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Down syndrome (DS) is a chromosomal condition that is characterized by multiple pathological phenotypes. Oxidative stress caused by DS in individuals leads to DS phenotypes, which include various morphological abnormalities and externalizing disorders. Oxidative stress is an imbalance between the production of free radicals and reactive metabolites and the antioxidant defenses. Considering the physical and behavioral problems of adolescents with DS, the family is the first source of support for these adolescents. So one of the methods that can help adolescents with DS is family-based intervention. This study aimed to investigate the effects of family-based interventions on oxidative stress and social skills of adolescents with DS. The design of the research was quasi-experimental and pre-test/post-test with a control group. The study sample was 24 adolescents with DS in Rasht City, Guilan Province, Iran, in 2023, who were selected by the convenience sampling method. To collect data, blood laboratory evaluation and strengths and difficulties questionnaire (teacher form) were used before and after the training. The experimental group received behavioral management group training for 10 sessions, and the control group did not receive any training. Data were analyzed using univariate and multivariate analysis of covariance. The results showed that family-based interventions improved oxidative stress and increased social skills of adolescents with DS (p < 0.001). According to these results, family-based interventions can have important implications for social adaptation and the prevention of physical problems in individuals with DS. [ABSTRACT FROM AUTHOR]

Objective: Beta-thalassemia major (B-TM) is an inherited hematological disease that affects nearly 300 million people worldwide. This study aimed to evaluate the effects of group-based mobile learning on stress, anxiety, depression, and pain among beta-thalassemia major patients. Materials and Methods: This randomized clinical study was conducted on 48 patients with beta-thalassemia major in Jahrom, Iran. Participants were randomly assigned to the control and intervention groups. Their partners in the intervention group were trained in self-care through mobile learning. The 21-item Depression, Anxiety, and Stress Scale and a visual analog scale for pain assessment were used to collect the data. Data were analyzed using the Statistical package for the Social Sciences version 23.0. Results: Although there was no significant difference between the control and intervention groups in the mean pre-test scores of depression (P = .21), anxiety (P = .05), stress (P = .48), and pain (P = .46), the mean post-test scores of depression, anxiety, and stress in the intervention group were significantly lower than the control group (P = .0001). The mean scores of depression (P = .33), anxiety (P = .74), stress (P = .83), and pain (P = .6) did not change significantly in the control group, while all these mean scores decreased significantly in the intervention group for DASS (P = .001) and pain (P = .002). Conclusion: Group-based mobile learning is effective in reducing depression, anxiety, stress, and pain in B-TM. [ABSTRACT FROM AUTHOR]

Context The incidence of anxiety, which stems from both intrinsic and extrinsic factors, has been increasing worldwide. Various methods by which it can be treated or prevented have been reported thus far. One of the most popular and effective treatments is supplementation therapy. Zinc, which is an essential nutrient found in various plants, animal foods, and supplements, has been shown to be a potential nutrient in anxiety reduction by acting on γ-aminobutyric acid (GABA), glutamatergic, serotonergic, neurogenesis, and immune systems. It can also influence important receptors, such as GPR39. Thus, zinc has received considerable attention with respect to its potential role as a therapeutic or detrimental factor for anxiety; yet, the available evidence needs to be analyzed systematically to reach a convergent conclusion. Objective The objective was to systematically review any potential connection between adult human anxiety and zinc intake. Data Sources and Extraction Nine original human studies, of which 2 assessed the relationship between zinc consumption and anxiety (based on a questionnaire) and 7 assessed the relationship between serum zinc levels and anxiety, were included based on specific selection criteria. Studies that had been written in English and published in peer-reviewed publications with no restrictions on the date of publication were searched in the Google Scholar and PubMed databases. This project was also reported according to the PRISMA guidelines. Data Analysis As per the studies analyzed in this review, there was a noticeable relationship between serum zinc levels and anxiety, which means that patients with anxiety have lower levels of zinc in their serum, as compared with healthy individuals. Furthermore, zinc consumption was inversely associated with anxiety. Conclusion The results provide plausible evidence for the positive role of zinc in the treatment of patients afflicted with anxiety, albeit with some limitations. [ABSTRACT FROM AUTHOR]

Background: Data on the epidemiology of inflammatory bowel disease (IBD) in the Middle East are scarce. We aimed to describe the clinical phenotype, disease course, and medication usage of IBD cases from Iran in the Middle East. Methods: We conducted a cross-sectional study of registered IBD patients in the Iranian Registry of Crohn's and Colitis (IRCC) from 2017 until 2022. We collected information on demographic characteristics, past medical history, family history, disease extent and location, extra-intestinal manifestations, IBD medications, and activity using the IBD-control-8 questionnaire and the Manitoba IBD index, admissions history, history of colon cancer, and IBD-related surgeries. Results: In total, 9746 patients with ulcerative colitis (UC) (n = 7793), and Crohn's disease (CD) (n = 1953) were reported. The UC to CD ratio was 3.99. The median age at diagnosis was 29.2 (IQR: 22.6,37.6) and 27.6 (IQR: 20.6,37.6) for patients with UC and CD, respectively. The male-to-female ratio was 1.28 in CD patients. A positive family history was observed in 17.9% of UC patients. The majority of UC patients had pancolitis (47%). Ileocolonic involvement was the most common type of involvement in CD patients (43.7%), and the prevalence of structuring behavior was 4.6%. A prevalence of 0.3% was observed for colorectal cancer among patients with UC. Moreover,15.2% of UC patients and 38.4% of CD patients had been treated with anti-tumor necrosis factor (anti-TNF). Conclusion: In this national registry-based study, there are significant differences in some clinical phenotypes such as the prevalence of extra-intestinal manifestations and treatment strategies such as biological use in different geographical locations. [ABSTRACT FROM AUTHOR]

• Women with polycystic ovary syndrome had higher Inflammatory diet score. • Dietary Inflammatory Pattern is positively associated with polycystic ovary syndrome. • Carbohydrate intake was significantly higher in polycystic ovary syndrome women. Polycystic ovary syndrome (PCOS), as the most common endocrine disorder in women of reproductive age, is influenced by various factors. Because there is evidence linking inflammation with chronic diseases, we hypothesized that there is a relationship between an empirical dietary inflammatory pattern score (EDIP) with odds of PCOS among the adult population. This case control study was conducted on Tehranian women in Iran. A total of 494 participants (203 women with PCOS in the case group and 291 healthy people in the control group), aged 18 to 45 years, were recruited for the study. Demographic information, anthropometric indices, physical activity level, and dietary intake were collected by a trained nutritionist. EDIP score was calculated to estimate overall dietary inflammatory potential based on 18 food groups. Statistical analysis was performed with SPSS version 19. Based on the results, the mean age of participants in the case and control groups were 28.98 ± 5.43 and 30.15 ± 6.21 years, respectively. Individuals with PCOS had a significantly higher difference in EDIP score compared with healthy participants (2.03 ± 1.13 vs 1.70 ± 0.93, P <.001). Also, the odds ratio and 95% confidence interval for the risk of PCOS across quartiles of EDIP showed a significant direct relationship (P =.003). In conclusion, our study showed that there was a direct association between PCOS risk and EDIP score. Findings suggest that inflammatory index might be a potential mechanism linking diet and PCOS development. This case control study, the possible association between an empirical dietary inflammatory pattern score (EDIP) and risk of polycystic ovary syndrome (PCOS), was investigated. A total of 494 participants (203 women with PCOS in the case group and 291 healthy people in the control group), aged 18 to 45 years were recruited. The results showed that there was a positive association between PCOS risk and EDIP score. [Display omitted] [ABSTRACT FROM AUTHOR]

Background. By utilizing the nursing care process, healthcare professionals can implement nursing knowledge effectively and efficiently, ultimately leading to a significant improvement in the quality of care provided. Objective. This study aimed to assess writing nursing care plan competence among Ardabil nursing students in northwestern Iran. Methods. The study involved 248 nursing students from the second to eighth semesters in three nursing and midwifery schools located in the Ardabil province of northern Iran. The data were collected using a simple random sampling method and included a demographic questionnaire along with a survey questionnaire on nursing care plan writing skills. This was conducted between May and June 2023. Descriptive statistics, Pearson correlation, t-test, ANOVA, and multiple linear regression analyses were conducted for data analysis. Results. The mean score (SD) for writing a nursing care plan in a student survey was 3.35 (0.57) on a scale of 1 to 5. The survey's weighted mean score for each dimension is as follows: data gathering (D) = 3.40 (0.73), identification of client's problems (P) = 3.40 (0.73), sustainable goals (G) = 3.31 (0.77), appropriateness of intervention (I) = 3.30 (0.67), and recognizing outcomes (O) = 3.37 (0.69). This indicates that the students performed well overall. However, the lowest score was in the appropriateness of interventions dimension. Multiple linear regression analysis revealed that four variables, mean score of grade point average (GPA), age, academic term, and time spent studying (hours per day), were significant predictors of the student survey's scores on writing nursing care plans. These variables could predict 61% of the total variance. Implication for Nursing Management. Nursing school administrators can establish programs to improve education and practice in nursing care plan development based on this study. They can use these findings to enhance nursing education and practice for students, which will ultimately lead to better nursing care plans. Administrators should ensure that students have the necessary skills for writing efficient care plans and provide training courses to improve their writing and critical thinking skills. Policies can be implemented to encourage students to increase their study hours and maintain quality care programs. Conclusion. Nursing students are skilled in creating well-written nursing care plans that follow the nursing process. The quality of these plans improves with higher GPAs and longer study hours. To enhance nursing care plans, nursing education should focus on developing skills and allocating sufficient time for studying and practicing. Collaborating with faculty and administrators, as well as using reliable resources, can also help improve the quality of care plans. [ABSTRACT FROM AUTHOR]

BACKGROUND: Healthcare organizations are among high-risk organizations due to the nature of their work as well as structural, physical and technological complexities. Accordingly, it is important to use risk management and control programs in all departments of these organizations. OBJECTIVE: The present study was conducted for the first time to evaluate the risk management status of the operating room and laboratory departments of Hamadan hospitals in 2022. METHODS: In this descriptive-observational cross-sectional study, laboratory and operating room departments were selected as the research environment. To conduct this research, a valid and reliable questionnaire was used to collect data, and the data were analyzed using SPSS 22 statistical software. RESULTS: The findings of the present study showed that the overall mean score of risk management status for the laboratory and operating room departments was 2.66 ± 0.15 and 2.89 ± 0.13, respectively. Furthermore, there was no statistically significant difference in the mean scores of the research components based on work experience, education level, and gender. CONCLUSION: It is suggested that the laboratory and operating room departments should focus more on adopting policies and solutions to improve the position of risk management, training and budget allocation for risk management. [ABSTRACT FROM AUTHOR]

Childhood cancer can affect meaning of life as well as spirituality, causing significant changes in the family members' life, accordingly, the present study investigated the relationship between depression and spirituality among mothers of children with cancer. This study is a descriptive-analytical research of correlation type was conducted on 70 mothers of children with cancer in 2019 by available sample method. The measurement instruments utilized included "Beck depression inventory-II," and spiritual attitude assessment" questionnaires. Results of this study indicated an inverse correlation between depression and spirituality in mothers of children with cancer. It seems that promoting the spiritual attitude of mothers can help them cope with depression. [ABSTRACT FROM AUTHOR]

Developing an anesthesia module in the operating room is one of the significant steps toward the implementation of electronic medical records (EMR) in health care centers. This study aimed to develop and evaluate the web based-anesthesia module of an electronic medical record Sciences, in the operating room of the Namazi Medical Training Center of Shiraz University of Medical Iran. This developmental and applied study was conducted in steps including determining the functional and non-functional requirements, designing and implementing the anesthesia module, and usability evaluation. 3 anesthesiologists, 3 anesthesiologist assistants, and 12 anesthetist nurses were included in the study as a research community. React.js, Node.js programming language to program this module, Mongo dB database, and Windows server for data management and USE standard questionnaire were used. In the anesthesia module, software quality features were determined as functional requirements and non-functional requirements included 286 data elements in 25 categories (demographic information, surgery information, laboratory results, patient graphs, consults, consent letter, physical examinations, medication history, family disease records, social record, past medical history, type of anesthesia, anesthesia induction method, airway management, monitoring, anesthesia chart, blood and fluids, blood gases, tourniquets and warmers, accessories, positions, neuromuscular reversal, transfer the patient from the operating room, complications of anesthesia and, seal/ signature). Also, after implementing the anesthesia module, results of the usability evaluation showed that 69.1% of the users agreed with the use of this module in the operating room and considered it user-friendly. [ABSTRACT FROM AUTHOR]

Introduction: Ethical issues are among the first concerns and important issues in the daily care of nurses, so that nurses always try to maintain and observe them in order to provide better and more basic care to patients. Moral intelligence (MI) can provide a framework for the proper functioning of nurses. The main purpose of this study was to determine the relationship between patient safety culture and the MI of nurses working in hospitals in Iran, Guilan province. Methods: In the present study which was descriptive and correlational research, the sample was 400 nurses from Iran. Data were collected by a standardized and modified questionnaire "Hospital Survey on Patient Safety Culture (HSOPSC)", and "Lennick & Kiel's Moral Intelligence Scale". The collected data were analyzed by Spearman correlation and Friedman test via SPSS software version 13. Results: The findings of the study showed that the relationship between the patient safety culture and MI, was significant, and the total MI score (P<0.0001 and r=0.30). Conclusion: There is a positive correlation between MI of nurses and patient safety culture. Therefore, planning to increase the MI of nurses can lead to improve patients' safety culture. [ABSTRACT FROM AUTHOR]

Developing an anesthesia module in the operating room is one of the significant steps toward the implementation of electronic medical records (EMR) in health care centers. This study aimed to develop and evaluate the web based-anesthesia module of an electronic medical record Sciences, in the operating room of the Namazi Medical Training Center of Shiraz University of Medical Iran. This developmental and applied study was conducted in steps including determining the functional and non-functional requirements, designing and implementing the anesthesia module, and usability evaluation. 3 anesthesiologists, 3 anesthesiologist assistants, and 12 anesthetist nurses were included in the study as a research community. React.js, Node.js programming language to program this module, Mongo dB database, and Windows server for data management and USE standard questionnaire were used. In the anesthesia module, software quality features were determined as functional requirements and non-functional requirements included 286 data elements in 25 categories (demographic information, surgery information, laboratory results, patient graphs, consults, consent letter, physical examinations, medication history, family disease records, social record, past medical history, type of anesthesia, anesthesia induction method, airway management, monitoring, anesthesia chart, blood and fluids, blood gases, tourniquets and warmers, accessories, positions, neuromuscular reversal, transfer the patient from the operating room, complications of anesthesia and, seal/ signature). Also, after implementing the anesthesia module, results of the usability evaluation showed that 69.1% of the users agreed with the use of this module in the operating room and considered it user-friendly. [ABSTRACT FROM AUTHOR]

This study aimed to examine the relationship between intelligence and creativity with sexual desire and the extent to which education, sex, and age moderate this relationship. In doing so, a total of 168 students (74 males and 94 females) aged 18–35 years (M = 23; SD = 3.58) were selected using convenience sampling from three universities in Tehran, Iran and they were asked to complete a set of measures including Raven's Progressive Matrices, Torrance Tests of Creative Thinking, and Hurlbert Index of Sexual Desire. Data analysis indicated that neither intelligence nor creativity was correlated with sexual desire. Moreover, current findings showed that education and sex did not moderate the relationship between intelligence and creativity with sexual desire, while there was a positive relationship between intelligence and sexual desire at older ages. These results suggest that sexual desire is not influenced by intelligence or creativity and only age moderates the relationship between intelligence and sexual desire. [ABSTRACT FROM AUTHOR]

Background: Rhinoplasty is a complex but popular surgery in Iran. The main complications of the surgery are post-operative bleeding and nasal septal hematoma due to poor intra-operative controlled hypertension. This study aimed to compare the efficacy of isoflurane-remifentanil (I-R) versus propofolremifentanil (P-R) to induce controlled hypotension and to assess surgeon satisfaction with each of these combinations during rhinoplasty. Methods: In 2020-2021, a single-blind clinical study was conducted on 98 patients aged 18-50 years undergoing rhinoplasty at Mother and Child Hospital (Shiraz, Iran). Patients were randomly divided into P-R (n=48) and I-R (n=50) groups. Changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) were assessed during surgery and in the recovery room. A questionnaire was used to evaluate the level of surgeon satisfaction. Data were analyzed using independent samples t test, Chi-square test, and repeated measures ANOVA with SPSS software. P<0.05 was considered statistically significant. Results: Five minutes after anesthesia induction, the P-R combination had a greater effect on reducing SBP (P=0.010), DBP (P=0.007), MAP (P=0.003), and HR (P=0.026) than I-R. However, from the 40th minute to the end of surgery and after 30 minutes of recovery, the I-R combination had a slightly better effect on blood pressure reduction than P-R. There was no difference in surgeon satisfaction with either of the two drug combinations. Conclusion: Both P-R and I-R combinations are recommended to induce hypotension during rhinoplasty. However, I-R is more effective than P-R in inducing the desired controlled hypotension. [ABSTRACT FROM AUTHOR]

This cross-sectional study evaluated patients' satisfaction with hospital meals in seven urban public hospitals using a validated questionnaire. The quality of food services based on the hospital standards was assessed using a checklist prepared by Iran's ministry of health. Of 800 subjects, the quality and quantity aspects of hospital meals, in general, were nearly satisfactory to the patients (mean score: 2.13, range: 1–3, SD: 0.39, 40% good and 36% moderate). The mean score of hospitals' food service quality based on hospital standards was 2.17 (range: 0–4, SD: 0.59). Females, younger patients and those with higher education level reported to be less pleased with hospital meal services. No relationship between patients' satisfaction and hospital food quality assessment based on hospital standards was found. [ABSTRACT FROM AUTHOR]

Systemic Lupus erythematosus (SLE) is a multisystem autoimmune disease. This disease triggers sexual dysfunction due to physiological, cognitive and mental effects. Since sexual function is often ignored in these patients, this study aimed to investigate the effect of sexual counseling based on EX‑PLISSIT model on improving the sexual function of married women with SLE. This clinical trial was conducted on 101 married women suffering from SLE (18–49 years) residing in Tehran. Randomization was performed by random block allocation with six blocks in a rheumatology clinic. A demographic questionnaire, the Depression, Anxiety, Stress Scales-21 Items (DASS-21), and the female sexual function index were used to collect the data. The intervention group received counselling sessions every week while the control group (n = 55) received routine care for the disease. Eight and twelve weeks after completion of counselling sessions, outcomes compared between the intervention and control groups, using independent ttest, paired t-test, repeated measures and Chi-squared test. The scores of sexual function in both groups did not differ significantly before the intervention (p > 0.05). At the first follow-up session, the score of all sexual function domains except sexual pain increased significantly in the intervention group while a significant reduction was observed in all domains of sexual function in the control group (p < 0.05). In the second follow-up, sexual function significantly increased in the intervention group whereas it significantly decreased in the control group (p < 0.05). According to the findings of this study, counseling based on EX-PLISSIT model positively affected the sexual function of women with SLE. Therefore, this model can be used as a cost-effective and simple counseling method to improve the sexual functions. [ABSTRACT FROM AUTHOR]

Background: Clinical competency is the ability to integrate knowledge, skills, attitudes and values into a clinical situation and it is very important in nursing education, clinical settings, nursing management, and crises. This study aimed to investigate nurses' professional competence and its correlates before and during the COVID-19 pandemic. Methods: We conducted this cross-sectional study before and during the COVID-19 outbreak and recruited all nurses working in hospitals affiliated to Rafsanjan University of Medical Sciences, southern Iran, so we included 260 and 246 nurses in the study before and during the COVID-19 epidemic, respectively. Competency Inventory for Registered Nurses (CIRN) was used to collect data. After inputting the data into SPSS24, we analysed them using descriptive statistics, chi-square and multivariate logistic tests. A significant level of 0.05 was considered. Results: The mean clinical competency scores of nurses were 156.97 ± 31.40 and 161.97 ± 31.36 before and during the COVID-19 epidemic, respectively. The total clinical competency score before the COVID-19 epidemic was not significantly different from that during the COVID-19 epidemic. Interpersonal relationships (p = 0.03) and desire for research/critical thinking (p = 0.01) were significantly lower before the COVID-19 outbreak than during the COVID-19 outbreak. Only shift type had an association with clinical competency before the COVID-19 outbreak, while work experience had an association with clinical competency during the COVID-19 epidemic. Conclusion: The clinical competency among nurses was moderate before and during the COVID-19 epidemic. Paying attention to the clinical competence of nurses can improve the care conditions of patients, and nursing managers should improve the clinical competence of nurses in different situations and crises. Therefore, we suggest further studies identifying factors improving the professional competency among nurses. [ABSTRACT FROM AUTHOR]

Introduction: Communication skills and acceptable levels of spiritual intelligence (SI) are the prerequisites of the nursing profession, which can significantly impact the individual and organizational performance of nurses. This study aimed to investigate the competency and self-efficacy of communication and its relationship with the SI of nurses. Methods: This cross-sectional study was conducted in 2021 and included 312 nurses working in a COVID-19 hospital in the south of Iran. The data collection instruments were the Standard Communication Competence Scale, Communication Self-Efficacy, and SI Questionnaires. Data were analyzed with SPSS software version 23 using descriptive and inferential statistics, and t-test, ANOVA, Pearson's correlation coefficient, and multiple linear regression were performed at 5% significance level. Results: The mean scores of nurses' communication competence, communication self-efficacy, and SI were 89.11 ± 7.32 out of 180, 64.45 ± 5.61 out of 120, and 147.13 ± 11.26 out of 210, respectively. A direct and significant correlation was observed between competence (r = 0.527, p<0.001) and communication self-efficacy (r = 0.556, p<0.001) with spiritual intelligence. The dimensions of spiritual intelligence, including the ability to deal with and interact with problems, self-awareness, love and affection, general thinking and doctrinal dimension, and dealing with moral issues, were identified as predictors of nurses' communicative competence and self-efficacy (p<0.05). There was a positive and significant correlation between nurses' competence and self-efficacy with their age (p<0.05). The nurses' mean communication competence and self-efficacy score were different regarding their level of education and the number of shifts (p<0.05). The mean scores of self-efficacy revealed a statistically significant difference between the participants' gender and the number of patients under observation (p<0.05). Moreover, the nurses' SI significantly correlated with age, and the mean scores of this intelligence had statistically significant differences regarding gender (p<0.05). Conclusion: The nurses' communication competence and self-efficacy were at a moderate level. Considering the correlation and predictive role of SI and its dimensions, it is recommended to promote problem-solving skills, improve self-awareness, and pay attention to moral standards to nurture communication competence and self-efficacy among nurses. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To familiarise yourself with factors that can affect employees' attitudes towards their role • To recognise the link between improved productivity in healthcare services and ensuring patients' health and well-being • To learn how organisational justice can be linked to improved productivity in emergency nurses Background: Human resource management and employees' performance are fundamental to the success of healthcare organisations. Therefore, it is important to consider the factors that may affect employees' performance. Aim: To determine the relationship between perceived organisational justice, positive organisational behaviour (POB) and the productivity of emergency nurses. Method: This was a descriptive-analytical study that involved distributing questionnaires to emergency nurses working in hospitals affiliated with Mazandaran University of Medical Sciences in Iran. The researchers used proportionate stratified sampling to calculate the sample size. Three questionnaires were used to collect data on organisational justice, POB and productivity. The data were analysed using the Pearson correlation coefficient and multiple regression tests. Results: The questionnaires were distributed to 284 emergency nurses and completed by 234 of them. The results demonstrated a significant relationship between the productivity of the emergency nurses and the variables of perceived organisational justice and POB. Conclusion: Higher levels of perceived organisational justice and POB in the ED setting are likely to lead to increased productivity among emergency nurses, and as a result the quality of patient care is likely to improve. Therefore, healthcare organisations should pay particular attention to the application of organisational justice, with the aim of promoting POB among nurses and increasing their productivity. [ABSTRACT FROM AUTHOR]

Objectives: When a married family member suffers from multiple sclerosis (MS), the collective physical and psychosocial well-being of the family is impacted and much of the burden is on the healthier spouse. The purpose of the present study was to determine the contribution of psychosocial support from spouses, friends, and others in overall family functioning in respect of Iranian patients with MS, considering the mediating role of spiritual experiences and moral foundations. Methods: Spouses of patients with MS were chosen through the judgmental sampling method. The research instruments comprised the Family Assessment Device, Social Support Appraisals Scale, Daily Spiritual Experience Scale, and Moral Foundations Questionnaire. Data analysis was done through the path analysis technique. Results: The subjects comprised 220 spouses of MS patients. We found a significant relationship between family support path and overall functioning mediated by the variable 'spiritual experiences', the root mean square error of approximation (RMSEA) value being < 0.001. Similarly, the relationship between spiritual experiences and moral foundations had a significant effect on overall family functioning (RMSEA < 0.001). After eliminating insignificant relationships and estimating fit indicators, the modified (adjusted) model indicated goodness of fit with data. Conclusions: This study found, for the first time in the Iranian community, a significant effect of family support focused on spouses of MS patients compared to the support from friends and others, with regard to family functioning. The mediating roles of spiritual experiences and moral foundations were confirmed. Further studies are suggested to delve into the role of family support for MS patients in developing countries. [ABSTRACT FROM AUTHOR]

Background: Despite the widespread knowledge about social support and health, there is little information about the association between social support and HIV risk behaviors such as condom use among female sex workers (FSWs) in Iran. This study aimed to determine the association between social support and frequency of condom use among FSWs in Tehran, Iran. Methods: Using mixed sampling methods, we recruited 170 FSWs in Tehran in 2017. We measured self-reported social support by face-to-face interviews using a standardized questionnaire. Linear regression was used to assess the association between socio-demographic characteristics (age, education level, marital status, and place of living), transactional sex characteristics (age at first transactional sex and frequency of transactional sex in the last month), HIV knowledge, social support network characteristics (social network size, duration of tie, intimacy, social support), and condom use behavior. Results: Of the total of 1193 persons in FSW's social networks, 615 (51%) were sexual partners, 529 (44%) were peer sex workers, and 36 (5%) were family members. The participants perceived moderate social support from sexual partners, low from peer sex workers, and very low from family members. Adjusted for individual and other network characteristics, peer sex worker social support (b = 0.28, 95%CI 0.06, 0.50), and family support (b = 1.12, 95%CI 0.028, 2.23) were significantly associated with condom use. Conclusion: Family and peer sex worker social support are associated with condom use, but less strongly than HIV knowledge or place of living. However, very few FSWs are socially connected with families. Interventions to promote condom use among this vulnerable population should also consider social and familial support. [ABSTRACT FROM AUTHOR]

Background. The incidence of coronary artery disease (CAD), the leading cause of mortality in most developed and developing countries, is increasing. The adoption of hospital registries can improve care delivery and facilitate the management of CAD through better planning, as well as help with outcome assessment through more effective data management. Objectives. The present study is aimed at designing a hospital-based CAD registry for managing CAD data. Methods. This developmental study was conducted in three phases. Initially, sources related to CAD registries were reviewed, the results of which were published in two studies. In the next phase, the prerequisites and requisites of the software were determined through a qualitative study. In this phase, the registry dataset was determined by using a questionnaire. Finally, the developed conceptual model of the software was validated. The software was then developed based on the validated conceptual model. Results. The registry data elements were classified into 13 main categories, including identification data, medical history, and risk factors. The dataset included 171 data elements, including data related to surgical and nonsurgical procedures. The conceptual model was approved by field experts, and the software was developed accordingly. Conclusion. The steps followed in the present study for developing the CAD registry can be used as an appropriate approach for designing similar hospital-based registries. Considering the pivotal role of the registry in the management of CAD, the routine and systemic use of the registry is suggested in all healthcare centers. [ABSTRACT FROM AUTHOR]

Background: Breast self-examination (BSE) is an important part of health care for all women in every stage of life. This study aimed to investigate the effect of theory of planned behavior (TPB) on doing BSE in a sample of Iranian women. Methods: A cross-sectional study was carried out to examine the factors affecting the BSE in 400 women. Then, a quasi-experimental study was conducted on 200 subjects (100 in experimental group and 100 in control group). The educational intervention for the experimental group consisted of 8 training sessions. A questionnaire including demographic characteristics, knowledge, and constructs of TPB was used to measure BSE performance before and 6 months after the intervention. Constructs of attitude, subjective norms, and perceived behavioral control predicted the intention to do the BSE. Results: The mean age of the subjects was 31.65 ± 7.59 years. The studied variables predicted 38.7% of behavioral intention (P <.001, odds ratio = 0.387). Six months after the intervention, the experimental group showed a significant increase in the knowledge, attitude, perceived behavioral control, subjective norms, intention, and BSE performance compared with the control group (P <.001). Conclusions: This study showed that educational intervention based on the TPB was effective in promoting breast cancer screening behavior such as BSE. Therefore, it is suggested that health educators and health care planners use educational texts based on these constructs of TPB to increase their influence on individuals via screening behavior for breast cancer. [ABSTRACT FROM AUTHOR]

Given that physical activity can improve health, the present study was conducted to affect education based on the theory of planned behavior on the promotion of physical activity and awareness in the prevention of diabetes in students. This parallel quasi-experimental study with two equal groups of intervention and control was carried out in three stages by multistage sampling method. Students who were physically ill or had absence were excluded from the study. Only the intervention group received the required intervention and the evaluation was done before, immediately after and 3 months after the intervention in both groups. The educational program was implemented in various forms such as oral, pamphlets, brain storming, group discussions, role play for behavior modeling, and written media such as posters, and exercise demonstrations. Data collection was performed in primary schools of Mashhad. The questionnaire was contained; demographic information, diabetes awareness, physical activity based on the theory of planned behavior and physical activity (IPAQ). Data analysis was done by SPSS-16 software using Fisher's exact test, Chi-square, and marginal longitudinal models at the significance level of 0.05. The mean scores of knowledge (p < 0.001), subjective norm (p < 0.001), perceived behavior control (p = 0.015) and physical activity (p < 0.001) immediately after the intervention were higher in the intervention group compared to the control group and the differences were significant. Results of this study supported the effectiveness of education based on theory of planned behavior in the promotion of physical activity and knowledge of students regarding diabetes prevention. [ABSTRACT FROM AUTHOR]

Background. Mental disorders during pregnancy can be associated with adverse delivery and neonatal outcomes, as well as a higher risk of postpartum mental disorders. Objectives. This study was conducted to determine the factors associated with mental disorders in pregnant women. Material and methods. Using stratified multistage random sampling, 332 participants were selected among pregnant women covered by health centres for prenatal care from April to September 2019 in the west of Iran. After obtaining informed consent from these people, the demographic questionnaire and the Persian version of the Goldberg GHQ-28 questionnaire were completed for them by a trained midwife. The data was analysed in SPSS 22 using descriptive statistics, the t-Test and ANOVA. Results. The mean age and mean gestational age of the 332 pregnant women under study were 29.01 ± 5.44 years and 22.95 ± 8.95 weeks, respectively. About 32.5% (n = 108) of the women were suspected of having general mental health disorders. The mean scores of the subscales and general mental health disorders were significantly higher in pregnant women with unwanted pregnancy, marital dissatisfaction, a history of domestic violence and in those between 43–47 years of age (p < 0.05). However, the differences between the mean scores of the disorders were not statistically significant in women with a history of abortion and infertility, gestational age and gender, educational levels and occupation. Conclusions. The results of this study showed that 32.5% of the pregnant women were suspected of having general mental health disorders. Mental health disorders were more common in pregnant women with unwanted pregnancy, marital dissatisfaction, a history of domestic violence in those between 43–47 years of age. [ABSTRACT FROM AUTHOR]

Reflective thinking and teaching style are considered as two prominent and influential factors in the process of education. There have been several studies carried out to investigate different aspects of each of these two factors. However, no studies have been done to explore the possible relationship between these two crucial elements. Therefore, the present study set out to fill the gap and explore the relationship between reflective thinking and teaching style among EFL teachers in Iran. Ninety EFL teachers including 50 males and 40 females were chosen as the participants of this research. The questionnaires selected for the data collection phase were given to the teachers and they were asked to fill them out. The collected data were analyzed and it was found that there was a positive correlation between EFL teachers' reflective thinking and their teaching style. The results of this research study can be of use for EFL teachers and teacher educators. [ABSTRACT FROM AUTHOR]

Rationale/Aim: Falls can have severe consequences particularly for older patients with cancer undergoing ambulatory care. The aim of the study is to identify the predictors of falls in older patients receiving cancer ambulatory care and evaluate the accuracy of the final multivariable model in detecting older patients with falls. Method: A retrospective study was conducted on 300 older patients aged 60 years and above that were referred for ambulatory care in three oncology clinics based at hospitals in Tehran, Iran. Participants completed a questionnaire comprising demographic, history of falls, and cancer‐related factors. Logistic regression was used to determine risk factors associated with falls. Results: A total of 35.3% of the older patients with cancer had experienced a fall in the 6 months following the start of their ambulatory care. The most important predictors of falls include the fourth stage of cancer (odds ratio [OR]: 6.47, 95% confidence interval [CI]: 3.20–13.08, p < 0.001), fear of falling (OR: 5.64, 95% CI: 2.58–12.33, p < 0.001), use of hearing (OR: 2.38, 95% CI: 1.07–5.29, p = 0.033) and visual aids (OR: 2.36, 95% CI: 1.12–5.01, p = 0.025), and the number of visits to the doctor (OR: 1.10, 95% CI: 1.01–1.21, p = 0.035). Conclusions: The results indicate that a reduction in falls is possible by introducing strategies to improve care for older patients in the advanced stage of cancer, eliminating the causes of fear of falling, examining and improving vision and hearing, and identifying and addressing the underlying causes of visits to the doctor. [ABSTRACT FROM AUTHOR]

Background: Hyperinsulinaemia is considered as a major risk factor for the development of a myriad of chronic diseases. We examined the association between the dietary insulinaemic potential and the odds of non‐alcoholic fatty liver disease (NAFLD) among Iranian adults. Methods: After being subjected to a liver ultrasound, 166 patients with NAFLD and 200 controls were included in the study. The dietary intakes and the physical activity levels of the participants were evaluated using a validated semi‐quantitative food frequency questionnaire and the International Physical Activity Questionnaire (short IPAQ), respectively. The insulinaemic potential of the diet was assessed by computing the scores of the Empirical Dietary Index for Hyperinsulinemia (EDIH) and the Empirical Dietary Index for Insulin Resistance (EDIR). Results: Compared with the control subjects, patients with NAFLD were significantly older; had higher values for body mass index, fasting blood sugar, triglycerides, low‐density lipoprotein cholesterol, total cholesterol and alanine transaminase; and were more likely to smoke. Moreover, NAFLD patients had significant lower levels of high‐density lipoprotein cholesterol and were less likely to perform physical activity. The risk of NAFLD was higher in the individuals in the highest tertile of the EDIH (odds ratio [OR] = 2.79; 95% confidence interval [CI] = 1.32–5.90; p value for trend < 0.05) and EDIR (OR = 2.42; 95% CI = 1.22‐4.79; p value for trend < 0.05) compared to those in the lowest tertile of these scores. Conclusions: Our study indicates that a higher dietary insulinaemic potential is associated with an increased risk of NAFLD. [ABSTRACT FROM AUTHOR]

Background and Objectives: Spirituality and psychological interventions are effective in promoting mental health and treating patients undergoing hemodialysis. The present study seeks to evaluate the effectiveness of treatment based on acceptance and commitment therapy (ACT) before dialysis, with and without mindfulness exercises during dialysis, on the spiritual health of these patients. Methods: The research design was quasi-experimental with a control group (two experimental groups and one control group) and a two-month follow-up. The study population included all patients on hemodialysis referring to hospitals affiliated to Imam Zaman Hospital in Mashhad City, Iran, from July to December 2020. A total of 60 patients were selected by a purposive sampling method based on the inclusion criteria. Then, they were randomly divided into three groups. The research instrument included a spiritual health questionnaire, and data analysis was performed by repeated-measures analysis of variance. Results: The results showed that both experimental groups of ACT before dialysis (P<0.001), with or without mindfulness plus exercises during dialysis (P=0.004), were effective on spiritual health in patients on hemodialysis. Conclusion: ACT alone as an effective intervention can be used in medical centers to increase the spiritual health of patients on hemodialysis. [ABSTRACT FROM AUTHOR]

Religion can lead to the creation of meaning. Therefore, religion gives meaning to the life and death of humans. Spirituality is far higher than religion and entails all concepts of human dimensions such as spiritual health, peace resulting from belief and spiritual adaptation as well as one's experiences in a unique and dynamic process (which is reflecting the belief in God and infinite power), connection (to someone, others, nature or God) and coalition. Regardless of considering the role of spirituality in the health section, what is worldly paid attention today, is the "spirituality" and "sublime values" in medical science education specially life skills and spiritual life skills education and the people of the society. This research sought to investigate the effect of religious and spiritual education on the mental health of girl students (2018–2019) of Technical and Vocational University in the architecture major of Tehran province. The methodology of the study was quasi-experimental having pretest and posttest and control group. The sample size included 152 individuals using Morgan table who were selected through multi-stage sampling. The statistical population was randomly divided into two experimental and control groups. Experimental group received educational–religious classes for 15 sessions. To analyze the data, Goldberg health questionnaire was utilized, and also descriptive as well as inferential statistics such as covariance analysis and LSD test were used in this regard. The results indicated that religious and spiritual effects were influential on the increase in mental health and social and physical performances as well as the decrease in students' depression. [ABSTRACT FROM AUTHOR]

Background and Aim Genetic and environmental factors are known to be related to the development of childhood Eczema. We aimed to assess the ecological factors associated with the prevalence of Eczema among children using the ISAAC questionnaire. Methods & Materials A total of 1600 primary school girls and boys were selected and examined by multistage random sampling in this cross-sectional study. Data were collected and completed using the International ISAAC Questionnaire, including demographic questions and risk factors through interviews with parents, especially the student’s mother. The data were analyzed in SPSS19 software using the Chi-square test and multiple logistic regression. Ethical Considerations This study was approved by the Ethics Committee of Zahedan University of Medical Sciences (Code: REC.1397.481). Results The prevalence of current Eczema was 10.4% (CI95% 8.9-11.9). Co-morbidity with Asthma and Rhinitis was 82.8% and 74.5%, respectively. In multiple logistic regression models, history of allergies in family members (OR: 2.35 CI95%:1.53-3.59), father snoring (OR: 3.00 CI95%:1.98-4.55), Keeping any animal in (OR: 1.6 CI95%:1.002-2.58), family size (OR:0.85 CI95%:0.68-0.95), exposure to tobacco smoke at home (OR:2.84 CI95%:1.18-6.81), showed a significant relationship with the occurrence of students’ Eczema. Conclusion Exposure to tobacco smoke at home, keeping any animal at home are effective factors in the prevalence of Eczema in children. By eliminating these factors, the prevalence of this disease can be reduced. However, the mothers have the most crucial role in screening and early diagnosis of Eczema in school children regarding determinants in this study. According to the results of this study, it is suggested that parents’ education, especially mothers, be emphasized by paying attention to these favorable factors. [ABSTRACT FROM AUTHOR]

In this experimental study, 200 cancer patients (100 subject in experimental group and 100 subjects in control group) referred to Amir Oncology Hospital in Shiraz were investigated. Educational intervention for experimental group consisted of 12 educational sessions for 50 to 55 minutes. A questionnaire including demographic information, PRECEDE constructs (knowledge, attitude, self-efficacy, enabling factors, and social support), was used to measure health promotion behaviors, patients' hope, and mental health before and 6 months after intervention. Six months after intervention, experimental group showed significant increase in knowledge, attitude, self-efficacy, enabling factors, social supports, health promotion behaviors, patients' hope, and mental health compared to the control group. This study showed the effectiveness of intervention based on PRECEDE constructs in mentioned factors 6 months after intervention. Hence, this model can act as a framework for designing and implementing educational intervention for health promotion behaviors of cancer patients. [ABSTRACT FROM AUTHOR]

Background and Objectives: Spiritual well-being is very important in adaptation and peace of mind, especially in certain periods of life. Middle age is associated with many biological, psychological, and social changes and problems such depression and hopelessness. This study aims to investigate the relationship between spiritual well-being, depression, and hope in middleaged women in Qom, Iran. Methods: This is a descriptive-analytical study with cross-sectional design that was conducted on 100 middle-aged women referred to community health centers in Qom city, who were selected by a convenience sampling method. Data were collected by three questionnaires including Paloutzian and Ellison's spiritual well-being scale (SWBS), Beck' depression inventory (BDI), adult hope scale (AHS), which were completed through interview. Data were analyzed in SPSS version 21 software using regression analysis. Results: The Mean±SD total scores of SWBS, BDI, and AHS were 73.43±1.25, 31.10±0.91, and 16.26±0.34, respectively. There was a significant relationship between spiritual well-being and depression and between spiritual health and hope (P=0.001). Moreover, spiritual well-being and hope had a significant relationship with depression (P=0.001). Conclusion: Middle-aged women with high spiritual well-being have less depression and more hope. It is recommended to pay more attention to spiritual well-being of these women to maintain their mental health and increase their hope. [ABSTRACT FROM AUTHOR]

The present study examines the moderating role of religiosity in the association between death anxiety and depression among Iranian community-dwelling older adults. This study recruited 340 participants using a cluster sampling method. The data were collected using the Templer Death Anxiety Scale, Goldberg Depression Questionnaire, and Allport-Ross Intrinsic/Extrinsic Religious Orientation Scale. The moderating role of intrinsic (death anxiety × intrinsic: β = -.048, p =.388) and extrinsic (death anxiety × extrinsic: β = -.011, p =.831) religiosity in the relationship between death anxiety and depression was not confirmed. The findings did not support the moderating role of religiosity in the relationship between death anxiety and depression. Further studies are recommended to confirm these results. [ABSTRACT FROM AUTHOR]

Introduction: The quality of nursing services is one of the main factors accelerating patients' recovery. The present study aimed to examine patients' perceptions of the quality of nursing services in the teaching hospitals of Iran. Methods: This cross-sectional research was a descriptive-analytical study conducted in 2021, in which 1067 patients were selected as the research sample. The Qualipak nursing quality questionnaire (QUALPAC) was used to collect the required data. Data were analyzed using t-test, ANOVA, and Pearson correlation coefficient using SPSS software version 23. Results: From the patients' perspective, the mean and standard deviation of the quality of nursing services was 191.47 ± 19.51. Among the quality dimensions, all services quality: psychosocial (91.34 ± 9.34), physical (65.72 ± 10.18), and communication (34.41 ± 6.21) were placed at the moderate level. A significant association was found between patients' age and nursing service quality. The perceived nursing service quality was subject to sex (P = 0.01, t = 1.921) and place of residence (P = 0.02, t = 1.873). Conclusion: According to the findings, the quality of nurses 'care was "moderate" from the patients' perspectives. Planning is recommended to reinforce and promote the quality of nursing services. [ABSTRACT FROM AUTHOR]

Objective: COVID-19, which is an international concern by far, had fundamental impacts on mental health of medical staff. Healthcare workers are the high-risk group to endure the emotional outcomes brought about by the outbreak. This study assesses the mental consequences of healthcare workers during the acute phase of COVID-19 pandemic in Tehran. Method: We conducted a cross-sectional study on healthcare workers from two tertiary referral hospitals in Tehran province. A total of 222 of the staff participated in the study. Our questionnaires comprised Impact of Event Scale- Revised (IES-R) and 12-item General Health Questionnaire (GHQ-12), which were handed to participants to obtain data on their general mental problems in addition to the psychological impacts of the evolving virus on this particular group. Epidemiologic and sociodemographic information of participants, level of perceiving exposure to disease, and underlying diseases of each of them were gathered during the recruitment period. Results: Results showed high probabilities (98.2%) in mental disorders among healthcare workers. Since our study was done during the initial phase of the pandemic, development of mental issues due to the newly emerged infectious virus was expected. However, we recorded mild (41.4%) to moderate (31.5%) impact of this novel virus. The possibility of having mental problems was much higher in females, assistant nurses, individuals with lower education, and those who provided care for COVID-19 patients. Conclusion: COVID-19 has brought about increased distress among healthcare workers. Noticeably, the forefront group in combating this virus bear the most emotional complications. Thus, efforts should be taken into practice to provide proper psychological support for this vulnerable group. [ABSTRACT FROM AUTHOR]

Background. Given the increasing prevalence of primary tooth caries in Iran and the importance of providing evidence- and theory-based family-centered prevention programs, the present study is aimed at determining the family-centered social cognitive factors preventing deciduous tooth caries among children using the intervention mapping protocol. Methods. This cross-sectional study was performed on 240 Iranian mothers in Ilam who were randomly selected to participate in the study. The data were collected using a self-designed questionnaire including items on demographic information and social cognitive constructs (knowledge, attitude, perceived severity, perceived benefits, perceived barriers, practice guidance, perceived self-efficacy, behavior intention, subjective norms, and social norms). The questionnaire was completed by mothers, and the data were analyzed by performing one-way analysis of variance and linear regression. Results. The results obtained from linear regression analysis showed that perceived self-efficacy (B = 0.295 , p < 0.001), perceived barriers (B = 0.084 , p < 0.028), practice guidance (B = 0.774 , p < 0.001), and social norms (B = 0.137 , p < 0.020) accounted for 71% of the behavioral intention variance and were the most important predictors for preventing primary tooth caries among children. Conclusion. The findings suggest that perceived self-efficacy, perceived barriers, practice guidance, and social norms are essential for developing family-centered programs to prevent primary tooth caries in children. [ABSTRACT FROM AUTHOR]

Introduction: Out-of-pocket (OOP) is among the payment methods in Iran's health system. The present study aimed to examine the OOP treatment costs for patients with COVID-19 in Iran. Methods: A descriptive-analytical, cross-sectional study was conducted in 2021. In this study, the cost records of 550 patients with COVID-19 hospitalized in a referral center of COVID-19 were selected using the stratified random sampling method. The required data were collected using a researcher-made questionnaire. Data were analyzed by t-test, ANOVA, and Pearson's correlation coefficient in SPSS software version 23 at p = 0.05. Results: The total direct costs were 1,037,992.15 US $. Moreover, the shares of patients (OOP), basic insurance, government subsidy, supplementary insurance, discounts, and out-of-government subsidy in the total direct costs were US $ 92,231.21, 746,932.99 US $, 155,127.08 US $, 39,690.25 US $ and 4010.61 US $, respectively. In addition, the results confirmed that there was a positive and significant relationship between the patients' OOP payments and the length of stay. It also found that the patients' OOP payments are subject to the type of insurance program and discharge method. Conclusion: According to the results, 8.89% of the total direct costs were directly paid out of the patients' pockets. The research findings confirm the urgent need to make decisions and implement effective interventions for COVID-19 disease by controlling risk factors and exploiting other countries' successful experiences and international organizations' recommendations to decrease the prevalence of the infected and consequently reduce the financial pressure of the disease on patients by approving the expansion of the insurance organizations' role. [ABSTRACT FROM AUTHOR]

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women of reproductive age and is affected by various dietary factors. Therefore, this study aimed to investigate the relationship between dietary diversity score (DDS) and the risk of PCOS. Our case-control study was conducted in the summer and autumn of 2019 in Taleghani and Arash hospitals in Tehran, Iran. A total of 494 participants (203 cases and 291 controls) were included in the study. Thereafter, their demographic information, dietary intake, and anthropometric and physical activity assessments were gathered. A validated semi-quantitative food frequency questionnaire was then used to calculate the DDS by scoring 5 food groups. To evaluate the risk of PCOS in association with DDS, the subjects were categorized based on the quartile cut-off points of the DDS. The mean ± SD age of the participants in both the case and control groups was 28.98 ± 5.43 and 30.15 ± 6.21 years, while mean ± SD body mass index was 25.74 ± 5.44 and 23.65 ± 3.90 kg/m2, respectively. The comparison between the case and control groups indicated that total DDS was 5.19 ± 1.19 for the cases and 5.51 ± 1.19 for the controls. The comparison of DDS in the highest versus the lowest quartiles showed a decreased risk of PCOS (p < 0.05). We demonstrated an inverse association between DDS and PCOS compared with the control group. Furthermore, a higher DDS was significantly associated with a lower risk of PCOS (odds ratio = 0.40). Novelty: This is the first investigation on the relationship between DDS and PCOS. Results depicted an inverse relationship between DDS and PCOS. [ABSTRACT FROM AUTHOR]

COVID-19 disease has quickly become a major threat and epidemic in the world. Many people are experiencing psychological disorders due to the rapid spread of the COVID-19 disease. The present study aimed to investigate the psychosocial status of the Iranian citizens during the prevalence of COVID-19. One thousand one hundred and sixteen citizens of Rafsanjan city participated in the cross-sectional study from March 15 to 30, 2020. The data were collected using demographic and COVID-19 related-items, and Health General Questionnaire (GHQ −28). The results showed that 35% of the participant had mental health problems. All participants had social functioning disorder, while 22.8% had physical symptoms, 26.8 had anxiety symptoms and sleep disorders. In addition, the risk of psychosocial disorder was higher in females, those who were living in the city, earning less than 1 million, thinking of being at risk for infection with the coronavirus, and those whose most important concern about COVID-19 was death (P < 0.05). The results of the present study showed that all participants had social dysfunction. Therefore, health-care providers are suggested to evaluate the psychosocial consequences routinely, design and implement appropriate interventions to deal with these complications. [ABSTRACT FROM AUTHOR]

• First study examining fiber intake and metabolic health in Iranian adolescents. • Total dietary fiber was inversely related to odds of metabolically unhealthy status. • Total dietary fiber was inversely related to odds of hyperglycemia. Little is known about the relationship between dietary fiber and metabolic health status in adolescents. This study was performed to investigate total dietary fiber intake and metabolic health status in a sample of Iranian adolescents with overweight/obesity. We hypothesized that higher total dietary fiber intake would reduce odds of metabolically unhealthy status. In this cross-sectional study, 203 adolescents (aged 12–18 years) with overweight/obesity were randomly recruited from several educational areas with different socioeconomic statuses using a multistage cluster sampling approach. Dietary intakes were evaluated by a validated food frequency questionnaire. Demographic, anthropometric, and cardiometabolic data were gathered through standard methods. Adolescents were categorized as having either metabolically healthy overweight/obesity or metabolically unhealthy overweight/obesity (MUO) phenotypes according to the International Diabetes Federation (IDF) and IDF/Homeostasis Model Assessment Insulin Resistance (HOMA-IR) criteria. Subjects had mean age of 13.97 (years) and mean fiber intake of 19.5 (g/d). After considering potential confounders, adolescents with the highest fiber intake, compared with the lowest intake, had decreased odds of MUO based on IDF (odds ratio [OR] = 0.14; 95% confidence interval [CI], 0.04–0.46) and IDF/HOMA-IR (OR = 0.16; 95% CI, 0.04–0.56) definitions. Also, each additional unit of total dietary fiber intake (1 g/d) was associated with lower chance of MUO phenotype considering IDF and IDF/HOMA-IR criteria. Individuals with higher intakes of dietary fiber were also less likely to have hyperglycemia (in fully adjusted model: OR = 0.17; 95% CI, 0.06–0.52). We found that consumption of total dietary fiber was inversely associated with odds of MUO among Iranian adolescents. Further prospective studies are required for confirming our results. The association between dietary fiber intake and likelihood of metabolically unhealthy status was investigated in a sample of adolescents with overweight and obesity. Higher intake of dietary fiber was associated with reduced odds of metabolically unhealthy phenotype based on International Diabetes Federation and International Diabetes Federation/Homeostasis Model Assessment Insulin Resistance criteria. Abbreviation: HDL, high-density lipoprotein. [Display omitted] [ABSTRACT FROM AUTHOR]

Background. A growing body of research has examined the psychometric properties of popular mindfulness inventories for different population. The present study is aimed at exploring the psychometric properties and factor structure of the Relaxation/Meditation/Mindfulness (RMM) Tracker t Inventory in Iran. Method. This was a cross-sectional and methodological study that conducted in Kerman, southeast Iran. Fifty, 300, and 163 Iranian adult participants were participated in the pilot, exploratory, and confirmatory phase, respectively. Face, content, and structural validities, Cronbach's alpha, and Omega coefficient were used to validate the Persian scale. Results. The results showed that the "Persian version of RMM t" had acceptable content and face validities. The Principal Axis Factoring (PAF) with Promax Rotation showed that the P-RMM t has 3 scales of "Mindful Love, Thankfulness, and Transcendence," "Relaxation," and "Mindful Deepening" which further confirmed with confirmatory factor analysis. The internal consistency of all three scales was acceptable (Cronbach's alpha coefficients > 80). Conclusion. The Persian version of RMM Tracker t seems to be a valid and reliable questionnaire to assess the levels of mindfulness in the Iranian general population. [ABSTRACT FROM AUTHOR]

Introduction: A new coronavirus, called COVID-19, is an acute respiratory disease, which may arouse many psychological disorders since there is no specialized knowledge about it. The present study aimed to investigate the level of resilience and its relationship with hypochondriasis in nurses working in a COVID-19 reference hospital in south of Iran. Methods: This cross-sectional study was conducted in 2020, in which 312 nurses participated using the census method. Data collection tools were the Conker-Davidson standard resilience scale (CD-RISC) and the Evans Hypoglycaemia Awareness Questionnaire. Data were analyzed using t-test, ANOVA, Pearson correlation coefficient, and multiple linear regression using SPSS software version 23. Results: The mean scores of resilience and hypochondriasis were 72.38 ± 7.11 and 49.75 ± 8.13, respectively, indicating the moderate level of these two variables among nurses. Hypochondriasis in 18.91, 61.22, and 1.28% of the nurses was mild, moderate, and severe, respectively. There was a significant negative correlation between resilience and hypochondriasis (r = − 0.214 and P < 0.001). In this regard, control (P < 0.001), positive acceptance of change (P < 0.001), spiritual effects (P = 0.001), trust in individual instincts (P = 0.001), and perception of competence (P = 0.002) were detected as the predictors of nurses' hypochondriasis. Conclusion: The nurses had moderate levels of resilience and hypochondriasis. Promoting knowledge about COVID-19and increasing information on how to protect oneself and others against the disease along with supportive packages from their managers are thus recommended. [ABSTRACT FROM AUTHOR]

Background: In this study, we investigated several socioeconomic, clinical, and psychological factors associated with medication adherence in a sample of Iranian patients with inflammatory bowel disease (IBD). Materials and Methods: This study was conducted on 110 IBD patients from 2013 to 2014 in Isfahan, Iran. The patients were invited to complete three anonymous questionnaires including the Hospital and Anxiety Depression Scale (HADS) for assessing the levels of anxiety and depression; IBD Questionnaire-Short Form (IBDQ-9) for the quality of life; and a visual analog scale assessing the medication adherence. A self-assessment adherence rate of more than 80% was considered "appropriate adherence." Results: Overall, 99 patients completed the questionnaires. Among them, 77.8% reportedly adhered to their medications. There was no statistical difference between adherence and nonadherence rates in terms of gender, educational status, disease type, disease severity, and family history of IBD. Conversely, single patients (100% vs. 74.1%; P = 0.03), nonsmokers (79.4% vs. 0.0%; P = 0.04), patients receiving immunosuppressive drugs (100% vs. 71.9%; P = 0.01), and corticosteroids (95.1% vs. 65.5%; P = 0.01) were more likely to be adhered than their counterparts. No differences emerged in terms of the mean HADS scores in either of the sexes. The mean IBDQ-9 score was significantly higher in adhered patients only in females (31.08 ± 11.6 vs. 24.7 ± 9.1; P = 0.04) but not in males. Conclusion: The adherence rate in our study is almost similar to developed countries. Single marital status, not smoking, receiving corticosteroids and immunosuppressive drugs, and higher IBDQ-9 score in females are associated with higher adherence rate. [ABSTRACT FROM AUTHOR]

The present study aims to analyze the factors affecting medical tourists' revisit and recommend intention such as perceived authenticity, destination image, perceived value, and satisfaction. To this end, a 50-item questionnaire is distributed among 384 medical tourists who have visited Iran's hospitals and beauty clinics in the spring, summer, and fall of 2017. The results indicate that medical tourists' perceived authenticity of medical centers has an impact on their destination image, and both of these factors affect their perceived value and satisfaction. In addition, medical tourists' satisfaction of their trip leads to their revisit intention and their revisit intention influence their word of mouth. [ABSTRACT FROM AUTHOR]

The aim of this study was to identify the effect of web-based communication between a nurse and a family member of a patient with COVID-19 on his/her perceived stress. In this multicenter parallel randomized controlled trial, 67 family members of COVID-19 patients admitted to the Intensive Care Unit (ICU) were investigated. In the intervention group, web-based communication was performed for four consecutive days for 10 to 15 minutes. The Perceived Stress Scale (PSS-14) were completed in both groups before and after the intervention. Mean and standard deviation of perceived stress scores in the two groups were not significantly different (p = 0.26) before the intervention; however, after the intervention, the mean PSS-14 in the intervention group was significantly lower than that of the control group (p < 0.001). Due to the need to follow the physical and social distancing to protect against Coronavirus disease, the use of web-based communication recommended in future studies. [ABSTRACT FROM AUTHOR]

Background: There is no validated measurement tool to assess vaginal symptoms (VS), sexual matter (SS), and quality of life (QOL) among Persian-speaking women. This study aimed at translating and assessing the validity and reliability of the Persian version of the International Consultation on Incontinence Questionnaire for Vaginal Symptoms (PICIQ-VS). Materials and Methods: In this cross-sectional study, after obtaining permission from the International Consultation on Incontinence Questionnaire (ICIQ) Advisory Board, the English version of ICIQ-VS was translated into Persian per a standard translate and back translate process, and the validity and reliability were studied. Two hundred women with and without pelvic organ prolapse were asked to complete the PICIQ-VS (mean age: 52.1, range: 22-84 years). A panel of 10 experts evaluated the content and face validity of the questionnaire. Cronbach's alpha examined the internal consistency reliability of the measure. To evaluate the test-retest reliability, we redistributed the questionnaire among 30 patients 2 weeks after their initial visit using intra-class correlation coefficient (ICC). Results: Content and face validity of the questionnaire was confirmed after some light modification (content validity ratio ranged from 0.69 to 1.00, and content validity index ranged from 0.79 to 1.00). PICIQ-VS showed an acceptable internal consistency and stability reliability (VS: α = 0.64, ICC = 0.84; SM: α = 0.69, ICC = 0.88; and total scale: α = 0.72, ICC = 0.91, respectively). Significant differences were observed between the asymptomatic and symptomatic groups for VS and the total score (P < 0.05). Conclusion: In the light of the results, interestingly, PICIQ-VS could be utilized as a valid and reliable tool to assess the VS among Persian-speaking women, both in research and clinical practice. [ABSTRACT FROM AUTHOR]

Background: Disruptive behavior can have lifetime consequences for youth. Prevention, early identification and treatment of disruptive behavior can improve outcomes for these youth. The purpose of the present study was to assess the prevalence of disruptive behavior among a sample of Iranian youth, and the relationship of disruptive behavior to other psychological phenomena that may be targeted for prevention, early identification and treatment. Method: The sample consisted of 600 high school students (300 boys and 300 girls; ages 15 to 18 years old) selected through multi-stage random sampling in Saveh city, of Iran, in 2015. Questionnaires assessed several phenomena including demographics, life satisfaction, social support, depression, stress, smoking and hopefulness. The Disruptive Behavior Scale was also utilized. Univariate analyses were followed by multiple logistic regressions to examine relations among disruptive behavior and other constructs. Results: Prevalence of disruptive behavior was 7.5%, in boys and 3.1%, in girls. Mean scores were 22.97 ± 1.17 for boys and 19.15 ± 1.06 for girls, with a significant difference between them (P < 0.05). The results of regression revealed low life satisfaction (OR = 3.75; 95% CI: (2.37–5.91), social support (OR = 0.72; 95% CI: (0.56–0.82) and hopefulness (OR = 0.85; 95% CI: (0.62–0.92); and smoking (OR = 3.65; 95% CI: (2.19–6.06), being male (OR = 2.55; 95% CI: (1.54–4.22), and higher stress (OR = 1.92; 95% CI: (1.60–2.91) and depression (OR = 2.76; 95% CI: (1.82–4.88) were significant factors in predicting disruptive behavior. Conclusion: Disruptive behavior was associted with life satisfaction, smoking, being a boy, social support, hopefulness, stress, and depression. Targeting constructs (e.g., support, stress) associated with disruptive behavior may assist in prevention, early identification and treatment of problem behavior. For example, health promotion programs to increase hopefulness, satisfaction and support, and reduce stress, depression and smoking might be of importance for prevention and treatment of disruptive behavior. [ABSTRACT FROM AUTHOR]

Introduction: Dream, as a kind of mental activity, includes various functions such as mood regulation, adjustment and integration of new information with the available memory system. The study was done for assessing the relationship between physiological and psychological components of cardiac diseases with emotionally negative dreams in cardiac rehabilitation. Methods: At the baseline of this cross-sectional study, 156 patients from Western Iran participated during April--November 2016. People 20 years--80 years able to recall the emotional content of dreams after cardiac surgery entered the study. The Beck depression inventory (BDI), Beck anxiety inventory (BAI), Buss and Perry's aggression questionnaire (BPAQ) and Schredl's dream emotions manual were used for collecting data. A binary logistic regression analysis used for the study of the relationship between risk factors and emotionally negative dreams. Results: The mean age of participants was 59 (SD = 9) years (men: 64.1%). The results showed that 25% of patients have negative emotional content. After adjustment for demographic variables, the results showed that increased anxiety [adjusted odds ratio (adj OR) = 1.08 [1.01-1.16], P = 0.020] and anger (adj OR = 1.03 [1.00-1.06], P = 0.024) and hypertension (adj OR = 2.71 [1.10-6.68], P = 0.030) can predict the dreams with negative content significantly. Conclusion: The increasing rates of anxiety and anger and history of hypertension are related to increasing dreams with the negative emotional load. The control of risk factors of dreams with negative emotional load can be the target of future interventions. [ABSTRACT FROM AUTHOR]

Background: Diseases have undeniable effects on Health-Related Quality of Life (HRQoL). Chronic diseases, in particular, limit the productive potentials and HRQoL of individuals. EQ-5D is a very popular generic instrument, which can be used to estimate HRQoL scores in any diseases. The current study investigates mean HRQoL scores in certain chronic diseases and examines the relationship between utility scores and chronic diseases in Iran. Method: This cross-sectional study was carried out among the general adult population of Tehran. 3060 individuals were chosen by a stratified probability sampling method. The EQ-5D-5L questionnaire was applied. The utility scores were estimated using the Iranian crosswalk-based value set. The effect of chronic diseases on the HRQoL scores was derived by the Ordinary Least Squares (OLS) method. Data was analyzed using Stata version 13 software. Results: The mean ± standard deviation utility and EQ-VAS scores were 0.85 ± 0.14 and 76.73 ± 16.55 in the participants without any chronic conditions. The scores were 0.69 ± 0.17 and 61.14 ± 20.61 in the participants with chronic conditions. The highest and lowest mean utility scores were related to thyroid disease (0.70) and Stroke (0.54), respectively. Common chronic conditions had significant negative effects on the HRQoL scores. Stroke (0.204) and cancer (0.177) caused the most reduction in the EQ-5D-5L utility scores. Lumbar disc hernia, digestive diseases, osteoarthritis, breathing problems, and anxiety/nerves cause 0.133, 0.109, 0.108, 0.087, and 0.078 reductions, respectively, in the EQ-5D-5L utility scores. Conclusion: This study provides insight into some common chronic conditions and their effects on the HRQoL. Policymakers and planners should pay attention to the effects of chronic conditions especially high prevalence one. They should adopt effective interventions to control this issue and increase health. The results of this study can also be beneficial in economic evaluation studies. [ABSTRACT FROM AUTHOR]

The assessment instruments for diagnosing children with autism spectrum disorder have been developed mostly in affluent, English-speaking countries. Among the most popular has been the Autism Diagnostic Interview–Revised. This article reports its use in Iran with the dual aims of confirming the factor structure of the revised Autism Diagnostic Interview when used to assess Iranian children for autism spectrum disorder and to identify the algorithms that best distinguish children with autism spectrum disorder from those who are developing typically and from those with intellectual disability. Study 1 contrasted the Autism Diagnostic Interview–Revised ratings given to 420 children with autism spectrum disorder from those of 110 typically developing children. In Study 2, the Autism Diagnostic Interview–Revised ratings of 720 children with autism spectrum disorder were compared with those of 172 children with intellectual disability, and from those with intellectual disability. Exploratory factor analyses identified one main factor that merged the social interaction and communication items of Autism Diagnostic Interview–Revised, but replicated the repetitive behaviour and verbal factors. Receiver operating characteristic analyses identified suitable cut-off points on the revised factor scores. Also, the age at which symptoms became apparent increased the sensitivity of the algorithm in distinguishing children with autism spectrum disorder from those with intellectual disability. These findings are in line with the Diagnostic and Statistical Manual of Mental Disorders (5th ed.), recommendations and suggest a commonality in autism spectrum disorder presentations across different nations. The methodology used in this research could guide similar adaptations of assessment instruments for use in other cultures. The diagnosis of autism spectrum disorder is a challenging task. Most of the current assessment scales have been developed in the West. The present study examines the applicability of one of the most used scales (the Autism Diagnostic Interview–Revised) in a Middle-Eastern culture. Two studies were undertaken. In the first, the Autism Diagnostic Interview–Revised ratings given to 420 children with autism spectrum disorder, aged 4–11 years, and 110 typically developing children were contrasted. In Study 2, the Autism Diagnostic Interview–Revised ratings of 720 children with autism spectrum disorder were compared with those of 172 children with intellectual disabilities to find out whether the Autism Diagnostic Interview–Revised scale would discriminate between these two types of developmental disabilities. The studies confirmed the acceptability of the scale to Iranian parents and assessors. However, the summary scores used to determine whether a child was likely to have autism spectrum disorder were recalculated on the two domains of social communication and repetitive behaviours, which were identified in the statistical analyses that are recommended for the evaluation of assessment scales. Thus the translated scale with the modified domain scoring proved very suitable for identifying Iranian children with autism spectrum disorder. Having a common tool such as Autism Diagnostic Interview–Revised will strengthen the opportunities to undertake cross-cultural research into the impact of autism spectrum disorder on the child and families. [ABSTRACT FROM AUTHOR]