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Abstract Background Spinal muscular atrophy (SMA) is a group of motor neuron diseases. In 95% of SMA patients, the telomeric copy of the SMN gene (SMN1) is homozygously deleted. Due to the autosomal recessive pattern of SMA inheritance, individuals with a family history of SMA are at risk of being carriers. A total of 622 individuals from SMA families, including parents, siblings, and first, second, and third-degree relatives, were recruited to the neuro-genetic clinic of Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. SMA cases and suspected carriers were referred to the genetic laboratory. Pregnant women underwent amniocentesis and chorionic villi sampling at 12–14 gestational weeks. RFLP-PCR and real-time PCR were performed for symptomatic and asymptomatic individuals (possible carriers), respectively. RFLP and real-time PCR were performed for amniotic fluid and chorionic villi samples. Results The study enrolled 622 subjects from SMA-affected families, including 159 fetuses and 463 non-fetuses. Two samples were missing. A total of 268 individuals (43.2%) were healthy (wild type), 187 individuals (30.1%) were heterozygous for exon deletion of SMN1, and 143 individuals (23%) were homozygous for exon deletion of SMN1. Four individuals (0.6%) showed three copies of the SMN1 gene. Conclusion The frequency of carriers with two SMN1 copies on a single chromosome (cis) was estimated at 2.9% (18/622), and the total rate of carriers was approximately 21.8%. Considering the high rate of SMA carriers in this study, genetic counseling and definitive prenatal diagnosis are of utmost importance for reducing the psychosocial burden of the SMA disease among Iranian families.

Parry-Romberg Syndrome (PRS) is an atypical condition characterized by hemiatrophy of the face. Despite its rarity, the precise pathophysiological processes underlying its etiology remain elusive. While previous reports have hinted at the potential involvement of autoimmune factors, our case report aims to explore a novel perspective. Specifically, we pose the question of whether multiple sclerosis (MS) could be a plausible causative factor for PRS. Additionally, we investigate the potential association between Radiologically Isolated Syndrome (RIS) and the development of Parry-Romberg Syndrome.

Safranal (a monoterpene aldehyde) is the major volatile component of saffron which is responsible for the saffron unique odor. Several studies have shown the pharmacological activities of safranal including anti-oxidant, anti-inflammatory, cardioprotective, neuroprotective, nephroprotective, gastrointestinal protective, etc. This study was designed to review the pharmacological and medical effects of safranal and up-to-date previous knowledge. Moreover, some patents related to the pharmacological effects of safranal were gathered. Therefore, electronic databases including Web of Sciences, Scopus, and Pubmed for pharmacological effects and US patent, Patentscope, and Google Patent for patents were comprehensively searched by related English keywords from 2010 to June 2022. According to our review, most of the studies are related to the safranal effects on CNS such as antianxiety, analgesic, anticonvulsant, antiischemic, anti-tremor, memory enhancement and its protective effects on neurodegenerative disorders such as Alzheimer’s, Parkinson and Huntington diseases. Other effects of safranal are antiasthmatic, antihypertensive, antiaging, anticataract, etc. Moreover, the protective effects of this agent on metabolic syndrome and diabetic nephropathy have been shown. Different mechanisms including anti-oxidant, anti-inflammatory, muscle relaxation, antiapoptotic, and regulatory effects on the genes and proteins expression related to signaling pathways of oxidative stress, inflammation, apoptosis, proliferation, etc. are involved in safranal pharmacological effects. Some patents for the prevention and/or treatment of different diseases such as liver cancer, sleep disorder, depression, cognitive disorder, obesity and PMS were also included. Based on the documents, safranal is considered a promising therapeutic agent although more clinical studies are needed to verify the beneficial effects of safranal in humans.

Preconception health is defined as the physical and psychological well-being of women and men throughout their reproductive life. It is a method that raises healthy fertility and focuses on activities that persons can take to minimize risks, raise healthy lifestyles, and increase preparation for pregnancy. The purpose of this systematic review study was to assess men’s knowledge of preconception health. Electronic databases, including Web of Science, PubMed, Scopus, Sciencedirect, ProQuest, Cochrane, SAGE, Springer, Google Scholar, were searched for published studies from 2000 to March 2021 to identify the studies carried out on men’s knowledge of preconception health. The quality assessment was done using the critical appraisal skills program tool for qualitative studies and the Newcastle-Ottawa scale for cross-sectional studies. Of the 1195 references identified in the initial search, 11 studies met the inclusion criteria. Because of the diversity in the study design and the data collection tools used in studies, meta-analysis was impossible. All the studies of the present systematic review found that men’s preconception health knowledge is poor. This systematic review showed that men’s preconception health knowledge is low. Due to the limited studies of men’s knowledge about the importance of optimizing their health before pregnancy, further study of the issue is still required.

Abstract Background In metamotivational monitoring, students try to identify the declined motivational component in order to regulate their motivation. There is scarcity of evidence on which motivational components are targeted by the medical students when they use each motivational regulation strategies. This study aims were identifying motivational components in motivational regulation process, developing a measurement tool and, testing the predictive relationship between the motivational components and motivational regulation strategies. Methods This exploratory sequential design mixed method study is part of a project has been started from 2018 with medical students at Tehran University of Medical Science. First, in a qualitative study conducting a semi-structured in-depth interview, the motivational components were explored. The interviews continued until saturation of data. Then, in a psychometric study the validity and reliability evidence of questionnaire obtained. In the quantitative study, applying the convenience sampling method, 508 students completed the questionnaires. Predictive relation between the motivational regulation strategies and motivational components was assessed utilising Structural Equation Modelling. Path coefficients, T-Value, and R2 index were reported by SmartPLS software. Results In the Exploratory Factor Analysis of Motivational Components Questionnaire (MCQ), 6 factors were discovered that explained 74% of the total variance. All paths in seven models of SEM showed a T-Value above 1.96 that means there is a significant correlation between all strategies and components. In examining the predictive relationships, each of the four components of self-efficacy, intrinsic value, self-relevant value and promotion value were specifically predicted by two motivational regulation strategies. Conclusions Evidence of validity and reliability of the MCQ indicates that this questionnaire can be used in medical education contexts. Health Profession Educators can improve the academic motivation of students by identifying one or more declined motivational component and teaching specific motivational regulation strategies. It is recommended to hold training courses on motivational regulation strategies for medical school faculty, study-skills advisors, and students.

Parkinson's disease (PD), a neurodegenerative disease characterized by both motor neuron and non-motor neuron symptoms, is the most frequent neurodegenerative disease after Alzheimer's disease. Both genetic and environmental factors take part in disease etiology. Most cases are considered complex multifactorial diseases. About 15% of PD appear in the familial form, and about 5% of all cases arise from a single gene mutation. Among Mendelian causes of PD, PARK7 is one of the autosomal recessive forms due to loss-of-function mutations in both gene alleles. Both single nucleotide variants (SNVs) and copy number variations (CNVs) are observed in PARK7. This study presents an Iranian family with familial PD where some relatives had psychiatric disorders. A homozygous 1617 bp deletion in a female with early-onset PD was detected through copy-number analysis from whole-exome sequencing (WES) data in this consanguineous family. Further investigation by surveying microhomology revealed that the actual size of the deletion is 3,625 bp. This novel CNV that was in the PARK7gene is supposed to co-relation with early-onset PD and infertility in this family.

Introduction: Preconception care is defined as a set of interventions that aim to identify and modify biomedical, behavioral, and social risks to a woman's health or pregnancy outcome through risk assessment, health promotion, and medical and psychosocial interventions. This study aimed to review the status, policies, and programs of preconception risk assessment in Iran. Methods: We searched scientific databases including Medline, PubMed, Web of Science, Scopus, CINAHL, Magiran, Iran Medex, SID, Iran Doc, Science Direct, and Google Scholar using key words such as "preconception care", "pre-pregnancy care", "instruction", "guideline", "risk assessment", "program", "policy", "Iran" and their combinations. No time limit was considered in searching the databases and all studies were published until February 1, 2020. Our search strategy resulted in the retrieval of 66 articles and guidelines, of which nine articles met the inclusion criteria and entered the study. Results: Multiple guidelines have been designed to assess the general health of women and men of childbearing age, with pay little attention to the reproductive health assessment in Iran. Assessment of reproductive health is specific to the integrated maternal health care program, which the reproductive health risk assessment from pre-pregnancy to postpartum period. The preconception care is a component of integrated maternal health care program that is faced in its content and faces challenges in implementation. Conclusion: Several strategies have been developed in the field of risk assessment for general health in Iran, but risk assessment in pre-pregnancy period is only exclusive to preconception care program that is moderate in performance.

Abstract Background The mission of medical schools is a sustainable commitment to orient education, research, and services based on the priorities and expectations of society. The most common complaints of patients from comprehensive health service centers (CHSCs) based on the data from electronic health records were assessed in order to determine primary health care (PHC) priorities for the educational planning of medical students in Iran. Methods A population-based national study was designed to assess clinical complaints of patients in all age groups who were referred to CHSCs at least once to be visited by physicians. All the data in the census were extracted from electronic health records in PHC system during 2015–2020, classified by the International Classification of Primary Care 2nd edition (ICPC-2e-English), and statistically analyzed. The total number of complaints that were recorded in the system was 17,430,139. Results 59% of the referring patients were women. The highest number of referrals was related to the age group of 18–59 years (56.9%), while the lowest belonged to the elderly people (13.3%). In all age and sex groups, the first ten complaints of patients with three top priorities in each category included process (follow-up, consultation, and results exam), digestive (toothache and gum complaint, abdominal pain, and diarrhea), respiratory (cough, sore throat, and runny nose), general (fever, pain, and weakness and fatigue), musculoskeletal (back pain, leg complaint, and knee injuries), endocrine and nutritional (weight gain, Feeding problem, and weight loss), cardiovascular (hypertension, palpitations, and Postural hypotension), neurological (headache, dizziness, and paralysis), sexual dysfunction (vaginal complaint, discharge, and irregular menstruation), and dermatological (pruritus, rash, and inflammation) problems. Conclusion High priorities in referring to PHC had a key role in assessing the country's health needs. Since this study was in line with the national pattern of complaints and patients' profile, the present findings can be helpful to amend policy-making, educational planning and curricula development in medical schools.

Background: The concept of negative population growth, population aging, and the need to implement child-encouraging policies is an important concern in many countries. As this issue is completely cultural and country-based, this study is designed to assess and prioritize the perception of newly married couples to the policies that may have a crucial role in the childbearing intention around the world. Materials and Methods: Through a descriptive cross-sectional study, 300 couples were selected by a simple random sampling method. Multilevel binary logistic regression was used for investigating the relationships among dimensions of family policies, socio-demographic variables, and childbearing intention. Results: Childbearing perception positively correlated with education and permanent job in both genders, maternal age range of 25–35, the higher length of marriage, having more children, and living in a government settlement. The most important family policies that couples preferred were contextual requirements (mean rank of 4.50%). Positive childbearing perception negatively correlated with higher age categories in women, the number of children, rental housing status, no insurance access, higher educational attainment, and low employment ranks in both men and women. Conclusions: This study cleared that family policies affect the childbearing intention of young couples. Polices involved contextual requirements, supporting couples to integrate work and home, health promotion plans, child-centered social support, and promoting the level of social and cultural relations.

Background: A growing body of evidence is showing that Preconception Care (PCC) can increase the health and well-being of women and couples and improve subsequent pregnancy and child health outcomes. The present study aimed to determine the quality of preconception care from women's and care providers' perspectives. Materials and Methods: This qualitative study was conducted in 2020 using conventional content analysis approach. Face to face Semi-structured interviews were conducted with 13 reproductive age women and 12 midwives recruited from urban health centers across Shahroud, Iran. Data were analyzed using qualitative content analysis. Results: Three major themes based on Donabedian's model emerged during data analysis: structure, process and outcome of care. Midwives and women's experiences of quality of preconception care included problems in organizing care, poor education performance of personnel and low-sensitivity about importance of preconception care in women. Conclusions: The findings suggest key considerations for the organizing and delivery of preconception care. Most especially, it seems necessary to adopt appropriate strategies to improve public awareness about the importance of pre-pregnancy care.

Abstract Background The present study has been undertaken with the aim to evaluate performance and ranking of various universities of medical sciences that are responsible for providing public health services and primary health care in Iran. Methods Four models; Weighted Factor Analysis (WFA), Equal Weighting (EW), Stochastic Frontier Analysis (SFA), and Data Envelopment Analysis (DEA) have been applied for evaluating the performance of universities of medical sciences. This study was commenced based on the statistical reports of the Ministry of Health and Medical Education (MOHME), census data from the Statistical Center of Iran, indicators of Vital Statistics, results of Multiple Indicator of Demographic and Health Survey 2010, and results of the National Survey of Risk Factors of non-communicable diseases. Results The average performance scores in WFA, EW, SFA, and DEA methods for the universities were 0.611, 0.663, 0.736 and 0.838, respectively. In all 4 models, the performance scores of universities were different (range from 0.56–1, 0.53–1, 0.73–1 and 0.83–1 in WFA, EW, SFA and DEA models, respectively). Gilan and Rafsanjan universities with the average ranking score of 4.75 and 41 had the highest and lowest rank among universities, respectively. The universities of Gilan, Ardabil and Bojnourd in all four models had the highest performance among the top 15 universities, while the universities of Rafsanjan, Ahvaz, Kerman and Jiroft showed poor performance in all models. Conclusions The average performance scores have varied based on different measurement methods, so judging the performance of universities based solely on the results of a model can be misleading. In all models, the performance of universities has been different, which indicates the need for planning to balance the performance improvement of universities based on learning from the experiences of well-performing universities.

Abstract Aim This study aimed to provide comprehensive information about the core determinants of fertility intentions. Design Systematic review. Methods Ovid, MEDLINE, EMBASE, PsycINFO, CINAHL, Web of Science, SCOPUS and GOOGLE SCHOLAR were searched for the relevant articles published from 1946–December 2017. We updated our records by searching three computerized databases (Ovid MEDLINE, SCOPUS and WOS) from 2018–January 2021. Results 53 studies included in the qualitative synthesis. The results of some studies indicated the impact of demographic factors, physical and psychological health, happiness and child desire. The most frequent variables in a couple's mesosystem were marital status, parity, partnership satisfaction and gender role attitude. The mesosystem of childbearing intention also included family and peers network. The EXEO system of the ECSM includes certain variables, such as job characteristics, urban residence, housing condition. The macrosystem comprises cultural and societal principles with broader influences on the couple's system.

Facioscapulohumeral muscular dystrophy is one of the most common musculoskeletal diseases with a considerable burden. Most of the affected individuals experience muscle weakness as the common muscular symptom. Despite the underlying genetic mechanism which is extensively studied, curative treatment is not available for patients with facioscapulohumeral muscular dystrophy, and only supportive care is considered as the treatment of choice. Recently, several studies addressed the treatment of facioscapulohumeral muscular dystrophy by genetic engineering strategies, most of which indicate the effectiveness of different types of small interfering ribonucleic acids. However, these studies are still in the preclinical phase and it seems that there is a long way ahead of curing facioscapulohumeral muscular dystrophy despite recent advances in the field of genetic engineering. This study aimed to review the underlying genetic mechanism of Facioscapulohumeral muscular dystrophy alongside providing the latest preclinical studies related to the treatment of this disease.

Abstract Background Physical inactivity enhances the risk of adverse health conditions such as non-communicable diseases, morbidity, and mortality among middle- and older-aged population. This study is aimed to design, implement, and evaluate a conceptual model of physical activity (PA) promotion among middle-aged Iranian women (MAIW). Methods An interventional study was conducted with 80 women aged between 30 and 59 years in intervention and control groups during 2018–2019. The subjects referred to health centers were selected by the available convenience sampling method. Data collection tools to assess the MAIW' PA level (metabolic equivalent tasks (MET)-min/week) included face-to-face interviews, body mass index (BMI) measurements, the four-question form of PA vital signs in the framework of Iran's Package of Essential Non-communicable (IraPEN) program, and the questionnaire is based on the Health Belief Model (HBM) constructs. Results The intervention led to a three-fold increase in the average PA (from 280.63 to 927.70 MET-min/week) of the intervention group. Although no significant difference in the BMI between both groups was found before the intervention, this educational program decreased the mean BMI from 30.36 to 28.83 kg/m2 (p = 0.01). After the intervention, the values of HBM-based perceived sensitivity/severity and self-efficacy were increased from 62.09 to 71.03% and from 27.01 to 83.15%, respectively (p

Background: Investment in the adolescents' health is an effective way to improve the public health. Objectives: This study aimed to explore the views and experiences of adolescent girls and key adults to identify the facilitators of access to sexual and reproductive health services among Iranian adolescent girls. Methods: In this qualitative study, the data were gathered through focus groups and semi-structured interviews with 247 adolescent girls and 71 key adults in Iran. The collected data were coded and categorized using a content analysis method in MAXQDA v10. Results: The main facilitators of Iranian adolescent girls’ access to reproductive health services were classified into five categories: 1) Factors associated with policymaking, such as governmental support; 2) benefiting from the religion’s potentials; 3) social and cultural factors, such as creating a supportive environment in the community; 4) public participation; and 5) factors associated with the methods of service delivery. Conclusion: The governments’ acceptance of sexual health education shortcomings is the most important factor affecting the successful implementation of reproductive health programs for Iranian adolescents. Overall, increasing public participation and intersectional collaboration, besides creating a supportive environment in the community, is the next step in improving sexual health education.

Abstract Background The role of family physicians (FPs) in the metropolitan area is critical in identifying risk factors for disease prevention/control and health promotion in various age groups. Understanding patients’ preferences and interests in choosing a FP can be an effective and fundamental step in the success of this program. In this study factors affecting the FP selection by Iranian patients referred to health centers in the most populous areas in the south of Tehran were assessed and ranked. Methods A sequential mixed-method (qualitative-quantitative) triangulation approach was designed with three subject groups of patients, physicians, and health officials. The Framework method was used to analyze interviews transcribed verbatim. After implementing an iterative thematic process, a 26-item quantitative questionnaire with high validity and reliability was drafted to evaluate the different factors. A convenient sampling method was used to select 400 subjects on a population-based scale to quantitatively rank the most critical selection factors as a mean score of items. Results The selection factors were divided into six centralized codes, including FPs’ ethics, individual, professional and performance factors; patients’ underlying disease and individual health, and disease-related factors, office’s location and management factors, democracy factors, economic factors, and social factors. After filling out the questionnaires, the most important factors in selecting FP were a specialist degree in family medicine (FM) (4.49 ± 0.70), performing accurate examinations with receiving a detailed medical history (4.43 ± 0.68), and spending enough time to visit patients (4.28 ± 0.75), respectively. However, the parameters such as being a fellow-citizen, being the same gender, and physician’s appearance were of the least importance. Conclusion There is a possibility to screen the most important factors affecting the FP choice through the combination of qualitative and quantitative studies. The first and last patients’ priority was physicians’ specialty in FM and being a fellow-citizen with them, respectively. The clinical and administrative healthcare systems should schedule the entire implementation process to oversee the doctor’s professional commitment and setting the visit times of FP.

Objectives: Successful marriage and the strengthening family foundation bring about numerous positive outcomes for both the family and society. Therefore, the purpose of this study was to investigate the concept and dimensions of successful marriage from the perspective of successful couples and experts in this field. Materials and Methods: This qualitative study was done by the conventional content analysis method through the participation of 10 Iranian couples (10 men and 10 women) and 14 experts in related courses to marriage. The research environment was health centers. The couples entered our study after obtaining at least %70 of the score from the ENRICH questionnaire. The sampling was done purposefully and the data were collected using unstructured in-depth interviews and continued until achieving saturation. In the meantime, data analysis was conducted using a conventional content analysis method. Results: The obtained main concepts from the data were four main themes and ten main categories. The main theme included recognizing and understanding the needs, life skills, personality liberation, along with development and flourishing. Conclusions: For a successful marriage, the couple’s premarital knowledge of each other and their spouse’s family, knowing necessary life skills, as well as recognizing and understanding married life are necessary. Moreover, the couples will acquire the necessary development and flourish to manage married life through achieving positive behavioral qualities including personality liberation. To achieve success in married life, one cannot ignore the role of training in acquiring life skills both before and after the married life.

Background: Changing the mental structure of students and identifying creativity inhibitors are essential for academic survival and the pursuit of innovation. This study aimed to identify the inhibitory cognitive factors in medical students. Methods: This study was a directional qualitative content analysis that conducted based on scientific literature review and opinions of experts in a semiformal expert panel by using semi-structured interviews ranging from 20 to 70 minutes from February 2015 to October 2016. Seventeen talented students were interviewed and conversations were recorded with a digital voice recorder at the Exceptional Talent Development Center (ETDC). The extraction and content analysis was continuously done by listening and writing through several times. The students were in various medical disciplines, and most of them were first rank students in scientific performance and they were collaborating with ETDC. Results: The inhibition variables of creativity were classified in the four main subcategories according to the semantic relationship and after compression, these classes of inhibitory factors included: teacher-related inhibitors, teaching and assessment methods related inhibitors, student barriers and inhibitors of the university's educational system. Finally, 10 codes were extracted from the 4th categories, which were mentioned as inhibitory variables of creativity. The teachers' lack of enthusiasm with the new ideas, the lack of creativity in the academic context and the lack of motivation among the students were the main inhibitors of creativity that were extracted from interviewing with talented students. Conclusion: In this study, the most important cognitional inhibitory factors in creativity promotion were the inhibitors related to the teacher’s character and his attitude to creativity, methods of teaching and the university environment. Planning for the removal of these barriers in medical students recommended.

Background Childbearing motives are considered as the primary stimulus of fertility and the importance of making fertility decisions in humans. Objective The aim of this study is to determine the effect of a new form of interactional program on the childbearing motives of students. Materials and Methods According to a well-defined, single-blind randomized controlled trial, we selected eight government schools in Tehran. Students in the age range of 7-12 yr and 16-18 yr (130 students in each school with a total number of 260) were selected for a series of intervention from storytelling to free discussion on a special subject through the concept of hidden curriculum. We evaluate the outcome with pretest-posttest based on the Miller childbearing motives questionnaire. One month after the last intervention, final evaluation took place. Results The findings showed that after an intervention conducted in the best way, all positive scores were promoted while the negative ones declined. One the other hand, no matter what really the participant's groups were, their total intention score got better. In this way, the total positive scores were significantly increased in the intervention groups (p = 0.000) Also, the students in high school significantly improved in positive scores and the negative score decreased in them. Conclusion This study showed that the fundamental childbearing motives even with small interventions can be improved. Our intervention could improve the positive childbearing motives among school girls. In this regard, the role of some confounding factor such as the role of some confounding factors such as religious beliefs in family, maternal education is most important.

Introduction: Learning procedural skills is one of the essentialaspects of undergraduate medical education. However, learningprocedural skills in clinical settings is less widely considered.This study aimed to explore the Iranian undergraduate medicalstudents’ perception of learning procedural skills and its outcomesin three universities of medical sciences in Iran.Methods: A descriptive exploratory qualitative methodologywith an in-depth unstructured, face-to-face interview, and contentanalysis was used in this study. Sixteen students in clinicalphases of general medical education programs from educationalhospitals were selected using purposive sampling. According tothe preferences of the participants, the interviews were conductedin medical schools or in hospitals.Results: The students participating in this study included 7females and 9 males (totally 16 people) with a mean age of 23.7years old with a range of 21-27 years. The three main themes ofthis study were “the gap of transferring formal teaching fromskill lab to clinical placement”, “learning self-leading proceduralskills in clinical settings”, and “students’ dissatisfaction withpatients’ vulnerability” with 8 subthemes which were extractedand explained based on the students’ perception.Conclusion: Unsupervised and self-learning by medical studentsand weakness in controlling the learning process have undesirableresults for patients and students.

Relative internet search volumes (RSV) is now being consider as a measurement of awareness for most of the trending topics. During the recent coronavirus disease (COVID-19) outbreak, many researchers used the RSVs to interpret the population responses to the pandemic in various ways. By using the RSVs searched by Persian language people, we demonstrated that the Iranian people increased their knowledge and awareness of COVID-19 during the early phases of the disease before the first peak. However, their relative searches about the COVID-19 and its clinical symptoms decreased gradually despite of the gradual rise of the confirmed cases. Their less tendency to seek information about the COVID-19 could be one of the possible explanation for the increasing number of confirmed cases even several days after easing the disease related lockdown.

BACKGROUND: Metamotivation is a process that students use to monitor their motivational states to reach their academic goals. To date, few studies have addressed the ways that medical students manage their motivational states. This study aim to identify the motivational strategies of medical students as they use the metamotivational process to monitor and control their motivational states. MATERIALS AND METHODS: This qualitative study uses directed content analysis of the narrative responses of 18 medical students to draft an in-depth and semistructured interview protocol which were conducted through WhatsApp due to social distance restrictions of COVID-19. Data were collected, encoded, and analyzed using deductive content analysis approach descripted by Elo and Kyngäs. RESULTS: Seven main themes were extracted as the motivational strategies of medical students including “regulation of value,” “regulation of situational interest,” “self-consequating,” “environmental structuring,” “efficacy management,” “regulation of relatedness,” and “regulation of situational awareness.” In this study by identifying new strategies, we provide a broader framework of metamotivational strategies in the field of the progression of learners in medical education. CONCLUSION: Medical students use a variety of strategies to regulate their academic motivation. To sustain and improve the motivation of medical students, identifying and strengthening metamotivational strategies is the first step.

BACKGROUND: Male reproductive health is a necessary pillar of childbearing. If a reproductive health assessment is conducted in the preconception period, the chance of a healthy pregnancy can increase. This qualitative study aimed to explore men's reproductive health needs before conception in Iran. MATERIALS AND METHODS: This research was a qualitative study conducted in Bushehr city, Iran to explore men's reproductive health needs from April 2021 to November 2021. 30 semistructured interviews were conducted with married men, women, healthcare providers, and specialists individually in the health centers. The sampling method used in this study was purpose-based with maximum variety. All interviews were digitally recorded and transcribed verbatim in Persian and analyzed using directional content analysis. MAXQDA software version 12 was used to facilitate data analysis. RESULTS: From the data analysis, 2 themes, 15 categories, and 38 subcategories emerged. The themes included evaluation and health promotion recommendations. It consisted of 10 categories: reproductive life plan evaluation, medical history evaluation, family and genetic history evaluation, social history evaluation, sexual health evaluation, medication evaluation, laboratory evaluation, physical examination, lifestyle evaluation, and mental health evaluation. Health promotion recommendations included five categories: nutritional recommendations, stress management, avoiding harmful behaviors, protective measures against harmful exposure, and need for education. CONCLUSIONS: Our results showed that men need a comprehensive evaluation of reproductive health and recommendations to improve their health in the preconception period. Our study findings can inform healthcare providers to increase men's participation in reproductive health.

Introduction: Patients have to change their behavior due to increased self-care needs. Also, family caregivers due to their critical role in rehabilitation of patients with physical and mental disabilities, can help patients to improve their abilities. This study was performed with aim to determine the relationship between the caregivers' health literacy and the behavior of patients with Multiple Sclerosis. Methods: This descriptive correlational study was performed on 76 women with MS and 76 caregivers in Bojnourd in 2016. Collection of data related to MS women were performed by using demographic information questionnaire, Test of Functional Health Literacy in Adults [TOFHLA] health literacy and patient behavior assessment. Data analysis was performed using SPSS software (version 16), and Pearson and spearman correlation and regression tests. P

ABSTRACT Background and Objectives: Non-synonymous single nucleotide polymorphisms are typical genetic variations that may potentially affect the structure or function of expressed proteins, and therefore could be involved in complex disorders. A computational-based analysis has been done to evaluate the phenotypic effect of non-synonymous single nucleotide polymorphisms in the gene encoding the human hypoxanthine-guanine phosphoribosyltransferase (HGPRT-1). HGPRT-1 is an enzyme involved in purine recycling pathway and its deficiency is associated with several human genetic disorders. Methods: We provide a list of all amino acid replacements in the human HGPRT-1 from the dbSNP, Uniprot and dbEST databases. Sorting intolerant from tolerant (SIFT) and PolyPhen softwares were also used in our study. Results: Of 94 amino acid substitutions, rs 267606863 was predicted to be the most deleterious. Substitutions of S110L and S104A in flexible loop and D194N, D201Y, H204R, Y195C, F199V and H204D in hood domain were predicted as functionally damaging. Conclusion: It could be concluded that these intolerant changes may lie within a functional region of the protein and may affect the stability and folding of HGPRT-1. These variants could be used for future functional and molecular epidemiology studies of HGPRT-1-related disorders. Keywords: Polymorphism, Single Nucleotide, Amino acid substitution, Hypoxanthine Phosphoribosyltransferase.

Background: Gestational diabetes is one of the most common health problems in pregnancy that requires participation through self-care to reduce the maternal and neonatal complications. The present study aimed to determine the needs of women as an essential first step to formulate a self-care guide fitting the Iranian culture. Materials and Methods: The present qualitative study was conducted through interviews with 13 diabetic pregnant women and 10 care providers using semi-structured questionnaires in several cities of Iran in 2016. Further, the data analysis was performed using conventional content analysis. In addition, purposive sampling was performed at the diabetes clinic of Kermanshah University of Medical Sciences, Imam Reza Hospital, and health centers across Kermanshah, Shahroud, and Tehran. Results: In the present qualitative content analysis study, four themes were identified: awareness and ability (knowing diabetes, mothers training and empowerment, continuity and quality, information resources), lifestyle (healthy diet, physical activity), mental health (counseling, interaction, spirituality, and religion), and supportive family (the husband's unique role, the psychological atmosphere at home). Conclusions: The present study highlighted main aspects of self-care educational/supportive needs, specifically in the domains of lifestyle, awareness and capability, mental health, and family. The results of our analysis highlighted the needs that can be useful for developing comprehensive self-care educational programs, with a higher focus on physical activity, mental health, the role of the family, and the use of religious interests.

Objectives It has been shown that assessment strongly affects students’ performance. A deeper insight needs to be gained into the interplay of assessment and learning. The aim of the current study was to develop a model to explain the educational impact of assessments on students’ learning, before, during and after the test.Design This study used semistructured interviews, focus group discussions and observation and collection of field notes. A qualitative methodology using the grounded theory data analysis approach was then used to generate an explanation of the process of how assessment impacts students’ learning.Setting School of Medicine, Tehran University of Medical Sciences.Participants Participants were medical students and teachers with first-hand experience or expertise in assessment as well as their willingness to participate in the study. Fifteen people (eight medical students, seven faculty members) were interviewed. One focus group discussion (with five students) was held.Results The extracted concepts from our study were classified into four main categories. These categories include elements of the assessment programme which affect learning, the mechanism through which they exert their effects, contextual factors and the impact they have on learning. These elements and their interplay occur within an environment with its antecedent characteristics.Conclusions This study suggested a model for understanding the elements of the assessment which, within the context, affect learning, the mechanisms through which they impart their effects and the final outcomes obtained.

Introduction: One of the most important factors and determinants of mental health, emotional stability of couples and successful marriage is marital satisfaction, a state that in most cases, males and females are satisfied with each other and their marriage. This review was conducted to survey the effective factors on marital satisfaction in view of Iranian men and women. Methods: This systematic review surveys published articles from 2005 to 2015. First, scientific databases such as Pubmed/Medline, Scopus, Elsevier, Cochran library, Springer, Scientific Information Database (SID), IranMedex, Magiran and Medlib were searched using relevant key words and phrases. All published peerreviewed articles studied exploring associations between marital satisfaction and effective factors were considered for inclusion. Results: According to results, the spiritual and religious, sexual and interpersonal factors, communication and interaction factors and mental health had positive impact on marital satisfaction in the vast majority of studies. Also in most articles, impact of some socio-demographic factors such as occupation, length of marriage, age, Number of children, economic factor and income had been emphasized. Conclusion: In mate selection, it is necessary to note various criteria, including religious matters, moral, mental health, communication skills and sexual factor and action through education, counseling and treatment if there is problem.

Background and Aim: Today, customer perception assessment as a way to measure satisfaction and expectations has an important role in improving the quality of services and organizational excellence. This study aims to measure customers’ perception at the Health Deputy of Iran’s Ministry of Health and Medical Education (MOHME). Materials and Methods: This cross-sectional study was performed in 2012-2013. The population comprised the health deputies of medical universities, among which 13 of the universities were randomly selected. As the main customers of MOHME health deputy, these universities’ managers and experts were asked questions like a census. The data collection device was the national award standard questionnaire consisting of 2 sections and 26 questions. The data were analyzed by SPSS 18 with level. Results: Of the 267 managers and experts, 147 (56.1%) were male. Many of them (57.3%) had a bachelorchr('39')s degree. Most of them (91.6%) were employed in technical units. The average perceived level of managers and experts regarding their reputation and image was 3.3±0.7, production and service 3.1±0.7, support while and after providing services 3.0±0.7, and loyalty and honesty 3.3±0.8 out of a maximum 5 points, respectively. There was no significant relationship between administrators and experts’ perception level on the one hand, and individual and organizational factors on the other (P>0.05). Conclusion: The study showed that customers’ perception of indices related to the quality of relationships, services and measures was at a moderate level. Therefore, it is recommended that the department of health should design and implement an appropriate intervention program for organizational excellence.

Introduction: A strategic plan provides the context for improving organizational performance by accurate, extensive, and in-depth identification and analysis of interior and exterior environments. This study was performed to develop and execute a strategic plan at the Medical Sciences Universities of Iran. Methods: This analytical and cross-sectional study was performed in 2012-2013. The study population was selected through systematic random and quota sampling and consisted of the vice-chancellery of health of 13 medical universities. In the selected universities, all managers and experts were interviewed trough census method. The data collection tool was a researcher-made questionnaire including 8 individual and organizational questions and 6 questions on the formulation, implementation, evaluation, and effectiveness of strategic plans. The validity and reliability of the questionnaire was confirmed. The data were analyzed in SPSS software using the related statistical tests with the significant level of α > 0.05. Results: From the point of view of 267 managers and experts, the participation level of administrators and managers in the formulation of a strategic plan was 2.9 ± 1.4, from a total of 5 scores. The level of informative content and objectives of the strategic plan was 2.8 ± 1.3. The level of assurance of managers and experts was 2.6 ± 1.22. The level of alignment of the strategic plan with the operational plan was 3.2 ± 1.2. The level of evaluation and revision of the strategic plan was 2.3 ± 1.2. The level of its effectiveness was 2.5 ± 1.1. There was a significant difference between the formulation, implementation, evaluation, and effectiveness levels of the strategic plan and university types (p > 0.05). Conclusion: This study showed that the level of alignment of the strategic plan with the operational plan was average, and the rest of the factors were lower than average. Therefore, it is recommended that in the future revision of the strategic plan, intervention programs be designed and implemented.

INTRODUCTION: Assessment interprofessional collaboration (IPC), in community health-care setting usually has been neglected due to the lack of standard tools and assessors. In the present study, the IPC checklist extracted from CANMEDS collaborator toolkit for teaching and assessing the collaborator role is contextualized in Iranian community healthcare. MATERIALS AND METHODS: According to CANMEDS Toolkit, an instrument extracted for IPC assessment. Using Chavez' toolkit, face and content validity were studied through two rounds of Delphi by 12 experts of TUMS. Qualitative content validity including content validity index (CVI), and content validity ratio (CVR) were assessed following watching a standard video about IPC by them. Construct validity was studied by confirmatory factor analysis through LISREL software. To check reliability, Cronbach's alpha was calculated, and the other 12 experts completed checklists in test–retest process with a 2-week interval. RESULTS: Face and qualitative content validity were confirmed using the Delphi method. CVI and CVR were calculated as 0.61 and 0.86. In factor analysis, x2/df and RMSEA were calculated as 1.363 and 0.036; CFI, IFI, GFI, and AGFI were >0.7, and hence, the construct validity was confirmed. Cronbach's alpha was 0.953 for internal consistency. Test–retest was also calculated as 0.918 indicated to confirm reliability. CONCLUSION: CANMEDS framework as an assessment tool for evaluating IPC in community health setting is not only valid and reliable in the Iranian context but also it is easy to use for respondents resulted from the rational number of items in community.

Background: This study aimed to evaluate the effect of self-care educational/training interventions on gestational diabetes. Methods: In this review, we searched the ERIC, Clinical Key, Cochrane, Scopus, PubMed, and ISI databases as well as Iranian databases from 1990 until Jan 2017. Having evaluated 3267 articles by three of the authors, 20 clinical trials with educational/training approach remained for analysis. In this study, CONSORT checklist, JADAD scale and Cochrane handbook were used to evaluate the validity of articles. Results: The quality of 34% of articles was found to be poor due to probability of bias in designing the interventions and the effect of absence of blinding of personnel and participants. However, absence of blinding had a low impact on the results of most studies carried out on objective scales like blood glucose levels, or maternal and neonatal results. Moreover, 66% of studies were assessed to be at a good level of quality. Conclusion: There are few articles with educational/training approach on self-care in gestational diabetes mellitus, but based on the homogeneity of participants and significant results of self-care interventions, especially lifestyle ones, self-care guidelines can be developed for gestational diabetes mellitus.

Background Whereas much has been written about the strategies, barriers and facilitator factors of effective and interactive lecturing in medical education little has been written about the effective and interactive lecturing skills educational programs for medical teachers based on peer observation of teaching. Objectives The current study aimed at designing and implementing an interactive and effective lecturing workshop using peer observation and feedback, and finally evaluating its results. Methods The current descriptive study was conducted in Tehran University of Medical Sciences from 2015 to 2016. The study population consisted of faculty members participating in the effective and interactive lecturing workshop and the study subjects were selected by convenience sampling method. The Kirkpatrick method was used to assess the workshop; for this purpose, the level of reaction, learning, and performance were evaluated using a valid and reliable questionnaire, as well as the one minute note technique, and a form addressing the extent of using interactive techniques in the classroom six months after participation in the workshop. Data were analyzed by using the SPSS 22. Data are presented as frequency and mean where appropriated. The notes were analyzed using manual content analyses. Results The participants believed that the workshop could successfully encourage them to use lecturing principles and interactive lecturing techniques, and provide them with the opportunity to practice and rethink the teaching process. The interactive techniques mostly used six months after participation in the workshop belonged to the question and answer (Q& A) techniques, active evaluation, and use of scenario. Conclusions It seems that the provision of training opportunities, observation of performance, and giving feedback were effective to improve the quality of empowerment programs. It was suggested that other empowerment programs should also address this point.

Purpose: To determine the distribution of Zernike coefficients and higher order aberrations in a normal population and its relationship with age, gender, biometric components, and spherical equivalent. Methods: During the first phase of the Shahroud cohort study, 6311 people of the 40-64-year-old population of Shahroud city were selected through random cluster sampling. A subsample of participants was examined with Zywave aberrometer (The Bausch & Lomb, Rochester, NY) to measure aberrations. Measurements of aberrations were done before cycloplegic refraction, and values generated from a minimum pupil diameter of 5 mm were reported in this analysis. Results: After applying exclusion criteria, 904 eyes of 577 people were analyzed in this study and mean age in this study was 49.5 ± 5.7 years and 62.9% were female. Mean root-mean-square (RMS) of the third−, fourth−, and fifth-order aberrations was 0.194 μm (95%CI: 0.183 to 0.204), 0.115 μm (95%CI: 0.109 to 0.121), and 0.041 μm (95%CI: 0.039 to 0.043), respectively. Total RMS coma (Z3−1, Z31, Z5−1, Z51), Total RMS trefoil (Z3−3, Z33, Z5−3, Z53), and spherical aberration (Z40) in the studied population was 0.137 μm (95% CI:0.129–0.145), 0.132 μm (95% CI: 0.123–0.140), and −0.161 μm (95%CI:−0.174 to −0.147), respectively. Mean higher-order Zernike RMS in this study was 0.306 (95% CI: 0.295–0.318) micrometer, and in the multiple model, it significantly correlated with older age and short axial length. The highest amounts of higher-order RMS were observed in hyperopes, and the smallest in emmetropes. Increased nuclear opacity was associated with a significant increase in HO RMS (p

Purpose: To determine the corneal elevation values and keratoconus indices in the 40- to 64-year-old population and their changes with aging. Methods: The 6311 invitees of this study were selected through random cluster sampling, and 5190 of them participated in the study (response rate = 82.2%). Here, we analyzed results of Pentacam acquisitions in 4148 respondents. Cases of keratoconus and forme fruste keratoconus (FFKC) were determined using topography and clinical data. Studied variables included keratoconus indices, central corneal thickness readings, maximum elevations on the anterior and posterior surfaces, and elevation values at the thinnest point, anterior steepest point, and posterior steepest point in healthy, FFKC, and keratoconus groups. Results: In all subjects, the mean maximum elevations were 6.80 ± 5.0 μm and 16.60 ± 7.7 μm on the anterior and posterior corneal surfaces, respectively. Maximum elevation values on the anterior and posterior corneal surfaces showed significant correlations in the keratoconus, FFKC, and healthy groups (P

Purpose: To determine the normal distribution of corneal diameter in a 40- to 64-year-old population and its association with other biometric components. Methods: In a cross-sectional population-based study, subjects were selected through multistage cluster sampling from the 40- to 64-year-old citizens of Shahroud in northern Iran. After obtaining informed consents, optometry tests including refraction and visual acuity and ophthalmic exams including slit lamp exams and retinoscopy were done for all participants. Biometric components and white-to-white (WTW) corneal diameter were measured with the LENSTAR/BioGraph. Results: Of the 6311 invitees, 5190 (82.2%) participated in the study. After applying exclusion criteria, analysis was done on data from 4787 people. Mean WTW corneal diameter in this study was 11.80 mm (confidence interval: 11.78–11.81), and based on two standard deviations from the mean, the normal range for this index was from 10.8 to 12.8 mm. WTW corneal diameter strongly correlated with corneal radius of curvature (r = 0.422) and axial length (r = 0.384). According to multiple linear regression, lower age, thinner cornea, longer AL, thicker lens, and flatter cornea were significantly related to higher WTW corneal diameter. Spherical equivalent significantly increased at higher corneal diameters (hyperopic shift). Conclusion: The average and normal range of corneal diameter, as measured with the BioGraph, was studied in an Iranian population for the first time. The corneal diameter strongly correlates with AL and radius of curvature. WTW is larger at younger ages.

Purpose: To investigate the association between ocular biometrics such as axial length (AL), anterior chamber depth (ACD), lens thickness (LT), vitreous chamber depth (VCD) and corneal power (CP) with different refractive errors. Methods: In a cross-sectional study on the 40 to 64-year-old population of Shahroud, random cluster sampling was performed. Ocular biometrics were measured using the Allegro Biograph (WaveLight AG, Erlangen, Germany) for all participants. Refractive errors were determined using cycloplegic refraction. Results: In the first model, the strongest correlations were found between spherical equivalent with axial length and corneal power. Spherical equivalent was strongly correlated with axial length in high myopic and high hyperopic cases, and with corneal power in high hyperopic cases; 69.5% of variability in spherical equivalent was attributed to changes in these variables. In the second model, the correlations between vitreous chamber depth and corneal power with spherical equivalent were stronger in myopes than hyperopes, while the correlations between lens thickness and anterior chamber depth with spherical equivalent were stronger in hyperopic cases than myopic ones. In the third model, anterior chamber depth + lens thickness correlated with spherical equivalent only in moderate and severe cases of hyperopia, and this index was not correlated with spherical equivalent in moderate to severe myopia. Conclusion: In individuals aged 40-64 years, corneal power and axial length make the greatest contribution to spherical equivalent in high hyperopia and high myopia. Anterior segment biometric components have a more important role in hyperopia than myopia.

Purpose: To explore the relationship between lens power and refractive error in older adults following age-related hyperopic shifts. Methods: From the Shahroud Eye Cohort Study, subjects aged 55-64 years without clinically significant cataracts (with nuclear opacity of grade 0 to 1) were included to maximize the proportion of subjects with age-related hyperopic shifts that normally occur between 40 to 60 years of age, before interference from the myopic shift due to nuclear cataracts. Mean axial length (AL) values, corneal power, anterior chamber depth, lens thickness, and lens power were analyzed and compared among three refractive groups (myopes, emmetropes, and hyperopes). Results: A total of 1,006 subjects including 496 (49.63%) male subjects were studied. Corneal power was similar in all refractive groups. Hyperopes had + 1.69 diopters higher mean spherical equivalent refractive error and − 0.50 mm shorter AL than emmetropes. Myopes had 0.67 mm longer AL than emmetropes. Hyperopes had significantly increased lens thickness as compared to emmetropes (4.42 vs. 4.39 mm respectively). In this adult sample, the hyperopic group had lower lens power (+22.29 diopters vs. +22.54 diopters in emmetropes, P = 0.132). Myopes had similar lens power as emmetropes. Conclusion: Axial length is the principal determinant of refractive errors. Lens power may have importance in determining hyperopia in adults free of cataract.

Background: The aim of this study was to determine the prevalence of overweight and obesity and their associated factors in the middle-aged population of Shahroud, North of Iran. Methods: In a population-based cross-sectional study with random cluster sampling, 300 clusters of Shahroud (north of Iran) were randomly selected from the 40-64 yr old population of the city, during 2009 and 2010. Upon enrollment, participants were weighed on digital scales and their heights were measured under standard conditions. Overweight and obesity were defined as a body mass index (BMI) of 25-29.9 kg/m2 and a BMI ≥30 kg/m2, respectively. Results: Of the 6311 selected people, 5190 people (82.2%) participated in the study. Their mean age was 50.9±6.2 yr, and 2977 of them were women (57.4%). Age and gender standardized mean BMI in the study population were 28.1 kg/m2 (95% CI: 27.9-28.2). Age and gender-standardized prevalence of BMI≥25 was 74.4% (95% CI: 73.0-75.8); 43.4% (95% CI 44.8-42.0) were overweight and 31.0% (95% CI 32.5-29.6) were obese. Overweight, Obesity and a BMI ≥25 prevalence's were significantly higher in women (P

Background: Health literacy is an important issue in public health and defined as the cognitive and social skills of an individual that determine his/her ability to obtain, access, understand, and apply health information. As the area of social determinant of health and structure content of the questionnaires, such as the perception of health and the health status of people, were neglected in the previous reviews, the present study was conducted to review and compare Health literacy questionnaires, which have domains in these areas, in English and Persian languages. Methods: We reviewed the most famous health literacy questionnaires designed and validated in English and Persian languages published in PubMed, Google Scholar, Ovid, Scientific Information Database, and Barakat Knowledge Network System. After removing repetitive articles, the remaining articles were studied and the questionnaires were qualitatively analyzed. Results: More than 31 well-known English and Persian questionnaires and articles were included in the present review. Among these tools, 17 questionnaires had a section on understanding and comprehension and 14 had calculation and analysis in addition to comprehension. Among the 31 questionnaires, three questionnaires had some items about social determinants of health and 12 had some items about perception of health. According to our study, the questionnaire that covers all areas of health literacy as well as social determinants of health is the HLS-EU-Q, which has been translated into different languages. Conclusion: Since health literacy levels are related to many social determinants of health, the HLS-EU-Q can be used for health literacy evaluation as a strong predictor of a person’s health status.

Background The current study aimed to determine eye care utilization, to assess the role of economic inequality in the utilization of eye care services, and to identify its determinants in Shahroud, North of Iran. Methods Of the 6,311 invited people, 5,190 (82.24%) individuals aged 40 to 64 years old participated in the study. A history of a visit by an ophthalmologist or optometrist was considered as eye care utilization. The gap between low- and high-economic groups was decomposed into its determinants using the Oaxaca decomposition method. Results Among the participants, 16.32% [95% Confidence Intervals (CI)= 15.31–17.33%] had never been examined by an ophthalmologist or optometrist, and 30.94% (95% CI= 29.69–32.20%) had not undergone an eye examination in the past 5 years. This negative history was significantly higher among female subjects [Odds Ratio (OR)= 1.79, 95% CI= 1.51–2.14], the low-economic group (OR= 2.33, 95% CI= 1.90–2.87), the visually impaired (OR= 1.41, 95% CI= 1.05–1.90), and the uninsured (OR= 1.93, 95% CI= 1.45–2.58). The negative history of eye examination decreased with increasing in age (OR= 0.94, 95% CI= 0.93–0.96) and education (OR= 0.94, 95% CI= 0.92–0.96). In this study, 24.72% (95% CI= 22.30–27.14) of the low-economic group and 9.94% (95% CI= 8.75–11.14) of the high-economic group had no history of eye examination. Decomposition of the gap between the two economic groups showed that education and gender were the most important determinants of inequality. Conclusion A considerable percentage of adults, even those with visual impairment, do not receive appropriate eye care. There is a definite economic inequality in the community for which poverty per se could be the major cause

Objectives: Despite the fact that cesarean delivery does not offer significant health benefits for either mother or newborn, there has been a noticeable upward trend in elective cesarean births in Iran, over the last two decades. This study aims to examine whether knowledge, perception of health threats, efficacy, and personal beliefs act as psychological predictors towards the intention of women to have a normal vaginal delivery.Methods: The mixed-method approach was used as quantitative and qualitative design. Simultaneously, 290 pregnant women who visited prenatal clinics participated in the study. Quantitative and qualitative data were collected using a structured questionnaire based on Witte’s Extended Parallel Process Model, and four focus groups, respectively.Results: Women perceived lower personal risk but higher levels of efficacy. Perceived self-efficacy, severity, and response efficacy emerged as significant predictors of intention to experience vaginal birth. The participants’ insufficient knowledge and misconceptions about birth methods were prevalent. Major themes were identified and divided into negative and positive beliefs about vaginal birth.Conclusion: This educational model is useful for understanding women’s intention to undergo a vaginal birth, especially when it is combined with a qualitative approach. Maternal care providers should acknowledge their clients’ beliefs and intended childbirth methods prior to offering medical intervention.

METHODS:As part of the first phase of Shahroud Eye Cohort Study with 5 190 subjects of 40 to 64 years of age, CCT and ACD were measured using Scheimpflug imaging with the Pentacam (Oculus, Inc., Lynnwood, WA, USA) and partial coherence interferometry with the Allegro BioGraph (Wavelight, Erlangen, Germany).RESULTS:After applying exclusion criteria, we had data of 4 387 subjects with a mean age of 50.7±6.2 years. Mean CCT with Pentacam and BioGraph were 528.6±33.2μm and 525.6±32μm respectively; the difference was statistically significant (PPCONCLUSION:For both CCT and ACD, the BioGraph gave significantly lower values than the Pentacam (P

Purpose: To determine the distribution of axial length (AL) to corneal radius of curvature (CRC) ratio and to evaluate its association with refractive errors in an Iranian population. Methods: In this cross sectional study, multistage cluster sampling was used to select subjects 40-64 years of age residing in Shahroud, northern Iran. All subjects underwent manifest and cycloplegic refraction, and biometry using the Allegro Biograph (WaveLight AG, Erlangen, Germany). Individuals with a history of intraocular surgery, extensive pterygia and ocular trauma were excluded. Results: Of a total of 6,311 patients, 5190 (82.2%) participated in the study. We excluded 247 patients to adhere with study criteria and 132 patients due to missing data. Mean AL/CRC was 3.034 [95% confidence interval (CI), 3.031-3.037]. AL/CRC was 3.028 and 3.042 in female and male subjects, respectively (P

Current study determined the overall incidence, common causes as well as main predictors of this final diagnosis among neonates admitted to a rural district hospital in Iran. This study was conducted on 699 neonates who were candidate for admission to the NICU. Study population was categorized in the case group, including patients exposed to final diagnosis of neonatal seizures and the control group without this diagnosis. Neonatal seizure was reported as final diagnosis in 25 (3.6%) of neonates. The most frequent discharge diagnosis in the seizure group was neonatal sepsis and in the non-seizure group was respiratory problems. No significant difference was found in early fatality rate between neonates with and without seizures (8.0% vs. 10.1%). Only gestational age

While pterygium is considered a common eye disorder, the etiology and pathogenesis is still not known. The aim of this study was to describe the prevalence of pterygium and pinguecula in the over 40 population of Shahroud and assess associated factors. The present study is part of the phase one of the Shahroud Eye Cohort Study conducted in 2009, in which the target population was people between 40 and 64 years of age. Ophthalmic examinations were performed by two ophthalmologists who made the diagnosis of pterygium and pinguecula. We used Chi-square tests, analysis of variance, and multiple logistic regression tests to examine associations. Of the 6311 invitees, 5190 people participated in the study (response rate: 82.2%). The prevalence of pterygium in at least one eye was 9.4% (95% CI, 8.6-10.3), while 2.9% (95%CI, 2.4-3.3) had bilateral pterygium. The prevalence was significantly higher in men (11.4% vs. 8.0%), and remained relatively constant with age, while the prevalence in women significantly increased with age. The prevalence of pinguecula was 61.0% (95%CI, 59.1-62.9) in at least one eye, and 49.0% (95%CI, 47.1-50.9) in both eyes. The age difference between those with and without pinguecula was significant and the prevalence was significantly higher among men than women (70.6% vs. 53.8%). The prevalence of pterygium in our study was lower than reported rates in the world but higher than Tehran and was significantly associated with age, gender, working outdoors, and the level of education. The prevalence of unilateral and bilateral pinguecula falls in the mid range and was significantly associated with age, male gender, smoking, working outdoors, and level of education.

Technology and its various development has evolved rapidly the industries specifically in the field of aviation products during the last decade . Different aviation companies and manufacturing industries put up their efforts to utilize different implements , modern technologies and new organizational methologies to optimize their working process . They intend to fulfill the customers requirements in relation to their products . Naturally it will be achieved through the factors such as the cut in cost and time , enhancement of performance and applying the required and modern technologies. The main emphasis has been switched toward the customers point of view ( such as delivery of the aircraft products per the appointed dates , quality and reliability and functional specifications ) . Providing the proper and quick supply of chain for provision process is as significance as production procedures and processes by incorporating the required Informatin Technology for the right product to deliver as per specified and promised date to the customer . This thesis attamps to recognize the basic provision criteria Informatin Technology alternatives along with their effective impacts in a company . In addition , it also determines the priorities of Informatin Technology influence on supply chain management which in turn optimize the research goals of the enterprise . For this purpose , the resrarch has been prepared with use of questionnaire and paired analogy in an aviation company . In this regard , experts and managers of commercial and supply division , planning and production control , computer (115 persons ) were questioned during the second midyear of 1390 and first midyear of 1391 . Finally it was revealed that all the known major measures of chain provision and information technology impact on each other and validated the conceptual model . Therefore trained human resourses on IT , support of senior executives , hardware and software substructures , commerce electronic and exchange of data with partners should be tacken into account as a model of optimization for application of IT in supply chain management .

Background: The aim of the study was to evaluate potential risk factors of children mortality between 1-59 months of age. Methods: This nested case-control study was conducted among children born from June 1999 to March 2009 in rural areas of Shahroud, located in the central region of Iran using health care visit reports and follow-up data available in household health records. Results: Mortality was significantly associated with breastfeeding duration (OR: 0.87, 95% CI: 0.81-0.93), total health care visits (OR: 0.90, 95% CI: 0.83-0.98) and low birth weight (LBW) (OR: 7.38, 95% CI: 1.37-39.67). Conclusion: In our study, a longer breastfeeding period and more frequent health care visits were two important protective factors, while LBW was an important risk factor for 1-59 month child mortality. It seems, that complex and multiple factors may be involved in mortality of under 5-year-old children, so combined efforts would be necessary to improve child health indicators.

This paper reports the results of a study designed to investigate the interrelationship of Foreign Language Reading Anxiety (FLRA), Reading Proficiency (RP) and Text Feature Awareness (TFA). The aim was to focus on how foreign language reading anxiety and text feature awareness are related and how, in turn, they affect students reading proficiency. That is, it south to determine how these three constructs correlate with each other. This study surveyed and analyzed 74 students from Shahid Bahonar University of Kerman. The results indicated that there is no significant relationship between RP and RA, positive significant relationship between RP and TFA and negative significant relationship between TFA and RA. Also results revealed that there is no significant difference between foreign language reading anxiety, reading proficiency and text feature awareness scores of male and female students, as a result; there is no relationship between gender and these three constructs.

Objective(s): To investigate the attitudes toward mode of delivery of pregnant women, midwives, obstetricians and anesthesiologists who participate in childbirth in Shahrood, Iran. Methods: This was a qualitative research with tri-angulations data collection strategy. The study sample was consisted of primiparous and multiparous women, midwives, obstetricians and anesthesiologists. A total of 18 women who seek prenatal care from Fatemiyeh obstetrics clinics during pregnancy, were asked to participate in 3 focus group discussions. 8 midwives in labour ward and clinic were interviewed individually. All of physicians were participate in study by Delphi method for data collection purpose. All interviews and discussions were tape recorded. Results: The main themes were categorized into two main categories: "causes of intention to cesarean" and "causes of intention to vaginal delivery". The main reason for intention to use cesarean was fear of pain due to vaginal delivery and the main reason for intention to use vaginal birth was fear of post cesarean pain and its morbidity. Other reasons that raise the cesarean section rate in Shahrood included, fear of legal complaints after vaginal birth complications fear of sexual disorders after vaginal birth, existing conflicts between midwives duties and obstetricians and negative attitudes. Conclusion: The results clearly show that although most of women and health providers do not consider cesarean section as the first option for delivery, but some essential obstacles remain as major reasons for increasing cesarean rate.