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This study was conducted to evaluate the effects of mealworm (Tenebrio molitor) dietary supplementation on egg production, egg traits, humoral immunity and ileal microbiota in Japanese quails. A hundred and twenty female Japanese quails (Coturnix coturnix japonica) were used in a completely randomized design with three treatments, five replicates, and eight birds in each replicate. Experimental diets included: basal diet (without any additives), basal diet + 0.1% full-fat mealworm powder, basal diet + 0.2% mealworm powder. The experiment lasted five weeks, and the quails had free access to the feed and water. The results showed that mealworm supplementation did not have any significant effect on feed conversion ratio of the quails during the whole period of the experiment. At the 5th week of the experiment, egg weight and egg mass of the quails fed with mealworm increased linearly, and the feed intake of the birds fed with 0.1% mealworm was different quadratically. Different levels of mealworm powder supplementation increased egg albumen weight and yolk height linearly during the whole period of the experiment. Adding mealworm powder increased antibody titer against sheep red blood cell in laying quails on 89 and 96 d of age. It is concluded that mealworm supplementation at the level of 0.1% improved egg weight, egg production, albumen weight, yolk height, and humoral immunity of Japanese laying quails, so it has the potential to be considered as an organic functional additive in quails' diet. [ABSTRACT FROM AUTHOR]

To compare (i) the evidence-based practice (EBP) profiles and (ii) socio-demographic characteristics of nurses in 4 selected low-middle income countries (LMICs).

Introduction: Nursing PhD program provides essential competency for professional role playing among the graduated according to society’s needs, but there are differences in the provided programs the analyzing of which would develop the discipline. This study aimed at comparing the curricula of nursing PhD programs in Bloomberg University and Iran. Materials and Methods: This descriptive-comparative study was carried out based on Bereday’s model in 2018 and compared the components of nursing PhD program curriculum in Iran and Bloomberg University. The data were collected by searching through the internet and described, interpreted, juxtaposed and compared. Results: Although there were similarities, the purpose, the curriculum and the program implementation were different in these two universities. Different contents of the curriculum, educational methods, and the expected role of graduates were considerably different in Bloomberg University. Conclusion: In order to improve the quality of PhD nursing graduates in Iran, it is suggested that the content and method of providing courses be reviewed according to the roles and expectations of graduates and society’s needs. For exploring the weaknesses and strength of the program and providing more information for future planning, it is suggested that the quality of the curriculum be evaluated from the viewpoint of PhD students and faculty members.

The concept of burnout describes a number of destructive aspects in the health-care system, especially in nursing. A descriptive study was carried out in order to investigate the relationship between burnout and productivity among 200 baccalaureate nurses working in educational hospitals in Tehran, Iran. Burnout and productivity questionnaires were employed and the data were analyzed by using descriptive and inferential statistics. The results showed that emotional exhaustion and depersonalization had significant negative correlations with productivity. Also, a significant positive correlation was found between personal accomplishment and productivity. Efforts to alleviate burnout among nurses should lead to an increased quality of patient care and improved quality of work life; if not, health-care systems will pay the price for nurses' burnout through the quality of services that they offer. [ABSTRACT FROM AUTHOR]

Abstract Background This study aims to explore the experience of conflict as perceived by Iranian hospital nurses in Tehran, Islamic Republic of Iran. Although conflict-control approaches have been extensively researched throughout the world, no research-based data are available on the perception of conflict and effective resolutions among hospital nurses in Iran. Methods A qualitative research approach was used to explore how Iranian hospital nurses perceive and resolve conflicts at work. A purposive sample of 30 hospital nurses and nurse managers was selected to obtain data by means of in-depth semi structured interviews. Data were analysed by means of the content analysis method. Results The emerging themes were: (1) the nurses' perceptions and reactions to conflict; (2) organizational structure; (3) hospital management style; (4) the nature and conditions of job assignment; (5) individual characteristics; (6) mutual understanding and interaction; and (7) the consequences of conflict. The first six themes describe the sources of the conflict as well as strategies to manage them. Conclusion How nurses perceive conflict influences how they react to it. Sources of conflict are embedded in the characteristics of nurses and the nursing system, but at the same time these characteristics can be seen as strategies to resolve conflict. We found mutual understanding and interaction to be the main factor able to prevent and resolve conflict effectively. We therefore recommend that nurses and nurse managers encourage any virtues and activities that increase such understanding and interaction. Finally, as conflict can destroy individual nurses as well as the nursing system, we must act to control it effectively.

Abstract Background During the two recent decades, advocacy has been a topic of much debate in the nursing profession. Although advocacy has embraced a crucial role for nurses, its extent is often limited in practice. While a variety of studies have been generated all over the world, barriers and facilitators in the patient advocacy have not been completely identified. This article presents the findings of a study exploring the barriers and facilitators influencing the role of advocacy among Iranian nurses. Method This study was conducted by grounded theory method. Participants were 24 Iranian registered nurses working in a large university hospital in Tehran, Iran. Semi-structured interviews were used for data collection. All interviews were transcribed verbatim and simultaneously Constant comparative analysis was used according to the Strauss and Corbin method. Results Through data analysis, several main themes emerged to describe the factors that hindered or facilitated patient advocacy. Nurses in this study identified powerlessness, lack of support, law, code of ethics and motivation, limited communication, physicians leading, risk of advocacy, royalty to peers, and insufficient time to interact with patients and families as barriers to advocacy. As for factors that facilitated nurses to act as a patient advocate, it was found that the nature of nurse-patient relationship, recognizing patients' needs, nurses' responsibility, physician as a colleague, and nurses' knowledge and skills could be influential in adopting the advocacy role. Conclusion Participants believed that in this context taking an advocacy role is difficult for nurses due to the barriers mentioned. Therefore, they make decisions and act as a patient's advocate in any situation concerning patient needs and status of barriers and facilitators. In most cases, they can not act at an optimal level; instead they accept only what they can do, which we called 'limited advocacy' in this study. It is concluded that advocacy is contextually complex, and is a controversial and risky component of the nursing practice. Further research is needed to determine the possibility of a correlation between identified barriers/ facilitators and the use of advocacy.

Background & Objective: Conflict occurs more frequently in health care organizations than the other settings due to complexity, frequent interaction between personnel, variations in specialties, roles, and hierarchy. Although conflict is not harmful and destructive in its nature; and some degrees of conflict can help to improve health care services, high levels of conflict or its continuity may be harmful. Therefore, it is necessary to manage and control conflict. This study was carried out to assess the relationship between components of the conflict control model. Methods & Materials: In this cross-sectional study, we developed a questionnaire that probed the relationships between components of conflict control model. A total of 290 nurses were recruited to the study using multi-stage sampling procedure from general educational hospitals in Tehran. Data were gathered using a questionnaire. Content validity of the questionnaire was examined by the expert panel. The internal consistency of the questionnaire was 0.81. Data were analyzed in the SPSS using descriptive statistics and spearman statistical test. Results: The range of age was 22-53 (34.5±8.2). The majority of the respondents (88.6%) were female, 57.6% were married; and 84.8% were staff nurses. From the majority of nurses' perspective, the meaning of conflict was discoordination, disagreement and disparity. However, some of the nurses meant it as violence, and difficult issues. About 41.4% of the respondents used negotiation, when they faced up to conflict. Other strategies were aggression, disagreement, avoidance, forgiveness, ignorance, and imposing own ideas to the others. From the respondents' point of view, factors that might cause or control the conflict were "mutual understanding and interaction" (32.4%), personality of nurses and their individual characteristics (26.6%), and conditions of the job (21.7%). Interaction was recognized to be the core strategy in conflict control model. Interaction had also significant associations with the five main variables in this study. Conclusion: Lack of appropriate and efficient communication was an important factor in occurrence of conflict from the nurses' point of view. It is essential to improve nurses' and managers' communication channels by helping personnel to use effective communication skills. This measurement can be helpful for staff in understanding each other and reducing misconceptions. In addition, recognizing additional factors and variables that increases the occurrence of conflict can help to modify effective approaches. [ABSTRACT FROM AUTHOR]

Background & Aim: Blended E-Learning is an educational method which has been used recently in higher education worldwide. So, it seems that it is crucial for the Iranian academic members to accept it as a new educational method. This study was conducted to investigate attitudes of the faculty of Nursing and Midwifery School at Tehran University of Medical Sciences toward blended E-learning. Methods & Materials: In this cross-sectional study, all faculty members of Tehran University of Medical Science (n=60) were recruited to the study. Data were gathered using validated and reliable self-designed questionnaires. The collected data were analyzed using SPSS software. Methods & Materials: In this cross-sectional study, all faculty members of Tehran University of Medical Science (n=60) were recruited to the study. Data were gathered using validated and reliable self-designed questionnaires. The collected data were analyzed using SPSS software. Conclusion: According to the positive attitude of the respondents toward blended e-learning, it is recommended that further studies take place in order to design and implement the approach in formal education in the school of Nursing and Midwifery of Tehran University of Medical Science. [ABSTRACT FROM AUTHOR]

Background & Aim: Although cervical cancer has high prevalence, few qualitative studies have been carried out to reflect the perceptions of women on the influential factors that affect cervical cancer screening in Iran. The aim of this study was to explore a culturally-based experience of Karaji women regarding the barriers to and motivating factors for Pap smear screening test among Karadj women in 2007. Methods & Materials: In this content analysis, eight focus groups were conducted using semi-structured guide questions (n=86). Results: Findings revealed that factors such as medical advice, advice from friends and family, knowledge about symptoms and pap smear screening method, free and accessible services, and perceived threats would influence the women to undergo a Pap test. Major barriers were lack of knowledge about cervical cancer and its causative factors, inappropriate beliefs, fear from cancer diagnosis, and pain related to the procedure. Conclusion: Regarding the influencing factors on the rate of Pap smear screening test, it seems that designing appropriate educational programs in order to promote knowledge and correct health beliefs using mass media and local communications will result in referring more women to undergo Pap smear screening test. [ABSTRACT FROM AUTHOR]

Introduction: Myocardial infarction (MI) is a critical emergency condition that affects all aspects of health. Patients with MI need specialized care in the Coronary care unit (CCU). The main goal of care is to ensure their comfort, which can be significantly affected by their illness and hospitalization. This study aims to explore MI patients' perceptions of support network challenges to ensure comfort in the CCU., Methods: A qualitative approach was adopted, and semi-structured interviews and notes were used for collecting data between 2020 and mid-2021. The participants were 27 MI patients in our country who had been hospitalized in the CCU of the University Heart Hospital. They were selected using purposive sampling. The data were analyzed using conventional content analysis by Graneheim and Lundman., Findings: The results of this research were revealed in the form of a "support network" theme comprising five categories: "Physical support", "Mental occupations", "Presence of peers", "relatives support "and "Spiritual strategies"., Conclusion: The study results showed that MI patients, in critical condition, receiving care, and hospitalized in the CCU require continuity in their support network to ensure comfort. The inconsistency between the components of each dimension leads to the challenge of ensuring comfort., (© 2024. The Author(s).)

Using cell phones by nurses can affect the quality of care. This study aimed to explore the consequences of using cell phones by nurses in hospitals. A qualitative approach was used. Data were collected through semi-structured interviews. Nursing staff, patients, and their relatives participated in this study. Categories of "emotionless care," "neglect in care," "impaired professional behavior" and a main theme of "Personal cell phone is a barrier to effective nursing care" extracted. Using cell phone during work could jeopardize patients' safety and ruins the nursing profession image. It is necessary to formulate guidelines on how to use cell phones in hospitals.

Background: During the COVID-19 pandemic, healthcare workers face the stigmatization of those caring for COVID-19 patients, creating a significant social problem. Therefore, this study investigated the stigmatization of healthcare workers in the context of the COVID-19 pandemic., Methods: In this scoping review study, searches were conducted from December 2019 to August 2023 in Persian and English using various databases and search engines including PubMed (Medline), Embase, Scopus, ISI Web of Science, ProQuest, Science Direct, Springer, Cochrane Library, Google Scholar, and national databases. The study used English keywords such as Social Stigma, Health Personnel, Healthcare Worker, Medical Staff, Medical Personal, Physicians, doctors, Nurses, nursing staff, COVID-19, and coronavirus disease 2019, and their Persian equivalents, and their Persian equivalents to explore healthcare workers' experiences of COVID-19-related stigma., Results: From a total of 12,200 search results, 77 eligible studies were included in this study. stigmatization of healthcare workers caring for COVID-19 patients was evident from the literature because of fear, misinformation, and negative self-image. Manifestations were violence and deprivation of social rights, resulting in adverse biopsychosocial, occupational, and economic consequences. This condition can affect negatively health staff themselves, their families, and society as well. Anti-stigmatization measures include informing society about the realities faced by healthcare workers, presenting an accurate and empathetic image of health workers, providing psychosocial support to health workers, and encouraging them to turn to spirituality as a coping mechanism. There are notable research gaps in comprehending the phenomenon, exploring its variations across diverse healthcare roles and cultural contexts, examining its long-term effects, and monitoring shifts in stigma perceptions over time., Conclusion: The COVID-19 pandemic has resulted in the stigmatization of healthcare workers, causing mistreatment and rights violations. This stigma persists even post-pandemic, posing a psychological dilemma for caregivers. Addressing this requires comprehensive strategies, including tailored stigma prevention programs and research to understand its psychological impact., (© 2024. The Author(s).)

Background: Effective communication is essential for high-quality healthcare, yet barriers often impede meaningful connection between nurses and patients. This study aimed to prioritize communication barriers between nurses and patients in Iranian hospitals, exploring nurses' perspectives., Methods: Thirty-one nurses participated in a six-step Q methodology study to identify different perspectives on communication barriers. Participants sorted a set of statements based on their own experiences and beliefs., Results: The average age of participants was 38.07 (SD = 6.49), with 70% being women. Four distinct factors emerged, explaining 47% of the total variance in perspectives: Organizational factors and work conditions (20%), Emotional distress and psychological barriers (11%), Lack of mutual understanding and awareness (7%), and declining professional motivation and engagement among nurses (9%)., Conclusion: These findings highlight the multi-faceted nature of communication barriers between nurses and patients in this context. Interventions should address organizational factors, emotional well-being of nurses, cultural awareness, and professional motivation to improve communication and ultimately, patient care. This study provides valuable insights for Iran and other developing countries that are facing similar challenges., (© 2024. The Author(s).)

Background: Mental illness has been a significant public health challenge in Thailand, where there is a shortage of specialists. Consequently, community nurses (CNs) who are not specialists have been tasked with enhancing mental health outcomes in the primary care system of the country. This study aims to shed light on CNs' lived experiences of caring for psychiatric patients within the primary care units (PCUs)., Methods: A phenomenological research approach and in-depth interviews were conducted with nine CNs responsible for psychiatric patient care purposefully selected at nine PCUs in southern Thailand, including Nakhon Si Thammarat, Krabi, Phangnga, and Chumporn provinces, between March and December 2019. Data analysis was carried out using Colaizzi's method., Results: The experiences of CNs were expressed through three main themes: "Confronting role expansion in long-term psychiatric care responsibilities," "Insecurity in role ambiguity," and "Duty of supportive caring for marginalized people.", Conclusion: Thai CNs face significant stress when providing care for psychiatric patients, grappling with their acknowledged lack of specialization and essential expertise in the field. Alongside the issue, they knew that supportive caring for marginalized people is their duty to humanity. Primary care systems must recognize CNs' vital role in enhancing psychiatric patient care. Comprehensive training empowers them, fostering confidence and enabling better connections and care management. This can lead to improved patient outcomes and overall care quality., Competing Interests: None declared., (Copyright: © International Journal of Community Based Nursing and Midwifery.)

Purpose: The COVID-19 pandemic and the use of facemasks have caused many communication challenges for pediatric nurses. The purpose of this study was to investigate these challenges and the strategies that nurses use to overcome them during the nursing care of sick children., Design and Methods: This was a qualitative study using conventional content analysis. The nurses were selected by purpose-based sampling and interviewed semi-structurally between April and June 2023 at the Children's Educational Therapy Center in Tabriz, Iran. The sample size was determined by the data saturation principle. The report of this research followed the COREQ guidelines., Results: Twelve nurses were interviewed. The analysis revealed four main categories: "Disturbances in communication", "Disturbances in trust", "Disturbances in providing care", and "Nurses' strategies to mitigate the challenges of mask usage. To solve the challenges caused by the mask, nurses used solutions such as removing the mask and mitigating the adverse effects of mask usage they used. The central theme of the study was "Humanistic care requires trust-based communication"., Conclusions: This study highlights the communication challenges faced by pediatric nurses due to mask-wearing during the COVID-19 pandemic. Despite these challenges, nurses have developed innovative strategies to improve communication and build trust with their young patients. Further research is needed to evaluate the effectiveness and feasibility of these strategies., Practical Implications: These strategies can be useful for other nurses who work with children in similar conditions. Further research is needed to evaluate the effectiveness and feasibility of these strategies in different settings and populations., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objectives: During the COVID-19 pandemic, healthcare workers (HCWs) are at a serious risk of contracting this virus. Therefore, they should use personal protective equipment (PPE) to protect themselves. Long-term use of these devices has led to many side effects, including headaches. This study investigated the prevalence of headaches related to using PPE in HCWs during the COVID-19 pandemic., Design: Systematic review and meta-analysis., Data Sources: Embase, PubMed, Scopus and Web of Science databases were searched from December 2019 to February 2023., Eligibility Criteria for Selecting Studies: All cross-sectional studies that investigated the prevalence of headache complications caused by PPE were included., Data Extraction and Synthesis: Two researchers reviewed the articles separately and independently. The Appraisal Tool for Cross-Sectional Studies was used to address study design quality and the risk of bias in cross-sectional studies. The heterogeneity of the studies was checked with the I 2 statistic, and due to the high heterogeneity, the random effects model was used for synthesis. Data were analysed using Comprehensive Meta-Analysis software V.3.3.70., Results: Out of 3218 articles retrieved for all side effects, 40 were eligible for this meta-analysis. The prevalence of headaches related to the use of PPE in these 40 studies, with a sample size of 19 229 people, was 43.8% (95% CI 43.1% to 44.6%, I 2 =98.6%, p<0.001). Based on the meta-regression results, no significant relationship was observed between the prevalence of headaches and variables such as year of publication, study location, sample size and quality of studies., Conclusion: Headache is one of the common side effects of PPE, which can interfere with HCWs' performance. It is suggested that manufacturers improve the quality of their equipment while healthcare managers should equip and train staff adequately to minimise side effects, ensuring health and enhanced service delivery., Prospero Registration Number: CRD42021264874., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Acute Coronary Syndrome is the most common heart disease and the most significant cause of death and disability-adjusted life years worldwide. Teaching a healthy eating style is one preventive measure to prevent the disease's recurrence. This study aimed to determine the effect of healthy nutrition education with the help of traffic light labels on food selection, preference, and consumption in patients with acute coronary syndrome., Methods: This randomized, single-blinded clinical trial was conducted with 139 participants (66 in the intervention group and 73 in the control group) from January 2021 to August 2021 in Shaheed Rajaie Hospital, Tehran, Iran. The control group received standard training. The intervention group, besides this, received additional bedside training with an educational poster on traffic light labels from the research team during their final hospitalization days. Data were collected using a researcher-made questionnaire on food selection, preference, and consumption., Results: The Brunner-Munzel test showed no significant difference between the two groups in terms of selection (P = 0.127), preference (P = 0.852), and food consumption (P = 0.846) in the baseline, while after the intervention, there were significant differences in selection (P > 0.001), preference (P > 0.001), and consumption (p < 0.004). Comparing the difference between the two groups in the difference between the before and after scores for selection (p < 0.001), preference (p < 0.001), and food consumption (p = 0.011) with the Brunner-Munzel test indicated a significant difference in all outcome variables., Conclusions: Teaching healthy eating styles with the help of traffic light labels affected food selection, preference, and consumption and led to healthier diets in these patients., Clinical Trial Registration Number: Clinical trial registration: It was prospectively registered in the Iran Clinical Trials Registration Center on this date 30/10/2020 (IRCT20200927048857N1)., (© 2024. The Author(s).)

Because of the high biocompatibility, self-assembly capability, and CD71-mediated endocytosis, using human heavy chain ferritin (HFn) as a nanocarrier would greatly increase therapeutic effectiveness and reduce possible adverse events. Anti-PD-L1 siRNA can downregulate the level of PD-L1 on tumor cells, resulting in the activation of effector T cells against leukemia. Therefore, this study aimed to produce the tumor-targeting siPD-L1/HFn nanocarrier. Briefly, the HFn coding sequence was cloned into a pET-28a, and the constructed expression plasmid was subsequently transformed into E. coli BL21. After induction of Isopropyl β-D-1-thiogalactopyranoside (IPTG), HFn was purified with Ni-affinity chromatography and dialyzed against PBS. The protein characteristics were analyzed using SDS-PAGE, Western Blot, and Dynamic light scattering (DLS). The final concentration was assessed using the Bicinchoninic acid (BCA) assay. The encapsulation was performed using the standard pH system. The treatment effects of siPD-L1/HFn were carried out on HL-60 and K-562 cancer cell lines. The RT-PCR was used to determine the mRNA expression of PD-L1. The biocompatibility and excretion of siPD-L1/HFn have also been evaluated. The expression and purity of HFn were well verified through SDS-PAGE, WB, and DLS. RT-PCR analyses also showed significant siRNA-mediated PD-L1 silencing in both HL-60 and K-562 cells. Our study suggested a promising approach for siRNA delivery. This efficient delivery system can pave the way for the co-delivery of siRNAs and multiple chemotherapies to address the emerging needs of cancer combination therapy., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: As a vulnerable group in HIV control programs, immigrants face various obstacles to HIV testing. Despite the effectiveness of peer interventions on health promotion in HIV testing, relatively little is known about how these interventions work. This realist review aims to understand why, how, and under what conditions peer interventions can improve immigrants' HIV testing uptake., Methods: We followed the steps suggested by Pawson and colleagues for conducting the realist review. To test a initial program theory, we first systematically searched databases of PubMed, Web of Science, Scopus, Embase, and Cochrane, as well as the websites of UNAIDS, World Bank, Global Fund, WHO, and IOM. After data extraction and quality appraisal, data synthesis was conducted to explain the intervention pathways corresponding to context-mechanism-outcome configurations., Results: Seventeen studies were included in the review. Peer interventions for improving immigrants' HIV testing uptake worked through four pathways: Following the improvement of communications (as a proximal mechanism): 1) increasing awareness, 2) reduced stigma, 3) improved support, and 4) increased access to services could lead to improved HIV testing uptake among immigrants. The identified mechanisms were influenced by three groups of individual/ interpersonal, service delivery, and structural factors., Conclusion: Peer interventions with multiple strategies to be designed and implemented considering the barriers to HIV testing and also moving beyond one-size-fits-all approaches can successfully improve the immigrants' HIV testing uptake. The refined program theory in this study can help the healthcare providers and policy-makers promote the immigrants' HIV testing uptake and reduce the risk of disease transmission., Competing Interests: The authors declare that they have no competing interests., (© 2024 The Author(s).)

Background and Objective: The needs and characteristics of veterans with post-traumatic stress disorder (PTSD) create significant challenges in family life, particularly for spouses. Identifying the nature of these challenges from the perspective of spouses leads to a more comprehensive and profound understanding of their existing problems and can be used for targeted interventions. Therefore, this research was conducted to explore the challenges of living with veterans suffering from PTSD from the perspective of their spouses., Methods: This qualitative study used conventional content analysis to explore Challenges of spouses of veterans with post-traumatic stress disorder. Fifteen spouses of veterans with PTSD from the Veterans Affairs Center in Iran between June 2022 and January 2023, were purposively selected to participate in the study. Semi-structured in-depth interviews were conducted to collect data. The interviews were audio-recorded and transcribed verbatim. The data were analyzed using the method proposed by Graneheim and Lundman content analysis method with the support of MAXQDA 2020 software., Results: The mean age of the participants was 56.74 ± 6.43 years. Through data analysis, seven main categories and sixteen subcategories were identified. These categories included burnout (sleep disturbances, feelings of exhaustion), apathy towards self-care and caring for the veteran (neglecting self-care, lack of interest in continuing care), depression (feelings of hopelessness and being at the end of the line, decreased self-confidence ( Crushed and ignored (being mistreated, having multiple roles), relationship disturbances (Dissatisfaction with marital relationship,isolation and limited social interactions, disconnection from God), financial burden (heavy costs of care, lack of insurance support), and declining social status (negative attitude of the society, suffering from discrimination and inequality)., Conclusion: The consequences of PTSD-related injuries in veterans directly and indirectly affect the overall living conditions of their spouses. These spouses experience emotional detachment and constant rejection, leading to a decrease in their resilience against existing stressors and exposing them to disruptive and challenging issues in individual, family, and social dimensions of life that affect their physical and mental well-being. Therefore, these spouses require empowerment and access to social support in dimensions of educational, caregiving, therapeutic, and supportive. It is recommended that health policymakers pay special attention to designing up-to-date interventions to enhance the health of these spouses in physical, mental, spiritual, and social dimensions., (© 2024. The Author(s).)

Background: Oral aphthous stomatitis is a chronic inflammatory condition. Numerous medications have been investigated to treat the symptoms of the disease. However, these days patients prefer herbal medicines due to lower side effects. Considering the anti-inflammatory, analgesic, and anti-oxidant properties of Caffeic acid and its few side effects, the aim of this study was to assess the impact of Caffeic acid on recurrent aphthous stomatitis (RAS). investigating the effect of caffeic acid mucoadhesive tablets on the size and pain intensity of the aphthous lesions., Methods: in this double-blinded clinical trial study, 47 patients who met the inclusion criteria were selected by convenient sampling method. The patients were assigned to two groups randomly; the control group (placebo recipients) and the intervention group (Caffeic acid recipients). Patients were followed up for 7 days following the intervention. The diameter of the inflammatory lesion was measured in millimeters, and the pain intensity was recorded based on the VAS scale (Visual Analogue Scale). This trial was approved by the medical ethics committee of Mazandaran University of Medical Sciences (Ethical code: IR.MAZUMS.REC.1401.261) and received IRCT code of IRCT20220815055700N1on 03/09/2022., Results: the diameter of the lesion in both groups decreased over time, and there was no significant difference between the intervention and control groups, except on the fifth day when the diameter of the lesion was significantly greater in the control group (P = 0.012). From the second day, the control group's average pain intensity was significantly higher than the intervention group's pain intensity (P < 0.05)., Conclusions: when comparing mucoadhesive tablets containing Caffeic acid and placebo, the findings demonstrated that Caffeic acid has a significant efficacy in reducing aphthous lesions' diameter and pain intensity of the patients and are suggested for palliative oral aphthous lesions treatment since they showed significant anti-inflammatory and analgesic effects on recurrent aphthous stomatitis., (© 2024. The Author(s).)

Background and Aims: Health literacy (HL) is an essential determinant of health in children. Inadequate HL causes problems for individuals and society, such as more hospitalizations, medication errors, poor health, and higher mortality and health care costs. A valid and reliable scale is needed to measure this population's HL. This study evaluated the cross-cultural adaptation and validation of the Persian version of the HL for School-Aged Children (HLSAC) Scale., Methods: In this methodological research, the HL scale of school-aged children was translated from English to Persian using the Backward-Forward translation protocol. The content validity, face validity, construct validity (Exploratory Factor Analysis [EFA] and Confirmatory factor analysis [CFA]), plus reliability, were evaluated by Internal consistency and stability methods. Two hundred forty samples from south of Tehran were selected by multi-stage sampling method to assess the construct validity. Data analysis was performed using SPSS v24 and Jamovi v2.2., Results: A qualitative evaluation of face and content validity showed that experts and the target group approved all items on the scale. The results of EFA indicated the existence of one factor, explaining 47.17% of the total variance of the scale. The CFA results showed that the one-factor model of the Persian version of the HL scale for children is almost acceptable. ( χ 2 / df  = 2.94, Root Mean Square Error of Approximation = 0.09, Normed-Fit Index = 0.89, Tucker-Lewis Index = 0.89, Comparative Fit Index = 0.92). Cronbach's alpha coefficient for the whole scale was 0.80, and the Intraclass Correlation Coefficient value for the whole scale was calculated as 0.78 using the single-rating, absolute-agreement, 2-way mixed-effects method., Conclusion: The study validates the HLSAC Scale, affirming its suitability for assessing HL in Persian-speaking child populations., Competing Interests: The authors declare no conflict of interest., (© 2024 The Authors. Health Science Reports published by Wiley Periodicals LLC.)

Background: Recurrent aphthous stomatitis has a complex and inflammatory origin. Among the great variety of medications it is increasingly common to use herbal medicines due to the adverse side effects of chemical medications. Considering the anti-inflammatory properties of cinnamaldehyde and the lack of studies related to the effectiveness of its nano form; This study investigates the effect of cinnamaldehyde and nano cinnamaldehyde on the healing rate of recurrent aphthous stomatitis lesions., Methods: In a laboratory experiment, cinnamaldehyde was converted into niosomal nanoparticles. The niosome vesicles diameter and polydispersity index were measured at 25°C using a dynamic light scattering (DLS) Mastersizer 2000 (Malvern Panalytical technologies: UK) and Zetasizer Nano ZS system (Malvern Instruments Worcestershire: UK). After characterizing these particles, the (2,3-Bis-(2-Methoxy-4-Nitro-5-Sulfophenyl)-2H-Tetrazolium-5-Carboxanilide) [XTT] assay was used to assess the toxicity of cinnamaldehyde and nano cinnamaldehyde on gingival fibroblast (HGF) and macrophage (THP-1) cells. By determining the release of TNF-α, IL-6, and TGF-β cytokines using ELISA kits, the level of tissue repair and anti-inflammatory capabilities of these two substances were evaluated., Results: The size and loading rate of the cinnamaldehyde nanoparticles were established after its creation. The optimized nanovesicle exhibited the following characteristics: particle size of 228.75 ± 2.38 nm, PDI of 0.244 ± 0.01, the zeta potential of -10.87 ± 1.09 mV and the drug encapsulation percentage of 66.72 ± 3.93%. PDIs range was between 0.242-0.274. The zeta potential values at 25°C were from -2.67 to -12.9 mV. The results of the XTT test demonstrated that nano cinnamaldehyde exhibited dose-dependent toxicity effects. Moreover, nano cinnamaldehyde released more TGF-β and had better reparative effects when taken at lower concentrations than cinnamaldehyde., Conclusion: Nano cinnamaldehyde and cinnamaldehyde are effective in repairing tissue when used in non-toxic amounts. After confirmation in animal models, it is envisaged that these substances can be utilized to treat recurrent aphthous stomatitis., (© 2023. The Author(s).)

Objective: Multiple sclerosis (MS) is a chronic neurological condition that significantly impacts the quality of life of affected individuals. Telehealth interventions (TIs) have emerged as a promising avenue for providing healthcare services remotely, potentially improving outcomes and enhancing the quality of life for people with MS. This systematic review aims to assess the impact and efficacy of TIs on outcomes of people with MS by synthesizing and comparing outcomes from related randomized controlled trials., Methods: The systematic review protocol will involve searching electronic databases (PubMed, Web of Science, Scopus, EMBASE, CENTRAL), gray literature resources, and key journals from 1997 to June 2023 for keywords related to Telehealth and MS. The collection of research-related articles will be followed by the removal of duplicates before they are included in the study. During the screening stage, the titles and abstracts of the articles will be reviewed, and irrelevant articles will be excluded. The full text of relevant articles will be independently evaluated by two researchers, and data will be extracted from the final articles. The findings will be classified and recorded in an extraction table. The risk of bias will be assessed using the Cochrane Collaboration tool. The data will be analyzed using STATA version 14.2. The PROSPERO ID for this study is CRD42023450081., Discussion: This study aims to address the current knowledge gap by investigating the comparative effectiveness of TIs. The findings of this research will provide valuable insights and evidence regarding the effectiveness of these interventions, assess their feasibility and accessibility, examine patient outcomes, identify research gaps, and offer guidance for clinical practice and policy-making., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Background: Adherence to complex drug regimens and polypharmacy are among the challenges of old age, which may negatively affect their motivation to continue drug therapy or lead to incorrect drug consumption. The present study was conducted to evaluate the effect of using a mobile drug management application on medication adherence and hospital readmission among polypharmacy older adults., Methods: In this randomized controlled trial study conducted in 2022, with Trial Registration Number (IRCT20191231045966N1) (18/07/2021), 192 Iranian older adults with polypharmacy were selected according to the inclusion criteria and allocated to case and control groups using the block randomization method. The data collection tools included a demographic questionnaire, case report form, and Morisky Medication Adherence Scale. The intervention was done using a mobile drug management application. Drug adherence was measured at baseline and both with hospital readmission were measured after 8 weeks. The collected data were entered into the SPSS software version 22 and analyzed using descriptive (frequency, percentage, mean, standard deviation) and inferential (Chi-square, Fisher's exact test, independent t-test) statistics., Results: The case and control groups were homogeneous in terms of demographic variables and drug adherence level before the intervention. A significant difference was found in the drug adherence level after using the app (p < 0.001). Moreover, a significant difference was found in adverse events, including re-hospitalization due to disease aggravation, re-hospitalization due to error in medication consumption, falling, hypo or hypertension, and hypo or hyperglycemia, and medication use accuracy between the groups after the intervention (p < 0.05)., Conclusion: The results showed that using a mobile drug management application that meets the specifications of older adults can improve drug adherence, reduce the adverse events and pave the way for a better disease period management., (© 2023. The Author(s).)

Background: Sex is one of the important aspects of marriage and a way of expressing intimacy. Unconsummated marriage is a common problem whose prevalence is about 1.5% in Iran and can significantly influence marital life., Objective: This study aimed to assess the unconsummated marriage in a qualitative mode to offer new and beneficial solutions resulting from a better understanding., Materials and Methods: In this qualitative study, conventional content analysis was used. Data collection and analysis were done from April 2013 to April 2014 with 11 women and 5 men participating, who were referred to the sexual disorders clinic of Tehran Psychiatric Institute and Rasool Akram hospital of Tehran, Iran. The researchers examined the files of people referred to these clinics with the diagnosis of unconsummated marriage. Our tool for data collection was a semi-structured interview. 2 experienced faculty psychiatrists recorded all the information based on standards for reporting qualitative research guidelines. Data were analyzed using qualitative technique and coding. Guba and Lincoln criteria was used for data validity., Results: The codes of the participants' experiences were classified into 6 main categories, which include self-concept, intrapersonal factors, partner's problem, preparedness for sex, emotional relationship between couples, and the effects of unconsummated marriage on the participant's life., Conclusion: Significant experiences among women included excessive anxiety toward the society and their spouses, and among men were weakness and guilt. Being unable to have sex negatively affected their view of life and caused great harm to their self-perception. Participants personality traits and their self-concept, and attitude toward their partners were important issues., Competing Interests: The authors declare that they have no competing interest., (Copyright © 2023 Setayesh et al.)

Background: Individual attitude is an essential component in facilitating people's participation in adopting cancer screening behaviors. People's attitudes toward cancer screening should be evaluated with a valid and reliable scale. Therefore, this study investigated the psychometric properties of the Persian version of the attitude scale for cancer screening., Method: In this psychometric study, the Farsi version of the attitude scale for cancer screening was prepared from English to Farsi using the Backward-Forward method. Then content, face, and construct validity, plus reliability, was evaluated by Internal Consistency and Stability methods. Construct validity was investigated using Exploratory Factor Analysis with a sample of 246 adults referring to health centers in the south of Tehran. Data analysis was done using SPSS V24 software., Results: All items received an acceptable Content Validity Ratio. The content Validity Index was confirmed for all items with a value greater than 0.79. In the qualitative review of content and face validity, all items were confirmed. Unlike the original version of the scale, which was a single factor, the results of Exploratory Factor Analysis indicated the existence of 2 factors explaining 63.84% of the total variance of the scale. Reliability based on Cronbach's alpha coefficient for the whole scale was 0.88, and Intraclass Correlation Coefficient for the entire scale was calculated for scale reliability using the single-rating, absolute-agreement, 2-way mixed-effects method as 0.84., Conclusion: This study confirmed the validity and reliability of the Persian version of the attitude scale for cancer screening with two factors (Willing Attitude and Unwilling Attitude). Therefore, it can be a suitable and valid scale to evaluate the attitude of the community for cancer screening., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Objectives: Thermoregulation is important for all age groups, and in neonates, it is considered a crucial event to adapt to extrauterine life. Therefore, using systems that provide frequent reminders in different ways in the field of thermoregulation can help thermal stability in neonates. The present study aimed to develop, implement, and evaluate a neonatal thermoregulation decision support system (DSS) as a web application., Methods: The present research was a multi-method study because it included the three phases of development, implementation, and evaluation of the neonatal thermoregulation decision support web application. In the system designing phase, the waterfall model is used. The second and third phases of the study, implementation, and evaluation, were conducted as a quasi-experimental study., Results: The results of this study were presented in two parts: the developed web application, and the results of the evaluation of the web application. The results of the statistical tests revealed that the use of the web application had a positive and significant effect on both the adjustment of the temperature of the incubator (maintaining the neutral temperature) and the maintenance of the temperature of the neonate's body (p = 0.000)., Conclusions: These results indicate that a nurse's sensitization and guidance with a neonatal thermoregulation decision support system can help to effectively neonate thermoregulation and the nurse has brought the temperature care close to the standard care based on the conditions of each neonate., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Objectives: Despite credible evidence, optimal neonates' pain management in the neonatal intensive care unit (NICU) is a challenging issue. In this regard, the organisational context is an essential factor. The existing challenges vary depending on the context, and investigating them can help to improve the quality of care. The study aimed to explore organisational challenges to neonates' pain management in the NICU., Methods: This qualitative study included 31 nurses and physicians in the NICU of Children's Hospital, Tabriz, Iran. Data collection was done through individual and focus group interviews. For data analysis, we used conventional content analysis., Results: The identified challenges included organisational culture (poor interprofessional collaboration and low parental participation), organisational structure (lack of unified approach in relieving pain and limited supervision for pain management) and organisational resources (lack of time due to high workload and inadequate educational programmes)., Conclusions: Many organisational factors consistently affect neonatal pain management. Adopting some approaches to enhance the cooperation of treatment team members, holding educational programmes, proper organisational supervision and implementing a unified neonatal-based pain management programme could improve neonatal pain management., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Aim: To estimate the effect size of distance education on the readmission of patients with heart failure., Design: This study was a systematic review and meta-analysis., Method: Both Persian and English interventional studies focused on investigating the effectiveness of any form of distance education interventions on the readmission of patients with heart failure were retrieved from the main databases: Embase, PubMed, Scopus, Web of Science, SID, and Google Scholar. Two independent teams screened the articles for eligibility. The Cochrane Risk of bias tool was implemented to evaluate the studies' quality. A random-effects model was applied to pool the effect sizes, I 2 was calculated to examine heterogeneity, and Meta-regression was used to investigate the source of heterogeneity. The proposal was registered in the PROSPERO database (no. CRD42020187453)., Results: Articles 8836 were retrieved, and 11 articles were selected. Nine studies investigated the effect of distance education on readmission with <12-month follow-up (RR: 0.78 [95% CI 0.67-0.92]) and the I 2 of 0.00%; and four studies examined the effect of distance intervention on readmission with 12-month or more follow-up (RR: 0.89 [95% CI 0.73-1.09]) and the I 2 of 71.59%., (© 2023 The Authors. Nursing Open published by John Wiley & Sons Ltd.)

Background: Getting overweight after pregnancy is a common phenomenon and getting back to pre-pregnancy weight in the postpartum period is a major concern for mothers. This study aimed to explain the challenges in performing post-pregnancy weight-management behaviors in nulliparous women being overweight and obese due to pregnancy., Methods: The present qualitative study was conducted with the conventional qualitative content analysis method based on Granheim and Landman's approach from October to December in 2021. In this study, participants were 15 women who referred to comprehensive health service centers in Tehran, Iran; they were purposefully selected according to the inclusion criteria. Data were collected through individual, in-depth, and semi-structured face-to-face interviews and simultaneously analyzed using the MAXQ Data version 10 software., Results: The mean age of the participants was 25.93±3.21 years. Data analysis resulted in three main categories: 1) failure to adhere to calorie-restricted diets, 2) inability to engage in physical activity, and 3) lack of adequate social support., Conclusion: Women with obesity due to pregnancy face many challenges to improve their weight-control behaviors. As such, improving healthy behaviors not only requires relevant stakeholders' commitment, but also demands women, their families and communities' intention to engage in healthy behaviors., Competing Interests: None declared., (Copyright: © International Journal of Community Based Nursing and Midwifery.)

Background: Patient education is a key component of patient care, positively affecting health promotion and self-care ability. In this regard, an extensive body of research supports the use of the andragogy model in patient education. The study aimed to explore the experiences of people with cardiovascular disease in patient education., Methods: This qualitative study involved 30 adult patients with cardiovascular disease who were hospitalized or had a history of hospitalization. They were purposively recruited with maximum variation from two large hospitals in Tehran, Iran. Data were gathered by conducting semi-structured interviews. Data collection was done by conducting semi-structured interviews. Then, the data were analyzed using directed content analysis and a preliminary framework based on six constructs of the andragogy model., Results: Data analysis resulted in the development of 850 primary codes, which were reduced to 660 during data reduction. These codes were grouped into nineteen subcategories under the six primary constructs of the andragogy model, i.e., need-to-know, self-concept, prior experience, readiness for learning, orientation to learning, and motivation for learning. The most common problems in patient education were associated with self-concept, previous experience, and readiness for learning components., Conclusion: This study provides valuable information about the problems of patient education for adults with cardiovascular disease. Correction of the issues identified can improve care quality and patient outcomes., (© 2023. The Author(s).)

Aim: The study aimed to explain the acute coronary syndrome (ACS) patients' perception of the nurse's healing presence in their comfort in the critical care unit., Design: This descriptive qualitative study was conducted from December 2020 to September 2021., Methods: Twenty-seven ACS patients were purposively selected from a cardiovascular university Hospital, Iran. Data were collected through semi-structured interviews (45-60 min). Data analysis was performed based on the contractual content analysis method of Graneheim and Lundman., Results: In the data analysis, the main theme 'nurses' healing presence' includes two categories: 'Nurse-patient communication' with two subcategories and the category 'Compassionate care' with three subcategories., (© 2023 The Authors. Nursing Open published by John Wiley & Sons Ltd.)

Single-parent adolescents are vulnerable individuals and it is necessary to improve their health, particularly during epidemics. This study aimed to investigate the effects of virtual logotherapy (VL) on health-promoting lifestyle (HPL) among single-parent adolescent girls during the COVID-19 pandemic. This single-blind randomized clinical trial was conducted on 88 single-parent adolescent girls recruited from the support organization for vulnerable individuals in Tehran, Iran. They were randomly allocated to a control and an intervention group through block randomization. Participants in the intervention group received VL in three-five person groups in 90 min biweekly sessions. The Adolescent Health Promotion Short-Form was used to assess HPL. Data were analyzed using the SPSS software (v. 26.0) and through the independent-sample t, Chi-square, Fisher's exact, and Mann-Whitney U tests. There was no significant difference between the intervention and the control groups respecting the pretest mean score of HPL (73.58±16.74 vs. 72.80±9.30; P=0.085). However, the posttest mean score of HPL in the intervention group (82 with an interquartile range of 78-90) was significantly more than the control group (71.50 with an interquartile range of 63.25-84.50) (P=0.001). Moreover, after adjusting the effects of the significant between-group differences respecting pretest mean scores, the pretest-posttest differences of the mean scores of HPL and all its dimensions in the intervention group were significantly more than the control group (P<0.05). VL is effective in significantly improving HPL among single-parent adolescent girls. Healthcare authorities are recommended to use VL for health promotion among single-parent adolescents.Trial registrationThis research was registered (17/05/2020) in the www.thaiclinicaltrials.org with registration number: TCTR20200517001., (© 2023. The Author(s).)

Aim: This study aimed to assess the relationship between emotional elder abuse and the developmental function of the family., Design: Community-based correlational cross-sectional study was conducted., Methods: Data were collected on 265 older adults from July to October 2019 in Tehran-Iran. The samples were selected by simple random sampling and they completed self-report tools: demographic information, emotional elder abuse developmental function in the family. Data analysis was performed using descriptive and inferential statistics and SPSS software v.16., Results: Mean score of the developmental function in the family was 67.38 (SD = 3.22, range = 0-129). There was a significant negative correlation between the total score of developmental function in the families and emotional elder abuse. Moreover, there was a relationship between the subscale of care and regulation, being attracted to human relationships, purposeful exchange, and creating representatives and ideas with emotional elder abuse., (© 2022 The Authors. Nursing Open published by John Wiley & Sons Ltd.)

Background: A significant percentage of head and neck cancer (HNCs) patients receiving RT experience oral mucositis (OM). This study aimed to evaluate the effect of the polyherbal (containing chamomile, peppermint oil, Aloe vera, and honey) and zinc mouthwashes in comparison to the control (chlorhexidine) and placebo groups for prevention of radiation-induced OM., Methods: This study was a double-blinded randomized clinical trial, conducted on 67 patients with HNCs undergoing radiotherapy. The eligible participants were randomized to receive either one of the following; zinc sulfate, polyherbal, chlorhexidine (Vi-one 0.2% CHX), or placebo mouthwash for 6 weeks. Follow-up evaluation of oral hygiene and the checklists of OM and the intensity of pain were filled out according to WHO assessment tool, Oral Mucositis Assessment Scale (OMAS), and Visual Analog Scale (VAS) in all the participants weekly for seven consecutive weeks., Results: The results of present clinical trial demonstrated that the use of either zinc sulfate or polyherbal mouthwash significantly reduced the scores of OM and the severity of pain during weeks 2 to 7 after consumption compared with the CHX or placebo mouthwashes (P < 0.05). According to the post hoc analysis and compared with the placebo, a significantly better result was reported for zinc sulfate and polyherbal mouthwashes at weeks 2 to 7, but not for the CHX mouthwash., Conclusion: This study showed that the use of zinc sulfate or polyherbal mouthwashes is effective in prevention of both OM severity scores and pain related to OM intensity at weeks 2 to 7 following consumption in HNCs patients. Trial registration IRCT20190123042475N1 and IRCT20190123042475N2. Registration date: 2019-06-09, 2019-07-26., (© 2023. The Author(s).)

Background: Mothers' involvement in the pain management of infants admitted to the intensive care unit can alleviate the infants' pain. Despite International guidelines, maternal involvement in neonatal pain management is low. Hence, investigating the perspectives of care providers (CPs) on barriers to maternal participation can be helpful in developing practice guidelines., Aims: The purpose of this study was to investigate the experiences of CPs on barriers to maternal involvement in neonatal pain management in the intensive care unit., Design: In this study, a qualitative design based on the content analysis approach was used., Method: We included 24 nurses and physicians in the neonatal intensive care unit from February to September 2020. Data were collected through conducting 11 individual interviews and two focus group discussions with eight and five participants, respectively., Results: Three main categories and seven sub-categories were found, including maternal barriers (inadequate emotional readiness and unfamiliarity with role), CPs' barriers (time pressure, fear of family-care provider tension, and insufficient knowledge), and organizational barriers (neglected joint decision-making and restricted organizational participative policies)., Conclusions: The identified barriers could be classified into those related to mothers, care providers, and organizations. The lack of appropriate interaction and cooperation between parents and care-providers can affect the emergence of barriers related to the mothers and staff., Relevance to Clinical Practice: There is a lack of knowledge regarding neonatal pain management in the health care team and mothers. Educating mothers and CPs about the benefits and ways of mothers' participation can increase readiness and capabilities. Providing clear guidelines about family-centred care and promoting parent-CPs' interactions can increase the mothers' participation., (© 2022 British Association of Critical Care Nurses.)