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Niloufar Shashaani,1 Reza Shiari,2 Abdullah Karimi,3 Shima Salehi,4 Roxana Ghanaei,3 Mehrnoush Hassas Yeganeh,2 Sara Shiari,1 Khosro Rahmani,2 Vadood Javadi Parvaneh2 1Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 2Department of Pediatric Rheumatology, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 3Department of Infectious Diseases, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 4Faculty of Medicine, Ali Asghar Children’s Hospital, Iran University of Medical Sciences, Tehran, IranCorrespondence: Reza Shiari Tel +98-21-22227033Email shiareza@yahoo.comIntroduction: Kawasaki disease (KD) is a systemic vasculitis that occurs mostly in children under five years old. Kawasaki affects the middle-size arteries, especially the coronary arteries. Therefore, without adequate treatment, it may cause coronary artery aneurysm in 25% of patients. The purpose of this study was to investigate the relationship between Kobayashi, Sano, and Egami criterions with coronary artery aneurysm in KD patients during the last ten years and to identify risk factors in patients with intravenous immunoglobulin (IVIG)-resistant and coronary artery aneurysms.Methodology: Medical records of 363 Kawasaki patients referred during 2008– 2017 were reviewed. Patients’ demographic data and Kobayashi, Sano, and Egami scores of each patient were calculated. Based on echocardiographic findings, cases of coronary artery aneurysm were determined. Sensitivity, specificity, positive and negative predictive value, and the accuracy of each criterion were determined to predicting IVIG resistance and detect coronary artery aneurysm.Results: There was a slight relationship between IVIG-resistance in Kawasaki children and its prediction based on the Kobayashi risk score, but no relationship was found between the Egami and Sano criteria. Sixty-three patients (17.4%) had coronary artery lesions (CALs) on time of diagnosis. There were no statistically significant differences between gender and mean age of children with and without CALs. Also, there was no significant relationship between coronary artery aneurysm in Kawasaki children and its prediction based on the above three risk factors. The area under the ROC-curve of all three risk measures of Kobayashi, Egami, and Sano indicated that all three criteria were not useful in predicting CALs.Conclusion: Despite the low accuracy of the three above criteria to predictive of patients with IVIG resistance, it seems that the variables of age, duration of fever, and C-reactive protein (CRP) are more useful than other variables and may be utilized to evaluate patients by establishing a more appropriate cut-off point.Keywords: Kawasaki disease, coronary artery aneurysm, IVIG-resistant, Kobayashi, Sano, Egami

Background: Nutritional problems are considered one of the main complications of hemodialysis, and the geriatric nutritional risk index (GNRI) is a new instrument for assessing geriatric nutritional status. The present study sought to evaluate the relationship between the GNRI and quality of life (QOL) among elderly hemodialysis patients., Methods: In the present analytical cross-sectional study, 110 hemodialysis individuals were selected by applying a simple random sampling method, among whom 57 and 53 were males and females, respectively (mean: 70.3±6.93 years). Demographic characteristics, GNRI, and QOL status were determined. The data were analyzed using SPSS 20 software and descriptive statistics, Pearson's correlation, ANOVA, independent sample t -tests, and multiple linear regression analysis., Results: The mean GNRI and mean total QOL were respectively obtained 93.903±11.067 and 20.95 ± 4.89. Among females, a significant direct relationship was observed between GNRI and total QOL ( P = 0.010, r = 0.352), autonomy ( P = 0.004, r = 0.389), and pleasure ( P = 0.015, r = 0.333), while GNRI was not directly and significantly related to QOL in males ( P = 0.161, r = 0.188)., Conclusion: Due to the presence of a significant association between Geriatric GNRI and QOL among elderly hemodialysis patients, particularly among females, highlighting the importance of addressing nutritional status in optimizing well-being., Competing Interests: The authors declare that they have no conflicts of interest.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: The spread of the coronavirus disease 2019 (COVID-19) pandemic caused a variety of psychological complications. One way to control the spread of this pandemic is compliance with health protocols and standards. Considering the limited research into the psychological effects of COVID-19 and the preventive behaviors among older adults, this study aimed to determine these variables and their relationship with associated factors., Materials and Methods: This cross-sectional study was conducted on 153 older adults who were referred to the clinic of Pirouz Hospital in the east of Guilan, in the north of Iran, in 2022. The research instruments included the Impact of Event Scale-Revised (IES-R) and the preventive behavior questionnaires. Descriptive (mean, standard deviation, frequency, and percentage) and inferential (Kruskal-Wallis and Mann-Whitney tests) statistics were used to analyze the data using Statistical Package for the Social Sciences (SPSS) software version 20 with a significant level of 0.05., Results: The findings showed that the overall mean score for preventive behaviors was 107 ± 10.38. The highest mean score of preventive behaviors was related to personal behavior (43.00 ± 5.58) and instructions to enter the house (30.15 ± 4.84), respectively. The highest mean scores of psychological effects were related to the intrusion dimension (11 ± 5.33) and avoidance dimension (7 ± 4.74), respectively. There was a significant relationship between drug use (F = 27.136, P = 0.028) and the psychological effects of COVID-19., Conclusion: Based on the results, the general condition of the preventive behaviors of older adults was average, and the majority of them were at a normal level of psychological effects. However, administrators and health policymakers should consider planning to develop interventions to encourage and improve preventive behaviors against COVID-19, especially among older adults during the COVID-19 pandemic., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Education and Health Promotion.)

Introduction  In today's world, old age has become an important global phenomenon following the increase in life expectancy and the decrease in birth rates. Communication skills are an important requirement in old age. Changing role of the family and existing tensions, mental pressures, and modern life undermine the social position of the elderly and lead to abuse of the elderly by family members. The goal of the present study is to determine the relationship between communication skills and family self-reported domestic abuse among older adult in Iran. Materials and Methods  For this cross-sectional-analytical study, 153 elderly adult people admitted in hospitals of the Guilan province were randomly selected. The research instruments were the following questionnaires: demographic characteristics, abbreviated mental test (AMT), the Persian version of Domestic Elder Abuse Questionnaire, family mistreatment of the elderly (Heravy), and Queendom Communication Skill Test-Revise (QCSTR). The data were analyzed by SPSS software (version 22) using descriptive (frequency distribution tables, mean, and standard deviation [SD]) and analytical statistics (Mann-Whitney, Kruskal-Wallis, and Spearman's correlation tests) considering the significance level of 0.05. Results  A majority of the elderly were men (51%), were in the age group of 60 to 69 years (72.5%) and married (75.5%), did not hold high school diploma (88.8%), had four to five children (41.2%) with low income (75.9%), and suffered from chronic diseases (68.6%). The mean score of communication skills was 129.09 ± 12.60. The mean score of domestic elder abuse was 2.89 ± 3.97. Communication skills have a significant relationship with age and marital status, but not with sex, education level, income, and chronic disease. There is an inverse correlation between communication skills and domestic elder&#95;abuse ( p  < 0.001, r  = -0.468). Conclusion  Communication skills are one of the influential factors of domestic violence. Therefore, to prevent or reduce the amount of violence, it is recommended that family members increase the communication skills of the elderly., Competing Interests: Conflict of Interest None declared., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. ( https://creativecommons.org/licenses/by/4.0/ ).)

Background: Quality of life (QOL) is a vital component in assessing the standard of living for seniors. Hand grip strength (HGS) is a widely used measure to diagnose muscle strength decline that often occurs due to age-related loss of skeletal muscle mass and function. This study focuses on the HGS in predicting the QOL of older adults who are referred to retirement centers in Guilan Province., Materials and Methods: In 2021, a cross-sectional analytical study was conducted among 115 older adults who were residing in retirement centers located in Guilan Province, Northern Iran. The participants were selected using a two-stage sampling method, where three retirement centers were randomly chosen followed by convenience sampling from each center. The selected retirement centers were situated in Langrod, Sowme'eh Sara, and Rasht cities in the east, west, and center of the province, respectively. The data were collected through a demographic information questionnaire, QOL scale (CASP-19), and HGS measurement using a dynamometer., Results: Of the participants, 57.4% were male, 51.3% had middle income, and 96.5% were categorized as young elderly. The mean overall QOL score was found to be 37.026 ± 6.123, while the mean HGS level was 31.74 ± 7.45 and 18.48 ± 5.13 among males and females, respectively. There was a significant association between the level of education and QOL ( P = 0.002). Moreover, there was a positive and significant correlation between HGS and QOL (r = 0.54, P = 0.001). The results of the multiple linear regression identified HGS as a predictor of QOL (Adj R 2 = 0.44, βHGS = 0.79)., Conclusion: Given that HGS has been identified as a predictor of QOL in older adults, improving this factor through exercise can lead to enhancement in their QOL. Therefore, regular sports exercises can be recommended as a means of improving HGS and subsequently enhancing the QOL of older adults., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Education and Health Promotion.)

Background: Patient satisfaction helps healthcare organizations to improve their quality level and nurse-patient relationship is effective in increasing satisfaction. The aim of this study was to determine the effect of communication using Peplau's theory on satisfaction with nursing care in hospitalized older adults' patients in cardiac intensive care unit., Materials and Methods: This quasi-experimental study was conducted by available sampling method on 78 hospitalized older adults (39 interventions, 39 control) in cardiac intensive care unit of Guilan hospitals in north of Iran in 2021. In the intervention group, Peplau's communication theory (four stages of orientation, identification, exploitation, and resolution) was implemented and the control group received routine care. At the time of discharge, patient satisfaction questionnaire of quality of nursing care was completed for both groups. Data were analyzed through descriptive and inferential statistics (independent t test, Chi-square test)., Results: The mean score of nursing satisfaction in the intervention group (5.4 ± 93.0) was significantly higher than the control group (6.8 ± 75.7) (t (64) = 11.54, P < 0.001, d = 2.84). In other words, the mean satisfaction scores of nursing care in the intervention group were 17.4 units (95% confidence interval: 14.4-20.4) more than the control group., Conclusion: Using Peplau's communication theory in the care of hospitalized older adults in cardiac intensive care unit can lead to improvement of satisfaction, so it is suggested to use this communication method in the care of these patients to improve the level of satisfaction, quality of care, and functional independence., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Education and Health Promotion.)

Background: Ultrasound is an important method to determine the volume of the gallbladder and check its structure. Considering the variation in the size and volume of the gallbladder in disease and physiological conditions, determining the volume of the gallbladder is clinically valuable. This study was carried out to evaluate the gallbladder volume and its association with patients' demographic data in the Prospective Epidemiological Research Studies of Iranian Adults (PERSIAN) Guilan cohort study (PGCS) population., Methods: In this cross-sectional study, 957 individuals aged 35-70 participated in determining the gallbladder volume by a radiologist based on the ultrasound method. The demographical data were collected using a questionnaire. After fasting for 12 h, the ultrasound was performed with an Ultrasonic device (Sonix SP series) with a 3.5 to 5 MHz probe., Results: The total frequency of gallbladder lesions was 2.2%. The results showed a significant association between marriage and gender with the presence or absence of lesions in the studied participants (P < 0.05). Also, significant differences were reported between the volume of gallbladder and gender, body mass index (BMI), social and economic status (SES), metabolic equivalent of task (MET), history of cardiovascular disease (CVD), and hypertension (P < 0.05). The results of a linear regression represented a significant association between gender, BMI, MET, and CVD and the mean volume of the gallbladder (P < 0.05). However, there was no significant association between the presence or absence of a lesion and the individuals' average gallbladder volume (P > 0.05)., Conclusion: According to our results, gender, BMI, MET, and CVD were significantly associated with gallbladder volume., (© 2023. The Author(s).)

Primary immunodeficiencies are a diverse group of rare genetic disorders, among which phagocytic dysfunction impairs neutrophil function in a wide range of inherited disorders. Due to the heterogeneity of the disorders a multidisciplinary approach is often required for early diagnosis and initiation of appropriate treatments. The aim of this study was to evaluate the imaging findings in children admitted with phagocytic primary immunodeficiencies. Thirty-five children who fulfilled the inclusion criteria for phagocytic dysfunction were enrolled in this study. The patients were under close observation and monitoring from January 2011 until data locking in December 2017. The diagnosis of phagocytic immunodeficiency was confirmed by the patient's clinical course, presentation features, and laboratory data.  Among the 35 patients studied, the most frequent condition was chronic granulomatous disease (CGD) (23 patients), followed by different types of neutropenia (8 patients) and Job's syndrome (4 patients). Mediastinal and hilar lymphadenopathies and consolidation were the most frequent presentations. There was a significant relationship between mediastinal/hilar lymphadenopathies and fungal infections. A meaningful relationship was also found between pulmonary nodules without halo signs in patients with concomitant tuberculosis and fungal infections. A significant correlation was found between CGD, pulmonary fibrotic changes, and mediastinal lymphadenopathies. The most frequent radiological manifestations in children included mediastinal and hilar consolidations. Physicians' awareness of the radiological and clinical manifestations of these inherited diseases may be helpful in the early diagnosis and timely initiation of specific prophylaxis measures to prevent infections and also to initiate hematopoietic stem cell transplantation as the curative management modality.

Introduction: Kawasaki disease(KD) is a vasculitis of childhood that tends to influence the coronary arteries. There is no national data about the prevalence of KD in Iran. This study aimed to perform a national registry in Iran for 13 years., Methods: In this retrospective study, the data for KD extracted from medical records of <19 year-old patients admitted to tertiary hospitals in Iran between 2007 and 2019 were recorded in the national KD registry system. Age, admission date, gender, location, and presence of KD criteria, laboratory and echocardiography findings, and treatment modalities were evaluated. Complete KD was considered if ≥4 clinical criteria of the KD existed and otherwise, incomplete KD was considered., Results: Data from 1,682 KD patients including 999(59.39%) boys and 683(40.61%) girls and male/female ratio of 1.46 were evaluated. The mean age was 3.08 ± 2.49 years and 1465(87%) were living in urban regions. The yearly incidence of the disease was between 2.62 to 3.03 from 2015 to 2019. The highest age-specific incidence was observed in children <1-year-old. Incomplete and resistant KD included 1,321(78.54%) and 9(0.54%) patients, respectively. Abnormal echocardiography was detected in 619(36.80%) patients. Leukocytosis, with dominancy of neutrophils, anemia, thrombocytosis and increased ESR and CRP were the most noticeable laboratory findings. No death due to KD disease was reported., Conclusion: Based on this study, most of the KD cases are presented with atypical presentation in Iran. So, increasing awareness of primary healthcare workers by educating and updating their data is very important in timely diagnosis and management of the disease., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Shahbaznejad, Hosseininasab, Mahboobi, Mohammadi, Esmaeili, Farrokhi Far, Alipour, Sedighi, Mansour Ghanaei, Sobouti, Taremiha, Malek, Ghadiri, Soleimani, Tabasizadeh, Ghadimi Moghadam, Barak, Salehi Abarghouei, Hashemian, Daryani Nezhad, Sherkatolabbasieh, Abedini-Varamini, Rahmati, Movahedi and Rezai.)

Background: Patients with surgical stoma experience problems, which can lead to their impaired adaptation and self-efficacy. The nursing process provides a framework for planning and implementing nursing care. This study aimed to investigate the effect of education based on the nursing process on ostomy self-care knowledge and performance of elderly patients with intestinal stoma . Materials and Methods. In this quasi experimental study, 52 elderly patients with intestinal ostomy who were referred to Razi Hospital in Rasht and met the inclusion criteria were invited to participate in research. Sampling was done by a simple random method. The intervention group received an educational programme based on the nursing process, whereas the control group received traditional training. The research instruments included a questionnaire to assess the level of ostomy self-care knowledge and ostomy self-care performance. Data were analyzed by SPSS software version 21 using descriptive and inferential statistics at a significant level of p < 0.05., Results: The mean scores of ostomy self-care knowledge and performance in both groups (intervention and control) were increased. However, the improvement in self-care knowledge and performance of the intervention group was significantly greater than that in the control group ( p < 0.001)., Conclusions: The educational programme based on the nursing process compared to the routine patients training caused more improvement in ostomy self-care knowledge and performance of older adult patients with surgical stoma. Therefore, an educational programme based on the nursing process can be used as an educational model for these patients., Competing Interests: The authors declare that they have no conflicts of interest associated with this manuscript., (Copyright © 2023 Roya Momeni Pour et al.)

Background: There is significant interest in the use of complementary therapies to control or reduce the severity of constipation., Aim: The aim of this study was to determine the effect of abdominal massage on the severity of constipation in elderly patients with fractures., Methods: In this randomized clinical trial, 60 elderly patients admitted to an Iranian orthopedic referral hospital who were suffering from constipation were randomly assigned to intervention and control groups. For the intervention group, abdominal massage was performed for 3 days, twice a day, for 15 minutes. Both groups were assessed using the Constipation Assessment Scale (CAS) and the Bristol Stool Scale (BSS)., Results: A statistically significant difference was observed between the two groups in BSS scores (p < 0.05). The mean CAS scores in the intervention group decreased from 10.74 to 4.51 after intervention and in the control group, it decreased from 10.20 to 7.37. There was a statistically significant difference in CAS scores between the two groups (p < 0.05)., Conclusion: The results of the study showed the positive effect of abdominal massage on stool consistency and reduction of severity constipation., Competing Interests: Declaration of competing interest The authors of this study declared no conflict of interest., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Hypertension is the main risk factor for cardiovascular disease. Low level of health literacy is more common in people with hypertension. Evidence suggests that hypertension is preventable and can be controlled by modifying lifestyle and improving self-care behaviors., Objective: This study aimed to determine the relationship between health literacy, self-efficacy, and self-care behaviors in older adults with hypertension., Methods: The present study was a cross-sectional study conducted with 150 older adult patients with hypertension admitted to the Cardiac Care Unit (CCU) and post-CCU wards in East Guilan public hospitals in the north of Iran in 2020. Sampling was conducted using a convenience method based on inclusion criteria (age 60 years and older, high blood pressure and taking antihypertensive drugs for at least 6 months, ability to speak and communicate, having the suitable physical condition (not ill) to participate in research and answer questions, and having informed consent to participate in the study). The research instruments included a Health Literacy Questionnaire for Iranian Adults, a self-efficacy questionnaire in patients with hypertension, and a self-care behavior questionnaire for patients with hypertension. Descriptive statistics and multiple linear regression were used to analyze the data using SPSS software version 19., Key Results: The results showed that most patients had adequate health literacy with a mean score of 116.77 (standard deviation [ SD ] = 8.34), excellent self-efficacy with a mean score of 23.06 ( SD = 1.99) and relatively desirable self-care behaviors with a mean score of 51.79 ( SD = 4.37). Findings also indicated that health literacy can predict self-efficacy (beta = 0.262, p = .001) and self-care behaviors (beta = 0.639, p = .000)., Conclusions: Based on results, health literacy is a predictor of self-efficacy variables and self-care behaviors. Therefore, planning to improve the health literacy of the older adult to promote self-efficacy and self-care behaviors and ultimately their health is recommended. [ HLRP: Health Literacy Research and Practice . 2022;6(4):e262-e269. ] Plain Language Summary: This study sought to determine the role of health literacy in predicting self-efficacy and self-care behaviors in older adults with hypertension admitted to CCU and post-CCU wards in East Guilan public hospitals in the north of Iran. Findings of this research demonstrate health literacy can predict self-efficacy and self-care behaviors.

Purpose: Geriatric nutritional risk index (GNRI) is one of the new tools to determine nutritional status in the elderly. This study assessed the association between GNRI and muscular strength through handgrip strength (HGS) in patients undergoing hemodialysis., Methods: This cross-sectional analytical study assessed 110 hemodialysis patients at Guilan, North of Iran, (mean age of 70.3 ± 6.93), 57 men and 53 women through simple random sampling. Demographic characteristics, GNRI, and HGS of patients were determined. Data were analyzed using descriptive and inferential statistics, including independent t test, AVOVA, Pearson correlation, and linear multiple regression tests., Results: The mean values of the GNRI and HGS were 93.90 ± 11.06 and 14.82 ± 3.72, respectively. Finally, it was identified that there is a direct and significant association between GNRI and HGS (p = 0.001, r = 0.734). Linear multiple regression showed that GNRI is an independent predictor of HGS (Adj.R 2  = 0.67, β GNRI  = 8.13)., Conclusion: GNRI can be used as a predictor of muscular strength in hemodialysis patients., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

Background: Despite the worldwide spread of Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2), information about the epidemiological and clinical patterns of this infection is still largely unknown in children. In addition, the prevalence of this disease is still very high in some parts of the world, including Iran. Thus, this study aims to evaluate the epidemiological features, laboratory and imaging findings, and the type of treatments in children with novel coronavirus 2019 (COVID-19)., Method: This study is conducted from March 2020-March 2021 by using the medical records of hospitalized confirmed COVID-19 children younger than 18 years in five cities of Iran: Tehran, Ahwaz, Isfahan, Bandar-Abbas, and Khorramabad. In addition to demographic and epidemiological data, we also studied clinical signs and treatments., Results: In total 278 confirmed COVID-19 children, the average age was 5.3 years, and 59.4%were boys. A total of 37.8% had an underlying disease, in which the most common was a malignancy. The most common symptoms were fever and cough. In this group of pediatrics, some abnormal laboratory findings have been seen. GGO (Ground-Glass Opacity) had been diagnosed in 58.6% of children. 3.6% needed oxygen therapy with ventilators, and 83.09% had received antibiotic treatments with the majority of ceftriaxone. Also, 10% had got steroids. In this study, the mortality rate was 4.3%., Conclusion: In this study, most of the children who died had an underlying disease, so timely care and action is important in them. Most children admitted to our study received antibiotics and were prescribed antivirals and steroids for a smaller number. Also, a small number of children received oxygen therapy, most of whom were in the age group of 1 to 5 years., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Shahnaz Armin et al.)

Background: Knee osteoarthritis is a common musculoskeletal condition in elderly individuals. This survey was conducted with the aim to identify the problems of this group of patients for compilation of healthcare programs targeted at determining the outcome of osteoarthritis before and 3 months after knee arthroplasty., Materials and Methods: In the present cross-sectional study, 150 elderly individuals who had volunteered for knee arthroplasty were selected through nonrandomized sampling and were evaluated using the Knee Osteoarthritis Outcome Score (KOOS) questionnaire and a demographic characteristics form before and 3 months after the surgery via nonparametric statistical tests (Wilcoxon, Mann-Whitney U, and Kruskal-Wallis tests)., Results: The mean (SD) age of the study subjects was 64.40 (7.20) years. A significant difference was observed between the mean scores of all subscales (pain with Z=10.62, knee pain/knee stiffness with Z=10.54, daily activity with Z=10.62, sport with Z=2.95, and quality of life with Z=10.48) before and after knee arthroplasty based on Wilcoxon test (˂0.05). The results of the Mann-Whitney U test showed a significant statistical relationship between the difference in the mean score of daily activities and history of opium consumption (Z=1.90, p ˂ 0.05) as well as that between knee pain/knee stiffness and gender (Z=2.57, p ˂ 0.05) and educational level (Z=2.11, p ˂ 0.05)., Conclusions: Knee arthroplasty and history of opium consumption were correlated with improvement of patients' performance in their daily activities, and gender (women) and educational level (unread) were correlated with improvement of the score of the knee pain/knee stiffness subscale., Competing Interests: Nothing to declare., (Copyright: © 2021 Iranian Journal of Nursing and Midwifery Research.)

Purpose: The most northern and northwestern regions of Iran are at a high risk for gastrointestinal cancers. In this study, we evaluated knowledge of gastrointestinal (GI) cancers in people referred for endoscopy and colonoscopy screening., Methods: This cross-sectional study was carried out among 461 people who were under the patronage of a local relief foundation and referred for endoscopy and colonoscopy to the Gastrointestinal and Liver Disease Research Center (GLDRC), Rasht, north of Iran, from March 2016 to March 2017. A well-defined two-sectioned questionnaire was carried out for each group., Results: Overall, 300 and 161 individuals were in the gastric and colon cancer knowledge group, respectively. The level of knowledge in various areas of gastric and colon cancer was desirable. In general, the average of different domains in gastric and colon cancer knowledge questions were 20.2 ± 6.6 and 19.2 ± 4.9, with the knowledge level higher than the mean in gastric cancer (58%) and colon cancer (67.1%). The mean score of knowledge of GI cancers in terms of risk factor indicated a significant relationship between BMI and alcohol consumption. Meanwhile, a meaningful relationship between symptoms and BMI with knowledge was declared. About domains of colon cancer, there was a significant relationship between younger age and knowledge in the risk factor., Conclusions: The results of this study can provide an opportunity to formulate strategies to achieve goals, especially in the field of education, prevention, and control of the disease by raising knowledge for the general public and educating people who are responsible for providing and delivering health services to this community.

Background: Dynamic aging depends on providing opportunities to improve the quality of life of the elderly. The objective of this study was to investigate the relationship between social support and quality of life in the elderly in Guilan., Materials and Methods: This descriptive-correlational study was conducted in the elderly who visited urban public places in the East of Guilan (mosques, parks, weekly markets, and clubs). A total of 168 elderly who met the inclusion criteria were selected through two-stage, cluster, and convenience sampling. Data were collected using Phillips Standard 23-item social support scale and 12-item quality of life scale-short form. Data were analyzed through descriptive and inferential statistics (Pearson correlation coefficient)., Results: The mean score of social support in the elderly in Guilan was 73.25 ± 9.18 and the mean quality of life was obtained at 24.67 ± 7.06. Data analysis showed that there was a significant and positive correlation between social support and quality of life (r = 0.29, P < 0.0001)., Conclusions: Increased social support leads to a higher quality of life in the elderly. Thus, it is necessary to timely identify the needs and promote comprehensive social support to improve the quality of life in the elderly., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Journal of Education and Health Promotion.)

Background: Non-Alcoholic Fatty Liver Disease (NAFLD) is the most common cause of chronic liver disease worldwide. Since the effect and safety of pharmacotherapy for NAFLD are unknown, the proper management of lifestyle is crucial., Aim: The present study was conducted to determine the status of food, Physical Activity (PA), and sleep in patients with and without NAFLD., Methods: In this analytical- cross-sectional study, 630 clients with 36-60 years old who referred to the PERSIAN Guilan cohort study were included through simple non-random sampling. The developed questionnaire and lifestyle characteristics, including the status of nutrition, physical activity, and sleep, were completed for all samples. BMI was also calculated by determining weight and height, and fatty liver was confirmed based on abdominal ultrasound., Results: The prevalence of NAFLD in this study was by 43.7% (275 / 630). Smoking, alcohol consumption, BMI, and weight loss over the past six months, regular exercise and exercise intensity, sedentary living, speed of eating, consuming fatty food, red meat, sweets beverages, and use of saturated fatty acid (SFA), and consuming fruits and vegetables were associated with presence of NAFLD (all p < 0.05). However, no significant relationship was observed between the parameters of sleep duration, the interval between dinner and night sleep, consuming breakfast and snack during the day and NAFLD (All p > 0.05)., Conclusion: The onset and progression of NAFLD are associated with lifestyle. Therefore, dietary therapy solutions, physical activity, and sleep and rest situations should be paid attention for people with or at risk of NAFLD., (Copyright: © 2019 Roya Mansour-Ghanaei, Fariborz Mansour-Ghanaei, Mohammadreza Naghipour, Farahnaz Joukar.)

Background: One of the main psychological problems in hemodialysis patients is hopelessness. Spiritual health leads the patients toward hope and goal in life. Given the importance of the issue and the little research in this area, this study aimed to assess hope and its relationship with spiritual health on hemodialysis patients in Rasht Razi Hospital of Iran., Materials and Methods: This correlational study carried out on 103 patients who admitted in Rasht Razi Hospital Hemodialysis Center by simple random sampling. The data were collected through Snyder's Hope Scale and Spiritual Health. The psychomotricity of these questionnaires has been confirmed in domestic studies. The data were analyzed by using descriptive and inferential statistics (Pearson correlation coefficient)., Results: The majority of the patients were male (59.2%), in the age group of above 60 (46.60%), married (83.5%), with low income (60.2%), and under diploma (53.4%). The mean of hope score was 36.36 (±9.10) that showed the high level of hope in the majority of the patients. The mean of the total spiritual health score was 227.93 (±19.01) that indicates the high level of spiritual health in hemodialysis patients. There was a positive and significant correlation between spiritual health and its dimensions and hope ( P < 0.05)., Conclusions: The results of this study approve the importance of spiritual health as an effective variable on hope among hemodialysis patients. Hence, health-care providers and clinical experts are recommended to focus on spiritual health to increase hope among such patients., Competing Interests: There are no conflicts of interest.

Background and Aim: Gastrointestinal (GI) symptoms are common in patients with diabetes mellitus (DM), which involved in high cost of health care and low quality of life. The aim of this study to investigate the prevalence of GI symptoms in diabetic patients referred to the Gastrointestinal and Liver Diseases Research Center (GLDRC), Guilan University of Medical Sciences (Rasht, Iran) using a validated questionnaire., Methods: In this descriptive, cross-sectional study, 255 diabetic patients and 255 non-diabetic subjects were recruited. Participants were randomly selected. The questionnaire recorded GI symptoms among the study population., Results: GI symptoms were reported in 91.4% of diabetic patients, and 42.1% of them were male. The common GI symptoms in diabetic patients were flatulence (33.0%), followed by retrosternal pain (14.9%), belching (13.7%), postprandial fullness (12.5%), and constipation (11.4%). Retrosternal pain, constipation, flatulence, loss of appetite, and abdominal distention were more prevalent in diabetic women than men., Conclusions: DM is associated with high prevalence rate of upper and lower GI symptoms. This effect may be linked to gender and poor glycemic control in diabetic patients, but not to type and duration of diabetes., (Copyright © 2019 Diabetes India. Published by Elsevier Ltd. All rights reserved.)

Colon cancer is the most commonly diagnosed gastrointestinal cancers in developed countries with varied incidence and the onset age of disease worldwide. Overall, 161 participants who were under patronage of a local relief foundation and referred to the endoscopy ward of Razi Hospital affiliated to the Guilan University of Medical Sciences. These patients have been aged more than 50 or more than 40 years with history of colorectal cancer in their first-degree family were enrolled from March 2016-March 2017. Demographic information were collected. Colonoscopy was performed and histopathological evaluation of observed lesions and polyps was done. Most of participants were female (113 individuals, 70.2%) and aged 50-60 years (83 individuals, 51.6%). Seventy-four (46%) had certain lesions. Most of colonoscopy findings were observed in the ascending colon in which depressed polyps and diverticulum were most frequent. However, rectum showed the most histological findings. All polyps of descending and ascending colons were neoplastic, while most of rectal polyps were non-neoplastic. Male patients, who were aged more than 60 years and smokers had significant higher percentage of both lesions and polyps in their colon (p<0.05). Moreover, significant positive association was detected between exposure to harmful industries and having polyps (p=0.01). We found male gender, higher age, smoking, and exposure to harmful industries as important risk factors for having colorectal lesions, which must be confirmed in further studies.

Background and Aim: Nonalcoholic fatty liver disease (NAFLD) is a global epidemic that is often asymptomatic and silent, and progresses slowly. This study aimed to determine the biochemical markers and lipid profile among NAFLD patients and their possible relationship with degrees of fatty liver., Methods: This is analytical cross-sectional study, in which, 950 individuals referred to the PERSIAN Guilan cohort study were included through sequential sampling method. The demographic information and blood pressure of the subjects were taken and the blood sample was prepared to investigate the biochemical markers and lipid profile. Also, abdominal ultrasonography was performed to investigate NAFLD and its grades. For data analysis, independent sample t -test, one-way ANOVA, and logistic regression model were used, where P < 0.05 was considered significant., Results: The systolic blood pressure (SBP) ( P < 0.001), diastolic blood pressure (DBP) ( P < 0.001), hepatic enzymes (aspartate aminotransferase [AST], P < 0.001, alanine aminotransferase [ALT], P < 0.001; gamma-glutamyle transferase [GGT], P < 0.001; AST/ALT ratio, P < 0.001), lipid profile (triglyceride [TG], P < 0.001; total cholesterol [TC], P = 0.008; high density lipoprotein [HDL], P < 0.001; LDL-C/HDL-C (ratio), P = 0.003; TC/HDL-C (ratio), P < 0.001); and fasting blood sugar [FBS], P < 0.001 correlated with NAFLD. However, there was no relationship between age ( P = 0.34), alkaline phosphatase [ALP] ( P = 0.26) and low-density lipoprotein [LDL] ( P = 0.72). Further, a significant relationship was observed between AST ( P < 0.001), ALT ( P < 0.001), and GGT ( P = 0.004) and NAFLD degrees based on the ultrasonography., Conclusion: Biochemical markers and lipid profile are associated with NAFLD. Thus, it is recommended to investigate NAFLD in clinical settings in cases in which their changes are observed in patients through ultrasonography., Competing Interests: There are no conflicts of interest.

Introduction: Non-alcoholic fatty liver disease (NAFLD) is an obesity-associated health problem that causes other liver diseases for the patient. Four anthropometric indices: body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) were analyzed as NAFLD predictors in the present study. Methods: From the total number of individuals who referred to the PERSIAN Guilan Cohort study (PGCS) located in the north of Iran during the period of study, a total of 960 people were enrolled in the present study. NAFLD was diagnosed using through an abdominal ultrasound exam. Height, weight, WC, BMI, WHR and WHtR were later calculated. Chi-square, ANOVA and logistic regression analyses were used to analyze the risk factors. Results: Out of the 960 individuals who were enrolled in the study, 597 (62.2%) were male and 363 (37.8%) were female (with an average age of 47.21 ± 7.29 years). There was a significant relationship between weight and NAFLD (P<0.001). There was also a significant relationship between BMI (OR= 8.41; 95% CI = 5.59-12.75), WC (OR= 2.67; 95% CI = 2.05-3.48), WHR (OR= 3.84; 95% CI = 2.26-6.52), WHtR (OR= 28.53; 95% CI = 6.94-117.31) and NAFLD (P<0.001). The results of the logistic regression analysis showed that WHtR, BMI and WC were effective predictors for the risk of NAFLD while WHtR played a more important role in the prediction of NAFLD. Conclusion: Anthropometric indices, especially WHtR, as a simple screening tool, seem to be an important criterion for the detection of NAFLD.

Background: Recent studies indicate an increased incidence of pertussis disease in recent years. The aim of this study was to evaluate the efficacy of the acellular vaccine for children (as a replacement of current whole cell vaccine in the Expanded Program on Immunization) and for high-risk adults in Iran through updating current best available evidence. Methods: We performed a systematic literature review in relevant databases we focused on previously published systematic reviews to select those that address our questions. The AMSTAR (assessing the methodological quality of systematic reviews) tool was used for screening available reviews. Then search in databases was done until Feb 2014 to update the evidence. We pooled results using meta-analysis methods by Stata statistical package. Results: Eleven systematic review articles were included in the initial evaluation. In the end, two systematic reviews on acellular vaccine booster doses and the acellular vaccine in children were selected as the baseline evidence. In the update phase, new clinical trials were screened, and the results were updated. Overall pooled estimate of relative efficacy of acellular to whole cell was 0.68 (95% CI, 0.55-0.81) for children immunization Pooled estimates for the efficacy of acellular versus placebo were 0.70 (95% CI, 0.60-0.80). Overall pooled estimate of efficacy of booster dose of acellular was 0.87(95% CI, 0.85-0.88) compared to placebo. In addition pooled estimate of acellular vaccine efficacy based on response to antigen was 0.78(95% CI, 0.64-0.93) in highrisk group. Conclusion: The results show higher performance and safety of the acellular vaccine in the prevention of pertussis in children versus the whole cell vaccine. Moreover, the efficacy of the acellular vaccine in high-risk adult groups is acceptable. This study provides evidence in favor of the introduction of an acellular vaccine to the national program of immunization. Studies on cost effectiveness and aspects of policy analysis are recommended.

This survey was designed to determine the association between knowledge, locus of control and health belief with self-management, Hb A1c level and Number of attendances in type 1 diabetic patients in Rasht, Guilan Province - North of Iran. Data was derived from chart reviews of 92 patients. Patients' glycosylated hemoglobin level and their number of health care attendances during the last 6 months were recorded. The four part questionnaires covered patients' demographic data, knowledge, perceived control and health belief of diabetes. A blood sample was taken from each patient. There was no significant relationship between demographic data such as gender, age, marital status, education, occupation, duration of the disease, place of living and family history with knowledge, health belief and locus of control (P > 0.05). Also the results didn't show any significant association between the complicated group and their knowledge and health belief (P > 0.05) while it was significantly related to their locus of control (P < 0.004). The majority of the samples had poor knowledge (59.8%), health belief (71.7%) and locus of control (62%). There was no significant relationship between patients' knowledge, health belief and locus of control with their glycosylated hemoglobin level, number of referrals and self-management. It is suggested by the present survey that locus of control, health belief and knowledge of patients are not found to have no practical effect upon diabetic self-management behavior or outcomes, according to the variables used and care for the diabetic patients must be tailored to individual requirements.

The present survey aimed to determine the knowledge level and attitude of medical students in Guilan University toward Hepatitis B and C viruses' infections. In a cross-sectional survey, the knowledge and attitude of 424 medical science undergraduate students of nursing, midwifery, operating room technician, laboratory, anesthesiology and radiology in Guilan University of Medical Sciences toward Hepatitis B virus (HBV) and Hepatitis C virus (HCV) infections were investigated using a standardized questionnaire. The mean (SD) knowledge level of the medical students toward HBV and HCV were 17 ± 5 from 28 and 10.58 ± 6.7 from 29 questions respectively. Females, nursing students, forth year students, those who worked in hospital and those who had needle stick injuries (NSI) history showed significantly higher knowledge scores toward HBV (P< 0.05). Married students, anesthesiology students, those who were in their fourth year of study, and those who worked in hospital had significantly higher mean knowledge scores toward HCV (P< 0.05). Also students' attitude toward HBV and HCV was positively correlated with their mean knowledge level (r=0.14, p=0.004), (r=0.18, p=0.0001). Education on the nature, symptoms, transmission, prevention and treatment of HBV and HCV infections may increase the willingness of health care workers to care for infected persons.

Background. Celiac disease (CD) is closely associated with other autoimmune endocrine disorders, particularly autoimmune thyroid disease. The aim of this study was to find the frequency of celiac disease in patients with hypothyroidism in Guilan province, north of Iran. Methods. A total of 454 consecutive patients with hypothyroidism underwent celiac serological tests antiGliadin antibodies (AGA), antitissue transglutaminase antibodies (IgA-tTG) and antiendomysial antibodies (EMA-IgA). Small intestinal biopsy was performed when any of celiac serological tests was positive. Results. Eleven (2.4%) patients were positive for celiac serology, and two patients with documented villous atrophy were diagnosed with classic CD (0.4%; 95%). Two patients with classic CD had Hashimoto's thyroiditis (HT) (0.6%; 95%). Six (54.5%) of 11 were suffering from overt hypothyroidism and 45.5% from subclinical hypothyroidism. Six (54.5%) had HT, and 45.5% had nonautoimmune hypothyroidism. Conclusions. In this study, prevalence of CD was lower than other studies. Most of the patients with CD were suffering from HT, but there was no significant statistical relation between CD and HT.