefer a Career in Community Medicine? 
Background:
Inadequate attention to management and institutional reforms is an important barrier to achieving universal health coverage. Skilled and motivated public health managers in adequate numbers are an important requirement to overcome this hurdle. However, what are the career choices of medical students? Are they interested in Community Medicine and Public Health? To document the career choices of MBBS students and their perceptions toward Community Medicine as a career option.
Methods:
A cross sectional survey was carried out among 226 MBBS students (III, V and VII semesters) studying in a tertiary care teaching hospital of South India during July-October 2011. A pre-tested semi-structured questionnaire was used, and information was collected on socio-demographic variables, choice of specialty and reasons for preference. Qualitative content analysis of student feedback was done by categorization and interpretation of data in terms of common themes.
Results:
Of the 226 available students, 204 (90.3%) students returned the completely filled questionnaires. Of them, 101 (49.5%) were girls. The mean (standard deviation) age of the participants was 20.13 (±1.3) years. Almost all (92.1%) wanted to pursue post-graduation in India and Internal medicine was the most preferred career choice (30.9%). The qualitative responses for opinion about Community Medicine as a career choice were interpreted under two themes; those that were favorable and those not so favorable.
Conclusions:
There is limited preference for Community Medicine as a career choice. curriculum modification and explanation of career path after post-graduation in Community Medicine will help to generate interest in the subject.
PMCID: PMC4274555  PMID: 25538844
Career choice; Community Medicine; medical education
17.  Combating Iron Deficiency Anemia among School Going Adolescent Girls in a Hilly State of North India: Effectiveness of Intermittent Versus Daily Administration of Iron Folic Acid Tablets 
Background:
National surveys in India have documented an increasing number of adolescent girls suffering from anemia. Efforts to build iron stores in adolescent girls will help them improve their prepregnancy hemoglobin level. To assess the effectiveness of school-based supervised weekly, bi–weekly, and daily regimen of iron folic tablets in the treatment of anemia among adolescent girls.
Methods:
This randomized clinical trial included 331 anemic school going adolescent girls of Shimla district of North India. Study subjects were randomized to once weekly, bi–weekly, and daily iron folic acid regimen group. An intent-to-treat approach was used to analyze the change in hemoglobin level and serum ferritin levels at the end of the trial period.
Results:
The rate of change of hemoglobin and serum ferritin levels from baseline to the end of the intervention was found to be similar in all the three groups (P = 0.64 and 0.98 for change in hemoglobin and serum ferritin). Bi-weekly treatment regimen results in comparatively more increase in hemoglobin levels (3.1 g/dl) as compared to once weekly (2.4 g/dl) and daily groups (2.3 g/dl) (ANOVA F statistics = 6.08, P = 0.003). Among the study subjects who reported side effects, more were from daily regimen group (55%) as compared to intermittent regimen group (25% in bi-weekly group; 18% in weekly group; P < 0.001).
Conclusions:
In Shimla hills of North India, school-based intermittent iron-folic acid therapy is a feasible and effective intervention for increasing hemoglobin and serum ferritin levels of anemic adolescent girls.
PMCID: PMC4274556  PMID: 25538845
Adolescent girls; anemia; intermittent; iron folic acid
21.  Rotavirus Infection in Children with Acute Gastroenteritis in Iran: A Systematic Review and Meta-analysis 
Background:
The recent studies show that Rotavirus is important cause of the acute gastroenteritis. The aim of this review is to estimate the number of Rotavirus infection among Iranian children by performing a systematic review and estimating a pooled data.
Methods:
We performed a systematic literature review in relevant databases including PUBMED, MEDLINE, OVID, SID, MAGIRAN, and IRANMEDEX. Search in databases was done in October 10, 2013. Meta-analysis was performed using the STATA statistical package version 11. We assessed heterogeneity by Q-test and used random model for pooling measures of proportion of Rotavirus infection among Iranian children with diarrhea (and 95% confidence intervals [CI]). Sub group analysis between in-patient and outpatient group were done and publication bias was assessed by Egger and Begg tests.
Results:
A total of 154 records were identified in our searching. There were 36 studies including a total of 15,368 children with diarrhea. Out of 15,368 children, 6,338 were positive for Rotavirus gastroenteritis. Overall pooled estimate of infection with Rotavirus among cases of gastroenteritis was 0.35 (95% CI, 0.28-0.41). Pooled estimates for hospitalized children and outpatient subgroups were 0.39 (95% CI, 0.30-0.48), and 0.31 (95% CI, 0.23-0.38), respectively.
Conclusions:
This study supports the importance of Rotavirus in the Iranian population such as common cause of diarrhea among children. Therefore, decision to adopt immunization programs to prevent Rotavirus infection might be helpful in Iran.
PMCID: PMC4223939  PMID: 25400878
Acute gastroenteritis; children; and diarrhea; Rotavirus infection
22.  Frequency, Causes, and Places of Unintentional Injuries in a Nationally Representative Sample of Iranian Children and Adolescents: The CASPIAN-IV Study 
Background:
This study aims to assess the frequency, causes, and places of injuries in a nationally representative sample of Iranian children and adolescents, as well as the referral, places allocated for injured individuals.
Methods:
This nationwide study was conducted in 2011-2012 among 13486 elementary, secondary and high-school students who were selected by random cluster stratified multistage sampling from 30 provinces in Iran. The Global School-based Health Survey questionnaire of the World Health Organization was used.
Results:
The study participants consisted of 50.8% boys, 75.6% urban resident with a mean age of 12.5 years. Overall, 20.25% of participants reported that they were minimally injured once in the last 12 months; this prevalence was higher in boys than in girls (25.74% vs. 14.58%, respectively, P < 0.001), without significant difference in urban (20.11%) and rural (20.69%) areas. Most of them (39.92%) were injured at homes or house yards with higher prevalence in girls than in boys (48.61% vs. 35.17%, respectively, P < 0.001) and in rural than in urban areas (27.30% vs. 20.89%, respectively, P < 0.001). Schools were reported as the second prevalent site of injury occurrence (22.50%). Emergency departments and physician offices were the most prevalent referral places for injured individuals (32.31% and 22.38%, respectively). Most of the school injuries occurred during play or sport activities (45.92%).
Conclusions:
Prevention of unintentional injuries should be considered as a health priority. Appropriate preventive strategies should be enhanced at homes and schools.
PMCID: PMC4223940  PMID: 25400879
Adolescents; children; injuries; Iran; prevention
23.  Human Herpesvirus-6 and Epstein–Barr Virus Infections at Different Histopathological Grades of Oral Squamous Cell Carcinomas 
Background:
The aim of this study was to determine the prevalence and viral load of Epstein–Barr virus (EBV) and Human herpesvirus-6 (HHV-6) in different histopathologic grades of oral squamous cell carcinoma (OSCC).
Methods:
Forty-five formalin-fixed paraffin-embedded tissue section of OSCC patients were analyzed by quantitative real-time polymerase chain reaction for detection of EBV and HHV-6.
Results:
The mean age of the patients was 58.6 years, 69% of whom were female, and 31% were male. Overall, the positive rate for EBV and HHV-6 were 16.7% and 27.1%, respectively; and the mean viral load EBV was 27.9 × 103 and 38.5 × 103 for HHV-6. No correlation was demonstrated between the viral load of EBV DNA (P = 0.35) and HHV-6 (P = 0.38) at the different OSCC histopathologic grades.
Conclusions:
These findings neither lend support to the hypothesis that EBV and HHV-6 are directly involved in OSCC nor rule out the possibility that these viruses play an indirect role in carcinogenesis in this area.
PMCID: PMC4223941  PMID: 25400880
Epstein–Barr virus; herpesvirus-6; infection; oral cancer
24.  The Effects of Probiotic Supplementation on Markers of Blood Lipids, and Blood Pressure in Patients with Prediabetes: A Randomized Clinical Trial 
Background:
Prediabetes is a high-risk condition for type 2 diabetes mellitus. The growing prevalence of diabetes emphasizes on the necessity of concentrating on various strategies to prediabetes prevention and management. Probiotics as a group of functional foods might exert antidiabetic effects. This study aimed to assess the effects of probiotic administration on blood lipid profile and blood pressure in patients with prediabetes.
Methods:
This randomized controlled trial consisted of 60 prediabetic patients, aged 25-65 years old, that were randomly assigned to the intervention (receiving 500 mg probiotic capsules, n = 30) or control group (receiving placebo, n = 30) for 8-week period. Demographic and anthropometric data were collected at baseline. Blood samples were collected at baseline and after 8 weeks for biochemical measurements. Blood pressure was measured at the baseline an after 8 weeks of intervention. Data regarding dietary intakes and physical activity were also collected during the study. We used SPSS software version 16 (SPSS Inc. Chicago, USA) for data analyzing.
Results:
Probiotic supplementation did not contribute to significant changes in total cholesterol, low-density lipoprotein (LDL)-cholesterol, high-density lipoprotein (HDL)-cholesterol, Triglycerides (TG), TG/LDL and LDL/HDL ratios, after 8 weeks. After adjusting for potential confounders, HDL-cholesterol reduced significantly in the placebo group compared with probiotic group. Percent change in systolic blood pressure was significantly different in the probiotic group in comparison with a placebo group (–3.10 ± 2.22 vs. 3.24 ± 1.96, P = 0.01), although this significance did not exist anymore after adjusting for confounders (P > 0.05).
Conclusions:
Our study showed that probiotics did not have significant effects on lipid markers although they had positive effects on systolic blood pressure.
PMCID: PMC4223942  PMID: 25400881
Blood pressure; lipid; prediabetes; probiotic
25.  Effect of Educational Intervention on Self-efficacy for Choosing Delivery Method among Pregnant Women in 2013 
Background:
Nowadays, there has been a growing trend of caesarean sections in Iran. One reason would be the mother's desire. Increased maternal self-efficacy can be an important step to reduce percentage of cesarean. This study aimed to determine the effectiveness of training-based strategies to increase the self-efficacy for choosing delivery method among pregnant women in Shahrekord city.
Methods:
This quasi-experimental study was conducted on 130 pregnant women who attended urban health centers in Shahrekord city in 2013. Intervention was applied in the experimental group in three sessions in about 60-90 min while control group did not receive any intervention. Fear of childbirth and self-efficacy questionnaire was completed before and after training.
Results:
While mean scores of the fear of childbirth, expectations and childbirth self-efficacy before the intervention between the two groups were not significantly different (P > 0.05), mean scores of childbirth in intervention group was reduced and expectation and childbirth self-efficacy had a significant increase after intervention (P < 0.05). In this study, 71.4% of mothers in intervention group and 53.8% of control mothers naturally delivered their children. Most of intervention group mothers desired to deliver through cesarean and had more fear (P < 0.001) but lower childbirth expectation (P > 0.05) and self-efficacy (P < 0.001) than those who chose normal method.
Conclusions:
Our findings showed that training-based self-efficacy procedure has been effective in encouraging mothers to choose natural childbirth. Therefore, the design and implementation of curriculum-based strategies for increasing self-efficacy is suggested for pregnant women.
PMCID: PMC4223943  PMID: 25400882
Cesarean delivery; efficacy; elective cesarean; natural delivery

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