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Abstract Background We aimed to examine medical students’ perceptions regarding their professional identity and explore their creative narratives utilizing the Dialogical-Self Theory (DST). Methods This is a mixed-method study. First-year medical students at Tehran University of Medical Sciences (TUMS, Tehran, Iran wrote a creative narrative about their perspectives on their future profession. Based on DST, qualitative-directed content analysis and summative approach were used to identify and quantify different “I-positions” to assess professional identity formation. Results One hundred eighty-eight first-year medical students at TUMS participated in the study in 2021–2022. In the creative narratives, the reference to “I” was more than other pronouns (he/she/they). The use of “I” positively correlated with rank in the university entrance exam (P value = 0.03). The highest application of “I” per participant belonged to the “present I-position,” and the lowest to the “promoter,” which has the highest rank in the formation of professional identity. Women tended to use the “present I-position” more than men (P value = 0.03). Conclusions First-year medical students have accepted their self-role in forming professional identity; however, they have not found a vast perspective of it, as shown by their inability to use meta I-position and promoter I-position. Therefore, educators must provide plans within the curriculum to enhance competencies of professional identity formation. These plans can include incorporating narration writing to encourage medical students to reflect on their professional identity.

ABSTRACT Introduction Neonatal diabetes mellitus (NDM) is a rare non‐immunological monogenic disorder characterized by hyperglycemic conditions primarily occurring within the first 6 months of life. The majority of cases are attributed to pathogenic variants in genes affecting beta‐cell survival, insulin regulation, and secretion. This study aims to investigate the genetic landscape of NDM in Iran. Methods We recruited a total of 135 patients who were initially diagnosed with diabetes at

Introduction: Understanding the relationship between medical students' attitudes towards conflict management and their dominant conflict management styles is crucial for improving their ability to effectively handle challenging situations. This study aimed to determine the relationship between medical students' attitudes towards conflict management and their conflict management styles. Method: This was a descriptive, analytical study involving 244 first-year general medicine students from Tehran University of Medical Sciences. The Conflict Management Attitude Questionnaire (CMAQ) and the Conflict Management Styles Questionnaire (DUTCH) were used to collect data. Pearson's correlation coefficient and independent t-tests were employed for data analysis. Results: The results showed that students predominantly used problem-solving (15.80 ± 2.18) and compromising (15.00 ± 2.23) styles. Pearson's correlation analysis revealed a significant positive correlation between the average score of attitudes towards conflict management and the average scores of the compromising and problem-solving styles (P = 0.014, r = 0.162; P = 0.000, r = 0.287, respectively). Additionally, a significant negative correlation was found between the average score of attitudes towards conflict management and the average score of the avoiding style (P = 0.010, r = -0.170). The t-test results indicated a significant difference in the competing style between male and female students (P = 0.038). Conclusion: Identifying the strengths and weaknesses of clinical education is the first step towards improving the quality of medical education. Then the faculty development programs planners should design, implement and evaluate educational development programs for clinical faculty to improve their educational skills in the clinical education environment.

Abstract Background This study aimed to adapt mental health first aid guidelines to support individuals with or at risk of developing eating disorders in Iran. This adaptation seeks to enhance the support available for the Iranian population dealing with these disorders. Methods We employed the Delphi expert consensus method, utilizing two panels: health professionals (n = 37 in the first round; n = 29 in the second) and individuals with lived experience (n = 20 in the first round; n = 18 in the second). The health professionals panel was selected from the graduates of various eating disorders associated scientific fields who had a history of providing services to or conducting research on people with eating disorders, and the lived experience panel had a history of eating disorders themselves or in their family. The panel of individuals with lived experience included those who had personal or familial histories of eating disorders. Efforts were made to ensure cultural, gender, and age diversity in the selection of panel members. Panellists rated the importance of each item for inclusion in the guidelines for Iran based on the English-language Mental Health First Aid guidelines for eating disorders. Items deemed essential by at least 80% of both panels were included in the final guideline. Additionally, panel members were invited to suggest any missing items. Results A total of 57 participants took part in the first round of the survey, and 47 participated in the second round. In the first round, 204 items across 11 categories were assessed, with 174 items endorsed by the panels. Thirteen items were re-scored in the second round, and 17 items were rejected. Participants suggested 11 new items in the first round. In the second round, 18 out of 24 items were endorsed, while six were rejected. Ultimately, 192 items were incorporated into the Iranian guidelines. Conclusions The adaptation process considered Iran's social and cultural characteristics, including the stigma associated with mental health disorders, religious beliefs and rituals such as fasting, linguistic differences between English and Farsi, distrust of strangers, the influence of friends and family, differences in food access, and low mental health literacy. We recommend piloting the adapted guidelines in high schools, universities, and non-governmental organizations to evaluate their feasibility and effectiveness in real-world settings. Furthermore, it is essential to establish mechanisms for feedback, update content based on the latest evidence, and collaborate with the media to promote educational programs and public participation.

Abstract Background Medical staff migration is one of the challenges for both developed and developing countries affecting society’s health and welfare, which limits access to equity. Therefore, this study was designed and conducted to investigate the tendency to migrate and the factors affecting it among medical students of the Tehran University of medical sciences, Tehran, Iran, in 2019. Methods This cross-sectional study was performed among 472 medical students using a valid questionnaire which was designed after reviewing the literature and using the opinions of experts. The tendency to migrate and its associated factors were analyzed and reported using the Pearson correlation test, independent t-test, one-way ANOVA test, Tukey post-hock test, and Kruskal–Wallis non-parametric test. Results According to this study, the tendency to migrate was 6.13 ± 2.82 out of 10. While there was no significant relationship between age, marital status, medical educational phase and the tendency to migrate (p > 0.05); There was a significant relationship between willingness to migrate with variables of gender (p = 0.027), pre-university study region (p

Abstract Background Reflection is a key element in learning from observation and experience of future profession’s roles and responsibilities in clinical encounters. Moreover, reflection helps students cope with the challenges, complexities, and uncertainties of professional development. Students’ written reflections on clinical exposure offer valuable information, and their analysis provides instructors with invaluable insight into students' experiences. This study evaluated Operating Room students’ written reflections on their first clinical exposure experiences towards their future profession through the shadowing program. Methods This study was a qualitative analysis on Operating Room freshmen’s reflections in the undergraduate program of Zahedan and Zabol University of Medical Sciences in Iran. After the shadowing program, all participants were asked to write an unstructured written reflection, and these fifty written reflections were de-identified and independently analyzed‏ using the thematic analysis approach. Results Qualitative analysis extracted 10 subthemes and four main themes including (i) Moving towards the guiding realities of future profession, (ii) Discovering milestones of realizing professional identity, (iii) Managing the emotions affecting the perception of future profession’s desirability, and (iv) Excellence in professional growth and development. Conclusion Reflecting on the experience of the shadowing program, the participants described being in the OR environment as a stimulating and valuable learning opportunity. Moreover, this experience helped improve their perception of future profession’s realities, as well as initiate realization of professional identity and planning for professional developments.

Key Clinical Message Infantile liver failure type 2 is described as repeated attacks of liver dysfunction with remission. This syndrome should be considered in the differential diagnosis of any child with symptoms of recurrent hepatic encephalopathy. Abstract Infantile liver failure syndrome 2 is described as recurrent attacks of liver dysfunction. ILFS2 should be included in the differential diagnosis of children with frequent and acute liver failure. We present a 2.5‐year‐old boy with clinical manifestation of acute liver failure. In past, he had two similar attacks.

Abstract Objective Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy syndrome (APECED) is a rare autosomal recessive systemic autoimmune disease caused by mutations in the autoimmune regulator (AIRE) gene. Incidence of this genetic disorder is estimated at 1/90,000–200,000 worldwide and 1/6500–9000 in genetically isolated populations such as Iran. Here, we investigated AIRE gene mutations in eight independent Iranian non-Jewish families. Methods We sequenced the coding regions of the AIRE gene and documented mutations which were further confirmed in respective parents. Results In total, 11 cases from 8 independent families were recruited. Mucosal candidiasis, Addison’s disease and hypoparathyroidism were the most common clinical manifestations in these patients. One novel homozygous splice acceptor mutation (c.308-1G>C), and one novel heterozygous stop-gain mutation (c.1496delC) combined with a known heterozygous c.232T>C missense mutation were found. Moreover, we observed previously described splice donor (c.1095+2T>A), frameshift (c.967-979del), stop-gain (c.415C>T), and missense (c.62C>T) mutations among the patients. All results were co-segregated in parents. Conclusion Here, we reported two novel mutations in the AIRE gene leading to APECED. Our data could provide insight into the phenotypic and genotypic spectrum of APECED in the non-Jewish Iranian population. These findings, in addition to future functional assays, can elucidate disease-causing mechanisms related to the AIRE gene and assist in genetic counseling and diagnosis.

Abstract Background The spread and severity of the COVID-19 pandemic have been to such an extent that to shape an effective, collective response, governments need the participation of society and the cooperation of a wide range of civil society organizations and institutions. The objective of this study was to identify the activities of non-governmental organizations (NGOs) in response to the covid-19 pandemic in Iran and the challenges they confronted. Methods We conducted a qualitative analysis based on twenty-two individual, virtual, and semi-structured interviews. Interviewees were selected through purposeful and snowball sampling. All interviews were performed with active health-related NGO representatives willing to participate in the study and continued until data saturation. Data analysis was performed using qualitative content analysis. Results The activities and challenges raised by NGO representatives were identified in 6 main categories, including the need for the participation of NGOs in the fight against pandemics, response to the COVID-19 crisis in the society, challenges in providing services to the target group in the COVID-19 crisis, NGOs challenges in interacting with governmental and non-governmental institutions, information sources used by NGOs in the COVID-19 crisis and strategies to support NGOs in their efforts. Conclusion Considering the crucial challenges for their participation, such as the NGO access to the target groups, lack of communication network, and constructive interaction between government institutions and the NGOs, it is recommended to increase the capacity of these institutions and intervene to establish a constructive and long-term relationship with the government.

Abstract Background The beliefs and attitudes of caregivers of working children about mental health issues and first aid and their attitudes about the stigma of mental health problems can affect their motivation to seek professional help for affected children. This study aimed to assess the mental health literacy among caregivers of child labor about first aid for mental health and their attitudes about the stigma of mental disorders. Methods The Depression Health Literacy Questionnaire has been used in this cross-sectional study. All caregivers of working children who were willing to participate were included in the study. This group is covered by a Non-Governmental Organization (NGO) located in the 17th district of Tehran. Results Questionnaires completed by 131 caregivers were analyzed. The average age of the participants was 32.6 (± 7.9) years. Of which 130 (99.2%) were mothers. Amongst, only 37 individuals (28.2%) were confident in their ability to help their children in case of depression symptoms. A majority of participants, 109 (83.2%), believed that asking a depressed child about suicidal ideation was harmful. Conclusion According to the findings of this study, the literacy among caregivers of child labor about mental health first aid in our study needs to be improved. There is also a need for educational and community-based programs to reduce the stigma about mental health disorders, including depression.

Introduction: Neonatal diabetes mellitus (NDM) is a rare non‐immunological monogenic disorder characterized by hyperglycemic conditions primarily occurring within the first 6 months of life. The majority of cases are attributed to pathogenic variants in genes affecting beta‐cell survival, insulin regulation, and secretion. This study aims to investigate the genetic landscape of NDM in Iran. Methods: We recruited a total of 135 patients who were initially diagnosed with diabetes at <12 months of age in Iran and referred to pediatric endocrinology clinics across the country. These patients underwent genetic diagnostic tests conducted by the Exeter Molecular Genetics Laboratory in the UK. The pathogenic variants identified were sorted and described based on type, pathogenicity (according to ACMG/AMP criteria), novelty, and the affected protein domain. Results: Genetic defects were identified in 93 probands, presenting various pathogenic abnormalities associated with NDM and its associated syndromes. 76% of the patients were born as a result of consanguineous marriage, and a familial history of diabetes was found in 43% of the cases. A total of 58 distinct variants in 14 different genes were discovered, including 20 variants reported for the first time. Causative variants were most frequently identified in EIF2AK3, KCNJ11, and ABCC8, respectively. Notably, EIF2AK3 and ABCC8 exhibited the highest number of novel variants. Discussion: These findings provide valuable insights into the genetic landscape of NDM in the Iranian population and contribute to the knowledge of novel pathogenic variants within known causative genes. [ABSTRACT FROM AUTHOR]

Abstract Background As a main challenge in paramedical faculties of medical sciences, freshmen lose interest in their academic field of study and then job motivation. Lack of developed knowledge about their academic field and unfamiliarity with their future job’s tasks and roles contribute to freshmen’s job motivation loss. Various interventional programs have been implemented to improve students’ job motivation by familiarizing them with their future job’s duties and responsibilities. Methods This was one-group pretest-posttest design study in 2019–2020. Students grouped into pairs of a freshman (shadowee) with a senior (shadower) in a clinical setting during shadowing program. This program helps freshmen to comprehend and discover realities of their academic field and can help them change their perspectives regarding their future job’s duties and responsibilities. The shadowees’ main task was reflective observation on operating room events and interactions and to be active in the program, several tasks e.g., how to wear gloves, guns, and disinfect equipment were assigned to them exclusively under the supervision of senior students. The Hackman and Oldham’s Job Diagnostic Survey (JDS) questionnaire and a novel Job Motivation Survey (JMS) questionnaire were distributed among participants. Results Fifty freshmen majoring in operating room participated in the shadowing program from November 2019 to January 2020. Before and after the program, they completed Hackman and Oldham’s job diagnostic survey and researcher-made job motivation survey questionnaires. Results were indicative of a significant difference in job diagnostic survey questionnaire score, where overall pre-test and post-test scores before and after the intervention were 57.78 (±9.78) and 68.58 (±5.02), respectively; the score difference was statistically significant (P

Background. Given the high prevalence of depressive disorders in the present world and the lack of adequate awareness about prevention and appropriate interventions, increasing mental health literacy is vital for promoting mental health to reduce depression and its consequences. Methods. In this descriptive cross-sectional study, participants were recruited among the second high school students in the 2018-2019 academic year. The sample size was 2038, and samples were selected by multistage cluster sampling from different areas of Tehran. Demographic variables like age, gender, level of education, and parents’ characteristics and mental health literacy questions in treatment and prevention areas were evaluated. Results. Analyses showed that of high school students, 83% considered getting help from psychiatrists and 80% considered learning stress management as the best preventive measures, while as the best treatment measures, 79.5% considered counseling the best place to refer for visiting a professional and 45% selected general counseling centers. Conclusion. The study results showed that high school students have a positive attitude toward preventing and treating depressive disorders, getting help from specialists, and useful measures for depressed people. But they did not know enough about preventive measures, including learning effective coping skills, reading self-help books, and continuing to take psychiatric medications. Planning and providing the necessary training are important, especially for high school students.

Objective: Mental health literacy is especially important during adolescence and youth, because the peak of the onset of mental disorders occurs in this period. The present study aimed to identify the effective systemic factors for improving Iranian adolescent mental health literacy from the Perspective of policymakers and experts. Method: This qualitative study was performed on 21 policymakers and health literacy/mental health experts since May 2020 to September 2020 in the workplace of the interviewees in Tehran. Purposive sampling (snowball method) was conducted based on experience, expertise, and the willingness to participate in an interview. All interviews were conducted with the presence of the interviewer at the interviewees' workplace in Tehran. The data were collected through semi-structured interviews and analyzed via the conventional content analysis method. Results: Five themes were extracted as systemic factors for improving adolescent mental health literacy. Themes were “mental health literacy training”, “integration and coordination of stakeholder organizations”, “resources and facilities”, “continuous assessment” and “provision of information.” Conclusion: Before policy-making and planning to enhance adolescents' knowledge and awareness of mental health issues, it is necessary to attract policymakers’ attention to the macro level and identify direct and indirect strategies for the correct implementation of policies adopted in this field.

Abstract Background and Aims Nongovernmental organizations (NGOs) have enormous potential to effectively prevent and manage diseases; however, little research is available on interventions used to improve NGOs' participation in this area. A scoping review was conducted to identify options proposed or implemented to improve the participation of the NGOs in preventive care. Methods Pubmed, Web of Science, and ProQuest were extensively searched. Google Scholar was also searched to find potential studies related to the subject. Relevant keywords were used in the English language. The reference list of relevant studies was also scanned. Studies were screened with defined inclusion and exclusion criteria. Relevant data were then extracted. Two individuals independently screened and extracted studies. The interventions implemented or proposed to promote the participation of the NGOs in the implementation of preventive interventions were deductively identified and classified. Results Eighteen articles were included in our review. We identified 31 interventions and categorized them into 11 strategies, including (1) building strong collaboration among NGOs and with governments; (2) expanding networks and sustained relations among NGOs; (3) evaluating the NGOs' performance; (4) increasing intersectoral collaboration; (5) advocating for the role of NGOs; (6) supporting NGOs from the side of government; (7) empowering the abilities and capabilities of NGOs; (8) defining the precise roles and responsibilities of the parties; (9) strengthening the health system governance; (10) increasing the health literacy of the community; and (11) developing required regulations, rules, and policies. None of the interventions identified had evidence of its effectiveness. Conclusion The current evidence on effective interventions to strengthen NGOs' participation in implementing health care is scanty. It means there is an information gap in the effect of interventions to improve NGOs' participation in health.

Background The diagnosis of esophageal varices (EV) is based on the findings of esophagogastroduodenoscopy (EGD), biopsy, and serum markers. Thus, noninvasive cost-effective tests through which high-risk EV children can be diagnosed are needed. Purpose This cross-sectional study aimed to identify the noninvasive markers for EV in children with liver cirrhosis. Methods A total of 98 children with liver cirrhosis were evaluated in this study. The spleen size, platelet count, serum albumin, liver function test results, and risk scores were evaluated prior to endoscopy. The endoscopic investigations aimed to identify the presence of EV and red signs, and determine varices sizes. Results Endoscopy revealed varices in 43 subjects (43.9%). The spleen size, platelet count, international normalized ratio, aspartate aminotransferase to platelet ratio index (APRI), platelet count to spleen size ratio, and risk score differed significantly between patients with and without EV on univariate analysis; however, the logistic regression analysis showed no differences, indicating that none of these parameters were independently associated with the presence of EV. Conclusion Platelet count, risk score, platelet count to spleen size, and APRI can be useful tools for the identification of high-risk patients with EV and might reduce the need for invasive methods like EGD.

Background: Chest pain is one of the most common reasons for people to go to cardiac emergency clinics. This study was conducted with the aim to evaluate the prevalence of psychiatric disorders in patients with chest pain referred to the heart emergency clinic of Taleghani Hospital, Tehran, Iran. Methods: This descriptive-analytic study was performed on 103 patients with chest pain who were referred to the emergency department. Furthermore, a follow-up was carried out. Data were collected using a demographic information form and mental health survey (28-item General Health Questionnaire; Goldberg & Hillier, 1979) in the two groups of cardiac and non-cardiac chest pain. Results: Among all the referred patients, 74 patients (71.8%) did not have a definitive diagnosis of cardiovascular disorders (CVDs). The results revealed that among the patients with non-cardiac chest pain, 56 (75.7%), 55 (74.3%), 54 (73%), and 22 (29.7%) individuals had phyisical disorder, anxiety, social dysfunction, and depressive disorder. Among the patients, who were definitively diagnosed with CVDs, 14 (48.3%), 10 (34.5%), 7 (24.1%), and 6 (20.7%) individuals had anxiety, physical disoreder, social dysfunction, and depressive disorder. Among all patients, physical disorder had a significant relationship with gender (P = 0.047), and physical and anxiety disorders had a significant relationship‎ with history of recurrent chest pain in the last 6 months (P < 0.05). Conclusion: Due to the high number of non-cardiac patients who refer to the emergency department with chest pain complaints, it is recommended that all patients with chest pain complaints be screened for psychiatric diseases.

Background: One of the community-based interventions for increasing mental health literacy is mental health first aid (MHFA) training. The current study measured literacy regarding MHFA for eating disorders (EDs) among the youth and adolescents. Methods: This cross-sectional study was performed on those aged 16-29 years in Tehran, Iran. The sample size was 252 individuals. For data gathering, the Mental Health Literacy Questionnaire (MHLQ)‎ was used that was modified for EDs. The validity and reliability of the Persian version of the MHLQ‎ was confirmed. Data were analyzed using SPSS software. To determine the demographic variables that can predict participants' literacy concerning EDs, logistic regression analysis was used. Results: Among the participants, 11.5 could successfully diagnose EDs, 34.5 were not at all confident in their ability to help, and 36.95 said they would not seek help if faced with a similar problem. Most of the participants selected “obtaining more information about the problems described in the ‎vignette and available services” and “listening to the problems of the ‎vignette character in an understanding way” as the correct first aid interventions. Family and friends were mentioned as the main influential people. Higher education could significantly predict the ability to correctly diagnose the disorder (P = 0.03) and help-seeking behavior (P = 0.002). Only relatives' history of exposure to the problems described in the vignette could significantly predict higher scores in diagnosing suitable first aid (P = 0.02). Conclusion: In general, mental health literacy regarding EDs was not suitable among the participants of this study. Thus, it seems necessary to consider targeted MHFA training, particularly in the field of EDs, to provide training in an understandable language to the community and with emphasis on seeking professional services.

Introduction: Myopathy and rhabdomyolysis are not common in children and, if not detected and do not treated it will be associated with high mortality and morbidity rate. The causes of rhabdomyolysis include hypokalemia, trauma, viral myositis, poisoning, rheumatoid diseases, and metabolic myopathies. Rhabdomyolysis treatment includes rapid supportive care and treatment of the underlying disease leading to rhabdomyolysis. Case Presentation: 10-year-old girl with progressive muscle weakness was admitted in Pediatric Intensive Care Unit (PICU) with acute renal failure and respiratory failure. The laboratory results showed myoglobinuria, high CPK, LDH. The initial diagnosis was severe rhabdomyolysis. In addition to fluid therapy and diuretic, she was treated with carnitine and riboflavin with possible glutaric aciduria type II. The patient showed progressive improvement after a few days. Result of plasma acyl carnitine and urine organic acid analysis stablished the diagnosis of glutaric aciduria type II. Conclusion Late onset glutaric aciduria type II has been described as a rare but treatable cause of myopathy and rhabdomyolysis. Glutaric aciduria type II is an important differential diagnosis to consider in children and adults presenting with myopathy and rhabdomyolysis.

Mucopolysaccharidoses (MPS) are a subgroup of lysosomal storage disorders. The underlying mechanism of MPS disorders are deficiency in specific enzymes which leads to accumulation of partially degraded glycosaminoglycans (GAGs) in various tissues. A wide variety of manifestations are reported but musculoskeletal complaints are common among them. In milder forms of MPS, musculoskeletal complaints are presenting symptoms. Delays in diagnosis due to unspecific and mild symptoms is common. Misdiagnosis of MPS as juvenile idiopathic arthritis and other inflammatory arthritis disorders is frequent. Early diagnosis and treatment prevents irreversible cellular damages and is a key factor in efficacy of enzyme replacement therapy. In this study we described two MPS patients with musculoskeletal complaints who were not diagnosed for a period of time. Although musculoskeletal manifestation are common in a variety of clinical conditions, their presence at low ages or co-occurrence of other manifestations (such as cardiac, respiratory, neurologic, etc.) in multiple systems should prompt evaluation of patients for MPS and other metabolic disorders. The rheumatologists’ awareness on MPS should be promoted to achieve timely diagnosis and subsequent early treatment.

Medical professionalism has a crucial role in educating medical students. The role of professionalism in the clinical environment is therefore an important factor in medical education. This study attempts to evaluate the opinions of medical students in the teaching hospitals of Tehran University of Medical Sciences (TUMS) about the professionalism environment in this university. A sample of 165 students filled out the Persian translation of UMKC-SOM (Climate of Professionalism Survey) questionnaire. This instrument evaluates students’ perspectives on the degree of adherence to professionalism by faculty, residents and other students. The results of the study revealed that the total score of professionalism climate was 53.9 for faculty, 42.09 for residents, and 50.76 for students and the difference between these three groups was statistically significant (p-value < 0.01). Results of further analysis through post-hoc tests for multiple comparisons among the groups revealed that the students found their fellow students and faculty more professional than residents. The study also showed that the medical ethics course had no impact on perceptions observations (p-values > 0.05).The study results also revealed that the students found their fellow students and faculty more professional than residents. This finding demonstrates the importance of teaching professionalism to residents since they serve as role models for students.Further multicenter studies are needed to improve the professionalism climate in the medical teaching environment.

Objective: Recognizing the status of mental health literacy among women and girls as effective and key individuals in family and society seem to be essential. Therefore, the present study was conducted to evaluate depression literacy among women and girls in Tehran on prevention and effective interventions for improving depression. Method: This study was part of a large mental health literacy project on residents of Tehran in 2017, with a sample size of 1023 girls and women aged 16-68 years. Random Digit Dialing (RDD) sampling was done using the Australian questionnaire, whose Persian version’s validity and reliability was tested in our previous study. Data were analyzed by SPSS 21 software. In order to determine the effect of demographic variables on predicting depression literacy among participants, multiple regression analysis was performed. Results: Receiving counseling, relaxation training, having physical activity, and studying self-help books were the most helpful items, respectively, from the participations’ point of view. More than 70% of participants agreed with avoiding stressful situations and close relationship with family and friends, while only 49.8% agreed with coping skills learning. Based on the regression analysis, only higher education and the history of exposure to a person with similar Vignette problem were able to predict mental health literacy in the area of intervention and prevention. Conclusion: Considering the effects of women’s and girls’ depression on individual, family, and even social life, more attention should be paid to improve depression literacy in this group.

Background: Happiness is the most basic requirement of human mental health. The health of medical students who deal with the health of the community is very important. The aim of this study was to compare the happiness of students in different fields in Shahid Beheshti University of Medical Sciences, Tehran, Iran. Methods: This descriptive-analytic study was performed on 100 medical, dental pharmacy, nursing, and health students in Shahid Beheshti University of Medical Sciences in 2019. The data were collected using the Iranian euphoria questionnaire. Results: All students obtained an average happiness score. The highest level of happiness was related to dentistry and the lowest was related to nursing and health. There was no significant difference in the level of happiness among students in different disciplines, and it did not correlate with gender, marital status, educational status, place of birth and residence, mother's education, number of children in the family, and employment. There was a significant relationship between happiness and father's education (P = 0.02) and satisfaction with the field of study (P = 0.003). Conclusion: Considering the moderate level of happiness observed in this study and the direct effect of students’ happiness on the future of the society, in order to educate a more productive generation, it is necessary to take measures to increase happiness and determine the factors affecting it. Creating job opportunities and valuing different jobs can increase the happiness of these students, which requires further in-depth studies.

Background: Growth disturbance is a common phenomenon in children with congenital heart diseases (CHD). Malnutrition and nutritional disturbances have a higher prevalence among children with down syndrome, especially children with Down syndrome; on the other hand, the prevalence of CHD is higher among syndromic children, which needs surgical repair as the definitive treatment. The nutritional status plays an important role in determining the postoperative complications and recovery. The purpose of this study was to investigate the growth status of children with Down syndrome and congenital heart disease before cardiac surgery. Methods: This study was conducted as a retrospective study by evaluating the records of all syndromic patients undergoing cardiac surgery at Children’s Medical Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran, from March 2011 to March 2017. Age, weight, height, weight-for-age z-score (WAZ), weight-for-height z-score (WHZ), height-for-age z-score (HAZ), mortality and hospitalization rate in an intensive care unit (ICU) were recorded in these patients. The z-scores more than -1 were considered as normal, between -1 and -2 as mild malnutrition, between -2 and -3 as moderate malnutrition and below -3 as severe malnutrition. Results: 35 (51.5%) patients were female and 33 (48.5%) were male. The mean age, weight, and height of these children were 26.9±24.9 months, 9.1±4.95 kg, and 79.55±17.95 cm, respectively. The mean of WHZ, WAZ, and HAZ in these children was -2.18+1.65, -1.95+2.25 and -1.22+3.11, respectively. Based on the values of WAZ, WHZ, and HAZ, 85.3%, 77.9% and 75% of patients have malnutrition (mild to severe forms, z-score less than -1). The most common cardiac defect was ventricular septal defect (VSD) accompanied by pulmonary arterial hypertension. Conclusion: Considering the high prevalence of impaired nutritional status in these children and considering the effect of preoperative malnutrition on surgical outcomes, including mortality, assessing the nutritional status is much important. The adequate nutritional support in these patients leads to a reduction of the mortality, postoperative complications and morbidities.

Factors affecting the time of survival after breast cancer (BC) diagnosis remain unknown. However, some of the prognostic factors have been identified. The aim of this study was to investigate the effects of biologic and socioeconomic factors on long-term survival of BC patients. This was a descriptive chart review and survey of all women with a confirmed diagnosis of BC registered in Shohada-e-Tajrish Cancer Research Center database from March 2004 to March 2015. The checklist of study consisted of biologic, demographic, reproductive, genetic, medical, and therapeutic information of patients. The minimum time of follow-up was 3 years and the maximum was 10 years. We then evaluated possible associations of these variables with BC survival using Cox and parametric regression models of survival analysis. The study population was 1276 BC patients. Their mean survival was 23 (range 1–120) months. Between the parametric models, Weibull regression model demonstrated the lowest Akaike information criterion and thus the best fit, and tumor size, number of lymph nodes, BC stage, educational level, and high-fat diet were significant in this model. Based on our findings, educational level, consumption of fat, and characteristics of tumor at the time of diagnosis (disease stage, tumor size, number of involved lymph nodes) are the most important prognostic factors affecting long-term survival of BC patients. We suggest that future studies assess the efficacy of possible interventions for these factors.

Providing care for terminally ill neonates is an important issue in NICUs. This research aimed to determine nurses’ attitudes toward providing care for terminally ill neonates and their families. A total of 138 nurses working in neonatal intensive care units (NICUs) affiliated to Tehran University of Medical Sciences participated in this cross-sectional study via convenience sampling in 2019. The Data collection tool was the Frommelt attitudes toward caring for terminally ill persons and their families scale. The nurses in this study had the most positive attitudes toward the items “nursing care should include the family of the terminally ill patient, too” (4.2 ± 0.6) and “the care provider can prepare the patient or his/her family for death” (4.1 ± 0.7). The nurses had the least positive attitude toward the item “the time spent on caring for terminally ill patients creates a sense of frustration in me” (1.06 ± 1). The mean score of the attitudes of NICU nurses toward caring for terminally ill neonates and their families indicates the necessity of improving this attitude.

Premature pubarche (PP) is the appearance of sexual hair in children before puberty. The PP phenotype may attribute to nonclassic congenital adrenal hyperplasia (NC-CAH). In this study, we investigated the role of CYP21A2 gene variants in patients with PP in the Iranian population. Forty patients (13 males and 27 females), clinically diagnosed with PP, were analyzed for molecular testing of CYP21A2 gene variants. Direct sequencing was performed for the samples. Also, gene dosage analysis was performed for the cases. Fourteen patients (35%) had a mutation of p.Gln318X and p.Val281Leu, out of which 10% had regulatory variants. Approximately 10% of the patients were homozygous (NC-CAH). 78.5% (11/14) of patients had trimodular RCCX of which 5 patients had two copies of CYP21A1P pseudogene. The prevalence of p.Val281Leu was higher than p.Gln318X in PP patients. In conclusion, CYP21A2 variant detection has implications in the genetic diagnosis of PP phenotype. The genetic characterization of the CYP21A2 gene is important for characterizing the variable phenotype of carriers and genetic counseling of PP and NC-CAH patients.

Objective (s): Decision making about characteristics of reward system is one of the main challenges in organizations. The current study was carried out in order to design and provide a reward system for staff working in hospital affiliated to Tehran University of Medical Sciences (TUMS) hospitals. Methods This study was performed in two steps from May 2014 to January 2016 in Tehran. First, the research team identified the main axes of reward system using semi-structured interviews with experts and stakeholders. Then the list of final criteria for rewarding was prepared in addition to weight for each criterion using ‘pairwise comparison analysis’. Secondly, in order to identify the executive requirements, the model was implemented in one hospital as a pilot. Results: The main aspects of reward system were scoring method; type of reward; awareness program; evaluation; executive requirements (including structure and process). After pilot study criteria and scoring method were improved. Conclusion: Although the findings were promising, it seems for model success defining executive requirements (including process and structure) proportionate to available capacities and advocacy from head and senior managers is essential.

Objective: The present study aimed to identify the neglected aspects of womenchr('39')s health during the three decades after the Islamic Revolution of Iran. Methods: This was a descriptive review of the literature. All Persian and English articles published in journals from 20 March 1981.to 20 March 2013. The data were collected on health status, determinants and health outcomes of Iranian women, regardless of age limit. Studies were reviewed for eligibility based on inclusion and exclusion criteria and duplicate studies were excluded. Then the information including year of publication, number of authors, 17 major diseases in women and infertility, SDH (social determinants of health), life stage and methods were recoded and were analyzed. Results: In all 1880 Persian articles and 4090 English articles were reviewed (a total of 5970 articles). The frequency of research type was 4.15% for reviews, 22.12% for interventional, 22.34% for comparative and 51.37% for descriptive studies. Most researches based on life cycle was about the reproductive age 76%, based on burden of disease was about pregnancy and its complications 30.12% and based on SDH factors was about education and awareness 6.36%. Conclusion: The findings suggest that although scientific publications on women’s health in Iran increased dramatically, no consistent trend observed nor the designs and topics showed integrative coherences.

Background: With the spread of the coronavirus disease 2019 (COVID-19), strict laws such as quarantine were implemented in many countries, including Iran. The spread of this disease and the general quarantine overshadowed the treatment and management of some chronic diseases, including type 1 diabetes, and many families faced a serious challenge in providing medicines and periodic tests for their children. This study was conducted with the aim of investigating the effects of the COVID-19 crisis on disease management in children with type 1 diabetes. Method: Based on a researcher-made questionnaire, this cross-sectional study was conducted on 85 children with type 1 diabetes between the ages of 2 and 18 years in 6 months at the Children's Medical Center Hospital. This questionnaire is either collected from the parents during the face-to-face visit of the child with type 1 diabetes, or the virtual visit (telemedicine), and they were asked to complete the relevant questionnaire. This questionnaire included demographic information, laboratory tests, and the challenges of patients' families during the pandemic. In order to properly understand the management of this disease, parents were asked to enter the results of tests related to fasting blood sugar and HbA1c 3 times at the beginning of the pandemic, during quarantine, and during the implementation of the study. Results: Based on the results, the level of HbA1c, the problem of insurance coverage, the problem of attendance, ketoacidosis, and infection before the pandemic, during the pandemic, and at the time of the study among children with type 1 diabetes were unchanged (P>0.05). There was a significant difference between fasting blood sugar levels, insulin levels, blood sugar control levels, and hospitalizations in type 1 diabetes patients before the pandemic, during the pandemic, and the study period (P<0.05). Conclusion: Increasing the use of continuous glucose monitors and the widespread use of telemedicine visits may improve the impact of the pandemic on disease management. It is suggested that more multicenter studies with a higher sample size should be conducted in order to investigate the impact of the COVID-19 crisis on children with diabetes. [ABSTRACT FROM AUTHOR]

Background: Reward system program is an investment tools in order to improve quality of services. Accordingly, this study was conducted aimed to identify the challenges of the reward system and the solutions for improving that based on the views of stakeholders in Tehran University of Medical Sciences hospitals. Materials and Methods: This directional content analysis qualitative study was performed in Tehran University of Medical Sciences during 2014and 2015 using content analysis method. Targeted sampling was done and in-depth semi structured and face to face interviews were performed with a wide variety of experts and professionals including managers, faculties and hospital staffs. After word by word transcripting and extracting codes (meaningful phrases), these codes was reviewed again in order to achieve subcategories. Based on subcategories, information was classified to assossiated categories. For validity and reliability checking, stakeholders and faculties member check and peer debriefing were used.Results: Eventually, a total of 29 interviews were held. The comments were classified within 6 main categories, 19 subcategories and 1100 codes. The main categories included existing arrangements in hospitals in order to improve staff motivation; reward system challenges; derived opportunities from rewarding experiences; rewarding systematic actions; types of appropriate rewards and making infrastructure for better rewarding system implementation. Conclusion: Regarding multiple aspects of a reward system which could have an effective role in increasing staff motivation or a contradictory effect when it is inefficient, implementation of an effective reward system in hospitals by designing an appropriate model based on identified key factors in this study, is recommended.

Objective: One of the main problems facing public health providers and administrators in many countries is ensuring the rational use of high-cost drugs. In this regard, on-going process of medication use evaluation can be considered as a useful tool. In this study, we evaluated certain usage aspects of a highly-cost medication, that is, recombinant growth hormone (GH). Methods: This cross-sectional study conducted from August 2012 to August 2014. Children receiving GH ± gonadotropin releasing hormone (GnRH) analogs were included in the study. A researcher-designed checklist was developed to evaluate the GH utilization in these patients. Baseline demographic characteristics and background clinical and growth data, as well as any aspects of drug therapy including indications, dosing, monitoring, and discontinuation were collected from the patients' medical records. Findings: Seventy children receiving GH entered the study, of which 23 patients (32.85%) received GH and GnRH analogs simultaneously. At the baseline, 67 children (95.7%) had GH stimulation test, whereas serum insulin-like growth factor-1 (IGF-1) levels were measured in 63 (90%) patients. Sixty-seven patients (95.71%) had thyroid function test, whereas bone age was determined in 68 children (97.14%). The mean ± standard deviation of GH dose for idiopathic short stature, GH deficiency, Turner's syndrome and born small for gestational age in our study was 0.22 ± 0.025 mg/kg/week, 0.23 ± 0.04 mg/kg/week, 0.22 ± 0.015 mg/kg/week, and 0.23 ± 0.02 mg/kg/week, respectively. Height and weight of all patients were followed every 3–6 months, regularly. Thirty patients were treated with GH for at least 1 year, of which thyroid hormones and IGF-1 levels were measured annually in 25 (83.33%) and 26 (86.66%) patients, respectively; while bone age was evaluated in 13 (43.33%) children, annually. GH treatment was discontinued in 15 patients (21.42%), while financial problem was the major reason. Conclusion: Diagnostic tests and monitoring of height, weight, IGF-1 level and thyroid function was properly performed in this setting. However, a number of patients with ISS and Turner's syndrome were under-dosed.

Superior mesenteric arteriovenous fistulae are rare. A 32-year-old woman presented with abdominal pain. The angiography showed that the superior mesenteric vein was aneurysmal. The patient underwent coil embolization, during which a balloon catheter was inflated before the fistula for the protection of coil migration with a high blood flow. After the balloon inflation, one 8-mm and two 7-mm coils were deployed at the fistula site. The final angiography showed successful embolization with no visualization of the fistula and the aneurysmal vein.

Introduction: Recognition of Acanthosis nigricans (AN) provides important opportunities for screening of obesity syndrome, dyslipidemia, hypertension and insulin resistance with diabetes mellitus 2. Considering the high prevalence of obesity among Iranian children, we designed this study to estimate the prevalence of AN and related laboratory factors in Iranian obese children. Materials and Methods: Seventy-one obese children were enrolled in this study. Diagnosis of AN was done by clinical examination. Body mass index (BMI), fasting blood sugar, total cholesterol, triglycerides (TG), alanine aminotransferase, aspartate aminotransferase (AST), alkaline phosphatase, high- and low-density lipoprotein cholesterol, insulin, thyroidstimulating hormone, free thyroxin (fT4), calcium, phosphorus and 25-hydroxyvitamin D were measured with routine techniques. Collected data were compared between cases with AN and without AN. Independent t-test was used for comparison of variables. Results: Twenty-five of children were female (35.2%). Fortyeight children (67.6%) had AN. In 20 cases (28.2%), homeostasis model assessment-insulin resistance (HOMA-IR) was