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Farideh Jalili Bahabadi, 1 Fatemeh Estebsari, 2 Camelia Rohani, 3 Zahra Rahimi Khalifeh Kandi, 4 Reyhaneh Sefidkar, 5 Davoud Mostafaei 6 1Student Research Committee, Community Health Nursing Department, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 2Community Health Nursing Department, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 3Community Health Nursing Department, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 4Department of Public Health, Iran University of Medical Sciences, Tehran, Iran; 5Department of Biostatistics, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 6Health Services Management, Shahid Beheshti University of Medical Sciences, Tehran, IranCorrespondence: Fatemeh EstebsariDepartment of Community Health Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, IranTel +98-2188655367 (330)Fax +98-2188202518Email fa_estebsari@yahoo.comBackground and Objectives: Pregnancy causes changes in women’s lifestyle; therefore, their health-promoting behaviors should be improved in order to avoid problems during this critical period, which requires knowledge of the factors affecting these behaviors. This study was conducted to determine the predictors of health-promoting lifestyles in pregnant women based on Pender’s health promotion model constructs.Methods: This descriptive study was carried out on 300 pregnant women in their second and third trimesters of pregnancy and sought to determine the correlation between lifestyle and the constructs of Pender’s health promotion model. Data were collected using a demographic questionnaire, the Health Promoting Lifestyle Profile II (HPLP-II) and a questionnaire based on Pender’s model constructs. Data were analyzed using descriptive and analytical statistics.Findings: A health-promoting lifestyle had a significant positive correlation with the constructs of social support and perceived benefits and a significant negative correlation with the construct of perceived barriers (P< 0.05). A health-promoting lifestyle also had a significant relationship with the constructs of perceived barriers, social support and perceived benefits in pregnant women (P< 0.05) based on the results of the regression analysis. The regression coefficients showed that all the three variables can significantly explain the variance in health promoting lifestyles in pregnant women (P< 0.05).Conclusion: According to the results of the present study and based on the constructs of Pender’s health promotion model, social support, perceived benefits and perceived barriers were the most important predictors of health-promoting lifestyles in pregnant women. These predictor constructs are recommended to be further considered in designing and implementing training packages and interventions for promoting pregnant women’s lifestyle.Keywords: pregnant women, lifestyle, health promotion model, health-promoting behaviors

Purpose: Breast cancer and its treatments can cause sexual problems both physically and psychologically by the changes it brings. This study aimed to investigate the effect of sexual health counseling based on acceptance and commitment therapy (ACT) on the sexual satisfaction of women with chemotherapy-induced menopause (CIM) in breast cancer survivors., Methods: Seventy women with CIM were randomly divided into two intervention (N = 34) and control (N = 36) groups. The intervention group attended eight sessions of 90-min sexual health counseling based on ACT. The control group received an educational booklet. The Sexual Satisfaction Scale for Women(SSS-W), the Sexual Quality of Life-Female questionnaire(SQOL-F), and the Menopause Rating Scale(MRS) were used to collect data before, after, and 1 month after the intervention in both groups., Results: The mean score of sexual satisfaction (F = 45.67, P < 0.001) and sexual quality of life (F = 33.39, P < 0.001) were significantly higher after the intervention and follow-up than before intervention in the intervention group. Also, the mean score of menopausal symptoms was significantly lower after the intervention and follow-up than before intervention in the intervention group (F = 11.80, P < 0.001). However, the mean score of sexual satisfaction (F = 0.02, P = 0.98), sexual quality of life (F = 0.05, P = 0.94), and menopausal symptoms (F = 0.08, P = 0.92) did not show significant differences before, after, and 1 month after the intervention in the control group., Conclusions: Therefore, sexual health counseling based on ACT seems to have salutary effect on sexual satisfaction, sexual quality of life, and menopausal symptoms of women with breast cancer who experience CIM., Trial Registration: This randomized control trial has been approved by Iranian Registry of Clinical Trials, IRCT20230105057055N1 at 2023-01-29., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: Diabetes is a chronic and concerning health condition that poses a significant public health challenge. Given that preventing, detecting early, and treating T2DM can enhance public health outcomes, the objective of this study was to identify the most effective obesity indices and determine their optimal cut-off points for predicting the risk of T2DM in an Iranian population., Methods: This study was conducted on 8,019 male and female participants aged between 35 and 70 years in the context of Shahedieh cohort study. The ROC curve analysis was utilized to determine the optimal cut-off point of each anthropometric index to predict diabetes in age-sex categories., Results: The overall diabetes incidence in the study population was 2.5%, with 2.5% in men and 2.4% in women. In men, significant differences in most of the anthropometric indices were observed between diabetic individuals and healthy counterparts. This study found that for women 45-65, BMI and weight, and for men under 65 years, weight, WHR, BMI, WC, WHTR, AVI, and BRI are efficient T2DM predictors. The AUC of these indices varied from 0.593 (95% CI: 0.510-0.676) to 0.668 (95% CI: 0.586-0.750) in men, and from 0.587 (95% CI: 0.510-0.664) to 0.644 (95% CI: 0.535-0.754) in women., Conclusion: Anthropometric indices and body roundness are simple, inexpensive, and noninvasive means markers to predict the risk of diabetes. Our findings show that most of the studied indices had acceptable prediction power for men except for elderly. For women over 45 years old, weight and BMI are appropriate predictors. It seems that the approach of reducing diabetes incidence through early detection and primary prevention is achievable., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Ghomi, Sefidkar, Khaledi and Jambarsang.)

This study investigated batch-fed vermicomposting of cow manure, with a specific focus on assessing the effects of tylosin on the weight of earthworms and the overall quality of the resulting manure. Five reactors, including three concentrations of tylosin (50, 100, and 150 mg/kg) and two control reactors, were employed. Residual tylosin concentrations were measured using high-performance liquid chromatography (HPLC). Quality parameters such as pH, temperature, volatile solids (VS), organic carbon content (OCC), electrical conductivity (EC), ash content, C/N ratio, total Kjeldahl nitrogen (TKN), and microbial content were evaluated. The toxicity and maturity of vermicompost were assessed by determining the germination index (GI). The study also monitored variations in the earthworm's weight. The results demonstrated a decreasing trend in VS, OCC, C/N, and fecal coliforms, along with increased pH, EC, ash content, and TKN during the vermicomposting process. Furthermore, investigations revealed significant reductions in the reactors with tylosin concentrations of 50, 100, and 150 mg/kg, resulting in the removal of 98%, 90.48%, and 89.38% of the initial tylosin, respectively. This result confirms the faster removal of tylosin in reactors with lower concentrations. Degradation of tylosin also conforms to first-order kinetics. The findings showed a significant influence of tylosin on the weight of Eisenia fetida earthworms and the lowest antibiotic concentration led to the highest weight gain. Finally, the high percentage of germination index (90-100%) showed that the quality and maturity of vermicompost is by national and international standards., (© 2024. The Author(s).)

Objectives: Exposure to cigarette smoke introduces a large amount of nicotine into the bloodstream through the lungs. So, smoking can be a risk factor for many diseases. The present study was conducted to investigate the effect of active and passive cigarette smoke on the blood lipid profile and dyslipidemia., Methods: This cross-sectional study was performed on 5052 individuals who participated in the recruitment phase of the Shahedieh cohort study. A logistic regression model was used to investigate the relationship between smoking exposure status and lipid profiles., Results: The prevalence of abnormal low-density lipoprotein-cholesterol (LDL-C), abnormal HDL-C, abnormal total cholesterol (TC), abnormal triglyceride (TG), and dyslipidemia were 254 (5.00%), 562 (11.10%), 470 (9.30%), 1008 (20.00%), and 1527 (30.20%), respectively. Adjusting for confounders, it was observed that current smokers had higher odds of having abnormal HDL-C [OR (95% CI), 2.90 (2.28-3.69)], abnormal TG [OR (95% CI), 1.71 (1.38-2.13)] and dyslipidemia [OR (95% CI), 1.86 (1.53-2.25)]. Ex-smokers also had greater odds of abnormal HDL-C [OR (95% CI), 1.51 (1.06-2.16)] compared to non-smokers who were not exposed to cigarette smoke., Conclusions: The findings indicated that current smokers had higher TG and lower HDL. So, necessary measures should be taken to reduce smoking. The findings also showed that the prevalence of abnormal TG and HDL in ex-smokers was lower than in current smokers. Therefore, the existence of incentive policies to quit smoking seems necessary., (© 2024. The Author(s).)

Background and Aims: Hypertension is the leading preventable risk factor for cardiovascular disease, chronic kidney disease and cognitive impairment, and mortality and disability worldwide. Since prevention, early detection, and treatment of blood pressure improve public health, the aim of present study was to determine the best obesity indices and estimate the optimal cut-off point for each one to predict the risk of elevated/stage 1 and undiagnosed hypertension in the population of center of Iran based on American ACC/AHA 2020 guidelines., Methods: This cross-sectional study was performed on 9715 people who enrolled in 2018 in Persian Adult Cohort in Shahedieh area of Yazd, Iran in 2018. The anthropometric indices including body mass index (BMI) and waist circumference (WC), wrist circumference, hip circumference, waist-to-hip ratio, and waist-to height ratio of individuals, were extracted. The receiver operating characteristic curve was utilized to determine the optimum cut-off point of each anthropometric index to predict hypertension stages and compare their predictive power by age-sex categories. Statistical analysis was done using SPSS version 23.0., Results: The results showed that BMI has the best predictive power to recognize the risk of elevated/stage 1 hypertension for female (area under the curve [AUC] = 0.72 and optimal cut-off = 30.10 kg/m 2 ) and WC for male (AUC = 0.66 and optimal cut-off = 93.5 cm) in 35-45 age group. BMI had the best predictive power for the risk of undiagnosed hypertension for 35-45 years old male (AUC = 0.73 and optimal cut-off = 28.90 kg/m 2 ) and female (AUC = 0.75 and optimal cut-off = 5.10 kg/m 2 ), and hip circumference revealed similar predictive power for female as well (AUC = 0.75 and optimal cut-off = 112 cm)., Conclusion: Based on our findings, BMI and WC, which are simple, inexpensive, and noninvasive means, are the best markers to predict the risk of elevated/stage 1 and undiagnosed hypertension in young Iranians. It shows that the approach of reducing hypertension prevalence through primary prevention, early detection, and enhancing its treatment is achievable., Competing Interests: The authors declare no conflict of interest., (© 2024 The Authors. Health Science Reports published by Wiley Periodicals LLC.)

The awareness, attitudes, and practices of mothers regarding rheumatic fever (RF) remain obscure, therefore, this study aimed to assess the level of awareness, attitude, and practice of mothers regarding RF. A Quasi-experimental study was conducted on 100 mothers who visited medical centers in Yazd province in 2023 to evaluate the level of awareness, attitude, and practice, with the results reported after the intervention using self-made questionnaires. Statistical tests such as the Kruskal-Wallis test, T -test, One-Way analysis of variance, and Mann-Whitney were used. A significance level of P  < .05 was assumed. The mean score of awareness was 6.63 (2.6) and 9.52 (2.59), attitude was 12.56 (4.75) and 17.51 (6.72) and practice was 13.97(5.52) and 19.25 (7.04) of mothers regarding rheumatic fever were before and after study, respectively. The results of mixed effects models showed that education has a significant effect on awareness ( P  < .001), attitude ( P  < .001), and practice ( P  < .001). The mean score of attitude, practice, and awareness were increased by 2.98, 5.28, and 4.95, respectively, after the intervention. Based on the findings, it was observed that mothers have a moderate awareness of rheumatic fever (RF) despite the high burden, poor attitude, and practice. The results of the current study also demonstrate the influence of education in promoting positive practices. Effective training can have a positive impact on the awareness, attitudes, and practices of mothers., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Participation and initiative of workers are effective in promoting safety in the workplace. Proactive-Safety Role Orientation questionnaire (PRO-SAFE) is a proper tool to evaluate the psychological drivers that support the proactive orientation of individuals toward workplace safety. This study was conducted to translate and measure the psychometric properties of the Persian version of PRO-SAFE., Methods: The PRO-SAFE was translated into Persian using procedures for translation and cross-cultural adaptation. To collect data, 252 employees of a steel complex were selected. To measure the validity of the questionnaire, face, content, convergent, and construct validity was utilized. The questionnaire's reliability was evaluated by assessing its internal consistency., Results: The mean of the content validity index and content validity ratio was equal to 0.83 and 0.85, respectively. We found a positive correlation between PRO-SAFE and safety behavior dimensions (r = 0.372 to 0.792, P < 0.001). Confirmatory factor analysis showed the Persian version of the PRO-SAFE questionnaire had an excellent six-factor model consistent with the original questionnaire. Cronbach's alpha of the Persian version of the PRO-SAFE questionnaire was obtained between 0.717 to 0.880., Conclusions: The Persian version of the PRO-SAFE questionnaire was found to have appropriate psychometric properties, indicating that it can be confidently used as a valid tool for assessing proactive role orientation toward safety management among Iranian employees., (© 2023. The Author(s).)

Background and Aim: Cardiovascular risk-prediction models are efficient primary prevention tools to detect high-risk individuals. The study aims to use three tools to estimate the 10-year risk of developing cardiovascular disease (CVD) and investigate their agreement in an Iranian adult population., Methods: The current cross-sectional study was carried out on 8569 adults between 35 and 70 who participated in the first phase of the Shahedieh cohort study in Yazd, Iran, and were free of CVDs (cardiac ischemia or myocardial infarction or stroke). World Health Organization/International Society of Hypertension (WHO/ISH) chart, Laboratory-Based (LB) and Non-Laboratory-Based (NLB) Framingham Risk Score (FRS) were used to predict the 10-year risk of developing CVD. The agreement across tools was determined by Kappa., Results: WHO/ISH chart indicated the highest prevalence of low CVD risk for males (96.10%) and females (96.50%), while NLB Framingham had the highest prevalence of high CVD risk for males (19.40%) and females (5.30%). In total, there was substantial agreement between both FRS models (Kappa = o.70), while there was a slight agreement between WHO/ISH and both FRS tools. For under 60 years males and females, substantial agreements were observed between FRS methods (kappa = 0.73 and kappa = 0.68). For males and females over 60 years, this agreement was moderate and substantial, respectively (kappa = 0.54 and kappa = 0.64). WHO/ISH and LB Framingham model had substantial agreement for over 60 years females (kappa = 0.61)., Conclusions: Framingham models classified more participants in the high-risk category than WHO/ISH. Due to the lethality of CVDs, categorizing individuals based on FRS can ensure that most of the real high-risk people are detected. Remarkable agreement between FRS methods in all sex-age groups suggested using the NLB Framingham model as a primary screening tool, especially in a shortage of resources condition., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Background: In premature ovarian insufficiency, the cessation of menstruation, and cessation of ovarian function occurs before the age of 40, and this phenomenon is associated with many complications and problems for women. Since several factors can affect this situation, this study was conducted to determine the relationship between fertility history, and premature ovarian failure., Methods: This cross-sectional study was conducted on the data of the first phase of cohort study, which was a sample of 10,000 people from an Iranian adult population (age: 35-70 years). 1276 women were included who naturally experienced menopause from this population. They were separated into three groups based on the age of menopause: premature ovarian failure for those who reached menopause before the age of 40, early menopause for those who reached menopause between the ages of 40 and 45, and natural menopause for those who reached menopause at or after the age of 45. The demographic and fertility characteristics of two groups of women, one with premature ovarian failure and the other with early menopause, were compared with a group of women experiencing normal menopause. The comparison was based on frequency and percentage. Moreover, the odds ratio (OR) of these two groups compared to normal group was crudely calculated, and adjusted based on age at the time of the interview using a logistic regression model. SPSS 23 software was used to fit models and calculations., Results: The prevalence of premature ovarian failure was 3%. The likelihood of premature ovarian failure decreases as the number of live births rises. The risk is considerably higher for births ranging from zero to three children compared to those with more than four. Increased duration of breastfeeding is associated to a reduced risk of premature ovarian failure compared to the spontaneous occurrence (OR = 0.98, 95% CI (0.97, 0.99)). This relationship is maintained even after adjusting for age (OR = 0.98, 95% CI (0.97, 0.99)., Conclusion: Based on the results of present study, it can be concluded that the factor of the number of births, and the duration of breastfeeding affect reducing the occurrence of POI, therefore, in health and treatment programs and policies, encouragement to have children, which is now part of the policies population of Iran, and the importance, and benefits of breastfeeding for mother and baby should be emphasized more., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Inadequate lighting will be associated with some degree of perceptual error such as sleepiness. The main purpose of this study was to investigate the interactions between mood, fatigue, mental workload, and sleepiness and their relationship with quantitative indicators of street lighting in passenger car drivers. The present study was a cross-sectional study that was performed on 270 drivers of passenger cars. The quantitative indices of lighting studied were illuminance, luminance, uniformity, and disability glare which were calculated using the Hagner device (EC1-L) and according to EN 13201 standard. Alertness and mood indices, fatigue scale (SAMN-PERELLI), mental workload (NASA-TLX), positive and negative affect schedule (PANAS) were used. Generalized structural equation modeling (GSEM) was used to investigate the relationship between mood, fatigue, mental workload, and drivers' sleepiness. Data analysis was performed in version 26 of SPSS software and version 14 of Stata software There is a significant relationship between illuminance and mood (P < 0.001). There is a significant relationship between the degree of disability glare on the streets and the mood (P = 0.006). There is a significant relationship between fatigue score and mood (P < 0.001) so that with increasing one unit in fatigue scale, mood score decreases by 0.669 units (P < 0.001). Finally, it can be assured that lighting interventions can be done as an effective way to increase alertness and reduce fatigue and the mental workload of drivers with the aim of reducing night traffic accidents., (© 2023 Published by Elsevier Ltd.)

Background: Preterm birth is the most important in children under 5 yr mortality. In this study, we used the Global Burden of Disease Data (GBD) to evaluate the trend of preterm infant mortality rate for all countries from 1990 to 2017 and to assess the effect of development factors on this trend., Methods: The preterm infant mortality rate data from 196 countries of the world, from 1990 to 2017, were extracted from the GBD database. To study the trend of preterm infant mortality rate, a mixed-effects log-linear regression model was fitted separately for each IHME super-region. In the next step of data analysis, the development factor was included in the model to determine its effect on this trend for all countries under study., Results: The average rate mortality rate has declined about 2% per year throughout the world over the mentioned period. The highest and lowest decreasing trends were observed in high-income countries (about 4.0%) and Sub-Saharan Africa (about 1.0%), respectively. Including the effect of development factor in the mentioned model revealed that in 1990, the rate of preterm infant mortality in developed countries was 2.2 times of this rate in developing countries and this rate ratio has increased to 2.69 in year 2017., Conclusion: Although the preterm infant mortality rate were decreasing in all super regions, there is a remarkable gap in this rate between developing and developed countries yet. Therefore, preventative strategies are needed to reduce preterm birth and its burden, especially in the developing world., Competing Interests: Conflict of interest The authors declare that there is no conflict of interests., (Copyright © 2021 Sefidkar et al. Published by Tehran University of Medical Sciences.)

Heavy metal contamination of vegetables is a great public health concern. One hundred samples of spinach, dill, cilantro, and cress from the production sites of Shiraz, Iran, and its outskirts were, therefore, examined for lead (Pb), cadmium (Cd), copper (Cu), zinc (Zn), nickel (Ni), and cobalt (Co) content. The potential health risks of these metals to local residents via the consumption of leafy vegetables were also estimated. The mean concentrations of Pb, Cd, Cu, Zn, Ni, and Co were 3.21, 0.28, 4.55, 40.44, 3.11, and 1.86 mg/kg dry weight, respectively. The Pb level exceeded the permissible limit of 0.3 mg/kg in 44.7% of vegetable samples. The other elements were, however, within FAO/WHO standards. The estimated daily intake (EDI) of Pb, Cd, Cu, Zn, Ni, and Co from leafy vegetables was 0.10, 0.01, 0.14, 1.26, 0.10, and 0.06 μg/kg body weight/day, respectively. At the mean and 97.5 percentile levels, all health risk index (HRI) values were less than the safe limit (< 1). Thus, within the area this study was focused on, leafy vegetables did not make a major contribution to the dietary intake of the elements which could be mainly attributed to the low vegetable consumption by the study population (20 g/day). Nevertheless, the lead content of the vegetables should be viewed with some concern. Regular monitoring of heavy metal contamination of foodstuff is recommended to control the sources of contaminants in the food chain.

Background: Proper Health-Care Waste Management (HCWM) and integrated documentation in this sector of hospitals require analyzing massive data collected by hospital's health experts. This study presented a quantitative software-based index to assess the HCWM process performance by integrating ontology-based Multi-Criteria Group Decision-Making techniques and fuzzy modeling that were coupled with data mining. This framework represented the Complex Event Processing (CEP) and Corporate Performance Management (CPM) types of Process Mining in which a user-friendly software namely Group Fuzzy Decision-Making (GFDM) was employed for index calculation., Findings: Assessing the governmental hospitals of Shiraz, Iran in 2016 showed that the proposed index was able to determine the waste management condition and clarify the blind spots of HCWM in the hospitals. The index values under 50 were found in some of the hospitals showing poor process performance that should be at the priority of optimization and improvement., Conclusion: The proposed framework has distinctive features such as modeling the uncertainties (risks) in hospitals' process assessment and flexibility enabling users to define the intended criteria, stakeholders, and number of hospitals. Having computer-aided approach for decision process also accelerates the index calculation as well as its accuracy which would contribute to more willingness of hospitals' experts and other end-users to use the index in practice. The methodology could efficiently be employed as a tool for managing hospitals' event logs and digital documentation in big data environment not only for the health-care waste management, but also in other administrative wards of hospitals., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: Induction of labor is a common obstetric procedure. Acupressure is a natural method that is used for inducing uterine contractions. Nevertheless, few studies have examined the impact of acupressure on the induction of labor., Aim: The aim of this study was to evaluate the effect of acupressure on the initiation of labor., Material and Methods: In this randomized clinical trial, 162 nulliparous pregnant women were admitted to the hospital. They were categorized into 3 groups; acupressure, sham acupressure and control. Acupressure points SP6, BL 60 and BL 32 were pressured bilaterally. The intervention was done by the researcher every other day between 9 am and 11 am. The intervention was carried out on women in the afternoon and the following day. Subjects were examined to determine the initiation of labor symptoms48 and 96h after the start of intervention and at the time of hospitalization. Data were analyzed using the ANOVA, Kruskal-Wallis and Chi-square tests (p<0.05)., Results: There was no significant difference among the groups for spontaneous initiation of labor within 48h (P=0.464), and 49-96h after beginning the intervention (P=0.111) and 97h after beginning the intervention to the time of hospitalization for the spontaneous initiation of labor (P=0.897). There were no significant differences in the secondary outcomes between the groups., Conclusion: According to the finding of this study, it seems that acupressure treatment was not effective in initiating labor as compared with the sham acupressure and the routine care groups., (Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)