Background: Sufficient intake of fruits and vegetables has been associated with a reduced risk of chronic diseases and body weight management but the exact mechanism is unknown. The World Health Organisation and Food and Agriculture of the United Nation reports recommend adults to consume at least five servings of fruits and vegetables per day excluding starchy vegetables. This review focuses on the importance of fruits and vegetables as well as the benefits and progress of nutrition education in improving intake.

Methods: For this narrative review, more than 100 relevant scientific articles were considered from various databases (e.g Science Direct, Pub Med and Google Scholar) using the keywords Fruit and vegetable, Nutrition education, Body weight, Obesity, Benefits and challenges.

Results: Existing data suggests that despite the protective effects of fruits and vegetables, their intakes are still inadequate in many countries, especially developing ones. Consequently enhancing strategies to promote fruit and vegetable intake are essential for health promotion among population. A number of reviews confirm that a well planned and behaviour focused nutrition education intervention can significantly improve behaviour and health indicators.

Conclusion: Despite challenges in nutrition education intervention programs, they are considered as a good investment in terms of cost benefit ratio. Rapid improvement in trends of nutrition education can be seen in many countries and majority of interventions has been successful in increasing fruits and vegetables intake. It is recommended that health professionals use multiple interventions to deliver information in several smaller doses over time to ensure improved outcomes.

Keywords: Fruit and vegetable, Nutrition education intervention, Body weight, Obesity, Benefit and challenges.

Background: In this study, we examined the epidemiological aspects of neonatal mortality due to intrauterine infections with regard to regional characteristics.

Methods: Consolidated report of the Ministry of Health and Social Development of the Republic of Kazakhstan on children deceased during their first 28 days of life due to intrauterine infections (P23 – congenital pneumonia, P35-39 – infectious diseases specific to the perinatal period) in the country and its regions for 2010 - 2014 was used in this investigation. Descriptive and analytical methods of medical statistics and epidemiology were used as the main method of this 5-year (2010-2014) retrospective study.

Results: Overall, 3,298 neonatal deaths from intrauterine infections were recorded in Kazakhstan during the period of 2010-2014, 1,925 of which were early and 1,373 were late neonatal deaths. The average annual rate of neonatal mortality rate from intrauterine infection in the country amounted to 1.73±0.23‰ (95% CI=1.27-2.19‰), whereas trends during the study period decreased (T=−15.3%). Regional characteristics of neonatal mortality were established. Different levels for cartograms of neonatal mortality from intrauterine infections were defined: low (up to 1.28‰), average (from 1.28‰ to 2.12‰) and high (by 2.12‰ and above). Neonatal mortality in the early and late periods was also analyzed.

Conclusion: This is the first epidemiological study of neonatal mortality from intrauterine infection, which contains a detailed space-time evaluation. The results of this investigation can be used to improve the state program to combat infant mortality.

Keywords: Neonatal mortality, Intrauterine infections, Trends, Cartograms, Kazakhstan

Background: The aim of this study was investigate drinking, driving, and socio-behavioral factors among university students in low and middle income and emerging economy countries.

Methods: Using anonymous questionnaires, data were collected from 18476 university students, of which 15151 (82.0%) were drivers of a car or motorcycle (41.3% men and 58.7% women), with a mean age of 20.7 years (SD=2.9), from 22 countries across Africa, Asia and Americas.

Results: Overall, 17.3% reported to have been driving a car or motorcycle after having had too much to drink in the past 12 months, ranging from below 5% in Bangladesh, Indonesia and Kyrgyzstan to above 35% in China, Singapore and Thailand. In multivariate logistic regression analysis, among both men and women, earlier year of study, living in an upper middle income or high income country (OR=3.58, CI=3.00-4.27 and OR=2.95, CI=2.52-3.46), low intrinsic religiosity (OR=0.67, CI=0.54-0.83 and OR=0.34, CI=0.28-0.42), injury from motorcycle accidents (OR=4.29, CI=2.69-6.82 and OR=3.24, CI=2.26-4.63), and weak belief in the importance of not drinking (OR=1.78, CI=1.50-2.11 and OR=1.61, CI=1.37-1.88) and driving were associated with drinking and driving. Further, among men, older age (OR=1.04, CI=1.01-1.07), binge drinking (OR=1.53, CI=1.27-1.86) and illicit drug use (OR=1.22, CI=1.01-1.47), and among women, younger age (OR=0.95, CI=0.97-0.98), and a lower country BAC limit (OR=0.01, CI=0.001-0.18) was associated with drinking and driving.

Conclusion: This study confirms low to high levels of drinking and driving in different cultures across Africa, Asia and the Americas. Various factors identified can be used to guide interventions to reduce drinking and driving among university students.

Keywords: Drink driving, Health behaviour, Health beliefs, University students, Multi-country

Background: Nephrotic syndrome is a disorder that leads to hyperlipidemia. L-carnitine and genistein can effect on lipid metabolism and the syndrome. In the present study, we have delved into the separate and the twin-effects of L-carnitine and genistein on the gene expressions of HMG-COA reductase and LDL receptor in experimental nephrotic syndrome.

Methods: In this controlled experimental study, 50 male Sprague–Dawley rats were randomly divided into five groups: NC (normal-control), PC (patient-control), LC (L-carnitine), G (genistein), LCG (L-carnitine-genistein). Adriamycin was used for inducing nephrotic syndrome and the spot urine samples and urine protein-to-creatinine ratio were measured. Hepatocytic RNA was extracted and real-time PCR was used for HMG-COA Reductase and LDL receptor gene Expression measurement.

Results: The final weight of the patients groups were lower than the NC group (P=0.001), and weight gain of the NC group was higher than the other groups (P<0.001). The proteinuria and urine protein-to-creatinine ratio showed significant differences between PC group and LC, G and LCG groups at week 7 (P<0.001). The expression of HMG-COA Reductase mRNA down regulated in LC, G and LCG groups in comparison with PC group (P<0.001). ΔCT of LDLr mRNA showed significant differences between the PC group and the other patient groups (P<0.001).

Conclusion: This study shows a significant decreasing (P<0.001) and non-significant increasing trend in HMG-COA Reductase and LDLr gene expression, respectively, and synergistic effect of L-carnitine and genistein on these genes in experimental nephrotic syndrome.

Keywords: Gene, Genistein, L-carnitine, LDL Receptor, Nephrotic syndrome

Background: Germ-line mutations of BRCA1 and BRCA2 genes are responsible for approximately 25-30% of dominantly inherited familial breast cancers; still a big part of genetic component is unknown. The aim of this study was to investigate genetic causes of familial breast cancer in a pedigree with recessive pattern of inheritance.

Methods: We applied exome sequencing as a useful approach in heterogeneous diseases gene identification in present study for familial breast cancer. Sanger sequencing was applied for validation and segregation analysis of mutations.

Results: Here, we describe a family with three affected sisters of early-onset invasive ductal carcinoma due to heterozygous frame shift mutation rs80359352 in BRCA2 gene as the first report in Iranian patients in association with a novel missense SNP of STK11 (p.S422G). These mutations are inherited from their normal father.

Conclusion: Despite apparent recessive pattern of inheritance a dominant gene (here BRCA2) can be involved in pathogenesis of hereditary breast cancer which can be explained by incomplete penetrance of BRCA2 mutations.

Keywords: BRCA2, Familial breast cancer, rs80359352, STK11, Iran

Background: Chemokine receptors have been shown to play an important role in the development and metastatic spread of various malignancies. In this study, the gene expression profile of some key chemokine receptors involved in metastasis has been investigated in esophageal and breast cancer cell lines.

Methods: In a descriptive study, gene expression profile of CCR1, CCR6, CCR7, CCR9, CXCR1, and CXCR4 in human esophageal cancer cell line (KYSE-30) and human breast cancer cell line (MCF7) were analyzed using real-time PCR and their results were compared accordingly.

Results: We demonstrated for the first time the expression of CCR1, CCR6, CCR7, CCR9, CXCR1, and CXCR4 at transcriptional level in human esophageal cancer cell line. The expression of CCR1, CCR7 and CXCR4 were lower in esophageal compared with breast cancer cells, although without significant difference. CCR9 was highly expressed in esophageal cancer cells as compared to the breast cancer cells (P < 0.05). Similarly, the expression of CCR6 and CXCR1 were higher, although without significant difference.

Conclusion: Esophageal cancer cells like breast cancer express some key chemokine receptors involved in metastasis. Targeting of proposed receptors in esophageal cancer may be a novel strategy for prevention of cancer metastasis.

Keywords: Esophageal cancer, Breast cancer, Metastasis, Chemokine receptors, Targeted cancer therapy

 Background: Cutaneous leishmaniasis (CL) caused by Leishmania tropica is endemic in Kerman, southeastern Iran. While dogs have long been implicated as the main domestic reservoirs of L. infantum, etiological agent of zoonotic visceral leishmaniasis (ZVL), they can also carry L. tropica infection. The objective of the present study was to determine molecular identity and to evaluate histopathological changes due to CL in dogs in a well-known focus of anthroponotic CL (ACL) in Kerman, southeastern Iran.

Methods: This study was carried out in three prospective series from 1994 to 2013 on dogs. Tissue samples were taken from 471 stray dogs. Pathological specimens including skin, spleen, liver and lymph nodes were prepared for paraffin blocks, sectioning and staining for further histopathological examination. PCR amplification of kDNA was performed to identify the causative agent and sequencing. Overall, two out of 471 stray dogs were infected with L. tropica. Hyperplasia of red pulp by the proliferation of histiocytes, lymphocytes, plasma cells and cytoplasm of histiocytes collection of amastigotes was noted.

Results: Based on the results of PCR products and sequencing analysis, the parasites isolated from the lesions of two dogs were characterized as L. tropica, corresponding to a band of 830 bp

Conclusion: This finding revealed infection with L. tropica in stray dogs in the city and suburbs of Kerman. This information is essential for public health concerns and planning effective future control programs. The role of dogs as potentional reservoir in the epidemiology of ACL needs further investigation.

Keywords: Leishmania tropica, Dog, Histopathology, Molecular, Epidemiology, Iran

Background: Excellence and quality models are comprehensive methods for improving the quality of healthcare. The aim of this study was to design excellence and quality model for training centers of primary health care using Delphi method.

Methods: In this study, Delphi method was used. First, comprehensive information were collected using literature review. In extracted references, 39 models were identified from 34 countries and related sub-criteria and standards were extracted from 34 models (from primary 39 models). Then primary pattern including 8 criteria, 55 sub-criteria, and 236 standards was developed as a Delphi questionnaire and evaluated in four stages by 9 specialists of health care system in Tabriz and 50 specialists from all around the country.

Results: Designed primary model (8 criteria, 55 sub-criteria, and 236 standards) were concluded with 8 criteria, 45 sub-criteria, and 192 standards after 4 stages of evaluations by specialists. Major criteria of the model are leadership, strategic and operational planning, resource management, information analysis, human resources management, process management, costumer results, and functional results, where the top score was assigned as 1000 by specialists. Functional results had the maximum score of 195 whereas planning had the minimum score of 60. Furthermore the most and the least sub-criteria was for leadership with 10 sub-criteria and strategic planning with 3 sub-criteria, respectively.

Conclusion: The model that introduced in this research has been designed following 34 reference models of the world. This model could provide a proper frame for managers of health system in improving quality.

Keywords: Quality model, Excellence model, Training centers, Primary cares, Iran

Background: Tremendous amount of researches have investigated the issue of water photodisnfection. The aim of this research is to illustrate the influences of bacterial density, turbidity, exposure time and potassium persulfate (KPS) dosage on the efficacy of associated solar disinfection (SODIS) with KPS for E. coli (ATCC: 25922) eradication as an efficient and inexpensive process.

Methods: Desired bacterial density and turbidity was achieved by spiking of 0.5 Mc Farland (1.5×10⁸ cell/ml) and sterile soil slurry in 1 liter of the commercially bottled water.

Results: The highest value of UV_A solar irradiation measured at 13.30 p.m was 5510 µW/Cm². Increase of bacterial density from 1000 to 1500 cell/ml led to an increase in disinfection lapse time, except in 2 mMol/l KPS. Spiking of 0.1 mMol/l of KPS was not effective; however, increase of KPS dosage from 0.1 mMol/l to 0.7, 1.5 and 2 mMol/l led to the enhancement of disinfection time from 4 h to 3 h and 1 h, respectively. For bacterial density of 1000 cell/ml, increasing KPS dosage up to 0.7 mMol/l had no improved effect; however, beyond this dosage the disinfection time decreased to 1 h. Without KPS and up to 150 NTU within 4 h exposure time, E. coli disinfection was completed. In 2 mMol/l KPS and 1000 and 1500 cell/ml, the 2 h contact time was sufficient up to 150 and 100 NTU, respectively; moreover, complete disinfection was not achieved at higher turbidity.

Conclusion: Association of KPS with SODIS can lead to decreasing of water disinfection time.

Keywords: Disinfection, Solar irradiation, Potassium persulfate, Water, E. coli

Background: Although the risk factors of ischemic strokes are well defined, there is slight information about their relations with the etiologies of ischemic strokes. This study investigated the distribution of ischemic stroke risk factors and their connections to diverse etiologies of cerebrovascular attack (CVA) and specific ischemic regions of brain.

Methods: In this cross sectional study, we analyzed the data of patients with definite diagnosis of CVA, excluding hemorrhagic strokes, registered in Imam Hossein Medical Center in Tehran, Iran. The data were collected from entire archived medical records from March 2010 until September 2012, retrospectively.

Results: Out of 1696 cases a total of 1011 subjects, 487 (48.2%) males and 524 (51.8%) females with mean age of 68.91±13.54 yr were included in the study. Patients suffering from atrial fibrillation (AF), valvular heart disease (VHD), and dilated cardiomyopathy were more prone to develop cardioembolic stroke. Those with diabetes mellitus (DM), carotid artery stenosis and dyslipidemia (DLP) had a higher prevalence of macroangiopathic stroke. Ischemic heart disease (IHD), AF, and VHD were associated with stroke in the brain territory supplied by middle cerebral artery (MCA) while DM and carotid artery stenosis were correspondent with posterior cerebral artery (PCA) stroke.

Conclusion: The diagnosis of the weight of each risk factor of ischemic strokes on different etiologies and territories of ischemia can assist care providers for a more efficient prevention of strokes. The results of this study can also be a basis for further investigations to corroborate the pathophysiology of such relations.

Keywords: Stroke, Cerebral arteries, Risk factors, Iran

Background: Spinal cord injury (SCI) imposes a significant burden on the social and marital life. Here, we assessed the divorce rate and changes in marital status among a sample of Iranian individuals with SCI.

Methods: Referred patients to Brain and Spinal Cord Injury Research Center were invited to participate in this cross-sectional investigation. The Main exclusion criteria were coincidental brain injury, history of chronic diseases before SCI and substance use. Demographic characteristics (including age, gender, educational level, marital status before and after injury and duration of marriage) and Injury characteristics (level of the injury, American spinal injury association (ASIA) scale and Spinal cord independence measure III (SCIM)) were collected.

Results: Total of 241 subjects with SCI participated in this investigation (164 (68%) male and 77 (32%) female). Among men, 16.5% [95% CI: 10.81%-22.18%] and among women 18.2% [95% CI: 9.58%-26.81%] got divorced after injury. Duration of marriage before injury was significantly related to lower divorce rate (P< 0.001 and 0.016 in men and women, respectively). Injury characteristics had no relationship with marital longevity. Age was a protective factor against marital dissolution only in men (P< 0.004).

Conclusion: Our study revealed the divorce rate of 17% [95% CI: 13%-20.9%] after SCI in a sample of Iranian population. The protective influence of age in maintenance of marriage was only detected in men, which proposes existence of a sexual polymorphism in the role of age. Divorce rate was similar between two genders and injury characteristics were not related to divorce rate as well.

Keywords: Marital status, Spinal cord injury, Divorce, Iran

Background: The trajectory of marital quality over the life course assumes a curvilinear pattern and declines over time. However, most studies to date have been conducted in developed societies, leaving the generalizability of their findings open to skepticism. In this study, we aimed to delineate the trajectory of marital satisfaction in Iran.

Methods: Using cluster-sampling method, representative sample of 800 Iranian married individuals from urban areas of seven provinces of Iran, between February and May 2011 was surveyed. Each cluster included 50 households. Sealed packages containing survey material were delivered to households. Self-administered surveys included a checklist collecting demographic and socioeconomic data, and the Comprehensive Marital Satisfaction Scale. Generalized additive models (GAM) were used to explicate the trajectory of marital satisfaction over marital duration.

Results: A total of 644 complete questionnaires were returned (response rate: 80.5%). Average age of the participants was 40yr and average duration of marriage 17yr. The fitted GAM showed that marital satisfaction is highest at the beginning but drastically declines over the first 10yr. After arriving a nadir, the downward progression is reversed in the next 10-15yr, reaching a level comparable to the beginning. At 23-25yr, a second declining wave initiates and marital satisfaction steadily declines thereafter. The overall shape remains the same after adjustment for number of children, economic status, and retirement.

Conclusion: Marital trajectory assumes a curvilinear pattern and has three periods of decline, stagnation, and decline. The shape of trajectory bears similarities to the observed patterns in the US but is distinct, nevertheless. 

Keywords: Collectivist culture, Marital Quality, Marital Relationship over time, Marital Trajector

Background: It is necessary to consider into hospital emergency services' quantity and quality in different aspects such as time-to-provider, left-without-treatment and length-of-stay. The aimof this research was to identify the effect of these factors on patient satisfaction in training hospitals.

Methods: In this descriptive-analytical and cross-sectional study, the sample size was calculated 768. The instrument included 54 questions and 8 sections. Three questions were in the field of following factors: 1) Time to provider was defined as the time from initial triage to initial provider evaluation. 2) Left-without-Treatment patients were defined as those who were initially triaged but were unable to be evaluated by a provider because they had left the ED. 3) Length-of-Stay was defined as time from initial triage to the time of final ED disposition, either discharge or admission. It was analyzed by descriptive statistics, simple logistic regression, multiple logistic regressions, simple linear regression and multiple linear regression.

Results: The time-to-provider lower than 15 minutes, LWOT and LOS lower than 6 hours were 92.8%, 3.9% and 90.3%, respectively. The mean of time-to-provider and the mean of LOS were 18.1 minutes and 202 minutes. Time-to-Provider affected satisfaction of admission, guardians, nursing care and managing proceedings (P<0.001). LOS affected satisfaction of admission, guardians and diagnosis proceedings (P<0.01). LWOT did not affect satisfaction and its domains (P>0.05).

Conclusion: Decreasing time-to-provider and LOS has the effect on patient satisfaction in some domains. Furthermore, left-without-treatment rate is not a good proxy of patient satisfaction.

Keywords: Time-to-Provider, Left-without-Treatment, Length-of-Stay, Satisfaction

A few numbers of patients admitted to the emergency department due to the lunate dislocation can cause a direct injury to the wrist ligament, which mainly occurs after wrist trauma, and often diagnosis is far from the mind. A 32 years old man due to severe pain and tenderness of the wrist started the previous day during swimming, referred to Emergency Department of Imam Reza Hospital of Mashhad, 2012. He did not recall any history of direct trauma to the wrist. However, he was prescribed NSAID and wrist splint, but the pain did not improve. In physical examination, the localized tenderness of the dorsal wrist without erythema and warmness was clearly evident and paresthesia of the skin was observed in the 4th and 5th fingers. Plain X-ray detected no fractures. The combination of these signs and symptoms prompted clinical suspicion of lunate dislocation confirmed by imaging. This patient was admitted to the orthopedic service with lunate dislocation diagnosis for the proper treatment.

Keywords: Lunate dislocation, Diagnosis, Median nerve injury

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