Iranian Journal of

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Introduction: In order to determine the relationship between serum lipid profile and diabetes mellitus as well as other cardiovascular risk factors, we carried out a cross-sectional study of 1255 oil industry workers at the Kharg Island oil terminal.
Methods: Increased levels of total cholesterol (TC≥200mg/dl), triglyceride (TG≥200mg/dl), and low-density lipoprotein (LDL≥130mg/dl) were seen in 32.7%, 39.5% and 18.5% of the workers, respectively. Decreased levels of high-density lipoprotein (HDL<40mg/dl) were seen in 13.1% of workers. 61.3% of the workers had a body mass index (BMI) ≥25kg/m2. Visceral obesity (waist circumference >100cm) was seen 32.4% of workers.
Results: There was a direct and significant relationship between TC levels and BMI (p<0.001), and between TG levels and BMI (p<0.0001). The same correlation existed between waist circumference and both TC (p<0.02) and TG (p<0.06). There was also a direct correlation between LDL levels and waist circumference (p<0.04). 10.6% of workers had some disorder of glucose metabolism. There was a direct correlation between diabetes and both TC and HDL levels (p<0.04 and p<0.05, respectively). 42.4% of workers smoked and 57.4% had a sedentary lifestyle. There was a trend toward lower blood glucose and cholesterol levels as the level of physical activity increased (p=0.1 and p=0.08, respectively). There was a significant difference between blue- and white-collar workers in the prevalence of excess weight, visceral obesity, diastolic hypertension, diabetes and cigarette smoking, but not serum lipid profile and level of physical activity.
Conclusion: The significant prevalence of dyslipidaemia and other cardiovascular risk factors in the oil workers of Kharg Island requires systematic preventive interventions to reduce cardiovascular mortality and morbidity in this population.

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Background: Family satisfaction in subpopulations referred to the endocrine clinic including diabetic and non diabetic patients and their spouses are compared in the present study. This study also assesses the correlation between family satisfaction and variables such as age, sex, educational level, economic status, type of diabetes, duration of the disease, type of therapy and dosage of drugs. A comparison of the frequency of sexual dysfunction between diabetics and non-diabetic pairs was also done.
Methods: In this case- control study, 400 subjects were selected as simplified non-randomized method from outpatients referred to the Shahre Kord endocrine clinic in 2002. We assigned samples to group I (diabetic patients, n=100), group II (diabetic patients spouses, n=100), group III (non-diabetic patients, n=100) and group IV (non-diabetic patients spouses, n=100). Groups I and II were similar in sex, socioeconomic status and educational level. GRIMS family relationship questionnaire was used to evaluate family satisfaction.
Results: Family satisfaction for diabetics in comparison with non-diabetics (P=0.05), diabetics in comparison with their spouses (P=0.003), and non-diabetics in comparison with their spouses (p=0.002) were significantly less. There was no significant difference between family satisfaction in diabetic and non-diabetic patients spouses (p>0.05). Relative frequency of sexual dysfunction was 76% and 29% and relative frequency of decreased libido was 32% an 12%, in diabetic and non- diabetic couples, respectively. Family satisfaction was less in patients with diabetes type I and whom using higher dosage of drugs.
Conclusion: This study emphasized on the attention to the family as a part of approach to the diabetic patients. According to our results, it is recommended to focus the most attention in this field to the patients with type I diabetes and who consume more amounts of drugs.

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Background: Type 1 diabetes mellitus (T1DM) is an autoimmune disease in which T-cell mediated selective pancreatic β- cell destruction occurs. Half the risk of T1DM development is given by the HLA gene region while the remaining risk is assigned to non-HLA genes , probably those engaged in the formation of antigen interaction complex. The CD4 gene product, which is among the most prominent T-cell surface receptors with a key role in antigen processing, could be regarded as a strong candidate.
Methods: We investigated the possible association of the CD4 gene polymorphism with T1DM using the candidate gene approach. The pyrimidine- rich pentanucleotide repeat polymorphism residing in the promoter region of the CD4 gene was studied. In the present study 92 Iranian T1DM patients and 108 healthy matched control individuals were screened by PCR technique.
Results: The analysis of our results shows the protective association of CD4*A3 (RR= 0.159, 95% CI: 0.036-0.707 Pc=0.025) and the susceptible role of CD4*A5 (RR= 7.379, 95% CI: 1.630-33.414 Pc=0.010) with T1DM. Conclusion: Our results suggest that the certain CD4 alleles are associated either negatively or positively with T1DM in the Iranian population.

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Introduction: The height measurements in the elderly are associated with several problems. In this study we used a model to predict of the Iranian people aged height from age, shin length and forearm length. Methods: A total 165 aged people ≥60 years were randomly selected based on medical record number of about 800 eligible older people who lived in Kahrizak Charity Foundation. Standing height, shin length and forearm length were measured. Data from 99 participants were used to creat a predicting multivariate linear regression model for estimation of standing height of older men and women. The data of the rest 66 participants were used for models testing. Result: The following equations were created: Men height = 78.928+ (1.430× shin length) + (0.817×forearm length)-(0.176×age) The height of women = 71.694+ (1.414×shin length) + (1.084× forearm length)-(0.277× age) R2 were calculated as 0.63 for men and 0.52 for women. Error of estimation was +0.44 cm and it was - 0.16cm and +1.09cm for men and women respectively. Estimated heights were not significantly different from standing statures. Conclusion: height was predictable from shin length and for forearm lengths and also age with a relatively small error in the estimation among Iranian older people. The error of model is more in women than men.

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Background: Food insecurity refers to the inability to afford enough food for an active, healthy life. The metabolic syndrome, otherwise known as syndrome X or the insulin resistance syndrome, is a collection of cardiovascular risk factors including hypertriglyceridemia, lowered HDL-cholesterol, glucose intolerance, abdominal obesity and hypertension. Recent studies indicate widespread prevalence of food insecurity and metabolic syndrome in various regions of Iran. No studies have been conducted so far to investigate the relationship between food insecurity and the metabolic syndrome in Iran. This study was conducted to investigate the relationship between food insecurity and metabolic syndrome in women. Methods: In this study, 130 women 30 to 60 years old with metabolic syndrome as cases and 130 women without metabolic syndrome as controls referred to clinics affiliated to Shiraz University of Medical Sciences were selected. The USDA household food security questionnaire was used to assess food insecurity status. The metabolic syndrome was defined according to the criteria of the Adult Treatment Pane l II (ATP III). Results: The prevalence of food insecurity was 69.2% in cases and 45.4% in controls (P< 0.001). After multiple logistic regression and removal of potential confounders, food insecurity was significantly associated with metabolic syndrome (OR3.2&CI 95%: 1.9-5.6)(P<0.05). Conclusion: Given that food insecurity is an important risk factors for metabolic syndrome, Planners should reduce food insecurity in society, especially women through measures to improve the economic situation and dietary patterns of households.

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Background: The purpose of this study was to investigate the effects of endurance training on muscle NHE1 and NBC1 gene expressions in type 2 diabetic rats. Methods: Male wistar rats (n=40), 4weeks old and 93.7±9.8g, were randomly selected and divided into control, diabetic control and diabetic training groups. The Endurance training was performed for 7 weeks on diabetic training groups (running on treadmill forrodent). NHE1 and NBC1 gene expression were determined by Realtime-PCR technique. The differences between groups in variables were determined by an independent t-test using REST Software. Results: NHE1 mRNA expression reduced significantly in EDL and Soleus by 25% and 19% in the diabetic control group compared with the control group, respectively (P<0/05).NHE1 mRNA expression also reduced significantly in EDL and Soleus by 35% and 29% in the diabetic control group compared with the control group, respectively (P<0/05).Endurance training increased NHE1 and NBC1 geneexpressions in both EDL and Soleus in the diabetic training group. Conclusion: The present study showed that NHE1 and NBC1 mRNA expressions decreased significantly in the diabetic control group and endurance training increased NHE1 and NBC1 mRNA expressions in the diabetic trained group leading to normalizing the mRNAs in diabetic trained group.

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Background: Vitamin D deficiency is associated with impaired insulin secretion, glucose intolerance and type 2 diabetes. This study was conducted to investigate the effects of supplementation with 50,000 IU vitamin D on improving serum vitamin D levels and insulin resistance in vitamin D insufficient or deficient type 2 diabetic patients. Methods: In this double blind randomized clinical trial, 81 type 2 diabetic patients with vitamin D levels between 10-30 ng/ml were randomly assigned to intervention (50,000 IU vitamin D3 once a week) and control (placebo once a week) groups according to gender. The study duration was 8 weeks. At the beginning and the end of study, blood samples were collected after 12 hours overnight fasting and fasting serum glucose, insulin and 25-hydroxyvitamin D were measured. Insulin resistance was obtained by HOMA-IR calculation. Results: After 8 weeks supplementation with vitamin D, 25-hydroxyvitamin D level was significantly increased and reached to normal levels in the intervention group. Fasting serum glucose and insulin concentrations and HOMA-IR were significantly decreased in the vitamin D group, but there were no significant changes in the placebo group. Conclusion: Supplementation with 50,000 IU vitamin D for 8 weeks compared to placebo can improve inadequate levels of vitamin D and glycemic indicators in vitamin D insufficient or deficient type 2 diabetic patients.

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Background: increasing the population of aged, Consequently Increasing rate of chronic disease and to decreasing quality of life level caused many problems in different communities. The important aim of this study was surveying the effect of an educational intervention by use of the educational components of precede model on quality of life in the elders. Methods: This semi-empirical research was performed on 54 aged people in two group-case and control- for the Aged in 2009. In this study two questionnaires the designed questionnaire based on PRECEDE model and the questionnaire on the quality of life standard of the World Health Organization (WHOQOL) were used and the quality of life of the aged people in two groups before and after one month from the educational interference was evaluated. Independent t-test paired T-test, one way ANOVA, was used for data analysis. Results: The average total score of the quality of life of the aged people of test group, showed a meaningful difference before and after educational interference with a p quality less than 0.05, but there wasn’t a meaningful difference between total scores of two groups. Though the relationship of attitude (predisposing factors), enabling factors (skills) and behavioral factors with quality of life of a p quality less than 0.05 was meaningful. But knowledge (predisposing factor) and reinforcing factors didn’t show a meaningful relationship with the quality of life. Conclusion: It seems that the health, education and health promotion programs are effective on quality of life in the aged people.

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Background: Health staffs have different attitudes and beliefs toward elders that have effect on their behaviors in health service delivery to elders. This study was done for determination of Golestan province health centers general practitioners (GPs) attitude toward elders. Methods: In this cross sectional study, 152 general practitioners of Golestan province health centers were selected via random sampling. The Kogan's Attitudes toward Older People Scale (KAOPS) questionnaire was used as data gathering tools. Data analysis was done in SPSS 16 software using Pearson correlation coefficient, paired t-test, t-tests and one way ANOVA test. Results: Mean (standard deviation) of participants age was 34.73 (6.26) years. Mean (standard deviation) of total score of attitude toward elder scale was 115.48 (10.22) (score range in scale 34-204). 54.2 percent of GPs have lower score than mean. Negative attitude mean score were higher than positive attitude mean score which was statistically significant (P= 0.0001). Conclusion: According to our finding, only half of GPs had favorite attitude toward elder. Whereas negative attitudes were higher than positive attitude toward elder, designing some programs for change in attitude of heath care staffs is necessary.

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Background: One of the common problems of the elderly, which increase of its prevalence with aging is the dementia and the cognitive impairment. We can help the involved patients to have a better quality of life with early diagnosis of the cognitive impairment. The aim of this study was an assessment of the validity and reliability of the Persian version of the abbreviated mental test (AMT) among the older people in a nursing home setting. Methods: 176 eligible elderly people aged ≥ 60 years living in KahrizakCharity Foundation (KCF), were selected randomly based on medical record number. Demographic information and past medical history of the participants were collected. Geriatric depression scale 15 (GDS-15), global deterioration scale (GDS) forms and also the Persian version of the abbreviated mental test (AMT) were administered. The participants were assigned to two groups the normal and impaired cognitive groups, based on DSM-IV diagnostic criteria. The GDS cut-points were used for assessment of validity, sensitivity and specificity of the Persian version of AMT. Results: The mean age of the participants was 77.30 (7.94) years. The Persian version of AMT had good discriminated validity in diagnosis of normal and impaired cognitive participants (7.35 ± 2.33 and 5.99 ± 2.29, P < 0.01 respectively) and at cut-point AMT< 8,(based on GDS cut-point) it had a sensitivity and specificity 92.15 % and 81.50% respectively. The sensitivity and specificity based on theism IVcriteriawere 64.9% and 64.0% at cut-off point equal to 7, respectively. The internal consistency of the Persian version of AMT was acceptable (Cronbach’salpha coefficient =0. 76). As well as the external reliability (intra-rater) of this instrument was good inter-class correlation coefficient (ICC) = 0.89) Conclusion: The Persian version of the AMT has appropriate validity and reliability in Iranian older people.

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Background: There is increasing interest about the relationship between metabolism, obesity and function of thyroid hormones in recent decades. This study aimed to determine the validity of a “thyroid and metabolism questionnaire” and its relationship with metabolism status and function of thyroid hormones. Methods: It was a descriptive cross-sectional study on 164 people aged 20-64 years who were selected randomly from nutrition clinic. “Thyroid and Metabolism questionnaire” including 25 questions were completed for everyone. Biochemical parameters including serum level of T3, T4 and TSH were measured. Resting energy expenditure [REE] was measured by indirect calorimeter. Results: The mean measured REE and calculated with Harris-Benedict formula were 1826.7 ± 475.34 and 2277.6 ± 454.54 kcal in men and 1410.8 ± 205.5 and 1670.73 ± 136.10 kcal in women respectively. The final score of this questionnaire had no significant association with measured REE. REE showed indirect relationship with serum level of T3, T4, T3/T4 and inverse relationship with TSH. Metabolism status of every participant was obtained via measuring and calculating REE with set and formula. The metabolism status of participants showed no agreements with metabolism status that predicted from “Thyroid and Metabolism” questionnaire. There was no significant association between metabolism status that was measured by indirect calorimeter and calculated from “Thyroid and Metabolism” questionnaire. From 25 questions of this questionnaire, only questions number 1, 4, 16 and 23 showed significant association with measured REE [P< 0.05]. Conclusion: Results of this study showed that “Thyroid and Metabolism” questionnaire had internal consistency, but not validity.

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Background: Diabetes is a chronic disease that can cause severe complications such as cardiovascular disease, blindness and kidney failure. Given the importance of self-care in diabetic patients, and considering that inadequate health literacy is a serious barrier for the management of diabetes that can affect patients' participation in self-care, Therefore this study aimed to assess the status of health literacy in patients with type 2 diabetes in three domains of functional, communicative and critical and Determine the factors associated with self-care behaviors in these patients. Methods: A cross-sectional study on 187 diabetic patients referred to Hazrat Ali diabetes clinic in Isfahan. The samples were selected by randomly Convenience sampling method. The level of health literacy and Status of self-care behaviors in patients was assessed by a standardized questionnaire (FCCHL) and (DMSES) respectively. Collected data were analyzed Using the ANOVA, t-independent, Pearson correlation coefficient at SPSS v.21 statistical software. Results: The mean age of the study population was 57.40 ± 11.07. Average health literacy score and self-care behaviors of the participants were 2.28± 0.57 and 3.84 ± 1.56 respectively. There was significant relationship between total health literacy, communicational and critical health literacy with self-care behaviors. There was no significant relationship between functional health literacy and self-care behaviors. Communicational health literacy was associated with diet, physical activity, blood glucose monitoring and foot care. Critical health literacy was associated with physical activity, blood glucose monitoring, foot care, and taking medication. There was no significant relationship between Communicational health literacy and taking medication and also between critical health literacy and diet. Conclusion: Considering that communication and critical health literacy was associated with the self-care of patients with diabetes so Emphasis and consideration should primarily be given on skills related to these domains of health literacy. Since that Patients’ functional HL capabilities that was associated with basic skills in reading and writing was not related to self-care, therefore assessment of education levels alone in the clinical setting is not recommended.

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Background: Evidences exist that abdominal obesity is a difference in terms of body mass index (BMI) and these two factors have different effects on bone density. This study examined the association between body mass index, obesity, the history of fracture and bone mineral density in Iranian population. There exist evidences on the effects of body mass index (BMI) and abdominal obesity, and the role of this two factor on bone density. This study examined the association between body mass index, abdominal obesity, and the frequency of fracture with bone mineral density in Iranian population Methods: The Study was done as a cross-sectional, population-based retrospective study. People over 18 years were included in the third part of the IMOS project (National comprehensive plan for the prevention, diagnosis and treatment of osteoporosis). Abdominal obesity was calculated based on waist to hip ratio that was considered positive > 0.95 in men and 0.85 in women. The linear regression test was used to examine the relationship between BMI and abdominal obesity with bone densitometry. Results: A total 2019 cases (717 men, 1302 women) with 41.85 ± 13.95 years enrolled in this study. Almost, 36% of men and women were obese based on waist circumference. Correlation coefficients of BMI with bone density were equal 0.236 for Hip, 0.133 for femoral neck, 0.138 for lumbar spine. Waist to hip ratio was inversely associated with bone density. Bone densities in the hip and lumbar spine, in individuals with a positive history of wrist fracture were significantly lower than those with a negative history of fracture. Conclusion: contrary to the total body fat, abdominal obesity based on waist to hip ratio is inversely associated with bone density. In other words, abdominal obesity increases the risk of fractures by reducing the bone density without creating protective shield of adipose tissue in vulnerable areas.

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Background: A unique subset of Individuals with normal body mass index (BMI= 18.5-24.9 kg/m2) and high body fat percentage (above 30% in women and 23% in men) that are termed as normal weight obese, are at increased risk for development of the metabolic syndrome and chronic diseases because the adipose mass and the excess of fat mass are an important source of proinflammatory cytokines. The aim of the present study was based on this hypothesis that women with high body fat percentage and normal body mass index are at increased risk for the metabolic syndrome in compared to healthy non obese women. Methods: This was as case-control study in which 40 obese women with normal weight (BMI= 18.5-24.9 kg/m2) and body fat percentage above 30% (FM> 30%) and 30 non-normal weight obese women (BMI= 18.5-24.9 kg/m2) and fat percentage less than 25% (FM <25%) who were matched for age (mean age = 28 years) recruited for this study. The components of metabolic syndrome including Anthropometric variables, blood pressure and fasting plasma concentrations of total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, glucose and insulin were measured. Results: The anthropometric measurements including waist and hip circumferences in NWO was higher than non-NWO (respectively 74.78±4.81 vs. 70.76±2.91 and 99.12±4.32 versus 93.16±2/91, Pvalue<0.001), while the waist-to-hip ratio did not differ between the two groups (p=0.448).Also no significant differences were observed in concentrations of total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, fasting plasma glucose, systolic and diastolic pressure between groups. Fasting serum insulin and insulin resistance was higher in NOW compared to non NWO (Pvalue<0.05) and insulin sensitivity in NWO was lower than non NWO (0.357 versus 0.374, pvalue = 0.043). Conclusion: Because of the higher serum insulin concentration and the lower insulin sensitivity, obese women with normal body mass index but high body fat percentage can be associated with a higher risk for metabolic dysregulation and metabolic syndrome compared to healthy women with the same body mass index and normal body fat percentage

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Background: Osteoporosis is the most prevalent metabolic bone disease which is characterized by low bone mass and increased risk of fracture. The present study was conducted to assess the prevalence of osteoporosis and T-score discordance between femur and lumbar spine as well as their risk factors in a group of healthy postmenopausal women and men older than 50 years old based on Iranian Multicenter Osteoporosis Study data in phase 3 compared to phase 1.

Methods: This research is a cross-sectional study. 295 men and 397 women in IMOS 3 from Arak and Sanandag, and 868 men and 685 women  from Tehran, Mashad, Tabriz, Shiraz and Bushehr were recruited based on randomized cluster sampling

Results:  osteoporosis and osteopenia prevalence in men were 32% and 50% respectively, which were more in IMOS 3 compared to IMOS 1 (28% and 49.3%) but no statistical significance was noticed p=0.258. In postmenopausal women there were no difference in osteoporosis and osteopenia prevalence between IMOS 3 and IMOS1. There were no difference in discordance prevalence in IMOS 3 compared to IMOS 1. Logistic regression analysis revealed body mass index and physical activity had protective role against osteoporosis and osteopenia.

Conclusion: It seems osteoporosis in men has greater rate compared to women. Lifestyle changes especially physical activity and nutrition can play a significant role in the prevention of osteoporosis. And based on T-score discordance between femur and lumbar spinebperforming BMD at two different sites is necessary for the Iranian population.

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Background: Household food insecurity is defined as limited or uncertain access to nutritionally adequate and safe food or limited ability to obtain foods in socially acceptable ways. The association between food security and obesity had been investigated before but so far, its association with body composition has not been investigated. Therefore, the aim of this study was to investigate the relationship between Food security with anthropometric measurements, body composition and blood pressure in women attending the sport clubs of municipality in west of Tehran.
Methods: This cross-sectional survey was conducted in 397 randomly selected healthy women from 14 sport clubs dependent to mayoralty in North West, South West and West of Tehran. To determine the food security, USDA food insecurity (18-item scale) was used. Weight, height, waist circumference (WC), systolic and diastolic blood pressure (SBP, DBP) were measured according to standard protocols Body composition was measured using body impedance analyzer (BIA). Socio-demographic and socioeconomic status were recorded. Data analysis included chi-square test, ANOVA test and multivariate analyses of variance.
Results: The prevalence of food insecurity in subjects was 54.4% that 45.3% were food insecure without hunger, and 9.1% were food insecure with moderate and severe hunger. Compared to food secure households, people with food insecurity significantly had more general obesity (Body Mass Index > 30kg/m2) and central obesity (Waist > 80 cm) (P-value < 0.0001).Also, most people with high blood pressure were in food insecure group and the association between blood pressure and food security was significant (P-value < 0.0001). Body composition and systolic and diastolic blood pressure of women were significantly greater in the group with food insecurity than food security group (P-value < 0.0001).
Conclusion: The results of this study showed that food insecurity was significantly associated with obesity, fat mass, visceral fat mass and blood pressure.

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Background: The major cause of obesity is an imbalance between energy intake and energy expenditure and resting energy expenditure (REE) is the most important determining factor in metabolism because it can reduce obesity and body fat mass gain. Overt hypothyroidism is associated with a lower resting energy expenditure (REE). With treatment, the resting energy expenditure (REE) will be normal. But a group of patients with treatment and normal serum level of TSH and thyroid hormones, Continue to complain of the lack of improvement of Clinical signs of overt hypothyroidism. This study is designed whether patients that have Clinical signs of overt hypothyroidism in compared with patients without Clinical signs, resting metabolic rate, body composition and lipid profile are different or not.
Methods: This study is a descriptive and comparative study on 100 women with overt hypothyroidism are treated with levothyroxine. The patients were divided into 2 groups of 50 patients with and without clinical signs. All patients were matched for age and BMI and menstrual cycle. 2 groups regarding anthropometric measurements, resting energy expenditure (REE), body composition, thyroid hormones, lipid profile and diet were compared with each other.
Results: The average resting energy expenditure (REE) and adjusted of it for weight was significantly lower in the group with Clinical signs (Pvalue<0.03). But there was no significant difference between the 2 groups for the form of an adjustment for fat free mass (FMM) and FT3. The body fat mass (FM) was higher in the group with Clinical signs (Pvalue<0.005).But there was no significant difference between the 2 groups in the percentage of body fat mass and fat free mass (FMM). Serum levels of TSH, TF4, FT4, TT3, FT3, total cholesterol, HDL, LDL, there was no significant difference between the 2 groups. But the level of blood triglycerides (TG) in the group with Clinical signs was significantly higher than the group without Clinical signs (Pvalue<0.01).
Conclusion: Patients with Clinical signs, lower resting energy expenditure (REE) and fat mass (FM) and triglycerides blood (TG) is higher than in patients without Clinical signs.

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Background: health care providers have different attitudes and belies toward elders that have effect on their behaviors in health service delivery to older adults. This study was done to determine the Golestan province health centers staffs attitude towards elders.
 Methods: In this cross-sectional study, 152 general practitioners of Glestan province health centers were selected via random simple sampling. Demographic questionnaire and Kogan's Attitudes toward Older People Scale (KAOPS) was used as data gathering tools. Data analysis was done in SPSS 16 software environment with Pearson correlation coefficient, paired t-test, t-tests and one way ANOVA.
Results: mean and standard deviation of participants age was 34.48 (4.31) years. Mean and standard deviation of total score of attitude toward elder scale was 116.42±9.58 (score range in scale 34-204). Lower score than mean were observed in 49.3 percent of health care providers. Negative attitude mean score were higher than positive attitude mean and paired t-test showed the difference is significant (P< 0.001).
Conclusion: according to our finding, only half of participants had favorite attitude toward aged people. Whereas, negative attitudes to this age group were higher than positive attitudes, designing some programs for change in attitudes of heath care staffs is necessary.  
 

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Background: Diabetic nephropathy is a chronic kidney disease and of more common complications of type 2 diabetes mellitus. The current diagnostic markers of diabetic nephropathy, albumin and creatinine, are only able to catch the disease in the stage of renal damage. The aim of this study is evaluation of targeted metabolomics of serum amino acids to identify the association of the changes of serum amino acid profile with diabetes and diabetic nephropathy.
Methods: This cross-sectional study was conducted in 2015-2016 on thirty patients with type 2 diabetes subsequent diabetic nephropathy and thirty type 2 diabetic patients without nephropathy attending diabetes clinic of endocrinology and metabolism institute and thirty non diabetic persons. Blood hemoglobin, HbA1c and BUN and also, serum albumin, uric acid and the albumin/creatinine ratio from a random urine specimen were measured by standard methods and serum amino acids level were identified using high performance liquid chromatography (HPLC). Statistical analysis ANOVA, Kruskal-Wallis, and nominal regression were used for the comparison of the investigated groups.  
Results: significant differences were seen in serum levels of 8 essential, branched-chains, aromatic and 8 non-essential amino acids alanine, aspartic acid, serine, glutamine, arginine, glycine, tyrosine and ornithine between three groups. Serum levels of arginine and isoleucine were higher in the diabetic group than non-diabetics. However, Levels of amino acids serine, glutamine, glycine, threonine, tyrosine, tryptophan, methionine, valine, ornithine, and lysine in 2 groups of diabetic nephropathy and diabetes were higher than non-diabetic patients.
For every standard deviation decrease in serum levels of amino acids serine, alanine and isoleucine, in comparison to diabetic patients, the risk of diabetic nephropathy were increased 3.257 (95%CI: 0.10- 0.94, P=0.039), 2.207 (95%CI: 0.18- 0.81, P=0.039) and 2.652 (0.21- 0.96, P=0.012), respectively.
Conclusion: Since this study was conducted in patients in the early stages of the disease, reduced serum levels of the amino acids serine, leucine and alanine may be associated with development and progression of diabetic nephropathy. and in the future with more studies in this field can be used in metabolic control and improvement of the prognosis of patients with diabetic nephropathy.

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Background: It is critical to understand how accurately physicians can estimate the importance of each clinical finding in estimating the probability of a specific diagnosis in the process of clinical decision making. This study aimed to investigate whether physicians’ estimates of the importance of various clinical findings of ascites correlated with the positive likelihood ratios of these findings in diagnosis of ascites.
Methods: One hundred and ten physicians were asked to respond to a questionnaire. In this questionnaire they were presented with a clinical scenario about a patient suspected of having ascites followed by a list of clinical findings. Participants were asked to assign a weight (between 0 and 100%) to each clinical finding based on their perception of how much the presence of that finding changed the probability of ascites for the patient. Positive likelihood ratios of those findings were extracted from current best evidence. We investigated if the weights assigned by physicians were associated with the positive likelihood ratios of those findings.
Results: Significant differences were discovered between the weights assigned by the physicians and the positive likelihood ratios for each clinical finding. Significant positive correlation was observed between the weights assigned by different groups of physicians.
Conclusion: Physicians inaccurately estimated the importance of various clinical findings in the diagnosis of ascites. Further research is needed to determine if such inaccurate estimations would lead to any adverse clinical outcomes.