Barriers to physical activity in the Iranian population: findings from the STEPwise surveillance 2021.

BACKGROUND: Physical inactivity is a critical predictor of all-cause mortality and many non-communicable diseases (NCD) including coronary heart disease, diabetes, hypertension, dementia, and several cancers. The main objective of this study was to determine the main barriers to physical activity based on the STEPwise Surveillance in Iran in 2021, to guide policymakers in developing the most effective physical activity increasing strategies. METHODS: This cross-sectional study was conducted on 27,515 female and male individuals aged over 18 years from the STEPwise Surveillance 2021. The barriers to physical activity according to the modified version of barriers questionnaire and intrapersonal, interpersonal, economic, cultural, and environmental domains based on social-ecological models were determined. Association between barriers domain and physical activity level was assessed. RESULTS: Lack of time due to job commitments (31.4%) and family (19.3%) and inappropriate physical conditions including illness, pain, injury, disability, and fatigue (30.4%) were the most frequent barriers to physical activity. Interest in sedentary leisure time activities including virtual space, computer games and watching TV were the next frequent barriers to physical activity (10.01%). Intrapersonal domain had the highest frequency (62.9%) and cultural domain had the lowest frequency (2.3%). Intrapersonal and interpersonal barriers reduced the odds of engaging in physical activity (OR: 0.62, P value < 0.001, OR: 0.76, P value < 0.001). CONCLUSION: Intra- and inter-personal domain barriers might reduce the odds of being active. Developing action plans addressing these factors is suggested to increase physical activity levels.

A Comprehensive Evaluation of Spine Kinematics, Kinetics, and Trunk Muscle Activities During Fatigue-Induced Repetitive Lifting.

OBJECTIVE: Spine kinematics, kinetics, and trunk muscle activities were evaluated during different stages of a fatigue-induced symmetric lifting task over time. BACKGROUND: Due to neuromuscular adaptations, postural behaviors of workers during lifting tasks are affected by fatigue. Comprehensive aspects of these adaptations remain to be investigated. METHOD: Eighteen volunteers repeatedly lifted a box until perceived exhaustion. Body center of mass (CoM), trunk and box kinematics, and feet center of pressure (CoP) were estimated by a motion capture system and force-plate. Electromyographic (EMG) signals of trunk/abdominal muscles were assessed using linear and nonlinear approaches. The L5-S1 compressive force (Fc) was predicted via a biomechanical model. A two-way multivariate analysis of variance (MANOVA) was performed to examine the effects of five blocks of lifting cycle (C1 to C5) and lifting trial (T1 to T5), as independent variables, on kinematic, kinetic, and EMG-related measures. RESULTS: Significant effects of lifting trial blocks were found for CoM and CoP shift in the anterior-posterior direction (respectively p < .001 and p = .014), trunk angle (p = .004), vertical box displacement (p < .001), and Fc (p = .005). EMG parameters indicated muscular fatigue with the extent of changes being muscle-specific. CONCLUSION: Results emphasized variations in most kinematics/kinetics, and EMG-based indices, which further provided insight into the lifting behavior adaptations under dynamic fatiguing conditions. APPLICATION: Movement and muscle-related variables, to a large extent, determine the magnitude of spinal loading, which is associated with low back pain.

Looking at time dependent differentiation of mesenchymal stem cells by culture media using MALDI-TOF-MS.

Mesenchymal stem cells (MSCs) are multipotent cells which are popular in human regenerative medicine. These cells can renew themselves and differentiate into several specialized cell types including osteoblasts, adipocytes, and chondrocytes under physiological and experimental conditions. MSCs can secret a lot of components including proteins and metabolites. These components have significant effects on their surrounding cells and also can be used to characterize them. This characterization of multipotent MSCs plays a critical role in their therapeutic potential. The metabolic profile of culture media verified by applying matrix-assisted laser desorption and ionization time-of-flight mass spectrometry (MALDI-TOF-MS) techniques. Also, the differentiation and development of MSCs have monitored through culture media metabolome or secretome (secreted metabolites). Totally, 24 potential metabolites were identified. Between them 12 metabolites are unique to BM-MSCs and 5 metabolites are unique to AD-MSCs. Trilineage differentiation including chondrocytes, osteoblasts, and adipocytes, as well as metabolites that are being differentiated, have been shown in different weeks. In the present study, the therapeutic effects of MSCs analyzed by decoding the metabolome for MSCs secretome via metabolic profiling using MALDI-TOF-MS techniques.

Indicators for Internationalization of Medical Universities: A Scoping Review.

Background: The internationalization of universities allows the exchange of knowledge, experiences, attitudes, and cultures across geographical borders, which leads to benefits such as visibility, human resource development, quality improvement and revenue generation for universities. Therefore, the assessment of universities is very important in terms of internationalization. The purpose of this study was to identify the indicators of internationalization assessment for medical universities in a logical framework. Methods: The reporting of this scoping review conforms to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Review checklist (PRISMA- ScR). Articles were retrieved through the search of related keywords in databases including Web of Science, PubMed, Scopus, Science Direct, and Google Scholar from January 2000 to October 2021 and by searching the references of retrieved articles. After applying the inclusion criteria, 36 papers were selected from a total of 1264. Data analysis is underpinned by the Ritchie and Spencer five-step framework. Results: 102 indicators have been identified and organized in the framework of IPO, which has provided input, process and output indicators in the educational, research, and management dimensions. Most indicators have been classified in the "Education" dimension (n=40) which consists of 6 inputs, 14 processes and 20 Outputs. The "Research" dimension consists of 3 inputs, 9 processes and 12 Outputs, and the "Management" dimension consists of 13 inputs, 16 processes and 9 Outputs. Conclusion: There is no single set of target indicators for the internationalization of all medical universities. Therefore, the selection of target indicators for medical universities to proceed toward internationalization depends on the strengths and weaknesses of universities in each dimension, as well as the feasibility of further ambition according to the national context. Also, the identified indicators are mainly in the four areas of facilities management, visibility, marketing, and networking.

Correction to: Comparison of cervical sagittal parameters among patients with neck pain and healthy controls: a comparative cross-sectional study.

Unfortunately, the affiliation of the second author (Jean Charles Le Huec) was incorrectly published in the original publication.

Comparison of cervical sagittal parameters among patients with neck pain and healthy controls: a comparative cross-sectional study.

INTRODUCTION: Previous studies have shown poor health-related outcomes among patients with spinal sagittal malalignment of the thoracolumbar or spinopelvic region, and less interest has been paid to the relationship between cervical sagittal balance and functional outcome of the patients. This study aims to compare the cervical sagittal parameters between patients with non-specific neck pain and asymptomatic controls. METHOD: Twenty-five patients (21 females/4 males) with non-specific neck pain and 25 age-, sex- and BMI-matched controls (18 females/7 males) participated in the study. Using a standard lateral cervical radiography, the Cobb angle between occiput-C2, C1-C2, C1-C7 and C2-C7 as well as the thoracic inlet angle (TIA) and C7 and T1 slope angles was measured. Also the spine cranial angle (SCA) and the C2-SVA (sacral vertical axis) and C1-SVA were measured. The primary outcome measure of the study was comparison of the sagittal balance variables between the patients and the healthy controls. Secondary outcome measures were correlation between pain intensity of the patients in neck pain group and their demographic and radiographic findings. Data analysis was performed using independent sample T test and Pearson's correlation for primary and secondary outcome measurements, respectively. RESULTS: There was no difference in cervical lordosis curvature (measured by C2-C7 and C1-C7 lordosis angle) between patients with non-specific NP and healthy controls (P value = 0.45 and 0.37, respectively). We found that T1 slope angle was significantly (P value = 0.02) lower in patients with neck pain. CONCLUSION: Our findings showed that the slope of the upper endplate of T1 vertebrae body (T1 slope) is significantly lower among patients with non-specific neck pain compared to controls. A compensatory mechanism to bring the center of head gravity back to the spinal axis might be the possible explanation for this difference. These slides can be retrieved under Electronic Supplementary Material.

Does Immediate Pain Relief After an Injection into the Sacroiliac Joint with Anesthetic and Corticosteroid Predict Subsequent Pain Relief?

Objectives: To determine if immediate pain response following an injection with local anesthetic and corticosteroid predicts subsequent relief. Design: Prospective observational cohort. Setting: An institutional review board-approved prospective study from a single academic medical center. Methods: Patients with clinical diagnosis of sacroiliac (SIJ) pain and referred for SIJ injection were enrolled; 1 cc of 2% lidocaine and 1 cc of triamcinolone 40 mg/mL were injected into the SIJ. Pain score on 0-10 numeric rating scale (NRS) during provocation maneuvers was recorded immediately before injection, immediately after injection, and at two and four weeks of follow-up. Oswestry Disability Index (ODI) was also recorded. Results: Various cutoffs were identified to establish positive anesthetic response and successful outcomes at follow-up. These were used to calculated likelihood ratios. Of those with 100% anesthetic response, six of 11 (54.5%, 95% confidence interval [CI]+/-29.4%, +LR 2.6, 95% CI = 1.1-5.9) demonstrated 50% or greater pain relief at follow-up, and four of 11 (36.5%, 95% CI+/-28.4%, +LR 3.00, 95% CI = 1.4-5.1) had 100% relief at two to four weeks. Fourteen of 14 (100%, 95% CI+/-21.5%, -LR 0.0, 95% CI = 0.0-2.1) with an initial negative block failed to achieve 100% relief at follow-up. Conclusions: Patients who fail to achieve initial relief after SIJ injection with anesthetic and steroid are very unlikely to achieve significant pain relief at follow-up; negative likelihood ratios (LR) in this study, based on how success is defined, range between 0 and 0.9. Clinically significant positive likelihood ratios of anesthetic response to SIJ injection are more limited and less robust, but are valuable in predicting 50% relief or 100% relief at two to four weeks.

Reliability and Validity of Athletes Disability Index Questionnaire.

OBJECTIVE: The purpose of this study was to evaluate validity and reliability of a new proposed questionnaire for assessment of functional disability in athletes with low back pain (LBP). DESIGN: Validity and reliability study. SETTING: Elite athletes participating in different fields of sports. PARTICIPANTS: Participants were 165 male and female athletes (between 12 and 50 years old) with LBP. INTERVENTIONS: Athlete Disability Index (ADI) Questionnaire which is developed by the authors for assessing LBP-related disability in athletes, Oswestry Disability Index (ODI), and the Roland-Morris Disability Questionnaire (RDQ). MAIN OUTCOME MEASURES: Self-reported responses were collected regarding LBP-related disability through ADI, ODI, and RDQ. RESULTS: The test-retest reliability was strong, and intraclass correlation value ranged between 0.74 and 0.94. The Cronbach alpha coefficient value of 0.91 (P < 0.001) demonstrated excellent internal consistency of the questionnaire. The correlation coefficient between ADI and ODI was r = 0.918 (P < 0.0001), between ADI and RDQ was r = 0.669 (P < 0.0001), and between ADI and visual analog scale was r = 0.626 (P < 0.001). According to ODI and RDQ, disability levels were mild in the large majority of subjects (91.5% and 86.0%, respectively). Alternatively, disability assessments by the ADI did not cluster at the mild level and ranged more broadly from mild to very high. CONCLUSION: The ADI is a reliable and valid instrument for assessing disability in athletes with LBP. Compared with the available LBP disability questionnaires used in the general population, ADI can more precisely stratify the disability levels of athletes due to LBP.

The Epidemiology of Migraine Headache in General Population of Tehran, Iran.

BACKGROUND: Migraine as one of the most common types of headache is known to cause serious intervention with routine activities of affected individuals due to the devastating nature of attacks. The aim of this study was to provide epidemiological data of migraine in Iranian general population. METHODS: In this cross-sectional general population study, migraine diagnoses (both episodic and chronic) were based on the International Classification of Headache Disorders. Face-to-face interviews were performed by 5 trained medical interns on a sample size of 2,300 people aged 12-65 years. RESULTS: A total number of 2,076 subjects were enrolled for final analysis. The mean age of the subjects at the time of the study was 36.27 ± 14.56 years (age range 12-65 years). The 1-year prevalence of migraine was 27.6%. The prevalence of migraine among female subjects was significantly higher than among male subjects (36.7 vs. 21.6%, p < 0.001). The mean age of the subjects with migraine was 35.9 ± 12.96 years. Totally, 49.9% of migraine sufferers experienced at least one episode of aura. The most prevalent type of aura was numbness reported in 32.4% of migraine subjects. CONCLUSIONS: Despite the higher prevalence of migraine among Iranian general population compared to most of the other populations investigated by previous studies, these individuals experience a less severe course of disease.

Low back pain status of female university students in relation to different sport activities.

PURPOSE: To investigate the prevalence of low back pain (LBP) and its absence rate among female university student athletes in different types of sports. METHODS: A cross-sectional study based on a standard self-reporting questionnaire was performed among 1335 athletes. Participants were female athletes who attended the National Sports Olympiad of Female University Students in basketball, volleyball, futsal, tennis, badminton, swimming, track and field, shooting, and karate. RESULTS: One thousand and fifty-nine athletes with the mean (SD) age of 23.1 (3.8) years responded to the questionnaire (response rate 79%). The 12-month prevalence of LBP was 39.0%; in addition, lifetime and point prevalence of LBP were 59.7 and 17.8%, respectively. Basketball (47.9 %) and karate (44.0 %) players had reported the highest 12-month prevalence of LBP. Also, LBP prevalences in shooting (29.7 %) and badminton (42.4 %) players were not negligible. Results show that, LBP led to relatively high absence rate from training sessions (27.9%) and matches (13.0%). CONCLUSION: While most of the existing literatures regarding female athletes' LBP have focused on particular sports with specific low back demands (such as skiing and rowing), many other sports have not been studied very well in this regard. Investigating LBP prevalence and related factors in other types of sports, such as combat sports, badminton and shooting, can help us better understand the prevalence of low back pain and provide us with necessary insight to take effective steps towards its prevention in athletes.

Cross-cultural adaptation and validation of Persian Achilles tendon Total Rupture Score.

PURPOSE: To cross-culturally adapt the Achilles tendon Total Rupture Score (ATRS) to Persian language and to preliminary evaluate the reliability and validity of a Persian ATRS. METHODS: A cross-sectional and prospective cohort study was conducted to translate and cross-culturally adapt the ATRS to Persian language (ATRS-Persian) following steps described in guidelines. Thirty patients with total Achilles tendon rupture and 30 healthy subjects participated in this study. Psychometric properties of floor/ceiling effects (responsiveness), internal consistency reliability, test-retest reliability, standard error of measurement (SEM), smallest detectable change (SDC), construct validity, and discriminant validity were tested. Factor analysis was performed to determine the ATRS-Persian structure. RESULTS: There were no floor or ceiling effects that indicate the content and responsiveness of ATRS-Persian. Internal consistency was high (Cronbach's α 0.95). Item-total correlations exceeded acceptable standard of 0.3 for the all items (0.58-0.95). The test-retest reliability was excellent [(ICC)agreement 0.98]. SEM and SDC were 3.57 and 9.9, respectively. Construct validity was supported by a significant correlation between the ATRS-Persian total score and the Persian Foot and Ankle Outcome Score (PFAOS) total score and PFAOS subscales (r = 0.55-0.83). The ATRS-Persian significantly discriminated between patients and healthy subjects. Explanatory factor analysis revealed 1 component. CONCLUSION: The ATRS was cross-culturally adapted to Persian and demonstrated to be a reliable and valid instrument to measure functional outcomes in Persian patients with Achilles tendon rupture. LEVEL OF EVIDENCE: II.

Reliability and validity of the Persian adaptation of the Core Outcome Measure Index in patients with chronic low back pain.

BACKGROUND: The purpose of the study was to determine whether the Persian Core Outcome Measures Index (PCOMI) is reliable and valid in patients with chronic low back pain (CLBP). METHODS: The Persian COMI was developed using forward-backward translational method. Subjects were100 patients with CLBP. Patients completed the PCOMI, Persian functional rating index, and visual analog scale. Fifty patients completed the PCOMI for the second time after 7days to evaluate test-retest reliability. Fifty healthy subjects participated to assess discriminant validity. RESULTS: There was no ceiling or floor effect. Cronbach's alpha was 0.85. The construct validity coefficient was 0.72. The ICCagreement for test-retest reliability was 0.86. Pearson correlation for criterion validity was 0.70. The PCOMI discriminated between patients and healthy subjects. The standard error of measurement and the smallest detectable change was 0.75 and 2.1, respectively. Factor analysis extracted 1 component. CONCLUSIONS: The results support the reliability and validity of the PCOMI for assessing patients with CLBP.

The Epidemiology of Exertional Headache in the General Population of Tehran, Iran.

OBJECTIVE: In this cross-sectional study, we investigated the prevalence and characteristics of primary exertional headache (EH) among the Iranian general population living in Tehran, the capital city of the country. BACKGROUND: Headache is the most common complaint and is listed in the top 10 most disabling conditions. Epidemiological researches on headache can demonstrate its actual burden. There are still limited data on EH, especially in Iran and the Middle East. METHODS: A Persian questionnaire was designed based on the International Headache Society (IHS) criteria of headache disorders (ICHD-II). Face-to-face interviews were performed by 5 trained medical interns on a sample size of 2300 people. RESULTS: Data for a total number of 2076 subjects were enrolled for final analysis. The mean age of the subjects at the time of the study was 36.3 ± 14.6 years. The 1-year prevalence of EH was 7.3% (95% confidence interval [CI]: 6.2-8.4%). The prevalence of EH was significantly higher in females compared to males (10.0% vs 5.4%, P < .001). The mean age of the subjects with EH was 32 ± 12.1 years. None of our EH patients received medical consult prior to the study. CONCLUSION: EH seems to be less prevalent among the Iranian population compared to previous studies.

Effect of abdominal resistance exercise on abdominal subcutaneous fat of obese women: a randomized controlled trial using ultrasound imaging assessments.

OBJECTIVES: The aim of this study was to compare the effect of diet and an abdominal resistance training program to diet alone on abdominal subcutaneous fat thickness and waist circumference of overweight and obese women. METHODS: This randomized clinical trial included 40 overweight and obese women randomly divided into 2 groups: diet only and diet combined with 12 weeks of abdominal resistance training. Waist and hip circumferences and abdominal skin folds of the subjects were measured at the beginning and 12 weeks after the interventions. In addition, abdominal subcutaneous fat thickness of the subjects was measured using ultrasonography. Percentage body fat and lean body mass of all the subjects were also measured using a bioelectric impedance device. RESULTS: After 12 weeks of intervention, the weight of participants in both groups decreased; but the difference between the 2 groups was not significant (P = .45). Similarly, other variables including abdominal subcutaneous fat, waist circumference, hip circumference, body mass index, body fat percentage, and skin fold thickness were reduced in both groups; but there were no significant differences between the groups. CONCLUSIONS: This study found that abdominal resistance training besides diet did not reduce abdominal subcutaneous fat thickness compared to diet alone in overweight or obese women.

Effects of aerobic exercise on blood pressure in patients with hypertension: a systematic review and dose-response meta-analysis of randomized trials.

We aimed to evaluate the dose-dependent effects of aerobic exercise on systolic (SBP) and diastolic blood pressure (DBP) and haemodynamic factors in adults with hypertension. PubMed, Scopus, and Web of Science were searched to April 2022 for randomized trials of aerobic exercise in adults with hypertension. We conducted a random-effects meta-analysis to estimate mean differences (MDs) and 95%CIs for each 30 min/week increase in aerobic exercise. The certainty of evidence was rated using the GRADE approach. The analysis of 34 trials with 1787 participants indicated that each 30 min/week aerobic exercise reduced SBP by 1.78 mmHg (95%CI: -2.22 to -1.33; n = 34, GRADE=low), DBP by 1.23 mmHg (95%CI: -1.53 to -0.93; n = 34, GRADE=moderate), resting heart rate (MD = -1.08 bpm, 95%CI: -1.46 to -0.71; n = 23, GRADE=low), and mean arterial pressure (MD = -1.37 mmHg, 95%CI: -1.80 to -0.93; n = 9, GRADE = low). A nonlinear dose-dependent decrement was seen on SBP and DBP, with the greatest decrement at 150 min/week (MD150 min/week = -7.23 mmHg, 95%CI: -9.08 to -5.39 for SBP and -5.58 mmHg, 95%CI: -6.90 to -4.27 for DBP). Aerobic exercise can lead to a large and clinically important reduction in blood pressure in a dose-dependent manner, with the greatest reduction at 150 min/week. The dose-dependent effects of aerobic exercise on systolic and diastolic blood pressure and haemodynamic factors in adults with hypertension.

Response-oriented measuring inequalities in Tehran: second round of UrbanHealth Equity Assessment and Response Tool (Urban HEART-2), concepts and framework.

BACKGROUND: Current evidence consistently confirm inequalities in health status among socioeconomic none, gender,ethnicity, geographical area and other social determinants of health (SDH), which adversely influence health ofthe population. SDH refer to a wide range of factors not limited to social component, but also involve economic, cultural,educational, political or environmental problems. Measuring inequalities, improving daily living conditions, andtackling inequitable distribution of resources are highly recommended by international SDH commissioners in recentyears to 'close the gaps within a generation'. To measure inequalities in socio-economic determinants and core healthindicators in Tehran, the second round of Urban Health Equity Assessment and Response Tool (Urban HEART-2)was conducted in November 2011, within the main framework of WHO Centre for Health Development (Kobe Centre). METHOD: For 'assessment' part of the project, 65 indicators in six policy domains namely 'physical and infrastructure','human and social', 'economic', 'governance', 'health and nutrition', and also 'cultural' domain were targetedeither through a population based survey or using routine system. Survey was conducted in a multistage random sampling,disaggregated to 22 districts and 368 neighborhoods of Tehran, where data of almost 35000 households(118000 individuals) were collected. For 'response' part of the project, widespread community based development(CBD) projects were organized in all 368 neighborhoods, which are being undertaken throughout 2013. CONCLUSION: Following the first round of Urban HEART project in 2008, the second round was conducted to trackchanges over time, to institutionalize inequality assessment within the local government, to build up community participationin 'assessment' and 'response' parts of the project, and to implement appropriate and evidence-based actionsto reduce health inequalities within all neighborhoods of Tehran.

Investigating the Relationship between Structural Features of Built Environment and Physical Activity using Geographic Information Systems (GIS).

Background: Built environment determinants of engaging in physical activity are dependent on the properties of societies. This study investigates the relationship between structural variables of the environment using geographic information systems (GIS) and the level of physical activity in 22 districts of Tehran. Methods: This cross-sectional study was based on Urban Health Equity Assessment and Response Tool (Urban HEART-2). Physical activity level was assessed via the Global Physical Activity Questionnaire (GPAQ). The characteristics of the neighborhood environment, including land use, street pattern, population density, and traffic, were determined via ArcGIS software. Walkability index (population density, street pattern, land use) was calculated to assess the effect of the main variables of living environment on physical activity level. Results: Among the built environmental variables, land use was associated with the total physical activity and travel-related physical activity level (r: 0.155, P value: 0.001, and r: 0.122, P value: 0.007, respectively). The walkability index indicated an association with the total physical activity level and travel-related physical activity level (r: 0.126, P value: 0.006, and r: 0.135, P value: 0.001, respectively). Higher levels of the walkability index were associated with an improved level of physical activity (OR: 2.04). Conclusions: Walkability index and land use positively correlate with total physical activity level, and providing action plans that improve walkability index and land use might lead to increased physical activity level.

Adding a back care package to the primary healthcare; a community-based cluster-randomized trial.

Introduction: The clinical course of LBP is complex and chronicity is more frequent than once thought. Moreover, insufficient evidence was found in support of any specific approach at the level of the general population. Research question: This study aimed to evaluate the effectiveness of providing a back care package through the primary healthcare system in decreasing the rate of CLBP in the community. Material and methods: Clusters were primary healthcare units with the covered population as participants. The intervention package comprised both exercise and educational content in the form of booklets. Data regarding LBP were collected at baseline, 3 and 9-month follow-ups. The LBP prevalence and the incidence of CLBP in the intervention group compared to the control group were analyzed using logistic regression through GEE. Results: Eleven clusters were randomized including 3521 enrolled subjects. At 9 months, the intervention group showed a statistically significant decrease in both the prevalence and the incidence of CLBP, compared to the control group (OR â€‹= â€‹0.44; 95% CI â€‹= â€‹0.30-0.65; P â€‹< â€‹0.001 and OR â€‹= â€‹0.48; 95% CI â€‹= â€‹0.31-0.74; P â€‹< â€‹0.001, respectively). Discussion and conclusion: The population-based intervention was effective in reducing the LBP prevalence and CLBP incidence. Our results suggest that preventing CLBP through a primary healthcare package including exercise and educational content is achievable.