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Abstract Background Bad news refers to any information that create negative changes in a person’s understanding or expectations of in present and future. Breaking Bad News (BBN) is a stressful task that may have disturbing effects on the professional performance and general health of the medical staff. Pre-hospital emergency staff often needs to deliver bad news to the patient or his family. This study was conducted to determine the effect of guided group reflection training on the ability and comfort of BBN in pre-hospital emergency staff. Methods This quasi-experimental study was conducted on 95 staff of the pre-hospital emergency, in the test and the control groups. For the test group, a 4-hour training workshop on BBN was held, and then a group was formed in virtual space to discuss and exchange opinions about the scenarios of BBN and reflecting on it. Data collection tools were SPIKES Questionnaire and the Visual Analogue Mood Scale. The data were analyzed with SPSS V.18. Results The mean score of the ability to BBN after the intervention was 44.01 ± 6.21 in the test group and 31.40 ± 4.51 in the control group, and a significant difference was found using the independent t-test (P = 0.0001). Besides, the mean scores of the convenience of BBN in post-test was 5.52 ± 1.64 in the test group and 3.50 ± 1.28 in the control group using the independent t-test with a significant difference (P = 0.0001). Conclusion According to the findings, training in guided group reflection improved the ability to BBN and its convenience in pre-hospital emergency staff. Therefore, it is suggested the use of this method in training for health care providers. Relating to BBN.

Background: Stroke is recognized as the second leading cause of death and the primary cause of disability in developing and underdeveloped countries. This study investigated the time trend of calls for suspected stroke received by the Emergency Medical Services (EMS) from 2013 to 2019 in Shiraz, Iran.Methods: This was a descriptive - ecological study using time series data. The necessary data were extracted from the Shiraz Emergency Medical Center from 2013 to 2019. Excel 2013 and SPSS (version 24.0) were used for data analysis. The results were then presented in figures and tables.Results: From 2013 to 2019, the EMS call center in Shiraz City received 844,004 calls, of which 6,620 were suspected stroke cases. The number of suspected stroke cases demonstrated a steady trend within a certain range from 2013 to 2016. However, there was a significant increase between 2016 and 2017, after which the number of stroke cases reached relative stability. In the short-term seasonal trend, we found that the number of suspected stroke cases reported to EMS was higher in cold seasons compared to warm seasons.Conclusion: The results showed that the long-term trend of reported suspected stroke cases to EMS is currently stable, following a previous increase in Iran.

Background: Learning life skills can improve students' performance. This study aimed to investigate the effect of online life skills training courses on resilience, locus of control, general health, and academic performance at Yazd University of Medical Sciences.Method: This intervention study was performed on 70 third and higher-semester students. For the experimental group, a life skills training program was performed in five sessions during the five weeks. Data collection tools included Connor and Davidson resilience questionnaires, Rutter locus of control, and Goldberg general health and average grade points of the student in the previous and new semester, completed before and one month after the training program. The data were analyzed using SPSS.v22 descriptive statistics and independent and paired t-tests.Results: Before the study, the mean resilience scores of the intervention and control groups were 57.17±2.40 and 58.70±3.58, respectively. After the study, the mean resilience scores of the intervention and control groups were 73.13±2.27 and 59.50±3.50, respectively. Also, the mean scores of the locus of control before and after the study in the intervention and control groups were 10.22 ± 2.04, 11.59 ± 1.32, and 9.02 ± 3.50, 8.95 ± 2.32, respectively. Statistical analysis showed that there was a significant difference between the two groups in terms of all mentioned variables (P

Objective: Diabetic patients with COVID-19 are at the higher risk of clinical complications and intensive care unit )ICU( admission. There is limited information available on the risk factors of mortality in diabetic patients with COVID-19 admitted to the ICUs. The aim of this study was identifying the mortality risk factors in diabetic patients with COVID-19 who are admitted to the ICU. Materials and Methods: In this study, we conducted a descriptive-analytical observational analysis on 391 patients admitted to the ICU for 18 months. We assessed the demographic, clinical, pharmaceutical, laboratory and imaging data of diabetic patients and statistically analyzed them to identify mortality risk factors. Results: The study found 156 (39.89%) diabetic out of 391 patients. The group of diabetic patients had significantly higher rates of endotracheal intubation (P< 0.001), mortality (P< 0.001), and complications during hospitalization due to COVID-19, including secondary bacterial infections (P = 0.005), venous thrombosis (P = 0.008), and gastrointestinal bleeding (P = 0.011), compared to the nondiabetic patient. Conclusion: Patients with diabetes who also have COVID-19 tend to experience more severe clinical outcomes and a higher mortality rate when admitted to the intensive care unit. The likelihood of mortality in these patients is closely associated with factors such as stroke occurrence, oxygenation levels, and the presence of secondary infections at the time of admission.

Objective: This study aimed to explore the global, prevalence, and risk factors of fever after percutaneous nephrolithotomy (PCNL) by conducting a systematic review and meta-analysis. Methods: The high-sensitivity searching was conducted without time limitation until December 30, 2020 in Web of Sciences, Scopus, and PubMed based on inclusion and exclusion criteria. Results: The prevalence rates of fever and sepsis among patient undergoing PCNL were estimated 9.5% (95% confidence interval [CI]: 9.3%–9.7%), and 4.5% (95% CI: 4.2%–4.8%), respectively. Nephrostomy tube was used in 9.96% (95% CI: 9.94%–9.97%) of patients. The mean preoperative white blood cells of patients were 6.401×109/L; 18.3% and 4.55% of patients were considered as the positive urinary culture and pyuria, respectively. About 20.4% of patients suffered from residual stones. The odds ratios (ORs) of fever in patients who suffering from diabetes mellitus, hydronephrosis, staghorn stones, and blood transfusion were 4.62 (95% CI: 2.95–7.26), 1.04 (95% CI: 0.81–1.34), 2.57 (95% CI: 0.93–7.11), and 2.65 (95% CI: 1.62–4.35), respectively. Patients who underwent PCNL in prone position were more likely to develop fever (OR: 1.23; 95% CI: 0.75–2.00) than patients in supine position. Conclusion: The current study showed that patients who suffer from diabetes mellitus, hydronephrosis, staghorn stones, nephrostomy tube or double-J stent, blood transfusion, and also patients who underwent PCNL in prone position surgery are more likely to develop a postoperative fever after PCNL.

Background: It is important to determine the risk factors that contribute to the mortality of a disease and take measures to prevent or alleviate it. In the case of COVID-19, old age, male gender, and comorbidities such as diabetes (DM) and hypertension (HTN) have been identified as potential risk factors. However, there is conflicting information on the effects of statins and ACEI/ARB in COVID-19 patients admitted to the ICU, particularly those with diabetes or hypertension. This study aims to investigate the effects of these drugs on the in-hospital prognosis of ICU COVID-19 patients, with a focus on patients with DM or HTN. Methods: During 18 months, we conducted a descriptive-analytical observational analysis on 391 patients who were admitted to the ICU. The study focused on COVID-19 patients and aimed to identify mortality risk factors by assessing their demographic, clinical, pharmaceutical, laboratory, and imaging data. We statistically analyzed the data to achieve this goal. Results: Out of 391 patients, 83 received statins and 89 received ACEI/ARBs. The research has revealed that the use of ACEI/ARBs in COVID-19 patients admitted to the ICU may increase the risk of endotracheal intubation (P

Abstract Introduction It is important to identify the relationship between the COVID-19 vaccination status and the prognosis of this disease in hospitalized patients to gain a more accurate picture of their status and the effect of vaccination, as well as take necessary measures to improve their medical care. Thus, the present study was conducted to investigate the relationship between the vaccination status of hospitalized COVID-19 patients and the disease severity index in terms of clinical, imaging, and laboratory criteria. Methods This research is a descriptive-analytical cross-sectional study. the study population consisted of patients with a positive RT-PCR test for coronavirus, admitted to COVID-19 departments of teaching hospitals in Yazd, Iran, during two months in the sixth peak of COVID-19. The patients’ data comprised demographic information (age, sex, and underlying disease), clinical information (length of hospital stay, length of ICU stay, and vaccination status), disease outcome (mortality and intubation), laboratory information (ESR, CRP, and NLR), and imaging information (lung involvement percentage), and finally, the relationship between patients’ vaccination status and disease severity indices were analyzed with the chi-square test, independent t-test, and logistic regression analysis at a 95% confidence interval (CI). Findings According to research findings, the duration of hospitalization was 5.25 ± 2.34 and 6.11 ± 3.88 days in groups of patients with complete and incomplete vaccination, respectively (P = 0.003). The lengths of ICU stay were 6 ± 4.63 and 5.23 ± 3.73 days in both groups of patients admitted to the ICU (P = 0.395). Furthermore, there were significant relationships between the ICU admission rates, endotracheal intubation, mortality rate, the lung involvement score in the chest CT scan, and the NLR with the vaccination status.Multivariate regression analysis indicated that DM, IHD, NLR, CT scan score and vaccination status were related to patients’ in-hospital mortality. Conclusion Complete vaccination of COVID-19 led to a milder disease in terms of clinical, imaging, and laboratory criteria of patients and decreased the possibility of hospitalization in ICUs, intubation, and mortality in patients.

Background During COVID-19, healthcare systems in underdeveloped nations had significant challenges and were unlikely to offer the necessary care. It appears that a new, reliable healthcare model that prevents hospitalization is necessary to reduce the pressure that COVID-19 is putting on healthcare systems and patients. More particularly, as Remdesivir's use as an outpatient treatment for mild to severe SARS-CoV-2 infection has rarely been examined; we aimed to investigate in-depth comprehension of the effects of Remdesivir in these cases. Methods In our two-month cross-sectional study, non-hospitalized patients with mild to moderate COVID-19 who were referred to the hospital for up to 5 days of Remdesivir treatment received 200 mg of Remdesivir intravenously on day 1, followed by 100 mg of Remdesivir once daily for the subsequent 4 days. Patients were divided into groups based on the time of starting Remdesivir treatment after the appearance of symptoms: group 1 less than and equal to 7 days, and group 2 more than 7 days. Two groups were evaluated for a correlation between Remdesivir administration time and clinical symptoms on days 1 and 14 (follow-up visits). Results The study enrolled 273 eligible patients with a mean age of 47.5 years, of whom 112 were males and 125 were females. Results showed that patients who received Remdesivir in the first 7 days had less dyspnea (P-value

Abstract Background Despite the confirmed association between higher BMI with increased risk of the acute respiratory distress syndrome (ARDS), the association between obesity with mortality in critically ill patients with coronavirus disease 2019 (COVID‐19) is not clear. The present study aimed to investigate the association between obesity with treatment duration, ICU length of stay, and the risk of death in critically ill patients with COVID‐19. Methods This case–control study was performed on 223 patients with COVID‐19 including 148 surviving patients as the control group and 75 eventually dead patients as the case group in Rasht, Iran. Data on demographic factors, comorbidities, anthropometric measurements, the length of hospitalization and the mortality were obtained from patients' medical records. Results The mortality rate was significantly associated with weight (OR = 1.04, 95% CI: 1.002–1.083, p = .04), but not with BMI after adjustments for age, gender, length of stay in ICU, chronic diseases and smoking. The results did not change after further adjustments for biochemical and pathological factors. Conclusions Weight was positively associated with mortality after controlling for confounding variables. Further studies should consider the patient's body composition such as fat mass to establish the relationship between obesity and COVID‐19 outcomes.

BackgroundFTO gene is associated with obesity, dietary intake, and the risk of colorectal cancer (CRC). In this study, patients with colorectal cancer were assessed for the interactions between FTO gene polymorphisms and dietary intake.MethodsThis case–control study was carried out on 450 participants aged 35–70 years including 150 patients with colorectal cancer and 300 healthy controls. Blood samples were collected in order to extract DNA and genotyping of FTO gene for rs9939609 polymorphism. A validated 168-item food frequency questionnaire (FFQ) and the Nutritionist-IV software were used to assess dietary intake.ResultsIn the participants with the TT genotype of FTO rs9939609 polymorphism, CRC risk was significantly associated with higher intake of dietary fat (OR:1.87 CI95%:1.76–1.99, p = 0.04), vitamin B3 (OR:1.20 CI95%:1.08–1.65, p = 0.04), and vitamin C (OR:1.06 CI95%:1.03–1.15, p = 0.04) and lower intake of β-carotene (OR:0.98 CI95%:0.97–0.99, p = 0.03), vitamin E (OR:0.77 CI95%:0.62–0.95, p = 0.02), vitamin B1 (OR:0.15 CI95%:0.04–0.50, p

Background: The risk of cervical cancer was reported to be influenced by dietary components. This study aimed to illustrate the association between cervical cancer with the intake of food groups in women with a history of cervical neoplasia. Methods: This nested case-control study was conducted in 558 people with a history of cervical intraepithelial neoplasia (CIN), including 279 women with cervical cancers and 279 controls with low-grade squamous intraepithelial lesions (LSIL). A validated food frequency questionnaire (FFQ) was used to assess the intake of food groups. Results: The intake of fruits and vegetables in the case group was significantly lower than the control group (P=0.001). Low intake of dairy products, vegetables, and fruits was associated with cervical cancer risk (OR=4.67; 95% CI 1.2-9.49, P=0.001; OR=9.75, 95% CI 1.36-19. 51, P=0.001; and OR=4.82, 95% CI 1.09-7.25, P=0.001, respectively). After adjusting for age, family history, age at first menstruation, number of children, history of vaginal infection, and age at first sexual intercourse, the results were still significant. Additional adjustments to BMI did not change the results. Conclusion: The results indicate that the risk of cervical cancer can be affected by the intake of certain food groups. Further longitudinal studies are needed to confirm these findings and determine the underlying mechanism of the influence of dietary components on cervical cancer risk.

Key Clinical Message Atrial myxoma is a rare disease but has a broad clinical presentation and complication that involves several systems‐ heart, lungs, brain, and systemic. An interdisciplinary approach is very important to optimize the outcome in patients with atrial myxomas. A thorough examination by primary care providers is crucial. Then radiologists or cardiologists can help with imaging modalities that can help diagnose and characterize the tumor. Prior to surgical resection by cardiothoracic surgeons, patients need to be evaluated by pulmonologists, cardiologists, and anesthesiologists for preoperative risk stratifications. In patients with neurological complications, pulmonary complications, or infectious endocarditis, input from neurologists, hematologists, infectious disease specialists is essential for patient care. In case antiplatelet/anticoagulation therapy or antibiotic treatment is warranted, pharmacists can provide valuable recommendations. Abstract Myxoma is the most common benign cardiac primary tumor, occurring in the right atrium in only 15%–20% of cases. This disease is asymptomatic initially depending upon size of the tumor, and symptoms develop as the tumor spreads. Atrial myxomas are associated with a triad of complications, including obstruction, emboli, and constitutional symptoms (such as fever and weight loss). This regard, embolization of the pulmonary circulation system is a complication of right myxoma. The patient was a 40‐year‐old male who presented to the emergency department complaining of fever and confusion. He had been previously hospitalized due to COVID‐19 and treated with Remdesivir and plasmapheresis. He had tachycardia, tachypnea, thrombocytopenia, and increased liver enzymes. Chest imaging showed nodular lesions with necrotic areas and cavitary lesions in both lungs and the right atrium infected clot was seen in echocardiography. He was treated with intravenous antibiotics and finally underwent heart surgery due to the diagnosis of pulmonary septic embolism. The patient was finally diagnosed with right atrial myxoma according to heart mass histopathology. It is worth noting that the patient's thrombosis had already developed on the right atrial myxoma, which delayed the diagnosis in this patient. This thrombus formation was due to the hypercoagulability state of COVID‐19 and following the insertion of a central venous catheter to perform plasmapheresis as a complication of treatment. Special attention should be paid to thromboprophylaxis and the early diagnosis of intravascular and intracardiac thrombosis in COVID‐19 patients. Furthermore, the use of imaging modalities is recommended to differentiate thrombus from myxoma.

Abstract Background The coronavirus disease‐2019 (COVID‐19) has become a worldwide health issue with widespread hospitalization and dependence on the intensive care unit (ICU). Vitamin D has a key role in modulating immune cells and modulating the inflammatory responses. This study aimed to investigate the association of vitamin D supplementation with inflammatory, biochemical, and mortality indices in critically ill patients with COVID‐19. Methods This case‐control study was conducted on critically ill COVID‐19 patients hospitalized in the ICU including the survived >30 day patients as the case group and dead patients as the control group. The status of vitamin D supplementation and inflammatory and biochemical indices of the patients were retrieved from the medical records. Logistic regression method was used to assess the association between 30 days survival and vitamin D supplement intake. Results Compared to the group of COVID‐19 patients who died in

Introduction. Proper oxygen therapy is crucial in hospitals, particularly intensive care units, to ensure safety and accuracy. The role of nurses during oxygen therapy is vital, as their knowledge and correct performance significantly impact patients’ clinical conditions. A study was carried out to examine the knowledge and performance of nurses regarding safe oxygen therapy. The study aimed to identify the obstacles hindering safe oxygen therapy and assess the impact of training on the knowledge and performance of intensive care nurses. Methods. This study was conducted among the ICU nurses at Shahid Rahnemoun Teaching Hospital in Yazd, Iran. The study method is a sequential combination of descriptive, qualitative, and educational phases. The first stage involved examining the knowledge and performance of 80 ICU nurses in oxygen therapy. The study employed content analysis to elaborate on participants’ perspectives on safe oxygen therapy challenges and potential solutions. The third phase involved a two-group study with pre- and post-tests to examine the effect of training on ICU nurses’ knowledge and performance in oxygen therapy. Results. The study found that intervention and control groups had low average scores in knowledge, performance, and total score of oxygen therapy before the study, with no significant difference. There was a significant difference between intervention and control groups one and three months after the intervention in the areas of knowledge (after-1 month 24.41 vs. 20.29, 95% CI [3.144–5.098], after-3 month 22.13 vs. 20.24, 95% CI [0.729–3.053]), performance (after-1 month 21.54 vs. 18.05, 95% CI [2.898–4.073], after-3 month 19.74 vs. 18.63, 95% CI [0.400–1.824]), and total score of oxygen therapy (after-1 month 45.95 vs. 38.34, 95% CI [6.288–8.925], after-3 month 41.87 vs. 38.87, 95% CI [1.394–4.613]). Conclusion. The study’s findings revealed that nurses in ICUs lack the appropriate knowledge and performance in oxygen therapy. A lack of knowledge and correct practice, insufficient monitoring of oxygen therapy, and defects in hospital equipment are contributing factors. The training was found to improve the knowledge and performance of nurses significantly. Consistent training at shorter intervals is suggested for nurses to keep their knowledge current.

Background. COVID-19 has led to significant hospitalization and intensive care unit admission rates. The demographic parameters of COVID-19 patients, such as age, underlying illnesses, and clinical symptoms, substantially influence the incidence and mortality of these individuals. The current study examined the clinical and demographic characteristics of COVID-19 intensive care unit (ICU) patients in Yazd, Iran. Methods. The descriptive-analytical cross-sectional study was conducted on ICU patients with a positive RT-PCR test for coronavirus, admitted to the ICU in Yazd province, Iran, over 18 months. To this end, demographic, clinical, laboratory, and imaging data were collected. Moreover, patients were divided into good and worse clinical outcome groups based on their clinical outcomes. Subsequently, data analysis was performed at a 95% confidence interval (CI) using SPSS 26 software. Results. 391 patients with positive PCR were analyzed. The average age of the patients in the study was 63.59 ± 17.76, where 57.3% were male. On the high-resolution computed tomography (HRCT) scan, the mean lung involvement score was 14.03 ± 6.04, where alveolar consolidation (34%) and ground-glass opacity (25.6%) were the most prevalent type of lung involvement. The most common underlying illnesses in the study participants were hypertension (HTN) (41.4%), diabetes mellitus (DM) (39.9%), ischemic heart disease (IHD) (21%), and chronic kidney disease (CKD) (20.7%). In hospitalized patients, the rates of endotracheal intubation and mortality were 38.9% and 38.1%, respectively. Age, DM, HTN, dyslipidemia, CKD, cerebral vascular accident (CVA), cerebral hemorrhage, and cancer were reported to be significantly different between these two groups of patients, indicating an increase in the rate of intubation and mortality among these patients. Furthermore, the multivariate logistic regression analysis revealed that DM, HTN, CKD, CVA, neutrophil-to-lymphocyte ratio (NLR), the percentage of lung involvement, and initial O2 saturation significantly increase the mortality of ICU patients. Conclusion. Several features of COVID-19 patients influence the mortality in these individuals. According to the findings, early detection of this disease in people at high risk of death can prevent its progression and lower mortality rates.

Background and Aim: Implementation of a program to support physicians’ working long in deprived areas is one of the most important programs of the Health System Transformation Plan in response to the challenge of the shortage of expert staff, particularly physicians. Numerous factors affect the persistence of physicians in different regions, especially in deprived ones. This study aims to explain the experiences of physicians in relation to the challenges of working long in deprived areas. Materials and Methods: The present research is a qualitative study that was conducted in 2020 in Tehran, Iran. To achieve information saturation, 16 physicians and specialists were chosen using purposive sampling method. Then, for data collection, semi-structured interviews were used. Moreover, data analysis was performed using Graneheim and Lundman contractual content analysis method, and data management was done with MAXQDA software version 12. Furthermore, Lincoln and Guba reliability criteria were applied to achieve data accuracy and reliability. Results: Three female and 13 male physicians with a mean work experience of 45.4±7.8 years and an average work experience in deprived areas of 8±6.3 years participated in the study. Six participants were native to the region and the rest were non-native. Twelve participants in the study were the faculty members of the university. When the data were analyzed, 286 initial codes were extracted. The information was divided into four main categories and eleven subcategories. Welfare, motivation, justice and security were the main categories of this study. Conclusion: Providing individual and social welfare for physicians, and fair treatment in financial payments and educational justice along with establishing security provide the necessary motivation for physicians to stay in a deprived area. Besides by combining several solutions at the same time, the presence of doctors in deprived areas can be guaranteed.

Abstract Background Superficial eye disorders are one of the most common complications of improper eye care in intensive care units that can lead to corneal ulcers and permanent eye damage. The aim of this study was to determine the effect of the implementation of eye care protocol on the incidence of infection and superficial eye disorders in patients admitted to intensive care units. Methods This study was a cross-over clinical trial that was performed on 32 patients admitted to the intensive care unit with reduced or no blink reflex following loss of consciousness or receiving sedatives. The eye of the test group received eye care according to the protocol and the eye of the control group received the routine care of the ward. The data collection form included demographic and clinical information and the clinical score scale of superficial eye disorders, which were completed in 7 days for both eyes. Data analysis was performed by McNemar and Cochran tests with a 95 % confidence interval. Results In the study of superficial eye disorders, the frequency of dacryorrhea and hyperemia was not significantly different in the second to seventh days in the control and test eyes (P

Abstract Patients with chronic diseases are severely affected by acute coronavirus syndrome. In this regard, patients with beta thalassemia intermedia and diabetes mellitus (DM) are also at high risk for coronavirus‐induced respiratory failure. The present study aimed to report a case with COVID‐19 with a history of chronic diseases, beta thalassemia intermedia, and DM. A 25‐year‐old man visited with complaints of severe shortness of breath, fever, cough without sputum, and tachypnea and admitted to the Intensive Care Unit. The patient had a history of DM, beta thalassemia intermedia, and pervious history of the splenectomy. In peripheral complete blood count (CBC diff), the number of white blood cell count was 41,100 of which 38.6% were lymphocytes. We measured the normal platelet count, hemoglobin level (9.4), and red blood cell count (3.56). ESR was 97, CRP = pos+++ and PCR was positive. The high‐resolution lung CT indicated ground glass opacities in peripheral areas. The patient underwent 13 days of oxygen therapy with reservoir bag‐mask, non‐invasive ventilation, nasal oxygen, and pharmacological treatment with IFN‐β1a and meropenem, and finally discharged with an improvement of the clinical condition. Timely initiation of treatment is very important and significant for patients with beta thalassemia intermedia with COVID‐19, especially despite the underlying disease of DM. According to the present report, the use of IFN‐β1a was effective as a treatment option for COVID‐19.

ObjectiveGenetics and dietary factors play important roles in the development of colorectal cancer (CRC). However, the underlying mechanisms of the interactions between CRC, gene polymorphisms, and dietary fat are unclear. This review study investigated the effects of polymorphisms of arachidonate lipoxygenase (ALOX) and cyclooxygenase (COX) genes in the association between CRC and dietary fat.MethodsAll the related papers published from 2000 to 2022 were collected from different databases such as PubMed, Science Direct, Scopus, and Cochran using related keywords such as colorectal cancer, ALOX, COX, polymorphism, and dietary fat. Non-English and unrelated documents were excluded.ResultsSome single-nucleotide polymorphisms (SNPs) in the ALOX and COX genes, such as rs2228065, rs6413416, and rs4986832 in the ALOX gene, and rs689465 in the COX gene may play significant roles in the association between the risk of CRC and dietary fats. SNPs of ALOX and COX genes may influence the effects of dietary fatty acids on the risk of CRC.ConclusionSome polymorphisms of the ALOX and COX genes may have important roles in the effects of dietary fat on the risk of CRC. If future studies confirm these results, dietary recommendations for preventing colorectal cancer may be personalized based on the genotype of the ALOX and COX genes.

Introduction: Peer instructor teaching is an educational model in which senior students teach to their classmates or junior students. Clinical supervision is a formal, systematic, and continuous that the inexperienced person reviews and improves their performance by receiving advice from a supervisor or expert. Clinical education is a vital component of the medical science curriculum and the quality and control of its stressors are important. The purpose of this study was to combine peer instructor training model with clinical supervision on the status and stressors of clinical nursing education. Methods: This is a quasi-experimental study in which a combined Peer instructor teaching and clinical supervision program was implemented. The research samples were 60 nursing students of Yazd nursing and Midwifery College who were studying in third and sixth semesters. They were selected by purposive sampling method. Data gathering tools included a four-part questionnaire including demographic characteristics, a questionnaire for assessing instructor performance in clinical education, a standard questionnaire for clinical stressors, a course satisfaction questionnaire and a clinical supervisor completed by self-report. Data analysis was done using SPSS 16 software. Result: on the finding the mean score of peer instructor evaluation was 56.42 ± 9.38 and mean score of clinical stressors was 38.72 ± 5.6. Peer instructor in most cases agreed with the peer instructor program and clinical supervision program. Conclusion: From the learnerschr('39') point of view, peer instructor performance is at a good level, as well as clinical stressors at the boundary level between moderate and weak, although both results are satisfactory but there is a need for more careful planning and more training by peer educators and more accurate clinical supervision.

Abstract Background Obesity and Overweight at an early age can contribute with many chronic diseases such as cancers, diabetes and cardiovascular diseases. Diet-related inflammation is one of the most important underlying mechanisms that may has a key role in obesity and overweight. This paper aimed to compare the dietary inflammatory index (DII®) in normal weight and overweight adolescent boys. Methods A total of 535 adolescent boys (214 cases were overweight and obese and 321 controls with normal weight) participated in this study from two schools in Tehran, Iran. The student’s weight and body composition were measured using a Bio-Impedance Analyzer (BIA) scale. A validated semi-quantitative Food Frequency Questionnaire (FFQ) was used to assess dietary inflammatory index. Results Results obtained from modeling DII® as a continuous variable identified a positive association between DII® and obesity (OR = 1.08, CI 1.01–1.16). After multivariable adjustment, subjects with DII® > 0.02 had at 1.5 times higher odds of obesity and overweight compared to subjects with DII® ≤ 0.02 (OR = 1.52; CI 1.04–2.22). Conclusion Our study indicated the importance of dietary-induced inflammation in the obesity and overweight during adolescence. Therefore, advising adolescent to consume diet with lower DII® with more fruits and vegetables, rich sources of fiber, flavonoids, zinc, magnesium and selenium and avoiding the consumption of saturated fatty acids (SFA), trans-fatty acids, and cholesterol may support a healthy weight.

Objective: Nurses exposed to COVID-19 could be psychologically stressed. The present study investigated the mental health and the resilience level in the nurses’ population. Method: This cross-sectional study was performed on 432 nurses in 27 hospitals working in Guilan province, north of Iran, between April 29, to May 14, 2020. Mental health and resilience were measured using the 12-item General Health Questionnaire-12 (GHQ-12) and the 10-item Connor-Davidson Resilience Scale (CD-RISC-10). Hierarchical multiple linear regression model was used to identify factors associated with mental health. Results: The mean GHQ-12 and CD-RISC-10 scores were 15.72 (SD, 5.67) and 25.97 (SD, 6.88), respectively. Probable psychological distress (GHQ-12 score ≥ 15) was present in 57.2% of nurses. Among demographic and COVID-19-related variables, only educational level was significantly and negatively correlated with mental health. After controlling the variables, hierarchical regression analyses results showed that lower resilience was associated with poor mental health (β = -0.49; P < 0.001). Conclusion: Regarding the nurses’ mental health, appropriate psychological/psychiatric intervention is necessary, and resilience can play a role as a mental health promoter.

Background: Nutrient imbalance can frequently occur in patients with indications for parenteral nutrition (PN) after gastrointestinal surgery. This study aimed to compare the recommendations of a surgeon to those of a dietitian in the field of parenteral nutrition.Methods: This study was performed on 256 patients undergoing gastrointestinal surgery who received PN, which included 120 patients who received PN based on recommendations of the surgeons and 136 patients who were referred to receive PN under the supervision of a dietitian in Razi Hospital in Rasht, Iran. Data on PN and clinical outcomes of the patients were collected.Results: Patients under the supervision of dietitians received higher vitamin B complex and lipids and lower vitamin A and vitamin E than the surgeon-supervised patients (all P < 0.001). In the group receiving PN under the supervision of a surgeon, the level of blood glucose (207 vs. 182, P < 0.01), sodium (138 vs. 136, P = 0.01), potassium (3.97 vs. 3.53, P < 0.01), and white blood cell count (9.83 vs. 9.28, P < 0.01) increased significantly at the end of the PN compared to baseline. In the group receiving PN under the supervision of a dietician, the level of serum Cr (1.23 vs. 1.32, P = 0.04), Mg (2.07 vs. 1.84, P < 0.01), and pH (7.45 vs. 7.5, P = 0.03) significantly improved after receiving parenteral nutrition compared to baseline.Conclusion: The amounts of nutrients recommended for PN by the surgeon and dietitian were different. Implementation of dietitian recommendations in critically ill patients under PN can improve patients' clinical parameters.

Background: Schools, as social infrastructure and an integral part of society, play an essential role in creating the resilience of the community to natural disasters. This study aims to systematically review and identify and categorize the components affecting schools’ resilience against emergencies and disasters. Materials and Methods: Without any time limit, we will search the PubMed, Scopus, Web of Science, and Google Scholar databases using the three keywords of “Disaster”, “School”, “resilience”, and their synonyms according to the MeSH website terms defined in the PubMed database. The inclusion criteria will be the articles related to school resilience, schools and emergencies and disasters, and school safety and resistance to threats. There will be no restrictions on the type of documentation, and all articles, books, and conference papers will be evaluated in this study. Search syntax strategies will be defined based on the guidance of each database. The final version of EndNote X8 is used to manage databases, delete duplicate and irrelevant articles, and extract relevant articles. The evaluation and selection of articles are based on the research question and the PRISMA checklist. Dissemination: The results of this systematic review determine appropriate criteria for school resilience, which are valuable for decision-makers and politicians, researchers in the field of education, Ministry of Health and Medical Education, Welfare Organization, Red Crescent, and people interested in research in the field of students and schools, especially in the event of emergencies and disasters. Also, according to the criteria extracted from this systematic review, the difference between resilient and non-resilient schools can be shown from an international perspective.

Introduction: Increase of the human capital and the quality of human resources due to the development of health level is one of the important factors in economic growth, which leads to productivity increase at constant levels of inputs. Methods: In this study the panel data of 30 provinces was used in 2005 -2013. These data were obtained from the regional data of statistics center of Iran using the estimates of Mankiw, Romer, and Weil models by data panel method and generalized method of moments. Data analysis was performed using Spss22 and Eviews 8 software. Results: The results showed that public health expenditures had a greater effect on the labor productivity than the private health expenditures. In this regard, per 100 rials increase in private and public health expenditures, the productivity increases by 0.75 rials and 27.4 rial, respectively. Conclusion: The private health expenditures has treatment applications and public health expenditure has sanitary applications. Furthermore, the heath expenditure has high cost for some families. SO, the government must reduce the total cost of health to increase the labor productivity.

Introduction: patients undergoing hemodialysis experience fistula puncture pain an average of 10 times per month. Reduction of these complications is important for adjusting the patients with long-term hemodialysis. This study aimed at investigating the effects of EMLA cream and ice pack on severity of pain induced by vascular needle punctures in hemodialysis patients. Methods: This was a quasi-experimental design carried out on 40 hemodialysis patients with arteriovenous fistula at Shahid Rahnemoon Hospital., Yazd, Iran, in 2015. In this study, the pain severity was measured in the patients upon insertion of vascular needles using EMLA cream and ice pack with numeric scale of pain severity measurement. The data were analyzed using SPSS16 and repeated measure ANOVA. Results: Our findings showed that the mean score of pain in three methods of uncontrolled pain method, ice pack method, and EMLA cream method, was 7.45±0.88, 5.38±0.83, and 2.80±0.70, respectively. Reduction in average pain intensity was more obvious with both EMLA cream and ice pack methods compared to the uncontrolled pain method (P < 0.001). Also, the mean of pain reduction was significantly greater with EMLA cream compared to ice pack (P < 0.001) Conclusion: Both methods of ice pack and EMLA cream were effective in reducing pain, but due to EMLA cream was more effective in decreasing fistula puncture pain, it could be suggested to hemodialysis patients.

Introduction. Sight is one of the most important and vital human senses. Lack of proper eye care (EC) in anesthetized patients can lead to serious ocular complications and even vision loss. Insufficient knowledge, attitude, and skills of nurses are considered as a barrier to providing EC in the intensive care unit (ICU). The aim of the present study was to determine the effect of training EC clinical practice guidelines for ICU patients on nurses’ knowledge, attitude, and practice of EC. Methods. This was an interventional study with a pre-post design performed on 60 ICU nurses. For the experimental group, EC clinical guideline training was performed for anesthetized patients in three sessions. The data collection tool included nurses’ clinical competence of the EC questionnaire with a possible score range of 0–86. This tool consists of three domains, including knowledge (0–18), attitude (0–28), and practice (0–40), which was completed in a self-assessment manner before and three months after the training program. Data analysis was carried out using SPSS16. Findings. The mean scores of knowledge, attitude, and practice after the intervention in the experimental and control groups were 15.03 ± 2.72 and 11.11 ± 3.50, 25.65 ± 3.47 and 22.07 ± 3.08, and 33.88 ± 4.14 and 28.5 ± 55.08, respectively, which were statistically significant (P≤0.001). Also, the total score of clinical competence of EC after the intervention in the experimental and control groups was 74.56 ± 7.93 and 61.74 ± 9.66, which showed a significant difference (P≤0.001). Conclusion. Training nurses based on EC clinical guidelines for anesthetized patients can improve the knowledge, attitude, and practice of ICU nurses. Evidence-based EC practice requires continuous training based on clinical guidelines and EC practice monitoring by nursing managers according to EC clinical guideline for an anesthetized patient.

BackgroundIn addition to their educational role, resilient schools have a good capacity in response to disasters. Due to the large student population, the schools can be a safe and secure environment during disasters, in addition to maintaining their performance after. Given the role and importance of the schools, the impact of culture and environment on resilience, without any indigenous and comprehensive tool for measuring the resilience in Iran, the study aimed to design and psychometrically evaluate the measurement tools.MethodThis study was conducted using a mixed-method sequential explanatory approach. The research was conducted in two main phases of production on items based on hybrid model and the psychometric evaluation of the tool. The second phase included validity (formal, content and construction) and reliability (multiplex internal similarity, consistency and reliability).ResultThe integration of systematic and qualitative steps resulted in entering 91 items into the pool of items. After formal and content validity, 73 items remained and 44 were omitted in exploratory factor analysis. A questionnaire with 5 factors explained 52.08% of total variance. Finally, after the confirmatory factor analysis, the questionnaire was extracted with 29 questions and 5 factors including "functional", "architectural", "equipment", "education" and "safety". Internal similarity and stability in all factors were evaluated as good.ConclusionThe result showed that the 29-item questionnaire of school resilience in emergencies and disasters is valid and reliable, that can be used to evaluate school resilience. On the other hand, the questionnaire on assessment of school resilience in disasters enables intervention to improve its capacity.

In some cases, impulse- or shock-type excitations as the dynamic loading are inevitable, and obtaining proper response with the well-known numerical methods is not easy. This paper focuses on dynamic response estimation against short-time loading with an updated finite element model using frequency response functions (FRF) and particle swarm optimization (PSO) technique. Because there is not an analytical method for assessing the numerical responses under shock-type excitations, in this paper, experimental tests are designed on a laboratory scale to evaluate the numerical responses. The vibration responses of the system against shock loading are compared with the Newmark average acceleration scheme and also with experimental data. The results reveal that the unconditionally stable Newmark method against regular loads has an appropriate performance. Still, under short-time loading, it faces numerical damping error, and this method should not be blindly applied under shock-type loads.

Evaluation the Status of Patient Safety Culture from the Perspective of Healthcare Personnel of Teaching Hospitals Affiliated to Alborz University of Medical Sciences Norouzinia Roohangiz1,2, Aghabarary Maryam3, Mirzaei Samaneh4, Rahimi Fatemeh5, Nouri Khaneghah Zahra6* 1. Lecturer, School of Paramedical Sciences, Alborz University of Medical Sciences, Karaj, Iran 2. PhD Student, Management and Health Economic Research Center, School of Management and Medical Information Sciences, Isfahan university of Medical Sciences, Isfahan, Iran 3. Assistant Professor, School of Nursing, Alborz University of Medical Sciences, Karaj, Iran 4. PhD Student, Department of Health in Emergency and Disaster, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran 5. MSc, Shahid Rajaee Center, Alborz University of Medical Sciences, Karaj, Iran 6. Lecturer, Department of Operating Room, School of Paramedical Sciences, Alborz University of Medical Sciences, Karaj, Iran *Correspondence: School of Paramedical, Golestan 6, Baghestan st, Karaj, Iran Tel: 00982634349807 Email: z_noori86@yahoo.com Abstract: Background & Objectives: Patient safety culture is one of the effective factors in the prevention of medical errors and keeping patient safety, therefore, its assessment will lead to the identification of improvable factors and provision of corrective action solutions for the weaknesses. This study aimed to evaluate patient safety culture from the perspective of healthcare personnel of teaching hospitals affiliated to Alborz University of Medical Sciences. Methods: This cross-sectional descriptive-analytical study was conducted in 2018. The study samples were 168 personnel who were selected from two teaching hospitals affiliated to Alborz University of Medical Sciences, using simple random sampling. Data were collected using Hospital Survey on Patient Safety Culture (HSOPSC) with 12 dimensions. Data were analyzed using descriptive statistics and independent t-test by SPSS version 20. Results: The total mean score of patient safety culture was 3.21. Of 12 dimensions, teamwork in units had the highest mean score (3.5), and non-punitive response to errors had the lowest mean score (2.7). There was no significant difference between total mean scores of organizational learning and continuous improvement; supervisor expectations and actions promoting patient safety; relationships and feedback of errors; and teamwork in the unites of two hospitals. Conclusion: Development of an encouragement culture instead of punishment/blame culture is one of the issues that politicians need to pay attention to. In addition, continuous training of staff at all levels and occupations in terms of patient safety culture will be effective. Key­words: Patient safety, Patient safety culture, Teaching hospital, Nurse, Healthcare personnel ­Citation: Norouzinia R, Aghabarary M, Mirzaei S, Rahimi F, Nouri Khaneghah Z. Evaluation the Status of Patient Safety Culture from the Perspective of Healthcare Personnel of Teaching Hospitals Affiliated to Alborz University of Medical Sciences. Journal of Health Based Research 2018; 4(2): 123-34. [In Persian]

Background: Failure Mode Effects Analysis (FMEA) is an analytical method for risk assessment that seeks to identify and rank as far as possible the potential risks within the scope of risk assessment, as well as the causes and effects associated with it. Considering the classification of the Intensive Care Unit (ICU) as one of the high-risk wards, this ward of Ziaee Hospital- Ardakan is studied to identify, prioritize and evaluate errors, and present and implement proposed measures to reduce or eliminate possible errors. Methods: This is a quasi-experimental study of interventional type. The present study is a quantitative, qualitative combination of inductive and applied method and evaluates and analyzes the states and effects of the error using FMEA method in the form of a before-after study. Studies of this research were carried out during the period of January 26 to December, 2016 on the processes of the intensive care unit of Ziaee Hospital in Ardakan. The information collection is based on FMEA standard worksheet and formation of FMEA team. Results: Re-evaluate the risk priority number (RPN) after performing corrective measures showed that the priority score of all common errors was decreased in the ward. The results of this study indicated that out of 26 identified clinical errors, 10 first error modes were selected for further study. Selected error modes accounted for the highest error rate. This was related to the non-usage of routine disinfectants in hand washing with a score of 504, and the lowest score was related to the failure of the nurse to identify alarm type with a score of 240. Conclusion: We can reduce as much as possible the severity of injuries by re-measuring the priority score and making effective control and corrective measures by identifying the errors and methods of reducing these errors in the intended ward or in any other ward in the organization.

BACKGROUND Intestinal mast cells may cause gastrointestinal symptoms in patients with diarrhea-dominant irritable bowel syndrome (IBS). The objective of this study was to determine the effect of mesalazine on the number of lamina propria mast cells and clinical manifestations of patients with diarrhea-dominant IBS referred to Shariati Hospital affiliated to Tehran University of Medical Sciences. METHODS This was a randomized placebo-controlled double-blind trial conducted on 49 patients with diarrhea-dominant IBS. The patients were randomly assigned to one of the experiment or control groups. The patients in experiment group took 2400 mg mesalazine daily in three divided doses for 8 weeks and the patient in control group took placebo on the same basis. Our first targeted outcome was an assigned downturn of mast cells number to the safe colonic baseline and the next one was a marked palliation of disease symptoms. Data were analyzed conforming intention-to-treat method. We used MANCOVA test to compare our both assigned outcomes in the two groups. We also compared the data with baseline values in both groups. All statistical tests were performed at the significance level of 0.05. RESULTS There was no significant difference between Mesalazine and placebo groups regarding the number of mast cells (p value=0.396), abdominal pain (p value=0.054), bloating (p value=0.365), defecation urgency (p value=0.212), and defecation frequency (p value=0.702). CONCLUSION Mesalazine had no significant effect either on the number of mast cells or on the severity of disease symptoms. This finding seems to be inconsistent with the hypothesis indicating immune mechanisms as potential therapeutic targets in IBS. The possible difference in this effect of Mesalazine should be evaluated in further studies among populations varying in race, ethnic, and geographical characteristics.

We report a 35-year-old woman referred to the Imam Ali Hospital, Kermanshah, Iran, in July 2014 for evaluation of postoperative dyspnoea after neurosurgery performed seven days previously for a ruptured cerebral artery aneurysm. She was known to have Behçet’s disease with a history of recurrent oral and genital aphthous ulcers and uveitis. At referral, her symptoms included vertigo, dysarthria, palpitations and chest pain. Transthoracic echocardiography (TTE) revealed a large thrombus in her right ventricle outflow tract and open-heart surgery was performed eight days after the previous surgery to remove the clot. The postoperative period was complicated by transient acute renal failure, which resolved spontaneously. The patient was discharged 13 days after the cardiac surgery on warfarin, prednisolone, azathioprine and cyclophosphamide. Cyclophosphamide and azathioprine were discontinued after three months as the symptoms had completely resolved; however, prednisolone was continued due to recurrent uveitis. A 10-month follow-up TTE scan revealed no thrombus recurrence and treatment with warfarin and prednisolone was continued.

OBJECTIVES: This study discussed about challenges and opportunities of institutional accreditation in Iranian medical universities. The lesson learned of the first round of the accreditation would direct initiatives and solutions for future accreditation. METHODOLOGY: This research is a qualitative content analysis research that studied the experience of the survey visit teams. Semistructured interviews with a purposive sampling approach were done to reach data saturation. Constant comparative method was used to analyze the data. RESULTS: The emergent themes were incompatible scheduling with accreditation workload, accreditation sustainability, the weakness of the survey instrument, advantage of the survey instrument, the quality of evaluators' survey, the opportunity of progress for universities, accreditation perspective, defendable cost opportunity, perceived injustice, and the leading strategies. In this study, the relationship between categories and themes was shown with a systematic approach. CONCLUSION: In medical education systems, it is necessary to continue the research and development studies using the findings in each accreditation period to achieve the prospect of international accreditation.

BACKGROUND AND OBJECTIVES: School resilience is defined as risk-reducing strategies used to create a safe environment for students when faced natural disasters. Resilient schools, in addition to their educational role, provide a suitable capacity for responding to disasters and rehabilitation after the incidence. This study determined the level of disaster resilience of schools in Yazd, central Iran. MATERIALS AND METHODS: This is a descriptive-analytic study conducted among 400 schools and 367 participants in Yazd, 2018. To collect data, we used the school resilience in disasters questionnaire (α =0.95 and intraclass correlation coefficient = 0.97 [95% confidence interval: 0.96–0.98]) containing 48 questions. We also analyzed the gleaned data through the Pearson correlation coefficient, one-way ANOVA, and independent t-test. RESULTS: The total score of school disaster resilience was 153.30 ± 29.57. In these schools, the function had the highest (47.76 ± 13.96), and safety had the lowest (6.74 ± 3.18) score among all areas of school disaster resilience. There was a positive significant correlation between total resilience and areas of function, education, structural, nonstructural, architecture, commute routes, safety, location, and equipment (P < 0.001). Location had the smallest (r = 0.424) and function had the greatest (r = 0.854) correlation with total resilience. CONCLUSION: It can help the school management board in assessing the level of resilience of their school and determining the priorities for disaster risk reduction. Awareness of the status of resilience can help policy-makers and experts create an effective program for increasing resilience.

Abstract Introduction: The SERVQUAL model is one of the most common models used for assessing the quality of educational services. The purpose of this study was to investigate the quality of educational services based on SERVQUAL model in viewpoint of medical students of Alborz University of Medical Sciences in three stages: basic sciences, externship and internship. Methods: The present study was a cross-sectional descriptive analytical study in which 332 medical students were enrolled in three stages: basic sciences, externship and internship randomly. The data gathered using a questionnaire of 25 questions which was designed based on the standardized SERVQUAL questionnaire. Data were analyzed using descriptive statistics, paired t-test, independent t-test and one way ANOVA with Spss V.24.0. Result: The results showed that there was a significant difference between the expectations and perceptions of medic al students in all aspects and in total score and their expectations had not been met. The maximum gap was related to the assurance dimension and the lowest gap was related to the reliability dimension. The overall gap was also 1.50. In addition, students' expectations at different stages were different in all aspects except "tangible dimensions" and "total quality of services". But their perception was different in two dimensions of tangible and reliable. Conclusion: According to the results of this study, the students are dissatisfied with the current condition in the university and there is a long way to accomplish the desired status and satisfaction of the students as the main customers of the university’s educational services, and in many cases there is a need to evaluate and improve the conditions. Keywords: Educational Service Quality, Medical Student, Internship, Externship

The creation of various risks followed by financial and human life losses has globally doubled the need for paying attention to education in order to promote the preparedness in higher order documents. With regard to disasters, the importance of education has been emphasized repeatedly in the operational program of Hyogo (2005-2015) (1) and Sendai framework (2015-2030) (2) by reducing the disaster risks and creating the resilience in line with the consistent development. In this realm, schools play a major role in educating the generations that can exert a significant effect on increasing disaster-resilience in the course of time (3). Schools, as educational places, host many students annually and students spend most of their time in schools. Schools can serve not only as educational sites, but also as emergency lodgings for people in emergency cases (4). However, some schools cannot be used for this purpose since they damage the building constructs leading to lack of resilience in disasters. On the other hand, many students get injured or die annually due to the natural disasters or man-made events. For instance, the earthquake and tsunami in Japan (2011) damaged 6000 schools and killed 607 people (575 students and 24 teachers) (5) and the earthquake of Bohol in the Philippines (2013) also damaged 604 primary schools and 92 high schools (6). These are examples of school damages while safety, preparedness, and school resilience against disasters can be enhanced by implementing and supervising the standards of constructs and infrastructures. Furthermore, developing the performance process in schools along with increasing sensitivity and attention can be helpful in this area (7).Thus, schools can be safe places for students and suitable shelters and lodgings for harboring disaster survivors. It should also be noted that disaster-resilient schools could increase the community preparedness for responding properly at the time of disasters and events through educational programs in the field of risk perception and preventive measures (8). Therefore, development of an instrument for measuring the resilience level is a challenging issue, which is considered as a serious problem for researchers in their studies on disasters. Consequently, it is mandatory to develop a local and suitable instrument for measuring the components that affect school resilience in disasters and introduce it to the interested parties

Objectives We aimed to investigate the frequency of depression among elderly residents of Sedigh Nursing Home and the related factors in Khorramabad. Methods & Materials In this descriptive-analytic study, 87 elderly people (21 men and 57 women) above 60 years were selected through census method. Depression was evaluated with the Geriatric Depression Scale (GDS). To assess the relationship between depression and demographic factors, independent t-test and Fisher's exact test and SPSS version 19 were used. Results 36% of the participants were not depressed and 64% of them showed some degree of depression; 19.2% had moderate depression and 16.6% had severe depression. The relationship between depression in the elderly, age and education level were significant. As with aging, the prevalence of depression decreased (P

Background: We aimed to explore whether maternal asymptomatic hepatitis B (HB) infection effects on pre-term rupture of membranous (PROM), stillbirth, preeclampsia, eclampsia, gestational hypertension, or antepartum hemorrhage. Methods: We searched the PubMed, Scopus, and ISI web of science from 1990 to Feb 2015. In addition, electronic literature searches supplemented by searching the gray literature (e.g., conference abstracts thesis and the result of technical reports) and scanning the reference lists of included studies and relevant systematic reviews. We explored statistical heterogeneity using the, I2 and tau-squared (Tau2) statistical tests. Results: Eighteen studies were included. Preterm rupture of membranous (PROM), stillbirth, preeclampsia, eclampsia, gestational hypertension and antepartum hemorrhage were considerable outcomes in this survey. The results showed no significant association between inactive HB and these complications in pregnancy. The small amounts of P-value and chi-square and large amount of I2 suggested the probable heterogeneity in this part, which we tried to modify with statistical methods such as subgroup analysis. Conclusion: Inactive HB infection did not increase the risk of adversely mentioned outcomes in this study. Further, well-designed studies should be performed to confirm the results.

Although poly vinyl alcohol-poly acrylic acid (PVA-PAA) composites have been widely used for biomedical applications, their incorporation into double-layer assembled thin films has been limited because the interfacial binding materials negatively influence the water uptake capacity of PVA. To minimize the effect of interfacial binding, a simple method for the fabrication of a double-layered PVA-PAA hydrogel was introduced, and its biomedical properties were evaluated in this study. Our results revealed that the addition of PAA layers on the surface of PVA significantly increased the swelling properties. Compared to PVA, the equilibrium swelling ratio of the PVA-PAA hydrogel increased (p = 0.035) and its water vapour permeability significantly decreased (p = 0.04). Statistical analysis revealed that an increase in pH value from 7 to 10 as well as the addition of PAA at pH = 7 significantly increased the adhesion force (p < 0.04). The mechanical properties—including ultimate tensile strength, modulus, and elongation at break—remained approximately untouched compared to PVA. A significant increase in biocompatibility was found after day 7 (p = 0.016). A higher release rate for tetracycline was found at pH = 8 compared to neutral pH.

Context: Advanced cancer is one of the most complicated conditions for both patients and their relatives. This study aimed at investigating the challenges of home parenteral nutrition (HPN) in patients with advanced cancer. Evidence Acquisition: In this study, all articles published in English from 2000 to 2022 on dietary support for HPN in patients with advanced cancer were collected from several databases, including Medline, Scopus, and Google Scholar, using related keywords such as "advanced cancer" and "home parenteral nutrition". Results: The different issues of HPN were examined for different dimensions such as HPN during palliative care, deciding HPN, patients' safety, supportive environment, and health literacy. Regarding ethical issues on HPN, 4 principles including charity, autonomy, harmlessness, and justice should be considered in patients with advanced cancer. Considering recent findings on the beneficial effects of nutrients in patients with advanced cancer, there may be a need to revise the guidelines related to parenteral nutrition support in these patients. Conclusions: Different challenges should be especially considered in adopting appropriate approaches in the field of HPN in patients with advanced cancer. More longitudinal studies in this field are needed. [ABSTRACT FROM AUTHOR]

Background: Despite the confirmed association between higher BMI with increased risk of the acute respiratory distress syndrome (ARDS), the association between obesity with mortality in critically ill patients with coronavirus disease 2019 (COVID‐19) is not clear. The present study aimed to investigate the association between obesity with treatment duration, ICU length of stay, and the risk of death in critically ill patients with COVID‐19. Methods: This case–control study was performed on 223 patients with COVID‐19 including 148 surviving patients as the control group and 75 eventually dead patients as the case group in Rasht, Iran. Data on demographic factors, comorbidities, anthropometric measurements, the length of hospitalization and the mortality were obtained from patients' medical records. Results: The mortality rate was significantly associated with weight (OR = 1.04, 95% CI: 1.002–1.083, p =.04), but not with BMI after adjustments for age, gender, length of stay in ICU, chronic diseases and smoking. The results did not change after further adjustments for biochemical and pathological factors. Conclusions: Weight was positively associated with mortality after controlling for confounding variables. Further studies should consider the patient's body composition such as fat mass to establish the relationship between obesity and COVID‐19 outcomes. [ABSTRACT FROM AUTHOR]