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Background: Healthy nutrition is necessary for normal growth and development. Although breakfast is considered the most important meal of the day, it is ignored by many adolescents. The purpose of this study was to apply the health promotion model (HPM) to predict breakfast consumption among adolescent girls using the structural equation modeling (SEM) approach. Methods: A descriptive-analytical study was performed on 450 Iranian female high school students in 2019. Sampling was performed through a multi-stage method. The data collection instrument was a two-part questionnaire. The first part was about demographic information and the behavior of breakfast consumption. The second part was a questionnaire based on the HPM. Data were analyzed by SPSS (version 21) and AMOS (version 21) using the Chi-square test and the regression model. Results: Based on SEM, the constructs of Pender’s HPM explained approximately 0.47 of the variation in the breakfast consumption behavior. The highest total effects on breakfasting behaviors belonged to behavioral perceptions (0.833), prior related behaviors (0.800), perceived self-efficacy (0.677), activity-related affects (0.659), perceived barriers (-0.598), and commitment to planning (0.361). Conclusion: HPM is a suitable theory for predicting commitment to the planning and behavior of breakfast consumption among Iranian adolescent girls. Accordingly, the impact of emotions and behavioral perceptions on a commitment to planning for breakfast consumption should be considered in designing nutritional interventions for female adolescents. Moreover, in planning educational interventions, pleasant experiences should be created to positively influence individual perceptions and effects related to the target behavior in order to enhance commitment to the breakfast consumption behavior.

Objective: Energy drink consumption has been increasing among youth. In this study, we aimed to examine the patterns of energy drink consumption and their relationships with the use of sweetened beverages such as soda and packaged fruit juice as well as alcohol consumption and smoking among college students. Methods: This was a cross-sectional analytical study in which data were collected during the 2018-2019 academic year for 9 months from October to July. Our sample was a random selection of 373 students attending Isfahan University of Medical Sciences. We used logistic regression analysis, chi-square, and independent t-tests for data analysis. Results: Overall, 31.6% of men and 27% of women had consumed energy drinks. Men consumed energy drinks 1.3 times more than women did. Preferring the taste was the most frequent reason (30.8%) for energy drink consumption. Having energy drinks was associated with consumption of sweetened beverages and alcohol (p < .001). The mean consumption of sweetened beverages and alcoholic drinks, and smoking was significantly higher among men than women (p < .05). Conclusion: A sizable percentage of students consumed energy drinks because of the taste. This indicates that they should be informed about the harmful ingredients in these drinks.

Background The present study was conducted to jointly assess some specific factors related to body fat measures using a multivariate multilevel analysis in a representative sample of Iranian mid-adolescents. Methods This study was conducted among 2538 students (1286 boys) aged 14–20 years old, who were randomly selected among 16 public high schools by multi-stage random sampling procedure from all education districts of Shiraz, Iran. Data on demographic characteristics, family history of obesity, physical activity, socio-economic (SES) variables and screen time were collected. Height, weight, triceps (TST), abdominal (AST), and subscapular (SST) skinfold thickness were measured and their body mass index (BMI) was calculated. A multivariate multilevel approach was used to analyze the factors associated with obesity measures of the TST, AST, SST at the child and district levels. Results In this study, the prevalence of overweight and obesity was estimated to be 10.2 and 5.1%, respectively. Overall, the major portion of the total variance in TST (97.1%), AST (97.7%), and SST (97.5%) was found at the child level. The results of multivariate multilevel method revealed that being girls, having a family history of obesity, and SES were significantly associated with increasing of three body fat measures (all the p-values were less than 0.05). There were significant positive associations between moderate to vigorous physical activities with AST and SST (for AST: β =2.54, SE = 1.40, p = 0.05; for SST: β =2.24, SE = 1.20, p = 0.05). Compared to children in 14–16 age group, children in age group 16–18 years had less TST (β = − 0.67, SE = 0.34, p = 0.04). Furthermore, other age groups and screen time did not play an important role in three outcome variables. Conclusions The results showed some factors that contribute to three body fat measures. Therefore, it is necessary to develop effective interventions to prevent the effects of individual and environmental undesirable factors on childhood obesity in both family and community levels.

Background: Depression and sexual dissatisfaction are among the most common psychological factors caused by infertility. Infertility is an essential topic in the Iranian culture, and many studies have already investigated it. Objectives: This study aimed to compare the depression severity and sexual dissatisfaction between fertile and infertile women in Iran. Methods: This case-control study enrolled 180 infertile women and 540 fertile women in 2019. The participants were selected through multistage stratified and cluster sampling methods. For each infertile woman, three fertile women were randomly selected. The data collection instruments consisted of a demographic form, the Depression Inventory Scale (Second Edition), and the Linda Berg Sexual Satisfaction Questionnaire. The multivariate marginal model and SPSS version 21 were used for data analysis at a significance level of 0.05. Results: After adjustment for confounding variables, the marginal model showed that the odds of depression increased by approximately 21.305 times among cases compared to controls (OR = 21.305, 95% CI = 14.75 - 32.021, P < 0.001). This model also found that by moderating the effects of confounding variables, infertility increased the odds of low sexual satisfaction by approximately 15.560 times (OR = 15.560, 95% CI = 5.089 - 47.571, P < 0.001). The chi-square test showed a significant relationship between infertility treatment and depression severity in infertile women (P = 0.001). Conclusions: The overall depression severity and sexual dissatisfaction were higher in the infertile group than in the fertile one. Most cases of severe depression were observed in IVF clinics with higher depression levels. The study may help reveal infertility's psychological and social aspects in Iran.

Background Human instinctively desire to have offspring. Infertility can cause painful emotional experiences throughout the life mainly known as quality of life impairment. This study aimed to investigate the impact of infertility on a woman’s quality of life. Methods A number of 180 infertile and 540 fertile women participated in this matched case-control study. The cases were selected through a combination of multistage stratified and cluster sampling methods. For each infertile woman three fertile women were randomly selected. The data gathering instrument consisted of demographic variables and the WHOQOL-BREF questionnaire. Data collection was conducted through interview with participants. The multivariate marginal model and SPSS software 21 were used for data analyses with a significance level of 0.05. Results The results of the multivariate modeling show infertility can potentially affect various aspects of women’s quality of life such as physical health (p

Background: The puerpose of this study was to assess the association between anthropometric measures and skinfold thickness as well as parental obesity and physical activity with body fat percentage (BFP) percentiles using a quantile regression (QR) model within a representative sample of Iranian adolescents. Methods: In this cross-sectional study, 2873 school children (1472 girls) aged 14-20 years old were selected by multi-stage random sampling approach from different areas of two cities of Fars Province in southern Iran. Demographic characteristics, parental history of obesity, physical activity were collected by using a self-reported questionnaire. Height, weight, waist (WC), hip (HC), arm (AC) circumferences, triceps (TST), abdominal (AST), clavicle muscle (CMST) skinfold thicknesses, and BFP were measured. A QR analysis was used to evaluate the association between the obesity measures with BFP at different quantiles.Results: The results of QR models showed that circumference measures and skinfold thicknesses were statistically significant positive associations with BFP across all quantiles (P< 0.05). Among boys, having a history of obesity in mothers associated with higher BFP at the 15th to 95th percentiles (the parameter estimates ranged from 1.9 to 4.9, Pth to 95th and all percentiles for maternal and paternal obesity, respectively (the prameter estimates ranged 1.6-2.6 and 2.7- 5.6 with Pth to 95th only in grils (prameter estimates ranged -2.5 to -1.7 with PConclusions: This study revealed that anthropometric measures and SF measures associated with higher BFP at all quantiles in Iranian adolescents. The findings of the study also showed that having a history of parental obesity as well as a high physical activity associated with higher and lower BFP, respectively.

Peak bone mass is established during childhood. This study aimed to evaluate the associations of the components of overall body mass with areal bone mineral density Z-score in children. The findings of this study showed that children with greater overall body mass had higher aBMD Z-score.Peak bone mass is established during childhood and adolescence. One of the important factors influencing predicted bone mass tracking in childhood and adolescence is alteration in the body composition during this growth period. This study aimed to evaluate the associations of the components of overall body mass with areal bone mineral density Z-score in children and adolescents.In this cross-sectional study, 478 healthy Iranian children and adolescents (237 girls and 241 boys) who had DXA measures participated. We evaluated the linearity of associations using generalized additive models.Children's mean age was14 years with a range of 9-18 years, and 49.6% were girls. We found an increase in aBMD Z-score with increasing overall body mass (r = 0.25, p0.001). We observed this association with fat-free mass and total fat mass up to the 60th (~30 Kg) and 75th percentile (~12.5 Kg) [0.051 (95% CI, 0.027-0.075) increase in aBMD Z-score per 1 Kg increase in fat-free mass and 0.079 (95% CI, 0.044-0.114) increase in aBMD Z-score per 1 Kg increase in the total fat mass]. The correlation between Z-score of overall body mass and its components with aBMD Z-score was strongly positive. (P value0.001 for all) CONCLUSION: The findings of this study showed that children with greater overall body mass had higher aBMD Z-score. In addition, this study adds to a growing literature, suggesting that the relationship between body composition and BMD may be influenced by the pattern of fat and fat-free mass distribution in population.

Motorcycle drivers are among the most vulnerable road users, accounting for a large proportion of global traffic accidents. This study aimed to investigate the association between the score of adult attention-deficit/hyperactivity (ADHD) traits and risky driving behaviors (RDB) with alcohol intake (AI) and narcotics consumption (NC) among motorcyclists in Iran. This multi-center cross-sectional study encompassed 1747 motorcyclists from three cities in Iran. A random sampling method was applied in this study, and the required data was collected using three standard questionnaires on ADHD, substance abuse, and RDB. Independent sample t-test, covariance analysis, and quantile regression (QR) were used to analyze the data. The results of t-test and analysis of covariance indicated that AI and NC were significantly associated with ADHD score and RDB among the motorcycle drivers. Additionally, the QR models showed that these effects were significant at all quantiles of ADHD and RDB, even for individuals who were at lower quantiles. Considering the potential dangers of driving after AI and NC, appropriate measures should be adopted before certifying a driving license to screen ADHD as a predisposing factor for substance abuse and RDB. Furthermore, it is essential to equip traffic police with adequate diagnosis kits and establish heavy penalties for the offenders. In this regard, all interventions aimed to reduce traffic accidents among motorcycle drivers should be done considering the interrelationship between ADHD, RDB, and substance abuse.

Background Self-medication by older adults has been always a public health concern. The present study aimed to modify the psychological constructs of Health Belief Model (HBM) in relation to self-medication behaviors using Freire’s Adult Education Model (FAEM) among older adults in Khorramabad, Iran, from 2017 to 2018. Methods The mean age of the older adults was 66.28 ± 7.18 years. This was a randomized controlled trial study conducted on 132 individuals older than 60 who were referred from different health care centers. The participants were selected using multistage sampling method and randomly divided into two groups of intervention and control. The data collection instruments included a questionnaire which was designed based on both HBM and self-medication behaviors questionnaire. The phase of adult education model (AEM) was used to modify the psychological constructs of HBM and self-medication behaviors. Data were analyzed using SPSS software version 20 with a significant level of 0.05. Descriptive statistical tests, chi-squared test, paired t-test, independent t-test, and univariate modeling were employed for the purpose of analyzing data. Results There was no significant difference between groups in terms of self-medication. Unawareness of the effects of medicine were the most important reason for self-medication (p = 0.50). The two groups were not significantly different in terms of knowledge, HBM constructs, and self-medication behaviors (p > 0.05). However, they came up to be considerably different for the above variables after the intervention was implemented (p p Conclusion The educational intervention, which was based on Freire’s AEM, had positive effects on the constructs of HBM and consequently on self-medication behaviors. The psychological constructs of HBM were affected at the phases of listening to problems. Self-medication was tempered at the action-reflection phase with shared creation and evaluation of the action plan geared toward the achievement of the behavioral objectives. The results might be of importance to healthcare professionals involved in care of older patients. Trial registration Current Controlled Trials IRCT2013091814512N2. Registered on January 2 - prospectively registered, the trial was registered in the Iranian Clinical Trials Registry http://www.irct.ir.

Background: Breakfast is an important sign of healthy nutrition for normal growth and development. Breakfast is considered as the most important meal of the day which is ignored by many adolescents. The purpose of this study was to predict breakfast behavior based on Pender Health Promotion Model(HPM) constructs using structural equation model(SEM).Methods: A descriptive-analytical study was performed on 450 high school female students in west of Iran in 2019. Sampling was done through a multi-stage method.The questionnaire contained two parts. The first part of which was about demographic and behavior of breakfast consumption; and the second part was a questionnaire based on Health Promotion Model. Data were analyzed by means of SPSS and AMOS both version of 20 software and using Chi-square test as well as regression correlation model.Results: The constructs of behavioral perceptions, commitment to action plan and behavioral effects explained 47% of the variance of breakfast intake behavior. In the structural equation model, the value of the chi-square statistic test came up to 429.2429 which was divided by resulted degree of freedom (1785), 2.405 and 5%, respectively (PConclusion: The HPM is a suitable theory for predicting the commitment to action plan and behavior of breakfast consumption in Iran.The structural equation model was evaluated as a comprehensive model through both direct and indirect approaches to predict the relationship between breakfast consumption and the predictive factors. This model showed a multi-factorial nature of the predictive factors.

Background : As people age, they are more likely to engage in self-medication and suffer from its adverse effects. The present study aimed to modifying knowledge, psychological constructs of Health Belief Model (HBM), and self-medication behaviors using Freire’s Adult Education Model (FAEM) among elderlies in Khorramabad, Iran, from 2017 to 2018. Methods: This research was of a randomized controlled trial conducted on 132 individuals older than 60 who were referred from health care centers. The participants were selected using multistage sampling method and randomly divided into two groups of intervention and control. The data collection instruments included a questionnaire which was designed based on both HBM and self-medication behaviors questionnaire. The phases of adult education model (AEM) was used to modify the psychological constructs of HBM and self-medication behaviors. Data were analyzed using SPSS software version 20 with a significance level of 0.05. Descriptive statistical tests, chi-squared test, paired t-test, independent t-test, and univariate modeling were employed for this purpose. Results : The mean age of the elderlies was 66.28±7.18 years. There was no significant difference between groups in terms of self-medication. Unawareness of the effects of medicine were the most important cause of self-medication (p=0.50). The two groups were not significantly different in terms of knowledge, HBM constructs, and self-medication behaviors (p>0.05). However, they came up to be considerably different for the above variables after the intervention was completed (p

Background: Depression and sexual dissatisfaction are among the most common psychological factors caused by infertility. Infertility is an important topic in Iranian culture and many studies have already targeted them. The aim of this study was to compare the severity of both depression and sexual dissatisfaction between fertile and infertile groups of women in Iran.Methods: A number of 180 infertile and 540 fertile women participated in this case-control study. The cases were selected through a combination of multistage stratified and cluster sampling method. For each infertile woman, three fertile women were randomly selected. Data gathering instrument consisted of demographic variables, Depression Inventory Scale, Second Edition, and the Linda Berg Sexual Satisfaction Questionnaire. The multivariate marginal model and SPSS 21 software were used for data analyses with a significance level of 0.05.Results: After adjusting for the effect of confounding variables, the marginal model showed the odds of depression increased by approximately 21.305 times among cases compared to control subjects (OR = 21.305, 95% CI for OR:14.75-32.021, P Conclusion: The overall severity of depression and sexual dissatisfaction were higher in infertile group than that of fertile one. Also, most cases of severe depression were seen in IVF clinics, which may boost their depression. The results of this study may help reveal the psychological and social aspects of infertility in, Iran.

Background & Aim: This trial aimed to compare the pain relief and side effects of Oral Acetaminophen (OA) and Intravenous Acetaminophen (IVA) after CABG surgery. Methods & Materials: This parallel-group, triple-blinded, randomized trial was conducted on 113 CABG patients from September 2017 through February 2018. The samples were selected through blocked randomization and allocated into two groups using computer-generated. The participants administered 1gr oral (OA group, n=57) or intravenous Acetaminophen (IVA group, n=56) every 6h for the first 24h following surgery; also, pain controlled in both group with Morphine multimodal analgesia strategy. Pain intensity measurement by VAS was followed after extubating the endotracheal tube at the 0, 1, 6, 12, 18 and 24 hours during the rest and deep breathing. The Morphine consumption and the incidence of nausea and vomiting in the first 24h were assessed. Data were analyzed using SPSS software and Chi-square, t-test, mixed ANOVA and ANCOVA test. Results: The pain score in the IVA group was found to be statistically significantly lower than the OA group at rest (P

Background The relationship between physician and patient is important topic in medical practice. How a physician dresses and addresses the patients are key factors that contribute to developing a rapport. This study aimed to investigate the psychiatrist's perspectives in order to facilitate an effective communication with patients.Methods This descriptive-analytic study was done on psychiatrists and psychiatric residents through a non-selective and non-randomized sampling method. Data were collected based on a questionnaire. Variables were such as age, sex, duration of practice as a psychiatrist, priority for male psychiatrist dress preference, priority for female psychiatrist dress preferences, priority for choosing a doctor from a gender perspective, priority for being addressed by patients, using the word of the gentleman or lady to address the patients, and the type of verbs and pronouns used by the psychiatrist and the patient during the interview in terms of the total number of verbs and pronouns. Subsequently, eight photographs of male and female physician’s coverage according to the in Iranian culture were shown to the participants and they were asked to choose one.Results A total of 77 psychiatrists participated in this study, of which 45 (58.4%) were male and 32 (41.6%) were female. In case of male psychiatrist’s coverage, 56 (72.7%) participants preferred suits; whereas in case of female psychiatrist’s coverages, 25 (32.5%) participants chose colored mantos and scarves, 22 (28.6%) selected black manteos and head dresses. Sixty three (81.8%) patients believed that the gender of the physician was not important in determining the treating physician. According to the type of addressing the psychiatrist by patients, 71 (92.2%) participants preferred to call the doctor's name followed by surname and 60 (77.9%) psychiatrists wanted patients to use the word "Mr. or Ms.” prior their names. Sixty three (81.8%) psychiatrists stated that it was better to use plural pronouns and verbs in interviewing patients, and 67 (87%) preferred their patients to use plural verbs to address them.Conclusions Psychiatrists’ appearance and the accuracy of the patient-referring type, based on what the physicians believe, along with the characteristics of the patients’ perspectives, help improving physician-patient relationship.

Background: Inhalation of lead oxide fumes may cause lead poisoning. Lead has been proven to have harmful effects on different organs. This study aimed to investigate the relationship between the concentration of lead fumes and the levels of reproductive hormones among exposed welders. Methods: A total number of 165 individuals of a construction industry of water pipelines, including 85 welders as the exposure group and 80 administrative staff as the non-exposure group were selected for study. The National Institute for Occupational Safety and Health (NIOSH) 7300 method was used for the purpose of sampling and analysis of lead fumes. Likewise, the NIOSH 8003 method was employed to determine the blood lead level. The level of luteinizing hormone (LH), follicle-stimulating hormone (FSH), and testosterone were measured by Chemiluminescence immunoassay(CLIA) test. Data analyses were done by SPSS ver.21 using descriptive statistics, Student›s t-test and Spearman›s correlation test. Results: The average concentration of lead fumes in the breathing zone and blood were 0.57 ± 0.12 mg/m3 and 460.28 ± 93.65 μg/L, correspondingly, which both were significantly higher than threshold limit values (TLV) and biological exposure index (BEI) recommended by American Conference of Governmental Industrial Hygienists (ACGIH)(P < 0.05). The mean levels of LH and FSH were higher in the exposed group than those in the control group (P < 0.05), however, the mean levels of testosterone were lower in the exposed group compared to non-exposed ones (P < 0.05). A strong correlation was found between the concentration of lead fumes and the blood lead levels (r = 0.82; P = 0.003). Blood lead levels were inversely related to the testosterone levels and directly related to LH (r = 0.72; P = 0.004) and FSH (r = 0.78; P = 0.001) levels. Conclusions: Occupational exposure to metal fumes containing lead among welders may alter the level of sexual hormones and potentially harm the reproductive system.

Background Fatigue is a common compliant among patients who undergo coronary artery bypass graft (CABG) surgery. This may affect patients’ function in all aspects. A few studies have already assessed the influence of complementary therapies on minimizing fatigue. This study aimed to investigate the combined effect of vitamin C and omega-3 polyunsaturated fatty acids (n-3 PUFA) on fatigue following CABG surgery. Methods In this randomized, triple-blind placebo-controlled trial, 160 patients who already underwent CABG surgery were randomly assigned into an experimental or a control groups. Each group consisted of 80 patients. The experimental group was given both n-3 PUFA and vitamin C the day before surgery. They also received the same supplements in the first 5 days of operation. The control group received only placebo. Subjects in both groups responded to Multidimensional Fatigue Inventory (MFI-20) scale in the beginning, and at the end of the intervention as well as on the fifth day of the operation. Chi-square test and independent t-test were used for data analysis. Results The mean fatigue score in experimental and control groups came up to 62.01 ± 4.06 and 67.92 ± 4.95 (p Conclusion Combination of vitamin C and n-3 PUFA effectively reduces post-operative fatigue among patients who undergo CABG surgery.

Complementary therapies have been increasingly used for the prevention and treatment of migraine so that there is a need for studies in this setting. This study sought to determine the effects of basil essential oil on the severity and frequency of migraine attack headaches.A triple-blind clinical trial study was performed on 144 patients diagnosed with migraine. Patients were randomly allocated by a stratified method to four groups of 36 titled basil essential oil 2, 4, 6%, and placebo groups. Medications were used topically every 8 h for 3 successive months. In addition, each individual received 325 mg of acetaminophen every 12 h. The severity and frequency of migraine attacks were measured prior to the study, at weeks 2, 4, 8, and 12. The visual analog scale was used to measure pain intensity. The marginal model and generalized estimation equations were used to compare changes in the intensity and frequency of pain over time.The interaction of the dose and time factors was significant on both pain intensity (p0.001) and frequency of attack (p0.001). The odds ratio of higher pain intensity and rate ratio of higher frequency of attack in the intervention groups compared to the placebo group were decreased over the study time.Time lapse and higher doses of basil essential oil would reduce both the intensity and frequency of migraine attacks.Ziel: Komplementäre Behandlungsansätze finden zuneh­mend Anwendung in der Prävention und Therapie der Migräne, daher bedarf es auch wissenschaftlicher Studien zu diesem Setting. Das Ziel dieser Studie war es, die Auswirkungen von ätherischem Basilikumöl auf die Schwere und Häufigkeit von Migräneattacken und damit einhergehenden Kopfschmerzen zu untersuchen. Methoden: Es handelte sich um eine dreifach verblindete klinische Studie, an der 144 Patienten mit diagnostizierter Migräne teilnahmen. Nach Randomisierung und Stratifizierung wurden die Patienten in vier Gruppen zu je 36 Patienten aufgeteilt: je eine mit essenziellem Basilikumöl 2, 4 und 6% behandelte Gruppe und eine Placebogruppe. Das ­Arzneimittel wurde drei aufeinanderfolgende Monate lang alle acht Stunden topisch angewendet. Zusätzlich erhielt jeder Patient alle zwölf Stunden 325 mg Acetaminophen. Die Erhebung der Schwere und Häufigkeit von Migräneattacken erfolgte vor Studienbeginn und nach Woche 2, 4, 8 und 12. Die Schmerzstärke wurde auf einer visuellen ­Analogskala gemessen. Vergleiche erfolgten anhand der Veränderung der Schwere und Häufigkeit der Schmerzen im Zeitverlauf laut marginalen Modellen und verallgemeinerten Schätzgleichungen. Ergebnisse: Die Wechselwirkungen zwischen den Faktoren Dosis und Zeit waren signifikant, sowohl im Hinblick auf die Stärke der Schmerzen (p0,001) als auch auf die Häufigkeit der ­Attacken (p0,001). Die Odds Ratio für eine höhere Schmerzstärke und die Rate Ratio für eine höhere Anfallshäufigkeit in den Interventionsgruppen im Vergleich zur Placebogruppe nahmen im zeitlichen Verlauf der Studie ab. Schlussfolgerung: Zeitverlauf und höhere Dosierung des ätheri­schen Basilikumöls scheinen die Stärke und Häufigkeit von Migräneattacken zu reduzieren.

There is limited evidence that the gestational age at delivery may influence the risk of maternal breast cancer. While extreme prematurity has been suggested to increase the risk, there seems to be no study available so far that investigates the due effects of a late delivery. This research aimed to identify the impact of both preterm and late deliveries on the risk of maternal breast cancer within a period of 5 years after birth. Our dataset was created by linking data from the Nevada Cancer Registry database (1995-2008) and the birth certificates issued by the Nevada State Health Division (1994-2003). The study cohort consisted of 213,250 women who gave birth from January 1, 1994 to December 31, 2003. We performed a nested population-based case-control study on 126 Nevada mothers with a first lifetime breast cancer diagnosed from January 1, 1995 through December 31, 2003, and 504 Nevada cancer-free mothers. Women with pregnancies who progressed beyond 40 weeks of gestation were at a significantly lower risk of developing breast cancer for the 5-year period following a delivery, when compared to women who delivered at 37-40 weeks of gestation (OR: 0.33, 95% CI: 0.11-0.92) in a multivariate model. Additional pregnancy characteristics did not significantly predict the risk of maternal breast cancer. Pregnancies that extended beyond 40 weeks of gestation were strongly associated with a lower likelihood of premenopausal breast cancer. Biological plausibility for this association may correspond to the fact that as pregnancy develops into more advanced stages, mammary cells have more time to attain complete differentiation and maturation; a process that starts early in the third trimester.

Chest tube removal is an extremely painful procedure and patients may not respond well to palliative therapies. This study aimed to examine the effect of cold and music therapy individually, as well as a combination of these interventions on reducing pain following chest tube removal.A factorial randomized-controlled clinical trial was performed on 180 patients who underwent cardiac surgery. Patients were randomized into four groups of 45. Group A used ice packs for 20 minutes prior to chest tube removal. Group B was assigned to listen to music for a total length of 30 minutes which started 15 minutes prior to chest tube removal. Group C received a combination of both interventions; and Group D received no interventions. Pain intensity was measured in each group every 15 minutes for a total of 3 readings. Analysis of variance, Tukey and Bonferroni post hoc tests, as well as repeated measures ANOVA were employed for data analysis.Cold therapy and combined method intervention effectively reduced the pain caused by chest tube removal (P 0.001). Additionally, there were no statistically significant difference in pain intensity scores between groups at 15 minutes following chest tube removal (P = 0.07).Cold and music therapy can be used by nursing staff in clinical practice as a combined approach to provide effective pain control following chest tube removal.