The effect of obesity phenotype changes on cardiovascular outcomes in adults older than 40 years in the prospective cohort of the Tehran lipids and glucose study (TLGS): joint model of longitudinal and time-to-event data.

BACKGROUND: Obesity is a worldwide health concern with serious clinical effects, including myocardial infarction (MI), stroke, cardiovascular diseases (CVDs), and all-cause mortality. The present study aimed to assess the association of obesity phenotypes and different CVDs and mortality in males and females by simultaneously considering the longitudinal and survival time data. METHODS: In the Tehran Lipid and Glucose Study (TLGS), participants older than three years were selected by a multi-stage random cluster sampling method and followed for about 19 years. In the current study, individuals aged over 40 years without a medical history of CVD, stroke, MI, and coronary heart disease were included. Exclusions comprised those undergoing treatment for CVD and those with more than 30% missing information or incomplete data. Joint modeling of longitudinal binary outcome and survival time data was applied to assess the dependency and the association between the changes in obesity phenotypes and time to occurrence of CVD, MI, stroke, and CVD mortality. To account for any potential sex-related confounding effect on the association between the obesity phenotypes and CVD outcomes, sex-specific analysis was carried out. The analysis was performed using packages (JMbayes2) of R software (version 4.2.1). RESULTS: Overall, 6350 adults above 40 years were included. In the joint modeling of CVD outcome among males, literates and participants with a family history of diabetes were at lower risk of CVD compared to illiterates and those with no family history of diabetes in the Bayesian Cox model. Current smokers were at higher risk of CVD compared to non-smokers. In a logistic mixed effects model, odds of obesity phenotype was higher among participants with low physical activity, family history of diabetes and older age compared to males with high physical activity, no family history of diabetes and younger age. In females, based on the results of the Bayesian Cox model, participants with family history of diabetes, family history of CVD, abnormal obesity phenotype and past smokers had a higher risk of CVD compared to those with no history of diabetes, CVD and nonsmokers. In the obesity varying model, odds of obesity phenotype was higher among females with history of diabetes and older age compared to those with no history of diabetes and who were younger. There was no significant variable associated with MI among males in the Bayesian Cox model. Odds of obesity phenotype was higher in males with low physical activity compared to those with high physical activity in the obesity varying model, whereas current smokers were at lower odds of obesity phenotype than nonsmokers. In females, risk of MI was higher among those with family history of diabetes compared to those with no history of diabetes in the Bayesian Cox model. In the logistic mixed effects model, a direct and significant association was found between age and obesity phenotype. In males, participants with history of diabetes, abnormal obesity phenotype and older age were at higher risk of stroke in the Bayesian Cox model compared to males with no history of diabetes, normal obesity phenotype and younger persons. In the obesity varying model, odds of obesity phenotype was higher in males with low physical activity, family history of diabetes and older age compared to those with high physical activity, no family history of diabetes and who were younger. Smokers had a lower odds of obesity phenotype than nonsmokers. In females, past smokers and those with family history of diabetes were at higher risk of stroke compared to nonsmokers and females with no history of diabetes in the Bayesian Cox model. In the obesity varying model, females with family history of diabetes and older ages had a higher odds of obesity phenotype compared to those with no family history of diabetes and who were younger. Among males, risk of CVD mortality was lower in past smokers compared to nonsmokers in the survival model. A direct and significant association was found between age and CVD mortality. Odds of obesity phenotype was higher in males with a history of diabetes than in those with no family history of diabetes in the logistic mixed effects model. CONCLUSIONS: It seems that modifications to metabolic disorders may have an impact on the heightened incidence of CVDs. Based on this, males with obesity and any type of metabolic disorder had a higher risk of CVD, stroke and CVD mortality (excluding MI) compared to those with a normal body mass index (BMI) and no metabolic disorders. Females with obesity and any type of metabolic disorder were at higher risk of CVD(, MI and stroke compared to those with a normal BMI and no metabolic disorders suggesting that obesity and metabolic disorders are related. Due to its synergistic effect on high blood pressure, metabolic disorders raise the risk of CVD.

Association between metabolic syndrome and myocardial infarction among patients with excess body weight: a systematic review and meta-analysis.

BACKGROUND: Cardiovascular diseases (CVDs) are a major cause of morbidity and mortality worldwide. Controversial views exist over the effects of metabolically unhealthy obesity phenotypes on CVDs. This study aimed to perform a meta-analysis to assess the association between metabolic syndrome and myocardial infarction (MI) among individuals with excess body weight (EBW). METHODS: We searched PubMed/Medline, Scopus, and Web of Science databases as of December 9, 2023. Cohort studies involving patients with overweight or obesity that reported the relevant effect measures for the association between metabolic syndrome and MI were included. We excluded studies with incomplete or unavailable original data, reanalysis of previously published data, and those that did not report the adjusted effect sizes. We used the Newcastle Ottawa Scale for quality assessment. Random-effect model meta-analysis was performed. Publication bias was assessed by Begg's test. RESULTS: Overall, nine studies comprising a total of 61,104 participants were included. There was a significant positive association between metabolic syndrome and MI among those with obesity (hazard ratio (HR): 1.68; 95% confidence interval (CI): 1.27, 2.22). Subgroup analysis showed higher HRs for obesity (1.72; 1.03, 2.88) than overweight (1.58; 1.-13-2.21). Meta-regression revealed no significant association between nationality and risk of MI (p = 0.75). All studies had high qualities. There was no significant publication bias (p = 0.42). CONCLUSIONS: Metabolic syndrome increased the risk of MI in those with EBW. Further studies are recommended to investigate other risk factors of CVDs in EBW, in order to implement preventive programs to reduce the burden of CVD in obesity.

Classification and Diagnostic Prediction of Colorectal Cancer Mortality Based on Machine Learning Algorithms: A Multicenter National Study.

INTRODUCTION: Colorectal cancer (CRC) ranks as the second leading cause of cancer-related deaths. This study aimed to predict survival outcomes of CRC patients using machine learning (ML) methods. MATERIAL AND METHODS: A retrospective analysis included 1853 CRC patients admitted to three prominent tertiary hospitals in Iran from October 2006 to July 2019. Six ML methods, namely logistic regression (LR), Naïve Bayes (NB), Support Vector Machine (SVM), Neural Network (NN), Decision Tree (DT), and Light Gradient Boosting Machine (LGBM), were developed with 10-fold cross-validation. Feature selection employed the Random Forest method based on mean decrease GINI criteria. Model performance was assessed using Area Under the Curve (AUC). RESULTS: Time from diagnosis, age, tumor size, metastatic status, lymph node involvement, and treatment type emerged as crucial predictors of survival based on mean decrease GINI. The NB (AUC = 0.70, 95% Confidence Interval [CI] 0.65-0.75) and LGBM (AUC = 0.70, 95% CI 0.65-0.75) models achieved the highest predictive AUC values for CRC patient survival. CONCLUSIONS: This study highlights the significance of variables including time from diagnosis, age, tumor size, metastatic status, lymph node involvement, and treatment type in predicting CRC survival. The NB model exhibited optimal efficacy in mortality prediction, maintaining a balanced sensitivity and specificity. Policy recommendations encompass early diagnosis and treatment initiation for CRC patients, improved data collection through digital health records and standardized protocols, support for predictive analytics integration in clinical decisions, and the inclusion of identified prognostic variables in treatment guidelines to enhance patient outcomes.

The effect of education based on health belief model on hand hygiene behavior in the staff of Tehran dentistry centers: A quasi-experimental intervention study.

Background and Aims: Considering the increasing prevalence of dental services in the community and the impossibility of identifying each infected patient, hand sanitation is the most critical factor in controlling infection in these centers. Therefore, this study aimed to determine the effect of educational intervention on the hand health behavior of the staff of Tehran dentistry clinics based on the health belief model (HBM). Methods: In this quasi-experimental study in 2017, 128 employees of the health centers were selected through a multistage sampling method and they were placed in two groups of intervention and control (each 64 people). The data was collected using a questionnaire devised by the researcher. The validity and reliability of the questionnaire were determined. The questionnaire consisted of demographics, knowledge, structures of the HBM, and behavior variables. Then, the intervention was administered based on HBM-based education. Data were analyzed by SPSS16 and independent t test, χ 2, and repeated measurement analysis of variance. Results: Before the intervention, the two intervention and control groups did not differ significantly in terms of demographic variables, mean scores of knowledge, constructs of HBM, and hand hygiene behavior (p > 0.05), while the intervention group was scored higher significantly compared to the control one after the intervention (p < 0.001). Conclusion: According to the findings, the HBM can be used as a framework for designing educational interventions to improve hand hygiene behavior to control infection in health centers.

Spatiotemporal variations in childhood lymphoma cancer incidence and its survival rate in Iran, 2005-2015: a cross-sectional study.

BACKGROUND: Childhood lymphoma is the second leading cause of cancer in children under 15 years of age in Iran. The aim of this study was to investigate the spatial and time variations in lymphoma incidence as well as the children's survival time in Iran. METHOD: This cross-sectional study was conducted using lymphoma cases (children under 14 years of age) from 2005 to 2015, and the data were obtained from the National Cancer Registry Center. The frequency, age-standardised incidence rate (ASIR), spatial clustering in national level and the survival rate (1 year and 5 years) using Kaplan-Meier method were evaluated. We used Spatial and Temporal Scan statistics software in order to detect statistically significant clusters in spatial analysis. RESULTS: A total number of 746 girls and 1610 boys were diagnosed with lymphoma during a 10-year period. ASIRs (per 100 000 people) for girls ranged from 0 in Ilam to 3.47 in Yasuj, and it ranged from 0.19 in Ilam to 5.91 in Yazd for boys from 2005 to 2015. Spatial analysis result showed a large statistically significant cluster (the most likely cluster) for both boys (relative risk (RR)=2.37) and girls (RR=2.49) located in the northwest of Iran. Fortunately, survival rate for both boys and girls was over 95.5%. CONCLUSION: Lymphoma incidence rates had heterogeneous geographical distribution, and some significant clusters were identified which strengthens the role of possible aetiological factors, and further studies are needed to clarify this ambiguity. Fortunately, the survival rate of this cancer in Iran was good and it was similar to the high-income countries.

Burden of injury due to occupational accidents and its spatiotemporal trend at the national and subnational levels in Iran, 2011-2018.

PURPOSE: The spatiotemporal trend of the burden of injury due to occupational accidents in Iran, 2011-2018 were assessed at the national and subnational levels. METHODS: The burden of occupational injury was estimated using three datasets of occupational injury data, the employed population, and duration and disability weight of injuries. RESULTS: The disability-adjusted life years (DALYs), deaths, DALY rate, and death rate (per 100,000 workers) of occupational injury in Iran drastically decreased from 169,523, 2,280, 827, and 11 in 2011 to 86,235, 1,151, 362, and 5 in 2018, respectively. The DALY rates of occupational injury were significantly different by gender and age in a manner that the DALY rate of men was much higher than that of women and the DALY rates by age group in 2018 ranged from 98 for 50 y and over to 901 for 15-19 y. The shares of injury outcomes in the total DALYs in 2018 were as follows: 63.6% for fatal injuries, 17.4% for fracture, 7.9% for open wound, 7.3% for amputation, and 3.8% for other injuries. Over 83% of the DALYs was observed in three economic activity groups of construction, manufacturing, and community, social, and personal service activities. The three provinces with the highest DALY rates in 2018 were Markazi, West Azarbaijan, and East Azarbaijan, respectively. CONCLUSION: Despite the decreasing temporal trend, the burden of occupational injury in Iran in 2018 was high. The high-risk groups and hot spot provinces should be taken into more consideration for further reduction of the injury burden.

White Noise and Its Potential Applications in Occupational Health: A Review.

Background: White noise (WN), because of its unique behavior and characteristics, has different applications in different sciences. Nevertheless, the results of studies and reviews of the literature on occupational safety and health found that this type of noise is often used as a noise source to assess the effects of hearing and its physical characteristics. Its possible applications in this area have not received as much attention. The present review study aimed to answer the question, "Can WN be used as a means of promoting occupational safety and health at the workplace?". Methods: In this review, we reviewed the articles published in reputable databases from 1990 to 2020. Our study included 33 articles from 120 that were searched in full text and followed the inclusion and exclusion criteria. Results: Various applications were examined, including noise masking, white noise therapy, cognitive functions, and sleep. WN can enhance the work environment and meet occupational safety and health objectives based on the study's results. The results of this study will provide a basis for continuing research into the use of WN in the workplace as an engineering and management control method. Conclusion: WN is being used in various fields that may hold promise for its application in occupational health sciences and maintaining the well-being of workplace workers.

Irrational prescription and its costs in neonatal surfactant therapy: public and private hospitals of Iran in 2018.

BACKGROUND: Irrational prescription and its subsequent costs are a major challenge worldwide. Health systems must provide appropriate conditions for the implementation of national and international strategies to prevent irrational prescription. The aim of the present study was to determine the irrational surfactant prescription among neonates with respiratory distress and the resulting direct medical costs for private and public hospitals in Iran. METHODS: This was a cross-sectional descriptive study performed retrospectively using data belonged to 846 patients. Initially, the data were extracted from the patients' medical records and the information system of the Ministry of Health. The obtained data were then compared with the surfactant prescription guideline. Afterward, each neonatal surfactant prescription was evaluated based on the three filters listed in the guideline (including right drug, right dose, and right time). Finally, chi-square and ANOVA tests were used to investigate the inter-variable relationships. RESULTS: The results showed that 37.47% of the prescriptions were irrational and the average costs of each irrational prescription was calculated as 274.37 dollars. It was estimated that irrational prescriptions account for about 53% of the total surfactant prescription cost. Among the selected provinces, Tehran and Ahvaz had the worst and the best performance, respectively. As well, public hospitals outperformed private hospitals in terms of the in drug selection, but they underperformed them in terms of the right dose determination. CONCLUSION: The results of the present study are considered as a warning to insurance organizations, in order to reduce unnecessary costs caused by these irrational prescriptions by developing new service purchase protocols. Our suggestion is the use of educational interventions to reduce irrational prescriptions due to drug selection as well as using computer alert approaches to reduce irrational prescriptions caused by wrong dose administration.

The influencing factors of elder-friendly public open spaces promoting older adults' health in deprived urban neighborhoods: Partial Least Square Structural Equation Modeling approach.

Background: Public open spaces (POSs) is considered a feature of the built environment that is important for physical, mental, and social health during life and contributes to active aging. Hence, policymakers, practitioners, and academics have recently focused on indicators of elder-friendly environments, particularly in developing countries. Objective: This study aimed to examine the attributes of POSs and socio-demographic status that positively influence older people's health in Tehran's deprived neighborhoods using a pathway model. Methods: We employed a pathway model to explore the relationships between place function, place preferences, and process in the environment as the perceived (subjective) positive features of POSs associated with older adults' health, compared to the objective attributes of POSs. We also included personal characteristics, including physical, mental, and social dimensions, to explore how these factors are related to the health of older adults. To assess the subjective perception of POSs attributes, 420 older adults were asked to complete Elder-Friendly Urban Spaces Questionnaire (EFUSQ) from April 2018 to September 2018 in the 10th District of Tehran. We used the SF-12 questionnaire and "The self-Rated Social Health of Iranians Questionnaire to measure older people's physical and mental health and elder social health." Geographical Information System (GIS) measures (Street connectivity, Residential density, Land use mix, Housing quality) were derived as objective measures of neighborhood features. Results: According to our findings, the personal aspect, socio-demographic status (such as Gender, Marital status, Education, Occupation as well as Frequency of being present in POSs), place preferences (Security, Fear of Falling, Way Finding and Perceived Aesthetics), and process in the environment's latent (Social Environment, Cultural Environment, Place Attachment, and Life Satisfaction)constructs collectively influenced the elders' health. Conclusion: We found positive associations between Place preference, Process-in-environment, and personal health-related factors to elders' health (social, mental, and physical). The path model presented in the study could be guided in future research in this area and inform the development of evidence-based urban planning and design interventions for improve older adults health and social functioning and quality of life.

Epidemiology of pediatric sarcoma in Iran.

BACKGROUND: Pediatric sarcomas are divided into two major groups of soft-tissue sarcomas (STSs) and malignant bone tumors (MBTs). AIMS: The aim of the present study was to determine the incidence and survival rate of STSs and MBTs in the Iranian population based on diagnosis date, gender, age, and histological types. METHODS AND RESULTS: Data was retrieved from Iran National Cancer Registry between 2008 and 2015. The dataset was classified according to the third edition of the International Classification of Childhood Cancer. The survival information was merely available for 291 (21% of total data), including 142 (49%) MBTs and 149 (51%) STSs. The age-standardized incidence rates (ASIRs) and five-year survival rates were calculated. CONCLUSION: The present study is the first comprehensive study of pediatric sarcomas in Iran, in which a lower incidence and survival rate of MBTs and STSs compared with high-income countries were found. However, the survival rates of these malignancies were higher in high-income countries compared to Iran. This study showed the need to improve the quantity and quality of the population-based registry in Iran for acquiring progress in the prevention and control of sarcomas.

Spatiotemporal analysis of childhood cancers in Iran (2005-2013).

BACKGROUND: Childhood cancers are among the leading causes of child mortality worldwide. We aimed to analyze the spatiotemporal incidence patterns of five common cancer types in Iran. MATERIAL AND METHODS: A total of 17155 incident malignant 0-14 years old cases during 2005-2013 recorded by the Iran National Cancer Registry were included. An adaptive spatiotemporal smoothing model was applied to explore spatiotemporal variations of the age-standardized incidence rate (ASIR). RESULTS: The highest overall ASIR was estimated at 137.9 per million person-years in 2011-2013. Most of the five common cancers had an increasing trend in most provinces for both males and females during this time. CONCLUSION: Increasing ASIR and risk of cancers were observed during the study period, which follows the trend of childhood cancers incidence worldwide. The health system should take this rise as a serious alarm and provide appropriate prevention plans.

Irrational prescription of surfactant replacement therapy in neonatal respiratory distress.

PURPOSE: Respiratory distress is known as one of the leading causes of neonatal death. In recent decades, surfactant therapy has revolutionized respiratory failure. Since the implementation of the health system reform plan as well as the allocation of new financial resources for health system in Iran, the rate of irrational prescription has increased and prescription of surfactant for neonates, has raised unexpectedly, which is thought to be due to irrational prescriptions partly. The present study aimed to determine the rate of irrational prescription of surfactant for neonates with respiratory distress. METHODS: This research was a cross-sectional descriptive study, which was conducted retrospectively. In the current study, determining the rate of irrational prescription was done in terms of the surfactant prescription guideline. Finally, the medical data of 846 neonates who underwent surfactant therapy in Iran in 2018, were extracted from the information system of the Ministry of Health and the neonatal medical records. RESULTS: The results show that drug selection index, dose index, and time index were irrational for 14.30%, 27.42%, and 1.06% of neonates, respectively. Moreover, the total index of drug prescription, which is a combination of the above-mentioned three components, was found to be irrational for 31.47% of neonates. CONCLUSIONS: The results of the present study are considered as a warning to providers and decision makers in the field of neonatal health to reduce irrational prescriptions of surfactant for neonates. This study suggests the use of educational interventions in order to reduce irrational prescriptions due to drug selection as well as the use of computer alert approaches in order to reduce irrational prescriptions due to wrong dose.

Effect of tonal noise and task difficulty on electroencephalography and cognitive performance.

Objectives. The present study aimed to investigate the effect of tonal noise and task difficulty on electroencephalography (EEG) and cognitive performance. Methods. Twelve healthy volunteers participated in the present study. Four noise signals were generated by four prominence tone levels (0, 2, 5 and 9) at background noise levels of 55 dBA and frequency of 500 Hz using the Test Tone Generator from Esser Audio (USA). The participants were asked to perform the tasks with low, moderate and high levels of difficulty while exposed to the noises in an acoustics laboratory. The values of reaction time, correct rate and missed numbers were recorded during each step. Moreover, the EEG signals were measured. Results. The results showed that higher tone level and more task difficulty significantly decreased the correct rate, and increased the miss numbers. However, no significant effect was observed on reaction times. Furthermore, tone level and task difficulty significantly increased activity of the θ and ß bands and decreased activity of the α band. Conclusion. Task difficulty and tone level could significantly affect the parameters of performance and the activity of EEG bands. Therefore, noise control can help sustain appropriate performance.

Epidemiology of small intestine cancer in Iran.

BACKGROUND: Little is known about the epidemiology of small intestine (SI) cancer in Iran, a rare cancer entity worldwide. AIMS: The aim of the present study was to investigate the incidence patterns and survival rates of SI cancer in Iran through a population-based study. METHODS AND RESULTS: Data on all reported cases of SI cancer were extracted from the Iran National Cancer Registry based on ICD-O-3 codes. Age-standardized incidence rates (ASIR), age-specific incidence rates, standardized rate ratios (SRR), time trends, and absolute survival rates were calculated. During 2005-2015, a total of 4928 SI cancers (ASIR: 0.87/100 000) were diagnosed, including 2835 carcinomas (ASIR: 0.51), 214 neuroendocrine malignancies (ASIR: 0.04), 228 sarcomas (ASIR: 0.04), and 704 lymphomas (ASIR: 0.11). Carcinomas and lymphomas occurred more frequently in men than in women (SRR: 1.37/100 000 and 1.85/100 000, respectively), while the other two histological subtypes were almost equally distributed. 78% of carcinomas and 53% of neuroendocrine tumors were located in the duodenum. Sarcomas occurred most frequently in the jejunum (41%), while lymphomas were most frequently in the ileum (44%). From 2005 to 2015, the number of reported cases of SI cancer increased by 9.6% per year. The median age of diagnosis for women and men was 61. The absolute 5-year survival rate was 35.3%, varying by sex, age, and subtype. Carcinomas had the lowest survival rate (24.1%) while neuroendocrine carcinomas had the highest survival rate (69.7%). CONCLUSION: Epidemiological patterns of SI cancer in Iran differed slightly from patterns in the United States and the United Kingdom. In contrast to other countries, the neuroendocrine form is presented as the rarest subtype in Iran. The overall incidence of SI cancer was lower in Iran than in high-income countries. In contrast, the average prognosis of SI cancer was worse in Iran, indicating the need to improve early detection, diagnosis, and treatment.

Response to Fluvoxamine in the Obsessive-Compulsive Disorder Patients: Bayesian Ordinal Quantile Regression.

BACKGROUND: Obsessive-Compulsive Disorder (OCD) is a chronic neuropsychiatric disorder associated with unpleasant thoughts or mental images, making the patient repeat physical or mental behaviors to relieve discomfort. 40-60% of patients do not respond to Serotonin Reuptake Inhibitors, including fluvoxamine therapy. INTRODUCTION: The aim of the study is to identify the predictors of fluvoxamine therapy in OCD patients by Bayesian Ordinal Quantile Regression Model. METHODS: This study was performed on 109 patients with OCD. Three methods, including Bayesian ordinal quantile, probit, and logistic regression models, were applied to identify predictors of response to fluvoxamine. The accuracy and weighted kappa were used to evaluate these models. RESULTS: Our result showed that rs3780413 (mean=-0.69, sd=0.39) and cleaning dimension (mean=-0.61, sd=0.20) had reverse effects on response to fluvoxamine therapy in Bayesian ordinal probit and logistic regression models. In the 75th quantile regression model, marital status (mean=1.62, sd=0.47) and family history (mean=1.33, sd=0.61) had a direct effect, and cleaning (mean=-1.10, sd=0.37) and somatic (mean=-0.58, sd=0.27) dimensions had reverse effects on response to fluvoxamine therapy. CONCLUSION: Response to fluvoxamine is a multifactorial problem and can be different in the levels of socio-demographic, genetic, and clinical predictors. Marital status, familial history, cleaning, and somatic dimensions are associated with response to fluvoxamine therapy.

The effects of combined exposure to road traffic noise and whole body vibration on types of attention among men.

BACKGROUND: Noise and vibration are considered as harmful physical agents in the environment which have adverse effects on cognitive performance. One of the occupations at risk is driving, where there is a possibility of simultaneous exposure to road traffic noise and whole body vibration (WBV) transferred through the vehicle. This study aims to assess the effects of single and combined exposure to road traffic noise and WBV on different types of attention in men. METHODS: The experiment was conducted on 24 men in 4 steps, executed on each participant inside an acoustic room. After recording a number of various attention scores at background conditions (27 dBA noise, no vibration) the participants were given single and combined exposure to noise levels at 55 and 85 dBA and vibration frequencies of 0.65 and 0.95 m/s2. RESULTS: As for combined exposure to noise and vibration, increasing vibration acceleration and noise levels at the same time compared to background condition caused a rise in the score of all visual attention types among groups exposed to low vibration acceleration and those exposed to medium acceleration and low noise. Nevertheless, when noise level and vibration acceleration is increased at the same time compared to background, auditory attention type scores mostly fell among groups with similar vibration accelerations. CONCLUSIONS: Overall, single and combined exposure to environmental stressors under investigation had a predominantly negative effect on auditory attention while the effects on visual attention were inconclusive. Definitive conclusions however require further systematic and comprehensive experiments.

Internet addiction theory-based intervention among university students: A case of health belief model.

BACKGROUND: The phenomenon of Internet addiction has increased due to the delay between Internet technology and the culture of using it. According to the high prevalence of Internet addiction among students and its associated complications, the present study was conducted to determine the effect of education based on the health belief model on Internet addiction status among students in Tehran, Iran. MATERIALS AND METHODS: In this interventional study, two dormitories were divided into two groups of control and intervention in a completely random manner using the random cluster sampling method from a total of eight dormitories. Then 134 girls in each group answer two questionnaires of Young (about Internet addiction) and health belief model-based scale. After the need assessments of the primary results, intervention was performed in the experimental group in a way that a textbook based on the health belief model and ten educational text messages were sent to the students' E-mail. Two months later, questionnaires were again given to both groups. The results were analyzed with the help of independent t-test, Chi-square test, Fisher's exact test, Mann-Whitney test, analysis of covariance, and logistic regression with repetitive measures with GEE approach. RESULTS: The average scores of knowledge (P < 0.001), perceived susceptibility (P < 0.001), perceived severity (P = 0.006), perceived barriers (P < 0.001), and self-efficacy (P = 0.002) between the two groups, had a significant difference after the intervention. The average scores of perceived benefits (P = 0.6), Internet addiction behavior (P = 0.11), and the frequency of Internet addiction (P = 0.63) after intervention did not have a significant difference in the two groups. CONCLUSIONS: The results of this study show the effectiveness of educational intervention design based on the structures of health belief model on reducing the frequency of Internet addiction and adopting preventive behaviors.

Nomogram to Predict the Overall Survival of Colorectal Cancer Patients: A Multicenter National Study.

BACKGROUND: Colorectal cancer (CRC) is the third foremost cause of cancer-related death and the fourth most commonly diagnosed cancer globally. The study aimed to evaluate the survival predictors using the Cox Proportional Hazards (CPH) and established a novel nomogram to predict the Overall Survival (OS) of the CRC patients. MATERIALS AND METHODS: A historical cohort study, included 1868 patients with CRC, was performed using medical records gathered from Iran's three tertiary colorectal referral centers from 2006 to 2019. Two datasets were considered as train set and one set as the test set. First, the most significant prognostic risk factors on survival were selected using univariable CPH. Then, independent prognostic factors were identified to construct a nomogram using the multivariable CPH regression model. The nomogram performance was assessed by the concordance index (C-index) and the time-dependent area under the ROC curve. RESULTS: The age of patients, body mass index (BMI), family history, tumor grading, tumor stage, primary site, diabetes history, T stage, N stage, and type of treatment were considered as significant predictors of CRC patients in univariable CPH model (p < 0.2). The multivariable CPH model revealed that BMI, family history, grade and tumor stage were significant (p < 0.05). The C-index in the train data was 0.692 (95% CI, 0.650-0.734), as well as 0.627 (0.670, 0.686) in the test data. CONCLUSION: We improved a novel nomogram diagram according to factors for predicting OS in CRC patients, which could assist clinical decision-making and prognosis predictions in patients with CRC.

The emerging epidemic of inflammatory bowel disease in Asia and Iran by 2035: A modeling study.

BACKGROUND: The projection studies are imperative to satisfy demands for health care systems and proper response to the public health problems such as inflammatory bowel disease (IBD). METHODS: To accomplish this, we established an illness-death model based on available data to project the future prevalence of IBD in Asia, Iran in particular, separately from 2017 to 2035. We applied two deterministic and stochastic approaches. RESULTS: In 2035, as compared to 2020, we expected a 2.5-fold rise in prevalence for Iran with 69 thousand cases, a 2.3-fold increment for North Africa and the Middle East with 220 thousand cases, quadrupling of the prevalence for India with 2.2 million cases, a 1.5-fold increase for East Asia region with 4.5 million cases, and a 1.6-fold elevation in prevalence for high-income Asia-Pacific and Southeast Asia regions with 183 and 199 thousand cases respectively. CONCLUSIONS: Our results showed an emerging epidemic for the prevalence of IBD in Asia regions and/or countries. Hence, we suggest the need for immediate action to control this increasing trend in Asia and Iran. However, we were virtually unable to use information about age groups, gender, and other factors influencing the evolution of IBD in our model due to lack of access to reliable data.

Patients' attitude toward informal payments in Iran: an application of the cluster analysis method.

INTRODUCTION: Attitude is a factor affecting the behaviour of consumers. In the literature, the effect of health care consumer's attitude on making informal payments has been highlighted. The purpose of this study was to investigate the attitude of Iranian patients regarding informal payments and socio-demographic factors associated with it. METHODS: In this cross-sectional study, conducted in 2017 in Tehran, 450 patients who were admitted to the clinics of four public hospitals for post-surgical care and follow-up, were invited to participate in the study. The data collection tool was a questionnaire, which validity and reliability were confirmed. Cluster analysis was used to identify the main attitudinal groups. To investigate the effect of socio-demographic factors on patients' attitudes, generalized linear model regression analysis was carried out in SPSS 22. RESULTS: Our findings showed that 57.3% of patients had agreeing attitude, 24.2% indifferent attitude, and 18.4% opposing attitude toward informal payments. Patients from rural areas and those from the high-income group had higher odds of having an agreeing attitude. There was a significant association between informal payment history and attitude. The odds of having agreeing attitude among patients with a history of informal payment were two times higher than among patients who did not have an informal payment history (p ≤ 0.05). CONCLUSION: A positive attitude towards informal payments is an obstacle to the fight against this phenomenon. Therefore, changes in public attitudes regarding informal payments will be an essential strategy, among other strategies, for eradicating these payments. This could be achieved through public campaigns for raising people's awareness and knowledge.