Iranian Journal of Public Health
Volume:51 Issue: 11, Nov 2022

Almost all diseases have a genetic basis. However, several disorders stem from a combination of genes and environmental conditions. In the present study, databases including PubMed, Scopus and Google scholar were searched and reviewed and those relevant studies that investigated the association between environmental and genetic factors with the incidence of diseases were extracted and used. At the final step, it is concluded that in many cases, disorders have a multifactorial etiology. Having a gene related to a specific disorder is not the only reason for contracting the disease. Both genes and environmental factors play a role in human disease etiology. Everything outside of DNA, may affect health and even in many people with a positive family history of a specific disorder, environmental factors can facilitate or prevent the occurrence of the disease. Therefore, living a healthy lifestyle is important in reducing exposure to diseases, and long-life expectancy.

This overview is conducted to evaluate the effect of telerehabilitation on Health-Related Quality of Life (HRQOL) in patients with cardiovascular diseases (CVDs).

A comprehensive search was performed through the [MeSH] keywords (heart diseases, coronary disease, coronary artery disease, myocardial infarction, coronary artery bypass, heart failure, cardiac rehabilitation and telemedicine) until January 20, 2021 in databases of Science Direct, Medline/PubMed, Web of Science, Scopus, ProQuest, Google Scholar and Cochrane library. Finally, 20 reviews were entered into the analysis.

The results of meta-analyses showed that receiving telerehabilitation program by telemedicine method has a positive effect on the physical dimension and changing the mental status of patients following this intervention depends on age so that the use of these technologies in heart patients with younger ages promotes mental status. On the other hand, increasing the duration of the intervention 18 months or more affects the physical dimension and 12 months or more affects promoting overall HRQOL. Among the various types of Telemedicine methods, telephone support has a greater effect on promoting the physical dimension.

The ability to use virtual technology is less at older ages, so age conditions of patients should be considered in choosing this type of intervention. The living place of the people and the level of access to advanced care, seem to play an important role in changing outcomes and choosing this type of intervention because the main purpose of telerehabilitation is to provide treatment care in areas with low access levels.

This study has been conducted to analyze the processes, models, and policies to assess fitness to drive and improving driving in the elderly in the world.

The Arkesy and O’Malley frameworks were employed. Articles with at least one aspect of driving eligibility in the elderly were included. Expected data were collected using appropriate keywords from PubMed, Web of Science, Scopus, Embase, IranDoc, SID, and MagIran. Data were analyzed using the Content Analysis method.

Out of 675 records, 24 papers and reports were included in the study that all of them were High-Income Countries (HICs). Among the studies that referred to the baseline age, the highest frequency was 70 yr old (4 studies). Vision assessment was the main item to judge driving fitness (mentioned in 75% of the studies). The in-person (5 studies) was the most common method of renewal. General practitioners were the principal performers to measure driving fitness (7 studies). Thirteen studies referred to the road tests as part of the driver's license renewal process. In most all reports and papers, there were policies on empowering the elderly driver, including providing safe driving tips, optional driving skills tests, holding retraining courses, etc. The most frequently supporting policies included introducing alternative transportation.

Most HICs have worthwhile experience in measuring and improving the fitness to drive in the elderly and enforce different laws according to social and political conditions. Utilizing these experiences by considering economic and social differences can be useful and practical for middle and low-income countries.

The association between Helicobacter pylori infection and overweight, as one of the most common health issues, remains controversial. In this study, we systematically reviewed the effect of H. pylori infection and overweight to get a reliable answer.

We used the Preferred Reporting Items for the Systematic Review and Meta-Analysis statement. We searched the association between H. pylori and overweight infection in international databases including Medline, Web of knowledge and Scopus, without any limitations of language, publication type, and publication status in search step of this systematic review from 2000 to 2020. We surveyed the title, abstract and full text of each research studies, and we used Newcastle-Ottawa quality for assessing the quality of each paper. A random effects model was used to calculate the pooled odd ratio with 95% confidence intervals.

Fifteen papers were eligible for this review. The selected studies reported different Odd Ratio between overweight and H. pylori infection but Odds Ratio (95% confidence interval) in our systematic and meta-analysis study was estimated at 1.42 (95%CI; 1.12, 1.81) and it was statistically significant (P: 0.003).

H. pylori infection is significantly associated with overweight, therefore, the eradication of H. pylori infection is suggested because this infectious might be resulted in overweight.

Depression has been recognized as one of the most significant factors affecting mental health status. For this reason, several efforts to prevent and reduce depression in all ages have been made in various domains to identify the relevant factors as well as the causes of depression. The objective of this meta-analysis was to examine the effect size between physical fitness and depression in adolescents and adults.

A systematic search for meta-analysis (2009-2020) was performed using PubMed, Scopus, Web of Science, and RISS, with key terms such as depression, depressive illness, and physical fitness or fitness. Overall, 19 out of 448 articles were included in the meta-analysis with strict inclusion criteria.

The effect size is a medium between physical fitness and depression in adolescents and adults. Two fitness factors, namely cardiovascular endurance and muscle strength, are more relevant for alleviating depression in adolescents and adults, whereas agility was not related to depression. In particular, the cardiovascular fitness factor has an impact on almost all ages; however, muscular strength has less impact on depression in young adolescents, but has a great impact on older adults’ depression.

The effect size in this study is a medium between physical fitness and depression in adolescents and adults. Thus, more longitudinal and clinical studies with larger sample sizes are needed to clarify the relationship between physical fitness and depression.

The number of patients with osteoporosis ranks first in the world in China and as a precursor state of osteoporosis, the number and incidence of osteopenia are much higher than that of osteoporosis. This meta-analysis was conducted to evaluate the incidence and distribution of osteopenia in adults in mainland of China over 10 years to provides reference for the early prevention of osteoporosis and policymaking.

Relevant data were extracted from the databases including CNKI, Wanfang, VIP, Web of Science, PubMed, EMBASE, and Medline about the surveys on osteoporosis and bone loss from 2010 to 2021 by searching. The random effects model was adopted for Meta-analysis, and the funnel plot was used to test publication bias.

Forty-seven literatures were included in this study, covering 27 provinces and 38 regions in the mainland of China, with the study of 135,688 cases, showing that the prevalence of osteopenia in adults in the past decade was 28.3%(95% CI 24-33%), aged 40~60 yr old , reaching the highest level. The incidence of osteopenia in males was higher than that in females (P<0.05), without significant difference in south and north China.

There is a large population with osteopenia in China, especially middle-aged population, both men and women should pay attention to osteopenia to delay its further progression.

Stroke remains a leading cause of adult disability, and it decreases the health-related quality of life due to functional disability and poor functional recovery in stroke. Tai Ji has been recently introduced to overcome disabilities. This review aims to explain the effects of Tai Ji on functional recovery in stroke patients, linking it to current approaches, concepts and therapies such as Bobath and proprioceptive neuromuscular facilitation techniques. A compilation of recent literature on Tai Ji's use in stroke rehabilitation from Google scholar and PubMed Central (2018 to 2022). The benefits of Tai Ji in stroke functional recovery were studied and explained based on its similarity in concepts to current conventional stroke rehabilitation approaches. There were few randomized controlled trials on Tai Ji in functional recovery among stroke patients. However, all literature identified Tai Ji as beneficial in stroke rehabilitation. However, there was no literature on explaining the Tai Ji movement based on current conventional stroke rehabilitation approaches. Tai Ji carries similar theories to the current neurorehabilitation approach. Tai Ji can be modified and incorporated into stroke rehabilitation programs based on patients’ needs to produce promising outcomes.

The coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected socially disadvantaged groups; however, the association between socioeconomic status and healthcare utilization among COVID-19 patients remains unclear. Therefore, a systematic review and meta-analysis was conducted to assess the association between socioeconomic status and hospitalization and intensive care unit admission among COVID-19 patients.

PubMed, Embase, and the Cochrane Register of Controlled Trials were searched for relevant literature (updated to Jun 2022). Studies that investigated the association of social deprivation with hospitalization and intensive care unit admission in COVID-19 patients were included. The primary outcomes included risk of hospitalization and intensive care unit admission, measured by odds ratio.

Eleven studies covering 2,423,095 patients were included in the meta-analysis. Socially disadvantaged patients had higher odds of hospitalization in comparison to socially advantaged patients (odds ratio 1.25, 95% confidence interval: 1.14 to 1.38; P<0.01). The odds of intensive care unit admission among more deprived patients was not significantly different from that of less deprived patients (odds ratio 1.03, 95% confidence interval: 0.78 to 1.35; P=0.85). These findings were proven robust through subgroup and sensitivity analyses.

Socially disadvantaged populations have higher odds of hospitalization if they become infected with COVID-19. More effective medical support and interventions for these vulnerable populations are required to reduce inequity in healthcare utilization and alleviate the burden on healthcare systems.

This narrative review aims to identify psycho-social issues related to the COVID-19 pandemic, especially among vulnerable populations. Through understanding the psychosocial meanings underneath, the suffering from the pandemic and the transformative experiences toward better society could be substantiated. Searching relevant studies and literature on psycho-social impacts in relation to COVID-19 was conducted from psycho-social points of view. Vulnerable populations such as the mentally ill, the poor, refugees, immigrants, the elderly, and other stigmatized groups were focused on. Reflections and plans on the worsened health disparities and increased stresses among vulnerable groups will help our society to be healthier and safer.

The majority of the Khmer ethnic people living in the Mekong Delta had a difficult socio-economic life and limited access to information and health services. The study was conducted to determine the prevalence of dyslipidemia and risk factors in men and women of the Khmer ethnic people, in Vietnam.

A cross-sectional study was conducted on 1.800 Khmer people aged 25 – 64 yr living in Tra Vinh Province in the Mekong Delta region of Vietnam. Data were analyzed using descriptive statistics and multivariate logistic regression.

The prevalence of dyslipidemia was high in men (47.3%) and in women (51.4%). Men had a higher prevalence of high TG (28.9% vs. 23.9%), whereas the prevalence of high TC (34.1% vs. 42.4%), and high LDL-C (28.2% vs. 37.9%) were lower in women, (all P<0.05). In men, dyslipidemia was significantly associated with central obesity (OR=2.58, 95% CI=1.32-5.06), overweight/ obesity (OR=2.50, 95% CI=1.75-3.56), and diabetes (OR=2.15, 95% CI=1.22-3.78). In women, dyslipidemia was significantly associated with diabetes (OR=2.14, 95% CI=1.08-4.24), central obesity (OR=1.69, 95% CI=1.18-2.42), overweight/ obesity (OR=1.50, 95% CI=1.06-2.10), and hypertension (OR=1.43, 95% CI=1.03-1.99). Age was significantly associated with increased risk of dyslipidemia in both genders.

Overall, the prevalence of dyslipidemia among Khmer men and women adults aged 25 - 64 years in Vietnam was high. Our findings indicated an urgent need to have dyslipidemia prevention intervention programs for the Khmer ethnic people in the Mekong Delta, especially training about obesity and increasing healthy lifestyles.

To explore the effects of miRNA-218-5p on inflammation and extracellular matrix proteins of vascular smooth muscle cell line in abdominal aortic aneurysm (AAA).

miR-218-5p expression was detected with RT-qPCR. The proliferative activity of vascular smooth muscle cells (VSMCs) was detected with CCK-8, the migration was detected by Transwell, and the apoptosis was detected with flow cytometry. The expression levels of inflammatory factors (IL-1β and IL-18) were detected by ELISA. The expression levels of proteins (MMP-9 and Netrin-1) and ADAMTS5 were detected by Western blot. The targeting relationship between miR-218-5p and ADAMTS5 was verified with dual-luciferase reporter assay.

Up-regulating miR-218-5p could significantly inhibit the proliferation and migration of VSMCs and induced the apoptosis (P<0.05). Down-regulating miR-218-5p could significantly promote the proliferation and migration of VSMCs and inhibit the apoptosis (P<0.05). Up-regulating miR-218-5p could inhibit the expression levels of THP-1 cytoinflammatory factors (IL-8 and IL-1β), MMP-9 and netrin-1. ADAMTS5 was the target gene of miR-218-5p. When there were both overexpression of ADAMTS5 and upregulation of miR-218-5p, the upregulation of miR-218-5p could alleviate the effects of overexpression of ADAMTS5 on the proliferation, migration and apoptosis of VSMCs.

miR-218-5p/ADAMTS-5 molecular axis regulates the proliferation, migration, and apoptosis of VSMCs, as well as the expression of THP-1 cell inflammatory molecules and extracellular matrix molecules.

In Indonesia, around 400 health workers died due to Covid-19 between June-July 2021, therefore the health workers need to be given further immunity. Health workers were among the first to get a booster shoot. However, they may experience side effects after vaccination. We aimed to describe side effects of Moderna vaccine as a booster in health workers.

A cross sectional study was conducted on health workers who received mRNA Covid-19 vaccine booster (Moderna) at Sulianti Saroso Infectious Disease Hospital, Indonesia and had filled the questionnaire assessing side effects form. We associated the form of the questionnaire assessing side effects from the originating source of hospital immunization unit in September 2021.

A total of 101 health workers who received mRNA Covid-19 vaccine booster in Jul-Aug 2021 were included. Most of health worker experienced more than 3 side effects. The side effects were sore arm (100%); chills (72%); fatigue (57%); headache (53%) and fever (51%), other symptoms (28%). The side effects mostly happened a day of receiving a booster shot (61.4%). There was no association between age, gender, comorbid to amount of side effects (P>0.05).

Since the public must fulfil the immunization program during pandemic, it is the responsibility of the healthcare provider to inform about the potential side effects and benefits of a new Covid-19 vaccine.

Currently, Korea is witnessing a steady increase in the number of adolescents from multicultural families. we aimed to identify the trends in life satisfaction changes and identifies the predictors of life satisfaction in multicultural adolescents at the grade level.

  Data from the Multicultural Adolescent Panel Survey (2012-2015) were analyzed in this study. Accordingly, we performed multiple linear regression analysis with previously identified life satisfaction predictors in adolescents as the explanatory variables for each school year.

Multicultural adolescents experienced higher life satisfaction in the sixth than fifth grade, and their satisfaction tended to decline after the sixth grade. Academic satisfaction, depression, self-esteem, ego-resilience, and family support significantly predicted the group’s life satisfaction in fourth to eighth grades; however, since these factors changed across grade levels, their impact on life satisfaction also varied across grades.

These findings highlight the necessity of developing approaches that consider the varying factors and their grade-level effects on multicultural adolescents’ life satisfaction and implementing effective policies and programs tailored to each grade level or developmental stage. These results provide valuable data to determine the timings and contents of such policies and programs.

To investigate the preventive effect of early multidisciplinary collaboration combined with cluster strategy on acquired frailty syndrome in ICU of patients with acute myocardial infarction (AMI).

A total of 240 patients with myocardial infarction (MI) admitted to ICU in The Third Affiliated Hospital of Qiqihar Medical University, Qiqihar, China from March 2018 to March 2020 were selected. The patients were randomly divided into experiment group and control group equally according to random number method. The experimental group was treated with early multidisciplinary collaboration and cluster strategy, while the control group was treated with routine nursing mode. Duration of ventilation, total length of stay, length of ICU stay, New York College of Cardiology cardiac function classification, MRC-Score, BI and complications during hospitalization were recorded.

After intervention, there were statistically significant differences in ventilation duration, total length of stay, length of stay in ICU, Heart function classification of New York Cardiology Society, MRC-Score, BI index, SF-36 score and complications during hospitalization in 2 groups (P < 0.05), and the above indicators in the experimental group were better than those in the control group.

Early multidisciplinary collaboration combined with cluster strategy can significantly reduce the incidence of AMI in ICU of MI patients.

We aimed to analyze the influence survival swimming experience on positive emotions, self-efficacy, and safety behaviors among swimming club members in Korea.

A total of 205 adult men and women involved in swimming clubs in the Seoul and Gyeonggi areas of Korea were surveyed via convenience sampling from 2021-22. A self-administered questionnaire was used to obtain data related to positive emotions, self-efficacy, and safety behaviors. Frequency analysis, Cronbach’s ɑ, reliability analysis, confirmatory factor analysis, correlation analysis, and structural equation modelling were performed.

Survival swimming experience had a positive effect on positive emotions (P<0.05), self-efficacy (P<0.05), and safety behaviors (P<0.05). Positive emotions did not have a positive effect on self-efficacy; however, they were found to have a positive effect on safety behaviors.

Positive emotions, self-efficacy, and safety behaviors can be improved via survival swimming experience. Successful experiences with survival swimming could promote self-efficacy and safety behaviors, highlighting the importance of survival swimming education. Therefore, proficiency should be emphasized when attempting to increase the effectiveness of survival swimming education. To achieve this outcome, developing diverse survival swimming programs for each level of proficiency is necessary to ensure adequate transmission of knowledge.

In Thailand, data on colorectal cancer (CRC) patient characteristics and overall survival (OS) rates are limited. We aimed to describe the overall 5-year, 10-year survival and to examine factors effecting the survival outcome among patients who were diagnoses of colorectal cancer.

We reviewed medical records of patients diagnosed with invasive CRC from 2007 through 2016. Demographic and clinical data were collected upon diagnosis. Kaplan-Meier method and Cox proportional hazards model to evaluate the association of overall (OS) with risk factors.

A total of 3,402 CRC patients (colon 59.4%, rectum 34. 5%, and rectosigmoid 6.1%) were identified. Mean (SD) and median age were 62.9 (12.7) and 63 years old (rang 14-98 years). Stages at diagnosis were I (10.1%), II (23.3), III (35.9%) and IV (30.7%). Five-year and 10-year OS of the entire cohort were 52.7% and 41.5%, respectively. Over the part 10 years, there was a trend toward improved 5-year OS in stages I, II and III. However, 3-year OS in stage IV patients remained unchanged. Confirmed poor prognostic factors included patient age ≥65 years, high grade, and advanced stage at diagnosis.

Advanced disease was a significant prognostic factor for shorter survival. A trend toward improvement in 5-year OS in early stages over the past decade might be related to better surgical quality, improved radiation technique, and adjuvant chemotherapy. Given that patients received better systemic treatment in stage IV disease, the reason their OS was not improved should be examined.

We aimed to examine the effectiveness of Aptima HPV E6/E7 mRNA test for detection of cervical lesions in a large Chinese population.

Overall, 4,350 women, who received simultaneously Aptima HPV E6/E7 mRNA test and HPV DNA test, followed by cervical biopsy in the Department of Gynecology of the Second Affiliated Hospital of Soochow University, Jiangsu Province, China from 2016-2020, were recruited. The detection of cervical lesions was compared between Aptima HPV E6/E7 mRNA test and HPV DNA test.

Overall, HPV DNA test exhibited a higher detection of all cervical lesions than Aptima HPV E6/E7 mRNA test (P<0.05), and showed a higher efficacy for detection of normal tissues and chronic cervicitis (P<0.05) and low-grade squamous intraepithelial lesions (LSILs) (P<0.05) than Aptima HPV E6/E7 mRNA test; while Aptima HPV E6/E7 mRNA test showed a greater detection of high-grade squamous intraepithelial lesions (HSILs) (P<0.05) and invasive cervical carcinoma than HPV DNA test. Aptima HPV E6/E7 mRNA test exhibited a higher specificity P<0.05), positive and negative prediction rates than HPV DNA test for detection of cervical lesions, and the sensitivity was comparable between the two tests (P>0.05).

Aptima HPV E6/E7 mRNA test gradually improves the detection of cervical lesions with disease severity, and shows a higher specificity, positive and negative prediction rates and comparable sensitivity for detection of clinical cervical lesions as compared with HPV DNA test.

Research handling structural differences among groups presume that the measurement tool works similarly among the groups and the results of measurements provide similar psychometric properties. Therefore, the aim of the study is to provide evidence for measurement invariance of the construct validity Perceived Health Outcomes of Recreation Scale (PHORS).

The research sample consisted of a total of 1984 adults who exercise, including 864 women and 1120 men during 2021- 2022 in Antalya City, Turkey. The MI of the PHORS was tested by multigroup confirmatory factor analyses, which test the invariance of the covariance structures within the scope of structural equation modelling. Invariance tests were gradually conducted for the implicit variables in the model, CFI (comparative fit index criteria) and AIC (Akaike information criterion) were inquired between structural invariance, where no restriction was applied on the analyses and the other invariance tests (metric invariance, scalar invariance and string invariance respectively) where more restraints are applied.

The study yielded evidence showing that the measurement model defined for the factor structure of the scale provided measurement invariance by gender. ∆CFI values were ≤0.010 in all subscales for metric and scalar invariance.

The items of PHORS represented the same psychological structure, different groups responded to the items in the same way, the constant values in regression equations generated for the items in regression equations were equal/invariable between the groups.

COVID-19 has been confirmed as a public health emergency and may give rise to adverse emotions such as anxiety and fear, and even stress reactions in serious cases. In a critical period of emotional development, adolescents experience more psychological stress fluctuations. Mindful self-compassion training is a simple and easy psychological assistance technology that has been recognized as effective, but it has not been applied to adolescents’ psychological problems caused by the epidemic.

From September 2021 to January 2022, adolescent volunteers were recruited in this study from four communities in Chongqing, China. A total of 107 adolescents volunteered to participate in this intervention experiment and were divided by the table of random numbers into 53 in the experiment group and 54 in the control group. The experiment group was intervened using mindful self-compassion training in combination with aerobic exercise for two months, while no intervention measures were taken in the control group. Stress Appraisal Measure, Profile of Mood States and Pittsburgh Sleep Quality Index were the scales adopted to evaluate the effect before and after the intervention.

The experimental group had significantly lower negative mood, stress, sleep scores than the control group (P < 0.001) and significantly higher differences before and after treatment than the control group (P < 0.001).

The intervention in this study can effectively reduce the level of negative mood and stress in individuals, and improve their vitality and sleep quality and provides new insights for the implementation and improvement of psychological assistance technology.

The administration of chemotherapy positively correlates with diverse adverse drug reactions, including the significant impact of hematological hazards such as anemia, leukopenia-neutropenia, thrombocytopenia, and pancytopenia. This pilot pharmacoeconomic study aimed to estimate the total direct costs of treating hematological toxicity induced by chemotherapy and its main determinants.

The study was conducted as a retrospective cost of illness study using the ''from bottom to the top'' approach from the perspective of the Republic Health Insurance Fund. This study included 88 patients treated due to developing at least one episode of one of the types of hematological complications of cytostatics in 2018 at the Oncology Clinic of the University Clinical Center Kragujevac, Kragujevac, the Republic of Serbia.

Among cancer patients who developed haematological toxicity, treating pancytopenia was most demanding in a pharmacoeconomic manner compared to neutropenia and thrombocytopenia, with an estimated value of direct costs of 264,14, 178,19 and 157,76 euros per patient per year respectively. Regarding total direct costs, the main determinants were the costs of drugs, their parenteral administration, and costs due to hospitalization.

Due to the rising cancer incidence and obligatory hospital treatment of hematological toxicity induced by chemotherapy, the identification of the pharmacoeconomic aspects of the treatment of these complications is needed. Future research should focus on the development of new modalities of treatment regarding patient characteristics anticipating high costs.

The role of preschool administrators in raising children is increasing day by day, so the purpose of this study was to detect the validity and reliability of the professional competency questionnaire and its psychometric assessment in preschool administrators.

This descriptive study was conducted on 380 preschool administrators with a minimum age of 25 and a maximum of 65 year participated in 2018. The sampling method was stratified from four regions of north, south, west and east of Tehran, Iran. Rosenberg self-esteem questionnaire was used for convergent validity. Cronbach's alpha coefficient was used to examine the internal consistency. Face validity, content validity and structural validity were also calculated. The data collection tool was a researcher-made questionnaire.

The questionnaire of professional competency of preschool administrators was appropriate in terms of face validity. Indicators related to content validity were appropriate in terms of relevance, transparency and necessity in this study. Cronbach's alpha coefficient was 0.98. The correlation between the total score of the managers' professional competency test and self-esteem was equal to 0.08 with a significance level of 0.58.

The professional competency questionnaire of preschool administrators had good validity and reliability to assess the level of professional competency of preschool administrators. Researchers can use this questionnaire to assess the professional competency of preschool administrators.

Preeclampsia is one of the challenging complications of pregnancy, of which little is known about its etiology and pathogenesis. Many studies have shown higher mean platelet volume (MPV) in preeclamptic patients. Vitamin D deficiency is in association with larger-size platelets. Thus, we aimed to determine the correlation of vitamin D with MPV in preeclamptic patients.

This prospective case–control study was conducted in two tertiary hospitals in Tehran, Iran. Overall, 85 preeclamptic pregnant women and 85 normotensive pregnant women were entered between 2017 and 2018. Serum vitamin D concentration (ng/ml) and MPV (femtoliter) were measured for all patients.

MPV was significantly higher in the cases compared to controls (10.59±1.08 vs 8.10±0.95, P=0.0001). In addition, serum vitamin D level in the preeclamptic group was significantly lower in compare to the control group (17.79±11.03 vs 30.24±12.49; P=0.0001). In multivariate logistic regression analysis, high age of mother (OR: 1.13; 95% CI: 1.01-1.27; P=0.03), low level of serum vitamin D (OR: 0.93; 95% CI: 0.87-0.99; P=0.02) and high MPV (OR: 8.83; 95% CI: 4.17-18.67; P=0.0001) were independent predictors of preeclampsia. Moreover, a correlation analysis revealed that vitamin D levels correlated negatively with MPV (r= -0.41, P<0.0001).

Low levels of vitamin D in preeclamptic pregnancy are associated with higher platelet activity and thrombosis. In fact, the increment of MPV level might be a potential pathway for adverse outcomes of pregnancy including preeclampsia in the context of vitamin D deficiency.

Cancer imposes a significant economic burden on the health system and society. Acute myeloid leukemia (AML) is the third deadliest leukemia and is one of the leading health problems worldwide. The present study aimed to estimate the economic burden of AML in Iran for 2020.

In this study, we estimated a prevalence-based on the cost-of-illness of the AML in Iran. A societal perspective was considered, in which the direct costs and productivity losses with the adoption of the human capital approach in the AML cases were estimated for 2020. Moreover, in the present study, several resources including national cancer registry reports, hospital records, occupational data, and interviews with experts were cited.

Approximately 98% of patients with AML received induction therapy. The AML economic burden was $33,243,107.39. Indirect costs accounted for 60% (21,593,764.4$) of this amount, and direct medical costs and direct non-medical costs make up for 19% (6,359,380.88$) and 16% (5,289,962.11$) of this estimated economic burden, respectively

The economic burden of AML in Iran is very remarkable and due to the increasing prevalence of this disease, it is expected to increase gradually. Having insights into the costs associated with the disease provide an excellent opportunity for health policymakers and managers to effectively improve resource allocation.

Anxiety and depression (A&D) are common among patients with diabetes (DM). We assessed the mediatory effect of obesity on the pathway between past and current mental health (as measured by A&D) on self-care DM treatment adherence and DM treatment failure.

We used data collected in two rounds (2009-12, 2014-2018) of a population-based cohort study in Kerman, Iran (KERCADRS). By a random cluster sampling approach, 5900 residents of Kerman aged 15 to 75 yr were recruited to the study to measure demographic characteristics, body measures (to calculate BMI), adherence to DM treatment, and symptoms for A&D (Beck questionnaires). Fasting blood also collected for biochemical tests and glycemic control (as an indicator for treatment failure). We used path analysis and Structural Equation Modeling (SEM) for analysis.

We analyzed data for 264 patients with diabetes who attended in both study rounds. While only 5.7% reported not adherence to DM treatment, 67.9% had diabetes treatment failure. Past mental health had a significant positive association with HbA1c (standard beta coefficient for total effect =0.148, P=0.044), of which 42% was indirect effect through obesity. Current mental health had a positive association with current no adherence to diabetes treatment (standard beta coefficient for total effect=0.077, P=0.001).

Our study showed an important indirect path from A&D to diabetes treatment failure outcome which mediated by obesity. Screening for A&D symptoms and treating those as well as obesity among patients with diabetes may improve glycemic control.

Peroxisome proliferator-activated receptor gamma (PPARγ) has recently been studied for its potential influence on the functional response of the human body to exercise. We aimed to investigate the association of habitual physical activity (PA) with PPARγ mRNA level in the visceral and subcutaneous adipose tissues (VAT and SAT) in non-obese and obese non-diabetic adults.

VAT and SAT were obtained from 95 individuals, including 40 non-obese (BMI<30kg/m2) and 55 obese (BMI≥30kg/m2) who underwent elective abdominal surgery (Tehran, Iran, 2012-2015). The assessment of habitual PA was performed by a valid and reliable International PA Questionnaire-long form, and the metabolic equivalent of task (MET) was evaluated. Real-time quantitative reverse transcriptase-PCR evaluated the PPARγ expression in VAT and SAT.

PPARγ expression in both VAT (1.18 vs. 0.37 fold change, P<0.001) and SAT (2.07 vs. 0.29 fold change, P=0.004) among obese subjects was higher than the non-obese group. After controlling for age, sex, and total energy intake, a positive association was found between total METs and PPARγ expression in both VAT and SAT among obese participants (β=0.22, P=0.007 and β=0.12, P<0.001, respectively). Among obese participants, there was a direct association between leisure time-related METs with VAT PPARγ expression (β=0.05, P=0.026). Moreover, in this group, an association was observed between occupation-related METs with PPARγ in both fat tissues (β=0.11, P=0.002 and β=0.17, P=0.013, respectively), and household work-related METs with SAT PPARγ (β=0.21, P=0.011).

High PA as an indispensable part of a healthy lifestyle may exert its beneficial effect by regulating PPARγ expression.