The evaluation of breakfast intake pattern and short-term memory status in junior secondary school students in Shiraz 2007

زمینه و هدف: یادگیری، حافظه و پیشرفت تحصیلی کودکان در مدرسه تحت تاثیر عوامل مختلف تغذیه ای و از جمله صبحانه قرار دارند. مواد مغذی اعم از ویتامین های نیاسین (B3)، فولیک اسید (B9)، کوبالامین (B12)، آهن، ید و غیره بر حافظه کوتاه مدت موثرند. از آنجا که صبحانه از عادات مطلوبی است که بر حافظه کودکان موثراست. لذا این مطالعه با هدف بررسی الگوی صبحانه دریافتی و وضعیت حافظه کوتاه مدت دختران دانش آموزان مدارس راهنمایی شهر شیراز صورت گرفت. روش بررسی: در این مطالعه توصیفی-تحلیلی 150 نفر از دختران دانش آموز مدارس راهنمایی شیراز به روش تصادفی چند مرحله ای انتخاب شدند. اطلاعات دموگرافیک اجتماعی-اقتصادی با پرسشنامه والگوی صبحانه با پرسشنامه بسامد و یادآمد صبحانه 3 روزه جمع آوری و از هر فرد یک تست حافظه وکسلر به عمل آمد. داده ها با استفاده از آزمون های آماری همبستگی پیرسون و ANOVA تجزیه و تحلیل شد. یافته ها: بین شغل و تحصیلات والدین، وضعیت تحصیلی، سن و حافظه‌ رابطه‌ معنی داری وجود نداشت. طی بررسی تغذیه ای بین مصرف پیریدوکسین (ویتامینB6 )، B12، ید، کالری، پروتیین، چربی یا کلسترول و نمره ی حافظه رابطه‌ی معنی داری وجود نداشت (05/0P>)، اما بین مصرف ویتامین B3، کربوهیدرات و آهن در صبحانه و نمره ی حافظه رابطه ی معنی دار و همبستگی از نوع مستقیم وجود داشت (05/0

Medical and Dental Students' Attitudes toward Their Study Field before and after Experiencing Clinical Practice in Kerman University of Medical Sciences, Iran

Background & Objective: Learning environment should be opportunities for positive change in students' attitude to encourage them and create more interest, leading to sustainable learning. To make constructive changes, having information on the current status and about students' attitudes toward their discipline is essential. This study was designed to assess the medical and dental students' attitude toward their study field (learning environment, practicability, attraction, social rank, and future employment) before and after experiencing clinical practice in Kerman University of Medical Sciences, Iran. Methods: This cross-sectional analytic study was conducted in 2012. The study population were 95 medical and dental students of Kerman University of Medical Sciences, as census of students. A researcher-made questionnaire was designed consisting 33 questions in five areas of the components of medical education and health care (education environment, applicability of the course, the attractiveness of the field, career and social status). Data were analyzed using paired t, ANOVA, and Mann-Whitney U tests via SPSS software. Results: There were significant differences between the medical students' attitude toward educational environment and practicability of the field before and after experiencing clinical practice; but there was no significant difference between their attitude toward attraction, future employment, and social rank of the field. On the other hand, there were significant differences between dental students' attitudes toward educational environment and future employment before and after experiencing clinical practice; but there was no significant difference between their attitudes toward practicability, attraction and social rank of the field. In addition, there was no significant difference between the two groups based on gender and age. Conclusion: The results showed significant differences only in three educational components between two groups of students. According to obtained data, short- and long-time plans could be designed for increasing the efficiency of education, improving educational structure, and obtaining welfare and economical possibilities for students. Key Words: Major, Education, Attitude, Medical, Dental, Students, Clinical course

Idiopathic Hirsutism and Insulin Resistance

Background and Objectives. Polycystic ovary syndrome (PCOS) and idiopathic hirsutism (HI) are the two most common causes of hirsutism. Insulin resistance plays a key role in PCOS, but there are not enough data showing that patients with HI also have insulin resistance. This study was designed to evaluate the presence of insulin resistance in women with HI. Methods. Based on a cross-sectional study, two groups of age-BMI matched, hirsute women were compared to age-BMI matched, nonhirsute women. Sixty nonobese women with PCOS, thirty nonobese women with HI, and sixty nonobese control women were included in the study. Samples of hormones including androgens were measured. Insulin resistance based on homeostasis model assessment of insulin resistance (HOMA-IR) was compared between three groups by the Kruskal-Wallis test. Results. Patients with PCOS had significantly higher basal insulin level (16.04±1.4 versus 7.32±6.85 μIu/mL) and HOMA-IR score (3.7±3.36 versus 1.75±1.67) than patients with HI (P  0.001). Patients with HI also had significantly higher basal insulin level and HOMA-IR score than control group (P  0.001). Conclusion. Our data suggest that both PCOS and HI are associated with insulin resistance and these patients are more insulin resistant than healthy control people

Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017

A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of <5% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8–38.5) million) in 2000 to 6.0% (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950-2019 : a comprehensive demographic analysis for the Global Burden of Disease Study 2019

Background: Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019. Methods: 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10–14 and 50–54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. Findings: The global TFR decreased from 2·72 (95% uncertainty interval [UI] 2·66–2·79) in 2000 to 2·31 (2·17–2·46) in 2019. Global annual livebirths increased from 134·5 million (131·5–137·8) in 2000 to a peak of 139·6 million (133·0–146·9) in 2016. Global livebirths then declined to 135·3 million (127·2–144·1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2·1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27·1% (95% UI 26·4–27·8) of global livebirths. Global life expectancy at birth increased from 67·2 years (95% UI 66·8–67·6) in 2000 to 73·5 years (72·8–74·3) in 2019. The total number of deaths increased from 50·7 million (49·5–51·9) in 2000 to 56·5 million (53·7–59·2) in 2019. Under-5 deaths declined from 9·6 million (9·1–10·3) in 2000 to 5·0 million (4·3–6·0) in 2019. Global population increased by 25·7%, from 6·2 billion (6·0–6·3) in 2000 to 7·7 billion (7·5–8·0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58·6 years (56·1–60·8) in 2000 to 63·5 years (60·8–66·1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019

The effect of vitamin D on insulin resistance in patients with type 2 diabetes

Abstract Introduction Over the past decade, numerous non-skeletal diseases have been reported to be associated with vitamin D deficiency including type2 diabetes mellitus (T2DM). Different studies provide evidence that vitamin D may play a functional role in glucose tolerance through its effects on insulin secretion and insulin sensitivity. This study evaluates the effects of vitamin D supplementation on insulin resistance in T2DM. Method Through a before-after study, 100 patients with T2DM, 30–70 years old, were recruited from an Arak diabetes clinic as consecutive attenders. Participants were assessed for clinical and biochemistry. Serum insulin and, 25(OH)D concentration, and HOMA-IR was calculated. All measurements were performed at the beginning and the end of the study. Patients received 50,000 unit of vitamin D3 orally per week for eight weeks, Statistical analysis was made using SPSS17. The results were analyzed by descriptive tests, and a comparison between variables were made using paired T-tests or Wilcoxon tests, as appropriate. Results 100 participants including 70 women (70%) and 30 men (30%) took part in the study. All results were presented as Mean±SD, or medians of non-normally distributed. 24% of the participants were Vitamin D deficient {serum 25(OH)D ≤ 20 ng/ml(50 nmol/l)}. Mean serum 25 (OH) D concentration was 43.03± 19.28 ng/ml (107.5±48.2 nmol/l). The results at baseline and at the end, for FPG were 138.48±36.74 and 131.02±39 mg/dl (P=0.05), for insulin, 10.76±9.46 and 8.6±8.25 μIu/ml (P=0.028) and for HOMA-IR, 3.57±3.18 and 2.89±3.28 (P=0.008) respectively. Conclusion Our data showed significant improvements in serum FPG, insulin and in HOMA-IR after treatment with vitamin D, suggested that vitamin D supplementation could reduce insulin resistance in T2DM.</p

The Effect of Motivational Interview on Puberty Knowledge and Practice among Adolescent Girls

Background: Adolescence is a critical stage of life with a significant role in reproduction and fertility. Interventions are needed to promote the health of adolescent girls as prospective mothers. Objectives: This study aimed to investigate the effects of motivational interviewing on adolescent girls' puberty knowledge and practice. Methods: This quasi-experimental study was conducted in 2018 on 240 eighth-grade female students recruited through multistage sampling from ten high schools in Shahroud, Iran. Schools were allocated into an intervention group and a control group through simple randomization. Participants in the intervention group received a five-session puberty-related motivational interviewing intervention. Puberty knowledge and practice in both groups were assessed before, immediately after, and 1 month after the intervention. Data were analyzed through the Chi-square and the independent-samples t-tests and the repeated-measures analysis of variance. Results: Participants' age was 14.47 ± 0.51 years, on average. About 70 of them had poor or moderate puberty knowledge. Although there was no statistically significant between-group difference respecting the mean scores of puberty knowledge and practice at pretest (P> 0.05), the mean scores of puberty knowledge and practice in the intervention group were significantly higher than the control group at both posttests (P = 0.001). Conclusion: Motivational interviewing is effective in improving adolescent girls' puberty knowledge and practice

VEGF delivery by smart polymeric PNIPAM nanoparticles affects both osteogenic and angiogenic capacities of human bone marrow stem cells

Objective: Bone tissue engineering (BTE) faces a major challenge with cell viability after implantation of a construct due to lack of functional vasculature within the implant. Human bone marrow derived mesenchymal stem cells (hBMSCs) have the potential to undergo transdifferentiation towards an endothelial cell phenotype, which may be appropriate for BTE in conjunction with the appropriate scaffolds and microenvironment. Hypothesis and methods: We hypothesized that slow delivery of vascular endothelial growth factor (VEGF) by using nanoparticles in combination with osteogenic stimuli might enhance both osteogenic and angiogenic differentiation of angiogenic primed hBMSCs cultured in an osteogenic microenvironment. Therefore, we developed a new strategy to enhance vascularization in BTE in vitro by synthesis of smart temperature sensitive poly(N‑isopropylacrylamide) (PNIPAM) nanoparticles. We used PNIPAM nanoparticles loaded with collagen to investigate their ability to deliver VEGF for both angiogenic and osteogenic differentiation. Results: We used the free radical polymerization technique to synthesize PNIPAM nanoparticles, which had particle sizes of approximately 100 nm at 37 °C and LCST of 30–32 °C. The cumulative VEGF release after 72 h for VEGF loaded PNIPAM (VEGF-PNIPAM) nanoparticles was 70%; for VEGF-PNIPAM loaded collagen hydrogels, it was 23%, which indicated slower release of VEGF in the VEGF-PNIPAM loaded collagen system. Immunocytochemistry (ICC) and inverted microscope visualization confirmed endothelial differentiation and capillary-like tube formation in the osteogenic culture medium after 14 days. Quantitative real-time polymerase chain reaction (QRT-PCR) also confirmed expressions of collagen type I (Col I), runt-related transcription factor 2 (RUNX2), and osteocalcin (OCN) osteogenic markers along with expressions of platelet-endothelial cell adhesion molecule-1 (CD31), von Willebrand factor (vWF), and kinase insert domain receptor (KDR) angiogenic markers. Our data clearly showed that VEGF released from PNIPAM nanoparticles and VEGF-PNIPAM loaded collagen hydrogel could significantly contribute to the quality of engineered bone tissue

Comparing the Effectiveness of the Transcranial Alternating Current Stimulation (TACS) and Ritalin on Symptoms of Attention Deficit Hyperactivity Disorder in 7-14-Year-Old Children

Several studies have been conducted on the effect of transcranial direct current stimulation on adult patients. But, in recent years, only a few studies have been carried out in children and teenagers because the aim of the present study was to compare the effectiveness of TACS and Ritalin in the treatment of attention deficit hyperactivity disorder (ADHD) symptoms. This interventional clinical trial study was performed on 62 children with ADHD who were referred to the private psychiatric clinic of children in Tehran. The children were randomly assigned to two coded groups based on a lottery so that they were enrolled in the TACS or the Ritalin group. A questionnaire child syndrome inventory (parental form) and integrated visual and auditory (IVA) test with a pretest and posttest design was used in this study. TACS therapy protocol was employed (3 days a week for eight weeks using alternating current stimulation at 10 Hz over two points on the prefrontal cortex: the anode centered over F3 [the left dorsolateral prefrontal cortex] and the cathode over F4[the right dorsolateral prefrontal cortex]). Results showed that the posttest scores of the TACS-treated group were higher than those of the Ritalin-treated group, and there was a significant difference between the areas of visual attention (visual vigilance, visual focus, Sustained attention visual) and response control visual and auditory prudence (P<0.05). Results indicated that TACS was more effective and more durable compared to Ritalin in reducing attention deficit, hyperactivity, and impulsivity.