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Background: Performing CPR (Cardiopulmonary Resuscitation) is an extremely intricate skill whose success depends largely on the level of knowledge and skill of Anesthesiology students. Therefore, this research was conducted to compare the effect of the scenario-based training method as opposed to video training method on nurse anesthesia students' BLS (Basic Life Support) knowledge and skills., Methods: This randomized quasi-experimental study involved 45 nurse anesthesia students of Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran in 2022-2023. The practical room of the university formed the research environment. The participants were randomly divided into three groups of scenario-based training, video training, and control. Data were collected by a knowledge questionnaire and a BLS skill assessment checklist before and after the intervention., Results: There was a significant difference between the students' scores of BLS knowledge and skill before and after the educational intervention in both SG (scenario group) (p < 0.001) and VG (video group) (p = 0.008) (p < 0.001). However, no significant difference was observed in this regard in the CG (control group) (p = 0.37) (p = 0.16). Also, the mean scores of BLS knowledge and skills in the SG were higher than those in the VG (p < 0.001)., Conclusion: Given the beneficial impact of scenario-based education on fostering active participation, critical thinking, utilization of intellectual abilities, and learner creativity, it appears that this approach holds an advantage over video training, particularly when it comes to teaching crucial subjects like Basic Life Support., (© 2024. The Author(s).)

Introduction: Distance education as a training method is used today to train nurses around the world. This study aimed to determine the impact of using the community of inquiry model on the quality of distance learning of airway management among anesthesia nurse students., Methods: This is a quasi-experimental study with a pre-test post-test design conducted at Ahvaz Jundishapur University of Medical Sciences. Participants were selected by census, and they were second, third, and fourth-year nurse anesthesia students (n=66). The participants were assigned to intervention and control groups (n=33 each) based on the table of random numbers. Given the three dimensions of the community of inquiry model, interventions were carried out in terms of social, teaching, and cognitive dimensions to increase social presence, teaching presence, and cognitive presence. Data collection tools included a questionnaire. The data were analyzed using Independent T-test, paired T-test, ANCOVA, and Chi-square in SPSS software, version 16., Results: The results showed that the promotion of each of the three elements of the community of inquiry model had a significant effect on the quality of distance learning of airway management. Moreover, the mean scores of these elements were significantly different (P<0.001) in the intervention and control groups [teaching presence (3.742±0.453 vs. 2.573±0.241), social presence (2.245±0.488 vs. 1.434±0.297), and cognitive presence (3.421±0.569 vs. 2.369±0.223)]., Conclusion: The community of inquiry is a practical and effective framework for the better design and implementation of distance education courses. Therefore, nursing educators and course designers are strongly recommended to use this framework in nursing education., Competing Interests: The authors declare that there is no conflict of interests., (Copyright: © Journal of Advances in Medical Education & Professionalism.)

This study examined the efficiency of the health belief model in understanding preventive behaviors of pregnant women in Iran. A cross-sectional descriptive-analytical methodology study was conducted of pregnant women who were referred to a healthcare center in 2021. The data were the responses to a questionnaire designed for this study. The data were analyzed with SPSS 24 software, Amos 22 software, correlation tests, regression analysis, and independent t tests. In terms of the health belief model, pregnant women with high perceived susceptibility showed the highest vaccination rate, while those with high perceived barriers had the lowest. The model predicted 20% variance in the preventive behavior from COVID-19, with perceived susceptibility and cues to action being the strongest and weakest predictors of behavior, respectively. The conclusion of the study was that the health belief model was an appropriate model to guide the care of pregnant women., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the authorship and/or publication of this review.

Background: Numerous medical costs are spent each year on treating and preventing the progression of diabetes. The positive effect of apple cider vinegar (ACV) has been shown on post-prandial hyperglycemia. This study aimed to evaluate the effects of prolonged consumption of ACV on blood glucose indices and lipid profile in patients with type 2 diabetes., Methods: This study was a randomized clinical trial and the participants were adults with type 2 diabetes. Participants were divided into two groups: ACV and control. The ACV group was treated with 30 ml of ACV per day. Both the intervention and control groups received the same recommendation for a healthy diet. Before and after eight weeks, fasting blood glucose, insulin, hemoglobin A1C, insulin resistance, total cholesterol (Chol), low-density lipoprotein (LDL), high-density lipoprotein (HDL) and triglyceride were measured., Results: Fasting blood glucose decreased after intervention in both groups, which was only significant in the ACV group (p = 0.01). There was a significant difference in hemoglobin A1C levels between the two groups (p < 0.001) after eight weeks. LDL was decreased in the ACV group (p < 0.001). Total Chol, LDL/HDL and Chol/HDL ratio decreased after the intervention period in the ACV group compared to the control group (p = 0.003, p = 0.001 and p = 0.001, respectively)., Conclusion: Daily consumption of ACV may have beneficial effects in controlling blood glucose indices and lipid profile in patients with type 2 diabetes., Clinical Trial Registration: http://www.irct.ir, identifier IRCT20140107016123N13., 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., (Copyright © 2023 Jafarirad, Elahi, Mansoori, Khanzadeh and Haghighizadeh.)

Introduction: Learning professional ethics can enhance the effectiveness of medical graduates as future health care providers. Therefore, this study was conducted to examine the effectiveness of professional ethics education based on a multi-method approach in organizational commitment and job involvement of senior nurse anesthesia students of Ahvaz Jundishapur University of Medical Sciences (AJUMS), Ahvaz, Iran, in 2022., Methods: This was a quasi-experimental study with a pre-test post-test design including 64 senior nurse anesthesia students of AJUMS who were selected using census method and randomly divided )using simple random method( into two groups of intervention and control (n = 32 each). For the intervention group, two 5-hour training workshops were held in 2 consecutive weeks using different training methods offered in an integrated manner, while participants in the control group received no education. Finally, the data were collected and analyzed using SPSS version 16, based on Kolmogorov-Smirnov test, paired and independent t-tests, chi-square test, and analysis of covariance., Results: Professional ethics education based on a multi-method approach had a positive effect on the organizational commitment and job involvement of senior nurse anesthesia students. There was a significant difference between the two groups in terms of their job involvement (P=0.005 and F=1.65) and organizational commitment scores (P=0.025 and F=35.56). These findings suggest that professional ethics education based on a multi-method approach can improve job involvement and organizational commitment and its dimensions (normative, continuance, and affective)., Conclusion: Teaching professional ethics by explaining the moral virtues of work, business affairs, and code of professional conduct promotes job involvement and organizational commitment of senior nurse anesthesia students., Competing Interests: None declared., (Copyright: © Journal of Advances in Medical Education & Professionalism.)

Background: Diabetes is one of the most common diseases in the world. The most important underlying cause of death in diabetic patients is the lack of self-care and management. However, there is little known about the influence of coping strategies and spiritual well-being (SWB) on self-care in diabetic patients., Aims: This study aimed to investigate the relationship between self-care activities with coping strategies and spiritual well-being (SWB) in patients with type 2 diabetes mellitus (T2DM)., Methods: In this descriptive-analytical study, we selected 236 patients with T2DM referred to the diabetes hospital clinics in the southwest of Iran. Inclusion criteria were patients diagnosed with T2DM, with the age group ranging 20-80 years, literate, not suffering from severe and debilitating complications of diabetes and lacking acute psychological illness. Exclusion criteria included refusing to complete questionnaires and cognitive or emotional impairment. Instruments include the demographic questionnaire, Summary of Diabetes Self-Care Activities, Lazarus and Folkman's Coping Strategies Questionnaire and the Spiritual Well-Being Scale (SWBS; developed by Paloutzian and Ellison). To examine the relationship between variables, the Pearson correlation and multiple stepwise regression analysis were used., Results: The findings of this study on 236 patients with T2DM (53.25 ± 10.91) including 76 (32.2%) males and 160 (67.8%) females showed the majority of participants were female, the age group was between 41 and 60 years (68.22%), had a Diploma (63.98%), were insured (63.55%) and had a moderate economic situation (55.93%). There was a direct and significant correlation between self-care activities and coping strategies ( r  = 0.163, p  < 0.05), and only a problem-focused coping strategy was considered as a predictor variable of self-care ( p  < 0.01). There was a direct and significant correlation between self-care and SWB ( r  = 0.385, p  < 0.01)., Conclusion: The results of this study showed that there is a significant relationship between self-care and the problem-focused dimension of coping strategies and SWB in patients with T2DM., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Objective: Fetal occiput posterior (OP) position is associated with more maternal and neonatal complications. This study aimed to investigate the effect of maternal position during labor on fetal OP position and pregnancy outcomes., Materials and Methods: This randomized clinical trial study included 180 primigravida women in labor with a single fetus and approved OP position. Participants were randomly allocated into three groups: semi-prone position (n=45), knee-chest position (n=45), and supine position (n=90). All participants were placed in the defined positions 15-30 min in labor until delivery. Data collected using Visual Analogue Scale and researcher made checklist. The ANOVA, Tukey post hoc, and the chi-square test were used to analyze., Results: Among all participants who had OP, after intervention 16.3% in the semi-prone position, 14/3 % in the knee-chest position, and 33.7% of the control groups remained with OP at birth (X 3 =7/87, P=0.019). The rate of natural delivery was significantly higher in the semi-prone position and knee-chest position. The duration of active phase of labor and low back pain were significantly reduced in the semi-prone and knee-chest position compared to the control groups (P<0.05). There were no differences in the duration of the third stage of labor, APGAR score, and the rate of neonatal addition to neonatal intensive care unit, using oxytocin, and perineal tears (P>0.05)., Conclusion: The semi-prone and knee-chest positions increase the spontaneous rotation of occiput to the anterior position, vaginal delivery rates as well as a reduction in duration of active phase of labor and low back pain after delivery., Competing Interests: Conflict of Interests Authors declare no conflict of interests., (Copyright © 2023 Tehran University of Medical Sciences. Published by Tehran University of Medical Sciences.)

Background and Aims: Dermatological surgeons must master the factors affecting wound healing. Suturing is the most common method of wound closure. One of the significant factors in suturing that affects wound healing and cosmetic results is the distance between sutures, which has been studied very little to date. The aim of the current study was to investigate the effect of simple interrupted suture with a distance of 2 and 5 mm on the esthetic and functional results of suture closure in different age groups., Methods: In patients with two skin lesions, one wound was sutured with a distance of 2 mm and the other with a distance of 5 mm, and the wounds were evaluated 1 and 3 months after the operation using the POSAS scale., Results: Patients' opinions indicate that, in the suture intervals of 2- and 5-mm and at 1 and 3 months, the average was lower in the younger group than it was in the older group and also, as per the physician's opinion, the average in the age group under 50 years was significantly lower than that in the age group over 50 years., Conclusions: According to the results of the present study, a suture of 2-mm and a suture of 5-mm would result in different esthetic and functional outcomes depending on the patient's age. The average in the age group less than 50 years was significantly lower than that of the age group greater than 50 years., Competing Interests: The authors declare no conflict of interest., (© 2023 The Authors. Health Science Reports published by Wiley Periodicals LLC.)

Introduction: Various nursing models are usually employed to achieve self-management and improve the quality of life in chronic conditions. Given its person-based characteristics, the 5 A nursing model can improve the quality of life of hemodialysis patients., Purpose: This study aimed to determine the role of a self-management program based on the 5 A nursing model in the quality of life of patients undergoing hemodialysis., Materials and Methods: This clinical trial was conducted on hemodialysis patients in Iran. Random sampling was adopted to assign 60 patients to intervention and control groups. After the participants completed a demographic questionnaire and the Kidney Disease Quality of Life-Short Form (KDQOL-SF), routine measures were taken in the control group. However, the 5 A nursing model was implemented in the intervention group for three months. The self-care program was executed in face-to-face sessions or via phone calls and SMSs. After three months, the quality of life was measured again in both groups., Findings: There were significant differences after the intervention between the intervention and control groups in specific dimensions of quality of life, such as cognitive functions, symptoms, sleep, dialysis, social support, and renal complications (P < 0.05). The two groups also had significant differences in the general scores of quality of life (P < 0.05)., Conclusion: The 5 A self-management intervention as a person-based model could improve self-care in hemodialysis patients. Nurses can implement this model to mitigate care costs, enhance interventions, and improve patients' quality of life., Trial Registration: Iranian Registry of Clinical Trials (IRCT20211103052955N1; 19/11/2021)., (© 2023. The Author(s).)

Purpose: The present study aimed to investigate the effect of a mini-clinical evaluation exercise (CEX) assessment on improving the clinical skills of nurse anesthesia students at Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran., Methods: This study started on November 1, 2022, and ended on December 1, 2022. It was conducted among 50 nurse anesthesia students divided into intervention and control groups. The intervention group’s clinical skills were evaluated 4 times using the mini-CEX method. In contrast, the same skills were evaluated in the control group based on the conventional method—that is, general supervision by the instructor during the internship and a summative evaluation based on a checklist at the end of the course. The intervention group students also filled out a questionnaire to measure their satisfaction with the miniCEX method., Results: The mean score of the students in both the control and intervention groups increased significantly on the post-test (P<0.0001), but the improvement in the scores of the intervention group was significantly greater compared with the control group (P<0.0001). The overall mean score for satisfaction in the intervention group was 76.3 out of a maximum of 95., Conclusion: The findings of this study showed that using mini-CEX as a formative evaluation method to evaluate clinical skills had a significant effect on the improvement of nurse anesthesia students’ clinical skills, and they had a very favorable opinion about this evaluation method.

Background: Menopause is one of the developmental stages of women. One of the most common problems during this period is sleep disorders. Sleep disorders can affect the quality of life of these people. To improve sleep disorders, auriculotherapy has received less attention due to its low cost and effectiveness, and side effects. Therefore, the aim of this study was to determine the effect of auriculotherapy on improving sleep quality in postmenopausal women aged 45-60 years., Materials and Methods: The present study is a clinical trial study that was performed on 82 postmenopausal women aged 45-60 years under the auspices of health centers in Mahshahr city, Iran from 2021-2022. Women with inclusion criteria were randomly divided into two groups (intervention and control). The intervention group underwent auriculotherapy for 4 weeks. The St. Petersburg Sleep Quality Questionnaire was completed by both groups at the beginning and 4 weeks after the start of the intervention. Finally, the data were analyzed by SPSS software version 22 and independent t -test, paired t -test and Chi-square test., Results: At the beginning of the study, both groups were homogeneous in terms of demographic variables. The results of data analysis using independent t -test showed that before the intervention, mental quality ( P = 0.513), length of incubation period ( P = 0.285), sleep duration ( P = 0.121), sleep efficiency ( P = 0.513), sleep disorders ( P = 0.685), use of sleeping pills ( P = 0.530), daily functioning ( P = 0.60), and overall sleep quality score ( P = 0.30) in the control and intervention groups were not statistically significant. However, comparing the mean scores after the intervention in the control and intervention groups showed that mental quality ( P < 0.001), incubation period ( P < 0.001), sleep duration ( P < 0.001), sleep efficiency ( P < 0.001), sleep disorders ( P < 0.001), use of hypnotics ( P = 0.002), daily functioning ( P = 0.001), overall sleep quality score ( P < 0.001), sleep duration ( P = 0.822), sleep efficiency ( P = 0.889), sleep disorders ( P = 0.889), use of sleeping pills ( P = 1.00), daily performance ( P = 0.767), overall sleep quality score ( P = 0.69) were statistically significant between the two groups. In-group comparison using paired t -test in the control group showed that mental quality ( P = 0128), length of the incubation period ( P = 1.00), and before and after the intervention did not differ significantly in the mean scores. However, a within-group comparison in the intervention group showed that mental quality ( P < 0.001), incubation period ( P < 0.001), sleep duration ( P < 0.001), sleep efficiency ( P < 0.001), sleep disorders ( P = 0.003), use of sleeping pills ( P = 0.007), daily functioning ( P < 0.001), and overall sleep quality score ( P < 0.001) before and after the intervention had a significant difference in the mean scores., Conclusion: The results showed that auriculotherapy has significant effectiveness in improving the quality of sleep, and its dimensions and can be used as an effective method in this area that can be implemented at a low cost and easily. According to reports from participants and previous studies in this field, auriculotherapy did not have any side effects and can be used as a safe way to improve sleep quality., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Journal of Education and Health Promotion.)

Introduction: Chest pain is an unpleasant and the most common symptom in patients suffering from unstable angina. This study was implemented to investigate the effect of Thai massage on severity of pain in patients with unstable angina. Methods: This study was a randomized controlled clinical trial that carried out on 70 patients with unstable angina who had been hospitalized in hospital affiliated to Ahvaz Jundishapur University of Medical sciences, Ahvaz, Iran. The participants were allocated randomly to either the intervention (n=35) or control group (n=35) between August 1, 2016 and April 30, 2017. The patients in the intervention group received routine care beside and Thai massage with the duration of 30 minutes in two consecutive days. The patients in the control group received routine care. The intensity of pain was assessed by using the numeric rating scale, five minutes before and immediately, 15, 30 and 60 minutes after the intervention. The independent t-test and repeated measures analysis of variance (ANOVA) were used to analysis data through SPSS 13. Results: After the intervention, the severity of pain was significantly diminished by about four measurement points ( P =0.001) with the linear pattern of pain reduction. Nonetheless, in the control group, no statistically significant difference in the intensity of pain was found. Conclusion: This study showed that Thai massage as non-invasive approach, concomitant with standard nursing care, has the potential to decrease chest pain. Nurses should be taught about pain relief methods for improving the quality of patient care., Competing Interests: The authors declare no conflicts of interest., (© 2023 The Author(s).)

Purpose: Menopause is associated with complications that may affect quality of life, such as hot flashes, night sweats, and mood swings. This study aimed to compare the effects of phone versus face-to-face counseling based on cognitive-behavioral therapy (CBT) for vasomotor symptoms in postmenopausal women., Methods: In this study, 40 eligible postmenopausal women were randomly assigned to face-to-face ( n = 20) and phone counseling methods ( n = 20). Six counseling sessions were held weekly for each person, and the women were requested to record their hot flashes (HF) and night sweats (NS) in a diary. HF and NS were measured at baseline, and 6 and 8 weeks after the completion of intervention. Data were analyzed using χ2, repeated measures ANCOVA, and independent t -test., Results: Means of weekly hot flashes and night sweats decreased after intervention in both groups (face-to-face group: HF frequency from 31.92 ± 7.98 to 18.83 ± 7.35, HF severity from 2.24 ± 0.28 to 1.21 ± 0.23, HF duration from 4.22 ± 1.17 min to 2.79 ± 0.91 min, NS frequency from 2.34 ± 0.31 to 1.21 ± 0.24 and NS severity from 1.70 ± 0.34 to 1.03 ± 0.29; and also in the phone counseling group: HF frequency from 33.32 ± 7.77 to 19.53 ± 7.7, HF severity from 2.23 ± 0.24 to 1.20 ± 0.18, HF duration from 4.29 ± 1.23 min to 2.68 ± 0.95 min, NS frequency from 2.33 ± 0.31 to 1.14 ± 0.16 and NS severity from 1.59 ± 0.34 to 1.01 ± 0.30). Although the differences within each group were significant ( p < 0.001), there was no significant difference between the groups after the intervention in terms of HF frequency, severity, and duration, as well as NS frequency and severity ( p > 0.05)., Conclusions: Face-to-face and phone counseling methods based on CBT had a similar effect on reducing hot flashes and night sweats. Both methods can be used for women with postmenopausal complications such as hot flashes and night sweats., Competing Interests: Absent., (Copyright © 2022 Institute of Psychiatry and Neurology.)

Background: Cancer-related fatigue, physical changes, and pain are among the most troublesome symptoms caused by breast cancer treatment and influence the patients' quality of life. The aim of the present study was to examine the effect of mobile health educational intervention on body image and fatigue in breast cancer survivors., Methods: The present clinical trial study conducted on 38 women with breast cancer referred to Golestan and Shahid Baghaei 2 hospitals, Ahvaz, south west Iran in 2018-2019. Patients were randomly assigned into two intervention group, and control groups on 1:1 basis. Data collection tool included three parts: cancer fatigue scale, body image concern inventory, and demographic information. Text messages sent to intervention group via WhatsApp messenger for 7 weeks on a daily schedule. The control group did not receive any messages. Data were analyzed using SPSS Version 23.0., Results: The mean age of participants was 46.34 ± 9.96. The mean score of cancer fatigue scale after the intervention in the intervention group was decreased significantly (p = 0.005), but no statistically significant difference was observed in the control group. There was a significant difference in the mean score of body image concern inventory in the intervention group (p = 0.002) after the intervention compared with the control group., Conclusion: Mobile health educational intervention improved cancer-related fatigue and body image among women breast cancer survivors. The integration of education for the management of fatigue and body image disturbance as part of routine care among breast cancer survivors is recommended., (© 2021. Royal Academy of Medicine in Ireland.)

Background: Female sexual dysfunction (FSD) is a common complaint among postmenopausal women, which is largely because of the genitourinary syndrome in these women (GSM)., Aim: Considering the phytoestrogenic effects of chamomile, the present study was primarily aimed to investigate the effect of chamomile vaginal gel on the sexual function of postmenopausal women. The side effects of these drugs were evaluated as a secondary outcome of the study., Methods: This randomized double-blind clinical trial and placebo-controlled study was conducted on postmenopausal women with sexual dysfunction (FSFI ≤26.55). To this aim, 96 postmenopausal women were randomly assigned into three groups (n = 32 each) including women receiving (i) chamomile vaginal gel 5%, (ii) conjugated estrogen vaginal cream, and (iii) placebo vaginal gel, for 12 weeks (ie, every night in the first 2 weeks, and 2 nights per week in the next 10 weeks, each night 1 g was used). The sexual function was measured using female sexual function index (FSFI) before and after the intervention. Data analysis was performed by chi-square, one-way ANOVA, descriptive statistics, analysis of covariance (ANCOVA), and paired t test using SPSS software version 22. P < .05 was considered statistically significant., Outcomes: The main study outcome measure was evaluate the effects of vaginal administration of chamomile gel in comparison with conjugated estrogen cream and placebo gel on postmenopausal FSD using the FSFI., Results: The findings showed that chamomile vaginal gel in compared to placebo vaginal gel caused a significant improvement in all six sexual function domains and the total FSFI score (effect size = +2.9 [95% CI, +2.1 to +3.6], P < .001). Also, there was no significant difference between the chamomile vaginal gel and conjugated estrogen vaginal cream groups in terms of the total score and all sub-domains of sexual function with the exception of orgasm (effect size = +0.13 [95% CI, -0.36 to +0.63], P = .02) and sexual satisfaction (effect size = 0 [95% CI, -0.49 to +0.49], P = .04). Two women in the chamomile group and one in the placebo group experienced a burning sensation (P = .345)., Clinical Implications: This treatment can be considered as a treatment option for postmenopausal women with sexual dysfunction who have contraindications to the use of hormone therapy., Strengths & Limitations: This study is the first study to investigate the effectiveness of chamomile vaginal gel on sexual function in postmenopausal women. However, in this study, treatment duration was 12 weeks and no follow up was performed beyond this time CONCLUSION: Based on the results of this study, the use of vaginal chamomile gel improved sexual function in postmenopausal women. Bosak Z, Iravani M, Moghimipour E, et al. Effect of Chamomile Vaginal Gel on the Sexual Function in Postmenopausal Women: A Double-Blind Randomized Controlled Trial. J Sex Med 2022;19:983-994., (Copyright © 2022 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Mental disorders is one of the main causes of disability and lower life expectancy among patients with Multiple Sclerosis (MS). The present trial aimed to examine the efficacy of multi-strain probiotic supplementation on circulating levels of BDNF, NGF, IL-6 and mental health in patients with MS. Methods: This trial was conducted among 70 patients with MS that referred to the MS Association. Patients were randomized into intervention and control groups to receive 2 multi-strain probiotic capsules or placebo, daily for six months. Serum BDNF, NGF and IL-6 was measured by ELISA kits. Mental health parameters were assessed by valid questionnaires in the baseline and end of the study. Results: Of the 70 patients enrolled in this study, 65 subjects were included in the final analysis. From baseline to 6 months, probiotic supplementation resulted in a significant increase in BDNF and a significant reduction in the IL-6 levels ( P  < 0.001). Our findings revealed that probiotic supplementation compared to placebo caused a significant improvement in the general health questionnaire-28 (GHQ-28) (-5.31 ± 4.62 vs. -1.81 ± 4.23; P  = 0.002), Beck Depression Inventory-II (BDI-II) (-4.81 ± 0.79 vs. -1.90 ± 0.96; P  = 0.001), Fatigue Severity Scale (FSS) (-3.81 ± 6.56 vs. 0.24 ± 5.44; P  = 0.007) and Pain Rating Index (PRI) (-3.15 ± 4.51 vs. -0.09 ± 3.67; P  = 0.004). However, we not found any significant difference between the two groups in other factors ( P  > 0.05). Conclusion: Overall, six months of probiotic supplementation resulted in greater improvement in mental health parameters.

Background: Cystic fibrosis (CF) is a hereditary disease with a high mortality rate. The present study aimed to determine the effect of a physical activity program (PAP) on the life quality of children with CF at school age., Materials and Methods: This study conducted on 70 children with CF, the samples were randomly divided into intervention and control groups. A demographic information questionnaire and the Pediatric Quality of Life Inventory were used for data collection. This study was conducted in three stages and 2 months after the last intervention. Finally, the data were analyzed in SPSS software version 22 using the Chi-square test, independent t-test, and paired t-test at a p-value of less than 0.05., Results: The results indicated that the two groups had no significant difference in terms of demographic variables before the intervention. Moreover, it was observed that the mean scores of life quality in the physical, emotional, social, and academic performance of children in both groups before the intervention in child and parent evaluations did not show significant differences. After the intervention in the experimental group, the mean scores of life quality in all aspects significantly increased, compared to those of the control group (P<0.001). Moreover, there were no significant differences between the mean scores of life quality in the control group before and after the intervention., Conclusion: Given the effectiveness of the intervention to enhance life quality, PAP is feasible and possible in the field of CF. It has to be noted that this method is an effective way to improve life quality., (Copyright© 2022 National Research Institute of Tuberculosis and Lung Disease.)

The menopausal period is associated with several complications in women. One of these complications is sleep disorders including insomnia disorder that can affect all aspects of personal life. The present study aimed to evaluate the effectiveness of cognitive behavioural therapy for insomnia (CBT-I) on insomnia severity and sleep quality among postmenopausal women. This was a randomised clinical trial in which 46 women were recruited and randomly allocated into two groups, one receiving CBT-I and a control group. The CBT-I group received six sessions of training, while the control group received only usual care. A demographic questionnaire, Insomnia Severity Index (ISI), and Pittsburgh Sleep Quality Index (PSQI), were used to collect the data. The ISI and PSQI were measured at baseline, 3 and 6 weeks after intervention, and in a 4-week follow-up. The Independent t test, the chi-square test, generalised estimating equation models, and Bonferroni correction were applied to analyse the data. According to our results, in the CBT-I group compared to the control group, the mean ISI, PSQI, sleep onset latency, sleep time, and sleep quality score reduced continuously from baseline to week 3 and from week 3 to week 6, and remained constant from week 6 to week 10. The mean sleep efficiency score improved significantly from baseline to week 3 in the CBT-I group and remained unchanged until the end of the study. CBT-I could significantly improve insomnia severity and sleep quality in postmenopausal women. Therefore, using this method is recommended for menopausal women with insomnia., (© 2021 European Sleep Research Society.)

Cleft lip and palate is a major problem that disrupts the child's family life. The present study aimed to investigate the effect of combined education on the knowledge and care and supportive performance of parents with children with cleft lip and palate. This is a clinical trial study was conducted on 40 parents referring to hospitals. The data were collected using the demographic information questionnaire, the questionnaire of parental knowledge and care supportive performance questionnaire and analyzed using descriptive and analytical tests. After education the intervention group, the mean score of parents' care and supportive knowledge significantly increased in the intervention group as compared to the control group. There was also a significant difference in the mean score of parents' care-supportive performance between the two groups ( P < 0.001). It is recommended to use the combined education as an effective method to increase knowledge and performance in parents of children with cleft lip and palate., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2021.)

Background: Personality plays an important role in food choices. The aim of this study was to assess the association of personality traits with dietary habits and food preferences., Methods: This cross-sectional study was carried out on 224 healthy female students aged 18-30 years with a normal BMI. Dietary habits, food preferences, and personality were assessed using validated questionnaire., Results: Our results showed that neuroticism and openness were associated with low scores while conscientiousness was related to high scores of dietary habits (r = -0.33 P < 0.001, r = -0.13, P < 0.05 and r = 0.26, P < 0.001, respectively). In addition, neuroticism was correlated with preference to salty, sour and fatty foods and negatively associated with dairy products ( P < 0.05). Extraversion showed a positive correlation with preference to fast foods, ice cream, chocolate, cocoa, and negative correlation with meat. Openness was positively correlated with preference for meat and biscuit and negatively correlated with fruits ( P < 0.05). Agreeableness was related to having soft drinks and sweetened fruit juices and conscientiousness had a positive association with preference to dairy products, vegetables, nuts, food with salty tastes, and a negative association with biscuits ( P < 0.05)., Conclusions: Overall, assessing personality traits could be useful to identify young women who may be at risk of unhealthy dietary habits., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 International Journal of Preventive Medicine.)

Obesity has reached epidemic proportions globally. Among several methods for treating obesity, the use of dietary supplements is common recently. One supplement that can help in this regard might be vitamin B6 in high doses. The objective of this study was to evaluate the effect of pyridoxine hydrochloride supplementation on anthropometric indices, body composition, visceral adiposity index (VAI), and metabolic status in obese and overweight women. In this randomized controlled clinical trial, 44 obese and overweight women aged 18-50 years were selected and divided randomly into 2 groups: an intervention group (receiving 80 mg pyridoxine hydrochloride supplement for 8 weeks) and a control group (receiving placebo for 8 weeks). In the pyridoxine hydrochloride group, weight (p = 0.03), body mass index (p = 0.023), fat mass (p = 0.003), waist circumference (p = 0.005), VAI (p = 0.001), fasting insulin, insulin resistance (homeostasis model assessment of insulin resistance; HOMA-IR), total cholesterol, low-density lipoprotein, triglycerides (TG) and leptin (p < 0.001) decreased whereas adiponectin (p < 0.001) increased in comparison to the baseline values. There was a significant difference in fat mass, VAI, fasting insulin, HOMA-IR, and TG between pyridoxine hydrochloride and control groups following intervention in adjusted models (p < 0.05). The findings suggest that vitamin B6 supplementation may be effective in reducing BMI and improving body composition and biochemical factors associated with obesity., Trial Registration: Iranian Registry of Clinical Trials Identifier: IRCT20181002041206N1., Competing Interests: Conflict of Interest: The authors declare that they have no competing interests., (Copyright © 2021. The Korean Society of Clinical Nutrition.)

Background: Gestational diabetes is the most common medical complication in pregnancy, and it has many side effects for the mother and the fetus. The aim of this study was to evaluate the effect of oat bran consumption on gestational diabetes., Methods: This study is a randomized clinical trial that was performed on 112 women with gestational diabetes treated with diet. Participants were randomly divided into two groups of 56. Participants in both groups were given a diet for gestational diabetes. In addition to the diet, the intervention group received 30 g of oat bran daily for 4 weeks at lunch and dinner. Tests of fasting blood glucose and two-hour postprandial (2hpp) glucose were taken from both groups: before the intervention, and 2 and 4 weeks after the start of the intervention. Data analysis was performed using SPSS statistical software (version 22) using independent t-test, as well as Chi-square and Mann-Whitney tests. P values less than 0.05 were considered statistically significant., Results: There was no statistically significant difference between the two groups in terms of mean blood glucose before the intervention, while 2 and 4 weeks after the intervention, mean fasting blood glucose and two-hour postprandial (2hpp) glucose decreased significantly in the intervention group compared with the control group (P < 0.001)., Conclusion: Based on the results of this study, the addition of oat bran to the standard diet for pregnant women with gestational diabetes reduced fasting blood glucose and two-hour postprandial (2hpp) glucose. More detailed studies with higher sample sizes are recommended to prove the effectiveness of this valuable dietary supplement., Trial Registration: IRCT registration number: IRCT20191220045828N1 . Registration date: 2020-04-18. Registered while recruiting.

Introduction: The purpose of this double-blind clinical trial, was to examine the effect of supplementation with the synbiotic and probiotic on the mental health, quality of life, and anemia in HD patients., Methods: Seventy-five HD patients were randomly assigned to receive the synbiotic ( n = 23) as 15 g of prebiotics, 5 g of probiotic powder containing Lactobacillus acidophilus, Bifidobacterium bifidum, Bifidobacterium lactis , and Bifidobacterium longum (2.7 × 107 CFU/g each); probiotics ( n = 23) as 5 g probiotics similar to the synbiotic group with 15 g of maltodextrin as placebo; and placebo ( n = 19) as 20 g of maltodextrin. Serum hemoglobin (Hb) and albumin (Alb) were measured. Beck depression and anxiety index (BDI/BAI) was used to assess symptoms of depression and anxiety. The health-related quality of life (HRQoL) was assessed using the questionnaire SF-36., Results: From baseline to 12 weeks, synbiotic and probiotic supplementation resulted in a significant decrease in BDI and BAI score in comparison to the placebo ( P < 0.05). Between and intergroup comparison showed no significant changes between the groups in terms of HRQoL. However, the serum Hb level increased significantly in the synbiotic and probiotic group compared to the placebo group ( P < 0.001)., Conclusion: Overall, 12 weeks of synbiotic and probiotic supplementation resulted in an improvement in mental health and anemia compared with the placebo, whereas they failed to enhance the quality of life in HD patients., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Indian Journal of Nephrology.)

Aim: The aim of this study was to investigate the effect of dietary education on cardiovascular risk factors in patients with rheumatoid arthritis., Methods: In this randomized clinical trial, 112 patients with rheumatoid arthritis were randomly assigned into two groups, intervention and control. Dietary education was provided for the intervention group in 4 sessions; anthropometric measurements, serum levels of RF, triglycerides, cholesterol, HDL, LDL, and fasting blood sugar were measured before and three months after the intervention. Data were analyzed using SPSS software and appropriate statistical tests., Results: The mean of total cholesterol (p <0.001), triglycerides (p = 0.004), LDL (p <0.001), systolic blood pressure (p = 0.001), diastolic blood pressure (p = 0.003), FBS and BMI (p <0.001) were decreased significantly in the intervention group after education compared the control group., Conclusion: Traditional care for rheumatoid arthritis patients is not enough. Patients need more education in order to improve their situation., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Coronary artery disease is a multifactorial genetic disease caused by the interaction between genetic and environmental factors. Angiography is the gold standard method for the diagnosis and determining the stage of cardiac disorder. The rs1800588 at the Hepatic Lipase gene and rs1799983 at the endothelial nitric oxide synthase (eNOS) gene are two candidate SNP that result in increased risk of this disease. The aim of this study was to find out the associations of the two mentioned polymorphisms with angiographically proven coronary artery patients in a southern Iranian population. In this study, this two polymorphisms in 287 patients and 229 matched controls were confirmed by angiography and analyzed. Genotype analysis was carried out by PCR and RFLP. Data showed that a significant difference for the eNO S gene polymorphism ( p  = 0.004) and a non-significant difference for the Hepatic lipase polymorphism ( p  = 0.261) and increasing severity of angiographic evidences of coronary artery disease were observed. Conclusively the significant association of the G894T with the narrowing of two or three coronary vessels of this patients in an Iranian population have been detected.

Bakground and Objective: Sleep disorder is among the most common problems in the life of postmenopausal women. Because of the complications of chemical drugs, many women prefer to use herbal supplements for relieving sleep problems. So, the main objective of this study was to determine the effect of the jujube seed capsule on sleep quality in postmenopausal women., Materials and Methods: This study was a double-blind clinical trial conducted on 106 postmenopausal women in Khuzestan province, southwest of Iran. All participants were selected by a simple non-probability sampling method. Data were collected through a demographic data form and the Pittsburgh sleeps quality index (PSQI). Individuals were randomly divided into intervention ( n = 53) and control ( n = 53) groups. The intervention group received 250 mg oral jujube seed capsule and the control group received a placebo capsule twice a day for 21 days. After the treatment, the PSQI was completed in both intervention and control groups. Data were analyzed using the independent t-test and the Chi-square test using SPSS software version 24, and p -value < 0.05 was considered as the significance level., Results: The results revealed that after treatment, the mean scores of sleep quality decreased in the intervention and control group. Although this difference was statistically significant in both intervention and control groups ( p -value < 0.05), more reduction observed in the intervention group ( p -value < 0.001)., Conclusion: Consumption of the jujube seed capsule had a positive impact on improving the sleep quality of postmenopausal women and could be recommended as a useful herbal medication., Competing Interests: The authors declare no conflicts of interest., (© the Author(s).)

Objective: The purpose of this study was to determine the effect of chamomile vaginal gel on dyspareunia and sexual satisfaction in postmenopausal women. The phytoestrogenic properties of Matricaria chamomilla were the reason for selection of this plant., Materials and Methods: This double-blind clinical trial research was conducted on 96 eligible postmenopausal women referring to Gotvand city Health Center No. 1 in 2018. In this research, 96 postmenopausal women complaining from dyspareunia and sexual dissatisfaction were randomly assigned into three groups (each contained 32 subjects) to receive 5% chamomile vaginal gel, conjugated estrogen vaginal cream and placebo gel, for 12 weeks. All women completed the Larsson and a four-degree pain self-assessment questionnaires. Data was analyzed using SPSS version 22. A p-value of less than 0.05 was considered significant., Results: After the intervention period, a significant difference was seen between the intervention and the placebo group in the mean sexual satisfaction (p<0.001). Also, a significant reduction was seen in painful sexual intercourse between the groups using vaginal gel of chamomile and conjugated estrogen vaginal cream (95% CI: chamomile: 0.68-1.04, estrogen: 0.63-0.98, placebo: 1.8-2.1; p<0.001)., Conclusion: Using chamomile vaginal gel can cause a reduction in painful sexual intercourse and an increase in sexual satisfaction in postmenopausal women.

Background: Iron deficiency is prevalent in overweight and obese individuals and may be induced by adiposity-related inflammation that affect iron metabolism., Objective: The objective of this study was to investigate the relationship between hematological parameters and obesity-induced inflammation among young females., Methods: A total of 170 young women (aged between 18-35 years) participated in this cross-sectional study. Obesity was assessed by BMI (body mass index), WHR (waist to hip ratio), and body fat percentage. Inflammatory and hematological parameters including hs-CRP (high-sensitivity C-reactive protein), serum Fe, hemoglobin, ferritin, transferrin, TIBC (total iron binding capacity) were measured. Dietary intakes of some nutrients (total iron, proteins, calcium, and vitamin C) were assessed according to BMI, WHR and fat mass categories., Results: Serum iron were negatively correlated with BMI ( P = 0.045, r = -0.154) and hs-CRP ( P = 0.032, r = -0.165). Hemoglobin were also negatively correlated with BMI ( P = 0.043, r = -0.155). A significant correlation was also shown between WHR with transferrin ( P = 0.034, r = 0.163) and TIBC levels ( P = 0.035, r = 0.162), hs-CRP was positively correlated with BMI ( P = 0.014, r = 0.183), WHR ( P = 0.009, r = 0.202) and body fat percentage ( P = 0.037, r = 0.353). Dietary intakes did not differ significantly among BMI, WHR and fat mass categories ( P > 0.05)., Conclusions: Obesity-induced inflammation, regardless of dietary intake of iron, can lead to iron deficiency. Therefore, weight control, especially in obese subjects is necessary to prevent iron deficiency and anemia., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 International Journal of Preventive Medicine.)

Background: Weight management is an important strategy to prevent the consequences of obesity. The aim of the study was to compare the effect of yoga practice and energy-restricted diet on resting metabolic rate (RMR), anthropometric indices, and serum adiponectin and leptin in overweight and obese women., Materials and Methods: Obese or overweight women were divided into two groups: yoga practicing and energy-restricted diet. Exercise trials consisted of 60-min Hatha yoga equal to 200 kilocalories (kcal) combined with 300 kcal restriction per day, and an energy-restricted diet consisted of 500 kcal restriction per day. The intervention period for both the groups was 8 weeks. RMR, anthropometric indices, and serum adiponectin, leptin, and lipid profiles were measured at baseline and at the end of the study., Results: RMR was increased in yoga but not in the diet group ( P = 0.001). The level of adiponectin was increased in the yoga group compared with the diet ( P = 0.035). The concentration of high-density lipoprotein-cholesterol was decreased in the diet group significantly but not in yoga ( P = 0.006). The level of leptin was decreased in both the groups ( P = 0.001), and there were no significant differences between the two groups., Conclusion: The findings of the study demonstrated the effect of yoga practicing on RMR, and serum adiponectin, in overweight and obese women. It seems yoga practice with less energy restriction compared with a common energy restriction diet and is more effective in weight management for those who are in weight loss programs., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Journal of Research in Medical Sciences.)

The aim of this study was to investigate the effects of probiotic and synbiotic supplementation on serum inflammatory markers, endotoxin, and anti-HSP70 in hemodialysis (HD) patients. This study was a randomized, double-blind, placebo-controlled trial. Seventy-five hemodialysis patients who met the inclusion and exclusion criteria were randomly assigned for 12 weeks to one of the three arms: synbiotics [n = 23; 15 g of prebiotics, 5 g of probiotic powder containing Lactobacillus acidophilus T16, Bifidobacterium bifidum BIA-6, Bifidobacterium lactis BIA-6, and Bifidobacterium longum LAF-5 (2.7 × 10 7  CFU/g each)], probiotics [n = 23; 5 g probiotics as in synbiotic group with 15 g of maltodextrin in the sachet as placebo], and placebo [n = 19; 20 g of maltodextrin in the sachet]. Blood and feces were collected at baseline and after intervention. Serum high sensitive C-reactive protein (hs-CRP), interleukin-6, endotoxin, and anti-heat shock protein 70 antibodies (anti-HSP70) were measured. The number of fecal colonies was determined using the plate-counting method. The mean serum level of hs-CRP, anti-HSP70, and endotoxin decreased significantly between groups (p = 0.007, p = 0.037, and p = 0.036, respectively). For the synbiotic group, the mean changes in hs-CRP and IL-6 were significantly lower than for the placebo (p < 0.001 and p < 0.001, respectively) and probiotic group (p = 0.011 and p = 0.008, respectively). Anti-HSP70 mean changes in the synbiotic and probiotic groups differed from the placebo group (p = 0.002 and p = 0.013, respectively). Administration of synbiotics was more effective than probiotics for improvement of inflammatory markers, endotoxin and anti-HSP70 serum levels. Trial registration number: IRCT2017041233393N1.

Background: Workplace nutrition has been identified as a priority setting that can significantly reduce cardiovascular diseases (CVD) risk factors. This study was conducted as a part of the workplace education program to improve nutritional practices and cardiometabolic status in industrial personnel., Methods: The present research was a randomized controlled field trial conducted on employees of a regional petrochemical company. The health-related priorities of the program were defined and addressed in the study in which 104 employees with dyslipidemia were randomly divided into two groups of education and control. Data were collected pre- and post-intervention, using valid and reliable multi-session questionnaires on demographic data, nutritional knowledge, and nutritional intake. Anthropometric measures, serum FBS, HbA1C, hs-CRP and homocysteine (Hcy) were assessed in both groups. In the education group, the nutrition program included five educational workshops about healthy nutrition and regular exercise along with educational messages over a 3-month period. The controls did not receive any education during the study., Results: There were no statistically significant differences between the two groups regarding the baseline variables. The education group significantly improved their nutritional knowledge ( p  < 0.001), dietary intakes ( p  < 0.005), serum FBS (p < 0.001) and Hcy levels (p < 0.001) and anthropometric indices., Conclusion: Workplace nutrition education programs can improve knowledge and reduce important CVD risk factors., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s). 2020.)

Dental caries, caused by oral microbiota, is one of the most common human diseases. The present study aimed to investigate the effect of consumption of probiotic yogurt containing Bifidobacterium lactis Bb12 on salivary Streptococcus mutans and lactobacilli in students with initial stages of dental caries. In this double-blind randomized placebo-controlled clinical trial, 66 students (18-30 years) with initial stages of dental caries were selected and randomly assigned into 2 groups: the intervention group received 300 g/day of probiotic yogurt and the control group received 300 g/day of conventional yogurt for 2 weeks. An unstimulated fasting saliva sample was collected pre- and post-intervention. Bacterial counting was performed for salivary S. mutans and lactobacilli. A significant reduction in salivary S. mutans and lactobacillus counts was observed in the intervention group compared to their baseline and compared to the control group. In conclusion, it is suggested that the consumption of probiotic yogurt containing B. lactis Bb12 may modify the oral biofilm., (© 2019 S. Karger AG, Basel.)

The aim of this study was to investigate the effect of synbiotic and probiotic supplementation on serum vascular dysfunction and necrosis markers in hemodialysis (HD) patients. In this randomized, double-blind, placebo-controlled trial, 75 HD patients were randomly assigned to either the synbiotic or probiotic or placebo group. The patients in the synbiotic group received 15 g of prebiotics and 5 g probiotic powder containing Lactobacillus acidophilus strain T16 (IBRC-M10785), Bifidobacterium bifidum strain BIA-6, Bifidobacterium lactis strain BIA-6, Bifidobacterium longum strain LAF-5 (2.7 × 10 7  CFU/g each) in sachets (n = 25), whereas the probiotic group received 5 g probiotics same to the first group with 15 g of maltodextrin powder in sachets (n = 25) and the placebo group received 20 g of maltodextrin powder in sachets (n = 25) for 12 weeks. At baseline and the end of the study, serum concentrations of soluble intercellular adhesion molecule type 1 (sICAM-1), soluble vascular cell adhesion molecule type 1 (sVCAM-1), cytokeratin 18 (CK-18) as the necrosis marker, uric acid, and phosphate levels were measured. Feces also were collected for microbiota colony counting. Serum ICAM-1 level reduced significantly in the synbiotic group after the intervention period (P = 0.02), and this reduction was significantly different in the synbiotic group in comparison to the placebo group (P = 0.03). Serum levels of VCAM-1 and CK-18 were not significantly different between the groups. However, the reduction in serum levels of VCAM-1 in the synbiotic group was significantly higher in comparison to the placebo group (P = 0.01). Multivariate linear regression analysis revealed that ∆ phosphate was the sole independent determinant of ∆ICAM-1 (P = 0 < 001). The study indicated that synbiotic supplementation reduced serum ICAM-1 level, which is a risk factor for cardiovascular diseases in HD patients, but has no effect on the necrosis marker. Trial registration: www.irct.ir (IRCT2017041233393N1).

Background: Inflammation and oxidative stress have been reported to be higher in subjects with normal weight obesity (NWO) syndrome [normal body mass index (BMI) (<25 kg/m 2 ) but excessive body fat (for women ≥ 30% and for men ≥ 20%) according to World Health Organization (WHO) definitions]; however, it is unclear whether this is due to inadequate dietary antioxidant intake or the pathophysiology of NWO. The aim of present study was to assess the association between dietary factors and body antioxidant status with NWO syndrome in male university students. Methods: This study was a case-control study carried out on ninety age-matched male university students [30 normal weights (NW), 30 NWO and 30 overweight-obese (OB)]. A validated food frequency questionnaire (98 items) and 3-day 24-h recalls were used for dietary assessment. Total antioxidant capacity (TAC) of diet and serum and high-sensitive C-reactive protein (hs-CRP) concentrations were also measured. Results: Dietary intake of fruits (frequency factor (FF) = 2.3 vs 2.9, p < 0.05), legumes (FF = 0.7 vs 1.3, p < 0.01), nuts and seeds (FF = 0.4 vs 0.8, p < 0.05), beta-cryptoxanthin (p < 0.05), lycopene (p < 0.05) and serum TAC levels (p < 0.01) were significantly lower in NWO compared to the NW group. No significant differences in these parameters were observed between NWO and OB group. A significant negative correlation was observed between serum TAC levels and BMI (r = -0.57, p < 0.001) and body fat percent (r = -0.52, p < 0.001). Conclusions: This study shows that NWO male subjects consume lower amounts of dietary antioxidants and share the same low body antioxidant status as obese individuals, although they appear lean.

Background: Non-alcoholic fatty liver disease (NAFLD) is one of the metabolic disturbances associated with inflammation. Nigella sativa (NS) seed oil has different chemical compounds including Thymoquinone (TQ), unsaturated fatty acids, and flavonoids. NSs are used as anti-inflammatory and antioxidants in medical sciences. This study aimed to investigate the effect of NS oil on several parameters in serum levels of patients with NAFLD., Methods: Forty-four patients diagnosed with NAFLD participated in a randomized, double-blind, placebo-controlled clinical trial. Patients were randomly assigned into two groups; one receiving NS oil and the other receiving placebo (paraffin oil), for 8 weeks. Blood samples were taken from the patients at the beginning and the end of the study. Afterwards, liver enzymes (ALT, AST, and GGT), inflammatory markers (Hs-CRP, TNF-α, and IL-6), insulin, lipid profiles (total cholesterol, triglyceride, VLDL, LDL-C, and HDL-C), FBS, and blood pressure were measured., Results: Consumption of NS seed oil as supplement decreased the FBS level, lipid profiles (TG, TC, LDL, VLDL), liver enzymes (AST and ALT), hs-CRP inflammatory marker, IL-6, TNF-α, while it increased the HDL-C levels, compared to the placebo group ( P  < 0.05). Receiving NS oil had no significant effect on serum levels of insulin, blood pressure, and GGT in comparison with the beginning of the study ( P  < 0.05)., Conclusion: NS seed oil supplements may decrease the liver enzymes and lipid profiles in the patients with NAFLD and play a protective role in the liver via reducing the inflammation in this group of patients., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© Springer Nature Switzerland AG 2019.)

Introduction: Phosphodiesterase inhibitors (PDEs) increase intracellular cyclic adenosine monophosphate, which results in a wide range of anti-inflammatory effects and pathologically leads to improve asthma disease. Because no human study has surveyed the effect of PDEs on pulmonary function, except some case reports and animal researches, we decided to perform a pilot study for evaluating the effect of sildenafil (PDE5) on pulmonary function in patients with severe asthma., Methods: This randomized controlled trials study was conducted on 20 patients with severe asthma in 2019 in Iran. For case group, was prescribed sildenafil (50 mg) daily and the control group received the placebo. In the beginning of the study and one month later, volume parameters, 6-minute walk distance (6MWD), and the quality-of-life questionnaire were measured and compared in the two groups., Results: Twenty patients were entered into this study. 8 patients (40%) were male and 12 (60%) were female. The results showed that mean forced vital capacity 1 in the sildenafil group turned from 1259 ± 170 to 1603 ± 527, while in the placebo group it changed from 1135 ± 125 to 1365 ± 251 (P-value = 0.215). There is no statistically significant difference between two groups. In addition, in comparison with placebo, sildenafil did not show any significant improvement in the volume parameters, the quality-of-life questionnaire scale, and 6MWD at the end of the study., Conclusion: According to present result can be concluded that sildenafil does not improve the severity of asthma and the quality of life in patients with severe asthma., Competing Interests: There are no conflicts of interest.

Background: Kidney stone is a common and costly disease, but it may be improved by a healthy diet. The aim of this study was to evaluate the association between dietary intake and stone formation in patients with urinary stones in Shiraz. Methods: In this cross sectional study, 110 patients with kidney stone were selected from Faghihi hospital, Shiraz. Demographic information was collected, and anthropometric indices, disease-related variables, physical activity (using IPAQ), and dietary intake (using food frequency questionnaire, analyzed by Nut 4 software, to estimate micro and macro nutrients) were evaluated. Independent sample t test and one-way ANOVA were used to compare the quantitative variables between the 2 groups and multi groups, respectively. Chi square test was also used to compare qualitative variables. The correlation between variables was determined using Pearson test. Results: Out of 110 participants in this study, 37 (33.6%) were female, with the mean BMI of 27.0 ± 4.68 kg/m2, and 73 (66.4%) were male, with the mean BMI of 24.21±2.96 kg/m2. The mean intake of calcium-containing foods (p=0.02) and high-fructose beverages (p=0.03) was significantly greater in patients with calcium stones compared to those with uric acid stones. The mean intake of high-purine foods was significantly higher in patients with uric acid stones than in those with calcium stones (p=0.007). The mean intake of vitamin A (p=0.02), beta-carotene (p=0.03), and fructose (p=0.03) was significantly higher in patients with calcium stones than in those with uric acid stones, while caffeine intake was significantly higher in patients with uric acid than in those with calcium stones (p=0.01). There was a significant correlation between consumption of high-oxalic beverages (p=0.005, correlation coefficient = 0.26) and high-fructose (p=0.048, correlation coefficient = 0.18) with spontaneous stone expulsion. Conclusion: There was a significant relationship between consuming vitamin A, beta-carotene, and foods containing calcium, purine, fructose, and oxalate and formation of kidney stones. Therefore, adopting a healthy diet and increasing physical activity may be effective in the treatment of kidney stones.

Background: An appropriate snack for patients with diabetes mellitus should be considered to help them in their treatment due to their hard administrative diet. This study was conducted to evaluate the effect of dark chocolate on inflammatory markers, serum adiponectin, and certain biochemical factors in patients with type 2 diabetes (T2D)., Methods: This study was a randomized parallel clinical trial. Thirty grams of 84% dark chocolate, along with therapeutic lifestyle changes (TLCs) guidelines, were administrated to patients with T2D. Control group received only TLC guidelines. The intervention period was 8 weeks. Twenty-one subjects in dark chocolate and 23 subjects in control group completed the study. Fasting blood samples were collected before and after the intervention period and inflammatory markers, biochemical factors, and adiponectin levels were assessed., Results: Fasting blood sugar, hemoglobin A1C, low-density lipoprotein and triglyceride levels declined significantly in the dark chocolate group and this decrease was significant between the intervention and control groups. Tumor necrosis factor-alpha, interleukin-6, and high sensitive C-reactive protein were significantly decreased in the dark chocolate group. Adiponectin levels were not significantly different between the two groups., Conclusions: In this study subjects who received dark chocolate along with TLC guidelines had lower levels of inflammatory markers such as hs-CRP, TNF-α, and IL-6, compared with the subjects who were devoid of dark chocolate and followed only the TLC guidelines. Other studies should be conducted to evaluate the most effective and administrative dosage of dark chocolate as a snack along with the common treatment of diabetes., Competing Interests: There are no conflicts of interest

Objective: Primary dysmenorrhea is one of the most commonly reported disorders for women that have unfavorable effects on patient's quality of life. Based on the evidences that suggest the anti-inflammatory and analgesic properties of chlorella, this double-blind, randomized, placebo controlled clinical trial aimed to evaluate the effects of Chlorella supplementation on the severity of menstrual pain in a group of young women with primary dysmenorrhea., Study Design: In this clinical trial, 44 girls with primary dysmenorrhea were randomly divided into intervention and control groups. Patients in the intervention group received 1500 mg/day of chlorella as 5 soft gel and the control group received placebo soft gels for eight weeks. Menstrual and food information were collected using a previously validated and published questionnaire. Anthropometric measurements and biochemical parameters including prostaglandin E2 (PGE2), ProstaglandinF2a (PGF2a), high-sensitivity C-reactive protein (hs-CRP) and malondialdehyde (MDA) were assessed at baseline and end of week eight., Results: In chlorella supplemented group the PGE2, PGF2a, hs-CRP and MDA decreased significantly (P < 0.05). The severity and duration of dysmenorrheal pain were significantly reduced in the intervention group compared to the control group (p < 0.05). Systemic symptoms of dysmenorrhea (fatigue, headache, nausea, vomiting, lack of energy) decreased in the chlorella group (p < 0.05). The mean of menstrual characteristics, anthropometric indices and daily energy and macronutrient intake in both intervention and control groups were not changed significantly., Conclusion: This study showed that chlorella supplementation could decrease the severity of pain and systemic symptoms and improve serum levels of prostaglandins, inflammatory and oxidative markers in women with primary dysmenorrhea., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Introduction: Considering the fact that depression in patients with breast cancer increases the severity and complications of medical treatments such as chemotherapy (including fatigue, nausea, and cognitive problems), the identification of its related factors can be one of the important steps in reducing the complications of this disease. Therefore, the purpose of this study was to determine the relationship between psychological hardiness and resilience with depression in women with breast cancer., Materials and Methods: The present study was a descriptive-analytic study, the population of which included all women with breast cancer under chemotherapy referred to Oncology Center of Imam Hassan Mojtaba Hospital in Dezful city from July 2015 to December 2016. A sample size of 114 people was selected. Data collection instruments included demographic information form, Ahvaz Psychological Hardiness Scale, Connor-Davidson Resilience Scale (CD-RISC), and Beck Depression Inventory. Data were analyzed using SPSS ver.21., Findings: Findings showed that 61.4% of respondents had depressive symptoms. Mild, moderate and severe depression symptoms were prevalent among 37.7%, 20.2% and 3.5% of the participants, respectively. Also, there is a significant relationship between resiliency and hardiness with depression in women with breast cancer (P<0.05)., Discussion and Conclusion: The depression rate in women with breast cancer decreased if hardiness and resiliency against the disease has been increased. This means that there is a need for training courses and counseling services for women with breast cancer in order to improve their mental health status.

Introduction: Increasing life expectancy in women and having menstrual problems and hormone-associated complications have led people to use complementary and alternative medicine. In menopause, the reduction in estrogen and androgen physiologically leads to a decrease in blood flow in the volvuleous and vaginal zone, resulting in a reduction in sexual desire and arousal. Sexual satisfaction plays an important role in mental health. The aim of this study was to investigate the effect of Tribulus terrestris on sexual satisfaction in postmenopausal women., Methods: This double-blind clinical trial was conducted in 2017 with the aim of investigating the effect of hydro-alcohol extract of T. terrestris on sexual satisfaction of postmenopausal women on 60 women referred to health center number 1 in eastern Ahvaz. A total of 60 postmenopausal women were randomly assigned into two groups of 30 to receive a syrup containing T. terrestris extract at a concentration of 0.9 mg and placebo for 8 weeks. Sexual satisfaction was calculated based on Larsson questionnaire. Data were analyzed by SPSS software (version 22) and t -test was used for comparing two groups in quantitative variables and Chi-square test was used for qualitative variables. P value less than 0.05 was considered significant., Findings: After intervention, the mean of sexual satisfaction in the intervention group was significantly higher than in the preintervention group ( P < 0.005), and a significant increase in sexual satisfaction was observed in the tetanus syrup group., Results: Taking T. terrestris syrup increased sexual satisfaction in postmenopausal women., Competing Interests: There are no conflicts of interest.

Background: Despite advances in the treatment of cardiovascular diseases in recent decades, patients experience high levels of depression, anxiety, stress, and insomnia. Since the calming effect of Melissa officinalis (MO) has been known, this study aimed to determine the effects of MO supplementation on depression, anxiety, stress, and sleep disturbances in patients with chronic stable angina (CSA)., Methods: In this double-blind placebo-controlled clinical trial, 80 patients with CSA were divided randomly into two groups (taking 3 g MO supplement or placebo daily for 8 weeks). The shortened 21-item version of the depression, anxiety and stress scale (DASS-21) test and Pittsburgh sleep quality index were done before and after the intervention., Results: At the end of the study, the intervention group receiving MO capsules had a significant reduction in scores of depression, anxiety, stress, and total sleep disturbance, compared with the placebo group (P < 0.05)., Conclusions: The results showed that 8-week supplementation with 3 g MO can decrease depression, anxiety, stress, and sleep disorder in patients with CSA., (Copyright © 2018 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

Objective: Considering the high prevalence of nonalcoholic fatty liver disease and based on the evidence about the role of dietary cholesterol in liver inflammation, and also with regard to the effect of phytosterols on the metabolism of cholesterol, we aimed at exploring the therapeutic potential of phytosterol supplementation against nonalcoholic fatty liver disease., Method: Thirty-eight patients with nonalcoholic fatty liver disease were randomly divided into two groups: The phytosterol group (n = 19) received a 1.6-g phytosterol supplement daily and the control group (n = 19) received 1.6 g starch daily as placebo for an 8-week period. Blood samples of all patients were taken at baseline (week 0) and at the end of the study (week 8) for measurement of lipid profiles, liver enzymes, inflammatory markers, adiponectin, and leptin., Results: Phytosterol supplementation significantly improved the levels of low-density lipoprotein cholesterol, aspartate aminotransferase, alanine aminotransferase, and tumor necrosis factor alpha compared to the placebo group. On the other hand, there were no significant differences between the two groups in total cholesterol, triglycerides, high-density lipoprotein cholesterol, very-low-density lipoprotein cholesterol, ratios of low-density lipoprotein cholesterol/high-density lipoprotein cholesterol and total cholesterol/high-density lipoprotein cholesterol, gamma-glutamyl transferase, interleukin 6, high-sensitivity C-reactive protein, adiponectin, and leptin., Conclusions: The present study suggested that daily consumption of 1.6 g phytosterols efficiently lowers low-density lipoprotein cholesterol, aspartate aminotransferase, alanine aminotransferase, and tumor necrosis factor alpha in patients with nonalcoholic fatty liver disease.

Objective: This study evaluated the effect of cinnamon on disease activity, serum levels of some inflammatory markers, and cardiovascular risk factors in women with rheumatoid arthritis (RA)., Methods: In this randomized double-blind clinical trial, 36 women with RA were randomly divided to 2 groups, receiving 4 capsules of either 500 mg cinnamon powder or placebo daily for 8 weeks. Fasting blood sugar (FBS), lipid profile, liver enzymes, serum levels of C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), erythrocyte sedimentation rate (ESR), blood pressure, and clinical symptoms were determined at baseline and end of the week 8., Results: At the end of the study, there was a significant decrease of serum levels of CRP (p < 0.001) and TNF-α (p < 0.001) in the cinnamon group as compared to the placebo group. Diastolic blood pressure was also significantly lower in the intervention group compared with the control group (p = 0.017). Compared with placebo, cinnamon intake significantly reduced the Disease Activity Score (DAS-28) (p < 0.001), Visual Analogue Scale (VAS) (p < 0.001), and tender (TJC) (p < 0.001) and swollen joints (SJC) (p < 0.001) counts. No significant changes were observed for FBS, lipid profile, liver enzymes, or ESR., Conclusion: Cinnamon supplementation can be a safe and potential adjunct treatment to improve inflammation and clinical symptoms in patients with RA.

Introduction: Cardiovascular disease is the main cause of disability and morbidity in many countries. Considering the significance of education in correcting unhealthy eating habits and improving nutritional behaviors that prevents cardiovascular diseases, the current study has been carried out to investigate the impacts of Beliefs, Attitude, Subjective Norms, Enabling Factors (BASNEF)-based educational program on the employees' nutritional behaviors., Materials and Methods: This study was carried out on 120 randomly selected employees of Water and Wastewater Organization of Kermanshah. Individuals were divided into the control and intervention groups. Questionnaires devised based on BASNEF model and food frequency questionnaires were collected preintervention and 3-month postintervention. Educational program was performed in four training sessions., Results: Significant differences between mean scores of knowledge and other items of BASNEF model as well as nutritional improvements were observed in the intervention group after 3 months ( P < 0.01)., Conclusion: BASNEF educational model positively affected nutritional behaviors of the employees to reducing cardiovascular risk factors., Competing Interests: There are no conflicts of interest.

Background and Objectives: This randomized, placebo-controlled trial was performed for 8 weeks to investigate the potential effects of astaxanthin (AST) supplementation on the adiponectin concentration, lipid peroxidation, glycemic control, insulin sensitivity, and anthropometric indices in participants with type 2 diabetes mellitus., Methods and Study Design: We enrolled 44 participants with type 2 diabetes who met our inclusion criteria. Eight milligrams of AST supplementation or a placebo were randomly administered once daily for 8 weeks to these participants., Results: The 8-week administration of AST supplementation increased the serum adiponectin concentration and reduced visceral body fat mass (p<0.01), serum triglyceride and very-low-density lipoprotein cholesterol concentrations, and systolic blood pressure (p<0.05). Furthermore, AST significantly reduced the fructosamine concentration (p<0.05) and marginally reduced the plasma glucose concentration (p=0.057)., Conclusions: We demonstrated that because participants with type 2 diabetes often have hypertriglycemia and uncontrolled glucose metabolism; our findings of dual beneficial effects are clinically valuable. Our results may provide a novel complementary treatment with potential impacts on diabetic complications without adverse effects.

Background and Objectives: Coronary artery disease (CAD) is a major cause of death worldwide. Chronic stable angina (CSA) is the primary sign of CAD. Oxidative stress and inflammation play a substantial role in pathogenesis and progression of CAD. The aim of this study was to investigate the effects of oral administration of powdered Melissa officinalis (MO) on biomarkers of oxidative stress, inflammation, and lipid profile in patients with CSA., Methods and Study Design: A randomized, double-blind, placebo-controlled clinical trial was performed in 80 patients with CSA. The subjects were randomly assigned to obtaineither oral MO 3 g/d (n=40) or placebo (n=40) for eight weeks. Anthropometric indices, biomarkers of oxidative stress, inflammation, and lipid profile were evaluated at baseline and post-intervention., Results: The mean serum concentrations of triglycerides, total-cholesterol, LDL-cholesterol, and malondialdehyde (MDA), and high sensitive C-Reactive Protein (hs-CRP) were lower in the intervention group compared with placebo (p<0.01) post intervention. Moreover, the mean serum concentration of paraxonase 1 (PNO1) and HDL-c were higher (p<0.001) in the intervention group compared with the control group., Conclusion: Oral MO supplementation improves the lipid profile, MDA, hs-CRP, and PNO1 in patients with CSA.

Aims: Self-care in patients with diabetes reduces the number of hospital admissions, costs and improves their quality of life so that just by training self-care to them can reduce 80 percent of diabetic complications. Therefore, this study aimed to investigate the effect of educational program based on precede-proceed model on improving self-care behaviors in patients with type 2 diabetes referred to health centers in city Bavi in 2016-2017., Materials and Methods: This quasi-experimental study, conducted on 110 patient women with type 2 diabetes referred to health centers in Bavi city in 2016-2017. The training program was designed based on Precede-Proceed Model. Data collection tools included the Precede researcher-made questionnaire and the Glasgow questionnaire. The duration of the training course was three months. After one month, the effect of this program, and the amount of improvement of the patients' self-care behavior were evaluated. Independent t-test, paired t-test, Chi-square and Fisher's exact tests were carried was used for data analysis., Results: After the intervention, the average score of predisposing factors (knowledge, attitude and self-efficacy), reinforcing factors, enabling factors and self-care behaviors, in the intervention group compared to the control group, significantly increased (P<0.05). After the training, the fasting blood sugar (FBS) and body mass index (BMI) decreased in the experimental group, but this reduction was not statistically significant (P>0.05)., Conclusion: The findings of this research showed that Precede-Proceed Model would be an appropriate framework to educate patients with type 2 diabetes as well as promote self-care behaviors., (Copyright © 2017 Diabetes India. Published by Elsevier Ltd. All rights reserved.)