Sex-specific compensatory model of suicidal ideation: a population-based study (Urban HEART-2).

INTRODUCTION: Suicidal ideations (SI), also known as suicidal thoughts, refer to impulses, desires, and obsessions related to death. Prevalence of suicidal ideation was 14 percent. The current study assumed that identifying the true predictors of SI would allow for a greater understanding of suicide risk. METHODS: In this cross-sectional population-based study, 17,644 residents aged from 15 to 90 years were selected through a multi-stage sampling method from 22 districts of Tehran. Using hypothesized causal models, the pathways through which various variables influenced the components of SI were identified. Also, the applicability of the compensatory and risk-protective models of resiliency for the prediction of SI was tested by using the interaction multiple regression analyses. RESULTS: SI was experienced by 13.44% of the study population. SI was more prevalent with individuals between the ages of 15 to 24. There are no differences between men and women when covariate analysis is used. The significant predictions by anxiety and physical activity (moderate) indicate support for the compensatory model for male and female, while the significant prediction by those indicates support for the risk-protective model for females. CONCLUSION: PA would both lessen the detrimental impact of anxiety on suicidal thoughts and potentially reduce the probability of SI. It's important to develop and evaluate PA-enhancing treatments, especially for woman who are experiencing anxiety.

Physical Inactivity and Food Insecurity Are Associated with Social Capital: A Large-Scale Population-Based Study in Tehran.

Background: There are limited studies on food security, physical activity, and social capital in the Iranian population. This study aimed to evaluate the social capital's associations with physical inactivity and food insecurity in a large-scale study in Iran, Urban HEART-2. Methods: This cross-sectional study was conducted in 22 districts of Tehran, the capital of Iran. Residents of Tehran who were 15 years or older were selected by a multi-stage, stratified, and random sampling method. Food insecurity and physical activity were evaluated using Household Food Security Scale and Global Physical Activity Questionnaire, respectively, and their associations with social capital were evaluated. Results: A total of 5030 individuals were included in this study, with 3139 (62.4%) males. The mean age of participants was 44.08 years (SD = 16.33, range = 15-90). Participation in social events (OR = 0.893, 95% CI = 0.819-0.974, P = 0.011), social network (OR = 0.849, 95% CI = 0.786, P < 0.001), and voluntary activities (OR = 0.865, 95% CI = 0.812-0.921, P < 0.001) were all negatively associated with food insecurity. Also, voluntary activities (OR = 0.823, 95% CI = 0.776-0.872, P < 0.001) and participation in the associations activities (OR = 0.665, 95% CI = 0.582-0.759, P < 0.001) were negatively associated with physical inactivity. Conclusion: The prevalence of food insecurity and physical inactivity is relatively high among Tehran residents. As a factor affecting the physical activity and food security, social capital can be targeted in interventions to improve physical activity and food security among Iranians.

Validity and reliability of the persian version of the world health organization quality of life disabilities module.

This study aimed to assess the validity and reliability of the world health organization quality of life questionnaire for people with intellectual disability (WHOQOL-DIS-ID). This was a cross-sectional study of 118 adults with intellectual disability. Internal consistency and temporal reliability were evaluated using Cronbach's alpha and intraclass correlation coefficient (ICC), respectively. Construct validity of the structure was assessed using confirmatory factor analysis. Multiple linear regression analysis was performed to determine the factors associated with the quality of life. Cronbach's alpha for all, but not for discrimination area, as well as ICC for all questions except for 23 and 6, were higher than 0.7. The variables such as periodic check-up, number of friends, entertainment outside the home, parental separation, physical activity, unmet needs score, caregiver's mental health status, and available facilities were the predictors of QOL. The Persian version of the WHOQOL-DIS-ID shows acceptable validity and reliability.

COVID-19 and Fear, Which Comes First?

Today people have a few unanswered questions in their mind, such as "Do negative emotions will co-survive with the COVID-19 pandemic? Which one is worse? Which one will disappear quicker? Is there any connection between negative emotions and being infected by COVID-19 or the severity of infected individuals' symptoms? How are we supposed to live with COVID-19 and adapt our emotional system to the virus for more than one upcoming year?" These uncertainties could result in massive pressure on people. While there is no clear consensus regarding what establishes psychological stress on an individual, the effect of negative affect and psychological stress on increased susceptibility to disease due to altered immune functions is well established. Here we are going through the possible effect of emotions associated with the present pandemic on COVID-19 course of disease and severity of symptoms.

Repetitive Transcranial Magnetic Stimulation for the Treatment of Lower Limb Dysfunction in Patients Poststroke: A Systematic Review with Meta-Analysis.

PURPOSE: To investigate the effectiveness of repetitive transcranial magnetic stimulation (rTMS) in recovery of lower limb dysfunction in patients poststroke. PARTICIPANTS AND METHODS: Cochrane Central Register of Controlled Trials, Medline, ISI web of knowledge, EBSCO, Embase, Cumulative Index to Nursing and Allied Health Literature and Scopus. RESULTS: Fifteen trials with 385 patients were included. Results showed that rTMS had a significant effect on balance (standard mean difference [SMD] = .38; 95% confidence interval [CI], .07: .69; I2 = 51%) and mobility (SMD: -.67; 95% CI, -1.08: -.26; I2 = 72%). However, rTMS had no significant immediate effects on the lower limb subscale of the Fugl-Meyer Assessment (FMA-L) (SMD = .01; 95% CI, -.29: .31; I2 = 0%). Continued effects of rTMS was also found to be significant during the follow-up period (SMD = .46; 95% CI, .09: .84; I2 = 14%). CONCLUSION: rTMS was found to result in positive effects on mobility, balance and long-term prognosis of FMA-L. However data indicated that there is insufficient evidence for the effectiveness of rTMS in improving lower limb function.

The role of phthalate esters in autism development: A systematic review.

BACKGROUND: Available evidence implicates environmental factors in the pathogenesis of autism spectrum disorders (ASD). However, the role of specific environmental chemicals such as phthalate esters that influence ASD risk remains elusive. This paper systematically reviews published evidences on association between prenatal and/or childhood exposure to phthalate and ASD. METHODS: Studies pertaining to systematic literature search from Scopus, PubMed, PsycInfo and Web of Science prior to December 2015 were identified. The authors included studies which assessed the effect of exposure to phthalates on occurrence of ASD. This comprehensive bibliographic search identified five independent studies. Each eligible paper was summarized with respect to its methods and results with particular attention to study design and exposure assessment. Because of the heterogeneity in the type of included studies, different methods of assessing exposure to phthalates and the use of different statistics for summarizing the results, meta-analysis could not be used to combine the results of included studies. RESULTS: The results of this systematic review have revealed the limited number of studies conducted and assessed phthalate exposure. Seven studies were regarded as relevant to the objectives of this review. Two of them did not measure phthalate exposure directly and did not result in quantitative results. Out of the five studies in which phthalate exposure was mainly measured by the examining biomarkers in biological samples, two were cohort studies (one with positive results and another one with not clear association). Among the three case control studies, two of them showed a significant relation between exposure to phthalate and ASD and the last case control study had negative results. Indeed, this case control studies showed a compromised phthalate metabolite glucuronidation pathway, as a probable explanation of mechanism of the relation between phthalate exposure and ASD. CONCLUSIONS: This review reveals evidence showing a connection between exposure to phthalates and ASD. Nevertheless, further research is needed with appropriate attention to exposure assessment and relevant pre and post-natal cofounders.

Burden and Epidemiology of Mental Disorders in the Middle East and North Africa from 1990 to 2019: Findings from the Global Burden of Disease Study

Background: Previous studies have mainly focused on individual mental disorders, and there is no study addressing the total burden of mental disorders in the Middle East and North Africa (MENA). Aims: To evaluate the burden of mental disorders in the MENA region from 1990 to 2019. Study Design: A cross-sectional study. Methods: We utilized global burden of disease data to examine the burden of 12 mental disorders from 1990 to 2019 across age groups, genders, and the 21 MENA countries. We collected data on prevalence, incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years (DALY), including both crude and age-standardized rates per 100,000 people. Results: The DALY rate of mental disorders in MENA countries increased by 13.88% from 1,747.92 per 100,000 people in 1990 to 1990.5 per 100,000 people in 2019. The highest percentage increases in the DALY rates of mental disorders were observed for bulimia nervosa (35.69%), other mental health disorders (34.58%), and schizophrenia (33.02%) from 1990 to 2019. However, the DALY rates for idiopathic developmental intellectual disability (-26.48%), conduct disorder (-23.91%), attentiondeficit/ hyperactivity disorder (-16.46%), and autism spectrum disorders (-4.12%) decreased in the MENA region from 1990 to 2019. In 2019, the highest DALY rates for idiopathic developmental intellectual disability, anxiety disorders, and major depressive disorder were observed in age groups ≤ 4 years, 5-19 years, and ≥ 20 years, respectively. The age-standardized DALY rate of mental disorders was the highest in Palestine (2,396.9 per 100,000), Iran (2,295.8 per 100,000), and Lebanon (2,126.0 per 100,000) compared with other MENA countries in 2019. Conclusion: There has been a slight increase in the burden of mental disorders in the MENA region between 1990 and 2019. National policies should prioritize evidence-based preventive measures and ensure accessible treatment options for mental health disorders in the population, especially in the MENA region.

Burden of alcohol use disorder and its consequences in Iran from 1990 to 2019: Findings from the global burden of disease study.

Background: This study aimed to provide an up-to-date evaluation of the burden of alcohol use disorder and its consequences in Iran from 1990 to 2019. Methods: We assessed the burden of alcohol use disorder and its three subsequent disorders, including cirrhosis and other chronic liver diseases, liver cancer, and cardiomyopathy using Global Burden of Disease (GBD) data. We retrieved data on incidence, prevalence, death, Years of Life Lost from mortality (YLL), Years of healthy life Lost due to Disability (YLD), and Disability-Adjusted Life Year (DALY), which is calculated by summing YLL and YLD values, indices, as well as sociodemographic index (SDI) values. Results: Age-standardized DALY rate of alcohol use disorder reduced from 55.5 in 1990 to 41.8 per 100,000 in 2019 (-24.1 %). Similarly, age-standardized DALY rates of cirrhosis due to alcohol use (-28.7 %), liver cancer due to alcohol use (-20.9 %), and alcoholic cardiomyopathy (-36.3 %) decreased in Iran from 1990 to 2019. In 2019, alcohol use disorder had the highest DALY rate among individuals younger than 55 years, while cirrhosis due to alcohol use imposed the greatest burden on those older than 55. After adjusting for the year, SDI was negatively associated with the age-standardized DALY rate of liver cancer due to alcohol use (p < 0.001), positively associated with that of alcoholic cardiomyopathy (p = 0.002), and not significantly associated with the burden of other conditions (p > 0.05). Conclusions: Despite reductions in the age-standardized DALY rate of alcohol use disorders and related consequences among Iranians, they remain a serious public health concern in Iran.

Automated diagnosis of autism with artificial intelligence: State of the art.

Autism spectrum disorder (ASD) represents a panel of conditions that begin during the developmental period and result in impairments of personal, social, academic, or occupational functioning. Early diagnosis is directly related to a better prognosis. Unfortunately, the diagnosis of ASD requires a long and exhausting subjective process. We aimed to review the state of the art for automated autism diagnosis and recognition in this research. In February 2022, we searched multiple databases and sources of gray literature for eligible studies. We used an adapted version of the QUADAS-2 tool to assess the risk of bias in the studies. A brief report of the methods and results of each study is presented. Data were synthesized for each modality separately using the Split Component Synthesis (SCS) method. We assessed heterogeneity using the I 2 statistics and evaluated publication bias using trim and fill tests combined with ln DOR. Confidence in cumulative evidence was assessed using the GRADE approach for diagnostic studies. We included 344 studies from 186,020 participants (51,129 are estimated to be unique) for nine different modalities in this review, from which 232 reported sufficient data for meta-analysis. The area under the curve was in the range of 0.71-0.90 for all the modalities. The studies on EEG data provided the best accuracy, with the area under the curve ranging between 0.85 and 0.93. We found that the literature is rife with bias and methodological/reporting flaws. Recommendations are provided for future research to provide better studies and fill in the current knowledge gaps.

The Duke University Religion Index (DUREL): validation and reliability of the Farsi version.

This study examined the validation and reliability of the Farsi version of the Duke University Religion Index (FDUREL), a brief measure designed to evaluate the primary dimensions of religiosity. The study was conducted in two phases. In the first phase, after translation of the original version of DUREL by using standard forward-backward translation, the FDUREL was administered to 427 medical students at different training levels. Reliability of the FDUREL was assessed by internal consistency and test-retest reliability. Principal components factor analysis was employed to assess the construct validity of the measure. In the second phase, 557 medical students were asked to fill out the FDUREL and Hoge Intrinsic Religiosity Scale to examine concurrent validity. The FDUREL was unidimensional and had good internal consistency and test-retest reliability. Results suggest that the FDUREL is a reliable and valid measure of religiosity in Farsi-speaking populations.

Public awareness and stigma of autism spectrum disorder in Iran; An online survey.

BACKGROUND: There is no systematic examination of the Iranian general population's knowledge of autism spectrum disorders (ASD). AIM: In this study, we aimed to assess stigma and knowledge about ASD among Iranian people and determine the sociodemographic factors associated with them. METHODS AND PROCEDURES: This study was conducted as a cross-sectional online survey from April to May 2020, using a convenience sampling method. We designed an online questionnaire using Google forms. We sent a message explaining the study goals and the link to the online questionnaire to groups on popular social platforms in Iran. We used Autism Stigma and Knowledge Questionnaire (ASK-Q) to assess ASD knowledge and stigma. OUTCOMES AND RESULTS: In total, 600 individuals participated in the study, of whom 301 (50.2 %) were women and 299 (49.8 %) were men. Out of 600 participants, 216 (36 %) had adequate knowledge of the diagnosis/symptoms subscale, 206 (34.3 %) for the etiology subscale, 200 (33.3 %) for the treatment subscale, and 260 (43.4 %) had no stigma toward ASD. CONCLUSIONS AND IMPLICATIONS: The level of knowledge about ASD is insufficient among Iranian people of this study. People with lower knowledge of ASD, including older adults and individuals with lower educational levels, may benefit the most from ASD awareness interventions.

Brace-Related Stress and Quality-of-Life Parameters in Adolescents with Idiopathic Scoliosis.

Introduction: This study investigated brace-related stress, trunk appearance perception, and quality of life in adolescent girls with idiopathic scoliosis who wear the Milwaukee brace for treatment. Methods: Fifty-two adolescent girls with idiopathic scoliosis participated in this study. They had been under treatment with Milwaukee brace for at least three months. They filled out four questionnaires, including the revised 22-item Scoliosis Research Society questionnaire (SRS-22r), the Brace Questionnaire (BrQ), the Bad Sobernheim Stress Questionnaire-Brace (BSSQ-Brace), and the Trunk Appearance Perception Scale (TAPS). Results: Twenty participants had high stress levels, and thirty-two had moderate stress levels. The total score and emotional and social function scores of the BrQ were significantly higher in participants with high stress compared to those with moderate stress. There was no significant difference between the two groups in the SRS-22r and TAPS questionnaires scores. However, a high Cobb angle had significantly worsened their perception of trunk appearance. Conclusions: It seems that among quality-of-life parameters, social and emotional functions are more affected by stress level in treating adolescent girls with idiopathic scoliosis with a brace. In addition, patients with high stress levels have a worse perception of their trunk appearance.

Are all types of empathy associated with lower aggression in athletes? A cross-sectional study on Iranian athletes.

BACKGROUND: This study aimed to evaluate the association between cognitive and affective empathy and aggression in a sample of Iranian athletes. METHODS: We designed a cross-sectional study. The participants were selected by multistage random sampling among six colleges in Tehran, Iran's capital. We used the interpersonal reactivity index (IRI) to evaluate empathy, and Reactive Proactive Aggression Questionnaire, and the Buss-Perry aggression questionnaire to evaluate aggression. RESULTS: In total, 492 athletes with a mean age of 27.42 years (SD = 7.72) participated in the study, of which 298 (60.6%) were male, and 194 (39.4%) were female. IRI's fantasy and personal distress subscales scores were positively associated with proactive and reactive aggression scores (p < 0.05). The score of the perspective-taking subscale of IRI was negatively associated with proactive and reactive aggression scores (p < 0.05). The score of the empathic concern subscale of IRI had a negative association with the proactive aggression score (p < 0.001). The score of the perspective-taking subscale of IRI had negative associations with all Buss-Perry aggression questionnaire subscales' scores (p < 0.05). The score of the personal distress subscale of IRI had positive associations with all Buss-Perry aggression questionnaire subscales' scores (p < 0.05), except with the verbal aggression subscale score. The score of the fantasy subscale of IRI was positively associated with the score of the hostility subscale of the Buss-Perry questionnaire (p = 0.001). CONCLUSION: Perspective-taking is negatively associated with all kinds of aggression in athletes. Future studies can be conducted to determine the possible role of perspective-taking in preventive aggression, which can be a target for interventions. On the other hand, the score of the personal distress subscale of IRI is positively associated with all types of aggression scores, indicating that not all types of empathy inhibit aggression in athletes.

An Overview of the Available Intervention Strategies for Postural Balance Control in Individuals with Autism Spectrum Disorder.

Background: Postural instability is a prevalent issue among individuals with autism spectrum disorder (ASD) that affects the development of their perceptual-motor skills and social functioning. Visual and somatosensory processing deficits, hypotonia, basal ganglia dysfunction, and anxiety are some of the concurrent disorders in individuals with ASD. Nevertheless, a definite management protocol for postural instability in ASD has not been introduced yet. Hence, we aim to shed light on the available intervention strategies for postural instability in individuals with ASD. Methods: Even though several studies have been conducted on the effects of various interventions for balance control in individuals with ASD, no study has compared their efficacy, limitations, and clinical implications. Results: This review discusses diverse proposed interventions contributing to ASD postural instability, including martial arts, water-based interventions, animal-assisted therapies, trampoline, balance training, vestibular therapy, transcranial direct current stimulation, sports, play, and active recreation for kids (SPARK), and square-stepping exercise (SSE). Conclusion: Enhancing motor skills, cerebellum function, and sensory input integration were some of the main mechanisms of these interventions to improve balance control in ASD. Some interventions, such as water-based exercises and video games, were enjoyable for children with ASD and could raise their treatment adherence. In most studies, small sample sizes and the lack of a control group represented their major limitations. Therefore, future well-designed randomized controlled trials are required to assess the effects of available interventions on postural control in ASD.

Iran's higher education and COVID-19: the "new normal" for Tehran University of Medical Sciences.

When the emergency committee of the World Health Organization declared that the outbreak of COVID-19 meets the criteria of a "Public Health Emergency of International Concern" on January 30th, 2020, no one could ever imagine how soon it will spread globally, and a health crisis would turn to a social crisis that affects everything including higher education. However, during this uncertainty, Tehran University of Medical Sciences (TUMS) tried to respond quickly. In this study, we explain how a nerve center has helped TUMS respond to this crisis and ensure safety to keep key operations going, and set up a functional decision-making system for the future. We also share perspectives on the critical issues, the challenges ahead, and the opportunities emerging in the "new normal."

Acceptance or Rejection of the COVID-19 Vaccine: A Study on Iranian People's Opinions toward the COVID-19 Vaccine.

We aimed to assess the Iranian people's attitude and confidence in the COVID-19 vaccine, their concerns about the safety of vaccines, and their reasons for accepting or rejecting the COVID-19 vaccine. We conducted a web-based cross-sectional study with a mixed qualitative−quantitative approach from December 2020 to February 2021. Our questionnaire consisted of a COVID-19 vaccine attitude questionnaire, a COVID-19 vaccine confidence inventory, a modified vaccine safety scale, and questions about participants' decision to accept or refuse the COVID-19 vaccine, and their explanations for their decisions. The research included 1928 people with an average age of 34.88 years with 1236 (64.1%) being female. A total of 1330 participants desired to have the COVID-19 vaccine (69%). Female gender, lower educational levels, following COVID-19 news through sources other than websites and social media, not following COVID-19 news, and loss of a first-degree relative due to COVID-19 were all associated with a more negative attitude toward the COVID-19 vaccine (p < 0.01). To conclude, the acceptance rate of the COVID-19 vaccine among Iranians is comparable to the international average; however, it is still unfavorable. There are serious challenges to the vaccination program in Iran, such as older adults' lower intention to undergo the COVID-19 vaccine and misinformation.

A Randomized Crossover, Pilot Study Examining the Effect of Acupuncture in the Management of Competitive Anxiety in Athletes.

Background: Excessive competitive anxiety induces adverse effects on athletic performance and planning efficient management methods is crucial. Objectives: We aimed to assess the effects of acupuncture on competitive anxiety. Methods: In this cross-over study, 20 male soccer players under 21 years (U-21) were randomized equally into acupuncture or control groups. The acupuncture group received acupuncture on fifteen anxiety-related points and the control group received acupuncture on fifteen points unrelated to anxiety for thirty minutes. We measured the participants' resting heart rate and galvanic skin conduction and asked them to answer the Competitive State Anxiety Inventory-2 (CSAI-2) questionnaire at baseline and the end of the intervention. Results: We detected a significant treatment effect in the cognitive anxiety level (-1.05 ± 0.91; p = 0.02) but not in the somatic anxiety level (-0.46 ± 1.68; p = 0.43), Sport Self-Confidence (-1.06 ± 2.21; p = 0.11), heart rate (0.20 ± 2.2; p = 0.93), and skin conductance (-0.50 ± 0.77; p = 0.19). Conclusion: Based on these results, acupuncture might decrease cognitive anxiety but might not affect somatic anxiety.

Saffron (Crocus Sativus L.), Combined with Endurance Exercise, Synergistically Enhances BDNF, Serotonin, and NT-3 in Wistar Rats.

BACKGROUND: Evidence indicates that combined approaches based on exercise and nutrition benefit neural development. We aimed to determine the effect of saffron and endurance training on hippocampus neurogenic factors, neurotrophin-3 gene expression in soleus muscle, and short-term memory in Wistar rats. METHODS: The study analyzed four groups of ten rats each: control, exercise, saffron, and saffron plus exercise. The rats in the exercise groups were trained on a rodent motor-driven treadmill. All rats were gavage daily with either saffron extract (40 mg/kg) or water. After eight weeks of intervention all rats were evaluated using the novel object recognition (NOR) test. Blood and tissue samples were collected to measure proteins and neurotrophin-3 gene expression. RESULTS: Rats that received saffron treatment combined with exercise had significantly greater brain-derived neurotrophic factor (BDNF) and serotonin in hippocampus compared to the control and saffron-only-treated rats (p< 0.05). Neurotrophin-3 mRNA in soleus muscle was higher in the saffron plus exercise group than rats in the other three groups (p< 0.05). Hippocampus 5-hydroxyindolacetic acid and short-term memory were significantly greater in all the intervention groups than in the control group (p< 0.05). CONCLUSION: Saffron, combined with endurance exercise, synergistically increased hippocampus BDNF, serotonin, and muscular neurotrophin-3 mRNA in Wistar rats.

Effect of saffron (Crocus sativus L.) and endurance training on mitochondrial biogenesis, endurance capacity, inflammation, antioxidant, and metabolic biomarkers in Wistar rats.

We aimed to evaluate the effect of saffron (Crocus Sativus L.) treatment on endurance capacity, mitochondrial biogenesis, inflammation, antioxidant, and metabolic biomarkers in Wistar rats. Forty male rats were allocated equally into four groups: Saffron, Exercise and Saffron, Exercise and Placebo, and Placebo. Endurance training was accomplished on a specified rodent motor-driven treadmill. Running to fatigue test and also metabolic and molecular indices were measured after eight weeks of intervention. mtDNA copy number and NRF-1 gene expression increased significantly in the Ex + S group compared to the exercised and control group (p < 0.05). Endurance capacity time increased in the Ex + S group compared to the Ex group (p < 0.05). Malondialdehyde, CPK, AST, and IL-6 decreased and antioxidant parameters including Glutathione peroxidase and Glutathione increased in the Ex + S group compared to exercised rats (p < 0.01). Saffron enhanced mitochondrial biogenesis, decreased oxidative stress, inflammation, and modulated metabolic biomarkers in exercised rats. PRACTICAL APPLICATIONS: The influence of potential nutrient factors on exercise performance has reached much attention in recent years. Athletes require an appropriate sport supplement to reimburse their fatigue and improve their resilience. Saffron (Crocus Sativus L.) is a well-known spice in the food trade which is quite popular around the world by giving a desirable taste to food. In an experimental study, we showed that saffron extract treatment during endurance training could improve endurance capacity by modulating several metabolic and genomic factors. Therefore, by relying on the results of this study and the positive effects of saffron published in previous studies, saffron could be added to sport beverages and supplements to enhance an athlete's performance.