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Background Domestic violence threatens maternal physical, psychological and emotional safety. Abused pregnant women required several interventions based on their actual needs with the purpose of reducing domestic violence and its negative consequences. The present study aimed to explore the exclusive needs of abused pregnant women in Iran. Methods This qualitative study was performed from September 2019 to August 2021 in Mashhad, Iran. Semi-structured interviews with 14 abused women (8 pregnant and 6 after birth) who were the victims of domestic violence, and 11 key informants with various discipline specialties until the data saturation was achieved. Participants were selected through purposive sampling. Qualitative data were analyzed based on the conventional content analysis adopted by Graneheim & Lundman. Findings: "Family and society empowerment" was the main concept emerged from the data analysis comprising of three categories such as "need to empower couples to reduce domestic violence during pregnancy", "demand for improved health care services", and "need to strengthen inter-sectoral, legal and social supports". Conclusion Abused pregnant women experienced several individual, interpersonal and inter sectoral needs. Family and society empowerment constituted the actual needs of abused pregnant women. Awareness of policymakers and health system managers of these needs could be the basis for designing a supportive care program according to abused women’s actual needs. In addition to the educational and skill empowerment of couples, it is essential that supportive organizations cooperate with each other to provide integrated and coordinated services to abused pregnant women and strengthen and facilitate maternal access to supportive resources.

Background: In recent years, in order to improve the quality of medical care, physicians have integrated their clinical expertise and best available research evidences to form evidence-based medicine. This study aims to assess the impact of training of evidence-based medicine on knowledge and attitude of medical students of Mashhad University of Medical Sciences.Methods: This experimental study had a before-after design and did not use a control group and was carried out among 244 medical externs in a course of an educational year. During the one-month course of family medicine, a three-day workshop consisting of seven two-hour sessions were held by faculty staff of community medicine department about definition, components, and how to clinically use EBM in practice. SPSS version 16 was used for data analysis.Results: The average attitude (total 5 points) improved from 2.2 before the workshop to 4.1, which was statistically significant (P = 0.001). The attitude regarding the positive effects of evidence-based medicine on patient outcome and its practicality and cost-effectiveness for the patient changed drastically. The knowledge of the participants regarding common concepts of EBM improved from 1.4 points to 2.4 points (total 3 points) after the workshop, which was statistically significant (P = 0.001).Conclusions: Considering negative attitude and inadequate knowledge of students regarding evidence-based medicine, and favorable impact of the workshops on the knowledge and attitude of the students, even in the short-term, necessitates more extensive programs to be designed by the educational staff of the university.

Background Perinatal intimate partner violence is a hidden under reported and difficult to identify problem which has negative effects on mother and child. The present study aimed to explore women's experiences with perinatal intimate partner violence disclosure. Methods This qualitative study was carried out from October 2019 to January 2021 in Mashhad, Iran. Participants included 23 abused women (11 pregnant and 12 postpartum) which were selected via purposive sampling. Semi-structured in-depth interviews and focus group discussion were conducted until the data saturation was achieved. The data analysis was performed based on conventional content analysis adopted by Graneheim & Lundman. Results The main themes "barriers to disclosure" and "facilitators of disclosure" were emerged as the result of data analysis. Barriers to disclosure included negative disclosure consequences. Facilitators of disclosure included maternal self-efficacy, intensity of violence, and formal and informal supportive networks. Conclusions Most abused women did not disclose violence despite routine screening for perinatal intimate partner violence in antenatal care. Recognizing the barriers to and facilitators of violence disclosure play an important role in eliminating barriers, strengthen facilitators, providing effective supportive services for abused women, and reducing perinatal violence. Focus on the barriers to and facilitators of disclosure will be useful to policymakers, health program planners, and health care providers to identify and manage intimate partner violence, appropriately.

Hydatidosis is a substantial zoonosis infection with a significant socio-economic burden. Surgery is the most effective treatment of hydatidosis. The utilization of scolicidal agents is a method to minimize the risk of distribution of infective protoscoleces during surgery. So far, most of the available scolicidals result in local or systemic side effects. Considering essential oils of Artemisia dracunculus and Satureja sahendica have shown several bioactivities, we decided to characterize A.dracunculus and S.sahendica nanoemulsions and evaluate the scolicidal activity of these two nanoemulsions and the EOs using albendazole as positive control. To reach this goal, 10 3 protoscoleces of E.granulosus in 1 ml medium M199 were exposed to four concentrations of 1, 2, 5, and 10 µg/ml of EOs and nanoemulsions at 30, 60, and 120-minute time points. For all tested plants, a significant effect of the treatments (F5,60=61.47, PPPS. sahendica nanoemulsion was significantly higher than other treatments and it was 83.13% (P˂0.05). Among all the tested compounds of the present study, nanoemulsion of S.sahendica demonstrated the highest toxicity on protoscoleces and may serve as a candidate for research and development on novel scolicidas.

Background Domestic violence in pregnancy is a severe public health problem. Victimized pregnant women are confronted with the threats posed by domestic violence. Pregnancy and protection of the unborn child could affect maternal strategies for managing violence. The purpose of this study was to explore Iranian women's strategies for managing domestic violence in pregnancy.Methods This was a qualitative descriptive study, which was conducted in October 2019 to June 2021 in Mashhad, Iran. Data were collected through Individual semi structured interviews with 13 women who experienced perinatal domestic violence, two relatives and 24 related specialists as well as two focus group discussion with attendance of 20 victimized mothers until the data saturation was achieved. Data were analyzed by the conventional content analysis approach of Graneheim & Lundman.Results The main themes "adopting escape strategies" and "applying situation improvement strategies" were emerged as the result of data analysis. Adopting escape strategies was comprised of three categories including concealment, passive dysfunctional behaviors and neutral behaviors to control maternal emotional distress. Applying situation improvement strategies was comprised of three categories including active self-regulation, protecting family privacy and help seeking to control violence.Conclusion Understanding the experience of managing domestic violence among pregnant women is essential to design evidence based violence prevention programs, which enable supportive healthcare and social systems to encourage victimized mothers to use more effective strategies and seeking help to overcome domestic violence.

Background Fever is the most important and common symptom of pediatric diseases. Fever can be a sign or symptom or complication of disease. Considering the development of complementary and alternative medicine worldwide and the prevalence of this symptom in children, we aimed to investigate their application based on Persian medical textbooks by searching herbs used in pediatric fever. Materials and Methods In this review study, materials were extracted by searching in reliable Persian medical textbooks of the10th -20th century using related Persian medicine keywords. Then the documentations for herbs extracted were searched in the databases based on the conventional medicine. The interpretation was made based on the results. Results Based on the Persian medical textbooks, seventeen herbs have been prescribed for decreasing pediatric fever. Among them, 16herbs have proven mechanisms of action for treatment of fever, classified into five categories (diaphoretic, anti-inflammatory, anti-septic, immunomodulatory, anti-oxidant) based on literature review. On the other hand, according to Persian medicine, there were thirteen cold temperament herbs and only four hot temperament ones. They were administrated using various oral and topical methods. The maternal and neonatal treatment was emphasized. Conclusion According to this study and documentations of conventional medicine, many of these herbs can be effective in the treatment of pediatric fever, so further clinical studies are recommended for evaluating their efficacy.

Background: Infertility is recognized as one of the major medical problems in the world. Infertility treatment is a complex, long, and stressful process, and may lead to unsuccessful treatment. It seems necessary to follow up the patients after unsuccessful treatment, to identify their needs and desires, and to provide health services for their health promotion. Therefore, this systematic review was conducted to investigate the needs and preferences of infertile couples after unsuccessful treatment with assisted reproductive technologies (ARTs). Methods: In this systematic review, searching was performed without time restrictions in PubMed, Scopus, the Cochrane Library, PsycINFO, Web of Science databeses, as well as Google Scholar search engine, and Iranian databases including Magiran, Scientific Information Database (SID), Iranpsych, Clinical key, and Iranmedex. Keywords included infertility treatment, assisted reproductive techniques, needs, expectations, unsuccessful treatmen,t and their equivalent words. The relevant articles were retrieved from English and Persian databases. The articles were independently evaluated by two researchers, and disagreements were discussed with the third author. Findings: 24 eligible studies (16 cross-sectional and 8 cohort studies), published between the years 1980 and 2019, were included in the study. The needs expressed by infertile patients in these studies includes educational-informational needs, the need to psychological counseling, supportive needs, men's special needs, the need to strategies for stress management, the need for couples counseling, and the need for receiving respect and empathy from health care staff. Conclusion: Infertile couples' needs included a wide spectrum of needs including educational, psychological, supportive, and counseling needs as well as men's special needs. Recognition of this vulnerable group’s needs can help policymakers and programmers to plan and implement counseling services in fertility clinics. In such a way, the quality of health services in these clinics would be improved and infertile couples' needs would be met.

Aims This study aimed at investigating the impact of Dicrocoelium ova on experimental autoimmune encephalomyelitis (EAE) treatment in C57BL6 mice. Methods and results Twenty-eight C57BL/6 mice were assigned into four groups as PBS, prophylaxis (P), treatment1 (T1) and treatment2 (T2). Prior to induction of EAE in prophylaxis group and on days 7 and 18 in T1 and T2 groups, respectively, Dicrocoelium eggs were injected intraperitoneally to each mouse. The clinical score, weight changes and incidence time of EAE were recorded. IFN-γ and IL-4 expression is quantified on spleen cells. Also, histopathological study by (H&E) and Toluidine-Blue (TB), and Luxol Fast Blue (LFB) were performed. The data were analysed using SPSS version 21. Mean disease scores were significantly lower in P and T1 groups than the PBS group (P = .01). IFN-γ was lower in P and T1 groups than the PBS group. The highest level of IL-4 was observed in T1 group. The total number of neuroglia cells of corpus callosum was similar in all groups, but the density increased in T1 group compared to the PBS group (P = .03). Conclusions Dicrocoelium eggs have a great potential to stimulate immunomodulation towards treatment of EAE during the initial phase.

Background: Designing a health promotion program for infertile couples with unsuccessful treatment can play an important role in promoting their health in physical, social, psychological, and spiritual dimensions. There are different techniques for validation of programs. In this study, the Delphi technique was used to validate a health promotion program developed for infertile couples with unsuccessful treatment.Purpose: Validating the health promotion program for infertile couples with unsuccessful treatment using the Delphi technique.Methods: In this study, three rounds of Delphi were conducted with attendance of 17 specialists in different fields to validate the content of a health promotion program, which was developed based on a grounded theory study, review of literature, and focus group discussion. The selection of specialists was done by purposive and snowball sampling. In the first round of Delphi, the experts were asked to give feedback on the program draft. After analysis of the first round data and adding the new suggestions, in round two, members were asked to grade the value of statements based on the Likert scale to state their agreement. In the third round, the discussion on disagreements and reaching consensus was accomplished. Results: The program was validated by all participants with 6 main themes and 45 strategies including the stakeholders' awareness and attitude (11 strategies), fair financial participation (4 strategies), improving the executive process (6 strategies), psychological and counseling support (11 strategies), resolving legal, managerial, religious and ethical challenges (6 strategies), and logistic facilities (7 strategies) at a consensus level of at least 70%.Conclusions: The validated program proposes clear and functional strategies for implementation of a health promotion program for infertile couples with unsuccessful treatment.

Background Experimental Autoimmune Encephalomyelitis (EAE) is an animal model of Multiple Sclerosis (MS). This study was conducted to evaluate the efficacy of Dicrocoelium ova on Experimental Autoimmune Encephalomyelitis (EAE) treatment in C57BL6 mice.Methods Twenty-eight C57BL/6 mice were assigned in four groups as control(C), prophylaxis (P), treatment1 (T1), and treatment2 (T2). Prior to induction of EAE in prophylaxis group and on days 7 and 18 in T1 and T2 groups, respectively, Dicrocoelium eggs were injected to each mouse. Clinical score, weight changes, and incidence time of EAE were recorded. IFN- γ and IL-4 assay and histopathological study by (H&E) and Toluidine-Blue (TB), and Luxol Fast Blue (LFB) were done. Data were analyzed using SPSS software version 21.Results The disease score was significantly lower in P and T1 groups than the control group (p=0.01). IFN- γ was lower in P and T1 groups than the control group. The highest level of IL-4 was observed in the T1 group. The total number of Neuroglia cells of corpus callosum was similar in all groups, but density increased in T1 group compared to the control group (P = 0.03).Conclusions : The results of the study showed that, Dicrocoelium eggs have the great potential efficacy to stimulate immunomodulation toward treatment of EAE during the initial phase.

Objectives: Assisted reproductive technologies (ARTs) give hope to some infertile couples; however, in vitro fertilization (IVF) is expensive and not subsidized by the Iranian state. More than 75% of IVF cycles in Iranian couples are unsuccessful. The aim of this study is to describe the challenges experienced by infertile couples after unsuccessful treatment. Materials and Methods: In this descriptive qualitative study, 36 participants including 29 Iranian infertile couples recruited after unsuccessful ART treatments, five infertility treatment team members and 2 relatives of infertile couples were interviewed at an Infertility Center in Northeastern Iran from April 2016 to June 2017. Data were collected using semi-structured, face-to-face interviews. Data analysis was carried out following Sandelowski. Results: Iranian infertile couples’ experiences following failed ART cycles are described. The findings presented here show that Iranian infertile couples experience stressors during treatment cycles and systemic challenges which may be unique to the Iranian cultural context. Conclusions: Iranian infertile couples face particular challenges related to the cultural context in which ARTs are delivered. Further exploration of the effects of culture on the experiences of failed ARTs needs to be considered by infertility clinics in Iran.

Introduction: This study aimed to evaluate the effectiveness of teaching communication skills and sexual difference (sexual knowledge) on marital satisfaction in couples referred to the Mashhad city Health Center, Iran. Methods: In This Quazi-experimental study, with pre test and post-test methods, 25 coups who referred to a Mashhad city health center, were randomly selected. Enrich marital satisfaction questionnaire was used to measure variables. Teaching communication skills and sexual difference as independent variables were held during 2 months in 14 sessions (communication skills in seven 2-hours sessions and sexual differences (sexual knowledge) in six 60-minutie sessions). Paired T-test has used for data analysis. Results: Results showed that there is significant difference between pre-test and post-test scores (P

Many infertile couples feel vulnerable after failed treatment cycles and find insensitive remarks or inappropriate support distressing. They fear that the stress of failed treatment cycles may affect their marriage and lead to marriage breakdown. This study explored the strategies a sample of infertile couples used to manage social interactions after unsuccessful treatment with assisted reproductive technologies. A descriptive qualitative study was conducted with 34 participants including nine infertile couples, nine infertile women and two infertile men with primary infertility, two relatives, and three fertility clinic staff. The participants were selected through purposive sampling at an infertility centre in Iran, between 2016 and 2017. Data were collected using semi-structured face-to-face interviews and analysed by qualitative content analysis approach. Participants found some social interactions after failed assisted reproductive treatment cycles to be distressing and painful. They described tolerating painful emotions which cause them sadness and sorrow as well as feeling embarrassed. As a result, they found they needed to maintain their adopting concealment strategies with their families through not permitting speculation, selective disclosure, not giving details and hiding the truth. This study showed that social interactions following failed assisted reproductive cycles can be upsetting for infertile couples. Couples use different strategies to manage potentially distressing social interactions. Healthcare providers and psychologists may provide a space for safe social interactions in order to help couples to use appropriate strategies in these circumstances.

Given the importance of heavy menstrual bleeding (HMB), we investigated the effect of plantain syrup on HMB. This randomized clinical trial was performed on 68 women with HMB who were referred to the traditional medicine clinics of Mashhad University of Medical Sciences. The intervention group received placebo capsule and plantain syrup, whereas the control group received mefenamic acid capsule and placebo syrup in the first 5 days of menstruation for three menstruation cycles. Patients were asked to complete pictorial blood assessment chart one cycle before the intervention and three intervention cycles. Hemoglobin was measured at the beginning and at the end of the study. The results showed that the bleeding duration and severity diminished in both groups. No significant difference was observed between two groups in severity of bleeding after intervention (Cohen's d = .24), but duration of bleeding in mefenamic acid group was reduced significantly in comparison with plantain group (Cohen's d = .57). Although mean hemoglobin alterations in mefenamic acid group had a significant difference before and after the intervention, there was no significant difference between the two groups in mean hemoglobin alterations postintervention. Plantain syrup could be suggested as a complementary treatment for HMB, but further studies are required.

Lactase deficiency problem discourages many adults from consuming milk as a major source of micro- and macronutrients. Enzymatic hydrolysis of lactose is an ideal solution for this problem but such processing adds significant costs. In this study, a cold active β-galactosidase from Planococcus sp-L4 (bgal) was optimized for expression of recombinant "BGalP" in Pichia pastoris. As a result of codon optimization, the codon adaptation index was improved from 0.58 to 0.85 after replacing rare codons. After transformation of two P. pastoris strains (KM71H and GS115), the activity of BGalP enzyme was measured in the culture supernatants using ortho-Nitrophenyl-β-galactoside (ONPG). Maximal activity was recorded as 3.7U/ml on day 11 in KM71H clone #2 which was 20% higher than the best GS115 clone. Activity measurements under different conditions indicated optimal activity at pH 6.5. It was active at temperatures ranging from 0 to 55°C with deactivation occurring at or above 60°C. Protein analysis of the crude ultra-filtrate showed the enzyme was ∼75kDa and was the major constituent (85%) of the sample. This enzyme have the potential to find utility for the breakdown of lactose in chilled milk and subsequently can be deactivated by pasteurization. The use of BGalP would minimize energy consumption thus decreasing cost and also help to preserve the nutritional elements of the milk.

INTRODUCTION: A limited number of risky behaviors cause most morbidity and mortality. The aim of this study was to determine the possible clustering of lifestyle behaviors, including transportation behaviors, diet, physical activity, and smoking in Shiraz, Iran. METHODS: There were 776 representative Shirazi adults who participated in this cross-sectional study. The questionnaires were completed via person-to-person interviews. The datasets were searched for any clustering patterns. Cluster analysis was used for statistical analysis, and the data were analyzed using SPSS version 11.5. RESULTS: Three distinct clusters were identified. Cluster 1 was named "Healthy," and it included non-smokers, safe drivers, appropriate or acceptable fruit, vegetable, and fast-food consumers, and physically-active people. Cluster 2, "Moderately Healthy," was relatively risky drivers who had appropriate behaviors on the rest of the health-related behaviors. Cluster 3, "Unhealthy," was smokers, risky drivers, inappropriate or unacceptable fruit, vegetable & fast-food consumers, and a sedentary lifestyle. CONCLUSIONS: It was obvious that health-related behaviors were clustered together and unhealthy behaviors were not established in isolation. Language: en

Introduction: Infertility is a major medical issue. Investigations and treatment of infertility are the beginning of a complex, time-consuming and stressful process for couples that may fail well. The present study explored the needs of infertile couples following treatment failure with Assisted Reproductive Technologies (ARTs). Methods: A descriptive qualitative study was conducted in an Iranian infertility center, in the Northeast of the country between April 2016 and June 2017. The researchers recruited 29 individuals including 9 couples, 9 women and two men with primary infertility through purposive sampling. The data were collected using semi-structured interviews and analyzed iteratively, using conventional content analysis with MAXQDA software. Results: The main concepts obtained from the data were classified into one theme titled: ""The need for support"" and four main categories along with their subcategories, and included the need for psychological support, the need for more useful information, the need for social support and the need to access to supplementary services. Conclusion: The findings show that following treatment failure, the infertile patients’ expressed needs and preferences were not met. Identifying and meeting their needs may help the infertile couples to deal with ARTs failure and to reach a decision about future treatment.

Introduction: Confirmation of proper endotracheal tube placement is one of the most important and lifesaving issues of tracheal intubation. The present study was aimed to evaluate the accuracy of tracheal ultrasonography by emergency residents in this regard. Method: This was a prospective, cross sectional study for evaluating the diagnostic accuracy of ultrasonography in endotracheal tube placement confirmation compared to a combination of 4 clinical confirmation methods of chest and epigastric auscultation, direct laryngoscopy, aspiration of the tube, and pulse oximetry (as reference test).Results: 150 patients with the mean age of 58.52 ± 1.73 years were included (56.6% male). Sensitivity, specificity, positive predictive value, negative predictive value, and positive and negative likelihood ratio of tracheal ultrasonography in endotracheal tube confirmation were 96 (95% CI: 92-99), 88 (95% CI: 62-97), 98 (95% CI: 94-99), 78 (95% CI: 53-93), 64 (95% CI: 16-255), and 0.2 (95% CI: 0.1-0.6), respectively.Conclusion: The present study showed that tracheal ultrasonography by trained emergency medicine residents had excellent sensitivity (>90%) and good specificity (80-90) for confirming endotracheal tube placement. Therefore, it seems that ultrasonography is a proper screening tool in determining endotracheal tube placement.

Background and Purpose: As the leaders of educational organizations, universities use various models and approaches in evaluating their activities. However, excellence model for evaluation of educational services can demonstrate the distinction of this evaluation procedure. The aim of this study is to investigate the status of training quality of ophthalmologic residents in Khatam-Ol-Anbia Hospital in Mashhad based on the standards of organizational excellence model EFQM in the educational year of 2012-2013.Methods: This descriptive cross-sectional study has been conducted in the second half of 2013 in the educational, research, and therapeutic hospital of Khatam-Ol-Anbia, among the hospitals affiliated with Mashhad University of Medical Sciences. All students in the stage of residency in Ophthalmology entered this study. In this research, 18 men and 6 women participated. Moreover, in the statistical population of this research, 14 of the residents were non-native and 10 were native. Using standardized questionnaire of organizational excellence model in higher education sector and the degree of achievement of the educational services outcomes presented to learners was investigated. This questionnaire was first adapted from the main booklet published by Sheffield University, England. Following the extraction of the preliminary questionnaire, normalization of the instrument for validity was done by expert judgment, to examine the internal consistency of the various sections of the instrument and the reliability, Cronbach’s alpha coefficient of 0.96 was obtained. The questionnaire consists of 4 main sections, each of which questions contain certain indices of educational services. Using SPSS 16 and congruent with the background and research questions, the results were obtained.Results: The mean value of general status of the training quality of Ophthalmology residents has been obtained as 6.66 (of a max of 10). The mean value for the indices of general perception; educational, research, and pedagogy; support and guidance; and for loyalty, honesty, and values; were obtained as 6.19, 6.39, 6.61, and 7.44, respectively. The total score was obtained to be 129.32 (out of the standard 200 according to the criterion of customer results in EFQM model). Moreover, the status of training quality of learners in Ophthalmology residency in terms of gender and academic years did not show a significant difference. However, the mean value of indices in native residents showed a higher number in comparison with the students who declared themselves as non-native, indicating a significant difference (P=0.01).Conclusions: In this research, the general status of training quality of Ophthalmology residents, based on the required mean value and extraction of the total score obtained, reveals a higher than average level. These results, together with the difference in the mean value of indices in the native and non-native residents can act as a guide for decision-making and managerial policymaking in this subspecialty therapeutic, educational, and research hospital.Keywords: ORGANIZATIONAL EXCELLENCE, EFQM, TRAINING QUALITY, RESIDENTS