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Abstract This study aims to assess the effect of familial structures on the still-missing heritability estimate and prediction accuracy of Type 2 Diabetes (T2D) using pedigree estimated risk values (ERV) and genomic ERV. We used 11,818 individuals (T2D cases: 2,210) with genotype (649,932 SNPs) and pedigree information from the ongoing periodic cohort study of the Iranian population project. We considered three different familial structure scenarios, including (i) all families, (ii) all families with ≥ 1 generation, and (iii) families with ≥ 1 generation in which both case and control individuals are presented. Comprehensive simulation strategies were implemented to quantify the difference between estimates of $$\:{\text{h}}^{2}$$ and $$\:{\text{h}}_{\text{S}\text{N}\text{P}}^{2}$$ . A proportion of still-missing heritability in T2D could be explained by overestimation of pedigree-based heritability due to the presence of families with individuals having only one of the two disease statuses. Our research findings underscore the significance of including families with only case/control individuals in cohort studies. The presence of such family structures (as observed in scenarios i and ii) contributes to a more accurate estimation of disease heritability, addressing the underestimation that was previously overlooked in prior research. However, when predicting disease risk, the absence of these families (as seen in scenario iii) can yield the highest prediction accuracy and the strongest correlation with Polygenic Risk Scores. Our findings represent the first evidence of the important contribution of familial structure for heritability estimations and genomic prediction studies in T2D.

Abstract Alzheimer’s Disease and Related Dementias (ADRD) affect millions of people worldwide, with mortality rates influenced by several risk factors and exhibiting significant heterogeneity across geographical regions. This study aimed to investigate the impact of risk factors on global ADRD mortality patterns from 1990 to 2021, utilizing clustering and modeling techniques. Data on ADRD mortality rates, cardiovascular disease, and diabetes prevalence were obtained for 204 countries from the GBD platform. Additional variables such as HDI, life expectancy, alcohol consumption, and tobacco use prevalence were sourced from the UNDP and WHO. All the data were extracted for men, women, and the overall population. Longitudinal k-means clustering and generalized estimating equations were applied for data analysis. The findings revealed that cardiovascular disease had significant positive effects of 1.84, 3.94, and 4.70 on men, women, and the overall ADRD mortality rates, respectively. Tobacco showed positive effects of 0.92, 0.13, and 0.39, while alcohol consumption had negative effects of − 0.59, − 9.92, and − 2.32, on men, women, and the overall ADRD mortality rates, respectively. The countries were classified into five distinct subgroups. Overall, cardiovascular disease and tobacco use were associated with increased ADRD mortality rates, while moderate alcohol consumption exhibited a protective effect. Notably, tobacco use showed a protective effect in cluster A, as did alcohol consumption in cluster B. The effects of risk factors on ADRD mortality rates varied among the clusters, highlighting the need for further investigation into the underlying causal factors.

Abstract Background and Aims The oral glucose tolerance test with 75 g glucose is commonly regarded as the gold standard (GS) for the detection of gestational diabetes mellitus (GDM). However, one limitation of this test is its administration in the late second trimester of pregnancy in some countries (e.g., Iran). This study aimed to evaluate the accuracy of pregnancy‐associated plasma protein‐A (PAPP‐A) for predicting GDM in the early first trimester of pregnancy using a novel statistical modeling technique. Methods The study population consisted of 344 pregnant women who participated in the first trimester screening program for GDM. Maternal serum PAPP‐A levels were measured between 11 and 13 gestational weeks for all participants. A Bayesian latent profile model (LPM) under the skew‐t (ST) distribution was employed to estimate the diagnostic accuracy measures of PAPP‐A in the absence of GS test outcomes. Results The mean (standard deviation) age of the participants was 28.87 ± 5.20 years. The median (interquartile range (IQR)) PAPP‐A MoM was 0.91 (0.69‐1.34). Utilizing the LPM under the ST distribution while adjusting for covariates, the sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) of PAPP‐A were 92% (95% credible interval [CrI]: 0.89, 0.98), 81% (95% CrI: 0.76, 0.91), and 0.91 (95% CrI: 0.83, 0.97), respectively. Notably, the pregnant women with GDM had significantly lower PAPP‐A values ( β = −0.52, 95% CrI [−0.61, −0.46]). Conclusion Generally, our findings confirmed that PAPP‐A could serve as a potential screening tool for the identification of GDM in the early stages of pregnancy.

Abstract Background Gastric cancer (GC) is considered a silent killer, taking more than three quarters of a million lives annually. Therefore, prior to further costly and invasive diagnostic approaches, an initial GC risk screening is desperately in demand. Methods In order to develop a simple risk scoring system, the demographic and lifestyle indices from 858 GC and 1132 non-ulcer dyspeptic (NUD) patients were analysed. We applied a multivariate logistic regression approach to identify the association between our target predictors and GC versus NUD. The model performance in classification was assessed by receiver operating characteristic (ROC) analysis. Our questionnaire covering 64 predictors, included known risk factors, such as demographic features, dietary habits, self-reported medical status, narcotics use, and SES indicators. Results Our model segregated GC from NUD patients with the sensitivity, specificity, and accuracy rates of 85.89, 63.9, and 73.03%, respectively, which was confirmed in the development dataset (AUC equal to 86.37%, P 70 (RS:+ 241, SP:7.23), 60–70 (RS:+ 221, SP:6.60), 50–60 (RS:+ 134, SP:4.02), 2) history of gastrointestinal cancers (RS:+ 173, SP:5.19), 3) male gender (RS:+ 119, SP:3.55), 4) non-Fars ethnicity (RS:+ 89, SP:2.66), 5) illiteracy of both parents (RS:+ 78, SP:2.38), 6) rural residence (RS:+ 77, SP:2.3), and modifiable dietary behaviors (RS:+ 32 to + 53, SP:0.96 to 1.58). Conclusion Our developed risk calculator provides a primary screening step, prior to the subsequent costly and invasive measures. Furthermore, public awareness regarding modifiable risk predictors may encourage and promote lifestyle adjustments and healthy behaviours.

Abstract Several vaccines have been developed against SARS-CoV-2 and subsequently approved by national/international regulators. Detecting specific antibodies after vaccination enables us to evaluate the vaccine’s effectiveness. We conducted a prospective longitudinal study among members of Tarbiat Modares University of Tehran, Iran, from 4 September 2021 until 29 December 2021. We aimed to compare the humoral immunogenicity of 3 vaccine types. Participants consisted of 462 adults. Anti-SARS-CoV-2 receptor-binding domain [RBD] IgG titer was compared in 3 groups, each vaccinated by available vaccines in Iran at the time: Oxford/AstraZeneca, COVIran Barekat, and Sinopharm. The median IgG titer was: 91.2, 105.6, 224.0 BAU/ml for Sinopharm, COVIran Barekat and Oxford/AstraZeneca respectively after the first dose; 195.2, 192.0, 337.6 BAU/ml after the second one. We also analyzed the frequency of antibody presence in each vaccine group, in the same order the results were 59.0%, 62.6% and 89.4% after the first dose and 92.1%,89.5% and 98.9% after the second. The comparison of results demonstrated that AstraZeneca vaccine is a superior candidate vaccine for COVID-19 vaccination out of the three. Our data also demonstrated statistically significant higher antibody titer among recipients with an infection history.

Abstract Background To determine the health needs and promote women's health, their quality of life should be investigated. For this purpose, a valid tool is needed, that has credible validity and reliability, and its concepts are clearly defined and culturally appropriate. This study aimed to develop and assess the psychometric properties of “Iranian Women’s Quality of Life Instrument (IWQOLI)”. Methods The items of “IWQOLI” were generated from themes extracted (150 items) from a content analysis approach with the participation of 40 women. Face validity of the questionnaire with the participation of 10 women and content validity by 10 experts was approved. To determine the domains of the questionnaire, exploratory factor analysis (principal component extraction method) was performed. Internal consistency and test—retest reliability methods with 14-day intervals (30 women) were used to assess the reliability of WQOLI. Results After performing the face and content validity, 32 items were deleted. S-CVI/Ave was obtained for the instrument (0.93). The factor structure of the inventory was identified by undertaking a principal component analysis in a sample of 590 women. Five factors were extracted with a total variance account of 56.24% and 28 items dropped at this point. The IWQOLI score was significantly correlated with the SF-36 (r = 0.717, p

Background & aim: Infertility has serious implications on psychological and social well-being as well as the sexual life. Considering that sexual health is an essential element of human health, the present study was performed to explore the experiences of Iranian infertile women regarding their sexual health. Methods: This qualitative study was conducted using conventional content analysis (Lundman and Graneheim's approach) in Tehran, Iran from November to March 2018. Twenty infertile women (aged 25-42 years old with various reasons for infertility), who were selected purposefully, participated in this study. The data were collected through in-depth semi-structured interviews All interviews were tape-recorded and transcribed verbatim. Guba and Lincoln's criteria including credibility, transferability, confirmability, and dependability were applied to achieve trustworthiness. Results: Three themes emerged from the data analysis including 1) Impact of the process of diagnosis and treatment on women’s sexuality 2) Psychological, behavioral, interpersonal and economic factors influencing sexual health, and 3) cultural and religious norms affecting sexual life. Conclusion: Infertile women's sexual health is influenced by the process of diagnosis and treatment; psychological reactions to infertility, economic, personal, and cultural-belief system.

Abstract Background Breastfeeding mothers’ decisions to donate their milk is influenced by their knowledge, attitudes, and subjective norms such as their family’s opinions on milk donation. In Iran, women have favorable knowledge and positive attitudes toward breastfeeding, but they lack sufficient information and education about milk banks. With respect to current childbearing policies, an increase in the number of infants who will be admitted to neonatal intensive care units is expected. Accordingly, improving milk donation behavior, which requires mothers’ intention and ability to donate breast milk, is important for infants’ survival and well-being. Therefore, this study aims to evaluate whether an educational program based on the theory of planned behavior affects breastfeeding mothers’ decisions to donate their breast milk. Methods This cluster randomized controlled trial will be conducted in health centers affiliated to Tehran University of Medical Sciences and will enroll 66 breastfeeding mothers (intervention, n = 33; control, n = 33). After collecting baseline data, the intervention group will begin receiving a 60-minute weekly educational program based on Theory of Planned Behavior components for four weeks. The first follow-up assessment will be conducted immediately after the intervention, and the final one will be conducted 12 weeks later. The primary outcomes are the number of mothers who have donated their breast milk and changes in breastfeeding mothers’ knowledge, attitude, subjective norms, and perceived behavioral control about donor human milk and intention to donate milk. Discussion This trial will evaluate if a well-designed educational program can improve breastfeeding mothers’ knowledge and promote their behavioral factors regarding milk donation and lead to a significant increase in the number of potential milk donors. Trial registration irct.ir (IRCT20230124057203N1) registered February 14, 2023.

Objective: Metabolic syndrome (MetS) is a complex multifactorial disorder that considerably burdens healthcaresystems. We aim to classify MetS using regularized machine learning models in the presence of the risk variants ofGCKR, BUD13 and APOA5, and environmental risk factors.Materials and Methods: A cohort study was conducted on 2,346 cases and 2,203 controls from eligible TehranCardiometabolic Genetic Study (TCGS) participants whose data were collected from 1999 to 2017. We used differentregularization approaches [least absolute shrinkage and selection operator (LASSO), ridge regression (RR), elasticnet(ENET), adaptive LASSO (aLASSO), and adaptive ENET (aENET)] and a classical logistic regression (LR) modelto classify MetS and select influential variables that predict MetS. Demographics, clinical features, and commonpolymorphisms in the GCKR, BUD13, and APOA5 genes of eligible participants were assessed to classify TCGSparticipant status in MetS development. The models’ performance was evaluated by 10-repeated 10-fold crossvalidation.Various assessment measures of sensitivity, specificity, classification accuracy, and area under the receiveroperating characteristic curve (AUC-ROC) and AUC-precision-recall (AUC-PR) curves were used to compare themodels.Results: During the follow-up period, 50.38% of participants developed MetS. The groups were not similar in terms ofbaseline characteristics and risk variants. MetS was significantly associated with age, gender, schooling years, bodymass index (BMI), and alternate alleles in all the risk variants, as indicated by LR. A comparison of accuracy, AUCROC,and AUC-PR metrics indicated that the regularization models outperformed LR. Regularized machine learningmodels provided comparable classification performances, whereas the aLASSO model was more parsimonious andselected fewer predictors.Conclusion: Regularized machine learning models provided more accurate and parsimonious MetS classifyingmodels. These high-performing diagnostic models can lay the foundation for clinical decision support tools that usegenetic and demographical variables to locate individuals at high risk for MetS.

Abstract Background The Naive Bayes (NB) classifier is a powerful supervised algorithm widely used in Machine Learning (ML). However, its effectiveness relies on a strict assumption of conditional independence, which is often violated in real-world scenarios. To address this limitation, various studies have explored extensions of NB that tackle the issue of non-conditional independence in the data. These approaches can be broadly categorized into two main categories: feature selection and structure expansion. In this particular study, we propose a novel approach to enhancing NB by introducing a latent variable as the parent of the attributes. We define this latent variable using a flexible technique called Bayesian Latent Class Analysis (BLCA). As a result, our final model combines the strengths of NB and BLCA, giving rise to what we refer to as NB-BLCA. By incorporating the latent variable, we aim to capture complex dependencies among the attributes and improve the overall performance of the classifier. Methods Both Expectation-Maximization (EM) algorithm and the Gibbs sampling approach were offered for parameter learning. A simulation study was conducted to evaluate the classification of the model in comparison with the ordinary NB model. In addition, real-world data related to 976 Gastric Cancer (GC) and 1189 Non-ulcer dyspepsia (NUD) patients was used to show the model's performance in an actual application. The validity of models was evaluated using the 10-fold cross-validation. Results The presented model was superior to ordinary NB in all the simulation scenarios according to higher classification sensitivity and specificity in test data. The NB-BLCA model using Gibbs sampling accuracy was 87.77 (95% CI: 84.87-90.29). This index was estimated at 77.22 (95% CI: 73.64-80.53) and 74.71 (95% CI: 71.02-78.15) for the NB-BLCA model using the EM algorithm and ordinary NB classifier, respectively. Conclusions When considering the modification of the NB classifier, incorporating a latent component into the model offers numerous advantages, particularly within medical and health-related contexts. By doing so, the researchers can bypass the extensive search algorithm and structure learning required in the local learning and structure extension approach. The inclusion of latent class variables allows for the integration of all attributes during model construction. Consequently, the NB-BLCA model serves as a suitable alternative to conventional NB classifiers when the assumption of independence is violated, especially in domains pertaining to health and medicine.

Abstract Purpose Wii Fit exergames have been less commonly used for the rehabilitation of athletes after Anterior Cruciate Ligament Reconstruction (ACLR). This study aims to investigate the effects of an expert system using Wii Fit exergames compared to conventional rehabilitation following ACLR. A forward-chaining rule-based expert system was developed which proposed a rehabilitation program that included the number and type of exercise in terms of difficulty and ease and the duration of each exercise in a progressive manner according to the patient's physical condition. Materials and methods Twenty eligible athletes aged 20–30 who underwent ACLR were enrolled in this study and randomly assigned to two groups; and received 12 sessions of either Wii Fit exergames as Wii group (n = 10) or conventional rehabilitation as CL group (n = 10). Results The main outcomes consisted of pain (Visual Analogue Scale (VAS)), knee effusion, knee flexion range (KFR), thigh girth (TG), single-leg hop for distance (SLHD), and for time (SLHT), static and dynamic balance tests. Both groups had considerable improvement in all outcomes, also there were significantly differences between Wii and CL groups as follows; VAS (P < 0.001), knee effusion (P < 0.001), TG (P = 0.001), KFR (P = 0.012), static balance in stable position (P < 0.001) and in unstable position (P = 0.001), dynamic balance in the anterior (P < 0.001), posteromedial (P < 0.001), posterolateral (P = 0.004) directions, symmetry index of SLHD (P < 0.001) and symmetry index of SLHT (P = 0.013). Conclusions The findings showed that using Wii Fit exergames in post-ACLR patients reduced pain and effusion while also improving function and balance significantly. Iranian Registry of Clinical Trials registration number is IRCT20191013045090N1, and the registration date is 03-03-2020.

Abstract Background As crises occur, attention to physical health usually becomes more than mental health, neglecting mental health, especially in some vulnerable groups such as pregnant women and new mothers, can have adverse consequences. Therefore, it is imperative to recognize and comprehend their mental health needs, particularly during critical situations such as the recent COVID-19 pandemic. The aim of this study was to explain the understanding and experience of mental health concerns faced by pregnant and postpartum women during this pandemic. Methods This qualitative study was conducted from March 2021 to November 2021 in Iran. Data were collected using semi-structured in-depth interviews to understand mental health concerns in pregnancy and the postpartum period during the COVID-19 pandemic. Twenty-five purposefully retrieved and participated in the study. Due to the prevalence of coronavirus, most of the participants preferred tele interviews. When data saturation was achieved, the data were codified manually and analyzed using Graneheim and Lundman’s approach 2004. Results Based on the content analysis of the interviews, 2 main themes, 8 categories 23 subcategories were identified. The identified themes were as follows: (1) Maternal mental health threats and (2) Inadequate access to the required information. Conclusion The results of this study showed that the main concern and fear of pregnant and postpartum women in the COVID-19 pandemic was the fear of the possibility of death for themselves and/or their fetus/infant. The knowledge that was obtained from the understanding of pregnant women and new mothers about the mental health concerns during the COVID-19 pandemic can help managers in planning to improve and promote women's mental health, especially in critical situations.

Abstract Background Missing data is a pervasive problem in longitudinal data analysis. Several single-imputation (SI) and multiple-imputation (MI) approaches have been proposed to address this issue. In this study, for the first time, the function of the longitudinal regression tree algorithm as a non-parametric method after imputing missing data using SI and MI was investigated using simulated and real data. Method Using different simulation scenarios derived from a real data set, we compared the performance of cross, trajectory mean, interpolation, copy-mean, and MI methods (27 approaches) to impute missing longitudinal data using parametric and non-parametric longitudinal models and the performance of the methods was assessed in real data. The real data included 3,645 participants older than 18 years within six waves obtained from the longitudinal Tehran cardiometabolic genetic study (TCGS). The data modeling was conducted using systolic and diastolic blood pressure (SBP/DBP) as the outcome variables and included predictor variables such as age, gender, and BMI. The efficiency of imputation approaches was compared using mean squared error (MSE), root-mean-squared error (RMSE), median absolute deviation (MAD), deviance, and Akaike information criteria (AIC). Results The longitudinal regression tree algorithm outperformed based on the criteria such as MSE, RMSE, and MAD than the linear mixed-effects model (LMM) for analyzing the TCGS and simulated data using the missing at random (MAR) mechanism. Overall, based on fitting the non-parametric model, the performance of the 27 imputation approaches was nearly similar. However, the SI traj-mean method improved performance compared with other imputation approaches. Conclusion Both SI and MI approaches performed better using the longitudinal regression tree algorithm compared with the parametric longitudinal models. Based on the results from both the real and simulated data, we recommend that researchers use the traj-mean method for imputing missing values of longitudinal data. Choosing the imputation method with the best performance is widely dependent on the models of interest and the data structure.

Background & Aims Patient care is the basis of the nursing profession, and the theoretical principles of nursing are based on understanding caring behaviors. Self-compassion can be a powerful source for these behaviors. This study aims to investigate the relationship between self-compassion and caring behaviors of Iranian nurses during the COVID-19 pandemic. Materials & Methods This cross-sectional study was conducted on 124 nurses working in selected hospitals affiliated to Iran University of Medical Sciences from March to May 2022. They were selected using a convenience sampling method. Data collection was done using a demographic/occupational form, Wolf’s caring behaviors inventory (CBI), and Neff’s self-compassion scale (SCS). After collecting the data, they were analyzed in SPSS software, vesion 22 using Spearman’s correlation test, Mann-Whitney U test, Kruskal-Wallis test, and linear regression analysis. Results The mean total score of CBI was 82.06±7.76, which is a relatively high score. The highest score was related to the dimension of knowledge and skill. The mean total score of SCS was 79.47±12.73. The results of the Spearman correlation test showed that the relationship between self-compassion and caring behaviors was positive and significant (P

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. It is linked to genetic and environmental factors such as nutrition. Insulin resistance (IR) is one of the major pathological changes in PCOS. This study aimed to determine the relationship between IR and macronutrient intake in PCOS subgroups. Methods: This case-control study was performed on 151 women with PCOS and were divided into four groups according to the Rotterdam diagnostic criteria: A=41, B=33, C=40, and D=37, and 31 women were also in the control group and did not have this syndrome. All macronutrients were assessed with a 168-item food frequency questionnaire (FFQ). Results: There was a significant relationship between HOMA-IR and some dietary components (Increased calorie in group A, increased total fat intake in group C, lower intake of unsaturated fats (PUFA and MUFA) in group D and higher intake of saturated fat (SFA) and protein intake in the control group). There was no correlation in subgroup B (ovulatory phenotype). Conclusion: Due to the significant relationship between IR and some dietary components in PCOS subtypes, it is recommended to maintain a balance in carbohydrate and fatty acids intake, and increase dietary fiber to improve health parameters in PCOS subjects.

Objective: This study aimed to introduce novel techniques for identifying the genes associated with developingchronic obstructive pulmonary disease (COPD) and to prioritize COPD candidate genes using regression methods.Materials and Methods: This is a secondary analysis of the data from an experimental study. We used penalizedlogistic regressions with three different types of penalties included least absolute shrinkage and selection operator(LASSO), minimax concave penalty (MCP), and smoothly clipped absolute deviation (SCAD). The models weretrained using genome-wide expression profiling to define gene networks relevant to the COPD stages. A 10-foldcross-validation scheme was used to evaluate the performance of the methods. In addition, we validate ourresults by the external validity approach. We reported the sensitivity, specificity, and area under curve (AUC) ofthe models.Results: There were 21, 22, and 18 significantly associated genes for LASSO, SCAD, and MCP models, respectively.The most statistically conservative method (detecting less significant features) was MCP detected 18 genes that wereall detected by the other two approaches. The most appropriate approach was a SCAD penalized logistic regression(AUC= 96.26, sensitivity= 94.2, specificity= 86.96). In this study, we have a common panel of 18 genes in all threemodels that show a significant positive and negative correlation with COPD, in which RNF130, STX6, PLCB1,CACNA1G, LARP4B, LOC100507634, SLC38A2, and STIM2 showed the odds ratio (OR) more than 1. However, therewas a slight difference between penalized methods.Conclusion: Regularization solves the serious dimensionality problem in using this kind of regression. More explorationof how these genes affect the outcome and mechanism is possible more quickly in this manner. The regression-basedapproaches we present could apply to overcoming this issue.

Abstract Postpartum depression (PPD) is the most important postpartum mood disorder due to its significant effect on both the infant and family health. Arginine vasopressin (AVP) has been suggested as a hormonal agent involved in the development of depression. The purpose of this study was to investigate the relationship between the plasma concentrations of AVP and the score of Edinburgh Postnatal Depression Scale (EPDS). This cross-sectional study was conducted in 2016–2017 in Darehshahr Township, Ilam Province, Iran. In the first phase, 303 pregnant women, who were at 38 weeks, met the inclusion criteria, and were not depressed (according to their EPDS scores) were included in the study. In the 6–8 week postpartum follow-up, using the EPDS, 31 depressed individuals were diagnosed and referred to a psychiatrist for confirmation. The maternal venous blood samples of 24 depressed individuals still meeting the inclusion criteria and 66 randomly selected non-depressed subjects were obtained to measure their AVP plasma concentrations with ELISA assay. There was a significant positive relationship between plasma AVP levels and the EPDS score (P = 0.000, r = 0.658). Also the mean plasma concentration of AVP was significantly higher in the depressed group (41.35 ± 13.75 ng/ml) than in the non-depressed group (26.01 ± 7.83 ng/ml) (P

Background: Polycystic ovary syndrome (PCOS) is with oxidative stress in women of reproductive age. Oxidative stress is an important factor in the development of insulin resistance. Some micronutrients are also linked to oxidative stress. The aim of this study was to determine the relationship between insulin resistance and micronutrient intake in PCOS subgroups. Methods: This case-control study was performed on 151 PCOS. They were divided into four groups according to the Rotterdam diagnostic criteria: D = 37, C = 40, B = 33, A = 41 and 31 women were also in the control group and did not have this syndrome. Micronutrient food intake was assessed with a 168-item FFQ feed frequency questionnaire. Insulin resistance was diagnosed with HOMA-IR index (Cut off> 2.5). The data were analyzed with SPSS 22 using Kruskal Wallis (KW), Spearman, and Chi-square tests. Results: The mean age of participants was 28.53 years. There was a significant relationship between the HOMA-IR and some dietary components (selenium depletion in group A, zinc depletion, vitamin D, and vitamin E in group D, and vitamin D and vitamin E depletion in control group) (P < 0.05). There was no relationship between subgroups B and C. Conclusion: Due to the significant relationship between insulin resistance indices, increasing the dietary intake of zinc, selenium, vitamin D, and vitamin E in women with PCOS, as well as increasing the dietary intake of these micronutrients in improving the physical health and fertility parameters of these people is recommended.

Background & Aims Knee osteoarthritis (KO) is one of the most common causes of pain, reduced function and disability in the elderly. Exercise is one of the methods suggested to manage the pain caused by KO. This study aims to determine the effectiveness of a home workout program on reducing pain in the elderly with KO. Materials & Methods In this randomized controlled clinical trial conducted in March 2021 for three months, 70 older adults with KO were selected using a convenience sampling method and randomly assigned to exercise and control groups. The workout program was first implemented twice a day for 4 weeks in the clinic as a trial. Then, it was performed twice a day at home for another 4 weeks. Before and after the exercise, the patients were evaluated by the pain subscale of the Knee Injury and Osteoarthritis Outcome Score (KOOS). The collected data were analyzed in SPSS software, version 18 using independent t, paired t test, chi-square test, and Fisher’s exact test. The significance level was set at 0.05. Results There was no statistically significant difference between the two groups in terms of demographic and clinical variables and in the mean pain score before the intervention (P=0.587). After the intervention, a significant reduction in pain intensity was reported in the exercise group (P= 0.009). Conclusion The home workout program is effective in reducing the pain of the elderly with KO. It is recommended to use it as a simple and cost-effective intervention to rehabilitate patients with KO along with other treatment methods.

Background & aim: There is sufficient information about female sexual function, but few studies have investigated postpartum female sexual function. Postpartum women’s sexual function may be dramatically affected by childbirth. This study aimed to explore women's perceptions and experiences of the concept of postpartum sexual function.Methods: This qualitative study was conducted using a directed content analysis approach based on Female Sexual Function Index (FSFI) between 2018 and 2019. Data were collected through semi-structured interviews with 13 women referred to the health centers of Babol University of Medical Sciences, Babol, Iran and were selected, purposively. The data were analyzed manually using directed content analysis adopted by Hsieh and Shannon (2005).Results: Overall, eleven categories emerged from the analysis. The six emerged categories were related to the predetermined components, namely sexual desire, arousal, lubrication, pain, orgasm, and satisfaction. The remaining five newly emerging categories included changes in the frequency of sexual intercourse, disturbed situation, changes in intimacy and relationship, physical (anatomical) changes, and psychological consequences.Conclusion: The results showed some new categories, in addition to the components of FSFI, which could be added to the concept of sexual function in postpartum period. Therefore, health service providers should consider these new additional concepts in the assessment, care, and treatment of female sexual dysfunction in postpartum women.

Abstract Background Two years after the beginning of the COVID-19 pandemic on December 29, 2021, there have been 281,808,270 confirmed cases of COVID-19, including 5,411,759 deaths. This information belongs to almost 216 Countries, areas, or territories facing COVID-19. The disease trend was not homogeneous across these locations, and studying this variation is a crucial source of information for policymakers and researchers. Therefore, we address different patterns in mortality and incidence of COVID-19 across countries using a clustering approach. Methods The daily records of new cases and deaths of 216 countries were available on the WHO online COVID-19 dashboard. We used a three-step approach for identifying longitudinal patterns of change in quantitative COVID-19 incidence and mortality rates. At the first, we calculated 27 summary measurements for each trajectory. Then we used factor analysis as a dimension reduction method to capture the correlation between measurements. Finally, we applied a K-means algorithm on the factor scores and clustered the trajectories. Results We determined three different patterns for the trajectories of COVID-19 incidence and the three different ones for mortality rates. According to incidence rates, among 206 countries the 133 (64.56) countries belong to the second cluster, and 15 (7.28%) and 58 (28.16%) belong to the first and 3rd clusters, respectively. All clusters seem to show an increased rate in the study period, but there are several different patterns. The first one exhibited a mild increasing trend; however, the 3rd and the second clusters followed the severe and moderate increasing trend. According to mortality clusters, the frequency of sets is 37 (18.22%) for the first cluster with moderate increases, 157 (77.34%) for the second one with a mild rise, and 9 (4.34%) for the 3rd one with severe increase. Conclusions We determined that besides all variations within the countries, the pattern of a contagious disease follows three different trajectories. This variation looks to be a function of the government’s health policies more than geographical distribution. Comparing this trajectory to others declares that death is highly related to the nature of epidemy.

Background: Most parents consider adolescence to be the most difficult stage of parenting. Parental practice is a determining factor in adolescents’ outcomes. Mothers play the main role of parenting in Iran. Coinciding the transition of adolescence with the transition of middle-aged mothers can affect the mothers’ parenting practice. The present study aimed at explaining the Iranian mothers’ practice in parenting an adolescent child. Methods: This qualitative conventional content analysis was conducted from July 2018 to November 2019 in Kashan. 21 in-depth semi-structured interviews with mothers of adolescent children were performed using a purposive sampling method. The data were analyzed through conventional content analysis. Data collection and analysis were performed simultaneously using MAXQDAv10 software. Results: Regarding the study objectives, two themes and six main categories were identified. The theme of ‘laying the groundwork for upbringing’ was detected by two main categories: ‘meeting the needs and ‘effective interaction with the adolescent’; also, the theme of ‘individual-social capacity building’ was explained by four main categories: ‘helping to gain independence’, ‘modeling individual-social behavior’, ‘socializing the adolescent’, and ‘preparing to accept future roles’. Conclusion: Mothers’ practice was mainly focused on adolescents’ independence, college education, career prospects, and marriage preparation and respect for older adults. Consistent with this transition to modernity, and contrary to the collectivist values of Iranian society, mothers’ practice was in line with developing adolescents’ independence and building their self-confidence, which is close to the authoritative parenting style.

Background: Despite the importance and prominent role as a clinical, theoretical, and research approach in nursing practice, humanistic care nature and boundaries are not explicit and challenging for nurses to understand. This study was conducted to clarify the concept of humanistic care in nursing. Materials and Methods: Based on Rogers's evolutionary concept analysis, keywords such as “humanistic car *,” “caring behave *,” “humanistic nurs *,” “humanistic model of care,” were searched in PubMed, SCOPUS, Science Direct, Web of Science, WILEY, Springer, SAGE, ProQuest, SID, Iranmedex without time limit until November 2018. Sixty-five documents in nursing and ten documents in the medical discipline were finalized for thematic analysis. Results: Nine attributes of the humanistic care, including “excellence in clinical literacy,” “creating a healing environment,” “a comprehensive and unique viewpoint,” “contribution to clients' adaptation and flourishing of their talents,” “unrequited love and affection,” “preservation of human dignity,” “real presence,” “constructive dynamic interaction,” and “nurse's self-care,” were recognized. Assessing the historical and evolutionary course of the concept's semantic tendency revealed three periods: The focus in first, second, and third was on the nurse-patient relationship, quantitative tendency/measurement, and metaphysics/spiritual humanism, respectively. The comparison of interdisciplinary differences indicated greater semantic comprehensiveness and depth in the nursing discipline. Conclusions: Clear and practical definition and identification of humanistic care in nursing can be helpful in the further development of existing knowledge, instrumentation, designing guidelines, clinical interventions, knowledge translation, and correction of concept misuse. The identified antecedents and consequences can be in various aspects of clinical management.

Background and objectivesThe population of older people is increasing across the world. Older people need care and support from their families to be able to live independently. This study aimed to design and evaluate the psychometric properties of the family support for older people (FSOP) questionnaire.MethodsIn this instrument development study using a mixed-methods design, the psychometric properties of the FSOP questionnaire in terms of validity and reliability were evaluated.ResultsThe FSOP questionnaire consisted of 50 items in six domains. It was shown to have appropriate qualitative and quantitative validities (score > 1.5). The indicators of content validity (CVR > 0.62, ICVI ≥ 0.80, and SCVI > 0.94) and confirmatory factor analysis (indexes of χ2/df = 2.50, CFI = 0.96, GFI = 0.97, AGFI = 0.96, NNFI = 0.96, PNFI = 0.89, TLI = 0.96, and RMSEA = 0.06) were satisfactory. Cronbach's alpha coefficient for reliability was 0.94, indicating an optimal score.ConclusionsHealthcare providers and family caregivers are suggested to use the FSOP questionnaire for improving the quality of life of older people at home.

Introduction: The Anterior Cruciate Ligament (ACL) plays a vital role in stabilizing the knee. ACL lesions cause joint instability and severe disturbances in physical function and balance. After ACL reconstruction surgery, patients' ability to perform daily activities is significantly reduced and rehabilitation programs are necessary. The objective of the present study was to use an expert system for virtual reality application with the Wii Fit system to run a rehabilitation program in patients after ACL reconstruction. Method: This pilot study was performed as a randomized clinical trial on 20 eligible patients in two treatment groups over four weeks; one group with an expert system-based program with Wii Fit (WF group) and the other group with a standard rehabilitation program (CT group). In the first phase of the study, an expert system was developed with the help of specialists, then in the clinical phase, all patients were evaluated and rehabilitated. In statistical analysis, paired t-test and independent t-test were used. Results: Findings from statistical analysis showed significant differences before and after rehabilitation between the two groups in pain (P

Background: The importance of strong self-regulation (SR) abilities for academic and social success is known, yet relatively few studies examine students’ SR and how it can be promoted especially in adolescents with special needs, such as those students with hearing loss. The purpose of this study was to determine whether a resilience intervention program enhances SR in adolescents with hearing loss. Methods: This study was experimental with a pre-test, post-test, follow up and control group design. Participants included 122 students with hearing loss in mainstream settings randomly assigned to intervention and control groups (61 students in each group). The interventional group had training for six weeks (two times per week for 75 min). The Adolescent Self-Regulatory Inventory was used to measure the self-regulation of students. Results: The results indicated a significant difference between the control and interventional groups in SR, short SR, and Long SR after the intervention, at both the 6-week and 14-week measurements (p < 0.001). Conclusion: This study’s findings indicate that implementing resilience intervention programs can promote the self-regulation skills in adolescent students with hearing loss.

Abstract Background Several hematological indices have been already proposed to discriminate between iron deficiency anemia (IDA) and β‐thalassemia trait (βTT). This study compared the diagnostic performance of different hematological discrimination indices with decision trees and support vector machines, so as to discriminate IDA from βTT using multidimensional scaling and cluster analysis. In addition, decision trees were used to determine the diagnostic classification scheme of patients. Methods Consisting of 1178 patients with hypochromic microcytic anemia (708 patients with βTT and 470 patients with IDA), this cross-sectional study compared the diagnostic performance of 43 hematological discrimination indices with classification tree algorithms and support vector machines in order to discriminate IDA from βTT. Moreover, multidimensional scaling and cluster analysis were used to identify the homogeneous subgroups of discrimination methods with similar performance. Results All the classification tree algorithms except the LOTUS tree algorithm showed acceptable accuracy measures for discrimination between IDA and βTT in comparison with other hematological discrimination indices. The results indicated that the CRUISE and C5.0 tree algorithms had better diagnostic performance and efficiency among other discrimination methods. Moreover, the AUC of CRUISE and C5.0 tree algorithms indicated more precise classification with values of 0.940 and 0.999, indicating excellent diagnostic accuracy of such models. Moreover, the CRUISE and C5.0 tree algorithms showed that mean corpuscular volume can be considered as the main variable in discrimination between IDA and βTT. Conclusions CRUISE and C5.0 tree algorithms as powerful methods in data mining techniques can be used to develop accurate differential methods along with other laboratory parameters for the discrimination of IDA and βTT. In addition, the multidimensional scaling method and cluster analysis can be considered as the most appropriate techniques to determine the discrimination indices with similar performance for future hematological studies.

Abstract Background The aim of this study was to provide a path model for assessing the direct and/or indirect effects of psychological/behavioral parameters on health-related quality of life among women with vaginismus. Methods A cross-sectional study was conducted on a sample of 236 women with vaginismus disorder attending to sex clinics in Tehran, Iran from April 2017 to March 2018. Data were collected using a demographic questionnaire, the marital satisfaction scale, the hospital anxiety and depression scale, the rosenberg self-esteem scale, the body image concern inventory, the short-form health survey (SF-12) and the female sexual quality of life questionnaire. In addition to descriptive statistical data, the fitness of the proposed model was investigated using path analysis. Results The results of path analysis demonstrated that the final model had a good fit to the data (Chi-Square/degrees of freedom (Normed Chi2) = 2.12, root mean square error of approximation = 0.069, goodness fit index = 0.99, both comparative fit index = 0.99 and Tucker–Lewis index = 0.96). In this model, anxiety and depression significantly predicted health-related quality of life as measured by the SF-12. Conclusions Anxiety and depression are important components in predicting health-related quality of life among those suffering from vaginismus.

Abstract Background The impact of COVID-19 pandemic on mental health of pregnant and lactating women is unclear. This study aimed to assess the impact of COVID-19 on psychological health, sexual function, and quality of life (QoL) in Iranian pregnant and lactating women and compare the results with non-pregnant/non-lactating women. Method This comparative cross-sectional study was carried out on pregnant and lactating women, with non-pregnant/non-lactating women from May to Jun 2020. Patients were asked to complete three questionnaires: Hospital Anxiety and Depression Scale (HADS), Female Sexual Function Index (FSFI), and Short-Form Health Survey (SF-12). One-way ANOVA was used to reveal the statistical differences between the three groups. Result The mean age of patients was 20.81 ± 5.92 years old. The mean (SD) score of HADS in pregnant, lactating and non-pregnant / non-lactating women were 12.11 (6.72), 11.98 (8.44) and 9.38 (6.2) respectively, and the results showed that the scores in pregnant, lactating women were higher than non-pregnant / non-lactating women (P

Abstract Background Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in reproductive-age women. It is one of the risk factors of metabolic syndrome (MetS). These two syndromes have an inflammatory etiologic foundation along with oxidative stress. The present study aimed to compare the dietary intake of antioxidant micronutrients in PCOS women with and without MetS. Materials and methods Overall, 42 participants eligible for this nested case control study were selected by the convenience sampling method. The case group included 14 PCOS patients with MetS and the control group included 28 PCOS patients without MetS. The dietary intake assessment of selenium, chromium, zinc, carotenoids, vitamin D and vitamin E was carried out by a 147-item Food Frequency Questionnaire (FFQ). PCOS and MetS were diagnosed using the Rotterdam criteria and NCEP ATP III, respectively. Statistical analysis was performed using SPSS16 software, T-test and Mann Whitney. Significant P-value was considered 0.05. Results Dietary intake of antioxidant micronutrients (selenium, zinc, chromium, carotenoids and vitamin E) was significantly lower in the PCOS women with MetS than in the control group (P

Background: While polycystic ovary syndrome (PCOS) is often associated with psychological distress, its most frequent clinical characteristics include acne, hirsutism and increased level of androgen hormones. Objective: To evaluate the level of depression and anxiety, hirsutism, acne, and level of androgen hormones in PCOS and control group and its association with cognitive function. Materials and Methods: This cross-sectional study was conducted on 53 women with PCOS and 50 healthy women as a control group. Data were collected using a questionnaire including the samples' demographic information, clinical features, clinical findings of hyperandrogenism, and the Beck Depression and Anxiety questionnaire. In addition, the acne and hirsutism levels of the subjects were evaluated using the global acne grading system and the Ferriman-Gallwey scoring system, respectively. The Montreal Cognitive Assessment (MoCA) is a screening test for cognitive impairment that covers major cognitive domains. Results: A significant difference was found between the two groups in the mean levels of acne, hirsutism, total testosterone, free androgen index, depression, and anxiety. However, some mean values of the MoCA were lower in the women of case group compared to the control group. Additionally, a significant difference was observed between the two groups in the domains of visual-spatial ability (p = 0.009), executive function (p = 0.05), attention (p = 0.03), and total MoCA scores (p = 0.002). Conclusion: The PCOS women demonstrated significantly lower performance on the tests of executive function, attention, and visual-spatial function than the healthy control women.

Background: Approximately 60% of individuals above 50 years of age are affected by knee osteoarthritis (KOA). KOA is most commonly assessed through radiographic evaluation and classified using the Kellgren -Lawrence (KL) grading system with KL Grade 0 (KLG0) indicating a definite absence of radiographic KOA (RKOA) and KLG2 presenting a definite presence of RKOA. The current study compared knee joint muscle flexibility among three groups with KLG0, KLG2, and KLG3 RKOA. Methods: In this descriptive cross-sectional study, 94 KLG0, KLG2, and KLG3 knees on 57 women aged ≥40 years were examined. The flexibility of the quadriceps, hamstring, iliotibial band, adductor, and gastrocnemius muscles was compared. Results: Iliotibial band flexibility was lower in subjects with KLG3 RKOA than those with KLG2 (p 0.05). Conclusion: In patients with RKOA, the flexibility of the iliotibial band and quadriceps muscles may decrease as the disease progresses from KLG2 to KLG3. Moreover, quadriceps and iliotibial band flexibility may be lower in KLG3 compared to KLG0, with a lower likelihood of quadriceps flexibility in KLG2 compared to KLG0. These results suggest that quadriceps and iliotibial band stretching may be potentially important components of treatment.

Abstract Background There is a growing body of evidence regarding the association between Adiponectin and mental disorders. We aim to evaluate the association between serum level of Adiponectin hormone and postpartum depression and marital satisfaction scores. Methods A prospective cohort study of 90 pregnant women was conducted in Mahdieh Hospital, Tehran, Iran. Blood samples were collected during the first 24 h after delivery. The serum Adiponectin concentration was measured with an Enzyme-Linked Immunosorbent Assay (ELISA) kit. The depression score was measured using a validated Iranian version of the Edinburgh Postnatal Depression Scale (EPDS) questionnaire at six weeks (6-weeks) and twelve weeks (12-weeks) after delivery. Using the Kansas questionnaire at twelve weeks (12-weeks) after delivery, the marital satisfaction score was measured. The measurements were compared between two groups, satisfied and dissatisfied mothers. P-values lower than 0.05 were considered significant. Results The mean serum level of Adiponectin was significantly higher in the dissatisfied group. It was 10.9 ± 13.4 μg/ml and 15.2 ± 17.7 μg /ml in the satisfied and dissatisfied groups, respectively (P = 0.04). The postpartum depression scores of 6- and 12-weeks after delivery were significantly higher in the dissatisfied group. At 6-weeks after delivery, the postpartum depression scores were 3.6 ± 3 and 8.7 ± 5.6 in satisfied and dissatisfied groups, respectively. Those were 2.7 ± 2.7 and 7.6 ± 5 at 12-weeks after delivery, respectively. There was a significant difference statistically (P

Abstract Background This study aimed to compare the lifestyle factors and SQ between women with and without endometriosis. Also in this essay, the influence of food intake, socio-demographic and clinical characteristics on sleep quality of women with endometriosis was determined. Methods Of the 156 infertile women approached for the study, 78 women had endometriosis and 78 were included in the control group. At first, each participant completed a checklist including questions about demographics, physical activity, reproductive and menstrual status. SQ was assessed by the Pittsburgh Sleep Quality Index (PSQI). Dietary data were collected using a validated 147-item semi-quantitative FFQ. Results Irregular menstrual status, menorrhagia, dysmenorrhea, pelvic pain, history of abortion, family history of endometriosis were associated with endometriosis risk (P

Abstract Background To determine the prevalence, related factors and maternal outcomes of primary PPH in governmental hospitals in Kabul Afghanistan. Methods An observational study was designed to determine the prevalence, related factors and maternal outcomes of primary PPH in governmental hospitals in Kabul-Afghanistan. The population of this study consisted of all women who gave birth to a child between August and October 2018. The structured checklist was used to collect the data from patients who were suffering from primary PPH. Results Among the 8652 women who were observed, 215 (2.5%) of them suffered from primary PPH and 2 (0.9%) of them died under caesarean section. The most common related factors of primary PPH were uterine atonia (65.6%), previous PPH (34.9%), prolonged labor (27%), genital tract trauma (26.5%), and induction of labor (20.5%). The most common maternal outcomes of primary PPH were respiratory failure (7%), hysterectomy (6%), and hypovolaemic shock (5.1%). Conclusions According to our findings, the major cause of postpartum bleeding was uterine atonia. Therefore, postpartum care of women is essential, especially for those with previous PPH and prolonged labor that require more attention.

Abstract Background Gestational diabetes mellitus (GDM) is associated with adverse diabetic complications for both mother and child during pregnancy. The common Gold Standard (GS) for diagnosis of GDM is 75 g oral glucose tolerance test (OGTT) during 24–28 gestational weeks which seems a little late for any proper intervention. This study aimed to employ the Bayesian latent class models (LCMs) for estimating the early diagnostic power of combination of serum multiple marker in detecting GDM during 14–17 weeks of gestation. Methods Data from a sample of 523 pregnant women who participated in gestational diabetes screening tests at health centers affiliated to Shahid Beheshti University of Medical Sciences in Tehran, Iran from 2017 to 2018 were used. The beta-human chorionic gonadotropin (β-hCG), unconjugated estriol (uE3), and alfa-fetoprotein (AFP) values were extracted from case records for all participants. The Bayesian LCMs were applied for estimating sensitivity, specificity, and area under receiver operating characteristic curve (AUC) of combining the three biomarkers’ results in the absence of GS, adjusting for maternal age and body mass index. Results The mean (standard deviation) maternal age of the participants was 28.76 (±5.33) years. Additionally, the mean (standard deviation) BMI was 24.57 (±3.22) kg/m2. According to the Bayesian model, the cSensitivity, cSpecificity, and cAUC for the optimal composite diagnostic test were estimated as 94% (95% credible interval (CrI) [0.91–0.99]), 86% (95% CrI [0.80–0.92]), and 0.92 (95% CrI [0.87–0.98]), respectively. Conclusions Overall, the findings revealed that the combination of uE3, AFP, and β-hCG results might be considered as an acceptable predictor for detecting GDM with a rather high level of accuracy in the early second trimester of pregnancy without a GS.

Objectives: The communication is not just being able to verbally pronounce words and sentences, but it includes understanding information through inspiration, inner instinct, or external guidance. To achieve a better quality of life (QoL), there is a need for determining pleasant communication. The current study aimed to explore the women’s perception about different aspects of communication in their life. Materials and Methods: This qualitative content analysis aimed to understand the meaning of communication as a key factor in Iranian women’s QoL, which was conducted on 40 women. The data were gathered through depth interviews from May to November 2016 in Tehran, Iran. The interviews were transcribed verbatim and analyzed using conventional qualitative content analysis in 8 stages recommended by Zhang. Results: Two categories were identified based on the interviews, including constructive spiritual and pleasant peripheral communication and each theme consisted of some categories. Conclusions: Overall, awareness about different aspects of communication in women’s life must be considered by politicians and health care providers in Iran. In addition, efforts would be made to improve nurses’ understanding of different aspects of the QoL, especially pleasant communication in women’s life which could help their health promotion.

Background: Polycystic ovary syndrome (PCOS) increases the risk of metabolic syndrome (MetS). Insulin resistance (IR) plays a major role in the pathophysiology of both PCOS and MetS. Objective: This study was designed to compare the prevalence of MetS among different phenotypes of PCOS and its relationship with androgenic components. Materials and Methods: 182 participants eligible for this five-group comparative study were selected by convenience sampling method. They were classified according to the Rotterdam criteria: clinical and/or biochemical hyperandrogenism (H) + PCOS on ultrasound (P) + ovulation disorders (O) (n = 41), clinical and/or biochemical H + PCOS on P (n = 33), PCOS on P + O (n = 40), clinical and/or biochemical H + O (n = 37), and control (without PCOS) (n = 31). MetS was measured based on the National Cholesterol Education Program Adult Treatment Panel III criteria. Androgenic components included free-androgen-index (FAI), total-testosterone (TT) level and sex-hormone-binding-globulin (SHBG). Results: A significant difference was observed between the study groups in terms of MetS prevalence (p = 0.01). In phenotype H+P+O, there was a statistically significant positive association between TG and TT, and a significant negative association between SBP and DBP with SHBG. In phenotype O+P, WC was inversely associated with SHBG. In phenotype H+O, FBS and TG were positively associated with FAI but HDL was inversely associated with FAI. Moreover, WC and DBP were positively associated with TT in phenotype H+O. No associations were detected between MetS parameters and androgenic components in other PCOS subjects (phenotype H+P) and in the control group. TT was significantly higher in the PCOS group suffering from MetS (p = 0.04). Conclusion: According to the research results, hyperandrogenic components are potent predictors of metabolic disorders. Thus, we suggest that MetS screening is required for the prevention of MetS and its related complications in PCOS women.

Abstract Background Gestational diabetes mellitus (GDM) is one the most common complications of pregnancy. The present work aimed at investigating the effect of ginger on the blood glucose level of GDM women with impaired glucose tolerance test (GTT). Methods This randomized double-blind placebo-controlled clinical trial was performed on the total of 70 women with GDM, who were in 24–28 weeks of pregnancy with impaired GTT from 2015 to 2016. For this purpose, the women were assigned to two groups of ginger or placebo. The ginger group received 126 tablets of ginger, and the placebo group received 126 tablets of placebo for six weeks. The serum Blood Sugar 2 h post-prandial (BS2hpp), Fast Blood Sugar (FBS) and insulin, as well as Homeostasis Model Assessment (HOMA) index were analyzed before and six weeks after intervention. Results The mean of FBS (P = 0.04), fasting insulin (P = 0.01), and HOMA index (P = 0.05) was reduced significantly in the ginger group six weeks after intervention in comparison to the placebo group. But the mean of BS2hpp did not show any significant reduction in the two groups (P > 0.05(. Conclusions Oral administration of ginger tablet improved FBS, serum insulin and HOMA index in the women with GDM; however, it could not reduce their BS2hpp level. The trial has been registered in the Iranian Registry of Clinical Trials (IRCT2015090523897N1).

Abstract Background The purpose of this study was to evaluate the maternal omentin-1 level, quality of life and marital satisfaction of women with cesarean and vaginal delivery. Methods This prospective cohort study was conducted on 45 women with elective cesarean delivery and 45 women with vaginal delivery who referred to a public hospital in Tehran, Iran. Maternal omentin-1 level was measured by ELISA kits within 24 h after delivery. The maternal quality of life and marital satisfaction in the third trimester of pregnancy and at 12 weeks postpartum were measured using WHOQOL-BREF and the Kansas marital satisfaction questionnaires, respectively. For making between-groups and within-groups comparison, independent samples t-test, paired samples t-test and chi-square test were applied accordingly. Results The level of maternal omentin-1 was reported to be higher in vaginal delivery group compared to the cesarean group (p = 0.02). No significant difference was found in the quality of life between the two groups in the third trimester of pregnancy and at 12 weeks postpartum period. However, women in both groups had lower scores in physical dimension at 12 weeks postpartum compared to the third trimester of their pregnancy [mean ± SD in vaginal group = 59.28 ± 15.5 vs. 64.44 ± 15.05, p = 0.003 and mean ± SD in cesarean group = 60.07 ± 14.84 vs. 66.50 ± 11.32, p

Background Endometriosis is an important gynecologic disease affecting reproductive-age women. Based on the effect of phytoestrogens on inflammatory, immunological and hormonal factors, limited studies have suggested that phytoestrogen consumption could probably modulate endometriosis risk. The aim of this study was to evaluate the relationship between phytoestrogen intake and endometriosis risk. Materials and Methods In the present case-control study, 78 women with a laparoscopically confirmed endome- triosis and 78 normal pelvis women (as the control group), were recruited. Common dietary intake was recorded by a validated 147-item semi-quantitative food frequency questionnaire (FFQ). Type of phytoestrogen in each dietary item was analyzed by the database from the United States Department of Agriculture (USDA). A logistic regression model was used to determine the association between phytoestrogen intake and endometriosis risk. Results Higher intake of total phytoestrogen (P-trend=0.01), total isoflavones (P-trend=0.002) specially formononetin (P-trend=0.04) and glycitein (P-trend=0.04), total lignan (P-trend=0.01) specially secoisolariciresinol (P-trend=0.01) and lariciresinol (P-trend=0.02) and matairesinol (P-trend=0.003), and total coumestrol [third quartile odds ratios (OR): 0.38; 95% confidence intervals (CI): 0.15-0.96; P-trend=0.1] was related to reduced endometriosis risk. Among food groups, only isoflavin (OR: 0.48; 95% CI: 0.44-0.63), lignan (OR: 0.66; 95% CI: 0.62-0.94), coumestrol (OR: 0.64; 95% CI: 0.51-0.99), phytoestrogen (OR: 0.46; 95% CI: 0.38-0.83) in dairy products and coumestrol in fruits (OR: 0.69; 95% CI: 0.03-0.77) were negatively associated with endometriosis risk. Conclusion Phytoestrogens have a major impact on the level of hormones, and immune and inflammatory markers; thus, it can play an important role in the control and prevention of many diseases. Due to the inflammatory nature of endometriosis and the effect of hormones on the progression of the disease, the role of phytoestrogens consumption in the progression and regression of the disease should be assessed in future works.

Background: Quality of life drives from the individuals' perceptions of their position in life long and allows holistic assessment of the effects of health conditions beyond the symptoms, signs, and complications. This study aimed to assess the quality of life and recognize females' point of view about the quality of life aspects. Hence, perhaps it could be a step toward improving women's health status. Materials and Methods: This study was an explanatory mixed method research one which was conducted in the two following steps. In the quantitative step, five hundred women aged 15–49 years were selected from varied zone of Tehran Province, using cluster random sampling method. In order to assess the quality of life, Short Form SF-36 instrument was used. In the qualitative step, forty women were selected by purposive sampling in a different range of quality of life based on the result of the first step. Data were collected through semistructured, in-depth individual interviews, which continued up to data saturation point. Data analysis was performed through conventional content analysis. Results: Among different aspects of quality of life, the highest and the lowest means (SD) were related to physical functioning mean (SD) 70.58 (24.52) and general health 67.72 (27.66), and mental health 55.27 (30.22) and social functioning 57.02 (30.62), respectively. From the interviews, three main themes were extracted as the following: (i) financial support, (ii) informational support, and (iii) service-based social support. Conclusions: The present study revealed that Tehranian women do not have high experience related to the quality of life; however, a sense of receiving support from different sources could help them to wrestle with a complicated condition in everyday life.

Background: Pregnancy is considered a period of emotional crisis. However, attention to the mental status of a pregnant mother is often neglected by health care providers. This study was conducted to determine the effect of narrative writing on the depression, anxiety, and stress of pregnant women referring to the pregnancy care clinics in the south health centers affiliated with Tehran University of Medical Sciences in Tehran, Iran. Methods: The research was a quasi-experimental field trial. A total of 120 eligible pregnant women referring to the south health centers of Tehran University of Medical Sciences were recruited by convenience sampling method. The health records of pregnant women were assessed at each center and the eligible subjects were identified. The sampling was performed during one week for the experimental group and during the next week for the control group. Mothers in the experimental group were asked to write a narrative about their deep thoughts and feelings, twice a week for two months according to the given instructions. The mothers in the control group received routine care. At first, both groups completed the Beck depression inventory and depression, anxiety, and stress scale 21 before the intervention. Then, at 4 and 8 weeks after the intervention, both groups just completed depression, anxiety, and stress scale 21. The obtained data were analyzed by the Mann-Whitney test, Chi-squared test, two-sample Kolmogorov-Smirnov test, and repeated measures ANOVA in SPSS V. 22. The significance level was set as 0.5 or less. Results: Pre-intervention levels of anxiety, stress, and depression were similar in both groups. Four weeks after the intervention, the variables of depression (P=0.014) and anxiety (P=0.004) were significantly reduced in the experimental group, but no statistically significant difference was found for the stress variable in this time interval. Finally, a significant decrease was observed in all three variables as the intervention continued for 8 weeks (P

Background: Knowledge management (KM) has a pivotal role in optimizing performance at organizations. In recent decades, hospitals used KM to achieve optimized performance. This study aimed to determine the knowledge management status in a non-governmental general private hospital in Tehran in 2019. Methods: This cross-sectional study was done in 2019. We selected 171 clinical and administrative staff at the hospital by using random sampling. Data wre collected through a valid and reliable questionnaire. Data analysis was done by SPSS v 22 through descriptive and analytical statistics. Results: The results of the study showed that KM dimensions had an inappropriate status (2.99 out of 5). Among the KM dimensions, Technology had a worse status than others (2.72 out of 5). Moreover, there was a significant relationship between People and Technology (pConclusion: Due to the inappropriate situation of technology in the hospital, the managers should help to provide hardware and software requirements and make it a leading hospital for technology use. Due to the positive relationship between People and Technology, equipping the hospital with new technologies led to an increase in the person's abilities and improvement of the health care services delivered to the patients.

Introduction: Many factors affect desirable quality of life. Regarding the subjective and multivariate nature of the quality of life concept and the need for attention in different cultures and groups of the society, the present study was performed to analyze the concept of quality of life from women's perspectives. Method: To analyze the quality of women's life, Schwartz-Barcott and Kim's hybrid model was used. At theoretical stage, in order to deeply analyze and redefine the concept of women's quality of life, 571 articles from available and reputable databases without a year limit and with keywords of life quality and women were searched in Persian and English. At practical stage, 40 Iranian women living in Tehran were interviewed. Then, the text of interviews was handwritten and analyzed using Zhang's content analysis method. Finally, the similarities and differences of definitions obtained from the previous two stages were evaluated and a general analysis was performed. Results: In the final analysis, women's quality of life was defined as follows: “The quality of life from women's perspectives is a subjective concept and expressed as the sense of happiness that they experience it in their lives by having peace of mind in life, satisfaction with health due to responsibility for health and communicating with themselves, God, environment, and others, sense of security, and understanding of the comprehensive support received to have an ideal life. Conclusion: Based on the findings, paying attention to the status of women in the field of comprehensive support, sense of security, health responsibility, and communication can bring useful and significant results to improve the quality of women's life.

Background: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in reproductive age women. The prevalence of PCOS among Iranian women is 14.6% based on the Rotterdam definition. PCOS can increase the risk of chronic metabolic complications. Metabolic syndrome (MetS) is one of the most important of them. Insulin resistance is fundamental in PCOS and MetS pathophysiology. MetS is a collection of chronic metabolic derangements, which promotes the risk of serious diseases such as cardiovascular disturbances and diabetes. The quality of diet is inversely correlated with obesity, which is one of the consequences of PCOS and it is a risk factor for metabolic syndrome. As the first study, the present study aimed to compare the dietary intake of macronutrients in PCOS women with and without MetS. Methods: In this nested case-control study, the convenience sampling method was used to select participants. The case group included 14 PCOS patients with MetS and the control group included 28 PCOS patients without MetS. The investigated macronutrients included fats (total fat, saturated fatty acids, mono and polyunsaturated fats, trans fatty acids), carbohydrate, protein, and fibers (total and soluble). The dietary intake assessment was carried out by a 168-item semi-quantitative food frequency questionnaire (FFQ). This study was performed on Arash Women's Hospital under support of Tarbiat Modares University, Tehran, Iran, from August 2014 to September 2015. Results: Dietary intake of total fat was significantly higher in PCOS women with MetS than the control group (P

Background:Situational influences can facilitate or impede stretching exercise behaviours. However, since there is no measurement to assess situational influences among office employees, it might be difficult to understand the role of situational influences on stretching exercises. The current study aimed to evaluate the psychometric characteristics of Short Form of Situational influences Scale for predicting Stretching Exercise among office employers based on the Health Promotion Model (HPM). Method: By multistage cluster sampling method, this cross-sectional study was conducted among 385 office employees selected from the health networks at Shahid Beheshti University of Medical Sciences of Iran (SBUMS) who were assessed through the Short Form of Situational influences Scale. Exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and Cronbach’s alpha were employed. Results: The mean age of the office employees was 39.4±7.76 years. Content Validity Index (CVI) and Content Validity Ratio (CVR) of each question were greater than 0.79. The result of EFA with principal component analysis showed one factor (Situational influences) with 43.6% cumulative variance and KMO with 90.4% (P < 0.001). This was a good fit index in CFA. The reliability of the questionnaire was confirmed through acceptable Cronbach’s alpha (α = 0.79). Regarding CFA, the result showed REMSEA = 0.048, GFI = 0.978, AGFI = 0.986 confirmed with Cronbach’s alpha (α = 79 %) and ICC =0.71 95% CI (0.69, 0.79). Conclusion: The current study revealed that the Short Form of Situational influences Scale for Stretching Exercise is a valid instrument. Therefore, it can be used as a reliable and valid instrument to investigate Stretching Exercise behaviours among office employers.

Background: The aim of this study was to assess the possible association between different factors such as age, sex, antibiotic consumption duration, angiogenesis and pain and “acceleration of wound healing” in pilonidal sinus patients after treating with platelet-rich plasma (PRP). Methods: In this clinical trial, 110 patients were randomly divided into treatment arm and control group. After surgery, control group underwent classic wound dressing and the treatment arm experienced PRP gel therapy. Before achieving complete healing, wound incisional biopsy was performed in order to evaluate angiogenesis. During the study, other data such as pain and antibiotic consumption duration were also collected. Wound healing time of pilonidal sinus disease was analyzed using Extended and Stratify Cox model. Data were analyzed using R and STATA software. p

Abstract Background Polycystic ovary syndrome (PCOS) is one of the most common endocrine diseases. At present, the cause of the disease is not fully understood, but many studies have shown that PCOS is associated with genetic and environmental factors. The present study aimed to assess the umbilical cord blood’s Anti-mullerian hormone (AMH) level in the newborns of mothers suffering from PCOS comparing to healthy mothers. Methods This prospective cohort study was conducted on 120 pregnant women with PCOS, who were selected through Rotterdam criteria, and 60 healthy pregnant women as the control group. The subjects in each group were divided into obese and non-obese mothers according to their body mass index (BMI) before pregnancy. The cord blood samples were collected from the offsprings on the time of childbirth. Finally, the circulating concentrations of AMH in both sexes of the newborns were determined by specific assays. Results The research results showed that the blood level of AMH was higher in the neonates of obese mothers with PCOS comparing to the controls (P