Search

Abstract Midwife-led continuity of care models have been linked to better clinical outcomes in certain developed countries. However, there is a paucity of research on these models in developing nations. This quasi-experimental study was conducted on primiparous women who referred to one private midwifery center and two public hospitals in Ahvaz, Iran to evaluate the effect of team midwifery care on maternal and neonatal outcomes of pregnant women in Iran. Two hundred women were allocated either into the experimental (n = 100) or control (n = 100) groups. Women in the experimental group, received team midwifery care, while women in the control group, received routine care. Data were collected using a demographic questionnaire, Mackey questionnaire, and a checklist. Women in the team midwifery care group experienced significantly higher rates of normal vaginal birth and exclusive breastfeeding compared to women in the control group. No statistically significant difference was observed between the two groups in terms of the rate of induction of labor and postpartum hemorrhage. The duration of labor was longer in the team midwifery care compared to the control group. Women in the team midwifery care group had a significantly higher rate of exclusive breastfeeding at six weeks postpartum compared to the control group (80 vs. 61%, p = 0.001). After excluding women with ruptured membranes and prolonged pregnancies, neonates in the intervention group had significantly higher first- and fifth-minute Apgar scores (p

Background and purpose: Culicidae plays a crucial role in the spread of diseases like Malaria and arboviral diseases such as Japanese Encephalitis, Zika virus, Chikungunya, Dengue fever, Yellow fever, and West Nile fever. Different mosquito species have different abundance and distribution due to a variety of factors, such as physicochemical factors, weather conditions, vegetation, and human activities. The characteristics of larval habitats are among the factors affecting the population, and diversity, and determining the preferred breeding places of the species. For this reason, a study was conducted to examine the species diversity of Culicidae and their larval habitats in Shushtar County. Materials and methods: This cross-sectional study was conducted in Shushtar County from the central, Mian Ab and Shuaibiya districts, 2021. Larvae were collected from the breeding places in the sampling areas including Noormohammadi, Konarpir, Saheli, Abu Gerva, and Pirdalu by using the dipping technique in spring and summer and kept in lactophenol solution. Then, a microscopic slide was prepared from the samples using licidophor, which were identified with valid diagnostic keys. Characteristics of larval habitat such as habitat type, water condition, vegetation, substrate type, water quality, and light condition were also recorded. To analyze the data and determine the relationship between the frequency and characteristics of larval habitats, SPSS version 16 software and a chi-square statistical test were used. Qualitative variables were also reported as numbers (percentages). Abundance and distribution maps of samples were prepared using ArcGIS software version 10.5. Results: In this study, a total of 527 larvae were identified, including five species of Anopheles stephensi, Culex pusillus, and Cx. sinaiticus, Cx. theileri and, Cx. Perexiguus. Anopheles stephensi with the lowest frequency (8.48%) was reported only from the Saheli area. This species was collected from temporary, stationary, without vegetation, mud substrate, cloudy water, sunny, and natural habitats. Culex theileri, one of the important vectors of arboviral diseases, was observed in temporary and natural habitats, stagnant waters without vegetation, and cloudy and sunny waters habitates. Culex pusillus was the only species observed in Pirdalo and Abu Gerva. By examining the larval habitats of Culicidae in Shushtar County, Cx. pusillus was the most abundant collected species, from temporary habitat (82.7%), stagnant waters (73.6%), mud substrate (100%), turbid waters (78.6%), natural (95%), and sunny (82.7%). Also, the abundance of collected larvae in temporary habitats, stagnant waters, in areas with vegetation, and mud substrate was high. Besides, it was more abundant in turbid waters and sunny areas, and these differences were statistically significant (P

BackgroundPostpartum depression is a major psychiatric disorder that affects the mother-baby attachment and may impair cognitive development of the child.ObjectiveThis study aimed to evaluate the effect of curcumax (including ginger, turmeric, and black pepper) on postpartum depression in reproductive-aged women.Material and methodsThis was a randomized controlled trial in which 124 women were recruited and randomly assigned into two groups of curcumax (n=62) and placebo (n=62) who consumed curcumax or placebo for 8 weeks (one capsule each day). Postpartum depression was measured using Edinburgh Depression Scale. Data were analyzed using Chi-square, independent t-test, and GEE.ResultsThe mean (SD) score of depression score was 15.83 (2.77) and 15.45 (2.97) before intervention, which reduced to 3.48 (4.29) and 7.22 (3.98) in the intervention and control groups, respectively after 4 weeks (p

Abstract Background This study sought to examine the impact of magnesium supplementation on clinical outcomes and biochemical factors among hospitalized patients with COVID-19. Methods This double-blind, randomized clinical trial was conducted at Razi Hospital, Ahvaz, Iran, between September 2021 and March 2022. Participants aged 18–70 years with moderate disease severity were enrolled. Magnesium supplementation (300 mg daily) was administered to the intervention group, while the control group received a placebo. Clinical outcomes, including the need for oxygen therapy, oxygen saturation, respiratory rate, fever, hs-CRP and TNF-α levels, as well as quality of life and mental health, were assessed. Blood samples were collected to measure biochemical variables. Results The main result was the count of individuals requiring oxygen therapy. Additional outcomes comprised of oxygen saturation, respiratory rate, fever, hs-CRP and TNF-α levels, as well as quality of life and mental health. Out of 64 participants, 60 completed the study. The results showed that magnesium supplementation significantly reduced the number of patients requiring oxygen therapy (9 vs. 14; P 0.05). Conclusion The findings suggest that magnesium supplementation may have beneficial effects on clinical outcomes and arterial oxygen saturation in COVID-19 patients. More investigation is necessary to delve into its potential mechanisms and long-term effects on patient outcomes. Trial registration This study is registered on Iranian Registry of Clinical Trials (IRCT) under identifier IRCT20210413050957N1. (The registration date: May 1, 2021).

Background: Transferring patients from intensive care units to general units can increase anxiety in patients and their families, which can lead to re-admission of patients in intensive units and increase hospitalization costs.Aim: The present study was performed with aim to determine the effect of the transition nursing program from intensive care units to general units on the anxiety and satisfaction of patients and their families.Method: This randomized clinical trial study was conducted on 50 patients hospitalized in surgical ICUs and 50 of their relatives. The research units were randomly assigned to the intervention and control groups. Before transfer, patients and their families filled out the Spielberger and satisfaction questionnaire. Then, the transition nursing program was implemented and the patient was examined by the liaison nurse immediately, 8, 16 and 24 hours after transfer. Then, the questionnaires were filled out again. Data were analyzed by SPSS software (version 22). p

Abstract Background and Aims Sexual self‐efficacy refers to a woman's belief that she can be sexually active and attractive for her sexual partner and has acceptable sexual function. One of the issues that may negatively affect sexual self‐efficacy is HIV infection. The present study aimed to evaluate the effect of 8 weeks of counseling based on mindfulness on sexual self‐efficacy of women affected with HIV. Methods This was a randomized controlled trial involving 62 HIV‐positive women in their reproductive age. Women in the intervention group were further divided into four groups. Each group received eight sessions of counseling based on mindfulness, while the control group received no intervention. A demographic questionnaire and sexual self‐efficacy questionnaire were used to collect the data. The independent t test, χ2, and repeated measure tests were used to analyze the data. Results The mean change of total score of sexual self‐efficacy in Week 8 compared with before intervention was 37.04 (95% CI: 31.38–42.70, p

Background: People with knee osteoarthritis have a low quality of life due to joint pain and stiffness, severely limiting their daily activities. This study aims to investigate the impact of self-acupressure on the pain, joint stiffness, and physical functioning of patients with knee osteoarthritis. Methods: This randomized clinical trial was conducted on 78 patients aged 50 to 70 with knee osteoarthritis, referred to Imam Khomeini Hospital and private orthopedic clinics in Ahvaz City, Iran, in 2018. The patients were recruited based on the inclusion criteria and then randomly assigned to three groups: self-acupressure (n=26), sham (n=26), and control (n=26). Patients in the intervention group applied daily self-acupressure to 5 specific points around their knees for 8 consecutive weeks. The sham group applied pressure on the points different from those used by the intervention group. The control group received no intervention. The study data were collected using the Western Ontario and McMaster osteoarthritis index (WOMAC), visual analog scale (VAS), and a checklist for daily recordings of pain medication. The obtained data were analyzed using the chi-square test and analysis of variance in SPSS software, version 20. The significance level was set at P

BackgroundFear of childbirth is one of the main causes of women’s emotional difficulty experienced in the perinatal period, especially those having their first child.ObjectiveThe aim of this study was to investigate the effect of emotional freedom technique (EFT) on the fear of childbirth among primiparous women in Ahvaz, Iran.Materials and methodsThis randomized clinical trial was conducted on 116 primiparous women. The participants were randomly divided into intervention (n = 58) or control (n = 58) groups. The intervention group received daily stimulation of certain points in their body for 12 weeks using EFT. The fear of childbirth was measured at the beginning of the study and 12 weeks after the intervention using the Wijma Delivery Expectancy/Experience Questionnaire (WDEQ-A) and at the first postpartum visit with WDEQ-B. Data were analyzed using independent t-test, paired t-test, Chi-square or Fisher’s exact test, and analysis of covariance (ANCOVA).ResultsAfter intervention, the mean score of fear of childbirth in the intervention group decreased from 49.39 ± 8.21 to 40.42 ± 13.43 (p

Background The gestational diabetes causes complications for the mother and the baby.Methods It was a randomised controlled trial that was conducted in Public Health Center No 1 in Baghmalek, Khuzestan province, Iran. Seventy-six women with gestational diabetes mellitus (GDM) were recruited and randomly allocated into an intervention (n=38) and a control group (n=38). A mobile app was developed, and the content of the educational programme was designed according to the six dimensions of Health Promotion Lifestyle Profile (HPLP). Participants in the intervention group followed instructions about healthy lifestyle for 4 weeks, whereas the control group received only routine care. A demographic questionnaire, and the HPLP-II were used to gather the data.Health promoting lifestyle and blood sugar of participants were measured after 4 weeks.Results The total score of HPLP was 98.34±13.99 and 92.39±14.56 before the intervention in intervention and control groups, respectively, which was improved significantly in the intervention group compared with the control group after intervention (143.13±23.41 vs 100.39±16.69, p

Background: A high-risk pregnancy (HRP) is adversely affects the health of the mother, baby, or both.Most prenatal care research, rather than quality concepts, focuses on the adequacy of prenatal careand describes the emotional-psychological experiences of women with HRP. The main purpose of thisstudy was to explore the perspectives of healthcare professionals regarding the quality of prenatal carefor women with HRP.Methods: This qualitative study was conducted in three university hospitals and 12 comprehensivehealth centers in Ahvaz (Iran) from December 2020 to May 2021. In the present study, 10 midwives,2 executive directors, and 7 specialists were purposefully selected with maximum diversity. In-depthsemi-structured individual interviews were used to collect the data. Data were analyzed concurrentlyusing Elo and Kinga’s content analysis. The MAXQDA software version 10 was used for data analysis.Results: During data analysis, the 6 main categories “infrastructure for care provision”, “optimalclinical care”, “organizing referrals”, “preconception care”, “risk assessment”, and “family-centeredcare” and 14 subcategories were identified.Conclusion: Our findings showed that professional groups focused on the technical aspects of caring.The findings from this study highlight several conditions that can affect the quality of prenatal carefor women with HRP. Healthcare providers can use these factors to effectively manage HRPs, therebyimproving pregnancy outcomes among women with HRPs.

Background: Fatigue and re-admissions are the important consequences of heart failure that cause limitations in patients’ daily activities, personal, and social affairs. Energy conservation techniques are among evidence-based and non-pharmacological approaches that can reduce fatigue in patients with chronic disease. Aim: The present study was performed with aim to determine the effects of tailored energy conservation training on fatigue and readmissions of patients with heart failure (HF).Method: This randomized clinical trial study was performed from May 2019 to March 2020 on 96 patients with HF admitted to CCU and cardiovascular clinics affiliated to Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Patients who met the inclusion criteria were randomly assigned to the intervention and control groups. A three-part tool (demographic-clinical questionnaire and need assessment), the Fatigue Severity Scale (FSS) and a readmissions record checklist were used to collect data. After determining the training needs of each individual, the intervention group received five 45-minute face-to-face individual training sessions of energy conservation strategies reinforced by telephone support every two weeks and followed up for 12 weeks. The control group only received routine post-discharge training. Fatigue scores by FSS and the readmissions recorded were tested at baseline and three months after the end of the intervention.Results: At baseline, the two groups were comparable in the mean hospital admissions and fatigue scores. However, after the intervention, the mean frequency of hospital admissions and the mean fatigue score were significantly lower in the intervention group (1.36±1.26, P< 0.001; 2.86±1.01,P< 0.001) than in the control group (0.42±0.77, P< 0.001; 5.25±1.03, P< 0.001) respectively.Implications for Practice: Nurses and physicians are recommended to teach energy conservation methods to patients with HF and chronic conditions who are prone to fatigue and its side effects.

Abstract Background and aim Standard airway care can reduce the incidence of ventilator-associated pneumonia (VAP). This study aimed to determine the effect of implementing infection control guidelines on the incidence of VAP in patients admitted to the intensive care unit (ICU). Materials and Methods In this clinical trial, 121 patients admitted to the intensive care units of Golestan and Imam Khomeini hospitals of Ahvaz, Iran who were under mechanical ventilation were assigned to two groups of control and intervention in non-randomly allocation. The study was conducted in two consecutive periods. In the intervention group, infection control guidelines were performed to prevent VAP and in the control group, routine care was performed. Data collection is done by used a three-part instrument. The first part included questions on the patients’ demographics and clinical information. The second part was the modified clinical pulmonary infection scale (MCPIS) for the early detection of VAP. The third part of the data collection instrument was a developed checklist through literature review. The MCPIS was completed for all patients on admission and the 5th day of the study. Results The two groups were homogenous respecting their baseline characteristics (P > 0.05) including the mean MCPIS score (P > 0.05). However, the intervention group had lower body temperature (P

Background: Preterm Birth (PTB) is one of the leading causes of infant morbidity and mortality. Prenatal care is an effective way to improve pregnancy outcomes but there is limited evidence of effective interventions to improve perinatal outcomes in disadvantaged pregnant women. This review was conducted with the aim to assess the effectiveness of prenatal care programs in reducing PTB in socioeconomically disadvantaged women. Materials and Methods: We searched the Scopus, PubMed, Web of Science, and Cochrane Library databases from January 1, 1990 to August 31, 2021. The inclusion criteria included clinical trials and cohort studies focusing on prenatal care in deprived women with the primary outcome of PTB (< 37 weeks). Risk of bias was assessed using the Cochrane Collaboration's tool for assessing risk of bias and the Newcastle–Ottawa Scale. Heterogeneity was evaluated using the Q test and I2 statistics. The pooled odds ratio was calculated using random-effects models. Results: In total, 14 articles covering 22,526 women were included in the meta-analysis. Interventions/exposures included group prenatal care, home visits, psychosomatic programs, integrated intervention on socio-behavioral risk factors, and behavioral intervention through education, social support, joint management, and multidisciplinary care. The pooled results showed that all types of interventions/exposure were associated with a reduction in the risk of PTB [OR = 0.86; 95% confidence interval: (0.64, 1.16); I2 = 79.42%]. Conclusions: Alternative models of prenatal care reduce PTB in socioeconomically disadvantaged women compared with standard care. The limited number of studies may affect the power of this study.

Background: In many studies, Cox regression was used to assess the important factors that affect the survival of cancer patients based on demographic and clinical variables. The aim of this study was to determine the factors affecting the survival of patients with Hodgkin's lymphoma using the random survival forest (RSF) method and compare it with the Cox model. Methods: In this retrospective cohort study, all patients with Hodgkin's lymphoma who were referred to the Oncology and Hematology Center of Ahvaz Shafa Hospital from March 2000 to February 2010 were included. The survival time was calculated from diagnosis to the first recurrence event date (based on month). To assess the process of the disease, demographic characteristics and disease-related variables (including disease stage, chemotherapy, site of lymph involvement, etc.) were extracted from the records of 387 patients with Hodgkin's lymphoma. To investigate the prognostic factors that affect the recurrence of disease the Cox model and RSF were implemented. Moreover, their performance based on the C-index, IBS, and predictor error rate of the two models were compared Data analysis was implemented by using R4.0.3 software (survival and RandomForestSRC packages). Results: The results of the Cox model showed that LDH (P=0.001) and classical lymphoma classification (P

Background: Natural disasters, such as floods provide the basis for spreading vector-borne diseases by creating environmental changes. This study aims to investigate the common vector-borne diseases during floods in Khuzestan Province, Iran, in 2019 and the strategies and challenges to control them. Materials and Methods: This research is applied objectively and it is a descriptive survey in terms of collecting data using a qualitative method. The statistical population in the qualitative section included 15 experts from health centers in Khuzestan Province with a history of presence in flooded areas who were purposively selected using the snowball technique. The data collection tool was a semi-structured interview. Results: Qualitative data were categorized into 5 categories of common arthropods, common vector-borne diseases, vector control strategies and challenges, and organs involved in vector control programs during floods. The most common arthropods were lice, mites, mosquitoes, flies, and scorpions. The most prevalent vector-borne diseases during the flood were scabies, pediculosis, mosquito bites, and scorpions. The critical challenge was the lack of national vector control guideline in disaster condition. Conclusion: Considering the history of floods and health problems caused by these natural disasters, it is necessary to recognize the common vector-borne diseases, develop national guidelines, and provide solutions to deal with them.

IntroductionThe COVID-19 virus spreads at a high rate, exerting many physical, mental and psychological effects on patients. Patients with COVID-19 have been reported to have high levels of interleukin 1 and interleukin 6. Therefore, this study was conducted to determine the association of physical, mental, and psychological problems with the levels of interleukin-1 and -6 in COVID-19 patients.MethodologyThis is cross-sectional descriptive-analytical research on 121 COVID-19 patients selected using simple random sampling method. The patients were hospitalized in university hospitals affiliated to Ahvaz Jundishapur University of Medical Sciences and Amir al-Momenin Hospital. Data collection tools included the depression anxiety stress scale (DASS), a demographic questionnaire, and a checklist of physical problems. Blood sampling was also done to perform an ELISA test and measure the level of interleukin-1 and -6. Data were analyzed based on independent t-tests, chi-square, regression, and Pearson’s correlation coefficient, using SPSS ver. 22.ResultsThe average age of the 121 patients participating in this study was 53.31 ± 14.09. A direct and statistically significant correlation was observed between body temperature on the first day and interleukin 1 level. A statistically significant negative correlation was observed between blood oxygen saturation level and interleukin-1 and -6 on the first, third and fifth days. Shortness of breath and coughing had a statistically significant correlation with the level of interleukin 1 on the third and fifth days. A direct and statistically significant correlation was observed between body temperature on the first, third and fifth days and interleukin 6 level. Coughing on the third and fifth days had a statistically significant relationship with interleukin 6 level. No direct and non-significant statistical correlation was found between depression and stress and the serum level of interleukin 1, but a significant correlation was observed between anxiety and serum level of interleukin 1. Finally, the results showed that depression, anxiety and stress had a direct and statistically significant correlation with the serum level of interleukin 6.ConclusionGiven the relationship between interleukin-1 and -6 and most physical and psychological problems, level of the inflammatory biomarkers interleukin-1 and -6 can be used to estimate the severity of physical and psychological symptoms in COVID-19 patients.

Introduction As recommended by the WHO, promotion of physiological birth is a main strategy to reduce the rate of caesarean section and achieve Sustainable Development Goals. A modified version of the physiological birth programme that may be included into the Iranian healthcare system was developed as a result of this mixed-methods research.Methods and analysis This embedded mixed-methods study had a qualitative phase that was conducted before a clinical trial. This qualitative phase was conducted via semistructured in-depth targeted interviews with the recipients and the providers of physiological birth programme services. Data analysis was performed using a conventional content analysis approach. Then, for designing the intervention, national and international guidelines of physiological birth were reviewed, and a panel of experts was convened using the Delphi method. A randomised controlled trial was used in the second phase of the research to examine the impact of the physiological birth programme’s intended intervention on maternal and neonatal outcomes as well as mothers’ experiences during labour. It was conducted on 252 eligible pregnant women in two intervention and control groups. Finally, the results of qualitative and quantitative phases contributed to developing a physiological birth programme which can be integrated into the Iranian health system.Ethics and dissemination This study was approved by the Ethics Committee of Ahvaz Jundishapur University of Medical Sciences (IR.AJUMS.REC.1401.050). All participants gave their informed permission. The study’s findings will be shared via the publishing of peer-reviewed articles, talks at scientific conferences and meetings with related teams.Trial registration number Iranian Registry of Clinical Trials (IRCT20220406054438N1).

IntroductionIncreased rate of caesarean section (CS) without medical indication is a global concern. According to the guidelines of the World Health Organization (WHO), the physiologic birth program is one of the strategies for reducing the rate of unnecessary caesarean sections. The aim of this study is to explain women's experiences with the implementation of the physiologic birth program in Iran.Materials and methodsThis study is a part of a mixed-method study involving 15 targeted semi-structured interviews individually conducted with women attending physiologic birth classes between January 2022 and June 2022. Interviews continued until data saturation was achieved. Data were analyzed using conventional content analysis approach based on the criteria proposed by Graneheim and Lundman, using MAXQDA10 software.ResultsAnalysis of the findings of the study led to the emergence of 2 themes, 4 categories, and 10 subcategories. The first theme was the positive experiences of the women (“satisfaction with pregnancy” and “making the childbirth process pleasant”), and the second theme was their negative experiences with physiologic birth (“challenges and limitation of physiologic birth program” and “lack of high-quality obstetric services in the public health system”).ConclusionThe results of this study showed that childbirth preparation classes reduced women's fear and stress and enhanced their positive attitude toward vaginal delivery by preparing them for childbirth. Also, effective communication with midwives and their support along with efficient implementation of physiologic birth techniques led to successful pain management and satisfaction with the birth process. Policymakers should implement strategies to remove limitations and make this program accessible to all women.

ObjectiveThe present study was conducted with the aim of determining the impact of rewriting pleasant events on the level of occupational stress in Intensive Care Unit (ICU) nurses.MethodsThis is a quasi-experimental research conducted on nurses working in the intensive care units of Imam Khomeini and Golestan hospitals in Ahvaz, from July to November 2021. Seventy-six nurses were selected based on the inclusion criteria, and were then randomly assigned to the intervention and the control groups. The nurses’ demographic information form and the Expanded Nursing Stress Scale (ENSS) were used to collect data. In the intervention group, the technique of rewriting pleasant events was used for 8 weeks, at least once a week. The data was analyzed with SPSS V20.ResultsNo significant difference in the demographic characteristics was observed between the intervention and the control groups (p > 0.05). The pre-intervention occupational stress of the nurses in the intervention and the control groups were reported to be 173.86 ± 26.75 and 173.05 ± 24.47, respectively, showing no statistically significant difference (p = 0.89). After the intervention, the occupational stress scores were 134.21 ± 16.09 and 172.36 ± 24.33, respectively, showing a significant difference between the two groups (p

Background and purpose: Khuzestan Province in Iran is one of the endemic foci of zoonotic cutaneous leishmaniasis (ZCL) caused by Leishmania major and Phlebotomus papatasi as the main vector. The aim of this study was to predict the probability of presence of Ph. papatasi in this province using Hierarchical Analysis Process (AHP) and Geographic Information System (GIS). Materials and methods: In order to determine the distribution of Ph. papatasi, sand flies were collected in five counties, including Izeh, Mahshahr, Ahvaz, Dasht-e-Azadegan, and Andimeshk by sticky paper traps in spring and summer, 2018. Six criteria, including average annual temperature, average annual rainfall, average annual relative humidity, land use, soil texture, and elevation were selected. Maps of criteria were prepared in ArcGIS 10.5 software. The weights of the criteria and sub-criteria were determined using Expert Choice 11. Then, the final map of the probability of vector presence was prepared by combination of weighted maps and including the weight of the criteria. Results: In this study, 13 species of sand flies of two genera, Phlebotomus and Sergentomyia, were collected. The abundance of Ph. papatasi from samples collected in Izeh, Dasht-e-Azadegan, Mahshahr, Andimeshk, and Ahvaz was 55%, 72%, 69.4%, 3%, and 66.5%, respectively. Based on the analysis of matrix tables, average annual temperature (0.406), average annual relative humidity (0.233), and average annual rainfall (0.156) had the highest weight in probability of the vector presence, respectively. Conclusion: This study provides useful information for health authorities in determining the distribution of Ph. papatasi to act properly based on facilities and budget in case of outbreak.

Background: Pain is the most crucial reason to seek treatment, and acupressure is one of the most common ways to relieve pain; therefore, this study was conducted with the aim to investigate the effectiveness of acupressure on the reduction of pain and stability of physiological indexes in addicted men. Methods: The present single-blind, randomized, clinical trial was performed on 90 participants who were hospitalized in an addiction treatment camp in Masjed-e-Soleyman, Iran. The participants were divided into acupressure group (n = 45) and control group (n = 45) through allocating permutation blocks method. The acupressure group received acupressure on SP6 and ST36 points for 3 consecutive sessions and each session for 10 minutes. The data collection tools used included a demographic information questionnaire, the Short-Form McGill Pain Questionnaire (SF-MPQ), and a physiological index registration form, tympanic thermometer, sphygmomanometer, pulse oximetry device, and digital watch. Repeated measures ANOVA was used to analyze the data. P ≤ 0.05 was considered statically significant. Findings: There was a statistically significant decrease in the sensory dimension of pain in the acupressure group compared to the control group in all 3 sessions (P ≤ 0.001; P ≤ 0.001; P = 0.001, respectively). There was no statistically significant difference in the overall pain score (P ≥ 0.005), emotional pain dimension (P ≥ 0.005), and physiological indexes of pain (P ≥ 0.005) between the two groups after the intervention. Conclusion: Acupressure is a non-invasive and cost-effective method that reduces the sensory dimension of pain, and its application does not require special tools; thus, the use of such a safe and secure method for relieving pain is recommended.

Background: Psychological Distress (PD) is one of the most common mental disorders during pregnancy and involves stress, anxiety, and depression. According to the literature, High-Risk Pregnancy' (HRP) is a major physiological risk factor associated with PD during pregnancy. The main purpose of this study was to explore the perception and experience of women with HRP who, based on standard questionnaires, had moderate-to-severe stress and anxiety scores. Materials and Methods: This qualitative study was conducted using conventional content analysis from December 2020 to June 2021. To this aim, 16 women with HRP were purposefully selected from Imam Khomeini Hospital in Ahvaz, Iran, with maximum diversity. In-depth, semi-structured, individual interviews were conducted to collect the data. The MAXQDA software was used for data analysis. Results: Data analysis led to the extraction of two main categories and nine subcategories. “Disrupted peace” and “inefficient adaptation to the situation” were the two extracted categories. The former included the five subcategories of concerns about pregnancy complications, concerns about the parenting process, concerns about the couple's relationship, fear of Covid-19, and occupation-related stress. The latter included the three subcategories of unpleasant feelings, current pregnancy experiences, and previous pregnancy experiences. Conclusions: This study highlighted a wide range of psychosocial factors involved in the PD of women with HRP. These findings can be used to design appropriate prevention strategies to manage the mental health problems of these women in order to turn their pregnancy into a pleasurable experience.

Background: Vulvovaginal candidiasis is the second most common cause of vulvovaginal infections. Due to the increasing resistance to synthetic antifungal drugs, the use of drugs with a natural origin is a priority. The aim of the present study was to compare the effectiveness of Arnebia euchroma with vaginal cream clotrimazole 1% United States Pharmacopeia (USP) for the treatment of vulvovaginal candidiasis. Materials and Methods: This triple-blind trial study was performed on 112 women with diagnosed Candida vaginitis clinically and by a laboratory test, patients were randomly divided into two groups receiving Arnebia euchroma and vaginal clotrimazole (56 people per group) in clinics and medical centers Ahvaz (Iran) from April 2018 to April 2019. Clinical and laboratory symptoms were recorded at the beginning of the study and 1 week after the end of treatment by a researcher-made questionnaire. Data analysis were performed using SPSS software v-23. p < 0.05 was considered significant. Results: After the intervention, vaginal culture was negative in terms of Candida in 17 (36.17%) patients of the Amoeba euchroma group and 37 (69.81%) patients of the clotrimazole group. The Chi-square showed that there was a significant difference between the culture results in both groups (χ2 = 10.10, df = 1, p = 0.001). No differences were observed between the two groups in terms of vaginal symptoms based on adjustment for age and using a logistic regression model. Conclusions: A vaginal cream containing Arnebia euchroma could reduce the complaints of vulvovaginal candidiasis. But, future studies with larger sample sizes and different dosages are recommended.

IntroductionThe rate of cesarean section is on the rise in both developed and developing countries, and Iran is no exception. According to the WHO, physiologic labor is one of the main strategies for reducing cesarean section and improving the health of mothers and newborns. The aim of this qualitative study was to explain the experiences of health providers regarding implementation of the physiologic birth program in Iran.MethodsThis study is a part of a mixed-methods study, in which 22 health providers were interviewed from January 2022 to June 2022. Data analysis was performed using Graneheim and Lundman's conventional content analysis approach and using MAXQDA10 software.ResultsTwo main categories and nine subcategories emerged from the results of this study. The main categories included "the obstacles to the implementation of the physiologic birth program" and "strategies for improving implementation of the program". The subcategories of the first category included: lack of continuous midwifery care in the healthcare system, lack of free accompanying midwives, lack of integrated healthcare and hospitals in service provision, low quality of childbirth preparation and implementation of physiologic birth classes, and lack of requirements for the implementation of physiologic birth in the maternity ward. The second category included the following subcategories: Supervising the implementation of childbirth preparation classes and physiologic childbirth, support of midwives by insurance companies, holding training courses on physiologic birth, and evaluation of program implementation.ConclusionsThe experiences of the health providers with the physiologic birth program revealed that policymakers should provide the ground for the implementation of this type of labor by removing the obstacles and providing the particular operational strategies needed in Iran. Important measures that can contribute to the implementation of the physiologic labor program in Iran include the following: Setting the stage for physiologic birth in the healthcare system, creating low- and high-risk wards in maternity hospitals, providing professional autonomy for midwifery, training childbirth providers on physiologic birth, monitoring the quality of program implementation, and providing insurance support for midwifery services.

Background: The intensive care unit memory (ICUM) assessment tool is a practical tool for memory monitoring after the discharge from ICU. Objectives: This psychometric study purported to validate ICUM for a sample population of Iranian patients hospitalized in ICU. Materials & Methods: This research was a descriptive-analytical study that was conducted at Ahvaz University of Medical Sciences in 2022. A total of 96 patients were selected through the convenience sampling method and were asked to complete the questionnaire 2 weeks and 8 weeks after their discharge from the hospital. Exploratory factor analysis was run to validate the tool’s structure. The reliability of the ICUM tool was checked by the testretest method and the Cronbach alpha coefficient for memory subscales. Results: To increase the qualitative face and content validity of the tool in Persian, some vague items were modified according to the suggestions of the participants, language, and nursing experts. For the quantitative face validity, the item coefficient was calculated, and the minimum score obtained was 4.4. For the quantitative content validity, the content validity ratio (CVR) and content validity index (CVI) were calculated. The minimum obtained scores were CVI=0.7 and CVR=0.6. Thus, all the items were confirmed. The implementation of the factor analysis was confirmed with KMO=0.65. The highest Cronbach alpha coefficient for delusional memory was 0.62 and the highest test-retest correlation for factual memory was 0.95. Conclusion: The Persian version of ICUM has strong test-retest reliability, but weak internal consistency reliability. It is recommended that future studies evaluate the tool’s reliability over an extended period.

Background: Asthma essentially represents a chronic inflammatory disease that manifests as a lifelong condition with different severity throughout the life of patients with asthma. Pomegranate holds three times the antioxidant activity compared to other polyphenol-rich food sources like green tea, which may positively impact asthma.Aim of the study: This research aimed to investigate the pomegranate supplementation influences clinical symptoms, eosinophil, basophil, and neutrophil counts in patients with allergic asthma.Materials and Methods: Participants (n = 64) suffering from mild to moderate allergic asthma were randomly divided into two groups: The control group received placebo capsules and the intervention group received 250 mg pomegranate extract capsules twice a day (for 8 weeks). To analyze the data, we used SPSS software (version 22). The significance level of p-value was considered less than 0.05.Results: The findings showed that the pomegranate extract improved patients’ clinical symptoms like daily breath shortness, nocturnal breath shortness, and limitation of asthma-related activity in the intervention group compared to the control group. Furthermore, eosinophil, basophil, and neutrophil counts were significantly decreased in the intervention group. Also, by comparing the two groups, the levels of change in neutrophils and eosinophils were statistically significant.Conclusion: It appears that the pomegranate extract can ameliorate some clinical symptoms and reduce neutrophils, basophils, and eosinophils in allergic asthma patients.Clinical Trial Registration:https://www.irct.ir/trial/45612; identifier: IRCT20200205046384N1.

Abstract Introduction This study aimed to evaluate the levels of sex hormones in patients with COVID‐19 in Ahvaz, Iran. Methods A prospective longitudinal study was conducted at Razi hospital, Ahvaz, Iran, from July 2020 to Febuary 2021. The levels of sex hormones including estradiol, progesterone, luteinizing hormone (LH), follicle stimulating hormone (FSH), and total and free testosterone were measured in 162 patients with COVID‐19 infection during hospitalization and 1 month after discharge. A demographic questionnaire and a checklist were used to collect the data. Mann−Whitney U test, χ2 test, Fisher's exact test, Wilcoxon test, and logistic regression were used to analyze the data. Results Sex hormones were assessed in 162 patients at baseline; however, a month after discharge, only 69 patients provided consent for assessment, and 9 had passed away. The estradiol level was 407.70 ± 623.37 and 213.78 ± 407.17 pg/ml in female patients with severe and moderate diseases at baseline, respectively which reduced to 195.33 ± 380.04 and 58.20 ± 39.45 pg/ml after discharge (p = 0.011 and p = 0.001). The alteration in the levels of progesterone, LH, and FSH were not significant. The level of LH in both groups of male patients with severe (6.64 ± 2.91 IU) and moderate disease (6.42 ± 4.44 IU) was high, which reduced after discharge (4.16 ± 2.44 and 3.93 ± 3.15 IU, respectively), but this decrease was significant only in the patients with severe disease (p

Background: In vitro, Ziziphus Spina-Christi (ZSC) leaves have been shown to have antimicrobial and antifungal effects. This study aimed to examine the effects of Ziziphus Spina leaves hydro-alcoholic extracts with Clotrimazole against Candida albicans in female rats. Methods: Four groups of rats were infected vaginally with C. Albicans, and 1 group not infected was considered negative control. The infected groups received the following treatments: 2 groups were treated with vaginal 5%, or 10%, of Ziziphus Spina extract creams. One group received 1% clotrimazole, and 1 group did not receive any treatment considered a positive control. Results: The mean number of colony-forming units (CFUs) before the intervention was 195.83 ± 395.126 in the 5% ZSC group, 346.33 ± 396.719 in the 10% ZSC group, 345.17 ± 507.431 in the clotrimazole group, 212.20 ± 148.304 in the positive control group ( P = .604), and 0 in the negative control group ( P = .003). After 1 week, the average number of CFUs considerably dropped to 65.14 ± 36.03 in the 5% ZSC group, 1.43 ± 3.60 in the 10% ZSC group, and 0.43 ± 1.13 in the clotrimazole group. The number in the positive control group remained unchanged (212.20 ± 148.304) ( P = .005). After 2 weeks, the average number of CFUs was 0 in the 10% ZSC group, Clotrimazole and negative control groups and was 4.57 ± 23.99 in the 5% ZSC group ( P < .001). Conclusions: Our findings indicated that the effectiveness of Vaginal creams containing 10% Ziziphus Spina is similar to Clotrimazole in eliminating C. Albicans.

Background: Pediculosis, caused by Pediculus spp is an important public health problem in urban and rural areas around the world. Natural compounds such as plant essential oils (EOs) have been suggested as a potential alternative for insect pest control recently. The purpose of this study was to investigate the toxicity of Foeniculum vulgare essential oil against the head louse, Pediculus capitis under laboratory conditions. Methods: Fennel essential oil components were analyzed using GC-mass apparatus. Immersion and contact filter paper bioassays were used to evaluate fennel essential oil toxicity at the two-fold concentrations of 2.5, 5, 10, 20, and 40% against nit and nymph/adult stages of the head louse. Results: Trans-anethole, α-Thujone, and limonene, which consisted of 76.08%, 10.37%, and 5.34% were the most com­ponents of fennel oil respectively. The LC50 values for the adult /nymphs were 11.5, 6.4, 3.9, 3.1 and 2.5% and LC99 values were 29.5, 15.2, 12.8, 10.8, and 7.4% at 10, 20, 30, 45 and 60 minutes after exposure respectively. The le­thal times (LT50) for adults/nymphs were 5.2, 8.1, 9.5, 20.5, and 45.8 minutes and LT99 were 138.6, 91.3, 23.8, 21.7, and 13.9 minutes in the concentrations of 2.5, 5, 10, 20 and 40%, respectively. LC50 and LC99 values were 2.32% and 7.36% after 5 days for the eggs. Conclusion: Fennel essential oil at the concentration of 15% after 20min is suggested to develop as an appropriate for­mulation to evaluate in clinical trials.

Existing asthma treatments are associated with side effects and limitations, which has led to an interest in alternative and complementary therapies. Given the anti-inflammatory properties of pomegranate, the present study aimed to determine the impact of pomegranate extract supplementation on lung function parameters evaluated through spirometry, high-sensitivity C-reactive protein (hs-CRP), pro-oxidant antioxidant balance, and interleukin 35) (IL-35) in participants with mild and moderate allergic asthma (based on forced expiratory volume in 1 second (FEV1) and clinical symptoms). Participants with mild and moderate allergic asthma (n = 64) were randomly assigned to two groups: the intervention group, which received two pomegranate extract capsules (500 mg/day), or the control group for eight weeks. Also, the physician prescribed similar drugs to the participants in the study. Independent samples T-test and Mann–Whitney U were used to compare the quantitative outcomes between the intervention group and the comparison group. The Wilcoxon test and the paired T-test were applied for within-group comparisons. A p-value

BackgroundOral candidiasis (OC) is one of the most common opportunistic fungal infections among people living with HIV/AIDS (PLWHA). The prevalence of OC and Candida profiles among HIV-infected patients might be changing in the era of Highly Active Antiretroviral Therapy (HAART). This study aimed to identify Candida spp., determine OC prevalence and associated risk factors for PLWHA.Materials and methodsOral candidiasis prevalence was explored in oral swabs of 276 patients who referred for consultation at Behavioral Diseases Counseling Center (BDCC). Clinical symptoms, culture and molecular assays were used for OC detection. In statistical analysis, we assessed socio-demographic characteristics, clinical information and treatment history of some infections.ResultsThe overall prevalence of OC was 41%. Candida albicans (64.6%) was the most common species, followed by C. glabrata (26.5%) and C. dubliniensis (19.5%). Candida famata, C. africana, and C. stellatoidea as the first fungi isolated from OC in PLWHA from southwest Iran. In 36.3% of patients, mixed cultures of more than one species were observed. Body mass index (BMI) (OR = 0.947; CI = 0.89–0.99; p = 0.045) and CD4 count ≤ 200 cells/mm3 (OR = 4.365; CI = 1.73–10.98; p = 0.002) were the predictors of OC in the final model of multiple logistic regression analysis. Education level, addiction status, sexual behaviors, chest X-ray, other infections and WHO clinical stage were other important risk factors for OC.ConclusionOral candidiasis remains a significant opportunistic infection in post-HAART era among PLWHA. Despite the increasing prevalence of NAC species, C. albicans (64.6%) was still the predominant species. Our results showed that low BMI with OC indicates treatment failure (i.e., failure to increase CD4 count or suppress viral load). Also, low CD4 counts (≤200 cells/mm3) in HIV patients show an impaired immune status, and our findings emphasize that OC can be a clinical indicator of HIV infection in individuals who do not know their HIV status or have failed treatment.

ObjectivesDuring the COVID-19 home-quarantines, home care services may act as an auxiliary component of health care system, which reduces the burden on the formal health care system. This study aimed to investigate the status of informal home care provided for home quarantined patients with COVID-19 in southwest Iran.MethodsThis descriptive study was conducted on 288 patients with COVID-19 in Ahvaz (southwest Iran). Inclusion criteria included a known case of COVID-19, willingness to participate in the study, recommendation of home quarantine from a health center, having a smartphone, and fluency in reading and writing in Persian, and the exclusion criterion was a history of COVID-19 longer than 3 months. The data collection method was structured interviews based on a questionnaire (face-to-face-telephone calls-video call). SPSS software was used for the analysis of data.Results45.5% of the participants in the study were women with a mean age of 37.82 (10.48%) and 55.5% were men with a mean age of 36.12 (11.93%). Findings showed that in most cases, the spouse (61.4) is responsible for the care of the patient, and in other cases, parents are responsible for this duty. 57.3% of the patients stated that they themselves had to leave home to provide for necessities of life, and 37.2% stated that they were in charge of cooking. 47.9% of the patients evaluated the quality of quality of care provided at home as good. Most of patients and caregivers referred to hospital for getting information (35.8% patients and 34% caregivers). Most of patients recovered from diseases (60.8%) and 39.2% were hospitalized. Although 43.9% of men and 33.6% of women were hospitalized and a there was a significant difference between men and women (P < 0.04).ConclusionDuring COVID-19 pandemic home care to reduce the burden on the health system are very important. We must also know that this type of care requires informed and planned support and sufficient community education. The health care system needs to put self-care and family care among its top priorities. The focus should be on educational and mental support of informal caregivers along with measures that protect their relatives from COVID-19.

Background COVID-19 has had a catastrophic effect on the healthcare system. Healthcare quality assessment measures the difference between expected and actual performances to identify gaps in the healthcare system. This study aimed to evaluate the quality of perinatal care for women with high-risk pregnancies (HPR) during the COVID-19 pandemic. Materials and Methods This cross-sectional study enrolled 450 women with HPR from health centers in Ahvaz, Iran, from December 2020 to May 2021, using a multi-stage sampling method. Quality of care was assessed using an observational checklist adapted from Ministry of Health guidelines. Data were analyzed using descriptive and statistical methods. Results The quality of the assessed aspect in comprehensive health centers and in peripartum, perinatal, and postpartum wards was moderate. The overall score for peripartum care was significantly positively correlated with the length of the retraining period, and the quality of perinatal care was significantly related to the proportion of elective cesarean sections and preterm delivery. Conclusion The development of care practices in health centers in Iran should focus on education and counseling. Practices in peripartum wards should emphasize the use of partographs, physical/mental support, and privacy for mothers, while perinatal wards should focus on timely counseling.

BackgroundThe issue of infertility is a worldwide challenge, estimated to affect around 50 million couples. This study aimed to evaluate the relationship between infertility stress and sexual function in men and women with infertility.MethodsIn this cross-sectional study, 300 men and women with infertility were recruited. A demographic questionnaire, the Fertility Problem Inventory, the Female Sexual Function Scale (FSFI), and the International Index of Erectile Function (IIEF) were used to collect data. Independent t-test, Chi-square, and linear and logistic regressions were used to assess the data.ResultsThe total score of sexual function in women and men was 22.18 ± 7.86 and 57.7 ± 17.8, respectively. Infertility duration and the ability to pay for the costs of infertility treatment had a significant relationship with sexual function in women. A significant association was found between communication concerns and sexual function scores in men with infertility. Infertile women had more sexual concerns, while infertile men had more communication concerns.ConclusionThis study showed that women with infertility had more infertility stress than men with infertility. Women with higher infertility duration and the inability to pay for the infertility treatment costs impaired sexual function. Women with infertility had more sexual concerns, while Men with infertility had more communication concerns. Policymakers need to consider strategies such as counseling for men and women with infertility to help them cope with their problems, especially their psychological problems. The lack of random enrollment of participants and lack of control group were the limitations of this study.

Introduction: Introduction: The evaluation of the student dissertation supervisor is one of the important issues in improving the scientific and research level of students that has received less attention. Therefore, this study endeavored to identify the components of evaluation instruments of medical students' dissertation supervisors. Methods: This study was conducted with a qualitative approach and conventional content analysis method in the academic year 2021 in Ahvaz University of Medical Sciences. After reviewing the available articles and texts, the interview guide questions in a group discussion session with the participation of the research team; designed. Data were collected through structured interviews (electronically) and group discussion, and by purposeful sampling of stakeholders. The proposed Lundman and Graneheim steps were employed to analyze the data. Results: In this study, 22 faculty members and 10 students participated, which was collected from data analysis; 260 initial codes were obtained and after the final analysis in group discussion sessions, 50 codes were classified into three categories. Nine codes were obtained in the category of Supervisor Capacity, 15 codes in the category of General Ethics, and 26 codes in the category of Professional Ethics. Conclusion: In this study, 50 major factors were identified as elements and components of the evaluation instruments of the student's dissertation supervisor that can be used in the evaluation process of professors.

Background & Aim: Fatigue and sleep disorders are the most common physical complaints in hemodialysis patients. It seems necessary to find effective, low-complication and cost-effective treatments to alleviate these problems. The aim of this study was to examine the effect of slow-stroke back massage on the level of fatigue and sleep quality in hemodialysis patients. Methods & Materials: In this randomized controlled trial, 82 hemodialysis patients hospitalized in Shahid Beheshti hospital in Abadan in 2018, were selected based on the inclusion criteria and were allocated to either the intervention or control group using permuted block randomization (4 blocks). The intervention group underwent massage therapy for 12 sessions. The numerical rating scale for measuring fatigue and the Pittsburgh Sleep Quality Questionnaire were completed 14 times and three times respectively, by both groups. Data were analyzed through the SPSS software version 22 using descriptive statistical tests, independent t-test and repeated measures analysis of variance. Results: The results showed that before the intervention, there was no statistically significant difference in demographic variables between the intervention and control groups (P>0.05). Significance of group and time interactions for fatigue score showed that the trend of changes in mean fatigue scores was different in the two groups and over the study time period (P

Background & Aim: Dialysis headache is one of the most common complications of hemodialysis and is often a challenge for nephrologists, neurologists and headache specialists. Therefore, this study was conducted to investigate the effect of inhalation aromatherapy using lavender on the severity of headache in hemodialysis patients. Methods & Materials: In this randomized clinical trial, 82 patients from hemodialysis wards of Golestan Hospital in Ahvaz and Shahidzadeh Hospital in Behbahan in 2019 were selected and randomly assigned to either intervention or control groups using the stratified permuted block randomization. For the intervention group, cotton soaked in three drops of lavender essential oil 20% was attached to the collar of the patient and he/she was asked to inhale it for 30 minutes. For the control group, distilled water was used. The intervention was repeated for four weeks (three days per week). The severity of dialysis headache was measured using the Numeric Rating Scale. Results: In the intervention group, both the severity and the frequency of dialysis headache decreased during 12 sessions of aromatherapy, compared to the control group (placebo), and the decrease was statistically significant (P˂0.001). Conclusion: Due to the fact that complementary medicine has increasingly become a part of nursing care, aromatherapy with lavender can be used as a complementary measure reducing the severity and frequency of dialysis headaches. Clinical trial registry: IRCT20190718044263N1

Abstract Background The COVID-19 pandemic has affected many countries around the world and Iran was no exception. The aim of this study was to evaluate health anxiety of Iranian pregnant women during the COVID-19 pandemic. Methods In this cross-sectional study, 300 pregnant women in different trimesters (n = 100 in each trimester) were recruited. A demographic questionnaire and the Health Anxiety Questionnaire were used to collect data. Scores of

Background: The effective design and implementation of the nursing interventions to evaluate the patients' readiness for ventilator weaning will reduce their connection time to the ventilator and the complications of their connection to it. This study was conducted to examine the effect of nursing interventions based on the Burns Wean Assessment Program (BWAP) on successful weaning from Mechanical Ventilation (MV). Materials and Methods: In this clinical trial, 70 patients undergoing MV in the Intensive Care Units (ICUs) of Golestan Hospital (Ahvaz, Iran) in 2018 were randomly assigned to intervention and control groups. The nursing interventions designed based on BWAP were implemented on the patients in the intervention group, who were later weaned from the device according to this program. The recorded data included demographic information, BWAP score, vital signs, and laboratory values, which were analyzed using the Pearson correlation coefficient, Chi-Square, Fisher, and Mann-Whitney U tests. Results: There was a statistically significant and inverse correlation between the BWAP score and the MV duration such that a high BWAP score was associated with a shorter MV time (p = 0.041). Also, the mean number of re-intubation (p = 0.001) and the number of re-connection to the ventilator in the intervention group were significantly lower (p = 0.005). Conclusions: The results showed that nurses' assessment of patient's readiness for weaning from MV based on this tool and designed nursing care reduced the duration of MV, re-intubation, and re-connection.

Objective: Proper pain control in cancer patients is one of the prime needs of metastatic cancer patients. It is, then, one of the essential objectives of health care workers. The present study aimed to pinpoint the impact of pain self-management education on the pain severity and the quality of life in patients with metastatic cancers using complementary medicine approaches. Methods: This clinical trial study was performed in the Oncology Specialty Clinic of Ahvaz Golestan Hospital on 82 metastatic cancer patients picked based on inclusion criteria. They were randomly assigned to two groups: the intervention group and one as the control group. In the intervention group, pain self-management was taught in the three steps of providing information, skill development, and guidance. Self-management approaches were also practically taught face to face along with feedback. Furthermore, the quality of life was measured at 1-and 3-month follow-ups and the pain severity was measured during 7 weeks. In the control group, the quality of life questionnaire and the pain severity checklist were given to the participants to fill out. Finally, data were analyzed through SPSS version 22 in general and repeated-measures ANOVA and Friedman tests. Results: It was observed that after the intervention, the trend of pain severity during weeks 1–7 was significantly different in the intervention and control groups (P < 0.0001). In addition, a significant difference was observed for the quality of life at 1 and 3 months after the intervention between the two studied groups (P < 0.0001). Conclusions: Findings of the present study indicate a positive impact of pain self-management on improving pain severity and the indicators of quality of life in metastatic cancer patients. Accordingly, the current study findings can help nurses, nursing students, and other team members improve pain control skills and subsequently increase the quality of life in patients with metastatic cancers.

Introduction Phlebotomus papatasi, the main vector of cutaneous leishmaniasis with the agent of Leishmania major is in Iran that is widely distributed in the country. The purpose of this study was to determine the effect of climatic factors on the presence probability of a vector in some counties of Khuzestan Province. Materials and Methods In this cross-sectional study, sand flies were collected from 5 selected counties during two seasons. The climatic information of the study areas was obtained from the Meteorological Organization. Spearman correlation coefficient was used to investigate the presence probability of the main vector with environmental variables. The spatial distribution of the main vector was prepared in ArcGIS 10.5. Results Of the 884 collected sand flies, 506 of them were Ph. papatasi. The highest number of Ph. papatasi was observed in Ahvaz 151 (29.8%) and the lowest number was observed in Andimeshk 4 (0.79%). There was a significant difference between the geographical location and the probability of being the main vector of rural cutaneous leishmaniasis (P˂0.0001). The temperature was significantly different in the sampling areas (P= 0.024). With the influence of the temperature factor, the highest and lowest probability of vector was reported in Dasht-e-Azadegan (0.71 ± 0.05) and Andimeshk (0.01 ± 0.03), respectively. Conclusion In the present study, Ph. papatasi is a dominant species. By controlling the confounding effect of environmental factor, temperature, there was a significant difference between the presence probability of this species in Andimeshk county with other counties.

Background: Breast cancer remains the most prevalent neoplasm in women, with more than 450000 deaths each year, worldwide. In cancer researches, several factors such as serum tumor markers have an important role in screening, treatment, and recurrence of the disease. Carcinoembryonic antigen (CEA) is one of the most widely used serum tumor markers in the clinical evaluation of patients with breast cancer. This study aimed to evaluate whether increasing serum CEA levels is an indicator of breast cancer patient’s survival or not. Materials and Methods: This retrospective study was done at Hematology Department of Shafa Hospital of Ahvaz, southwest of Iran. Only those patients who had mastectomy during 2006-2014 and regularly referred to the hospital were included. The joint survival longitudinal model was applied to analyze the data. JM package in R software was used for joint modeling analysis. Results: The five-year survival rate was 73.0%. Age and follow-up time were associated with CEA tumor marker values. Higher age is associated with higher CEA values over time (P=0.0156). There was a significant linear increasing trend in CEA values over time (P=0.0465). There was a significant difference between patients with and without nodal involvement (HR [95% CI]: 1.880 [1.330- 5.565]; P=0.0298). There was a positive correlation between CEA tumor marker levels and death (HR [95% CI]: 2.770 [1.369-5.603]; P=0.0046). Conclusion: Higher age is associated with higher CEA values over time. The involvement of lymph nodes increases the hazard of death. Death is more likely to occur in patients with higher CEA tumor marker levels.

Introduction: Chronic diseases, including Thalassemia, have a profound effect on the functioning and overall life of the individual, especially at an early age. Given the low quality of life of adolescents with thalassemia and the importance of their function in society, this study aimed to determine the impact of applying life skills on quality of life in adolescents in Ahwaz in 2018. Methods: This quasi-experimental study was performed on 84 adolescents with thalassemia major referred to Thalassemia Clinic of Baqa'i Hospital, Ahwaz city, Iran. The study was conducted from 2018 to 2020. Adolescents were randomly divided into intervention and control groups. Both groups completed the demographic information questionnaire and the Kidney Screening Questionnaire for Quality of Life of the Teenager 52. Then the experimental group received the educational content (holding a class, Q&A and booklet) for 6 sessions of 2-hour. The control group did not receive any training. Data were analyzed by SPSS 22 and Chi-square, independent t-test, and paired t-test. Results: The results showed that the difference between the mean of quality of life in the two groups of control and intervention was not significant (P

Abstract Background Worldwide, hypothyroidism affects 3.7% of the population, and is associated with impaired quality of life. This study aimed to evaluate the effect of cognitive- behavioral therapy (CBT) on the quality of life in women with hypothyroidism. Methods 96 women with hypothyroidism randomly allocated into two groups: CBT group (n = 48) and control group (n = 48). Women in the CBT group were classified into four sub-groups of 12, and each sub-group received eight sessions of counseling (each session lasting 90 min). We collected data using a demographic questionnaire and the 36-Item Short Form Health Survey (SF 36) for measuring the quality of life. We used the independent t-test, chi-square test and ANCOVA to analyze the data. Results Five women from each group withdrew from the study, leaving 43 women in each group. The scores on physical functioning, physical health problems, social functioning and pain improved in the CBT group after the intervention, but the differences between the two groups were not significant. The scores on emotional health, emotional health problems, energy and emotions, and general health were significantly better in the CBT group than those in the control group (p

Abstract Background Around 90% of postmenopausal women are suffering from vaginal atrophy. This study aimed to evaluate the effect of oxytocin vaginal gel on vaginal atrophy among postmenopausal women. Methods This was a randomized controlled trial that was conducted on 96 postmenopausal women who suffered from vaginal atrophy. The inclusion criteria were: literate women, age 40–60, at least 1 year passed from their last menstrual period or the level of FSH > 40 IU, monogamous women with the sexual relationship. Women in the intervention group, requested to use one applicator of 400 IU oxytocin gel per night and women in the placebo group used placebo each night. The subjective symptoms of vaginal atrophy, vaginal PH, maturation index were measured before and after the intervention. Results The number of superficial cells was increased significantly in the oxytocin group compared to placebo (38.7 ± 7.18 vs. 3.69 ± 2.76, p = 0.0001), while the number of parabasal cells was decreased significantly in the oxytocin compared to placebo after the intervention. The improvement of the maturation index was more dominant in the oxytocin group (increased from 7.76 ± 4.68 to 52.48 ± 7.54) in comparison to the placebo group (increased from 8.58 ± 4.35 to 13.25 ± 5.06). The PH of the vagina decreased significantly in the oxytocin group in comparison to the placebo group (p = 0.0001). After 8 weeks, 88.6 and 7.1% of women in the oxytocin and placebo groups did not show the severe symptoms of vaginal atrophy (p = 0.001). Conclusion The results of this study showed that eight- week intervention with oxytocin vaginal gel (400 IU) could significantly improve the vaginal maturation index, subjective symptoms of vaginal atrophy and reduce the PH of the vagina. Using this medication in women who have a contraindication for hormone therapy is recommended. Trial registration IRCT20160602028220N2 .

Background: Physical activity among women with type 2 Diabetes Mellitus (DM) is an undesirable level. This study aimed to determine the effect of a training program based on the Health Promotion Model (HPM) on physical activity in women with type 2 DM. Materials and Methods: This randomized clinical trial was performed on 128 women with type 2 DM, who were randomly assigned to control and intervention groups. Data were collected using the Baecke Physical Activity Questionnaire (BPAQ) and a researcher-made questionnaire designed based on the HPM constructs before and 2 months after the intervention. The training was carried out in four sessions in the intervention group and the control group received regular education at the clinic. Data were analyzed using Chi-square, Fisher's exact test, paired t-test, independent t-test, and Mann–Whitney and Wilcoxon tests in Statistical Package for the Social Sciences (SPSS) software. Results: The findings showed that the mean [Standard Deviation (SD)] of physical activity in the intervention and control groups before the intervention was 6.52 (0.86) and 6.56 (1.07), respectively, and there was no significant difference between the groups (p = 0.95). However, after the intervention, the mean (SD) of physical activity in the intervention and control groups was 8.04 (0.92) and 6.33 (1.60), respectively, which showed a significant difference (t126 =9.71,p < 0.001). Conclusions: The findings of this study revealed that the training program based on the HPM has a positive effect on improving physical activity in women with type 2 DM.

Recently published researches show that 59% of all transmission came from asymptomatic transmission and at the time of diagnosis health-care workers (HCWs) tend to present without respiratory symptoms. These evidences have raised questions on whether an essential policy for use of personal protective equipment (PPE) is the best approach in HCW and other people or not. Therefore, this study conducted to investigate the effectiveness of using face masks and PPE in reducing the spread of COVID-19 in health-care and non-health-care settings. This systematic review and meta-analysis study was prepared according to the preferred reporting items for systematic review and meta-analysis statement and guided by meta-analysis of observational studies recommendations. Searches in databases were conducted from December 2019 to July 2021. Random-effects meta-analysis was performed to investigate the effect of using face masks and PPE on spread of COVID-19. Heterogeneity among studies was assessed using Cochran's Q test and the I2 metrics. In total, 9920 individuals from 14 studies were included in this study. In all settings, application of PPE or any type of masks was associated with reduction in risk of COVID-19 (odds ratio [OR] = 0.44; 95% confidence interval [CI]: [0.29, 0.65]; I2 = 85.21%). In the HCW subgroup, the protective effect had a combined OR of 0.33 (95% CI: (0.15,0.73), I2 = 82.61%). Six studies were found protective effects of wearing mask in non-HCWs (OR = 0.58, 95% CI: (0.31, 1.06), I2 = 85.63%). Results suggest that there is association between face mask/PPE use and reduction of COVID-19.

Introduction: Anxiety in students is a challenge of educational systems. The present study was conducted to investigate the efficiency of Pop Quiz (unannounced formative tests) in teaching biostatistics to postgraduate midwifery students and its effects on their statistics anxiety, test anxiety and statistical analysis skills. Methods: This quasi-experimental study conducted during the first semester of the academic year of 2019-2020 in the Faculty of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences. The MSc midwifery students were divided into two separate classes. One of the classes was randomly selected for educational intervention (Pop Quiz). Teaching via the lecture method considered as control method. Test anxiety and statistical anxiety questionnaires were completed by the students in both groups before the educational intervention, during and at the end of semester. The final exam score considered as the statistical skills score.Data were analyzed in SPSS 22 using Fisher's exact test and GEE model. Results: Thirty eight MSC midwifery students (12 in intervention group and 26 in comparison group)were recruited in this study. The mean and standard deviation of the exam score of students in lecture and Pop Quiz groups were respectively 14.43 ± 3.80 and 15.95 ± 2.79 (P=0.182). The patterns of change in test anxiety score differed significantly over time between the two teaching methods (P = 0.003). Although, there was a decreasing trend in mean score of statistics anxiety scores in Pop Quiz group in comparison with lecture based group, but there were not statistically significant differences. Conclusion: Applying Pop Quiz to teaching biostatistics reduces test anxiety and statistics anxiety and increases statistical analysis skills in postgraduate midwifery students

Background & Aim: Nowadays, home-based cardiac rehabilitation (HBCR) program is one of the major methods that can improve the quality of life of patients following coronary artery bypass graft surgery. The present study aimed to investigate the effect of a HBCR on the quality of life of patients following CABG. Methods & Materials: In this clinical trial, 104 inpatients at Golestan and Imam Khomeini hospitals in Ahvaz in 2017, based on permuted-block randomization were assigned to an intervention or a control group. The intervention group received four training sessions for four days at the hospital and then six sessions of home-based cardiac rehabilitation (at 2-week intervals for three months). The Mac-New quality of life questionnaire was completed by the intervention and control groups before the surgery and three months after CABG surgery. Data were analyzed using the SPSS software version 22. Results: The postoperative mean scores for quality of life subscales and for overall quality of life in the intervention group were greater compared to the control group (P