Plasma levels of brain-derived neurotrophic factor in patients with Parkinson disease: A systematic review and meta-analysis.

BACKGROUND: Brain-derived neurotrophic factor (BDNF) is an abundant neurotrophin in the adult brain. Serum BDNF levels might be used as a proxy for its central expression. Considering conflicting reports, we aimed to answer "How do serum/CSF levels of BDNF change in patients with PD?". METHODS: We conducted a comprehensive search in MEDLINE, EMBASE and SCOPUS databases including 12 eligible studies. Five studies compared BDNF in serum of PD patients versus healthy controls (HC) and 3 studies provided BDNF levels in sera of non-depressed and depressed PD patients (NDPD and DPD). Review Manager and Software version 3.0 were used for meta-analysis and meta-regressions. Mean difference (MD) was used for measurement of effect size. RESULTS: PD patients had reduced serum BDNF levels compared to HC (MD = -2.99 ng/mL). Serum BDNF was highest in DPD patients compared to HC (MD = -4.83 ng/mL), with no difference between DPD and NDPD patients in serum BDNF levels. Among co-variates that were eligible for meta-regression, age, sex, and Hoehn and Yahr (H&Y) motor stage had significant positive associations with the effect size in the difference of serum BDNF between patients and HC. CONCLUSIONS: PD patients had reduced serum BDNF levels compared to HC, regardless of presence of co-morbid depression. PD is at least equally effective in reducing serum BDNF levels as depression. Motor progression predicts serum BDNF downregulation in PD. Acute exercise improves motor function and depressive symptoms in PD probably via BDNF upregulation. The paradoxical rise in serum BDNF in advance PD is probably compensatory in nature.

Factors Associated with Hookah Smoking among University Students.

BACKGROUND: These days, hookah smoking has gained popularity among people in many communities, especially among youths and students, and more attention to this issue seems necessary. The purpose of this study was to determine the factors affecting hookah smoking among Sabzevar Azad University students. METHODS: This cross-sectional study was conducted on university students in Sabzevar, Iran in 2014. The questionnaire was developed and its validity and reliability were assessed. Three hundred six male students of Sabzevar Azad University were selected by simple random sampling and questionnaires were filled out by them. The collected data were analyzed by SPSS software and the Chi-Square and Independent-samples t-test. RESULTS: The results showed that 47.7% of the participants had a history of smoking hookah. The main factors affecting hookah smoking from participants' point of view were: filling leisure time, availability of hookah, positive social appearance, friends' invitation and relief from anxieties. Chi-Square tests showed that there was no significant relationship between fathers' level of education (p=0.41), mothers' level of education (p=0.46), fathers' job (p=0.18), mothers' job (p=0.53) and students' current grade (p=0.41) with hookah smoking. The study showed significant relationship between present hookah smoking and awareness about complications of the hookah (p=0.01). CONCLUSION: Interventions to reduce and quit hookah smoking among students should include several items, such as teaching problem-solving skills to fill leisure time properly and to deal with the temptation of hookah smoking, as well as teaching refusal skills at the invitation of friends for hookah.

Comparing the Effects of Group and Home-based Physical Activity on Mental Health in the Elderly.

BACKGROUND: The present study focuses on comparing the effects of home-based (HB) and group-based (GB) physical activity on mental health in a sample of older adults in Shahr-e-kord. METHODS: In this quasi-experimental study, a twice-weekly physical activity program for 2 months was provided either individually at home or in a group format for 181 people who were divided into two groups (HB and GB). The outcome, mental health, was measured with the 28-item General Health Questionnaire (GHQ-28). RESULTS: Mental health status improved after participation in the physical activity program. The decrease in GHQ-28 total score in GB group, 3 months after intervention, was 3.61 ± 2.28 (P < 0.001). In HB group, this reduction was 1.20 ± 2.32 during the same period (P < 0.001). The difference of these "before-after differences" between the two groups in the GHQ-28 and all its subscales was statistically significant (P < 0.001). Also, the effects of GB physical activity on mental health compared with HB physical activity, adjusted for related baseline variables, were significant. CONCLUSIONS: These findings reveal the probable effects of GB rather than HB physical activity on mental health among the elderly.

Avoidable Mortality Differences between Rural and Urban Residents During 2004-2011: A Case Study in Iran.

BACKGROUND: Avoidable mortality as an indicator for assessing the health system performance has caught the attention of researchers for a long time. In this study we aimed to compare the health system performance using this indicator in rural and urban areas of one of Iran's southern provinces. METHODS: All deaths (29916) which happened during 2004-2011 in Bushehr province were assessed. Nolte and McKee's avoidable deaths model was used to distinguish avoidable and unavoidable conditions. Accordingly, all deaths were classified into four categories including three avoidable death categories and one unavoidable death category. STATA software was used to conduct Poisson Regression Test and age-standardized death rate. RESULTS: Findings showed that avoidable mortality rates declined in both urban and rural areas at 3.33% per year, but decline rates were influenced by Ischemic Heart Disease (IHD) and preventable death categories to treatable death category. Annual decline rate for IHD category in rural and urban areas was nearly the same as 8%, but in preventable death category, rural areas experienced more decreases than urban ones (7% vs 5% respectively). However, decline rate in treatable mortality neither in urban and nor in rural areas was statistically significant. CONCLUSION: Despite the annual decline in the rate of avoidable deaths, policy making initiatives especially screening and inter-sectoral measures targeting cause of deaths such as colon and breast cancers, hypertension, lung cancer and traffic accidents, can still further decrease avoidable deaths in both areas.

Mental disorder prevention and physical activity in Iranian elderly.

OBJECTIVES: Mental disorders such as depression, anxiety and dementia are common in elderly. However, physical activity is suggested to be effective in preventing such aging-related disorders. The aim of this study was to investigate the role of physical activity on mental health in later life. METHODS: Four hundred elderly people were randomly divided into the intervention and control groups. The intervention consisted of exercise twice a week for two months. Mental health status before, just after, and three months after the study was assessed with the 28-item General Health Questionnaire (GHQ-28). RESULTS: The mean of the GHQ-28 total scale decreased in the case group and this change remained significant after three months (before: 8 ± 5.5, after three months: 5.6 ± 4.6, p < .001). GHQ subscales including somatization, anxiety, social dysfunction, and depression decreased significantly in the case group just after and three months after the intervention. CONCLUSIONS: Physical activity significantly prevents mental disorder in older adults. Although it has effects on anxiety, social dysfunction, and depression, the greatest influence is on improving the somatization symptoms.

Factors Influencing Physical Activity Behavior among Iranian Women with Type 2 Diabetes Using the Extended Theory of Reasoned Action.

BACKGROUND: Findings of most studies indicate that the only way to control diabetes and prevent its debilitating effects is through the continuous performance of self-care behaviors. Physical activity is a non-pharmacological method of diabetes treatment and because of its positive effects on diabetic patients, it is being increasingly considered by researchers and practitioners. This study aimed at determining factors influencing physical activity among diabetic women in Iran, using the extended theory of reasoned action in Iran. METHODS: A sample of 352 women with type 2 diabetes, referring to a Diabetes Clinic in Khoy, Iran, participated in the study. Appropriate instruments were designed to measure the desired variables (knowledge of diabetes, personal beliefs, subjective norms, perceived self-efficacy, behavioral intention and physical activity behavior). The reliability and validity of the instruments were examined and approved. Statistical analyses of the study were conducted by inferential statistical techniques (independent t-test, correlations and regressions) using the SPSS package. RESULTS: The findings of this investigation indicated that among the constructs of the model, self efficacy was the strongest predictor of intentions among women with type 2 diabetes and both directly and indirectly affected physical activity. In addition to self efficacy, diabetic patients' physical activity also was influenced by other variables of the model and sociodemographic factors. CONCLUSION: Our findings suggest that the high ability of the theory of reasoned action extended by self-efficacy in forecasting and explaining physical activity can be a base for educational intervention. Educational interventions based on the proposed model are necessary for improving diabetics' physical activity behavior and controlling disease.

Developing criteria for cesarean section using the RAND appropriateness method.

BACKGROUND: Cesarean section rates are increasing worldwide, and a rapid increase has been observed in Iran. Disagreement exists between clinicians about when to use cesarean section. We aimed to identify the appropriateness criteria for the use of cesarean section in Iran. METHOD: A consensus development study using a modified version of the RAND Appropriateness Method (RAM). We generated scenarios from valid clinical guidelines and expert opinions. A panel of experts participated in consensus development: first round via mail (12 members), second round face-to-face (9 members). We followed the RAM recommendations for the development of the scenario lists, rating scales, and statistical analyses. RESULTS: 294 scenarios relevant to cesarean section were identified. 191 scenarios were considered appropriate, of which 125 scenarios were agreed upon. The panel found cesarean inappropriate for 21% of scenarios, and 'equivocal' for 14% of scenarios. CONCLUSION: RAM is useful for identifying stakeholder views in settings with limited resources. The participants' views on appropriateness of certain indications differed with available evidence. A large number of scenarios without agreement may partly explain why it has been difficult to curb the growth in cesarean section rate.

Comparison of artificial neural network and logistic regression models for prediction of mortality in head trauma based on initial clinical data.

BACKGROUND: In recent years, outcome prediction models using artificial neural network and multivariable logistic regression analysis have been developed in many areas of health care research. Both these methods have advantages and disadvantages. In this study we have compared the performance of artificial neural network and multivariable logistic regression models, in prediction of outcomes in head trauma and studied the reproducibility of the findings. METHODS: 1000 Logistic regression and ANN models based on initial clinical data related to the GCS, tracheal intubation status, age, systolic blood pressure, respiratory rate, pulse rate, injury severity score and the outcome of 1271 mainly head injured patients were compared in this study. For each of one thousand pairs of ANN and logistic models, the area under the receiver operating characteristic (ROC) curves, Hosmer-Lemeshow (HL) statistics and accuracy rate were calculated and compared using paired T-tests. RESULTS: ANN significantly outperformed logistic models in both fields of discrimination and calibration but under performed in accuracy. In 77.8% of cases the area under the ROC curves and in 56.4% of cases the HL statistics for the neural network model were superior to that for the logistic model. In 68% of cases the accuracy of the logistic model was superior to the neural network model. CONCLUSIONS: ANN significantly outperformed the logistic models in both fields of discrimination and calibration but lagged behind in accuracy. This study clearly showed that any single comparison between these two models might not reliably represent the true end results. External validation of the designed models, using larger databases with different rates of outcomes is necessary to get an accurate measure of performance outside the development population.