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Burn injury has been shown to significantly dampen erythropoiesis in both burn patients and in murine models. Our previous findings elucidated the erythropoietin independent defects in red cell development stages involving erythroid progenitor production and late stage erythroblast enucleation processes. We hypothesized that macrophages (MØ) in erythroblast islands (EBI) could be yet another roadblock impeding erythropoiesis following burn injury. Here we highlight that the methodology to study EBI can be achieved with single cell suspensions using a simple technique such as flow cytometry, as obtaining the central erythroblast island macrophages (EBIMØs) of interest is a delicate process. We elucidated the requisite of EBIMØ from the erythroblast as well as the MØ perspective. In addition to the primary erythropoiesis organ, the bone marrow (BM), spleens were also examined for extra-medullary erythropoiesis. Femurs and spleens were harvested from adult mice (B6D2F1) subjected to 15% total body surface area (TBSA) scald burn (B) or sham burn (S). Total bone marrow cells (TBM) and splenocytes were probed for total erythrons, early and late erythroblasts and EBIMØ by flow cytometry. There was only a marginal increase in the number of EBIMØ after burn, but, between the signatures of EBIMØ, Siglec-1 expression (MFI) was reduced by 40% in B with and a parallel 44% decrease in TBM erythrons in the BM. There were more (2.5-fold) EEBs and less LEBs (2.4-fold) per million TBM cells in B; with a corresponding decrease in Siglec-1 and Ly6G expressions in EBIMØ associated with EEB. Conversely, extra-medullary erythropoiesis was robust in spleens from B. Not only were the numbers of EBIMØs increased in B (p < 0.002), both EEBs and LEBs associated with EBIMØ were higher by 30 and 75%, respectively. Importantly, an increase in Siglec-1 and Vcam1 expressing F480+ splenic macrophages was observed after burn injury. Therefore, stagnant EEBs in the BM after burn injury could be due to low Siglec1 expressing EBIMØ, which perhaps impede their maturation into LEBs and reticulocytes. Repercussion of myeloid cell phenotype specific to BM after burn injury could plausibly account for a defective late stage RBC maturation resulting in anemia of critical illness.Summary Sentence: Characterization of erythroblast island macrophages (EBIMØ) in the bone marrow and spleen at different stages of erythropoiesis after burn injury.

Neutropenic conditions are prevalent in leukemia patients and are often associated with increased susceptibility to infections. In fact, emergency granulopoiesis (EG), a process regulating neutrophil homeostasis in inflammatory conditions and infections, may occur improperly in leukemic conditions, leading to reduced neutrophil counts. Unfortunately, the mechanisms central to dysfunctional EG remain understudied in both leukemia patients and leukemic mouse models. However, despite no direct studies on EG response in leukemia are reported, recently certain transcription factors (TFs) have been found to function at the crossroads of leukemia and EG. In this review, we present an update on TFs that can potentially govern the fate of EG in leukemia. Transcriptional control of Fanconi DNA repair pathway genes is also highlighted, as well as the newly discovered role of Fanconi proteins in innate immune response and EG. Identifying the TFs regulating EG in leukemia and dissecting their underlying mechanisms may facilitate the discovery of therapeutic drugs for the treatment of neutropenia.

Psychological stress contributes to increased susceptibility to a number of diseases including cancer. The present study was designed to assess the effect of chronic unpredictable stress on N-nitrosodiethylamine induced liver toxicity in terms of in vivo antioxidant status and DNA damage in Swiss albino mice. The animals used in this study were randomized into different groups based on the treatment with N-nitrosodiethylamine or chronic unpredictable stress alone and post-stress administration of N-nitrosodiethylamine. The mice were sacrificed after 12 weeks of treatment, and the status of major enzymatic and non-enzymatic antioxidants, liver function markers, lipid peroxidation and the extent of DNA damage were determined in circulation and liver tissues of all the groups. The N-nitrosodiethylamine treated group showed significantly compromised levels of the antioxidant enzymes, lipid peroxidation, and the liver function markers with enhanced DNA damage as compared to chronic unpredictable stress or control groups. A similar but less typical pattern observed in the chronic unpredictable stress treated mice. All the measured biochemical parameters were significantly altered in the group treated with the combination of chronic unpredictable stress and N-nitrosodiethylamine when compared to controls, or chronic unpredictable stress alone and/or N-nitrosodiethylamine alone treated groups. Thus, exposure to continuous, unpredictable stress conditions even in general life may significantly enhance the hepatotoxic potential of N-nitrosodiethylamine through an increase in the oxidative stress and DNA damage.

Background: The quantity and quality of interaction are critical elements of perceived interactions. This study aimed to summarize findings on the quality of interpersonal interactions in E-Learning at higher education and suggestions that inform future measurement efforts. Method: The scoping review proposed by Arksey and O'Malley (2005) was used. This approach consists of 5 steps: 1) identifying the research question,2) identifying relevant studies,3) study selection, 4) charting the data, and 5) reporting the results. PubMed, Scopus, and Web of Science have searched three databases, including manuscripts in English. The search was conducted from 2000 to July 2021. A PCC (population, concept, and context) was used as eligibility criteria and included the most relevant. The present PCC was defined as a population: university students, context: higher education, and Concept: E-learning and Interpersonal Interactions.Results: This review includes twenty-five articles chosen for inclusion. With the thematic analysis, the results of this scoping review are presented in the form of four themes: interaction in the online environment affects learning outcomes, numerous factors affect the interaction of learners in online settings, online interaction and hidden curriculum, and the importance of forming an online learning community.Conclusion: Findings showed that the quality of interpersonal interactions in e-learning seems to be a neglected link in e-learning. Further studies are needed focusing on the quality of interpersonal interactions in e-learning. It is necessary to develop appropriate tools to measure the quality of interpersonal interactions and further evaluate these interactions at the international level.

Abstract Background Improving the quality of clinical training is synonymous with accomplishing nursing education goals and improving the quality of nursing care. This study aimed to improve the quality of clinical training in Maternal and Neonatal Health (MNH) in nursing students. Methods This action research was conducted in two cycles from June 2017 to June 2018. The study setting was the School of Nursing and Midwifery of Lorestan University of Medical Sciences in southwest Iran. The participants were nursing students, faculty members, clinical trainers, educational managers, and teaching personnel. In the first cycle, semi-structured interviews were held with stakeholders to identify clinical problems and improvement strategies. Based on the results of these sessions, the changes needed to improve the quality of clinical training were planned and implemented. The weaknesses and strengths of the implemented changes were then identified through group discussions with the stakeholders. In the second cycle, a second plan was carried out to correct the weaknesses of the changes planned in the first cycle, and the modifications were implemented and evaluated. Results The main three categories extracted included an unsystematic curriculum and inadequate monitoring, inadequate resources and facilities, and the student’s lack of motivation. The measures taken for improvement included holding communication workshops, developing and internalizing logbooks, reducing the number of students in clinical training groups, using modern clinical training methods, and changing clinical evaluation methods. Conclusion Improving communication skills among the students, trainers, and hospital personnel and using modern clinical training methods, such as conceptual maps, triple jumps, and clinical skill centers, are the best strategies for improving clinical training in MNH nursing students.

Abstract Aim Dietary patterns could have a notable role in shaping gut microbiota composition. Evidence confirms the positive impact of the Mediterranean diet (MD), as one of the most studied healthy dietary patterns, on the gut microbiota profile. We conducted this systematic review to investigate the results of observational studies and clinical trials regarding the possible changes in the gut microbiota composition, metabolites, and clinical outcomes following adherence to MD in healthy cases or patients suffering from metabolic disorders. Methods A systematic literature search was conducted on PubMed, Web of Science, and Scopus databases until October 2023. Two researchers separately screened the titles, abstracts, and then full-text of the articles and selected the relevant studies. Quality assessment of observational and interventional studies was performed by Newcastle-Ottawa and Cochrane checklists, respectively. Results A total of 1637 articles were obtained during the initial search. Ultimately, 37 articles, including 17 observational and 20 interventional studies, were included in this systematic review. Ten observational and 14 interventional studies reported a correlation between MD adherence and microbiota diversity. Faecalibacterium and Prevotella were the most frequent bacterial genera with increased abundance in both observational and interventional studies; an Increment of Bacteroides genus was also reported in observational studies. Better glycemic control, lowering fat mass, better bowel movement, decreased bloating, inflammation, and hospitalization risk were the reported clinical outcomes. Conclusion Adherence to the MD is associated with significant beneficial changes in the gut microbiota diversity, composition, and functions and major clinical improvements in most populations.

Abstract Background Previous studies have examined relationship between cognitive function and lifestyle; however, the nature of this relationship is expected to vary in diverse cultural and low-income setting where lifestyle practices differ from those in high-income countries. Aim This study aims to investigate the correlation between lifestyle factors and cognitive function among individuals aged 60 years and older in 2021. Methods This cross-sectional, Community-based study involved 300 older adults from comprehensive urban health centers in Khorramabad, Iran, selected through stratified cluster sampling. Data were collected using the demographic information questionnaire, Mini-Mental State Examination, and Lifestyle Questionnaire. Data management and analysis were performed using SPSS (version 22) and independent t-tests, Pearson's correlation coefficient, ANOVA, and multiple linear regression analysis were used. A p value

Background: Simulation education based on flipped learning allows millennial students to adopt a self-directed learning style. This study aimed to determine the effect of simulation education based on flipped learning on academic performance, motivation in learning, and academic engagement of first-year undergraduate nursing students.Method: This study was conducted with semi-experimental design. 40 undergraduate nursing students at Lorestan University of Medical Sciences was selected by whole enumeration. Teaching was provided conventionally for the control group (n =18) while simulation education based on flipped learning was done for the intervention group (n = 22). The academic performance of the participants was measured using the observation checklists, also they completed the academic engagement scale and the Instructional Materials Motivation Scale at two points. Data were analyzed using t-test, paired t-test, chi-square, and ANCOVA.Results: There was no significant statistical difference between the two groups after the intervention in the mean of the performance (F=2.49, P0/34).Conclusions: Using the simulation teaching approach based on flipped learning can be an alternative teaching strategy for conventional simulation teaching. However, more research is needed on this educational approach to be considered a preferred approach.

Introduction: Infant colic, causing excessive crying, poses anxiety for parents and a challenge for pediatricians and nurses. The Infant Colic Scale (ICS) serves to assess the severity and causal factors of colic. Despite its significance, the psychometric properties of ICS have not been evaluated in the Iranian population. This study seeks to address this gap by assessing the psychometric properties of ICS in Iran. Methods: A sample of 220 mothers with 2–16-week-old term infants diagnosed with infantile colic was selected through convenience sampling. Following forward and back-translation, the face validity, content validity, and construct validity of ICS were systematically evaluated. Reliability was examined through both internal consistency (Cronbach’s alpha) and test-retest stability methods. Results: Content validity index (CVI) and content validity ratio (CVR) values for ICS were 0.94 and 0.81, respectively. The good fit indices confirmed the validity of the five-factor structure. Cronbach’s alpha coefficient and intraclass correlation coefficient (ICC) were 0.71 and 0.94, respectively. Conclusion: The Persian version of ICS is a valid and reliable tool, suitable for assessing infantile colic in the Iranian population. Future studies and clinical practice can utilize this tool to identify major causes of this disorder in the Iranian context.

Introduction: Episiotomy is a usual midwifery surgery. Iran is a country with an abundant source of medicinal plants. This study aimed to investigate ginger extract ointment’s effects on the pain and recovery of episiotomy incisions in nulliparous women. Methods: This randomized clinical trial was conducted in a public hospital in Iran on 70 nulliparous women with an episiotomy incision. The women were randomly assigned to ginger extract ointment and placebo groups. The primary outcomes included pain and wound healing that were assessed using a visual analog scale (VAS), redness, edema, ecchymosis/bruising, discharge, and an approximation scale (REEDA). The participants were followed up before discharge from the hospital and 5×1 and 10×1 days after the intervention. The secondary outcome was the number of painkillers used during the study. Data were analyzed by chi-square, independent t test, and the Mann-Whitney U via SPSS-13. The significance levels were determined to be P≤0.05. Results: There was no significant difference between participants treated with ginger extract ointment and placebo in the pain and wound healing scores before the intervention, 5×1 and 10×1 days after the intervention. But, the pain intensity decreased, and the recovery speed increased clinically. Also, regarding the secondary outcome of this study, no significant difference between the placebo and intervention groups in the number of painkillers participants took. Conclusion: The ginger ointment could not significantly improve episiotomy wounds’ pain and healing rate, but it was clinically helpful. So more studies with different doses of this ointment are needed.

Background: There is valid evidence that supports the impact of active teaching methods on student-related outcomes. One of these active teaching-learning approaches is co-teaching. This study aimed to determine the effect of co-teaching on nursing students' academic engagement and exam anxiety.Methods: This study was conducted with a two-group semi-experimental design. In total, 35 undergraduate nursing students in the second semester of 2021-2022 at Lorestan University of Medical Sciences, who had chosen the Fundamental of Nursing course, was selected by whole enumeration based on the inclusion criteria. Teaching was provided conventionally for the control group (n =18) while co-teaching was done for the intervention group (n = 17). The participants completed the academic engagement scale and the exam anxiety scale at two points: the end of the 10th session and the end of the 20th week. Data were analyzed using t-test, paired t-test, and chi-square in Stata 17 software.Results: The results showed that the collaborative teaching approach, compared to conventional teaching, had no significant difference in the students' average score of academic involvement and test anxiety.Conclusion: The co-teaching method did not show any difference in the variables of academic involvement and test anxiety compared to conventional teaching. More studies are suggested to plan co-teaching methods.

BackgroundOnline Interaction is a critical characteristic of distance learning, and effective online communication models empower students.PurposeThis research aimed to explain students' experiences on the quality of interpersonal interactions in e-learning.MethodThis study was conducted from November 2021 to October 2022. The qualitative descriptive design via conventional content analysis was utilized. Purposeful and maximum variation methods recruited sixteen participants from three medical science universities in Iran. The data were collected through semi-structured, in-depth, face-to-face, or online interviews. Interviews were recorded through a digital recorder, and analysis was achieved simultaneously with data collection using Graneheim and Lundman (2004). The Lincoln and Guba criteria, including credibility, dependability, transferability, and confirmability, were used to improve the trustworthiness of the findings.ResultsThe results indicated the importance of different dimensions related to teaching-learning. It seems crucial to develop a comfortable and safe environment to improve interpersonal interactions. Educators should be provided with pedagogical skills to support interactions. In addition, focusing on some learners' soft skills is also vital. In addition to the significance of the teacher's inclusive role, the educational content must have critical standards. Constructive feedback and the proper use of simultaneous and non-simultaneous communication tools and social networks are other important issues in strengthening interpersonal relationships. Ultimately, comprehensive and ongoing support of learners improves the quality of interpersonal interactions.ConclusionsThe results indicated the significance of different dimensions of teaching-learning as facilitating factors of interpersonal interactions. The proper use of simultaneous and non-simultaneous communication tools and social networks are other important issues in strengthening interpersonal relationships. Ultimately, comprehensive and ongoing support of learners improves the quality of interpersonal interactions.ImplicationsThe results of this study give teachers the insight to keep essential issues in mind when developing their online courses and students to be aware of their roles in the online learning process. Also, the characteristics of simultaneous and non-synchronous platforms, social messaging networks, and learner support are crucial.

Abstract Background Nurses who play the leading role in caring for patients, especially nurses in the chemotherapy department who are constantly exposed to high-risk drugs and their side effects, should pay more attention to occupational safety. This study was performed to determine the effect of training chemotherapy safety standards using a smartphone application on nurses’ knowledge, attitude, and performance. Methods The whole enumeration of fifty oncology nurses was recruited who they worked in 3 hospitals affiliated with Lorestan University of Medical Sciences (west of Iran). The study was conducted from June to November 2021. The training was done for four weeks with a smartphone application, including six main courses of familiarity with hazardous drugs, Personal Protective Equipment, preparation, storage and transfer, spilling, and wastes disposal of hazardous drudges . The nurses’ knowledge, attitude, and performance questionnaire were completed before, immediately after, and one month after the intervention. Data analysis was performed using SPSS version 26, descriptive and inferential statistical tests of independent t-test, one-way analysis of variance, Spearman’s rank correlation coefficient, repeated measures analysis of variance, and the Generalized Estimating Equation (GEE) model. Results Mean knowledge score of participants before, immediately after, and one month after the intervention was (47.18 ± 8.19), (60.08 ± 3.82), and (61.88 ± 3.45), respectively. The mean attitude score of participants before, immediately after, and one month after the intervention was (30.34 ± 3.94), (34.32 ± 3.25), and (34.98 ± 2.88), in order, and the mean performance score of participants before, immediately after, and one month after the intervention was (43.60 ± 5.11), (51.78 ± 3.15) and (52.88 ± 3.06), respectively. The mean nurses’ knowledge, attitude, and performance score increased significantly over time (P

Abstract Background Dyadic practice of learners creates supportive learning. So far, few studies have investigated the impact of this approach on students’ empathy and self-efficacy. This study aimed to investigate the effect of dyadic practice on nursing students’ clinical self-efficacy and empathy. Methods This study was based on a pretest-posttest randomized group from September to December 2018. All the junior nursing students (n = 44) were divided into intervention (n = 22) and control groups (n = 22) using stratified random sampling. The intervention group was trained for 6 days as student dyads, while the control group was under the supervision of an instructor and worked individually. The students’ levels of empathy and self-efficacy were evaluated on the first day (pretest) and the last day (post-test) by The Self-Efficacy in Clinical Performance Scale and Mehrabian and Epstein empathy scale. The data were analyzed using the SPSS software by Fisher’s exact test, Mann-Whitney test, independent t-test paired t-test, Wilcoxon signed-rank, and Analysis of covariance. Results Dyadic practice increased empathy in the intervention group compared to the control group (P

Abstract Background Comorbidities in heart failure (HF) are a complex clinical challenge. There is little data on the benefits of multidisciplinary postdischarge management programs in such patients. This study aimed to examine the effects of a multidisciplinary management program (MMP) on symptom burden and medication adherence in HF patients with comorbidities. Methods In this clinical trial study, 94 HF patients with comorbidities were assigned to intervention (n = 47) and control (n = 47) groups by the stratified-random method. The intervention group underwent MMP supervised by a nurse for two months after discharge, including multi-professional visits, telephone follow-ups, and an educational booklet. Medication adherence and symptom burden were assessed using Morisky Medication Adherence Scale (MMAS) and Edmonton Symptom Assessment Scale (ESAS), respectively, on three occasions: Before discharge, six weeks, and eight weeks after discharge. Results Both groups almost matched at the baseline, and the most frequent comorbidities included myocardial infarction (MI), hypertension, peptic ulcer, and depression, respectively. The interactive effect of time in groups showed that mean changes in total scores of symptom burden and medication adherence were significantly different (P

Abstract Background Metabolic syndrome (MetS) is a group of risk factors that increase the risk of death and a variety of chronic diseases. Recent studies have indicated that the imbalance of gut microbiota might contribute to development and progression of metabolic syndrome. Carbohydrate restriction in the diet has been proven to be one of the most effective methods in the management of metabolic syndrome, even in the absence of weight loss. However, no study has examined the effects of a carbohydrate-restricted diet on gut microbiota composition in metabolic syndrome patients. Thus, we will examine the effects of a “moderately restricted carbohydrate (MRC)” diet on gut microbiota, insulin resistance, and components of MetS among Iranian women. In addition, the stability of changes in dependent variables, including gut microbiota, will also be assessed. Methods This is a parallel randomized clinical trial in which 70 overweight or obese women aged 20–50 years with MetS will be randomly assigned to receive either MRC diet (42–45% carbohydrate, 35–40% fats) or a normal weight loss (NWL) diet (52–55% carbohydrate, 25–30% fats) for 3 months. Protein accounted for 15–17% of total energy in both diets. The quantity of gut microbiota including Firmicutes, Bacteroidetes, Bifidobacteria, Lactobacillus, Clostridium, Prevotella, Bacteroidetes, and Akkermansia muciniphila, as well as anthropometric, blood pressure, and metabolic parameters will be measured at study baseline and the end of trail. At the end of this phase, all participants will be placed on a weight maintenance diet for an additional 6 months. After following up study subjects in this duration, all dependent variables will be examined again to assess their stability over this period. Discussion To the best of our knowledge, this is the first randomized controlled trial investigating the effects of a moderately restricted carbohydrate diet on gut microbiota composition and several metabolic parameters during the weight loss and maintenance phases in women with MetS. Trial registration Iranian Registry of Clinical Trials ( www.irct.ir , IRCT20210307050621N1). Registered on May 31, 2021.

Abstract Background Given the possible effect of maternal anxiety on the severity of colic pain in infants, this study aimed to investigate the effects of behavioral therapy counseling on infantile colic (primary outcome), maternal anxiety, and mother-infant attachment (secondary outcomes) in anxious mothers with colicky infants. Method This randomized controlled clinical trial was conducted on 46 anxious mothers of 2–6-weeks-old exclusively breastfed colicky infants who had a score of 112 and above according to the Postpartum Specific Anxiety Scale (PSAS), reffered to the pediatric clinics of Al-Zahra, Taleghani and Children Hospitals of Tabriz, Iran. The participants were randomly assigned to the intervention (n = 23) and control (n = 23) groups using randomized block design. Mothers in the intervention group attended 8 systematic desensitization counseling sessions (2–3 sessions per week). Those in the control group received routine care. The researcher completed the Postpartum Specific Anxiety Scale (PSAS), Mother-Infant Attachment Questionnaire (MIAQ), and Infant Colic Scale (ICS) by interviewing the participants before and two weeks after the intervention. Results There was no significant difference between the intervention and control groups in the socio-demographic profile of participants. After the intervention, the mean postpartum anxiety score of women in the intervention group was significantly lower than that of those in the control group (Mean Difference (MD) = 22.5, 95% Confidence Interval (CI) = 2.3 to 42.7; p = 0.029). The mean infant colic score of the infants of mothers in the intervention group was insignificantly lower than that of those in the control group (MD = -2.9, 95% CI = -8.3 to 2.4; p = 0.271). In addition, no significant difference was observed between the two groups in terms of their mean mother-infant attachment scores (MD = -0.04, 95% CI = -3.1 to 0.3; p = 0.976). Conclusion Behavioral therapy counseling effectively reduced postpartum anxiety in women with colicky infants; however, this reduction did not lead to a significant decrease in the infants’ colic pain. Therefore, health care providers are recommended to use this counseling method in combination with other effective counseling approaches to promote mental health of these mothers. Trial Registration IRCT Registration Number: IRCT20111219008459N14, registered on 08/10/2020. https://irct.ir/user/trial/45949/view

Abstract Background Colorectal cancer (CRC) is one of the most common obesity‐associated cancers. Inflammation is also considered the most important factor between obesity and CRC. This study aimed to examine miRNAs binding sites variants on inflammatory genes identified using bioinformatics and systematic approach on clinical samples that were collected from CRC patients and controls. Methods The candidate variants related to CRC inflammatory genes were obtained from genome‐wide association studies and their population‐specific haplotypes. The variants were analyzed according to their genomic position on the miRNA targetome. Targetome variants in inflammation‐related genes were selected for genetic association study by TaqMan genotyping assay. Results The GG genotype of rs7473 decreased the risk of obesity (p

Abstract Background With the onset of the COVID-19 pandemic and the need to maintain social distancing and changes in wards' structure, families no longer access the routine support they received during the hospitalization of their patients in the ICU. This study aimed to determine the effects of ICU liaison nurse services on the anxiety in patients’ family caregivers after ICU discharge during the COVID-19 pandemic. Methods This randomized controlled trial was performed in western Iran from February 2020, to March 2021. Sixty subjects were selected from the family caregivers of the patients transferred from the ICU and were randomly assigned to the control (n = 30) and the intervention groups (n = 30). The control group received routine transfer care. In the intervention group, liaison nurse services were offered in 4 dimensions: patient support, family support, training, support of the ward’s staff, and the evaluation of the destination ward. The participants’ anxiety was measured using the Spielberger State Anxiety Inventory immediately after the patient transfer and 6 h after admission to the general ward. Data analyzed with SPSS V16, descriptive and inferential statistics, including Chi-square test, Mann–Whitney test, Wilcoxon test, and Generalized Linear Model with cumulative logit link function. Results were reported at a 0.05 significance level. Results A statistically significant difference was observed in baseline anxiety levels (P = 0.035) and age group (P

IntroductionAccumulating evidence has highlighted the critical role of the gut microbiota and its potential action as a regulator of metabolic disorders including insulin resistance, obesity, and systemic inflammation in polycystic ovarian syndrome (PCOS). Microbiota-modulating interventions, such as probiotics, prebiotics, and synbiotics, could be effective in PCOS management.MethodsWe conducted an overview of systematic reviews (SRs) and meta-analyses to summarize reviews regarding the effectiveness of probiotics/prebiotics/synbiotics on the management of PCOS through a systematic literature search in PubMed, Web of Science, and Scopus databases until September 2021.ResultsEight SRs and meta-analyses were included in this study. Our overview confirmed that probiotic supplementation had a potentially beneficial effect on some PCOS-related parameters including body mass index (BMI), fasting plasma glucose (FPG), and lipid profiles. Evidence shows that synbiotics in comparison with probiotics were less effective on these parameters. The methodological quality of SRs was assessed using the AMSTAR-2 assessment tool and was determined as high for four SRs, low for two SRs, and critically low for one SR. Due to limited evidence and high heterogeneity of the studies, it remains difficult to identify optimal probiotics strains, prebiotics types, length of duration, and doses.DiscussionFuture clinical trials with higher quality are recommended to clarify the efficacy of probiotics/prebiotics/synbiotics on the management of PCOS and provide more accurate evidence.

Introduction Family caregivers of patients with cancer face a care burden due to the responsibilities and problems of providing care to the patients. Applying appropriate strategies to reduce the burden is essential. Objective The study aimed to determine the effect of education and telephone follow-up on family caregivers’ burden on patients with cancer. Methods In this quasi-experimental study, 69 family caregivers of patients with cancer referred to only one chemotherapy center of a hospital in Lorestan province in Iran were recruited by convenience sampling method. They were randomly assigned to intervention ( n = 33) and control ( n = 36) groups. For the intervention group, two face-to-face training sessions and six telephone counseling sessions were held related to the care of the patients and self-care. The control group received only routine care. The family caregiver burden was measured by Novak and Gast Caregiver Burden Inventory (1989) completed before, immediately, and 6 weeks after the study. Data were analyzed by SPSS21 using independent t -tests, paired t -tests, and repeated measures. Results Both groups were homogeneous regarding demographic characteristics and the baseline care burden. The caregiver burden decreased significantly in the intervention group, so its score was 77.33 ± 8.49, 58.93 ± 8.03, and 52.78 ± 6.86 before the study, immediately after and 6 weeks later, respectively ( p

Abstract Background The COVID-19 pandemic has initiated digital developments in higher education while closing in-person university classes. As this crisis continues, the need to revive virtual learning opportunities was seriously felt. The present study was conducted to determine the online flipped classroom’s effect on nursing students’ self-directed learning readiness and metacognitive awareness. Methods This quasi-experimental single-group study with pretest-posttest design recruited 34 sophomore students of a nursing school in Lorestan province, Western Iran selected by census according to the inclusion criteria. Online asynchronous learning and online flipped classrooms were used during the semester’s first and second eight weeks, respectively. Students filled out self-directed learning readiness scale and metacognitive awareness inventory online before, in the middle of, and at the end of the semester. Data were analyzed using paired t-test in Stata-14 software. Results There was no significant difference between the mean score of metacognitive awareness before and after Online asynchronous learning (P=0.15), but the mean score of self-directed learning readiness increased significantly after OA (P=0.0004). After applying online flipped classrooms, students’ mean (SD) scores of metacognitive awareness and self-directed learning readiness were 272.03 (53.03) and 162.03 (21.77), respectively, which confirmed their significant improvement compared to before the intervention. A comparison of the mean score changes of both methods indicated that their implementation did not lead to significant differences between the mean total score of metacognitive awareness (P=0.15) and the mean total score of self-directed learning readiness (P=0.07). Discussion Online flipped classroom approach can be used as an effective method in nursing education by improving self-directed learning and metacognitive awareness, which are essential in online education for nursing students.

IntroductionThe sudden transition from face-to-face teaching to virtual remote education and the need to implement it during COVID-19 initially posed specific challenges to educational institutions. Identifying and understanding teachers' experiences pave the way for discovering and meeting educational needs. This study explored faculty members' teaching experiences during the COVID-19 pandemic.Materials and methodsThe qualitative descriptive design via conventional content analysis was used. It was conducted from January 13, 2020, to May 10, 2022. In-depth interviews (online and in-person) of ten faculty members, three managers, and one staff from Lorestan University of Medical Sciences were conducted. They were purposefully selected with maximum variation. Simultaneously with data collection, analysis was performed using the approach Graneheim and Lundman proposed (2004). Lincoln and Goba's criteria were used to obtain the study's rigor.ResultsSix categories emerged from the data: education in the shadow of the crisis, Challenges related to the teaching-learning process, Blurred boundaries between personal and professional lives, Positive consequences of e-learning, Trying to deal with the crisis, And dealing with the crisis.ConclusionsInitially, teachers faced several challenges in the teaching-learning process and even in their personal life. However, with time, the actions of the teachers and the managers caused an increase in the quality of education. However, planning and foresight are needed in developing countries, including Iran, to appropriately face and optimally manage similar crises and move towards blended learning.

Abstract Background Intermittent fasting has been reported to have positive effects on obesity, diabetes, cardiovascular diseases, hypertension, and several neurodegenerative diseases through different mechanisms such as alteration in the gut microbiota. This systematic review was conducted with the aim of providing an overview of the existing animal and human literature regarding the gut microbiota alterations in various fasting regimens. Method A systematic literature search was conducted on PubMed, Scopus and Web of Science databases up to May 2021 to find all relevant studies examining the gut microbiota alteration during the fasting. Original researches on animal models or human patients were included in this study. Results The search fulfilled 3072 documents from which 31 studies (20 animal and 11 human studies) were included. Upon fasting, abundance of several beneficial bacteria including Lactobacillus and Bifidobacterium shifted significantly. Moreover, some taxa, including Odoribacter which negatively associated with blood pressure bloomed during fasting. Ramadan fasting, as a kind of intermittent fasting, improves health parameters through positive changes in gut microbiota including upregulation of A. muciniphila, B. fragilis, Bacteroides and butyric acid–producing Lachnospiraceae. Conclusion The findings suggest that different fasting regimens including alternate-day fasting, calorie- and time-restricted fasting programs and Ramadan fasting could promote health maybe through the modulation of gut microbiome. However, further studies are needed to explore properly the connection between gut microbiota and meal frequency and timing.

Abstract Background Giving a healthy birth plays a vital role in a person’s personality development, but giving unhealthy birth and abortion can increase the risk of a range of mental disorders and psychological harms including reduced well-being and quality of life. Psychological interventions can reduce the problems of individuals, so the present study was conducted to evaluate the effect of counseling with hope therapy on psychological well-being (primary outcome) and quality of life (secondary outcome) of women with an experience of abortion. Method This randomized controlled trial was conducted in Alzahra and Taleghani educational and medical centers in Tabriz, Iran, on 52 women aged 16 years and above whose pregnancies led to abortion in 2020–21. Participants were assigned to intervention and control groups using random blocking method. The intervention group received counseling with hope therapy approach in 8 sessions of 45 min twice a week. The psychological well-being and WHO Quality of Life (WHOQOL) questionnaires were completed before the intervention and immediately and 4 weeks after the intervention. Independent t-test and repeated measures ANOVA were used to compare the outcomes in two groups. Results After the intervention based on the repeated measures ANOVA test and by adjusting the baseline score, the mean total score of psychological well-being in the counseling group was significantly higher than that in the control group (adjusted mean difference (AMD): 76.76; 95% confidence interval (95% CI): 63.81 to 89.70; P

Objective: To determine the status of self-care performance of pregnant women in the prevention of COVID-19 disease and its relationship with perceived stress during the epidemic period of this disease. Method: This cross-sectional study was performed on 228 pregnant women who referred to the health centers in Tabriz, Iran, for prenatal care. They were selected by cluster sampling. Data collection tools included questionnaires about Demographic-Social Characteristics, the Self-Care Performance Questionnaire and Cohen’s Perceived Stress Scale. Spearman correlation test was used to examine the correlation between self-care performance and perceived stress in bivariate and multivariate analyses. Also, multivariate linear regression was used, with control of demographic-social and obstetric characteristics as possible confounders. Results: The median (25-75 percentiles) self-care performance score of participants was 0.71 (0.65-0.76), from the achievable range of 20-80, and its mean (± SD) perceived stress score was 25.5 (± 5.6), from the achievable range of 0-56. The Spearman’s rank correlation test results showed a significant inverse correlation between perceived stress and self-care performance scores (r = -0.13; P = 0.041). According to multivariate linear regression test, the variables of self-care performance, education, spouse's education and number of family members were the predictors of perceived stress in pregnant women during the COVID-19 epidemic. Conclusion: According to the results of the present study, self-care performance of pregnant women in prevention of the COVID-19 disease was good and their stress was moderate. There was a significant inverse correlation between self-care performance and perceived stress that could indicate the high value and importance of the fetus for the mother and her strict adherence to health protocols to prevent COVID-19, which also leads to calming and reduced perceived stress.