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Abstract There is insufficient research on bioaerosols in hospital waste decontamination stations. This study aimed to investigate the effect of three-layer and N95 masks in reducing the inhalation risk of bacterial bioaerosols in a waste decontamination station at a teaching hospital. Active sampling was conducted on five different days at three locations: the yard, resting room, and autoclave room in three different modes: without a mask, with a three-layer mask, and with an N95 mask. Bacterial bioaerosols passing through the masks were identified using biochemical tests and polymerase chain reaction (PCR). The median concentration and interquartile range (IQR) of bacterial bioaerosols was 217.093 (230.174) colony-forming units per cubic meter (CFU/m3), which is higher than the recommended amount by Pan American Health Organization (PAHO). The resting room had high contamination levels, with a median (IQR) of 321.9 (793.529) CFU/m3 of bacterial bioaerosols. The maximum concentration of bioaerosols was also recorded in the same room (2443.282 CFU/m3). The concentration of bacterial bioaerosols differed significantly between using a three-layer or N95 mask and not using a mask (p-value

Background: Pragmatic impairment is commonly observed in individuals who have sustained right hemisphere damage (RHD). A limited number of neuroimaging studies have explored the relationship between pragmatics and the role of the right hemisphere.Objectives: The aim of this study was to investigate the association between pragmatic impairment and the specific lesion site in patients with RHD.Methods: This cross-sectional study was conducted on 34 patients with RHD referred to Ghaem Hospital in Mashhad from September 2020 to December 2022. The lesion site was determined using a combination of CT scans and MRI imaging. The pragmatic skills of the participants were assessed using the Adult Pragmatics Profile (APP), a validated assessment tool that evaluates three domains: verbal, nonverbal, and paralinguistic skills. The relationship between the lesion site and the scores of three test subscales was investigated using a one-way analysis of variance.Results: The results showed no statistically significant difference in the scores of verbal variables (P=0.11) across the different lesion groups (cortical, subcortical, and other brain areas). Moreover, no significant difference was found regarding the nonverbal (P=0.88) and paralinguistic (P=0.12) variables. Patients with lesions in the motor cortical area exhibited the lowest average total score of 19.71 out of a possible 35 points. Further examination of the individual subscale scores indicated that the verbal component had the lowest average score (17.97) among these patients.Conclusion: RHD patients exhibited pragmatic impairments; however, there was no clear relationship between lesion site and pragmatic test score. Patients with lesions in the motor cortical area had a lower overall score. Addressing these pragmatic deficits is crucial to improving the patient's overall quality of life, as pragmatics plays a key role in communication.

Background: Self-confidence is a key element in successfully promoting achievement strivings among the healthcare workforce. Targeted interventions can strengthen this characteristic in nursing students, thus improving the quality of hospital services. Objectives: We evaluated the effect of educational interventions on boosting self-confidence in nursing students using systematic review and meta-analysis. Methods: A comprehensive search was used to screen the related studies in Scopus, PubMed, Embase, Web of Science, and PsycINFO. Peer-reviewed literature in English until June 2023 was reviewed. Inclusion criteria were controlled trials, either non-randomized studies of intervention (NRSI) or randomized (RCTs). Studies were assessed for methodological quality by the Cochrane Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) and the Cochrane ''Risk of Bias'' tool for RCTs (RoB 2.0) and quality assessment tool for before-after (pre-post) studies with no control group. The main outcome was the self-confidence score of nursing students because of educational methods or intervention/s. Using the inverse variance weights method, a pooled standardized mean difference (SMD) estimate with a corresponding 95% confidence interval (CI) was determined. Random-effects meta-analysis was used to assess conceptual heterogeneity using Stata. Results: Twenty-two studies were selected involving 1758 participants and 940 cases of nursing students in the intervention group on boosting self-confidence (Fourteen Randomized controlled trials, Five Quasi-experimental, and three Before-After studies). The post-intervention self-confidence results in the nursing student's intervention group were significantly greater (SMD) (SMD for Controlled experimental design = 0.51; 95% CI = 0.14–0.89), (SMD for Quasi-experimental = 0.04; 95% CI = −0.33-0.41), (SMD for Before-After (Pre-Post) = 2.74; 95% CI = 1.85–3.63). The random-effect meta-analysis of 22 interventional studies determined that educational interventions are significantly associated with the improving self-confidence of nursing students. The intervention showed a moderate impact on the research units, according to Cohen's d results. Also, the results of simulation learning intervention (SMD = 0.42; 95% CI = 0.03–0.81) showed a significant relationship between intervention and outcome in studies. Conclusions: Analysis of our findings revealed the successful impact of most interventional approaches in boosting self-confidence, especially in the long term. It can be concluded that self-confidence is a multifactorial concept that can be improved by using targeted combination intervention strategies.

Abstract Aim To examine the association between the integrated care competencies and cross‐cultural competence of registered nurses prior to the integration of social and healthcare services in Finland. Design A descriptive correlational cross‐sectional questionnaire survey was conducted. Methods A simple random sample of 10,000 registered nurses was drawn from the Finnish Central Register of Valvira (National Supervisory Authority for Welfare and Health); 7000 of them were sent the online questionnaire, and a total of 1232 registered nurses participated in the study. We collected data using background questions, revised versions of the Competent Workforce for the Future tool in the four domains of client orientation, responsibility for personal or relative's welfare, fluency and clarity of services and access to the services and of the Cross‐Cultural Competence of Healthcare Professional tool in the four domains of motivation/curiosity, attitude, skill and emotion/empathy. Results Participants demonstrated a high level of integrated care competencies (mean = 4.00, SD ± 0.49). An association was observed between integrated care competencies and their domains of skills, motivation/curiosity, emotions/empathy, and cross‐cultural competence (p

Background: The investigation of Maternal Near-Miss (MNM) risk factors is important for the global reduction of maternal mortality. This study aimed to identify the determinants of MNM among pregnant women in northeastern Iran. Materials and Methods: A prospective case-control study was conducted on 250 women referred to the maternity ward of Nohom-e-Dey hospital in Torbat-e Heydarieh, Iran, from June 2018 to May 2020. Applying the criteria of the World Health Organization tool, near-miss mothers were taken as cases, and mothers with normal obstetric outcomes were selected as controls with convenience sampling. Logistic regression models using Stata version 14.0 and odds ratios (95% confidence intervals) were reported. Results: A total of 123 MNM cases and 127 controls were included in the study. The multiple logistic regression represented that having had previous abortion, living in rural or urban areas, whether the mother went through C/S or vaginal delivery and level of prenatal education were associated with MNM. Besides, having experienced chronic medical diseases during pregnancy had the strongest association with MNM, and next were complications during childbirth and neonatal outcomes which were associated with MNM, although in terms of statistical association, only the first two mentioned factors were statistically significant. Conclusions: Determinants of MNM could be experiencing chronic medical disorders during maternal complications. Health providers need to carefully manage past medical history and adverse perinatal outcomes, especially in pregnant women who live in rural areas. Encouraging mothers to attend pregnancy training classes is effective in reducing MNM.

Objectives: Investigating the prevalence of speech and language disorders and the contributing factors can help determine the best treatment options suited to the needs of these patients. So far, no comprehensive study has been conducted on screening speech and reading disorders and Problems in the Structure and Function of Articulation Organs (PSFAOs) in children in Mashhad City, Iran. This study aims to screen for these disorders and investigate the effects of demographic factors on such disorders. Methods: Via the stratified-cluster sampling method, 2770 native Persian-speaking children participated in this study, of whom 1381 were girls and 1389 were boys, ranging from preschool to the third grade (3 to 9 years old). After obtaining the demographic information, the PSFAOs screening was performed for all participants using a semi-structured questionnaire taken from Paul et al.’s report (2017). Screening for a grade of dysphonia was then carried out for children with suspected voice disorders using the grade, roughness, breathiness, asthenia, and strain test. Fluency of speech screening for children with suspected fluency disorders was performed using the stuttering severity instrument – fourth edition test, and screening of reading skills for school children was performed using the screening inventory reading test. Analytical analysis was performed via the Chi-square test between study variables, including disorders and other variables. Two types of logistic regression models were used. The data were analyzed using survey data analysis of the Stata software, version 14.1, and P

Background: This study aims to assess the productivity loss in diabetic patients living in South Khorasan Province, Iran, in 2017. Methods: This cost of illness and analytical study was performed on 1003 patients with diabetes referred to hospitals and healthcare centers in South Khorasan Province. After being randomly selected, the participants filled the short form health and labor questionnaire by the human capital method to estimate the productivity loss caused by health problems. Data were collected in person or via phone interviews. The collected data were analyzed by data quantile regression model using Stata v. 11. Results: The Mean±SD productivity loss based on actual and labor law income was 19.61±46.24 and 16.61±49.39 dollars, respectively. In addition, the results showed that the Mean±SD number of lost working days is 0.81±2.39 days. According to the regression model, gender, educational levels, marital status, and employment status affected the number of working days lost at 0.25 quantile (P≤0.05). Conclusion: Improving productivity in diabetic patients and consequently reducing the resulting economic burden is essential to promoting their physical, mental, and social health.

Introduction: Since November 2019, the world has been grappling with the rapid spread of the Coronavirus disease 2019 (COVID-19). In response to this major health crisis, the first vaccination rollout was launched in December 2020. However, even fully vaccinated individuals are not completely immune to infection, albeit with less severe symptoms. Melatonin is known as an anti-oxidant, anti-inflammatory, and immunomodulatory agent whose anti-viral properties, cost-effectiveness, and relatively few side effects make it a potential adjuvant in the treatment of COVID-19. This systematic review aims to summarize the clinical studies on the effects of melatonin on COVID-19 patients. Methods: The search of articles was carried out in the Web of Science, PubMed/MEDLINE, Cochrane library, and Scopus databases up to January 2022. Results: Ten articles were included in our study. It seems melatonin can decrease inflammatory markers, inflammatory cytokines, and the expression of some genes, including the signal transducer and activator of transcription (STAT)4, STAT6, T-box expressed in T cell (T-bet), GATA binding protein 3 (GATA3), apoptosis-associated speck-like protein containing a caspase recruitment domain (ASC), and caspase-1 (CASP1). In addition, melatonin appears to alleviate some clinical signs and symptoms and accelerate recovery. The use of melatonin in severe cases reduces thrombosis, sepsis, and mortality rate. Conclusion: This systematic review highlights the probable role of melatonin as a potential adjuvant in the treatment of COVID-19 after about two weeks of consumption. However, further high-quality randomized clinical trials are required.

Background Coronary heart disease (CHD) is the leading cause of morbidity and mortality globally, and specifically in Iran. Accurate assessments of Coronary heart disease (CHD) incidence is very necessary for public health. In current study we aimed to investigate the incidence of CHD and importance of several classical, modifiable and un-modifiable risk factors for CHD among an urban population in eastern Iran after 6 years of follow-up. Methods The population of MASHAD cohort study were followed up for 6 years, every 3 years in two step by phone and who reported symptoms of CVD were asked to attend for a cardiac examination, to estimate the incidence of CHD with 95% confidence interval (95% CI) as well multiple logistic regression analysis was performed to assess the association of several baseline characteristics with incidence of CHD event. Evaluation of goodness-of-fit was done using ROC analysis. CHD cases divided into four different classes which include: stable angina, unstable angina pectoris, myocardial infarction and sudden cardiac death. Results In the six years' follow-up of Mashhad study, the incidence rate of all CHD event in men and women in 100,000 people-years with 95% confidence intervals were 1920 (810-3030) and 1160 (730-1590), respectively. The areas under ROC curve (AUC), based on multivariate predictors of CHD outcome, was 0.7825. Conclusion Our findings indicated that the incidence rate of coronary heart diseases in MASHAD cohort study increases with age as well as our final model designed, was able to predict approximately 78% of CHD events in Iranian population.

مقدمه: ظهور همه گیری COVID19 نگرانی های زیادی را در رویکردهای پزشکی ایجاد کرده است. یکی از این مسائل این بود که تا چه میزان کادر پزشکی قادر به احیای قلبی ریوی ایمن با وجود این سطح بالای انتقال عفونت می باشند. بنابراین هدف از این مطالعه بررسی میزان آگاهی کادر درمان دانشگاه علوم پزشکی سبزوار در مورد CPR بیماران کووید -19 می باشد. روش کار:در این مطالعه 129 نفر از افراد شاغل در بیمارستان های دانشگاه علوم پزشکی سبزوار اعم از پرستار، پزشک، کارشناس اتاق عمل و فوریت های پزشکی با پرسشنامه تحت آزمون قرار گرفتند. پرسشنامه شامل 21 سوال میباشد که میزان آگاهی کادر درمان را مورد سنجش قرار داده است و روایی محتوایی این چک لیست توسط 10 پزشک متخصص تایید گردیده است. همچنین چند معیار دموگرافیک شامل سن، جنس، سابقه کار بر حسب سال، سابقه شرکت در کارگاه های CPR بیماران COVID19، تعداد دفعات حضور در کارگاه، بیمارستان محل کار، رشته تحصیلی و مقطع تحصیلی نیز در مطالعه می باشد که ارتباط این متغیر ها را با نمره هر فرد در آزمون ارزیابی شده است. یافته ها: مطالعه ی انجام شده نشان داده است که میزان پاسخدهی به سوالات با کارگاه های برگزار شده در خصوص احیای قلبی ریوی بیماران COVID19 ،سن و سابقه کار ارتباط مستقیم داشته است. همچنین سوالاتی که توسط اکثر شرکت کننده ها به درستی پاسخ داده نشده اند مربوط به ونتیلاسیون و انتوباسیون بیماران COVID19 می باشد. بررسی ها نشان داده که کارکنان بیمارستان های واسعی و امدادی نسبت به سایر بیمارستان ها نمرات بالاتری کسب کرده بودند. نتیجه گیری: شرکت در کارگاه ارتباط مستقیمی با نمره ی کسب شده ی بهتر کارکنان دارد و این درحالی است که بیمارستان های مبینی و حشمتیه نمرات پایین تری نسبت به سایر بیمارستان ها داشته اند و باید به مسئله آموزش و همچنین برگزاری کارگاه ها اهمیت بیشتری را اختصاص دهند.