Search

Background Diabetes self-management education programmes which have been reported to improve the self-efficacy of diabetic people can lead to their empowerment. Specialized diabetes nurses also play a fundamental role in empowering patients with diabetes through improving their knowledge and self-care. Aim The purpose of this study was to develop a valid and reliable questionnaire to measure empowerment in Iranian people with type 2 diabetes. Methods Important subscales of patient empowerment were identified by an expert panel. The subscales included active self-care, coping with personal and social concerns, basic knowledge related to diabetes management and patient-physician communication. Questions related to each subscale were generated and the expert panel renewed the questionnaire to ensure relevance and clarity of the items. Patient focus groups were conducted to establish the face validity of the questionnaire. The final questionnaire consisted of 15 items organized in three subscales. In a population-based study, a sample of 378 people with type 2 diabetes was recruited. Reliability coefficient ( Cronbach's α) was calculated for all of the subscales. Convergent validity was assessed by Pearson's product moment correlation. The scree test was used to select significant subscales. Findings Two hundred forty-seven female and 131 male subjects with type 2 diabetes filled out the questionnaire. Three subscales were derived from factor analysis considering item-component loading of 0.4 as significant: 'active self-care' ( Cronbach's α: 0.78), 'basic knowledge related to diabetes management' ( Cronbach's α: 0.72) and 'coping with personal and social concerns' ( Cronbach's α: 0.51). The scree plot of the eigenvalues of 15 items proposed three subscale solutions. Internal consistency reliabilities for the three subscales were acceptable (α: 0.51-0.78). Conclusions The Diabetes Empowerment Questionnaire is a reliable and valid tool to assess patient empowerment in Iranian people with type 2 diabetes. [ABSTRACT FROM AUTHOR]

The collection of cestodes from the carcharhiniform shark Carcharhinus cf. dussumieri in the Persian Gulf off Iran resulted in the discovery of the new genus and species of tetraphyllidean tapeworm, Doliobothrium haselii n. gen. n. sp. Collections from the carcharhiniform shark Rhizoprionodon acutus in the Timor Sea off northern Australia resulted in material that is consistent with a species originally described as Pithophorus musculosus from this host species in India, but that appears to represent a second species in the new genus. This second species is redescribed and transferred to Doliobothrium n. gen. The two species differ from one another in total length, testis number and total number of proglottids, with the latter species generally being smaller in overall size than the former species. Histological sections and scanning electron microscopy confirm that this new genus differs from all other phyllobothriid genera in the possession of bothridia that both lack apical suckers and are tubular in form, bearing proximal and distal apertures. Despite differences in scolex morphology, the proglottids of the new genus are remarkably similar to those seen in Orectolobicestus, Paraorygmatobothrium and Ruhnkecestus, all of which also parasitize sharks. These four genera also share the presence of serrate gladiate spinitriches on their proximal bothridial surfaces. This is only the second report of a cestode from an elasmobranch from the Persian Gulf. Limited available data suggest that the fauna of this region resembles that of other regions of the Indo-Pacific. Furthermore, owing to the paucity of available information and specimens, it is recommended that Pithophorus and three of its remaining described species (i.e. P. pakistanensis, P. trygoni, P. yamagutii) be considered as a genus inquirendum and species inquirenda, respectively. [ABSTRACT FROM AUTHOR]

There is an obesity epidemic worldwide, which has been increasing in recent years. An epidemiologic cross-sectional study was conducted among 3799 persons who were 30–70 years old in Semnan Province, Iran. Multistage cluster sampling was performed, and subjects were selected from urban and rural populations. Body weight, height and waist circumference (WC) were measured, and body mass index (BMI) and waist to hip ratio (WHR) were calculated. Overweight and obesity were defined as 25 ≤ BMI < 30 and ≥30 respectively in men with WHR ≥ 0.9 or WC ≥ 102 cm, and women with WHR ≥ 0.8 or WC ≥ 88 cm were considered centrally obesite. Prevalence of obesity and overweight was 26.3% and 40.6% respectively. Prevalence of obesity was more among women (39.5%) than men (14.5%) with central obesity prevalence using WHR and WC cut-points of 72.2% and 26.6% respectively. There was a significant association between obesity and age, gender, residential area and educational level ( P < 0.01). In conclusion, prevalence of obesity and overweight among 30–70 years old, especially among women, was higher than expected. A comprehensive educational programme on obesity risk factors and obesity-related diseases is necessary. [ABSTRACT FROM AUTHOR]

Adolescence is a crucial period of growth and the best time to recognize, rebuild, and improve different psychological and social aspects of a person's life. Anxiety is one of the variables that affect a person's mental health. Also, there is a connection between parenting styles and mental health during adolescence. The purpose of this study was to determine the relationship between perceived parenting styles and anxiety of adolescents in Isfahan (Iran). This descriptive-analytical study was conducted with the participation of 197 teenagers in the age group of 12-18 years in Isfahan, Iran. The participants were selected by cluster random sampling. The Parenting Styles Questionnaire (PSQ) and March Children's Anxiety Questionnaire were used to collect information. Data were analyzed using descriptive and analytical statistics through SPSS 26. The mean and standard deviation of anxiety in adolescents were 45.96 and 16.51, respectively (at a low level). The participants evaluated their parenting style in order as permissive (32%), authoritative (24.9%), neglectful (21.8%), and authoritarian (21.3%). A significant difference was observed between the anxiety level of adolescents and their parenting style (p < 0.001). In this way, the highest anxiety was related to the children of permissive parents, and the most minor anxiety was associated with the authoritarian parents (p < 0.001). The findings of this research indicate that there is a significant difference between the perceived parenting styles in terms of the level of children's anxiety. Therefore, considering the importance of parenting styles on children's psychological characteristics, It is recommended to educate parents about the importance of their parenting style on their children's health., (© 2024. The Author(s).)

Medication adherence is of utmost importance in achieving the desired therapeutic outcome and effectively managing seizures in patients with epilepsy (PWE). It is imperative to recognize self-esteem as a psychological determinant that potentially influences the optimal compliance with anti-seizure medications (ASMs) among PWE. The objective of this study was to explore medication adherence and its relationship with self-esteem among individuals diagnosed with epilepsy in Isfahan, Iran., Methods: This descriptive-analytical study was conducted in the year 2021, encompassing a cohort of 250 PWE who were referred to designated medical facilities in Isfahan, Iran, and were selected by the consecutive sampling technique. A 3-part instrument including demographic components, the Rosenberg Self-Esteem Scale, and the Morissky Drug Adherence Questionnaire employed for data collection., Results: The mean and standard deviation of adherence to the medicinal regimen in the participants were 6.9 ± 2.02, and 46.4 % had a low level of adherence to the medication regimen (total score 0-6). At the same time, the mean and standard deviation of self-esteem in these patients was 5.11 ± 2.11. There was a statistically significant and direct correlation between adherence to the prescribed drug regimen and self-esteem (rs = 0.464, p = 0.00)., Conclusion: Based on the findings of the study that showed a statistically significant and positive correlation between self-esteem and adherence to the medication regimen, it is advisable to enhance and advocate for these factors in PWE., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: Pharmacogenetics studies suggest that genetic variants have a possible influence on the inter-individual differences in therapeutic response to glucagon-like peptide 1 receptor agonists (GLP-1 RAs). We aimed to examine the potential role of genetic variability of glucagon-like peptide 1 receptor (GLP-1R) on glycemic response to GLP-1 RAs in a population of Iranian people with type 2 diabetes mellitus (T2DM)., Methods: In this study, we analyzed the data from participants in a non-inferiority randomized clinical trial between 2019 and 2020. Patients received liraglutide 1.8 mg/day subcutaneously for 24 weeks. They were stratified by the baseline hemoglobin A1c (HbA1c) into four categories: 7-7.99, 8-8.99, 9-9.99, and ≥ 10%. In each category, subjects with HbA1c reduction greater than the median ΔHbA1c value for that group were defined as optimal responders. The pooled number of optimal/suboptimal responders in the four groups was used for the comparison. We evaluated two genetic variants of GLP-1R, rs6923761 and rs10305420, using Sanger sequencing. Logistic regression analyses were performed to examine the associations of the GLP-1R variants with the glycemic response in different genetic models., Results: Out of 233 participants, 120 individuals were optimal responders. Median HbA1c reduction was - 2.5% in the optimal responder group compared with - 1.0% in the suboptimal responder group (P < 0.001). In genetic models, rs10305420 T allele homozygosity was associated with optimal glycemic response to liraglutide compared with heterozygous and wild-type homozygous states (recessive model: OR 3.28, 95% CI 1.41-7.65, P = 0.006; codominant model: OR 2.52, 95% CI 1.03-6.13, P = 0.04). No significant association was found between rs6923761 variant and HbA1c reduction., Conclusion: GLP-1R rs10305420 polymorphism can explain some of the inter-individual differences in glycemic response to liraglutide in a population of Iranian people with T2DM., (© 2024. The Author(s), under exclusive licence to Springer Healthcare Ltd., part of Springer Nature.)

Antimicrobial disinfectants have been extensively used to control hospital-acquired infections worldwide. Prolonged exposure to bacteria could promote resistance to antimicrobial disinfectants. This study evaluated the antimicrobial activity of four commonly used disinfectants; triclosan, chlorhexidine digluconate, benzalkonium chloride, and formaldehyde against Acinetobacter baumannii clinical isolates. This study also determined the prevalence and association of efflux pumps encoding genes qacE, qacED1, emrA, and aceI with tolerance to disinfectants. A total of 100 A. baumannii isolates were included in the current study. The antimicrobial disinfectants' minimum inhibitory concentration (MIC) was determined using an agar dilution method. Genes involved in resistance to disinfectants were investigated by PCR method. The benzalkonium chloride MICs ranged between 32 and 128 μg mL-1, chlorhexidine digluconate 8-64 μg mL-1, triclosan 1-32 μg mL-1, and formaldehyde 128 μg mL-1. Overall, the highest MIC90 value was identified for formaldehyde (128 μg mL-1), followed by benzalkonium chloride and chlorhexidine digluconate (64 μg mL-1, each one) and triclosan (4 μg mL-1). In the present study, the qacE, qacED1, emrA, and aceI genes were found in 91%, 55%, 100%, and 88% of isolates, respectively. The qacG gene was not identified in our A. baumannii isolates. The qacED1 gene was associated with higher MICs for all disinfectants tested (P < 0.05), while the qacE and aceI genes were associated with higher MICs for benzalkonium chloride and chlorhexidine. This study indicated that triclosan is the most effective disinfectant against A. baumannii isolates.

Background: Nonalcoholic fatty liver disease (NAFLD) is a complex metabolic disorder that increases the risk for cardiovascular disease in patients with type 2 diabetes mellitus (T2DM). Global longitudinal strain (GLS) is an indicator of left ventricular (LV) mechanics and can detect subclinical myocardial dysfunction. We compared the effects of pioglitazone and empagliflozin on GLS in patients with T2DM and NAFLD without established atherosclerotic cardiovascular disease., Methods: This study was a 24-week randomized, single-blind, and parallel-group (1: 1 ratio) clinical trial. Seventy-three participants with T2DM (being treated with metformin) and NAFLD but without established atherosclerotic cardiovascular disease (ASCVD) were randomized to empagliflozin or pioglitazone. Liver steatosis and fibrosis were measured using transient elastography, and GLS was measured by echocardiography. The primary endpoint was the change in GLS from baseline to week 24. Secondary end points include changes in controlled attenuation parameter (CAP) and Liver stiffness measure (LSM)., Results: In this study, GLS improved by 1.56 ± 2.34% (P < 0.01) in the pioglitazone group and 1.06 ± 1.83% (P < 0.01) in the empagliflozin group without a significant difference between the two groups (P = 0.31). At baseline, GLS was inversely associated with the severity of liver fibrosis: r = - 0.311, P = 0.007. LSM in the pioglitazone and empagliflozin group [(-0.73 ± 1.59) and (-1.11 ± 1.33)] kpa (P < 0.01) decreased significantly. It was without substantial difference between the two groups (P = 0.26). Empagliflozin and pioglitazone both improved controlled attenuation parameter. The improvement was more critical in the empagliflozin group: -48.22 + 35.02 dB/m vs. -25.67 + 41.50 dB/m, P = 0.01., Conclusion: Subclinical cardiac dysfunction is highly important in patients with T2DM and with NAFLD. Empagliflozin and Pioglitazone improve LV mechanics and fibrosis in patients without established ASCVD. This has a prognostic importance on cardiovascular outcomes in high-risk patients with T2DM. Moreover, empagliflozin ameliorates liver steatosis more effectively them pioglitazone. This study can serve as a start point hypothesis for the future. Further studies are needed to explore the concept in larger populations., Trial Registration: This trial was registered in the Iranian Registry of Clinical Trials (IRCT): "A Comparison between the Effect of Empagliflozin and Pioglitazone on Echocardiographic Indices in Patients with Type 2 Diabetes Mellitus and Nonalcoholic Fatty Liver Disease" IRCT20190122042450N5, 29 November 2020. https://www.irct.ir/search/result?query=IRCT20190122042450N5 ., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: Depression is more common in diabetic patients, with a 1.5-fold increased risk of death.Melissa officinalis (M. officinalis) have anti-diabetic and anti-depression activities. The study aimed to determine the efficacy of M. officinalis extract on depression, anxiety, and sleep quality in patients with type 2 diabetes with depressive symptoms., Methods: In this double-blind clinical trial, 60 volunteer patients (age range 20-65 years) with type 2 diabetes mellitus with symptoms of depression were randomized into the intervention (received 700 mg/day hydroalcoholic extract; n = 30) or control group (received 700 mg/day toasted flour; n = 30). Dietary intake, physical activity, anthropometric indices, FBS (Fasting blood sugar), hs-CRP(High-sensitivity C-reactiveprotein), depression, anxiety, and sleep quality were determined at the beginning and end of the study. Depression and anxiety were assessed by Beck Depression Inventory-II (BDI-II) and Beck Anxiety Inventory (BAI), respectively; sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI)., Results: Sixty participants received M. officinalis extract or placebo, of which 44 patients completed the 12-week double-blind clinical trial. After 12-week the mean change of depression and anxiety scores were statistically significant between the two groups (p < 0.001 and p = 0.04, respectively), but no significant differences were observed in FBS, hs-CRP, anthropometric indices, sleep quality, and blood pressure.In the intervention group, there was a significant decrease in depression and anxiety severity(p < 0.001 and p = 0.01, respectively) at the end of the study compared to the baseline., Trial Registration: All protocols in this study were followed in accordance with the Helsinki Declaration (1989 revision). Ethical approval for this study was obtained from the Iran University of Medical Sciences Ethics committee (IR.IUMS.FMD.REC 1396.9413468004; research.iums.ac.ir). The study was registered at the Iranian Registry of Clinical Trials (IRCT201709239472N16); Registration date: 09/10/2017., (© 2023. The Author(s).)

Background: Mesenchymal stromal cells (MSCs) injection has been proposed as an innovative treatment for knee osteoarthritis (KOA). Since, allogeneic MSCs can be available as off-the-shelf products, they are preferable in regenerative medicine. Among different sources for MSCs, adipose-derived MSCs (AD-MSCs) appear to be more available., Methods: Three patients with KOA were enrolled in this study. A total number of 100 × 10 6 AD-MSCs was injected intra-articularly, per affected knee. They were followed up for 6 months by the assessment of clinical outcomes, magnetic resonance imaging (MRI), and serum inflammatory biomarkers., Results: The primary outcome of this study was safety and feasibility of allogeneic AD-MSCs injection during the 6 months follow-up. Fortunately, no serious adverse events (SAEs) were reported. Assessment of secondary outcomes of visual analogue scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and knee osteoarthritis outcome score (KOOS) indicated improvement in all patients. Comparison between baseline and endpoint findings of MRI demonstrated a slight improvement in two patients. In addition, decrease in serum cartilage oligomeric matrix protein (COMP) and hyaluronic acid (HA) indicated the possibility of reduced cartilage degeneration. Moreover, quantification of serum interleukin-10 (IL-10) and interleukin-6 (IL-6) levels indicated that the host immune system immunomodulated after infusion of AD-MSCs., Conclusion: Intra-articular injection of AD-MSCs is safe and could be effective in cartilage regeneration in KOA. Preliminary assessment after six-month follow-up suggests the potential efficacy of this intervention which would need to be confirmed in randomized controlled trials on a larger population., Trial Registration: This study was registered in the Iranian registry of clinical trials (https://en.irct.ir/trial/46) in 24 April 2018 with identifier IRCT20080728001031N23.

Aim: The aim of this study was to explore the experiences of blindness simulation among a group of nursing students., Design: This qualitative study was conducted using an interpretive phenomenological method., Methods: Using purposeful sampling method, students were informed and invited to participate in the research through the Website of Tehran School of Nursing and Midwifery. We listed the candidates and until data saturation and compilation of the study, 8 students entered the study. They shared their experiences about blindness simulation through individual in-depth and semi-structured interviews. We continued the interviews until the data were saturated. The transcribed interviews were analysed by Colaizzi's approach., Results: The results of data analysis resulted in three major themes and nine sub-themes, which were conceptually named based on their nature. The major themes included abandoned in the labyrinth puzzle, vision of heart and self-alienation., (© 2021 The Authors. Nursing Open published by John Wiley & Sons Ltd.)

Background: In low and middle-income countries (LMICs), where millions of women give birth before the age of 18, the reproductive health status of married adolescent mothers, including family planning, sexual, psychosocial, and maternal health, remains a significant and recurring phenomenon. As a result, the purpose of this study was to assess the reproductive health status of married adolescent mothers who sought treatment at Ardabil health care centers in 2019., Methods: A cross-sectional study was carried out in five health centers in Ardabil, Iran. This research included 312 married adolescent mothers who were under 19 years old. Health workers who asked questions of each participant completed a demographic questionnaire and the Reproductive Health Assessment Scale for Married Adolescent Women, and all data were self-reported. Univariate and multivariate linear regressions were used to determine risk factors associated with reproductive health scores. The data was examined using statistical software (SPSS version 20)., Results: The mean age (years) of the respondents was 16.41 ± 0.85, the mean age of their husbands was 24.18 ± 2.29, and the mean age of their marriage was 15.06 ± 1.15. In this study, adolescent mothers had an average reproductive health score of 63.78 ± 11.06. There was a significant association between reproductive health status and age, education, husband's age and education, and contraceptive methods among married adolescent mothers (p < 0.05)., Conclusion: The research findings indicated that adolescent mothers had an average level of reproductive health. Several socio-demographic characteristics, including age, education, gravida, and contraception, were linked to reproductive health scores. Programmers and policymakers should prioritize improving the reproductive health of adolescent mothers through education and increasing women's and spouses' knowledge and awareness., (© 2022. The Author(s).)

One of the important issues regarding caring for patients with mental disorders is the high prevalence of stress, anxiety, and depression in their caregivers. This study aimed to investigate the effect of a spirituality-based program on stress, anxiety, and depression of caregivers of patients with mental disorders. This clinical-trial study involved 60 family caregivers of patients with mental disorders who were referred to the clinic of Shahid Ayatollah Modarres Psychiatric Hospital in Isfahan, Iran, during 2019-2020. Accordingly, the samples were selected using convenient sampling method and then divided into two groups of experimental and control by simple random allocation. Next, the spirituality-based intervention was performed for the intervention group, and the needed data were collected in both intervention and control groups before, immediately after, and one month after the intervention. The data collection tool used in this study was DASS-21 questionnaire. No significant differences were observed between the two groups in terms of the mean scores of stress, anxiety, and depression (p > 0.05) before the intervention. However, some significant differences were found in terms of the stress, anxiety, and depression scores between the two groups immediately (p < 0.001) and one month after the intervention (p < 0.001). The spirituality-based program seemed to affect stress, anxiety, and depression of caregivers of patients with mental disorders positively. So, it is suggested to perform this intervention as an inexpensive and available supportive method for family caregivers of patients with mental disorders., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Crimean-Congo hemorrhagic fever (CCHF) is an acute, feverous disease that is caused by tick bites or humans' direct contact with the blood and tissues of infected livestock and humans. The transmission of the disease is also possible via human-to-human contacts and nosocomial transmission is well described. The majority of patients suffering from this disease are slaughterhouse workers (including butchers), farmers, veterinarians and hospital staff. Thus, this study aimed to investigate the health behaviors of butchers regarding CCHF and study factors affecting such behaviors based on the health belief model., Methods: This is a descriptive cross-sectional study conducted on 500 butchers in Ardabil Province in 2020 by a multistage sampling method. The participants of the study completed the researcher-made questionnaire of health belief model and health behaviors model relevant to CCHF. The collected data were then analyzed by descriptive statistical tests and linear regression analysis., Results: The mean (SD) age of the participants was 44.4 (10.5) years, and 96% were males. Only 11.1% of the participants displayed acceptable disease-preventive behaviors. The validity and reliability of the developed questionnaire were confirmed. The results of the exploratory factor analysis showed that the constructs of the model explained 84% of the total variance. The results of the study revealed that among the variables of the health belief model, perceived susceptibility (p-value = 0.006, β = 0.152) and perceived barriers (p-value = 0.023, β = 0.14) were the strongest factors predicting disease-preventive behaviors regarding CCHF., Conclusion: The results of the study showed that the health belief model can predict preventive behaviors for CCHF. Therefore, designing and executing interventions based on the results of this study may encourage such preventive behaviors in butchers., (© 2022. The Author(s).)

We aimed to compare sociodemographic characteristics, smoking patterns, beliefs and perceptions, nicotine dependence, and psychological indicators between flavored waterpipe (WP) tobacco (FWT) and non-flavored WP tobacco (non-FWT) smokers in Iran. A cross-sectional study was conducted in 94 WP-serving venues surrounding Tehran and Ardabil metropolitans in Iran. Convenience sampling was applied to select 900 current WP smokers [508 (56%) FWT-only and 392 (44%) non-FWT-only smokers] aged 18 years and older. Multivariable logistic regression was used to examine the independent characteristics of FWT and non-FWT smokers. Compared to non-FWT smokers, FWT smokers were younger (adjusted odds ratio [AOR]=0.88, 95% confidence interval [CI]: 0.87-0.90) and more likely to have ≥ 1 sibling who smoked WP (AOR=1.54, 95% CI: 1.06-2.24), share WP with others (AOR=2.52, 95% CI: 1.68-3.77), report current cigarette smoking (AOR=2.05, 95% CI: 1.23-3.42), and report confidence in quitting at any time (AOR=3.64, 95% CI: 2.45-5.39). FWT smokers were less likely to have seen (AOR=0.40, 95% CI: 0.27-0.60) or read (AOR=0.44, 95% CI: 0.24-0.80) warning messages on WP tobacco packages relative to non-FTW smokers. The most common self-reported reason for smoking WP was entertainment for both groups, followed by stress relief for non-FWT smokers and the escape from loneliness for FWT smokers. FWT-only smokers differ from non-FWT-only smokers in several aspects including being younger, having more positive beliefs and perceptions regarding WP use, and having higher cigarette smoking prevalence. These findings will help in developing more effective and targeted policies and cessation interventions for WP smokers according to flavor type they use, especially in the Middle East., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: We sought to estimate the prevalence of diabetes mellitus (DM) and pre-DM and their associated factors among a sample of the Iranian urban population between 2017 and 2019., Methods: The present investigation is a sub-study on the HAMRAH cohort study, a longitudinal population-based cohort study to assess the 10-year risk of cardiovascular diseases and their related risk factors in the adult population of the Iranian capital, Tehran. Via a multistage cluster randomized sampling method, 2123 adults aged between 30 and 75 years who had no history of cardiovascular diseases were selected for the study. With the aid of the 2010 American Diabetes Association criteria for the definition of DM and pre-DM, age and sex-specific prevalence rates were estimated., Results: The estimated overall prevalence of DM was 14.3% (95% CI: 13.1%-15.8%): 10.4% known DM (95% CI: 9.1%-11.8%) and 4% newly diagnosed DM (95% CI: 3.1%-5.1%). Pre-DM was detected in about 29.2% of the study participants (95% CI: 22.9-36.3%). Our logistic regression analysis revealed that increasing age, higher systolic blood pressure, higher levels of triglycerides, and lower levels of high-density lipoprotein were significantly associated with DM., Conclusions: DM and pre-DM follow a notable incremental pattern among the Iranian urban population. This finding underscores the significance of the need to improve prevention and screening strategies in the Iranian urban population., (Copyright © 2021 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.)

This study was derived to investigation of BTEX (benzene, toluene, ethylbenzene, xylenes) concentrations in printing and copying centers (PCCs) in Ardabil city of Iran. Fifty-three PCCs were randomly selected from all the 136 number of PCCs and BTEX was sampled form their indoor air. The results showed that the concentration of BTEX in the indoor air PCCs is lower than the OELs (occupational exposure limit) in all cases. The obtained mean concentrations of benzene, toluene, ethylbenzene, and xylene were 93.6±63.2, 150.6±99.2, 34.3±16.8, and 29.5±15.2 μg/m 3 respectively. Type of printer, number of printing and copying device, and type of ventilation system had significant influence on the BTEX concentration. The mean inhalation lifetime cancer risk (LTCR) value for benzene and ethylbenzene in the indoor air of the PCCs with LaserJet and inkjet printers was 44.4 × 10 -6 and 153.3 × 10 -6 , and 23.4×10 -6 and 54.2× 10 -6 , respectively, which were higher than EPA (Environmental Protection Agency) and World Health Organization (WHO) recommended limits. The hazard quotient (HQ) of benzene in the indoor air of the PCCs with inkjet printers was >1, which indicates that the non-carcinogenic risks associated with exposure to these compounds are considerable.

Background: Caring for children with cerebral palsy (CP) for many aspects of their lives may affect caregiver's psychological health. Emergence of COVID-19 put added pressure on caregivers., Aims: The aim of this study was to investigate the psychological health of Iranian caregivers of children with CP and associated risks during a lockdown period., Methods: Using online snowball sampling, 160 caregivers of children with CP participated in this web-based cross-sectional study. The Hospital Anxiety and Depression Scale (HADS), Perceived Stress Scale (PSS-4), Caregiver Difficulties Scale (CDS), and a demographic questionnaire were administered. Hierarchical multiple linear regression analysis was applied to identify risk factors related to caregiver psychological health., Outcomes and Results: Mental health problems were prevalent; (depression = 45.0% and anxiety = 40.6%). Significant correlations were found between CDS and HADS-Anxiety (r = 0.472, P < 0.001), HADS-depression (r = 0.513, P < 0.001), and perceived stress (PSS) related to COVID-19 (r = 0.425, P < 0.001). After controlling for demographic and clinical variables, burden (CDS) was found to significantly predict caregiver anxiety, depression and stress. Furthermore, several demographic characteristics (being married, low educational level and low income) were significantly related to high HADS Anxiety scores. For depression, only having a physical problem was significantly related to HADS among demographic variables. No significant correlations were found between PSS-4 and demographic variables., Conclusions and Implications: During COVID-19 outbreak, the mental health of caregivers of children with CP is affected by multiple factors such as burden of care and demographic characteristics. Due to the importance of well-being among caregivers of disabled children, a comprehensive plan including psychological consultation, remote education, or in-person handouts for the self-care or handling of the children and adequate distance support may enable better mental health for these caregivers., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

The presence of airborne microorganisms in indoor air (home and work) is a serious public health concern. Bio-aerosols have a significant role in indoor air pollution as they can be pathogenic or cause an allergic reaction following inhalation, ingestion or skin absorption. This study aimed to assess bacterial bio-aerosols in the indoor air concentration of gyms, and its relationship with gym area per person, temperature, and relative humidity. Sampling was performed by the National Institute for Occupational Safety and Health (NIOSH) method 0800-0999 and using an Anderson single-step sampler. Fifty-five gyms were selected with simple random sampling method and 165 samples collected for evaluation of bacterial bio-aerosols. The concentrations of airborne bacteria were measured as colony-forming units per cubic meter of air (CFU/m 3 ) collected by impaction on to tryptic soy agar plates. The maximum and minimum densities of bacteria in the air of gyms were 877 and 117 CFU/m 3 , respectively. Pseudomonas, Staphylococcus and Escherichia Coli had an order of the highest to lowest frequency among the microorganisms, respectively. Generally, with increasing temperature and humidity, the density of bacteria was increased. The higher amount of the microorganisms was observed in the air of gyms in the lower available area per person. Athletes are at risk of high exposure to the bacterial bio-aerosol that can affect their health.

Background: Crimean-Congo hemorrhagic fever (CCHF) is highly fatal to humans and an acute viral disease. The CCHF disease has been reported in occupations such as butchers, slaughterhouse butchers and workers. The aim of this study was to investigate the pattern of CCHF related high risk behaviors among butchers and determine the effects of perceived self-efficacy of the participants on their membership in latent classes., Methods: The participants of this cross-sectional study were recruited from all the meat distribution centers in Ardabil Province in 2019-2020. The LCA approach was used to observe the CCFH related high risk behaviors patterns., Results: The statistical significance level was assigned at P-value < 0.05 in all the analyses. Three latent classes were identified; namely, 1) low risk (16.1%), 2) high risk (53.6%), and 3) very high risk (30.2%). After adjusting for other possible confounders higher score of perceived self-efficacy significantly decrease the odds of membership in high risk class (OR = 0.74) and very high risk class (OR = 0.62) compared to the low risk class. Also, age (OR = 1.07) and experience (OR = 0.91) associate with very high risk class., Conclusions: This study revealed the co-occurrence of CCHF related high risk behaviors in the majority of workers in the livestock and meat industry. It is necessary to provide butchers and slaughterhouse workers with general education, force them to use protective equipment and investigate the rate of tick bites in risky occupations.

Background: Shampoos remove fat and pus from the skin and hair. The most critical part of these products is their cleansing properties; therefore, the amount of shampoo cleanser plays an essential role in consumer acceptance., Aim: The production of herbal shampoos from root saponins in Hawthorn can lead to the removal of these substances from shampoos. Squarrosum is one of the 23 Acanthophyllum species that is native to Iran. The root of this plant has been used traditionally as a consumption detergent due to the presence of saponins., Method: To make the shampoo, saponins were extracted through several steps by a solvent after Acanthophyllum squarrosum scientific specimens had been prepared and identified The shampoo's fatigue strength was tested using the Ross-Miles method, and its cleansing power was assessed using Thompson's test., Results: The optimum formula with 15% total saponins content was evaluated., Conclusion: This liquid shampoo has an excellent cleansing effect, is suitable for regular hair; has pseudoplastic rheology; and has acceptable pH, surface tension, and organoleptic stability characteristics., (© 2020 Wiley Periodicals LLC.)

Despite the biological and economic importance of earthworms, the taxonomic status and evolutionary relationships of most lumbricid genera are still under debate. Further complications arise from the recognition that earthworms also show a high cryptic diversity. Past and current field studies of Iranian earthworm fauna have resulted in the identification of a total number of 28 earthworm species. However, many specimens do not fully fit into their original descriptions, making the species assignation very difficult. In this study, we evaluated the genetic diversity using mitochondrial markers as a tool to assess the species occurrence of some problematic species in Iran. Four species with high morphological variation were selected: Aporrectodea caliginosa (Savigny, 1826), Aporrectodea trapezoides (Dugès, 1828), Dendrobaena byblica (Rosa, 1893) and Dendrobaena veneta (Rosa, 1886). Morphological identification was contrasted with the molecular information generated through COI and 16S barcoding and the COI and 16S sequences stored in the Genbank. The results of this first integrative taxonomic analysis revealed that D. veneta consisted of two separated clades and that a number of species assigned to D. byblica showed very close relationships with those belonging to the genus Philomontanus. The lack of taxonomic expertise and identification characters providing a clear and unambiguous identification of earthworms highlights the urgent need of new tools to identify species unequivocally. Therefore, it is concluded that more taxonomical studies are needed to clarify the diagnostic characters and taxonomic status of the species belonging to two genera, Aporrectodea and Dendrobaena (Lumbricidae), in Iran.

The coronavirus infection is an evolving pandemic with high morbidity and mortality, especially in people with comorbidities. The case fatality rate (CFR) is 9.2% in the presence of diabetes, while it is 1.4% in those without any comorbidity. Diabetes is a prevalent disease globally; hence, healthcare professionals are highly concerned about severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic progression. Current evidence does not support higher incidence of coronavirus disease 2019 (COVID-19) in people with diabetes (PWD). However, people with diabetes are considered high risk for developing complications. Optimal metabolic control is a challenging concept, especially in the presence of an acute and severe respiratory viral infection. In this consensus, we considered the challenging issues in management of patients with diabetes during the COVID-19 pandemic. The consensus covers various aspects of outpatient as well as inpatient care based on the current evidence., (© 2020 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Objective: The aim of this study was to investigate the psychological and personality characteristics of the applicants for facial cosmetic surgery., Methods: This descriptive-analytical study was conducted on 385 facial cosmetic surgery applicants who referred to medical centers in Ahvaz (south Iran). The data collection tool included three questionnaires: (1) demographic questions, (2) the General Health Questionnaire (GHQ), and (3) the NEO Five-Factor Inventory (NEO-FFI)., Results: The results showed that 45.2% of the participants had abnormal health status. The mean score of the participants on the openness subscale was insignificantly lower than that of the general population (p > 0.05). On the other hand, the mean scores of the participants on the conscientiousness and agreeableness subscales were significantly lower (p < 0.001). Finally, the mean score of the samples on the extroversion subscale was significantly higher than that of the general population (p < 0.001)., Conclusion: Given the results of the study, it is strongly recommended to address the personality and psychological characteristics of the applicants for cosmetic surgery before operating on them., Level of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Emotional intelligence is a psychological component that may affect happiness level in patients with epilepsy. Given the high prevalence of depression in patients with epilepsy, as well as the limitations of studies in this regard in Iran, the aim of this study was to investigate the effect of an emotional intelligence component program on happiness in patients with epilepsy., Methods: This randomized clinical trial study conducted on 70 patients with epilepsy who were randomly divided into two experimental and control groups of 35 patients. Emotional Intelligence Training Based on Bar-On Combined Model was provided in eight 90-minute sessions for eight weeks. Data were collected using a two-part questionnaire: demographic data and the Oxford Happiness Questionnaire (OHQ)., Results: The mean age of the subjects was 33.3 ± 10.4 years in the intervention group and 34.4 ± 9.3 years in the control group. The independent t-test results showed no significant difference between the two groups before the intervention (p = 0.195). The Mann-Whitney test results showed a significant difference between the two groups after emotional intelligence training (p < 0.001)., Conclusion: Overall, the findings of this study showed that emotional intelligence training led to improvement of happiness in patients with epilepsy. According to the results of the study, it is suggested that training based on emotional intelligence components be used as an approach to improve happiness level in patients with epilepsy., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Whether pre-diabetes in the absence of hypertension (HTN) or dyslipidemia (DLP) is a risk factor for occurrence of major adverse cardiovascular events (MACE) is not fully established. We investigated the effect of impaired fasting glucose (IFG) alone and in combination with HTN, DLP or both on subsequent occurrence of MACE as well as individual MACE components., Methods: This longitudinal population-based study included 11,374 inhabitants of Northeastern Iran. The participants were free of any cardiovascular disease at baseline and were followed yearly from 2010 to 2017. Cox proportional hazard models were fitted to measure the hazard of IFG alone or in combination with HTN and DLP on occurrence of MACE as the primary endpoint., Results: Four hundred thirty-seven MACE were recorded during 6.2 ± 0.1 years follow up. IFG alone compared to normal fasting glucose (NFG) was not associated with an increase in occurrence of MACE (HR, 0.87; 95% CI, 0.19-4.02; p, 0.854). However, combination of IFG and HTN (HR, 2.88; 95% CI, 2.04-4.07; p, 0.000) or HTN + DLP (HR, 2.98; 95% CI, 1.89-4.71; p, 0.000) significantly increased the risk for MACE. Moreover, IFG + DM with or without HTN, DLP, or both was also associated with an increase in the incidence of MACE., Conclusion: IFG, per se, does not appear to increase hazard of MACE. However, IFG with HTN or HTN + DLP conferred a significant hazard for MACE in an incremental manner. Moreover, IFG without HTN, adjusted for DLP, can be associated with an increase in the risk for CVD- death.

Families are considered as primary sources of care for individuals suffering from mental disorders. However, one of the major stresses in families is the infliction of a family member with mental illnesses causing dysfunction in health dimensions or generally their quality of life. Currently, most experts believe that religion can affect physical health and other aspects of human life. So, the aim of this study was to investigate "the relationship between care burden and religious beliefs among family caregivers of mentally ill patients." This cross-sectional study was carried out in Iran on 152 families with mentally ill patients who were hospitalized in psychiatric wards. The sampling method was nonprobability and consecutive sampling method. The data collection instruments included a demographic characteristic questionnaire, Religious Beliefs, and Zarit Care Burden Questionnaires. The mean score for care burden was 30.99 (SD = 16.45). 5.9% of the participants reported a low level, and 39.5% experienced a moderate level of care burden. Moreover, the mean score for religious beliefs was 115.5 (SD = 13.49), and majority of the participants (70.4%) were endowed with strong religious beliefs. There were no significant associations between care burden and intensity of religious beliefs among the study samples (P = 0.483). Considering the results of this study indicating experience of moderate-to-high levels of care burden in families with mentally ill patients, it is recommended to consider such families and their religious beliefs as contributing factors in coping with challenges of mental disorders.

Background: Patients with morbid obesity appear to have adequate nutritional intake, but some studies suggest deficiencies in the micronutrient intake in these patients. Present study aimed to determine dietary intakes and their associated biochemical parameters in an Iranian population of patients with morbid obesity prior to bariatric surgery., Methods: One hundred seventy patients with morbid obesity who have referred to surgery clinic of Firoozgar Hospital were enrolled in the study. Ideal Body Weight (IBW) and Adjusted Ideal Body Weight (AIBW) were calculated. The dietary data were collected using a Food Frequency Questionnaire (FFQ). Anthropometrics and biochemical parameters were assessed. All the statistical analyses were done using the SPSS with an alpha of 0.05., Results: Mean age of participants was 37.4 ± 10.17 years. The mean and standard deviation (SD) of the BMI and EBW values was 45.75 ± 6.49 kg/m and 47.6 ± 13.74 kg, respectively. All the micro- and macro-nutrient intakes are significantly different from the recommended values, except for vitamin A in the men and calcium in the 51-70-year-old women. 47.1% and 17.1% of the participants were classified as patients with diabetes and pre-diabetes, respectively. Majority of participants had lower serum iron levels than the reference values. Almost all the participants (97%) had normal albumin levels., Conclusions: Despite their excess intakes of energy, patients with obesity usually suffer from micronutrient deficiencies, such as vitamin D, iron, and vitamin B12, which can be accompanied by complicated biochemical disorders like impaired glucose metabolism and dyslipidemia. Therefore, bariatric surgery candidates require close nutritional monitoring before and after their surgical operations.

Purpose: The aim of this study was to assess clinical features and therapeutic outcomes in patients with clinically non-functioning pituitary macroadenomas (NFPMAs)., Method: This is a retrospective cohort study of NFPMA patients treated surgically and followed periodically between 2015 and 2017 in a tertiary care center in Iran. Descriptive analysis was performed applying appropriate tests. Binary logistic regression models were used to determine the predictive factors for subtotal tumor resection (STR) and hormonal recovery. Data were analyzed by Stata software., Result: A total of 71 patients with a mean age of 50.6 ± 1.4 years were studied. The mean diameter of the adenoma was 26.8 ± 1.1 mm. The most frequent symptoms were headache (85.75%), visual field defect (VFD) (78.3%), and hypogonadal symptoms (40.3%). Gross total resection (GTR) was achieved in 45.1%. Preoperative hypopituitarism was observed in 50.7% of patients. Recovery of at least one axis occurred in 36.1% of the patients suffering from hypopituitarism preoperatively, while new-onset postoperative hormonal deficiency appeared in 14.3% of patients. Multivariate analyses showing preoperative tumor size (OR = 38.2; P = 0.008) and cavernous sinus extension (OR = 13.4; P = 0.020) were predictors of STR. Moreover, hormonal recovery was observed not to be related to age, gender, tumor size, or the extent of tumor resection., Conclusions: Tumor size and cavernous sinus extension are the main predictors for STR. Notably, recovery of the gonadal axis in a large proportion of patients supports the surgical resection of NFPAM in patients suffering from gonadal deficiency, even in the absence of VFD.

Introduction: Epilepsy is a common neurological disorder, and the patients with epilepsy are heavily influenced by the psychological and social aspects of the illness. Therefore, patients try to use coping strategies to control their stress and tension in this situation. Given the importance of the issue of adaptation and coping with stress in patients with epilepsy, as well as the different factors affecting coping strategies in these patients, the present study aimed to investigate the relationship between coping strategies and emotional intelligence in patients with epilepsy., Methods: This descriptive-analytic study conducted on 134 male and female patients with epilepsy referred to the Epilepsy Society of Isfahan, Iran. The consecutive sampling method was applied in this study. The data collection tool included a three-section questionnaire: the Demographic information, the Coping Inventory for Stressful Situations (CISS), and the Bar-On Emotional Quotient Inventory (EQ-i)., Results: The emotion-focused coping strategy was mostly used by 53.7% of the samples. The mean and standard deviation of the total score of emotional intelligence was 285.6 ± 39.5. Moreover, Pearson correlation test showed a significant difference between emotional intelligence variables and coping strategies (p < 0.001)., Conclusion: According to the relationship between emotional intelligence and coping strategies, it is suggested to consider ways to improve the emotional intelligence of patients with epilepsy in order to use more adaptive coping strategies., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Purpose: The aim was to determine the effect of multisensory stimulation (MSS) on the depression and anxiety status among nursing home-dwelling elderly people in Ahvaz, Iran., Design and Methods: This clinical trial study conducted on 28 old people living in nursing homes in Ahvaz, who were divided into two groups of intervention and control. The interventions included sensory stimulations of touch, sound, and sight for 4 weeks and 3 sessions weekly and 25 min per each session., Findings: The mean depression and anxiety scores of the intervention group before and after the intervention were 14.5 ± 5.5 and 10.1 ± 5.3 and, 9.6 ± 8.1 and 6.1 ± 6.2, respectively., Practice Implications: MSS could improve the condition of depression and anxiety in the elderly nursing home residents., (© 2018 Wiley Periodicals, Inc.)

Comparative studies were carried out on growth and reproduction patterns of eight populations of Eisenia andrei (Bouché, 1972) from different parts of western Iran along the Zagros Mountains, considered to lie within the natural range of this species. Parameters were gain in body weight, number of cocoon production, hatching success, number of hatchlings, hatchlings growth and survival. There were significant differences in mean numbers of viable cocoons, incubation time, reproductive rate, growth rate and final weight between different populations. The resulting groupings did only partially coincide with genetic clusters established in a previous study. It is nonetheless suggested to include life cycle parameters as an additional set of data to understand the micro-taxonomic structure of variable species.

Introduction: Despite the importance of cosmetic surgery in improving body image and promoting individuals' physical and mental health, it is accompanied with some physical, mental, and economic problems, because it is an invasive procedure. Considering such extensive consequences and given the rising demand for performing such surgeries, it is essential to consider programs for reducing such requests. The present study aimed to investigate the psychosocial causes of the tendency for facial cosmetic surgery in patients referred to medical centers in Ahvaz in 2016-2017., Materials and Methods: This study was conducted on 385 facial cosmetic surgery applicants referred to medical centers in Ahvaz and were selected using a sequential non-probability sampling method. The data collection tool was a questionnaire divided into two sections namely: (1) demographic questions and (2) a questionnaire on the psychosocial causes of the tendency for facial cosmetic surgery., Results: The mean scores of the psychological and social causes of the tendency for facial cosmetic surgery were 4.46 (SD = 1.67) and 3.44 (SD = 2.57), respectively. "Being interested in being beautiful" was the most frequent positive response of the participants regarding the cause of tending to undergo facial cosmetic surgery (88.6%) and the least frequent response was estimated to be 35.1% for the "inappropriate psychological state" cause., Conclusion: The results of this study showed that psychological factors affected the participants' tendency for facial cosmetic surgery more than social factors. Determining and identifying such psychological pressures and providing individual training and psychological support can prevent individuals from undergoing facial cosmetic surgery., Level of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Objective: Umbilical cord abnormalities increase fetal morbidity and mortality. This study was designed to compare antenatal umbilical coiling index (aUCI) in gestational diabetes mellitus (GDM) and non-gestational diabetes mellitus (non-GDM) pregnancy, considering uncertainties about the best time to perform antenatal ultrasonography scan., Materials and Methods: In this prospective study, 246 parturients were included, 123 with GDM and 123 with non-GDM pregnancy. Gestational diabetes was confirmed at 24-28 weeks of gestation (WG) using one-step strategy. An anatomical ultrasound survey of placenta and umbilical cord was performed at 18-23 as well as 37-41 weeks of gestational age., Results: At 18-23 WG, the frequency distribution (10th, 90th percentiles, mean ± SD) of the aUCI in the GDM and non-GDM groups were (0.13,0.66,0.32 ± 0.19) and (0.18,0.74, 0.4 ± 0.31) respectively. These values were (0.12,0.4, 0.25 ± 0.11) in the GDM group at 37-41 WG and (0.17,0.43, 0.29 ± 0.11) in the non-GDM group. A significant relationship was detected between UCI value and GDM/non-GDM groups at both antenatal evaluations (18-23 WG; P = 0.002, 37-41WG; P < 0.001). A significant association at 18-23 WG was found between GDM/non-GDM groups and aUCI categorization (hypocoiling <10th, normocoiling 10th-90th and hypercoiling >90th) (P = 0.001). However, hypocoiling were significantly more frequent in GDM than non-GDM in both antenatal evaluations (P < 0.001, P = 0.006)., Conclusion: Antenatal UCI in pregnancy complicated by GDM were lower in comparison with non-GDM pregnancy. The most abnormal pattern of coiling in gestational diabetes was hypocoiling in both trimesters. In addition, 18-23 WG is the best time to perform ultrasound scan to detect aUCI and umbilical cord pattern., (Copyright © 2018. Published by Elsevier B.V.)

The purpose of this study was to identify the factors affecting the social participation of Iranian children with cerebral palsy (CP). Participants were 274 (male = 62%; female = 38%) children with CP, 6- to 12-years old (mean = 1.64) and their parents. Several standardized measures were used to assess social participation, gather environmental factors, and demographic questionnaires. The results of stepwise linear regression analysis indicated that the type of CP, Manual ability level and cognitive level (IQ) appear to be strong predictors of social participation between personal and environmental factors.

Background: This study was designed to present initial results on clinical presentation, therapeutic modalities, and outcome information of patients with pituitary tumors registered in Iran Pituitary Tumor Registry (IPTR)., Methods: We collected data from a web-based electronic medical records of patients with various pituitary tumors referred to four tertiary care centers in the country. Retrospective analysis was performed on demographic, clinical, and therapeutic information of 298 patients including 51 clinically nonfunctioning adenoma (CNFA), 85 acromegaly, 135 prolactinoma, and 27 Cushing's disease (CD)., Results: From October 2014 to July 2016, 298 people with the diagnosis of pituitary tumor were registered. Prolactinoma was the most prevalent tumor (45.3%), followed by Acromegaly (28.6%), CNFPA (17.1%), and CD (9%). Female dominance was seen among patients with prolactinoma and CD, while the majority of patients with CNFPA were male and acromegaly was equally distributed between men and women. Hypogonadal symptoms were almost always seen in all types of pituitary groups. Surgery alone was the most common therapeutic modality used in cases of acromegaly, CNFPA, and CD. However, medical therapy alone was frequently applied for cases of prolactinoma. Finally, biochemical cure was achieved in most cases of prolactinoma and CD, but only in 36.5% of acromegalics. Moreover, 80% of patients suffering from CNFPA showed no residual tumor in their imaging., Conclusion: In conclusion, this comprehensive tumor registry enables early identification, selection of best therapeutic approaches, and evaluation of long-term treatment outcomes. Furthermore, this registry can be used to improve surveillance protocols., (2017 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

The aim of this study was assess the factor structure, reliability and construct validity of the Children Participation Assessment Scale in Activities Outside of School-Parent Version (CPAS-P). The participants of this study were 700 parents of children aged 6-12 years. For data analysis, the confirmatory factor analysis, internal consistency, and test-retest reliability were conducted. Convergent validity was calculated by correlation with the Vineland Adaptive Behaviour Scale. The results indicated the CPAS-P has good internal reliability. Overall, Cronbach's alpha for the participation measures ranged between 0.87 and 0.91, indicating good homogeneity, and Spearman correlations for convergent validity was acceptable. The temporal stability of the CPAS-P was supported with Intra-Class Correlations ranging from 0.79 to 0.94. Therefore, the CPAS-P, which evaluates all eight areas of occupation (i.e., activities of daily living, instrumental activities of daily living, play, leisure, social participation, education, work, and sleep/rest) has demonstrated good psychometric properties; and can be used as a reliable and valid measure to assess children's participation at the age of 6-12 years.

Purpose: To translate and cross-culturally adapt the Functional Independence Measure (FIM) into the Persian language and to test the reliability and validity of the Persian FIM (PFIM) in patients with stroke., Method: In this cross-sectional study carried out in an outpatient stroke rehabilitation center, 40 patients with stroke (mean age 60 years) were participated. A standard forward-backward translation method and expert panel validation was followed to develop the PFIM. Two experienced occupational therapists (OTs) assessed the patients independently in all items of the PFIM in a single session for inter-rater reliability. One of the OTs reassessed the patients after 1 week for intra-rater reliability., Results: There were no floor or ceiling effects for the PFIM. Excellent inter-rater and intra-rater reliability was noted for the PFIM total score, motor and cognitive subscales (ICC(agreement)0.88-0.98). According to the Bland-Altman agreement analysis, there was no systematic bias between raters and within raters. The internal consistency of the PFIM was with Cronbach's alpha from 0.70 to 0.96. The principal component analysis with varimax rotation indicated a three-factor structure: (1) self-care and mobility; (2) sphincter control and (3) cognitive that jointly accounted for 74.8% of the total variance. Construct validity was supported by a significant Pearson correlation between the PFIM and the Persian Barthel Index (r = 0.95; p < 0.001)., Conclusions: The PFIM is a highly reliable and valid instrument for measuring functional status of Persian patients with stroke., Implications for Rehabilitation: The Functional Independence Measure (FIM) is an outcome measure for disability based on the International Classification of Functioning, Disability and Health (ICF). The FIM was cross-culturally adapted and validated into Persian language. The Persian version of the FIM (PFIM) is reliable and valid for assessing functional status of patients with stroke. The PFIM can be used in Persian speaking countries to assess the limitations in activities of daily living of patients with stroke.

Background: To obtain information related to the knowledge and clinical practice of general practitioners (GPs) in management of people with type 2 diabetes, and to explore the impact of formal continuous medical education (CME) programs., Methods: A total of 1104 GPs participated in a cross sectional survey related to diabetes management considering ADA/EASD consensus 2011 focused on demographic and background characteristics, diabetes related knowledge, and patient care. Fisher's Exact and Chi-square tests were used in the analysis of contingency tables., Results: The majority of the participants (83.9%) worked in large cities and 39.8% had taken part in CME programs in diabetes management. Overall, 52% of the GPs knew the treatment goal for HbA1c. The rate was slightly higher for those taken part in CME (P = 0.003). Considering patient care, slightly more than half of the participants answered correctly to the questions on duration and distribution of physical activity, with no difference by taking part in CME programs. On average, 41.5% of the physicians selected metformin as the first OGLD for treatment of type 2 diabetes, and only 27.9% stated that they add basal insulin to OGLD if treatment failed., Conclusion: The results of this study provide the evidence that the knowledge and clinical practice of Iranian GPs in management of type 2 diabetes were not satisfactory. Furthermore, traditional CME programs in diabetes management were not effective in changing the GPs' clinical practice. Consequently, designing and implementing more effective strategies are necessary for improving patient health related outcomes.

Background & Objective: Self-esteem is viewed the most decisive factor in the psychological development of the elderly. This study was performed to assess self-esteem among the elderly referring to the elderly consulting unit of the healthcare centers in Kermanshah, Iran., Methods: A cross-sectional study was completed with 201 elderly respondents visiting the consulting unit of the healthcare services in Kermanshah, Iran. The samples were selected through convenience sampling. Rosenberg Self-esteem Scale (RSC) was used to gather the required data. Data were analyzed by using both descriptive (frequency, mean, median and standard deviation) and inferential statistics (chi-square and independent t-test)., Results: The findings showed a mean of 35.63±5.25 for self-esteem, indicating a high level of self-esteem (66.2%) among the elderly. A statistically significant difference was reported between the mean of self-esteem and career (p<0.001), marital status (p<0.04), history of health problems (p<0.04), residence (p<0.001), education (p<0.001) and income (p<0.001)., Conclusion: The findings of this study indicated that approximately one third of the elderly had a low self-esteem, which is indicative of the need to promote the self-esteem of the elderly in order to reduce their physical, psychological and social problems. Thus, it is necessary for the healthcare authorities to provide the elderly with financial, social and psychological support.

Zoonotic cutaneous leishmaniasis (ZCL), a vector-borne disease, poses serious psychological as well as social and economic burden to many rural areas of Iran. The main objectives of this study were to analyse yearly spatial distribution and the possible spatial and spatio-temporal clusters of the disease to better understand spatio-temporal epidemiological aspects of ZCL in rural areas of an endemic province, located in north-east of Iran. Cross-sectional survey was performed on 2983 recorded cases during the period of 2010-2012 at village level throughout the study area. Global clustering methods including the average nearest-neighbour distance, Moran's I, general G indices and Ripley's K-function were applied to investigate the annual spatial distribution of the existing point patterns. Presence of spatial and spatio-temporal clusters was investigated using the spatial and space-time scan statistics. For each year, semivariogram analysis and all global clustering methods indicated meaningful persistent spatial autocorrelation and highly clustered distribution of ZCL, respectively. Eight significant spatial clusters, mainly located in north and northeast of the province, and one space-time cluster, observed in northern part of the province and during the period of September 2010-November 2010, were detected. Comparison of the location of ZCL clusters with environmental conditions of the study area showed that 97.8% of cases in clusters were located at low altitudes below 725 m above sea level with predominantly arid and semi-arid climates and poor socio-economic conditions. The identified clusters highlight high-risk areas requiring special plans and resources for more close monitoring and control of the disease., (© 2014 Blackwell Verlag GmbH.)

Background: Lung cancer is a fatal malignancy with high mortality and short survival time. The aim of this study was to estimate survival rates of Iranian patients with lung cancer and its associate predictive factors., Materials and Methods: The study was conducted on 355 patients admitted to hospitals of West Azerbaijan in the year 2007. The patients were followed up by phone calls until the end of June 2014. The survival rate was estimated using the Kaplan-Meier method and log-rank test for comparison. The Cox's proportional hazard model was used to investigate the effect of various variables on patient survival time, including age, sex, Eastern Cooperative Oncology Group (ECOG) performance, smoking status, tumor type, tumor stage, treatment, metastasis, and blood hemoglobin concentration., Results: Of the 355 patients under study, 240 died and 115 were censored. The mean and median survival time of patients was 13 and 4.8 months, respectively. According to the results of Kaplan-Meier method, 1, 2, and 3 years survival rates were 39%, 18%, and 0.07%, respectively. Based on Cox regression analysis, the risk of death was associated with ECOG group V (1.83, 95% CI: 1 CONCLUSIONS: The survival time of the patients with lung cancer is very short. While early diagnosis may improve the life expectancy effective treatment is not available.

The objective of this study was to assess the capability of earthworms from the same ecological group as heavy metal bioindicators. Three earthworm species from the endogeic group were studied: Aporrectodea caliginosa (Savigny, 1826), Perelia kaznakovi (Michaelsen, 1910) and Octolasion lacteum (Örley, 1885). Their accumulation of the heavy metals lead (Pb) and cadmium (Cd) were studied from three stations in Tehran province, Iran. O. lacteum was used to compare metal accumulations in two sites located next to a highway. A. caliginosa and P. kaznakovi were used at a third site located near the edge of a sewage system to compare metal accumulations between the two endogeic species in this area. At both locations, the concentrations of Cd and Pb in earthworms were higher than in the surrounding soil. The results of the study revealed that P. kaznakovi and A. caliginosa were better bioindicators for Pb, but O. lacteum was a better bioindicator for Cd. These earthworms can therefore be used as Cd and Pb bioindicators in environmental assessment.

Earthworms were collected in forests, damp habitats, springs, orchards and agricultural fields of the Kohgiluyeh & Boyer Ahmad Province, Iran, from April 2009 to April 2010. Specimens were collected at 20 established stations by digging and by diluted formalin methods. Ten species belonging to family Lumbricidae were identified based on morphology: Aporrectodea caliginosa (Savigny, 1826), Ap. rosea (Savigny, 1826), Ap. jassyensis (Michaelsen, 1891), Dendrobaena veneta (Rosa, 1886), D. byblica (Rosa, 1893) complex, D. orientalis orientalis Cernosvitov 1940, Eisenia fetida (Savigny, 1826), Eiseniella tetraedra (Savigny, 1826), Octolasion lacteum (Örley, 1881), Perelia kaznakovi (Michaelsen, 1910). Ap. caliginosa was the dominant species in this province and D. orientalis orientalis is a new record for Iran. A checklist of all earthworms species form Iran is presented, containing 19 species. Then, in order to show earthworm geographical affinities, hierarchical analysis were applied to available data on earthworm of Iran.

Background: The aims of this study were to analyze the trend of cesarean section (CS), determining possible risk factors and also comparing the rate of CS in mothers with gestational diabetes (GDM) and normal pregnant population., Materials and Methods: A hospital-based midwives data collection including 37,997 pregnancies in Tehran was used for this study. The study population included all women giving birth between 1 January 1980 and 31 December 2009., Results: The global rate for CS was 37.8 and 85.9% in normal pregnant population and GDM subjects, respectively. An increase in the rate of CS was observed in normal population from 16.97% during 1980-1989 to 71.08% during 2000-2009. There was a similar upward trend for GDM subjects from 79.17 to 93.55%. The most frequent indications for CS in GDM subjects were unsuccessful induction (31%) and repeat CS (22.76%)., Conclusion: The rate of CS is surprisingly very high in normal pregnant population as well as subjects with GDM. This should be an alarming issue for healthcare policy-makers and a trigger for monitoring situation in the country.

Background: To evaluate the impact of mild to moderate maternal zinc deficiency on birth weight of offsprings in a group of Iranian pregnant population., Materials and Methods: One hundred forty pregnant subjects with no history of medical complications during pregnancy and without any inter-current illness enrolled in the study. Serum zinc concentration, ferritin, hemoglobin, iron, and total iron binding capacity (TIBC) were measured at the time of delivery. The receiver operator characteristic (ROC) curve analysis used to determine plasma zinc cutoff value for comparison., Results: Of 140 live neonates, 30% were below 2500 g. Mean serum zinc concentration was 56.60 ± 17.91 μg/dl which indicated mild to moderate zinc deficiency. None of the subjects were anemic. There was an inverse statistically significant relationship between maternal serum zinc concentration and neonatal birth weight., Conclusion: In this group of Iranian pregnant subjects with mild to moderate zinc deficiency, we observed no relationship between low maternal zinc status and low birth weight infants.

Cadmium and lead concentrations were compared in tissues of cutlassfish, Trichiurus lepturus L., its intestinal nematode Hysterothylacium sp. type MB larvae, and in water from the same location in the Sea of Oman. Metal accumulation in hosts, parasites and sea water was measured by ICP-OES. Hysterothylacium larvae from the intestinal lumen and visceral cavity showed much higher metal concentrations than in host tissues or sea water. Statistical analyses revealed no significant differences in metal accumulation between infected and uninfected hosts. Cadmium concentration in the host muscle was lower than in intestine, liver and gonad tissues. The mean concentrations of lead and cadmium in nematodes were 289·03 and 81·5 times higher than in host intestine, 188·4 and 225 times higher than in host muscle, 108·6 and 65·3 times higher than in host gonads, 70·5 and 19·5 times higher than in host liver and 3351 and 148 times higher than in sea water. The results show the value of this and possibly related nematodes as bioindicators of heavy metals and their potential use in environmental studies.

A total of 299 fish belonging to ten teleost species were studied in Iranian waters at the north-eastern coast of the Persian Gulf for larval trypanorhynch cestode infection. The following trypanorhynch species were identified: Callitetrarhynchus gracilis Pintner, 1931, Pseudogilquinia thomasi (Palm, 2000), Pterobothrium lesteri Campbell and Beveridge, 1996 and Pseudolacistorhynchus shipleyi (Southwell, 1929). The most abundant parasite was C. gracilis which was isolated from seven teleost species. The highest prevalence (62.9%) and dominance (0.98) were demonstrated for P. thomasi with a maximum intensity of 22 in Indian halibut Psettodes erumei. Collections of P. lesteri and P. shipleyi from the Persian Gulf represent new locality records, thus extending the known range of distribution for both species. Four new host records are established. The recorded combination of trypanorhynch species and the established host range correspond to other regions, such as off the Brazilian coast. In terms of species distribution, the north-western part of the Indian Ocean, together with the Gulf of Bengal and the Indonesian archipelago, share the same species, resulting from connected water bodies. All trypanorhynch species were isolated from the body cavity, except for P. thomasi which was recorded from the musculature of P. erumei. Relatively high intensities of infection in P. erumei may be of public health concern in the region, necessitating the consumption of well-cooked fish products.

Background: The quality of life in patients with various chronic disorders, including diabetes has been directly affected by depression. Depression makes patients less likely to manage their self-care regimens. Accurate assessment of depression in diabetic populations is important to the treatment of depression in this group and may improve diabetes management. To our best knowledge, there are few studies that have looked for utilizing questionnaires in screening for depression among patients with diabetes in Iran. Therefore the aim of this study was to assess the efficacy and accuracy of the Center for Epidemiological Studies Depression (CES-D) scale and the Patient Health Questionnaire-9 (PHQ-9), in comparison with clinical interview in people with type 2 diabetes., Methods: Outpatients who attended diabetes clinics at IEM were recruited on a consecutive basis between February 2009 and July 2009. Inclusion criteria included patients with type 2 diabetes who could fluently read and speak Persian, had no severe diabetes complications and no history of psychological disorders. The history of psychological disorders was ascertained through patients' medical files, taking history of any medications in this regard. The study design was explained to all patients and informed consent was obtained. Volunteer patients completed the Persian version of the questionnaires (CES-D and PHQ-9) and a psychiatrist interviewed them based on Structured Clinical Interview (SCID) for DSM-IV criteria., Results: Of the 185 patients, 43.2% were diagnosed as having Major Depressive Disorder (MDD) based on the clinical interview, 47.6% with PHQ-9 and 61.62% with CES-D. The Area Under the Curve (AUC) for the total score of PHQ-9 was 0.829 ± 0.30. A cut-off score for PHQ-9 of ≥ 13 provided an optimal balance between sensitivity (73.80%) and specificity (76.20%). For CES-D the AUC for the total score was 0.861 ± 0.029. Optimal balance between sensitivity (78.80%) and specificity (77.1%) was provided at cut-off score of ≥ 23., Conclusions: It could be concluded that the PHQ-9 and CES-D perform well as screening instruments, but in diagnosing major depressive disorder, a formal diagnostic process following the PHQ-9 and also the CES-D remains essential.