فهرست مطالب

  • Volume:11 Issue: 2, 2020
  • تاریخ انتشار: 1399/02/06
  • تعداد عناوین: 20
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  • Sara Ahmed Refeai*, Nashwa Nabil Kamal, Eman Ramadan Ahmed Ghazawy, Chrestina Monir Fekry Page 11
    Background

    This study aimed to assess perception of healthcare workers (HCWs) toward infection control measures and to identify the major barriers that may hinder the proper infection control practice and to compare perception of HCWs toward infection control measures between Minia University Hospital and Minia General Hospital. The study was a descriptive cross‑sectional study.

    Methods

    The study conducted on 350 HCWs (187 from Minia University Hospital, 163 from Minia General Hospital); data were collected using a structured questionnaire. The questionnaire was designed to assess perception toward infection control measures and to identify the major barriers that may hinder the proper infection control practice. Statistical Analysis Used: Data were gathered and entered into Statistical Package of Social Science (SPSS), version 22.

    Results

    About 85% of HCWs in Minia University Hospital compared with 82% in Minia General Hospital had a positive perception toward Standard precautions (SPs). Knowledge score was the only significant predictors of perception of HCWs toward infection control. One‑point increment in knowledge score is associated with significantly 13% lower odds to have negative perception; the multivariable‑adjusted odds ratio (95% confidence intervals) was 0.87 (0.81–0.95). The most frequent barrier of practice of SPs was absence of enough gloves and gowns.

    Conclusions

    HCWs demonstrated positive perception toward infection control and SPs measures. The most frequent reported barrier against practice of SPs was absence of enough gloves and gowns. The significant predictor that hindered the practice of SPs was that “Following SPs makes work harder.”

    Keywords: Barriers, infection control, perceptions, standard precautions
  • Roberto Menicagli*, Ortensio Marotta, Nunzia Maione Page 12
    Background

    Capsaicin binds the TRPV1 (transient receptor potential vanilloid), desensitizing the pain fibers that become insensitive to nociceptive stimuli. For this fact that the capsaicin has antipain and antiinflammatory properties, few studies verify possible harmful effects, especially with its use in high amounts. The aim of this study is to check salivary nitric oxide (NO) and malondialdehyde (MDA) as indicators of its possible oral health alterations.

    Methods

    The protocol calls for twelve volunteers to eat 20 g of sausage with a high content of chili pepper and capsaicin. The study analyzes their salivary concentration of NO and MDA and in control group, 2 min, 1 h, and 1.5 h after ingestion. The U‑Mann Whitney Calculator Test statistically analyzes these results.

    Results

    Immediately after eating, there is a significant increase of NO and MDA vs control: P value is 0.03752 and 0.03236, respectively. The values of NO and MDA vs control remain higher after 1 h: P value is 0.04036 and 0.0466, respectively, to return to normality after 1.5 h.

    Discussion

    This study shows that capsaicin increases the simultaneous production of MDA and NO. It is possible to hypothesize that MDA derives mainly from the inflammatory process up‑regulated by COX‑2, generated by capsaicin. We hypothesize instead that the excess of capsaicin inhibits and reduces the number of TRPV1, which produces an excess of NO and generates nitrosative stress. NO reacts with O2 to form hydroxyl radicals (OH) and H2 O, or with superoxide anions to form MDA.

    Conclusions

    The results of this study clearly show that the use not necessarily excessive of chili leads to developing an inflammatory process.

    Keywords: Capsaicin, food, free radicals, mouth, nitric oxide
  • Mehdi NasrIsfahani, Fereshte Davari*, Reza Azizkhani, Majid Rezvani Page 13
    Background

    In the past decade, factors such as population growth, increased environmental incidents, and substance abuse have caused patient‑overcrowding in emergency departments (EDs). Our main objective was to assess the effects of a discharge lounge on decreasing the patient waiting time and ED overcrowding by computer simulation.

    Methods

    In this cross‑sectional retrospective study, the statistical population consisted of 39264 persons referred to the ED of Al‑Zahra Hospital. The sample size was calculated as 1275 through systematic random sampling at 99% confidence. To increase research accuracy, the number of patients was increased to 2515. Data were collected by standardized checklists and hospital information systems.

    Results

    Mean waiting time for level 2 patients who left the ED against medical advice after completing the treatment was declined from 56 min to 44 min and before completing the treatment process from 80 min to 50 min. Average waiting time for level 3 patients for personal satisfaction after completing the treatment process decreased from 15 min to 13 min and before the completion of the treatment process from 67 min to 41 min; the number of discharged patients awaiting discharge was decreased at level 2 from 3 to 2 and at level 3 from 2 to 1. The number of patients waiting for admission at triage stations reduced from 44 to 39%, and the average number of patients discharged from emergency room was increased from 7 to 12.

    Conclusions

    ED overcrowding is the hallmark of a mismatch between the availability of health care resources and patient demand for emergency care. Among major factors contributing to these situations are hindrances in patient flow and occupation of ED beds by nonurgent patients. The establishment of a discharge unit in the ED could be a practical solution to ED overcrowding

    Keywords: Computer simulation, discharge unit, emergency department, hospital
  • Hamideh Mahdaviazad, Mehrdad Askarian*, Bahareh Kardeh Page 14
    Background

    Medical error reporting is fundamental for improving patient safety. We surveyed healthcare professionals to evaluate their experience of adverse events witness and reporting, knowledge about adverse events, attitude toward own and colleagues’ errors, and perceived barriers in reporting errors.

    Methods

    This cross‑sectional study was conducted on healthcare professionals from May to October 2017 at Chamran hospital, which is the largest referral orthopedic center in southern Iran. The self‑administered questionnaire comprised 32 items covering five domains: (1) demographic and professional characteristics, (2) medical error witness and reporting, (3) actual and perceived knowledge regarding type of events and the status of completed training courses, (4) attitude toward reporting one’s own and colleagues’ errors, and (5) perceived barriers in error reporting. Questionnaire validity and reliability was proven in our previous study.

    Results

    From a total of 210 participants, 164 returned completed questionnaires (response rate = 78.1%); 87 (53%) were physicians and 77 (47%) were nurses. Underreporting was common, particularly among physicians. Out of physicians and nurses, 57.1% and 49.4% had poor knowledge, respectively. Participants reported their own or colleagues’ errors alike, but physicians tended to only provide verbal warning to their colleagues (36.8%), and nurses stated they would report the colleagues’ errors, if it was serious (32.4%). Fear of blame and punishment and fear of legal ramification were the most important perceived barriers.

    Conclusions

    Improvements in current medical error registry system, implementing effective educational courses, and modifying the curricula for students seem to be necessary to resolve the problem of underreporting and poor knowledge level.

    Keywords: Barriers, education, health personnel, knowledge, medical errors, patient safety, qualityof healthcare
  • Hoda Zahedi, Shirin Djalalinia, Hamid Asayesh, Morteza Mansourian, Zahra Esmaeili Abdar, Armita Mahdavi Gorabi, Hossein Ansari, Mehdi Noroozi, Mostafa Qorbani* Page 15
    Background

    Inflamation is widely known as an adaptive pathophysiological response in a variety of cancers. There is an expanding body of research on the key role of diet in inflammation, a risk factor for all types of cancer. Dietary inflammatory index (DII) was recently develpoed to evalute the inflammatory potential of a diet either as anti‑inflammatory or pro‑inflammatory. In fact, several studies have shown the association of DII and risk of different cancer types. The aim of this meta‑analysis was to investigate the association of DII with risk of incidence and mortality of any cancer types.

    Methods

    We searched PubMed‑Medline, Scopus, and Web of Science databases for pertient studies util January, 2017. All studies conducted to investigate the association of DII and incidence, mortality, and hospitalization of all cancer types were included. According to degree of heterogeneity, fixed‑ or random‑effect model was employed by STATA software.

    Results

    Total 38 studies were eligible for the meta‑analysis. The results show that a higher level of DII increases the risk for all cancer types incidence by 32% (OR: 1.32; 95% CI: 1.22‑1.42) including digestive tract cancers (OR: 1.55; 95% CI: 1.33‑1.78), hormone‑dependent cancers (OR: 1.14; 95% CI: 1.04‑1.24), respiratory tract cancers (OR: 1.64; 95% CI: 1.11‑2.17), and urothelial cancers (OR: 1.36; 95% CI: 1.01‑1.73). Moreover, a higher level of DII is in association with a higher risk for mortality caused by all types of cancer by 16% (OR: 1.16; 95% CI: 1.01‑1.32). In addition, meta‑regression analysis reveals that the design of study can have a significant effect on the association of DII and incidence of all cancer types (slope: 0.54; P = 0.05). The stratified meta‑analysis shows that the association of DII and incidence of all cancer types in case‑control studies (OR: 1.53; 95% CI: 1.36‑1.71) were more prominent than cohort studies (OR: 1.18; 95% CI: 1.07‑1.30).

    Conclusions

    This study shows that a higher level of DII is associated with a higher risk of incidence and mortality of all cancer types. The findings of the present study suggest that modifying inflammatory properties of dietary patterns can reduce the risk of incidence and mortality of all cancer types.

    Keywords: Cancer, diet, dietary inflammatory index, inflammation
  • Hayder M.Al kuraishy*, Ali I. Al Gareeb, Marwa S. Al nami Page 16
    Background

    Overproduction of reactive oxygen species and free radicals is the main mechanism beyond gentamicin‑induced nephrotoxicity. Irbesartan and other angiotensin II blockers offer significant nephroprotective effect through improvement of renal function and reduction of renal inflammation. Therefore, the objective of this study was to illustrate the nephroprotective effect of irbesartan in rats regarding the oxidative stress of irbesartan biomarkers.

    Methods

    Thirty male Sprague–Dawley rats were used; they were divided into three groups: Group І (10 rats) treated with distilled water, Group ІІ (10 rats) treated with gentamicin, and Group ІІІ (10 rats) treated with gentamicin plus irbesartan for 12 days. Blood urea, serum creatinine, serum malondialdehyde (MDA), superoxide dismutase (SOD), glutathione reductase (GSH), neutrophil gelatinase‑associated lipocalin (NGAL), kidney injury molecule (KIM‑1), and cystatin-c were measured in each group.

    Results

    Irbesartan significantly reduced blood urea, serum creatinine, serum MDA, NGAL, KIM‑1, and cystatin-c [P < 0.05]. Irbesartan significantly increases SOD [P < 0.05] without significant effect in elevation of GSH serum levels.

    Conclusions

    This study concluded that irbesartan has a nephroprotective effect in attenuation of acute nephrotoxicity through modulation of oxidative stress and antioxidant capacity in rats.

    Keywords: Antioxidant capacity, gentamicin, irbesartan, nephrotoxicity, oxidative stress
  • Mohammadreza Ghazavi, Fateme Rastgu, Jafar Nasiri, Omid Yaghini* Page 17
    Background

    Stuttering is a kind of speech disorder that affects about 1% of total population. As the origin of this disorder is not obviously diagnosed yet, various remedies have been practiced and among them different medicines have been studied, but unfortunately no significant effective drugs have been recognized yet. As stuttering imposes a great social and mental costs to the patients and their families, finding an effective medicine will help significantly. In this study we have focused on the effects of levetiracetam (LEV) treatment on children suffering from stuttering.

    Methods

    In this clinical trial study, 30 children aged > 3 years (median 3.8 years) with stuttering and abnormal sleep electroencephalogram (EEG) were treated by LEV and followed‑up for a minimum period of 6 weeks. The starting dose of 20 mg/kg/day was increased at an interval of 1 week by 20 mg/kg/day, if necessary, up to maximum dose of 60 mg/kg/day.

    Results

    Overall LEV was effective in 70% of patients, decreasing stuttering to at least 50%. Three children (10%) became stuttering‑free and only in one (3.3%) child an increase in stuttering was observed. There were statistically significant differences for efficacy in the presence of variables such as age groups, seizure, stuttering family history, and EEG data.

    Conclusions

    LEV is an effective drug for treatment of childhood stuttering in those that have abnormal sleep EEG.

    Keywords: Child, disease management, etiracetam, stuttering, speech disorders
  • Nahid Tajeddin, Ali Mohammad Ahadi*, Gholamreza Javadi, Hoda Ayat Page 18
    Background

    There are numerous couples worldwide currently suffering from infertility. Several factors, including genetic abnormalities are involved in infertility. In this study, we investigated the expression of myc gene in uterine tissue of infertile women. The protein encoded by this gene is one of the important transcription factors involved in the expression of many genes in the embryonic growth, and development pathways.

    Methods

    There are about 45 samples of uterine tissue from women with primary and secondary infertility were involved in this study. After extracting RNA and synthesizing cDNA, using specific primers for the myc gene and the beta‑actin gene (as an internal control), gene expression was evaluated by Real‑time RT‑PCR method.

    Results

    The results of myc gene expression analysis showed no significant pattern between the affected and healthy women, however decreasing of its expression should not be rejected.

    Conclusions

    This study is the first report about myc gene expression and its relation with the primary and secondary infertility. Myc gene expression study at different times of sexual period of infertile woman is suggested. Also, we proposed here, as a preventive strategy, improvement of the expression level of myc gene by some methods, such as hormone therapy, can increase the implantation success in the infertile women.

    Keywords: Gene expression analysis, myc gene, women infertility
  • Jafar Mehvari Habibabadi, Mohamad Zare, Seyed Navid Naghibi*, Mahdieh Afzali, Iman Adibi, Nasim Tabrizi, Seyed Nader Naghibi Page 19
    Background

    Epilepsy is a chronic neurologic condition and affects people of all ages. Seizure clusters are generally referred to seizures that occur at close intervals with complete recovery between attacks. Various studies have reported a variety of frequencies and risk factors for this condition.

    Methods

    We designed a study to determine the frequency of seizure cluster and their associated risk factors in Iranian population for the first time.

    Results

    Among 40 variables analyzed, 18 of them were significantly associated with seizure clustering. Risk factors including educational level, age of onset, number of drugs, seizure types, perinatal complication, developmental delay, other illnesses, parental consanguinity, systemic diseases, number of drugs used, mentation, motor signs, sensory signs, cranial nerves signs, cerebellar signs, seizure duration, existence of magnetic resonance imaging (MRI) lesion, and type of MRI pathology are significantly associated with clustering of seizures. When associated risk factors were analyzed with multivariate analysis, age of onset of seizures, number of antiepileptic drugs currently used, lack of seizure‑free periods, seizure frequency, and type of MRI pathology are significantly defining for anticipating clustering of seizures.

    Conclusions

    Seizure cluster has a significant negative impact on the quality of life of patients. Important risk factors that are found to be associated are age of onset, parental consanguinity, frequency of seizure, lack of have seizure‑free period or periods, pathologies in neurological examination, and MRI findings.

    Keywords: Epilepsy, predictors, risk factors, seizure freedom
  • Saeed Salavati, Manouchehr Ahmadi Hedayati*, Amjad Ahmadi, Shohreh Fakhari, Ali Jalili Page 20
    Background

    The correlation of Helicobacter pylori infection with gastritis, peptic ulcer, and gastric cancer has been proven. The aim of this study was to determine the effects of cagA+ and cagA− genotypes of H. pylori on genes expression of interleukin (IL) -10 and tumor growth factor (TGF) β1 in gastric epithelial cells of patients with gastritis and H. pylori infection.

    Methods

    In all, 45 gastric biopsy samples were collected from patients with gastritis and H. pylori infection admitted to Tohid Hospital in Sanandaj city. Status of urease and cagA genes of H. pylori were directly determined from the biopsy samples using polymerase chain reaction (PCR) method. Expression of IL-10 and TGF-β1 genes in gastric epithelial cells of patients with gastritis and cagA+ and cagA− genotypes of H. pylori infection was serveyed using real-time PCR method.

    Results

    Overall, 25 samples had infection with H. pylori cagA+ and 20 with cagA− genotypes. This study showed that there is a positive correlation between cagA− genotypes of H. pylori and increasing of IL-10 gene expression in gastric epithelial cells of patients with gastritis (P = 0.001).

    Conclusions

    Level of gene expression of IL-10 as an anti-inflammatory cytokine in gastric epithelial cells of patients with H. pylori infection is connected to cagA- genotypes.

    Keywords: Cytotoxin‑associated gene A, gastric epithelial cells, Helicobacter pylori, interleukin‑10, transforming growth factor‑beta1
  • Masood Taheri Mirghaed, Hasan Abolghasem Gorji*, Sirous Panahi Page 21

    The prevalence of mental disorders in Iran is rising for many reasons including the population growth and its problems, the collapse of the family foundation, the economic problems, etc. Epidemiological studies of psychiatric disorders play an important role in determining the general mental health of the population and policy‑making and future planning of service delivery. To identify the relevant studies, two authors independently searched different scholarly databases including Embase, PubMed/MEDLINE, ISI/Web of Science (WOS), Scopus, Psych INFO, and Iranian databases such as MagIran, SID, IranPsych, and Irandoc from 1st January 2007 up to 1st July 2018. The gray literature (through Google Scholar) was also mined. Studies written in English or in the Persian language were searched. After searching the databases and removing duplicates cases, a total of 10 studies were selected and included in the study, which reported a total of 14 prevalence rates. There were a total of 72,262 participants, of whom 32,925 were male and 39,337 were female. The prevalence of psychiatric disorders in studies which used screening tool was 31.03% (95% confidence interval: 25.99–36.07). The prevalence was 25.42% in studies which used clinical interviews (95% CI: 15.96–34.88). There is an undeniable fact that the prevalence of mental disorders in Iran has been increasing, and this could be a warning to policy‑makers and health system managers. Hence, it is necessary to pay attention to this issue to maintain social capital, vitality, and efficiency of individuals and society as a whole.

    Keywords: : Iran, mental health, meta-analysis, prevalence, psychiatry
  • Abdolhosein Shiravi, Cyrus Jalili, Gholamhasan Vaezi, Ali Ghanbari, Alvand Alvani* Page 22
    Background

    Renal ischemia‑reperfusion disturbs both the function and the histology of this organ. Acacetin (Aca) is a natural flavonoid that is effective for relief of many diseases. The aim of this study was to determine the impacts of Aca on renal ischemia‑reperfusion process in mice.

    Methods

    In total, 84 male Balb/cmice divided into 12 groups and were administrated intraperitoneally for 4 days with or without surgery to dimethyl sulfoxide 0.01% or Aca (10, 25, and 50 mg/kg) as Control, control Acas, sham, sham Acas groups. Ischemia‑reperfusion without or with Aca (10, 25, and 50 mg/kg) treatments were the other groups. Parameters related to the function and the histology of the kidneys were evaluated and statistically analyzed from kidney and blood serum samples in the respect of the groups.

    Results

    In ischemia‑reperfusion and ischemia‑reperfusion + Aca (10 mg/kg) groups, there were significantly increased in urea, creatinine, malondialdehyde (MDA), and apoptosis rate, whereas total antioxidant capacity decreased compared to the control and sham and ischemia‑reperfusion + Aca (25 and 50 mg/kg) (P < 0.05). The histopathology alteration was seen in the ischemia‑reperfusion group than the others (P < 0.01). Moreover, there was a significant difference between ischemia‑reperfusion + Aca (25 and50 mg/kg) groups than ischemia‑reperfusion + Aca (10 mg/kg) one (P < 0.05).

    Conclusions

    The recovery effect of Aca was offered on renal ischemia‑reperfusion damage in a dose‑dependent manner in mice, showing by kidney histopathology and functional criteria improvements. The attributed mechanism for this impression would be the antioxidant property of Aca, decreasing both MDA levels and apoptosis rate in kidney tissue.

    Keywords: Acacetin, antioxidants, apoptosis, malondialdehyde, reperfusion injury
  • Sepideh Miraj, Seyedmehdi Pourafzali, Zohre Vakili Ahmadabadi, Zahra Rafiei Page 23
    Background

    Detecting pressure ulcer is an important nursing diagnostic care required for the patients hospitalized in ICU. The purpose of this study is to examine the effect of olive oil in preventing the development of pressure ulcer grade one in ICU patients.

    Methods

    In this clinical trial, 72 patients eligible for hospitalization in hospitals of Isfahan University of Medical Sciences were divided randomly into two groups; control and intervention (receiving olive oil). The standard program of skincare was implemented on both the groups; in addition, olive oil was applied topically in the intervention group. The data was collected on the first day through demographic information and Braden pressure ulcer risk assessment scale. An infrared thermometer was used to record the local temperature of the ulcers daily. Assessments were made based on pressure ulcer scale for healing (PUSH) tool and the pressure ulcer area was examined per square cm on the first, fourth, and seventh day. The data collected was analyzed by Fisher’s exact test, independent sample t‑test and repeated measure analysis using SPSS (version 22).

    Results

    On the fourth and seventh day, the PUSH score was lower in the olive oil group (7.50 ± 2.823 and 5.44 ± 3.806) than in the control group (9.50 ± 1.732 and 8.83 ± 2.864) (P‑value <0.001). Also, a significant improvement of ulcer was observed in the olive oil group (mean difference = 3.56; P value <0.001) but no change was observed in the control group (mean difference = 0.75; P value = 0.052).

    Conclusions

    Based on the effect of olive oil in the reduction of ulcer area and the average PUSH score obtained in ICU patients, the application of olive oil is recommended for healing grade one pressure ulcers.

    Keywords: Intensive care units, Iran, olive oil, pressure ulcer
  • Sedigheh Asgary, Rasool Soltani*, Najmeh Barzegar, Nizal Sarrafzadegan Page 24
    Background

    Animal studies have shown the anti‑obesity effects of Tamarindus indica L. (tamarind) fruit pulp. This study aimed to evaluate the weight‑reducing effects of T. indica L. fruit as well as its blood pressure‑ and lipid‑lowering effects in a clinical trial.

    Methods

    In a randomized controlled clinical trial, obese and overweight patients were randomly and equally assigned to tamarind and control groups. Both groups were instructed proper diet and maintaining physical activity for 6 weeks. Furthermore, the participants of tamarind group were instructed to consume 10 grams of tamarind fruit pulp twice daily with meals for the same period. Body mass index (BMI), waist circumference, systolic blood pressure (SBP) and diastolic blood pressure (DBP), fasting serum levels of glucose (fasting plasma glucose, FPG), total cholesterol, triglycerides (TG), low‑density lipoprotein cholesterol (LDL‑C), and high‑density lipoprotein cholesterol (HDL‑C) were determined and recorded for all patients pre‑ and post‑intervention.

    Results

    Twenty patients in each group completed the study. Tamarind significantly reduced BMI, WC, LDL‑C, SBP, and DBP compared to baseline. However, none of these effects were statistically significant compared to control group.

    Conclusions

    Consumption of tamarind fruit pulp with daily dose of 20 g has no significant effects on body weight, waist circumference, serum lipid profile, blood glucose, and blood pressure.

    Keywords: Clinical trial, obesity, overweight, serum lipid profile, Tamarindus indica L
  • Pramon Viwattanakulvanid, Ratana Somrongthong, Muskan Vankwani, Kavita FN, Ramesh Kumar* Page 25
    Background

    Parkinson’s disease (PD) is a neurodegenerative disorder that results in gradual decline of motor, autonomic, and neuropsychiatric functions of the patient. Knowledge and factors responsible for Parkinson’s disease (PD) are important among patients that could positively affect their attitude and perceptions. This study was conducted to determine the factors influencing and level of the knowledge regarding Parkinson’s disease in Thailand.

    Methods

    This cross‑sectional study was conducted on 125 patients admitted in King Chulalongkorn Memorial Hospital Bangkok, Thailand. Sociodemographic variables and clinical characteristics were collected as predictors of knowledge, treatment, and self‑care for PD. A validated, piloted, pretested tool was used for data collection. Multiple linear regressions were used to find the most influencing predictor of knowledge about PD. The study was approved by the Ethical Board of Chulalongkorn University, Thailand.

    Results

    The level of education was found to be the most significant (P = 0.005) predictor of PD knowledge. PD patients with high education had significantly higher knowledge scores than those with low education in all aspects of disease (P = 0.041), treatment (P = 0.014), and self‑care (P = 0.011). PD knowledge was poor in variables such as levodopa (62%), nonmotor symptoms (54%), and stem cell transplantation (40%), respectively.

    Conclusion

    The study results conclude that educational level is the most important predictor of knowledge about Parkinson’s disease.

    Keywords: Awareness, cure, education, knowledge level, misconception, determinants ofParkinson, motor disease awareness, Parkinson’s disease
  • Vijay Kumar Chattu*, Andy Knight, K. Srikanth Reddy, Obijiofor Aginam Page 32

    Human security is a concept that challenges the traditional notion of national security by placing the ‘human’ as the central referent of security instead of the ‘state.’ It is a concept that encompasses health and well-being of people and prioritizes their fundamental freedoms and basic livelihoods by shielding them from acute socioeconomic threats, vulnerabilities and stress. The epicenter of “health security” is located at the intersection of several academic fields or disciplines which do not necessarily share a common theoretical approach. Diverse players in the “health security” domain include practitioners in such fields as security studies, foreign policy, international relations, development theory, environmental politics and the practices of the United Nations system and other multilateral bodies like the World Health Organization (WHO) and the Pan American Health Organization (PAHO). Improvements in health are not only dependent on continued commitments to enhance the availability of healthcare and to strengthen disease prevention systems; they are very much enhanced by that intersection between global security and global health. What is emerging is global health diplomacy paradigm that calls for strengthening of core capacities in the public health and foreign policy arenas aimed at advancing human security through the strengthening of global health diplomacy practices. Human security in its broadest sense embraces far more than the absence of violence and conflict. It encompasses human rights, good governance, access to education and health care, and ensuring that each individual has opportunities and devices to fulfill his or her potential. Every step in this direction is a step towards reducing poverty, achieving growth and preventing conflict. Freedom from want, freedom from fear and the freedom of future generations to inherit a natural environment – these are the interrelated building blocks of human‑ and therefore national security.

    Keywords: Development, diplomacy, foreign policy, global health, human security, noncommunicable diseases
  • Mohammadtaghi Sareban Hassanabadi, Seyed Jalil Mirhosseini, Masoud Mirzaei, Seyedeh Mahdieh Namayandeh*, Omid Beiki, Fadoua Gannar, Paolo Boffetta, Mohammadreza Pakseresht, Maryam Tabesh, Nastaran Ahmadi, Mahmood Kazeminasab, Amin Salehi Abargouei Page 33
    Background

    Metabolic syndrome (MetS) is one of the world’s largest health epidemics, and its management is a major challenge worldwide. The aim of this 10‑year follow‑up study was to assess the most important predictors of MetS persistence among an Iranian adult population.

    Methods

    In this cohort study, 887 out of 2000 participants with MetS aged 20–74 years in the central part of Iran were followed‑up for about 10 years from 2005–2006 to 2015–2016. MetS was defined based on the criteria of NCEP‑ATP III adopted for the Iranian population. Cox proportional hazards regression was conducted to evaluate the predictors of MetS persistence in crude‑ and multivariate‑adjusted models.

    Results

    Our analyses showed that 648 out of 887 participants (73%) completed the follow‑up and 565 (87.2%) of them had persistence of MetS after 10‑year follow‑up. There was a significant association between age, weight, body mass index, triglyceride, and waist circumference in participants who had MetS compared to those without MetS after 10‑year follow‑up (P < 0.05). There was a direct association between increases in the mean changes of systolic/diastolic blood pressure, waist circumference, and low HDL‑C and risk of MetS persistence after adjusting the model for sex and age in the total population (Ptrend < 0.05). The trends were the same for women except in diastolic blood pressure. After adjustment for potential confounders, the risk of MetS persistence in men was significantly higher than women (HR = 1.98, 95% CI: 1.38–2.85, Ptrend = 0.001).

    Conclusions

    Most of the risk factors of MetS were positively associated with persistence of MetS. Therefore, modification of lifestyle is recommended to reduce MetS.

    Keywords: Cohort studies, metabolic syndrome, persistence