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Recognized as a reliable tool for assessing the hypothalamus-pituitary-adrenal (HPA) axis, measurement of salivary cortisol plays an important role in both the clinical and research settings. To establish a normative data, which forms the basis for the usage of this valuable parameter, we gathered 8:00 h saliva samples from 94 healthy individuals aged 6-14 years. Cortisol levels were measured by radioimmunoassay technique, using Orion Diagnostica's coated tube technology. Based on mean±2SD, we established a normal range for salivary cortisol concentrations in this age group: 1.69 - 12.81nmol/L. Considering a confidence interval for upper and lower limits, there was an upper limit equal to 11.42 -14.29 nmol/L and a lower limit of 1.21 - 2.25 nmol/L. Regarding the results of this study, cortisol levels were age dependent, and although with a low correlation coefficient, there was a positive correlation between cortisol levels and weight and height. There was no correlation with BMI and no sex difference was found.

Introduction: Population growth and its difficulties is one of the most important health problems in the world especially in developing countries. so the studies in this field are necessary and useful in IRAN. This study was done to find out the workers population specificities and their opinion about family planning programs. Methods: This descriptive study was held in the factories with more than 1000 workers in 1375. nearly 10 percent of the workers were chosen from 7 factories through the systematic random sampling The sample was about 1096 workers. They answered to multiple choise questionnaire during 3 months and the data were analysed by the descriptive statistical methods and also x2 and pierson correlation tests. Results: Most of workers (80 percent) were under 40 years old and 0.5 percent were single and others were married. The illiterates were 6 percent and about 82 percent were studied 8 grades and less. The mean of the number of their children was 3.7 and 33 percent had 5 children or more. The family planning methods were used by them as follows: Tubal ligation and Vasectomy 32 percent, Natural methods 22.3 percent, OCP 19.8 percent, Candom 11.1 percent, IUD 10 percent and Lactation as a method 0.53 percent. About 4.2 percent had used more than one birth control method. Disussion: Result showed that there was a reverse correlation between the age of marriage and number of existing children (P < 0.001) and also between the literacy status and the opinion about the number of children (P < 0.001) there was relation between the age of the workers and the opinion about the number of children (P < 0.01). the reverse correlation between the literacy status and the number of existing children was stables even after the control of the age rariable as a confonder. Study of birth control methods shows that the use of family planning method is different between the groups with different literacy levels.

Abstract Background & Aims: Health literacy is one of the most important priorities for improving health care quality through enhancing patient- provider communication. Implementing health literacy strategies enables nurses to provide information and instructions for patients in a manner that is more commensurate and understandable. The purpose of this study was to investigate the factors affecting nurses’ intention to implement health literacy strategies in patient education based on theory of planned behavior. Material & Methods: A cross- sectional study conducted among 148 nurse practitioners of Al-Zahra Hospital affiliated to Isfahan University of Medical Sciences, Isfahan, Iran, using descriptive-analytical method. Data collected via standardized questionnaire based on theory of planned behavior constructs and analyzed by SPSS v.17 using ANOVA, Independent T-test, Pearson correlation and linear regression. Results: There were statistically significant correlation between using health literacy strategies and marriage status, attending in retraining courses, employment type, job history, and job status. Perceived behavioral control was the most powerful predictor of intention (β= 0/417) and use health literacy strategies in patient education and behavior of nurses (β=0/319). Conclusion: According to the findings of this study, perceived behavioral control is a powerful determinant of nurses’ intention and behavior of using health literacy strategies in patient education. Hence we recommend nurse educators to pay special attention to the constructs of this theory mainly perceived behavioral control in retrain courses about patient education and health literacy strategies.

Background: It is important to care for the sexual function of women during menopause as it can affect their quality of life. However, the services related to this area have been neglected in the health system and are not provided at the desired level. Therefore, the present study aimed to identify strategies to promote the provision of sexual health services during menopause in Isfahan city, Iran., Methods: Participants of this qualitative study consisted of 19 menopausal women and 15 health service providers with work experience in providing sexual health services to menopausal women, selected using purposive sampling with maximum variation in the city of Isfahan, Iran. Data were collected through in-depth semi-structured individual interviews plus field notes and analyzed using conventional qualitative content analysis., Results: Data analysis led to the extraction of three main categories: 1-providing comprehensive and client-centered care with five sub-categories, namely "screening and active search for recognition of sexual dysfunction", "compliance with cultural considerations in service delivery", "tailoring treatment plans for individual patients", "collaborative decision-making approach", and "improving specialty care follow-up"; 2- improving infrastructure for better service delivery with three sub-categories, namely "allocation of appropriate physical space", "strengthening teamwork and interdisciplinary cooperation", and "provision of cost-effective services"; and 3- expanding services as well as enhancing access with five sub-categories, namely "integration of sexual health services in primary health care", "using telemedicine to provide services", "expansion of intersectoral relations", "introducing sexual health services", and "conducting research on sexual health services"., Conclusions: The results emphasize the importance of providing comprehensive and client-centered services and care, improving service delivery infrastructure, expanding services, and promoting access to sexual health to enhance the sexual function of postmenopausal women. Through these strategies, healthcare systems can significantly contribute to improving postmenopausal women's sexual functioning and ultimately their quality of life., Competing Interests: Declarations. Ethics approval and consent to participate: The Ethics Committee of the Isfahan University of Medical Sciences in Isfahan, Iran approved the protocol of this study (code number: IR.MUI.NUREMA.REC.1401.165). Written informed consent is taken from each participant. In this study, all methods were carried out in accordance with the Declaration of Helsinki. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: COVID-19 is a viral disease caused by the SARS-CoV-2 , leading to several variants. This study aimed to examine the effectiveness of booster doses against the Delta and Omicron variants over different follow-up times. Study Design: This was a longitudinal meta-analysis., Methods: Searches were performed in PubMed, Cochrane Library, Scopus, and Web of Science databases, and eighty studies were selected for investigation. The analyses were separately performed on the unvaccinated control group (UNVCG) and the complete two doses of the vaccine control group (C2DCG) against Delta and Omicron variants. Three outcomes were examined, including symptomatic infection, hospitalization, and death., Results: Vaccine effectiveness (VE) in UNVCG studies for symptomatic infection revealed a non-linear trend against Omicron with a peak of 67.3%, declining to 27.1% after 25 weeks after a booster dose. The mean of VE for hospitalization over time started to decrease after four weeks against Omicron and after eight weeks against Delta. The VE reached a peak at week eight (96.0%) and started to decline with a VE of 93.3% after 20 weeks after the booster dose against Delta. It was 90.8% at week four and decreased to 73.4% after 25 weeks after the booster dose against Omicron. VE in the C2DCG studies demonstrated more decreases in outcomes over time., Conclusion: Our findings showed a tendency to decrease effectiveness over time based on outcomes and variants. The early protection levels were lower in Omicron. Moreover, the VE decrease over time was stronger in Omicron compared to the Delta variant., (© 2024 The Author(s); Published by Hamadan University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Background: World Health Organization suggests that different societies should investigate the causes of abuse in their culture., Aims: This study was conducted to investigate the risk factors of elder abuse in Iran using an ecological approach., Materials and Methods: This is a qualitative study, and the participants were older adults and caregivers. The data were collected using 66 interviews. Analysis of data was simultaneously performed with data collection, using MAXQDA 10, and results were reported based on Elo's recommendation., Results: Five main categories of data analysis were obtained based on Bronfenbrenner's model: exo-system: conflict of care with caregivers' jobs, meso-system: failure to meet expectations of support systems, macro-system: social culture, socioeconomic structure, status of enactment, and implementation of legal and financial laws., Conclusions: This study showed risk factors of elder abuse in the sociocultural context of Iran, and its results can be used for health promotion interventions., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Education and Health Promotion.)

Background: Menopause is a natural event in women's life that leads to physical, psychological, and social consequences. A fundamental health concern in postmenopausal women is problems with their sexual function. This study aims to design an interventional program to promote sexual function in postmenopausal women., Materials and Methods: This sequential exploratory mixed methods study will be conducted in three phases. The first phase will be a qualitative study with a content analysis approach. The participants will be selected using a purposive sampling in Isfahan, Iran. The data will be collected through in-depth interviews and field notes and analyzed using conventional content analysis. In the second phase, the intervention will be designed and finalized to promote sexual function in postmenopausal women using the results of qualitative study and literature review, asking experts' opinions, and holding specialized panels. In the third phase, the intervention will be implemented (in the form of a quasi-experimental study) and the effect of the intervention will be determined. In this phase, the data will be collected using the female sexual function index. Finally, an appropriate interventional program will be presented., Conclusion: It is hoped to promote sexual function in postmenopausal women by conducting this study and implementing an appropriate interventional program that is culturally sensitive. If it is proved that the intervention is effective, a basis for health policy-making to promote sexual health in postmenopausal women can be provided by presenting evidence and increasing the knowledge in this field of health., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Education and Health Promotion.)

Introduction: This study assessed the incidence and severity of side effects associated with coronavirus disease 2019 (COVID-19) vaccination among healthcare workers registered with the Medical Council of the Islamic Republic of Iran., Methodology: A retrospective cohort study was conducted on the healthcare workers focusing on the side-effects of COVID-19 vaccines from March to June 2021. Data were collected using online questionnaires. Multivariable logistic regression was used to assess the association between side effects of the vaccines and demographic variables, comorbidities, vaccine type, and history of COVID-19., Results: Out of 42,018 people who were included, 55.85% reported at least one side effect after receiving the first vaccine dose. 4.59% of those with side effects sought diagnostic intervention or were referred to treatment centers. Multivariable logistic regression indicated that being a woman, higher education, having a history of COVID-19 infection, and having comorbidities increased the risk of side effects. The AstraZeneca vaccine significantly increased the risk of side effects compared to the Sputnik vaccine, while the Sinopharm vaccine decreased this risk. The risk of developing a side effect decreased with age. The risk of moderate and severe side effects was significantly associated with gender, younger age, comorbidities, and a history of COVID-19 infection. Moderate and severe side effects were less reported by those who received the Sinopharm vaccine., Conclusions: Clinical complications after COVID-19 vaccination, directly or indirectly caused by the vaccines, are common. However, the benefits of COVID-19 vaccines greatly outweigh the risk of reversible side effects, especially among the high-risk population., Competing Interests: No Conflict of Interest is declared, (Copyright (c) 2024 Hassan Roudgari, Koorosh Etemad, Manoochehr Karami, Farideh Mostafavi, Sahar Sotoodeh Ghorbani, Kosar Farhadi Babadi, Elham Rahimi, Niloufar Taherpour, Seyed Mahmood Fattahi Masoom, Masoud Habibi, Hossein Kermanpour, Reza Laripour, Omid Manoochehri, Mohammad Raeeszadeh, Alireza Salimi, Babak Shekarchi, Ali Tajernia, Mohammad Reza Zafarghandi, Alireza Zali, Afshin Zarghi, Seyed Saeed Hashemi Nazari.)

Background: The higher prevalence of hookah tobacco smoking (HTS) has become worrisome in women. Thus, it is essential to identify and measure the perceptions associated with this unhealthy behavior as well as the type of response to risk messages to design the effective programs. This study aimed to psychometric evaluation of a new instrument, named the Extended Parallel Process Model-Hookah Tobacco Smoking Questionnaire (EPPM-HTSQ), for female university students., Material and Methods: This methodological study was conducted in 2019-2020 in central and western Iran. The first version of the instrument was developed with 97 items. Face, Content, and construct validity methods were used to assess the EPPM-HTSQ validity. The data viability for factorability was guided through Kaiser-Meyer-Olkin (KMO) measure of sample adequacy (Values >0.7) and Bartlett's test of Sphericity ( P < 0.05). The Exploratory Factor Analysis (EFA) method with varimax rotation and SPSS software was performed to identify the main factors of the questionnaire and interpretable factors. The internal consistency and external reliability were determined. The test-retest was used for evaluating the stability of tools., Results: During the assessment of the face and content validity 71 items remained in the questionnaire. EFA led to the extraction of nine dimensions: "Focusing on superior rewards," "Response Efficacy," "Perceived physical threat," "Perceived social threat," "Self-efficacy," "Fear control," "Attitude," "Fear," and "Intention" Kaiser-Meyer-Olkin (KMO) test (0.957) and Bartlett's test ( P < 0.001). Cronbach's alpha (0.871-0.951) and ICC (0.985-0.998) were approved for scale dimensions., Conclusion: Important findings of the present study were the development and validation of the EPPM-HTSQ for measuring EPPM variables in relation to HTS; introducing a new variable "focusing on superior rewards"; as well as, the new classification of the concept of "perceived threat." The final version of the EPPM-HTSQ is a valid and reliable tool, but it is suggested to be re-evaluated in other studies with different populations and sample sizes., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Education and Health Promotion.)

Background: Endometriosis is a chronic disease affecting 6-10% of women worldwide. Sexual dysfunction has been reported in a significant percentage of these patients. Thus, the present study will be conducted to design, implement, and determine the effectiveness of an interventional program to improve the sexual function of women with endometriosis., Materials and Methods: This mixed-methods study will be carried out in three phases with a sequential exploratory approach. In the first phase (qualitative study) participants will be selected by purposive sampling in Isfahan, Iran. The data will be collected through in-depth interviews and field notes and analyzed using conventional content analysis. The interventional program will be designed in the second phase based on the results of the qualitative study and literature review and using the Delphi method and panel of experts. The interventional program will be implemented at the individual level in the third phase to investigate its effect on improving women's sexual function. This phase includes quasi-experimental research, in which the pre- and post-intervention data will be collected from the intervention and control groups using the FSFI questionnaire and analyzed by descriptive and inferential statistical methods. Ultimately, a suitable interventional program will be presented by combining the data obtained in the qualitative and quantitative phases of the research., Conclusion: Conducting the present study, along with the design and implementation of an appropriate, native, and culturally sensitive interventional program, can contribute to improving the sexual function of women with endometriosis and enhancing the quality of sexual relations between couples., (© 2024. The Author(s).)

Background: One of the well-known causes of subfertility is polycystic ovary syndrome (PCOS). Genetic components play a critical role in the etiology of PCOS. The recognition of differentially expressed genes in PCOS patients might provide a better understanding of the pathophysiology of this syndrome and paves the way for novel therapeutics. Gene expression profiles in cumulus cells (CCs) could be used as biological criteria for embryo competence and their analysis might lead to important molecular information about embryo quality. CALM1 , PSMD6 , and AK124742 are three well-known genes associated with embryo development. Therefore, the objective of this study was to compare the expression of CALM1 , PSMD6 , and AK124742 genes in the CCs of infertile PCOS patients with their expression in the CCs of the donor fertile group., Materials and Methods: CCs were collected from the follicular fluid of 33 patients with PCOS as the experimental group and 33 cumulus donor women who were referred to the infertility center for egg donation as the control group. CCs were frozen until genetic testing. The expression of CALM1 , PSMD6 , and AK124742 genes was detected by real-time polymerase chain reaction., Results: CALM1 and AK124742 gene expressions significantly increased ( CALM1 P = 0.003) ( AK124742 P = 0.000) and PSMD6 expression significantly decreased ( P = 0.002) in the PCOS group compared to the cumulus donor (control) group., Conclusion: Therefore, our research findings suggest that the potential impact of Polycystic Ovary Syndrome (PCOS) on fertility could be attributed to modifications in the expression levels of genes that affect the reproductive., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Advanced Biomedical Research.)

Background: Pregnancy, and childbirth can encounter many challenges for the teen mother, family, and health system. The simultaneity of two transition periods, i.e. transition to adulthood and post-partum period may disrupt the acceptance of new roles. Lack of knowledge, information and life skills in managing this situation may threaten the physical and mental health of the mother, and child, as well as reduce the level of role adaptation. One way to increase women's empowerment in postpartum care is self-efficacy promotion training program. The current mixed methods study will be conducted to provide an interventional program sensitive to the culture of the Iranian society for adolescent mothers to improve their self-efficacy., Method: This study will be conducted as an exploratory sequential mixed methods study (Qual-quan) based on a pragmatism paradigm in four phases. In the first phase, a qualitative study will be performed using a directed content analysis method to explore the needs and strategies related to promote postpartum self-efficacy from the viewpoint of teen mothers, their family, healthcare providers, and policymakers. In the second phase, using a scoping review, self-efficacy promotion strategies, and postpartum care service packages, programs, guidelines, and protocols in other countries will be identified. In the third phase, with integrating the results of qualitative phase and scoping review, the first draft of program will be developed, and validated by an expert panel based on the Delphi approach in three rounds. In the last step, the effectiveness of the interventional program will be evaluated on postpartum self-efficacy of teen mother., Discussion: Developing an interventional program that includes teen mother's experiences, evidence based practice principles, and health staff opinions in a distinct cultural and social context can supply new direction to lead manager, policymakers, and other health care provider to improve the maternal self-efficacy in infant, family, and self-care with considering their age characteristics., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: Excessive screen time has been associated with a variety of negative health outcomes. We aimed to evaluate screen time and phone and tablet use in Iranian adolescents and their relation to the socioeconomic status of adolescents' families in 2018., Methods: This descriptive-analytical study was carried out on 10-12-year-old adolescents from Kurdistan, Fars, and Markazi provinces. Cluster sampling was used for sampling. Data were collected by completing demographic questionnaires, calculating the BMI of adolescents and phone and tablet use, screen time, and socioeconomic status of the families. We used linear and logistic regression to estimate the final model. The concentration index was used to measure inequality and the Oaxaca decomposition to examine the different determinants of the inequality., Results: 1590 adolescents (52.58% boys) were enrolled in our study. Screen time activities were significantly higher in boys, older adolescents, higher BMIs, more educated mothers, and 35< year-old fathers ( P < 0.05). The use of mobile phones and tablets was significantly higher among boys, ten-year-olds, families with four or fewer members, higher BMIs, adolescents with higher levels of parental education, and more educated mothers ( P < 0.05). In addition, the concentration index for screen time activities (C = 0.083) and phone and tablet use (C = 0.536) showed that screen time and phone and tablet use activities were higher in adolescents with high socioeconomic status., Conclusion: Screen time, phone and tablet use were higher in adolescents with high socioeconomic status. Also, many other factors like gender, age, BMI, parents' education and age can affect screen time, phone and tablet use in adolescents., Competing Interests: The authors declare that they have no competing interests., (© 2023 Iran University of Medical Sciences.)

Legal abortion has adopted many beneficial measures to prevent the birth of fetuses with congenital anomalies and maintain the health of high-risk mothers. However, abortion has its own complications and, thus, most mothers need care in this regard. The aim of this study was to determine the effect of self-management model on behaviors related to the reproductive health of mothers after legal abortion. This clinical trial study was conducted on 72 women who had legal abortion with the permission from Isfahan forensic medicine. The intervention was conducted using the 5A self-management model. The control group received the usual health system cares. Data collection tool was a researcher-made questionnaire of behaviors related to reproductive health, which was completed before and two months after the intervention by the two groups. The total mean score of the behavior (P < 0.001) and its dimensions (Prevention of post-abortion complications with P = 0.01, Prevention of sexually transmitted infections, satisfactory sexual function and family planning with P < 0.001) in the intervention group two months after the outset of the intervention was significantly higher than before the intervention. The total mean score of the behavior (P < 0.001) and its dimensions (Prevention of post-abortion complications with P = 0.002, Prevention of sexually transmitted infections, satisfactory sexual function and family planning with P < 0.001) two months after the outset of the intervention in the intervention group was significantly higher than the control group. Based on the results, this educational model can be emphasized to promote reproductive health behaviors of women after abortion.Clinical trial protocol link: https://www.irct.ir/user/trial/55184/view ., (© 2023. The Author(s).)

Objectives: The worldwide incidence of metabolic syndrome (MetS) has increased in recent decades. In this study, we investigated the socioeconomic inequalities associated with MetS and its components in a sample of the Iranian Kurdish population., Methods: We used data from 3,996 participants, aged 35 years to 70 years, from the baseline phase of the Dehgolan Prospective Cohort Study (February 2018 to March 2019). The concentration index and concentration curve were used to measure inequality and the Blinder-Oaxaca decomposition method was used to examine the contribution of various determinants to the observed socioeconomic inequality in MetS and its components., Results: The prevalence of MetS was 34.44% (95% confidence interval [CI], 32.97 to 35.93). The prevalence of MetS was 26.18% for those in the highest socioeconomic status (SES), compared with 40.51% for participants in the lowest SES. There was a significant negative concentration index for MetS (C=-0.13; 95% CI, -0.16 to -0.09), indicating a concentration of MetS among participants with a lower SES. The most prevalent component was abdominal obesity (59.14%) with a significant negative concentration index (C=-0.21; 95% CI, -0.25 to -0.18). According to decomposition analysis, age, gender, and education were the highest contributing factors to inequality in MetS and its components., Conclusions: This study showed socioeconomic inequality in MetS. People with a low SES were more likely to have MetS. Therefore, policymakers and health managers need to develop appropriate strategies to reduce these inequalities in MetS across age groups, genders, and education levels, especially among women and the elderly.

Background: Vulnerable adolescents are exposed to sexual and reproductive health harms. Ignoring the sexual and reproductive health of this group can have irreparable consequences. The present qualitative study aimed to explore the barriers to the access of vulnerable adolescent girls to sexual and reproductive health., Methods: In this study, sixteen 14-19-year-old adolescent girls and twenty-two key informants were selected using purposive sampling method. Through in-depth semi-structured interviews, they expressed their experiences of barriers to sexual and reproductive health in vulnerable adolescent girls. The data were encoded using the conventional qualitative content analysis., Results: Based on the results of the study, neglecting the reproductive and sexual health of vulnerable adolescent girls at different levels leads to serious challenges and obstacles in providing and maintaining it. Lack of a responsible family, the repulsive behaviors of the family and following risky behaviors of peers led to ignoring the sexual and reproductive health of adolescent girls. Unanswered sexual questions, defective life skills, unwanted pregnancy during adolescence, lack of awareness of unsafe sex, violating cultural norms and wounded psyche in vulnerable adolescent girls threaten their sexual and reproductive health. Ineffectiveness of key organizations in providing sexual and reproductive health services alongside lack of legal, political and social support in this area indicate that the sexual and reproductive health of these girls is not a priority for the society., Conclusion: Numerous personal, family, social, legal and political barriers challenge the sexual and reproductive health of vulnerable adolescent girls. Developing a comprehensive and practical program beside legal and political support for this issue can provide the basis for the sexual and reproductive health of this group of adolescents in societies., (© 2022. The Author(s).)

Background: Despite newer therapeutic approaches against glioblastoma multiforme (GBM), the severely poor prognosis and treatment resistance are still disadvantages that slow down the patient's recovery process. Consistent with the need to develop more effective and optimized therapies to control GBM cell growth, the effects of a new series of tetrahydrobenzo(g)imidazo[α-1,2]quinolone derivatives on GBM cell growth and the underlying mechanism is investigated in the current study., Methods: U-87MG cell line, glioblastoma multiforme and normal skin fibroblast cell line, AGO1522 were used to study the anticancer effects of 5 derivatives of tetrahydrobenzo(g)imidazo[α-1,2]quinolone and paclitaxel as a standard drug. The cytotoxic effect on cell growth was assessed using the MTT assay. Annexin V FITC staining and PI staining were applied to detect apoptosis and cell cycle distribution using flow cytometry. The extent of reactive oxygen species (ROS) formation was assessed using the fluorescent probe 7-dichlorofluorescin diacetate and caspase-3 activity using the colorimetric assay kit., Results: Among the 5 derivatives of tetrahydrobenzo(g)imidazo[α-1,2]quinolone, the 5c derivative (5-(6-bromo-2-chloroquinolin-3-yl)-9a-hydroxy-8,8-dimethyl-4-Nitro-2,3,5,5a,7,8,9,9a-octahydroimidazo[α-1,2]quinoline-6(1H)) showed the strongest cytotoxic effect on U-87MG cells in a time and Dose-dependent manner compared to the other derivatives and paclitaxel. The IC50 (11.91 M) of the 5c derivative induced apoptosis accompanied by a significant increase in sub-G1 and super-G2 phases of U-87MG cells. The increased level of cellular ROS and caspase 3 activity after treatment of U-87MG cells with 5c derivative was significant compared to untreated cells., Conclusion: Our data provide insights into the potent anticancer effects of the 5c-derivative of tetrahydrobenzo(g)imidazo[α-1,2]quinolone on GBM cells via the caspase-dependent apoptotic pathway, which may merit further attention.

Background: Health information-seeking behavior is directed by various factors. Understanding the motivations of pregnant women to obtain health information can facilitate evidence-based policy-making to enhance their health literacy. Therefore, this study was conducted to explore the motivations of pregnant women to seek health information., Materials and Methods: In this qualitative study with a content analysis approach, 39 participants, including pregnant women, midwives, and gynecologists in Isfahan city, Iran, were selected via purposive sampling with maximum variation strategy. Individual interviews, field notes, and daily notes were used to collect data, which was then analyzed using conventional qualitative content analysis., Results: Analysis of data resulted in one main category of "strive to protect the health of mother and fetus." This main category consisted of four subcategories, including "increasing information related to maternal and fetal health," "preventing recurring problems or causing complications in pregnancy," "reducing worry about pregnancy problem," and "receiving encouragement from the spouse, relatives, and healthcare providers.", Conclusions: According to the findings, pregnant women seek health information for a variety of reasons, including learning more about their own health and that of their fetus, preventing recurring problems or complications, alleviating concerns about pregnancy problems, and receiving encouragement from husbands, relatives, and healthcare providers. Thus, health professionals, midwives, and antenatal care providers should be aware of these issues and provide more evidence-based information to pregnant women at the time they require it., Competing Interests: Nothing to declare., (Copyright: © 2022 Iranian Journal of Nursing and Midwifery Research.)

Background: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women. Given the prevalence of this disease in adolescent girls as well as its serious physical, psychological, and social consequences, the present study aimed to explore the health system-related needs for healthy nutritional behaviors in adolescent girls with PCOS., Methods: This qualitative content analysis was conducted in Shiraz, Iran between November 2016 and October 2017. Eighteen Adolescent girls with PCOS and 15 healthcare providers (midwives, gynecologists, nutritionists, and endocrinologists) were selected through purposeful sampling with maximum variation strategy. Data were collected through individual in-depth and semi-structured interviews, focus group discussions, and field note, and simultaneously analyzed using the conventional qualitative content analysis method., Results: Three main categories that appeared included: 1) education and counseling on healthy nutrition and support for adolescent girls with PCOS with sub-categories of "empowering adolescent girls with PCOS to adopt healthy nutritional behaviors", "providing services and education about healthy nutritional behaviors as a team", and "the health team attention to the concerns of adolescent girls with PCOS and closely following the disease status, 2) solving communication problems with sub-categories of "proper interactions and building trust between health team members and adolescent girls" and "proper interactions between members of the health team", and 3) developing the optimal structure for providing health services with sub-categories of "solving problems related to human resources, "promoting the position of health issues related to adolescent girls in the health system", and "promoting policy-making in the field of nutritional health of adolescent girls"., Conclusions: Based on the results of the present study, necessary measures should be taken to educate and advise on healthy nutrition, and to support adolescent girls with PCOS. The desired structure should also be developed to provide health services to these girls. By solving communication problems and building trust between the members of the health team and these girls, one can guide them to adopt healthy nutritional behaviors., (© 2022. The Author(s).)

The possibility of using weak optical signals to perform sensing of delicate samples constitutes one of the main goals of quantum photonic sensing. Furthermore, the nanoscale confinement of electromagnetic near fields in photonic platforms through surface plasmon polaritons has motivated the development of highly sensitive quantum plasmonic sensors. Despite the enormous potential of plasmonic platforms for sensing, this class of sensors is ultimately limited by the quantum statistical fluctuations of surface plasmons. Indeed, the fluctuations of the electromagnetic field severely limit the performance of quantum plasmonic sensing platforms in which delicate samples are characterized using weak near-field signals. Furthermore, the inherent losses associated with plasmonic fields levy additional constraints that challenge the realization of sensitivities beyond the shot-noise limit. Here, we introduce a protocol for quantum plasmonic sensing based on the conditional detection of plasmons. We demonstrate that the conditional detection of plasmonic fields, via plasmon subtraction, provides a new degree of freedom to control quantum fluctuations of plasmonic fields. This mechanism enables improvement of the signal-to-noise ratio of photonic sensors relying on plasmonic signals that are comparable to their associated field fluctuations. Consequently, the possibility of using weak plasmonic signals to sense delicate samples, while preserving the sample properties, has important implications for molecule sensing, and chemical detection., (© 2022 Fatemeh Mostafavi et al., published by De Gruyter, Berlin/Boston.)

Background: Daily consumption of fruit and vegetable (F and V) can effectively reduce the risk factors of cardiovascular diseases; therefore it is necessary to identify the factors affecting this behavior. This study aimed to determine the Predictive Power of Pender's Health promotion model (HPM) constructs in F and V consumption behavior and the effects of some background variables on this behavior., Materials and Methods: A descriptive-correlation study was conducted on 418 employees working in different offices of Qaemshahr, Mazandaran Province from April 8, 2019, to July 23, 2019. The participants filled out a questionnaire about perceived F and V Consumption behavior based on Pender's HPM Constructs. The data were statistically analyzed by descriptive statistics and parametric tests, including the Pearson correlation, Independent- Sample t -test, One-Way analysis of variance test, and multiple linear regression, in SPSS-22., Results: The mean age of participants was 40.25 ± 7.56 years. The results showed that F and V consumption behavior was positively correlated with some constructs of Pender's HPM including, behavioral outcome ( r = 0.51, P < 0.001), previous related behavior ( r = 0.48, P < 0.001), commitment to action ( r = 0.47, P < 0.001), perceived self-efficacy and behavior-related emotions ( r = 0.39, P < 0.001). Behavioral outcome alone explained 26% of the dependent variable changes (F and V consumption behavior). The results also indicated that there was a significant relationship between gender and F and V consumption behavior ( P = 0.01)., Conclusion: The study findings demonstrated that some of Pender's HPM Constructs could predict F and V consumption behavior. Behavioral outcome alone was a strong predictor of this behavior. Therefore, in addition to background variables, these constructs should be taken into account in the development of training interventions and courses., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Journal of Education and Health Promotion.)

Increasing fruit and vegetable (F&V) intake has a protective role against chronic conditions such as cardiovascular disease, cancer and diabetes. The present study aimed to validate an instrument for measuring the perception of effective factors on consumption behaviour of F&V based on Pender's health promotion model (HPM).This cross-sectional validation survey has consisted of five steps: literature review in order to plan and develop an instrument, face validity assessment, content validity assessment, reliability assessment and construct validity assessment with the cooperation of experts in health education, nutritionists and the target group (government employees). In the present study, reliability and validity of constructs were determined through Cronbach's alpha and exploratory factor analysis, respectively, in SPSS 22. The mean impact score was acceptable for 96·42 % of items in face validity. The mean scores of content validity ratio (CVR), content validity index (CVI) and reliability were 0·92, 0·97 and 0·96, respectively. According to the principal component analysis with varimax rotation, 104 items were identified in 15 factors contributing to 61·17 % of the model cumulative variance. Given the favourable scores of the research instrument in face validity, content validity and reliability as well as its ability to predict the extracted factors from the model, it can be used as a suitable instrument in future studies., (© The Author(s) 2022.)

Purpose : Waterpipe tobacco smoking (WTS) is currently a serious and growing public health threat in the world, especially in adolescents and young women. The aim of the study was to explore sociocultural factors contributing to WTS among adolescents and young adult women in Iran. Methods : This qualitative study was conducted from August 2017 to January 2019 in Isfahan and Hamadan cities, Iran; it included 13-30-year-old females with experience of WTS. For data collection, in-depth semi-structured personal interviews were conducted at participants' preferred time and place. Concurrent with data collection, data were analysed through conventional content analysis. Results : The study participants described the various sociocultural factors contributing to WTS. These factors were categorized into four following main categories: waterpipe glamorization by its producers and sellers, media advertisement or silence, common sociocultural traditions, and governmental policies and regulations. Conclusion : A wide range of sociocultural factors affects WTS among Iranian adolescents and young adult women. Therefore, interdisciplinary multidimensional strategies are needed for WTS management and prevention among these at-risk groups. Public education, strict supervision of tobacco import, export, and selling, ample employment opportunities for young people and effective leisure time management are essential to reduce WTS. Abbreviation WTS : Waterpipe Tobacco Smoking; MPOWER: Monitor tobacco use and prevention policies, Protect people from tobacco smoke, Offer help to quit tobacco use, Warn about the dangers of tobacco, Enforce bans on tobacco advertising, promotion and sponsorship, Raise taxes on tobacco.

For almost two decades, researchers have observed the preservation of the quantum statistical properties of bosons in a large variety of plasmonic systems. In addition, the possibility of preserving nonclassical correlations in light-matter interactions mediated by scattering among photons and plasmons stimulated the idea of the conservation of quantum statistics in plasmonic systems. It has also been assumed that similar dynamics underlie the conservation of the quantum fluctuations that define the nature of light sources. So far, plasmonic experiments have been performed in nanoscale systems in which complex multiparticle interactions are restrained. Here, we demonstrate that the quantum statistics of multiparticle systems are not always preserved in plasmonic platforms and report the observation of their modification. Moreover, we show that optical near fields provide additional scattering paths that can induce complex multiparticle interactions. Remarkably, the resulting multiparticle dynamics can, in turn, lead to the modification of the excitation mode of plasmonic systems. These observations are validated through the quantum theory of optical coherence for single- and multi-mode plasmonic systems. Our findings unveil the possibility of using multiparticle scattering to perform exquisite control of quantum plasmonic systems., (© 2021. The Author(s).)

Background: Polycystic ovary syndrome is the most common endocrine disorder among adolescents and adults. Given the importance of healthy nutritional behaviors in management of this disease, the present study was conducted to determine the impact of an educational intervention program based on the theory of planned behavior on the nutritional behaviors of adolescents and young adults with polycystic ovary syndrome., Methods: In this field trial study, 72 participants aged between 15 and 21 years old from four gynecology clinics in Shiraz, Iran, were assigned into the intervention and control groups. Educational intervention program was implemented based on the theory of planned behavior over 4 sessions during two weeks. The data collection tools were researcher-made questionnaires of demographic information, knowledge assessment, and assessment of theory of planned behavior constructs, as well as a questionnaire for assessing consumption of food groups, fast food, and snacks. The data were collected at two stages (once at baseline and once three months after the intervention), and then the changes in knowledge, attitude, subjective norms, the perceived behavioral control, behavioral intention, and nutritional behavior were analyzed using descriptive and inferential statistical methods (t-test, Chi-square, Mann- Whitney U, and Wilcoxon tests; as well as one- way ANOVA, repeated measures ANOVA, and ANCOVA, respectively)., Results: Statistically significant increases were observed in the mean scores of knowledge, attitude, subjective norms, the perceived behavioral control, behavioral intention, and nutritional behavior in the intervention group by passing three months from the intervention compared to the scores before the intervention (P < 0.001). However, these differences were not statistically significant in the control group (P > 0.05). Moreover, the mean scores of knowledge, attitude, subjective norms, perceived behavioral control, behavioral intention, and nutritional behavior had no statistically significant difference before the intervention between the two groups; however, this was statistically significant by passing three months from the intervention (P < 0.001)., Conclusion: Considering the effect of an educational intervention program based on the theory of planned behavior on creating healthy nutritional behaviors in adolescents and young adults with polycystic ovary syndrome, it is recommended to use it in order to improve the nutritional health of them., Trial Registration: IRCT, IRCT20160224026756N6. Registered 18 Aug 2018, https://en.irct.ir/user/trial/32693/view., (© 2021. The Author(s).)

Background: Triple-negative breast cancer accounts for approximately 15-20% of all breast carcinomas and is associated with earlier age of onset, aggressive clinical course, and dismal prognosis. A series of 1,3-diaryl-5-(3,4,5-trimethoxyphenyl)-4,5-dihydro-1 H-Pyrazole and 1,3-diaryl-5- (3,4,5-trimethoxyphenyl)- 1 H-Pyrazole were evaluated for their anticancer activity against MDA-MB-468, human triple negative breast cancer cell line., Methods: The cytotoxic effects of Pyrazole derivatives on the growth of MDA-MB-468 and AGO1522 were determined using MTT assay. Annexin-V-FITC and PI staining were performed to detect apoptosis and cell cycle distribution using Flow cytometry. The level of Reactive oxygen species (ROS) formation and caspase 3 activity were determined accordingly., Results: Pyrazole derivatives induced a dose and time-dependent cell toxicity in MDA-MB-468 compared with untreated cells. The results showed that 3-(4-methoxyphenyl)-1-(p-tolyl)-5-(3,4,5-trimethoxyphenyl)-4,5-dihydro-1H-Pyrazole (3f) was the most active compound with IC50 values 14.97 μM and 6.45 μM compared with Paclitaxel with IC50 values 49.90 μM and 25.19 μM, after 24 and 48 hours, respectively. Upon treatment with 14.97 μM of 3f after 24 h, the compound induced cell cycle arrest in S phase. 3f provoked apoptosis was accompanied by the elevated level of ROS and increased caspase 3 activity in MDA-MB-468 cells compared with untreated cells., Conclusion: The overall results of the present study provided evidence for the cytotoxicity of compound 3f against MDA-MB-468 cells in comparison to reference standard, Paclitaxel. It proves that compound 3f can trigger apoptosis through ROS production and caspase 3 activation. These bring supportive data for future investigations that will lead to their use in cancer therapy. , .

Background: Skipping breakfast and replacing it with non-nutritious snacks are progressively increasing among adolescents. This study aimed to develop an educational intervention based on the Social Marketing Model and evaluate its effects on healthy breakfast and snack consumption among female adolescent students., Methods: This mixed-methods study was conducted in 2016-2019 in two phases. In the first phase, a qualitative study was conducted through directed content analysis in guidance schools in Khorramabad, Isfahan, and Tehran, Iran, to explore factors affecting breakfast consumption. The results of this phase were set in the benchmarks of the Social Marketing Model. In the second phase, a randomized controlled trial was conducted based on the benchmarks of the Social Marketing Model on 94 students randomly recruited from guidance schools in Khorramabad, Iran., Results: The findings of the qualitative phase were categorized into the benchmarks of the Social Marketing Model, namely the social marketing mix, the intended behavior, internal and external competing factors for behavior modification, theoretical concepts related to the behavior, and the role of supporters. In the quantitative phase, the univariate analysis showed significant between-group differences concerning the product, price, promotion, and behavior (p < 0.05)., Conclusion: Healthy breakfast and snack consumption can be promoted through making acceptable the tastes, costs, preparations, and consumption places of breakfast and snack., Trial Registration: The trial was registered in the Iranian Registry of Clinical Trials (code: IRCT20170201032347N1 ). The trial was registered in 11/07/2018 and is accessible on the Iranian Clinical Trial Registration website.

Background: The present study was conducted to design and evaluate the software and web-based curriculum based on Pender Model in order to promote students' physical activity., Methods: This is a quasi-experimental study conducted on 225 eligible students who were randomly divided into two groups of web and software-based intervention and control. The sample size of the study was selected using stratified sampling method. The evaluation was done with pre-test and post-test and follow-up, which were performed immediately two and six months following the intervention. The data were analyzed employing statistical software SPSS using descriptive statistics, chi-square, one way ANOVA, and repeated measures ANOVA., Results: The obtained results revealed that the level of physical activity after the intervention in the web and software groups significantly increased compared to the control group (p < 0.001). Moreover, the mean score of Pender model constructs, immediately two and six months after the intervention, was significantly different in the web and software groups (p < 0.001)., Conclusion: Our results indicated that, providing tailored message based on health promotion model's constructs has a positive effect on promoting physical activity of students., Trial Registration: Name: Iranian Registry of Clinical Trials. Registration number: IRCT20181009041298N1 . Registration date: 2018-12-02 [retrospectively registered].

Background: Today, one of the most serious causes of mortality and disability among youth is the traffic accidents. Regarding its importance, this paper aimed to investigate the community-based program to promote the safe traffic behaviors among youth., Methods: This was a quasi-experimental conducted on 5000 youth in five Iranian cities named Lanjan, Gomishan, Fasa, Tehran, and Zahedan in 2015-2016. The questionnaire was based on the constructs of the theory of planned behavior as well as a questionnaire of pedestrian behavior and driving behavior, which was completed before and after the intervention. The educational intervention was carried out based on the theory of planned behavior. Finally, the obtained data were analyzed using STATA software., Results: Six months after the intervention, the mean score of the theory of planned behavior and safe driving behavior in different cities was significantly increased. Here, regarding the safe crossing of the street, the most behavioral changes were observed in Gomishan ( P = 0.000), Fasa ( P = 0.001), and Tehran ( P < 0.0001). The mean score of driving behaviors in Gomishan ( P < 0.000), Fasa ( P = 0.016), Lanjan ( P = 0.047), and Tehran ( P < 0.0001) scores was significantly higher., Conclusions: In most of the studied cities, it can be concluded that education based on the theory of planned behavior can improve the safe driving behaviors among youth. Therefore, it is recommended to be implemented this program in other cities using the theory of planned behavior., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 International Journal of Preventive Medicine.)

Background: The adherence of diabetic patients to their medication regimen is associated with many psychosocial factors that are still unknown. Therefore, the present study aims to identify the psychosocial barriers to medication adherence of patients with type2 diabetes (T2D)., Methodology: This descriptive qualitative study was done in Isfahan, Iran by conducting in-depth unstructured interviews with 23 purposively selected patients with T2D and 10 healthcare providers (HCPs). The participants were interviewed face-to-face between November 2017 and June 2018 at the patient's home, a Health Care Center, or at the diabetes clinic. Data analysis was performed using MAXQDA-10 software and the conventional content analysis., Results: The analysis of the data led to six categories of perceived psychosocial barriers: 1) fear, concern and distress, 2) exhaustion and burnout, 3) the children's issues being the priority, 4) poor financial support, 5) communication challenges, and 6) poor work conditions., Conclusions: This study identified some of the psychosocial barriers to medication adherence of patients with T2D, which will be of great help to researchers and HCPs in designing and implementing effective interventions to overcome these barriers and change patient self-care behaviors and increase their medication adherence.

Objective: Pregnant women need health information to ensure their health and to have a healthy delivery. Therefore, equipping them with adequate information can bring desired health outcomes for them and their fetus. The present study was conducted to explore health information needs of women during pregnancy. Materials and methods: The present research was a qualitative study. Thirty-nine participants (pregnant women, midwives, and obstetricians) were selected through purposeful sampling in Isfahan from June to November 2016. Data were collected through in-depth face-to-face semi-structured interviews, daily notes and field notes. Results: Data analysis led to emergence of ten sub-categories including: "common complaints during pregnancy", "problems and complications in pregnancy", "factors affecting fetal health", "proper nutrition and take supplements during pregnancy", "sex during pregnancy", "exercise during pregnancy", "diagnostic tests in pregnancy", "fetal growth and development", "types of childbirth and preparation for delivery" and "baby care and breastfeeding" and finally the main category was the "health information needs". Conclusion: Regarding the health information requests of pregnant women, their needs should be identified and taken into consideration when planning educational programs for this group of women., (Copyright © 2020 Tehran University of Medical Sciences. Published by Tehran University of Medical Sciences.)

Background: Mobile app education is one of the new educational models. Hence, the purpose of this study was to determine the effectiveness of mobile app intervention on knowledge, attitude, and practice of youth for a healthy marriage., Materials and Methods: This quasi-experimental study was conducted in 2019 on 88 young people who were selected by simple random sampling in premarital counseling center of Falavarjan city (Isfahan). Then, participants were randomly allocated to an intervention and a control group. Mobile application intervention was installed on the intervention group's mobiles. Data were collected by questionnaire in two times. Data were analyzed using paired t -test and independent t -test., Results: The mean (Standard deviation) of couples' age was 21.11 (5.06) years. The results showed that after the installation of educational consulting app in the intervention group, the mean score of knowledge ( P = 0.001), attitude ( P = 0.001), and practice ( P = 0.001) after intervention were significantly higher than before the intervention., Conclusion: Mobile-based educational and counseling app increases couples' knowledge, attitude, and practice in premarital education. Therefore, it is recommended that this type of education (mobile app) be used to promote premarriage education classes., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Journal of Education and Health Promotion.)

Background: breakfast elimination as well as consumption of low-value snacks is ever increasing among adolescents. This study sought to explain the dimensions of social support for breakfast and healthy snacks among students., Methods: A qualitative research was conducted in Isfahan, Tehran, and Khorramabad, Iran high schools in 2017-18. Data were obtained from five focus group discussions and 35 in-depth interviews as well as semi-structured interviews with students of both sex, parents and school authorities. The data simultaneously analyzed using conventional content analysis in three stages including preparation, organization, and reporting. Prolonged engagement, maximum variation of sampling and member check were the enrichment factors of the research., Results: Three main categories emerged. First, family supports with sub- categories of family in the school programs as well as mother-sponsored support and family life patterns. Second, school supports with sub- categories of instrumental and informational support. And third, support of other community organizations with sub- categories of intra-department coordination and mass media., Conclusion: The concepts emerging in the present study develop multilevel ecological strategies to promote nutritional health including family, school, and community organizations such as school renovations, municipalities, police, education, and mass media to promote healthy breakfast and snack behavior are applicable for students., (© 2020 Walter de Gruyter GmbH, Berlin/Boston.)

Background: This study aims to determine the prevalence of physical inactivity in Iranian adolescents aged 10-12 years and the impact of socioeconomic inequality on it., Methods: In this descriptive study, the study population consisted of 10-12 years old adolescents from an Iranian population from Kurdistan, Fars and Markazi provinces in 2018. The sample size was 1590 individuals. The sampling method was cluster sampling. Data was collected using demographic questionnaire, modifiable activity questionnaire (MAQ) and socioeconomic questionnaire. Cut points on the MAQ for light activity, moderate activity and heavy activity were MET< 3, MET = 3-6 and MET> 6, respectively. Linear and logistic regression were used to estimate the final model and the Oaxaca analysis method was applied. All analyses were performed in Stata/SE 14.0., Results: Of the 1590 participants, 52.82% were male. The results showed that 25.79% of the subjects were physically inactive and 7.30% engaged in moderate physical activity during the week. The average physical activity during 1 week was more in boys than in girls (P-value< 0.05). Adolescents of mothers with secondary and high school education were more likely to have physical inactivity than mothers with a high school diploma or higher (AOR: 1.35, 95% CI: 1.02-1.77). The concentration index was -.11, indicating a greater concentration of physical inactivity in adolescents with low socioeconomic levels., Conclusion: One-fourth of the study population had physical inactivity in this age group. Socioeconomic levels, parental literacy, and sex of adolescents were associated with the level of physical activity.

Aims: Type 2 diabetes is a major global health concern, and its prevalence is rapidly increasing throughout the world. The present study was conducted to explore the experiences of patients and healthcare providers to identify the social barriers to patients' adherence to their recommended diet and thus help the design of future interventions., Design: This study was conducted as a qualitative study with content analysis approach., Methods: The present qualitative study was conducted from November 2016-July 2017. Data were collected through 38 unstructured in-depth interviews with 33 T2D patients and their treatment supervisors and field notes. The interview transcripts were coded using the MAXQDA 10 software. To extract categories and themes, the thematic analysis approach was used. We followed the COREQ Checklist to ensure rigour in our study., Results: The analysis of the study revealed the emergence of five categories of perceived barriers including social priorities and rivalries, family's food habits, poor social support, social impasses and dominant food patterns., Competing Interests: The authors declare that they have no competing interests., (© 2020 The Authors. Nursing Open published by John Wiley & Sons Ltd.)

Background: Polycystic Ovary Syndrome (PCOS) is one of the most common endocrine disorders in the women of reproductive age. In addition to multiple physical problems, this syndrome has many psychological manifestations. Thus, the present research was conducted aimed at investigating the psychological experiences of the adolescent girls with PCOS., Materials and Methods: This research was conducted using the qualitative content analysis method. A total of 18 adolescent girls with PCOS and 15 healthcare providers were selected by the purposive sampling method. The data were collected through in-depth interviews, focus group discussions, and field notes, which were analyzed using the conventional content analysis method., Results: After analyzing, three main categories and seven subcategories were extracted. First, the psychological experiences related to the disease symptoms had three subcategories: "psychological experiences related to hirsutism, alopecia, and acne," "psychological experiences related to obesity," and "psychological experiences related to menstrual disorders." Second, the psychological experiences related to disease complications had two subcategories: "psychological experiences related to infertility" and "psychological experiences related to disease progression." Third, the psychological experiences related to treatment of the disease had two subcategories: "psychological experiences related to prolongation of the treatment and uncertain fate of the disease" and "psychological experiences related to the complications of the medical treatment.", Conclusions: Results of the study showed that adolescent girls with PCOS were exposed to multiple concerns endangering their psychological health. Therefore, it is recommended to provide adequate and appropriate information about the disease and its consequences, as well as psychosocial supports and regular assessment of psychological state by the team of healthcare providers in the adolescent girls with PCOS., Competing Interests: Nothing to declare., (Copyright: © 2020 Iranian Journal of Nursing and Midwifery Research.)

Background: Despite the goal of horizontal equity in Iran, little is known about it. This study aimed i) to assess socioeconomic inequality and horizontal inequity in the healthcare utilization; and ii) to explore the contribution of need and non-need variables to the observed inequalities., Methods: This study used national cross sectional dataset from Utilization of Health Services survey in 2015. Concentration Index (C), Concentration Curve (CC) and Horizontal Inequity index (HI) were calculated to measure inequality in inpatient and outpatient health care utilization. Decomposition analysis was used to determine the contribution of need and non-need factors to the observed inequalities., Result: Results showed the pro-poor inpatient services in both rural (C = - 0.079) and non-rural areas (C = - 0.096) and the pro-rich outpatient services in both rural (C = 0.038) and non-rural (C = 0.007). After controlling for need factors, HI was positive and significant for outpatient services in rural (HI = 0.039) and non-rural (HI = 0.008), indicating that for given need, the better off especially in rural make greater use of outpatient services. The HI was pro-poor for inpatient services in both rural (HI = - 0.068) and non-rural (HI = -0.090), was significant only in non-rural area. Non-need factors were the most important contributors to explain inequalities in the decomposition analysis., Conclusion: Disentangle the different contribution of determinants, as well as greater HI in rural areas for outpatient and in non-rural areas for inpatient services, provide helpful information for decision makers to re-design policy and re-distribute resource allocation in order to reduce the socioeconomic gradient in health care utilization.

Background: Polycystic ovary syndrome (PCOS) is a hormonal disorder in women of reproductive age. It seems that over the recent years, PCOS has augmented in adolescent girls due to unhealthy food habits and obesity. So, the present study was conducted to explore the food habits in overweight and obese adolescent girls with PCOS., Methods: In the present qualitative study, 33 participants were selected using a purposive sampling method. Data were collected through individual in-depth interviews, focus group discussions (FGDs), and field notes. These data were analyzed through the use of conventional qualitative content analysis., Results: Three main categories were extracted: First, the high consumption of unhealthy food had three sub-categories: "high consumption of fatty and salty foods", "high consumption of unhealthy snacks", and "high consumption of sugar-rich foods". Second, low consumption of healthy food had three sub-categories: "low consumption of dairy products", "low consumption of fiber-rich foods", and "low consumption of meat, beans, fish and seafood" Third, inappropriate behavioral habits had three sub-categories: "lack of concentration and consumption of large meals", "inappropriate dietary and physical activity patterns", and "skipping the meals and going on arbitrary diets"., Conclusion: This research through presenting an image of food habits in overweight and obese adolescent girls with PCOS is able to help for designing the necessary interventions to change the food habits, control the symptoms and complications of PCOS, and finally, improve the reproductive health of these girls.

Introduction: The present study aims at designing and evaluating the effect of new educational media-based educational intervention on students' stages of behavior change of physical activity., Subjects and Methods: In the present interventional study, 225 students of medical sciences university were assigned into two experimental and one control groups using proportional stratified random sampling, where web-based and software-based educational interventions were used. Data were collected using International Physical Activity Questionnaire, Marcus's stages of change scales, and a self-made questionnaire including constructs of barriers, benefits, and self-efficacy. Evaluation was conducted through pretest and posttest and immediate and 2 and 6 months of follow-ups after the intervention. Data were analyzed by SPSS software using descriptive statistics and Chi-square, Friedman, one-way ANOVA, and ANOVA with repeated measure., Results: Based on the results, there was no significant difference between the experimental and control groups before the intervention ( P = 0.37); however, immediately and 2 and 6 months after the intervention, there was a significant difference between the experimental and control groups in terms of stages of change ( P < 0.001). Furthermore, in the experimental group, the educational intervention led to improvement of individuals in the stages of change of physical activity. At 6-month follow-up, 75.4% of the software group and 60.6% of the web group achieved the maintenance stage., Conclusion: The results suggest that designing intervention based on people's level of preparation for changing behavior and using new educational methods such as web and software were effective on individuals' progress in different stages of change of physical activity behavior and physical activity rate., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Journal of Education and Health Promotion.)

Background: Reproductive health of vulnerable adolescent girls is a top priority in global programs. Alcohol consumption, drug abuse, high risk sexual behaviors, sexually transmitted diseases, sexual assault, escape from home, unrestrained sex in the family, history of robbery, imprisonment and living in drug hangouts expose adolescents to different sorts of damage and injury. These adolescent girls are at risk of AIDS and other STDs, unwanted pregnancies, illegal and unsafe abortions, unplanned pregnancy and childbirth, and unsafe motherhood. Therefore, assessing these girls' reproductive health needs and designing programs to improve their sexual and reproductive health seem to be essential. This study will be conducted to design a comprehensive program for improving the reproductive health of vulnerable adolescent girls., Methods: The present study is an exploratory sequential mixed methods study (Qual-Quan) designed in three phases. In the first phase, a qualitative study will be used to describe the reproductive health needs of vulnerable adolescent girls, identify facilitating and inhibiting factors, and explain the strategies of reproductive health programs for these girls. Participants will be selected in this phase using purposive sampling method, and the data will be collected through semi-structured interviews. The obtained data will be analyzed using conventional qualitative content analysis. In the second phase, through a quantitative study, the strategies obtained from the qualitative study and review of the literature will be provided to reproductive health care providers, experts, policymakers, and planners to prioritize and select the best strategies. In the third phase, the initial draft of the program will be formulated based on prioritized strategies and will be proposed in a panel comprised of specialists in the areas of reproductive and sexual health, health promotion, social injuries and a psychiatrist. Finally, the final program will be developed and presented after obtaining the agreement and approval of the panel members., Discussion: Designing a program based on a qualitative study, review of the existing evidence and programs, and using the opinions of experts in different areas can lead to different aspects of reproductive and sexual health of vulnerable adolescent girls. On the other hand, taking into account all cultural sensitivities and taboos as well as political, economic and social barriers, the development of such a program can provide the appropriate possibility of presenting comprehensive reproductive and sexual health services to vulnerable adolescent girls and achieve the goals agreed universally.

Objective: Acceptance and commitment therapy (ACT) interventions increase psychological flexibility and improve mental health and quality of life in patients with myocardial infarction. Study design: A controlled clinical trial study was conducted to evaluate the efficacy of an ACT intervention in improving the quality of life in patients with MI in Isfahan, Iran. Method : The present controlled clinical trial with a pre and post-test design was conducted on a statistical population consisting of patients with MI admitted to hospitals in Isfahan (n = 60) who were selected through sequential sampling based on the study inclusion criteria and were randomly divided into an intervention and a control group (n1 = n2 = 30). The case group received 8 weekly 90-minute sessions of ACT and the control group received no interventions. The pretest-posttest design was administered in both groups using a demographic questionnaire and the Minnesota Living with Heart Failure Questionnaire (MLHFQ) designed to assess the health status of patients with heart failure in terms of quality of life. The data obtained were analyzed in SPSS-20 using descriptive statistics and the ANCOVA. Results: In this study, 2 general areas of quality of life, including physical and mental health, were examined in the patients. There was a significant increase in the quality of life and subscales of mental and physical health in the experimental group (p < 0.001). Conclusion: Considering the effectiveness of ACT in improving quality of life in these patients, this method of intervention can be used as a complementary therapy in health care centers to reduce the side-effects experienced by these patients., (Copyright © Psychiatry & Psychology Research Center, Tehran University of Medical Sciences.)

Background: The prevalence of consuming fast foods and non-nutritious snacks is progressively increasing among adolescents. This study aimed to explore factors behind snack consumption at school among Iranian high-school students., Methods: This descriptive qualitative study was conducted in 2017 in four boys' and four girls' high-schools located in Isfahan, Khorramabad, and Tehran, Iran. Data were collected through 42 in-depth semi-structured interviews and four focus groups with male and female students, their parents, and their school teachers and administrators. The conventional content analysis approach was used for data analysis. Trustworthiness was applied to the study through prolonged engagement, maximum variation sampling, and member checking techniques., Results: Factors behind students' snack consumption came into two main groups, namely influential behaviors, and influential emotions and perceptions. Influential behaviors included the behaviors of students, their family members, peers, school administrators, and snack sellers. Moreover, influential emotions and perceptions included positive and negative feelings towards healthy snacks, fear over the consequences of unhealthy snacks, and perceived positive outcomes of healthy snacks., Conclusions: Students' snack consumption at school is affected not only by their own behaviors, emotions, and perceptions, but also by significant others' behaviors and environmental factors. School administrators need to make environmental modifications to turn school environment into a pleasant place for healthy snack consumption and make healthy snack consumption a pleasurable experience for students.

Background: The consumption of non-nutritious snacks instead of a proper breakfast is becoming more widespread among adolescents. It is expected that using the 4P (product, price, place, promotion) strategies of the social marketing (SM) model can help to better identify factors affecting healthy breakfast and snack consumption. The objective of this study was to develop and evaluate the psychometric properties of the Healthy Breakfast and Snack Consumption Scale (HBSCS) using the SM model., Methods: This was a cross-sectional descriptive study that was conducted in 2017. First, a scale was developed using the results of a qualitative research based on the SM model. Then, its face, content and construct validities as well as its reliability were assessed. Construct validity was evaluated via exploratory factor analysis conducted on a random sample of 300 high school pupils selected from five girls' schools located in Isfahan, Iran, using the multistage cluster sampling method. Exploratory factor analysis was performed using the methods of principle components extraction and varimax rotation with eigenvalues greater than 1., Results: A four-factor structure that explained 61.73% of the total variance of the HBSCS included healthy breakfast and snack preferences, readiness to pay the price, place preferences and communication channel preferences. Items with an impact score of less than 1.5 were removed. Additionally, items with content validity ratio values of less than 0.62 and content validity index values of less than 0.79 were deleted. The Kaiser-Meyer-Olkin measure value was 0.74 [chi-squared (χ 2 ) = 2353.622; p-value < 0.001]. The Cronbach's α values of the scale and its four dimensions were 0.71 and 0.56-0.72, respectively., Conclusion: This scale has acceptable validity and reliability. School authorities and health professionals can use this scale to screen adolescents at risk of consuming unhealthy foods and snacks. Besides, the scale might be used as a framework for assessing, implementing and promoting healthy eating behaviors among pupils., (© 2019 Walter de Gruyter GmbH, Berlin/Boston.)

Here we report the consumption of traditional cottage cheese (Koupé) in western Iran, as a new way of transmission of botulism. All the patients (a nine member family) had at least two specific symptoms of botulism. Given the clinical symptoms and contact history, antitoxins were injected in the early hours of hospital admission. On Jan 27, 2017, three patients clinically suspected of foodborne botulism were referred to the hospital in Sanandaj, western Iran from their local hospital in Baneh, western, Iran. Because of the worsening of clinical conditions, a 34-yr-old man with both gastrointestinal and neurological symptoms was admitted to the ICU, while other family members were treated in the infectious diseases ward of the hospital. The disease was diagnosed through isolating toxin A from the cheese and testing the serum sample of one of the patients. This case of botulism showed that traditional Koupé cheese could cause foodborne botulism. Hence, it is necessary to train and inform people about how to process and keep the cheese to prevent similar cases., Competing Interests: Conflict of interest The authors declare that there is no conflict of interests., (Copyright© Iranian Public Health Association & Tehran University of Medical Sciences.)

Background: Appropriate health information seeking behavior can play an effective role in self-care and promotion of women's quality of life during pregnancy. However, different barriers can impede pregnant women while accessing health information. The aim of this research was to explain challenges to access health information during pregnancy., Methods: The present qualitative study was carried out on 28 participants who were selected using the purposeful sampling technique. Data were collected through in-depth interviews, field notes, and daily notes; data were analyzed using conventional content analysis., Results: The main barriers to access health information during pregnancy were as follows: many duties of women at home as well as out-of-home education and employment, inability to make distinction between correct and incorrect information, insufficient interactions between women and healthcare providers, failure to access to various information resources, common complaints of pregnancy, and stress and anxiety of confronting the problems during pregnancy., Conclusion: Based on the results, pregnant women experienced personal, social, and structural barriers when accessing health information. Therefore, policymakers and health planners should remove the barriers, encourage self-care, and enhance the quality of life for pregnant women, thus, promoting their health status in the end.