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Purpose The purpose of this paper is to assess the validity of the Autism Diagnostic Interview-Revised (ADI-R) in an Iranian population to determine its efficacy in identifying children with autism spectrum disorder (ASD) who parents have Persian-speaking parents. Design/methodology/approach A case–control study was performed in March until July 2020 in Hamadan city, Iran. The case group was children were examined by the clinicians used a coding scheme based on the DSM-IV criteria for ASD. The control group was all children in the family, including healthy siblings, were asked to participate in the study. The reliability, content and face validity were performed to assess the psychometric properties of the tool. Confirmatory factor analysis (CFA) was performed to evaluate the four-dimensional structure of the tool (Scores A, B, C and D). Statistical analysis was performed using AMOS for SPSS 21, and the statistical significant level was less than 0.05. Findings The quantitative content validity analysis revealed that the mean of content validity ratio (CVR) and content validity index (CVI) for all domains was 0.94 and 0.91, respectively. For CFA, four domains A, B, C and D were used and demonstrated a good fit (CFI = 0.92 and RMSEA = 0.06). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) in domains A, B (verbal), C and D were 100%. For domain B (non-verbal), the sensitivity, specificity, PPV and NPV were 86.7%, 100%, 100% and 88.2%, respectively. Research limitations/implications This study showed that ADI-R has sufficient ability to discriminate between children with ASD and those with no psychiatric diagnosis, and it is a reliable tool in Iran. The sensitivity and specificity for correctly diagnosing ASD was high, regardless of the age and cognitive level of the examiner. Originality/value To the best of the authors’ knowledge, this is the first paper on psychometric properties of ADI-R in children with ASD.

This study aimed to compare the effect of audiovisual distraction on physiological indicators and pain of burn dressing change among 6-12 year-old children.The study was a single-blind clinical trial with a three-group that sample size was 120 children aged 6-12 years admitted to the burn ward of Hamadan Besat Hospital. Data collection tools were the Oucher pain scale, a Cheklist form of the physiological Indicators, and apulse oximetry device. The cartoons were shown for visual group and the melodic poems were played for the auditory group 2 min before the dressing until the end of the procedure (at 2-min intervals). Data were analyzed by SPSS-16 software one-way, variance analysis and post-hoc Bonferroni test.Therewere statistically significant differences between visual, auditory and control groups in the mean pain intensity scores at all measurement times, the mean arterial blood oxygen saturation percentage at all measurement times except for the10 min before the dressing and the start of the procedure and the mean heart rate at all measurement times except for 10 min before dressing (p 0.001). Post-hoc tests showed that the difference in the mean heart rate was related to the difference between the visual and auditory distraction groups during and at the end of the dressing (p 0.05), the visual and control groups at all measurement times (P 0.001) and the auditory and control groups at all measurement times (p 0.05).Audiovisual distraction is effective in reducing the fluctuations of physiological indicators and the burn dressing pain intensity in children at all times of measurement, especially during changedressing.The findings of this study are relevant to clinical practice because they suggest preparing children before and during a burning procedure situation.

BACKGROUND: Work-related fatigue can cause disruption in mental and physical activities of the workers. Considering the importance of recovery from fatigue in emergency services, as seen in firefighting duties, the preparation and validation of the Need For Recovery Scale (NFRS) questionnaire can be useful and effective. OBJECTIVE: This study assessed the reliability and validity of the Persian version of Need For Recovery Scale among industrial firefighters. METHODS: Need for recovery scale contains 11 questions. First, a questionnaire was translated using backward-forward method. Then, for measuring validity of the questionnaire, the opinions of 10 experts in related fields were obtained. Content Validity Index (CVI) and Content Validity Ratio (CVR) were calculated. The reliability was determined through 107 questionnaires completed by the industrial firefighters. RESULTS: The average age of the firefighters in this study was 37.5 years and they had an average of 10 years of work experience. The mean Need For Recovery Index from fatigue was 33.03 for the study population. Of the first 11 questions, 9 questions in the original NFRS showed a satisfactory level of CVR. The Content Validity Index and Cronbach’s α were 0.89 and 0.77 respectively. CONCLUSION: Based on the results, the Need For Recovery Scale is a reliable tool for assessing fatigue and revealed an acceptable level of validity and reliability that makes it usable for fatigue assessment in the industrial firefighters.

Objectives Hemodialysis (HD) patients suffer more sleep problems (poor sleep quality and restless leg syndrome [RLS]). Complementary therapy, especially massage with aromatherapy oil is one of the non-pharmacological treatment options with less adverse effects than routine methods. The purpose of this study was to determine the effects of foot massage with of lavender and orange essential oil on HD patients’ sleep quality and RLS. Methods This is a double blind randomized controlled trial on 105 HD patients was conducted at a large educational hospital in Iran, Hamadan province between January and September 2017. Patients divided into three groups with random allocation (35 participants per groups in lavender, orange, and control group). Foot massage during HD with lavender and orange essential oil was administered to the patients three times a week for three weeks, and every massage lasted half an hour. The control group received routine care. Before the intervention, the end of the first, second, and third weeks Pittsburgh Sleep Quality Index (PSQI) and RLS questionnaire were completed for all three groups. Data were statistically analyzed with Independent Samples t-test, chi-square test and repeated-measures analysis of variance (ANOVA) by SPSS version 16. Results The mean score of sleep quality and RLS in the intervention groups were significantly different compare with the control group in all three time of data collecting (p Conclusions Aromatherapy prepared with lavender oil and sweet orange may be recommended to increase sleep quality and RLS level of the HD patients.

Background: Diabetes mellitus type 1 (DM-1) is associated with pancreatic beta-cell destruction, inflammatory processes, and cardiovascular disorders. C-reactive protein (CRP) and homocysteine are considered as inflammatory processes and cardiovascular disorder indicators that can be used for monitoring patients with DM-1. The present study aimed to compare the salivary levels of homocysteine and CRP of DM-1 patients with those of healthy people. Methods: In this case-control study, 82 patients participated, including 41 DM-1 patients (case group) and 41 healthy people (control group). The case and control groups were matched in terms of age, gender, and body mass index, and 5 mL of the saliva was collected from each participant. Then, the salivary levels of CRP and homocysteine were measured for each patient. Finally, several parameters were recorded for diabetic patients, including fasting blood glucose (FBS), 2-hour postprandial glucose (2hpp), and glycosylated hemoglobin (HbA1c), as well as the duration of the disease and the type and amount of insulin injections. Eventually, data were analyzed by SPSS software using descriptive statistics, independent t-test, and Pearson correlation coefficient. Results: The salivary CRP and homocysteine concentration had no significant difference between patients and controls (P>0.05). There was no significant correlation between the salivary level of homocysteine and CRP and FBS, 2hpp, HbA1c, albuminuria, duration of disease, type and amount of insulin injection (P

Background Despite the vulnerability of pregnant women, few studies have been conducted on their perceived risk and protective behaviors during the COVID-19 pandemic. The present cross-sectional study aims to investigate the perceived risk and protective behaviors regarding COVID-19 among pregnant women, in Hamadan, Iran. Using a two-stage cluster sampling method, 225 pregnant women referring to the health centers completed the questionnaires. Data were analyzed using the Kruskal-Wallis and Spearman correlation tests as well as a stepwise linear regression model at 95% confidence level. Results 93.8% of pregnant women had a high level of knowledge, 97.3% had a high performance in protective behaviors, and 72.9% had a moderate level of risk perception related to COVID-19. The highest mean score of knowledge was observed in women who had a history of influenza in their previous pregnancies (90.97 ± 5.94). The mean score of protective behaviors was significantly higher in women with a high economic level (97.78 ± 5.11), and the highest level of risk perception was observed in nulliparous women (59.97 ± 9.80). Risk perception was an independent predictor of protective behaviors related to COVID-19 (P < 0.05). Conclusions Pregnant women had a high level of knowledge, high performance in protective behaviors, and a moderate level of risk perception related to COVID-19. History of influenza in previous pregnancies, high economic level, and nulliparity were associated with higher levels of knowledge, protective behaviors, and risk perception, respectively. Risk perception of pregnant women regarding COVID-19 can predict their protective behaviors.

Background: Chlamydia pneumonia has currently been proposed to be involved in multiple sclerosis (MS) pathogenesis. The aim of this study was to evaluate the serum level of anti-C. pneumoniae immunoglobulin G (IgG) in patients with MS compared to the control group, which may be helpful in further understanding of MS etiology. Methods: The serum was obtained from 66 people with MS and 20 healthy people as patient and control groups, respectively. Serums were matched to the patient’s age, gender, and place of residence. Finally, anti-C. pneumoniae IgG was measured by a sandwich enzyme-linked immunosorbent assay (ELISA). Results: Sixty-six patients (25 men and 41 women within the age range of 17-56 years and mean±SD of 35.53±9.56) with MS and 20 control subjects (8 men and 12 women with the age range of 25-56 and mean±SD of 38.3±9.66) were enrolled in this study. The mean serum anti-C. pneumoniae IgG of patients with MS (28.82±33.54 RU/mL) was compared with that of the control group (4.075±6.691 RU/mL) and a statistically significant difference was observed in this regard (P

Young adults not only face somatic and psychiatric disorders but they also engage in risky behaviors. The aim of this study was to address the association between psychiatric disorders and multiple health-risk behaviors. This study reports on a national survey of psychiatric disorders and addictive behaviors (PDABs) among 4261 Iranian university students from 13 medical science universities throughout Iran in 2017. The outcome of interest was psychiatric disorders, and the evaluated health-risk behaviors were cigarette smoking during the past month, using any kind of illicit drugs during the past month, drinking alcohol during the past month, having unprotected sexual intercourse during the past year, having suicidal ideation during the past month, attempting suicide in the past year, and Internet addiction. Of the 4261 university students, 1655 (39%) had a certain level of psychiatric disorder and 1590 (37.3%) had engaged in at least one risky behavior. There was a significant association between psychiatric disorder and female gender [odds ratio (OR) = 1.40; 95% confidence interval (CI) 1.22, 1.61], single status (OR = 2.01; 95% CI 1.66, 2.44), illicit drug abuse (OR = 2.42; 95% CI 1.75, 3.33), suicidal ideation (OR = 3.03; 95% CI 1.98, 4.64), suicide attempt (OR = 2.53; 95% CI 1.62, 3.97), lack of future goal clarity (OR = 2.41; 95% CI 2.06, 2.82), and Internet addiction (OR = 5.16; 95% CI 3.79, 7.04). More than one-third of the students not only have a certain type of psychiatric disorder but also engage in at least one risky behavior.

Background: Care and treatment adherence are important factors for given good liver transplantation outcomes. Objectives: Design and validate an instrument to appraise adherence to care and treatment in liver transplantation recipients. Methods: A mixed-methods sequential exploratory study was conducted in two phases from 2017 to 2019, in the Liver Transplantation Clinic Tehran, Iran. In the qualitative phase, the concept of care and treatment adherence in liver transplantation recipients extracted by a conventional content analysis was performed on semi-structural interviews that were conducted on 18 liver transplantation recipients that were recruited through purposive sampling technique. Also, two physicians, one nurse coordinator of the liver transplantation team, and two family members were interviewed. The scale was developed based on operational definitions extracted from the qualitative phase. The validity was assessed by face, content, construct validity, and confirmatory factor analysis. The reliability was also evaluated by calculating test-retest intraclass correlation coefficient and Cronbach's alpha. The exploratory factor analysis was carried out with 286 filled the questionnaire. Results: Four factors were extracted in factor analysis. These factors explained 45.622% of the variance. The final version of the scale consisted of 20 items. The Cronbach's alpha coefficient reported as 0.889 for the total scale and the intraclass correlation coefficient was reported as 0.912. The confirmatory factor analysis led to a fitting model. Chi-square indices were reported as CMIN/DF = 2.34, NFI = 0.94, CFI = 0.96, and RAMSEA = 0.067. Conclusions: With a four factors structure, validity and reliability of adherence to care and treatment scale are acceptable; therefore, it can be used for appraisal care and treatment adherence in liver transplant recipients.

Background The cytokine gene polymorphism is important for the genetic susceptibility of infectious diseases. The aim of the present study was to investigate the relationship between TNF-α, IL-12, and IL-13 gene polymorphisms and predisposition to brucellosis. Methods In this study, 107 patients with brucellosis and 107 healthy individuals were evaluated. The SNPs of TNF-α)- 238 G/A) and IL-12 (+ 1188 A/C) were done by amplification refractory mutation system-polymerase chain reaction (ARMS-PCR) and IL-13 genotyping at positions − 1512 (A/C) and − 1112 (C/T) were analysis by restriction fragment length polymorphism-polymerase chain reaction (RFLP-PCR) methods. IL-12, IL-13 and TNF-α serum levels were measured by a sandwich enzyme-linked immunosorbent assay (ELISA). Results IL-13 (−1512A/C) was associated with Brucellosis risk in dominant model (OR (95% CI) = 2.17 (1.02–4.62)), P-value = 0.041. However, there was no difference in allele and genotype frequencies of TNF-α)- 238 G/A), IL-12 (+ 1188 A/C) and IL-13 [− 1512 (A/C) and − 1112 (C/T)] between patients and controls. Serum levels of IL-12 and TNF-α were significantly more frequent in the patients than in the control groups. Conclusions The IL-13 gene polymorphism can be used as a biomarker for detecting susceptibility to Brucella disease.

Background Sexual satisfaction is considered as one of the key factors in assessing a person’s quality of life and the quality and continuity of marital relationships. According to the results of reports in Iran, many couples are dissatisfied with their sexual lives. Sexuality education is one of the important strategies to prevent early sexual problems and improve sexual satisfaction. The aim of this randomized controlled trial is to compare the efficacy of sexual and marital enrichment package using information, motivation and behavioral skills model on sexual satisfaction of new couples in Iran to routine sexual care program that provided at governmental health centers. Methods This is a randomized, controlled, superiority trial with two parallel groups. One hundred new couples (n = 200) will be recruited and randomized with simple randomization method and a 1:1 allocation. Recruitment will be from governmental health centers and calling on social networks. Couples will be randomized to intervention which will receive Sexual and Marital Enrichment package and control group (routine care at health centers). Couples will be followed up for 4 months. Then primary outcomes (mean score of couples’ sexual information, motivation and behavior skills) and secondary outcome (mean score of couples’ sexual satisfaction) of study will be measured through the online questionnaire. Discussion This trial will be examined the impact of the sexual and marital skills training package tailored to the values and norms governing the sexual life of Iranian couples on their sexual satisfaction. If the trial is effective, its results will be presented to policy makers for implementation at national level. Trial registration (Iranian Registry of Clinical Trials (IRCT) number): IRCT20181211041926N1. Date of registration: March 2, 2019.

—Glypican-3 (GPC3), a heparan sulfate proteoglycan is an emerging tumor marker; its overexpression has been stated in several types of cancer such as hepatocellular carcinoma (HCC), melanoma and etc. In this study, the expression of the GPC3 mRNA was investigated in 61 human colorectal cancer (CRC) tissues and 61 normal adjacent tissues, using the real-time PCR assay. Using immunohistochemistry (IHC), the expression of the GPC3 protein was examined in the cases that showed a marked elevation in the expression of the GPC3 mRNA in the tumor tissues, compared to the normal tissues. A significant increase in the expression of the GPC3 gene was revealed in 49.2% of the cases of CRC tumors, compared to the normal adjacent tissues. The expression of the GPC3 mRNA was found to significantly correlate with the pathological differentiation and the age of the patients. Interestingly, a significant reduction in the expression of the GPC3 mRNA was found in the tumor tissues of the 16 patients, who underwent the neoadjuvant chemotherapy, compared to the normal adjacent tissues. Unexpectedly, the GPC3 protein was not detected by IHC in 30 tissues, exhibiting the upregulation in the expression of the GPC3 mRNA. Our results indicated that GPC3 could be expressed in the CRC tissues at the mRNA level, while its expression could not be found at the protein level.

Background: Despite the growing epidemic of problematic Internet use (PIU), little information is available on PIU and related factors in Iran. Methods: This cross-sectional study was conducted on 4261 university students among 13 universities throughout the country in 2017. The data collection tool included demographic characteristics, the status of using the Internet, social media, computer games, tobacco, alcohol, and illicit drugs, suicide ideation and attempt, and unprotected sex. PIU was measured using the 15-item PIU questionnaire. The status of general health was evaluated using the 28-item general health questionnaire (GHQ) questionnaire. The simple and multiple logistic regression analysis were used to measure the crude and adjusted associations between various factors and PIU. Results: Of 4261 university students, 55.9% were female, 13.5% were smokers, 4.9% were drug abusers, 7.9% were alcohol abusers, 7.8% had unprotected sex in the past year, 7.4% had suicidal ideation in the past month, 1.7% had attempted suicide in the past year, and 27.3% suffered from PIU. Only 61.1% had normal health. In contrast, 30.9%, 7.2%, and 0.8% had mild, moderate, and severe general health problems, respectively. There were significant relationships between PIU and age group 20-24 vs.

Background: The aim of the present study was to determine the most effective oral hygiene method in fixed orthodontic patients. Methods: A total of 125 patients who had recently started their orthodontic treatment and had not received oral hygiene instructions were randomly assigned to 5 groups (n=25): verbal instructions (V), verbal instructions plus pamphlet (V+P), verbal instructions plus video film (V+F), verbal instructions plus the use of disclosing agents (V+D), and pamphlet plus the use of disclosing agents (P+D). One week after the installation of orthodontic appliance, plaque index (PI) and gingival index (GI) were recorded and oral hygiene instructions were provided. One week and 4 weeks after oral hygiene instructions, PI and GI were recorded again. Results: PI and GI showed significant decreases in 5 groups after 1 week and 4 weeks (P ˂ 0.05). No statistically significant differences were detected between the 5 study groups in terms of plaque reduction after one week. However, after 4 weeks PI values were significantly lower in V+D group compared to P+D group. Regarding GI, V+D method resulted in a significantly lower GI than P+D after 1 week and 4 weeks. Conclusions: To sum up, all the oral hygiene motivation methods applied in this study can be effective in decreasing PI and GI. However, it appears that the best way is the verbal oral hygiene instruction plus the use of disclosing agents.

Background: Among male sexual dysfunctions, erectile dysfunction and early ejaculation have the highest prevalence rates. Here, we tested the influence of lisdexamfetamine dimesylate (Vyas®) on early ejaculation. To this end, we performed a double-blind randomized clinical trial among males with early ejaculation. Methods: A total of 46 males with early ejaculation (mean age: 35.23 years) and in stable marital relationships with regular weekly penile–vaginal intercourse were randomly assigned either to the lisdexamfetamine dimesylate condition (30 mg) or to the placebo condition. Compounds were taken about six hours before intended penile–vaginal intercourse. At baseline and four weeks later at the end of the study, participants completed a series of self-rating questionnaires covering early ejaculation. Female partners also rated participants’ early ejaculation profile. Results: Compared to the placebo condition, dimensions of early ejaculation improved over time in the lisdexamfetamine condition, though improvements were also observed in the placebo condition. Conclusions: Among male adults in stable marital relationships with regular weekly penile–vaginal intercourse, lisdexamfetamine dimesylate improved dimensions of early ejaculation. Given that improvements were also observed in the placebo condition, psychological factors such as increased attention to early ejaculation and favorable expectations of the compound should be considered.

Background Nutrition is not a treatment for COVID-19, but it is a modifiable contributor to the development of chronic disease, which is highly associated with COVID-19 severe illness and deaths. A well-balanced diet and healthy patterns of eating strengthen the immune system, improve immunometabolism, and reduce the risk of chronic disease and infectious diseases. Objective This study aims to assess the effect of diet, nutrition, obesity, and their implications for COVID-19 mortality among 188 countries by using new statistical marginalized two-part models. Methods We globally evaluated the distribution of diet and nutrition at the national level while considering the variations between different World Health Organization regions. The effects of food supply categories and obesity on (as well as associations with) the number of deaths and the number of recoveries were reported globally by estimating coefficients and conducting color maps. Results The findings show that a 1% increase in supplementation of pulses reduced the odds of having a zero death by 4-fold (OR 4.12, 95% CI 11.97-1.42). In addition, a 1% increase in supplementation of animal products and meat increased the odds of having a zero death by 1.076-fold (OR 1.076, 95% CI 1.01-1.15) and 1.13-fold (OR 1.13, 95% CI 1.0-1.28), respectively. Tree nuts reduced the odds of having a zero death, and vegetables increased the number of deaths. Globally, the results also showed that populations (countries) who consume more eggs, cereals excluding beer, spices, and stimulants had the greatest impact on the recovery of patients with COVID-19. In addition, populations that consume more meat, vegetal products, sugar and sweeteners, sugar crops, animal fats, and animal products were associated with more death and less recoveries in patients. The effect of consuming sugar products on mortality was considerable, and obesity has affected increased death rates and reduced recovery rates. Conclusions Although there are differences in dietary patterns, overall, unbalanced diets are a health threat across the world and not only affect death rates but also the quality of life. To achieve the best results in preventing nutrition-related pandemic diseases, strategies and policies should fully recognize the essential role of both diet and obesity in determining good nutrition and optimal health. Policies and programs must address the need for change at the individual level and make modifications in society and the environment to make healthier choices accessible and preferable.

Publisher's version (útgefin grein), Background Past research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries. Methods We reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs). Findings In 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty interval: 338 174 876 to 371 610 802) new cases of injury globally, which increased to 520 710 288 (493 430 247 to 547 988 635) new cases in 2017. During this time, age-standardised incidence decreased non-significantly from 6824 (6534 to 7147) to 6763 (6412 to 7118) per 100 000. Between 1990 and 2017, age-standardised DALYs decreased from 4947 (4655 to 5233) per 100 000 to 3267 (3058 to 3505). Interpretation Injuries are an important cause of health loss globally, though mortality has declined between 1990 and 2017. Future research in injury burden should focus on prevention in high-burden populations, improving data collection and ensuring access to medical care., Bill and Melinda Gates Foundation OPP1152504, "Peer Reviewed"

Introduction. Improving well-being and overall system performance are the ultimate goals of ergonomics, which are achieved through ergonomic interventions. This systematic review aimed to answer th...

Burns are one of the most important childhood injuries that can be controlled and prevented. Mothers play an important role in preventing child burns. Health education and promotional theories facilitate a precise recognition of the behavioral factors in mothers that help preventing burn injury in their children. Burns in children under five years old and the factors in prevention of burn by their mothers were examined using PRECEDE Model. The study environment was rural and urban areas of Kermanshah, Iran.This cross-sectional study was conducted on 330 mothers in urban and rural areas of Kermanshah County in the west of Iran. The participants were randomly selected among mothers who had at least one child younger than five years old. Data was collected through interviewing the mothers using a valid and reliable questionnaire. The questionnaire included questions on demographic characteristics, PRECEDE Model, and history of burn. The data were analyzed using SPSS-16.The mean age of the mothers in urban areas (29.33 ± 5.987) was higher than that of those in rural areas (28.77 ± 6.236). More than 90% of the mothers were housewives, both in urban and rural areas. The rate of a history of burn in rural children under the age of five (8.3%) was greater than that in urban children (5.2%). Most of the burn cases in urban areas were mild whereas those in rural areas were moderate. The majority of burn cases had happened at home in children 1-3 years' age range; this rate was higher in boys. The majority of burns cases had happened when the child was playing (urban: 64.3%, rural: 100%). In addition, liquids and hot objects were the main causes of the burns (urban: 78.5%, rural: 100%). Among the constructs of PRECEDE models in the urban areas, knowledge (P 0.001), attitudes (P = 0.027), and environmental factors (P = 0.03) had a significant relationship with burn-preventive behaviors in mothers. In addition, in the rural areas, attitudes (P = 0.038) had a significant relationship with burn-preventive behaviors in mothers.Burn was an important injury in the study population, especially in the rural areas. The PRECEDE model can help us to identify the factors in burn injuries in children and the preventive behaviors in mothers. The findings can be used to develop preventive interventional programs to better protect this vulnerable group in society.

The population with emerging diseases such as COVID-19, which is used to calculate the basic reproduction number of epidemic outbreak (R0) cannot be simply observed. In this article, we have proposed a method for estimating the hidden population of people with COVID-19 disease. Knowing the number of people with COVID-19 disease is very important for health policy. The provision of medical equipment (e.g., masks, alcohol, ventilators, medication, etc.), the reopening of schools and universities, the start of tourism and public gatherings, the provision of medical staff and preventive planning depend on the number of patients with the disease. Therefore, it is very important to estimate the number of patients. Key words: • Corona virus • Covid-19 • Epidemiology • Hidden population • Attack rate Copyright © 2020 Soltanian et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial (CC BY-NC 4.0) License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial.

Background Multiple risk-taking behaviors are associated with increased risk of poor educational attainment, morbidity and premature mortality. This study involved a large representative sample of Iranian university students addressing multiple risk behaviors and associated factors. Methods This cross-sectional study included 4261 participants, involving 13 medical universities throughout the country in 2017. The following six risky behaviors were addressed: (a) smoking cigarettes during the past month, (b) using some kinds of illicit drugs during the past month, (c) drinking alcohol during the past month, (d) engaging unprotected sex during the past year, (e) having suicidal ideation during the past month or attempting suicide in the past year, (f) and Internet addiction. The 20-item internet addiction test and the 28-item general health questionnaire were used. Results Almost 37.3% of the participants engaged in at least one out of six risky behaviors. The prevalence of Internet addiction was 24.5%, cigarette smoking 13.5%, alcohol use 7.8%, illicit drug abuse 4.9%, unprotected sex 7.8%, suicidal ideation 7.4%, attempting suicide 1.7% and general health problems 38.9%. Conclusion A majority of the Iranian university students studied engaged in at least one risky behavior. Engaging in one risky behavior increases the risk of engaging in other risk-taking behaviors.

Objectives: A questionnaire was designed to determine public understanding of early and late complications of Type 2 diabetes mellitus (T2DM) . Methods: A cross-sectional study was performed in participants who were selected using a multi-stage sampling method and a standard questionnaire of 67 questions was proposed. An expert panel selected 53 closed-ended questions for content validity to be included in the questionnaire. The reliability of the questionnaire was tested using Cronbach's alpha coefficient giving a score of 0.84. Results: Of the 825 participants, 443 (57.6) were male, and 322 (41.87) were 40 years or more. The proportion of low-, moderate- and high- awareness about T2DM and its complications was 29.26, 62.68, and 8.06, respectively. Friends (56.31) and internet and social networks (20.55) were the 2 major sources of awareness, respectively. The medical staff (e.g., physicians) had the lowest share in the level of public awareness (3.64) compared to other sources. Conclusion: These results present data that shows the general population awareness of T2DM is low. Healthcare policymakers need to be effective at raising awarenes of diabetes and it should be through improved education. © 2018 Korea Centers for Disease Control and Prevention. All rights reserved.

Introduction: Adherence to treatment programs is a major challenge in patients with chronic heart failure. In the event of non-compliance, these patients will be associated with adverse health outcomes. Since the interventions such as training to improve adherence to health regimens have a special place, this study aimed to compare the effect of the patients’ education with or without their families’ participation, to evaluate the effect of this education on adherence to the treatment regimen in patients with chronic heart failure. Methods: In this quasi-experimental study, 60 patients with chronic heart failure were selected from those referred to the heart clinic of Farshchian Hospital in Hamadan, Iran. The subjects were randomly divided into two groups of 30 patients and their families and 30 patients alone. The training was performed in six 30-minutes sessions with same conditions in both groups. Information was collected using questionnaire before and six weeks after the intervention, and analyzed using SPSS 16. Results: Before training, the two groups had no significant deference in the rate of adherence to the treatment regimen (P>0.05). After training, the rate of adherence to the treatment regimen in the patients’ education group with family participation was higher than the patients’ education group alone (P

Introduction: Kangaroo mother care is a standard method based on skin contact with the mother and newborn skin. The aim of this study was to evaluate the effect of kangaroo mother care counseling on postpartum blues in women in Fatemieh Hospital, Hamadan. Methods: A randomized clinical trial was conducted on 104 pregnant women who referred to Fatemieh hospital in Hamadan city, 2016. Those who had gestational age of 37-42 weeks were randomly divided in to two groups of case and control according to the day of delivery. Postpartum routine care was performed in both groups. In the case group in first 24 hours after delivery, kangaroo mother care was taken with a counseling session (20-30 minutes) was performed until the 10th day of delivery. The after birth Stein questionnaire was completed before and after intervention in two groups. Data was analyzed using SPSS16, t-test and ANOVA. Results: The results showed that the intervention in the experimental group was about 4 times lower in postpartum distress score (P

Introduction Obesity is a serious health problem that leads to low quality of life and early mortality. To the purpose of prevention and gene therapy for such a worldwide disease, genome wide association study is a powerful tool for finding SNPs associated with increased risk of obesity. To conduct an association analysis, kernel machine regression is a generalized regression method, has an advantage of considering the epistasis effects as well as the correlation between individuals due to unknown factors. Materials and methods In this study, information of the people who participated in Tehran cardio-metabolic genetic study was used. They were genotyped for the chromosomal region, evaluation 986 variations located at 16q12.2; build 38hg. Kernel machine regression and single SNP analysis were used to assess the association between obesity and SNPs genotyped data. Results We found that associated SNP sets with obesity, were almost in the FTO (P = 0.01), AIKTIP (P = 0.02) and MMP2 (P = 0.02) genes. Moreover, two SNPs, i.e., rs10521296 and rs11647470, showed significant association with obesity using kernel regression (P = 0.02). Conclusion In conclusion, significant sets were randomly distributed throughout the region with more density around the FTO, AIKTIP and MMP2 genes. Furthermore, two intergenic SNPs showed significant association after using kernel machine regression. Therefore, more studies have to be conducted to assess their functionality or precise mechanism.

Background: Moral reasoning is a vital skill in the nursing profession. Teaching moral reasoning to students is necessary toward promoting nursing ethics. Objectives: The aim of this study was to compare the effectiveness of problem-based learning and lecture-based methods in ethics education in improving (1) moral decision-making, (2) moral reasoning, (3) moral development, and (4) practical reasoning among nursing students. Research design: This is a repeated measurement quasi-experimental study. Participants and research context: The participants were nursing students in a University of Medical Sciences in west of Iran who were randomly assigned to the lecture-based (n = 33) or the problem-based learning (n = 33) groups. The subjects were provided nursing ethics education in four 2-h sessions. The educational content was similar, but the training methods were different. The subjects completed the Nursing Dilemma Test before, immediately after, and 1 month after the training. The data were analyzed and compared using the SPSS-16 software. Ethical considerations: The program was explained to the students, all of whom signed an informed consent form at the baseline. Findings: The two groups were similar in personal characteristics (p > 0.05). A significant improvement was observed in the mean scores on moral development in the problem-based learning compared with the lecture-based group (p < 0.05). Although the mean scores on moral reasoning improved in both the problem-based learning and the lecture-based groups immediately after the training and 1 month later, the change was significant only in the problem-based learning group (p < 0.05). The mean scores on moral decision-making, practical considerations, and familiarity with dilemmas were relatively similar for the two groups. Conclusion: The use of the problem-based learning method in ethics education enhances moral development among nursing students. However, further studies are needed to determine whether such method improves moral decision-making, moral reasoning, practical considerations, and familiarity with the ethical issues among nursing students.

Purpose. The present study aimed to analyze human and organizational factors involved in mining accidents and determine the relationships among these factors. Materials and methods. In this study, ...

Background: Breast milk is a highly nutritious food for children which affects the craniofacial development. Breastfeeding also plays a significant role in muscle function and alignment of the teeth in dental arch. Given the resources in determining the evaluation of malocclusion and harmful oral habits, in this study we aimed to determine the effect of child feeding methods on non-nutritive sucking habits and anterior open bite. Methods: In this cross-sectional study, 191 children aged 3 to 6 years from different kindergartens of Hamadan city were studied. Data were based on the questionnaires that were answered by parents. Then children were classified into the following 4 groups based on the history of breast-feeding: G1- bottle fed, G2- breast fed for less than 6 months, G3- breast fed for 6 to 12 months, G4- breast fed for more than 12 months. Children were examined for the presence of anterior open bite. Data were collected and analyzed by statistical tests. Pearson chi-squared test, logistic regression and Fisher exact tests were used. Results: The statistical analyses showed that demographic characteristics such as children’s age and birth order, maternal education, employment, and family income had no impact on child feeding methods and there was no significant relationship between them. Moreover, no meaningful relationship was found between non-nutritive sucking habits and feeding methods. Results showed that there was a significant relationship between feeding methods and incidence of anterior open bite. Conclusions: Feeding methods affect the prevalence of anterior open bite, and by increasing the duration of breast-feeding, prevalence of anterior open bite can be reduced.

Background Dental caries among Iranian elementary school children aged 6–12 years continue to rise. To estimate treatment needs and guide health initiatives, current epidemiologic data are required. Such data are currently unavailable for dental health. The purpose of this study was to assess caries experience, dental plaque, and associated factors in elementary school-aged children from Iran. Methods In this cross-sectional study, 988 elementary school children aged 7–12 years were selected by multistage cluster sampling. Dental caries was studied using the WHO criteria, dental plaque was examined according to O’Leary index. Data on parental education and occupation, living district, dental pain within the past year, and tooth brushing habits under parental supervision were collected through interviews based on questionnaire. The data were analyzed with descriptive statistics and logistic and linear regression. Results The mean (SD) age of the elementary school children was 9.64 (1.73) years. The highest dmft was seen in elementary school children aged 7–8 years 6.53 (4.37) and the highest DMFT and dental plaque was in 12 year olds recorded as 1.17 (1.77) and 51.97 (25.86), respectively. The proportion of decayed teeth in 7 years old elementary school based on dmft index was 80.36%, moreover, the proportion in 12 years old elementary school was 40.17% based on the DMFT index. Age, gender, and dental pain within the past year were significantly associated with DMFT and dmft. The odds of developing dental caries (DMFT) was 1.70 times higher in girls than in boys (p

Background In the search for new psychopharmacologic options in the treatment of obsessive-compulsive disorders (OCD), some findings suggested that augmentation with buprenorphine, a partial-opioid agonist used to treat opioid addiction, moderate acute pain and moderate chronic pain, is worthy of consideration. Accordingly, to explore this possibility further, a double-blinded, placebo-controlled clinical trial was performed. Method A total of 43 patients (mean age: 34.41 years; SD = 6.58; 53.5% males) with refractory OCD and treated with SSRIs or clomipramine at therapeutic dosages were randomly assigned either to an adjuvant buprenorphine or to an adjuvant placebo condition. Patients completed the Yale-Brown-Obsessive-Compulsive Scale (Y-BOCS) at baseline, weeks 3, 9 and 12 (study completion). Buprenorphine (2–4 mg; sublingual) and placebo (tablets with identical shape, color, consistency, and scent) were given daily. Results Symptoms of obsessive-compulsive disorders decreased over time, but more so in the buprenorphine than in the placebo condition. Substantial improvements were observed up to week 3 and then 9. Response and partial response were observed in the buprenorphine at week 9 more than in the placebo condition. The advantage had disappeared by week 12. Conclusions The pattern of results suggests that adjuvant buprenorphine augmentation can reduce symptoms of obsessive-compulsive disorders after only three weeks, compared to a placebo. Adjuvant buprenorphine seems to accelerate symptom improvement.

Background Timely prevention of type 2 diabetes decrease socio-economic burden of disease in a society. To measure people’s knowledge, the existence of valid and accurate tool such as questionnaires is very important. In the study we tried to make a comprehensive questionnaire to measure knowledge of apparently healthy individuals. Material and methods In this study a questionnaire to assess general population awareness about type II diabetes disease and its complications was Design, developing and validation based on 10 experts’ panel and statistical inferences. Results Initially 67 questions designed and according to the experts’ panel 16 questions were removed and 11 questions were edited. Finally, content validity of 51 questions has been approved by the experts’ panel. According to Lawshe’s score if CVRs were at least 0.8, items will be has content validity. The results show that both internal consistency and intra-class-correlation were good (>0.75). Cronbach’s alpha and ICC were 0.84 and 0.82, respectively for all questions. To confirm structure of conceptual model, confirmatory factor analysis and Amos software was used. Goodness of Fit Index was RMSEA = 0.027, GFI = 0.95, AGFI = 0.91, CFI = 0.97; and showed that the hypothesized model is approved. Conclusion In general, we can say that the questionnaire is approximately comprehensive and complete. It is suggested that to assess awareness of diabetes type 2 in seven dominants (e.g. fundamentals, common symptoms, early and late complications, diet, control methods, and source of information of DMT2) this questionnaire should be used in general population.

Background and Objectives: Marital relationship has been regarded as one of the deepest types of communication. This study was performed to determine the effect of communication skills training on increasing marital satisfaction among couples by applying the social support theory on females referred to health centers in Bahar. Materials and Methods: This experimental study was performed on 100 females, referred to Bahar health centers in Hamadan province, during year 2016. For the sampling purposes, 100 females were randomly selected from health centers of Bahar city. The participants were randomly divided to 2 experimental and control groups (each group included 50 females). Data collection tools consisted of 3 questionnaires, including Enrich marital satisfaction questionnaires, social support questionnaire, and Burton communication skills questionnaire, which were completed through self-reporting by couples. An educational program in 3 sessions and 2 consulting classes were performed only for the intervention group and post-test questionnaires were completed after one month. Data were analyzed by SPSS-16 software using independent t test, paired t test, Fisher Exact test and Analysis of Covariance (ANCOVA). Results: Results showed that the mean scores of communication skills, marital satisfaction, and social support after the intervention were significantly increased in the experimental group compared to the control group (P

Objective The aim of this study was to assess the effect of inhalation aromatherapy with lavender essence on the pain severity of intravenous catheter insertion in hospitalized preschool children. Method A quasi-experimental study involving 60 participants using convenience sampling were assigned to control (n = 30) and aromatherapy (n = 30) groups. Children in the aromatherapy group inhaled 5 drops of the essence, while children in the control group inhaled 5 drops of distilled water, 20 min before venipuncture. Pain severity was measured using OUCHER scale 10 min after catheterization. Results Mean of pain severity between the aromatherapy and control groups demonstrated a significant difference immediately (P = 0.002) and 5 (P = 0.001) and 10 min (P = 0.01) after intravenous catheter insertion. Mean of pain severity in the three assessed time points had significant differences in aromatherapy and control groups (P = 0.001). Conclusion Aromatherapy with Lavender essence helped to reduce pain severity of intravenous catheter insertion in children.

Introduction: With the increasing use of cardiac catheterization and its complications, such as urinary retention, finding a safe and non-invasive way to solve this problem is essential. The aim of this study was to evaluate the impact of planned nursing interventions on prevention of acute urinary retention in male patients, following cardiac catheterization, at educational and health centers of Hamadan city. Methods: In this interventional study, 74 patients with the study inclusion criteria and undergoing cardiac catheterization were selected by random sampling and were divided evenly to 2 intervention and control groups. Planned nursing interventions for the intervention group and routine nursing care for the control group was performed. The signs of incidence of acute urinary retention was investigated and compared in both groups at 0, 1, 2, 4, and 6 hours after the angiography procedure. Finally, the data was analyzed using by SPSS version 16 software. Results: According to the results, there was no significant difference between the intervention and control groups, regarding urinary retention at different times (P= 0.148). However, this difference was significant in the intervention group during specified times (P= 0.017). Conclusions: The results indicated the positive outcomes of planned nursing interventions in the prevention of acute urinary retention in patients following cardiac catheterization. This method could be used to prevent acute urinary retention in patients after coronary angiography

Introduction: Multiple Sclerosis threatens independence and ability of individuals in their family and society. The purpose of this study was to determine the effect of peer educational program on multiple sclerosis patient’s self-efficacy referred to Farshchian hospital and the Multiple Sclerosis Association of Hamadan City in 2015. Methods: In this quasi-experimental study, 80 Patients with multiple sclerosis were selected with convenience sampling and randomly allocated to control and experimental groups. Four sessions, each 60 minutes, was performed twice a week. After one month after the last training session, self-questionnaires were completed by both experimental and control groups. Data were collected from both groups using the Sherer General Self-Efficacy Questionnaire. Data were analyzed with SPSS/16 using descriptive statistics, independent t and paired t tests. Results: There was a significant difference between the mean scores of self-efficacy in the experimental group. The difference was not significant in the control group. There were no significant differences between the mean scores of self-efficacy of experimental and control groups before and after the intervention. Conclusions: Peer education methods could increase the level of efficacy in patients with multiple sclerosis. This method could be used as a valuable strategy to improve the treatment and control of physical and psychological effects and increase the efficacy of the patient.

Introduction: Marriage is a social capital in society, so that makes the behavioral and social stability of parents and children in a generation, productive. Various factors can affect the intention of marriage, including individual, economic, social and cultural factors. The present study aimed to determine predictors of university students' intention to marriage based on the theory of planned behavior (TPB). Methods: This cross-sectional study was performed among 192 single students (Master and PhD students with five to seven years of dentistry and medicine) in Hamadan, in 2014. The samples in this study were selected through convenient sampling. The data collection tools were demographic and TPB questionnaires. A questionnaire based on the TPB model was used in order to assess attitude toward behavior, subjective norms, perceived behavioral control, and intention. Data were analyzed by using SPSS16 and descriptive indexes, independent-samples t-test, One-way ANOVA and multivariate linear regression at 95% significant level. Results: The results showed that attitudes toward marriage (β=0.217; p=0.001), subjective norms (β=0.366; p

Aim: Unprotected sex and injection drug use are considered as major risk factors associated with HIV infection in Iran. This theory-based study explains the predictability of the Theory of Planned ...

Background and Objectives: Student-life stress can lead to various negative consequences such as physical illness, mental disorders or exhaustion. The present study was conducted to evaluate the level of student life stress and its related factors among medical students of Hamadan University of Medical Sciences. Materials and Methods: This cross-sectional study applied multistage random sampling to select 500university students at Hamadan University of Medical Sciences during 2015. The data collection tool used in this study was a self-report questionnaire containing two parts: a section on subjects' demographic details and another section for Student-Life Stress Inventory (SLSI). Data were analyzed in SPSS20-using descriptive and inferential statistics, such as independent t-test, Pearson’s correlation test and one-way ANOVA. Results: This study revealed that %57of the students had moderate levels of stress. The most important stressors included self-impose and pressure, and also the most important reactions to stressors included cognitive appraisal and emotional reactions, respectively. There was a significant association between exam stressors and branch, educational level, and mother's and father's education level (P< 0.05). Conclusions: According to the high level of stress in students and the recognition of demographic factors, effective educational interventions can be conducted to reduce stress.

Background Sexuality is interwoven with individuals’ information, motivation, and behaviors. Objective To explore sexually related information, motivation, and behaviors that Iranian newly married couples utilized through their marital lives. Methods We employed in-depth face-to-face interviews with 22 couples between the ages of 21 and 35 years to collect rich qualitative data. Content analysis was used to analyze the data. Our data analysis process was guided by the Information-Motivation-Behavioral skills (IMB) model as a potential framework for understanding of the participants’ sexual and marital lives. Results IMB’s conceptual bases were adequately reflected in the participants’ sexual narratives. The participants highlighted information needs related to their sexual relationships and services that should be provided by the relevant programs in the educational and national health system. Fulfillment of each other’s sexual needs was identified as the most important motivation of the participants. Sexual needs of husband, love, and liking were the main motivations for women’s sexual submission. The main behaviors found included couples’ communication skills and performing using feminine traits by women in order to fit the role of a sexually skillful wife. Conclusion Our data analysis revealed that couples shared a proper comprehension of each other’s means of sexual behaviors. A dominance of religious discourse, non-verbal, mostly physical means of communication was employed by the couples to express or initiate sexual interactions. Furthermore, our findings support the utility of IMB as a potential basis for understanding married couples’ sexual lives. Our data highlight an implication to expand the motivation structure of the IMB model to incorporate an individual’s sexual understandings and the sexual needs to promote mutual and pleasurable sexual life within the Iranian culture.

PURPOSE: The purpose of this study was to evaluate the association between rs13266634 polymorphism in SLC30A8 gene and type 2 diabetes in Iranian population, and also to provide a way for adjusting the deviation from the Hardy-Weinberg equilibrium. METHODS: This was a case-control study, the patients were selected from the East Azerbaijan province, Iran. In this study, 125 patients with type 2 diabetes (cases) and 125 healthy individuals (controls) were studied. Genotype and allele frequencies were determined in both groups, and the deviations from the Hardy-Weinberg equilibrium were assessed using Bayesian analysis. RESULTS: A statistically significant association was observed between rs13266634 polymorphism in SLC30A8 gene and type 2 diabetes. In genotype assessing, data analysis showed that, TT genotype play a role in diabetes type 2 risk (P = 0.001). Subjects with TT genotype had a lower risk of diabetes compared to those with CC and CT genotypes. Also, there was no significant relationship between this polymorphism and type 2 diabetes mellitus in the absence of Hardy-Weinberg equilibrium. CONCLUSION: Our findings show that, rs13266634 polymorphism was associated with the type 2 diabetes risk in the population of Eastern Azerbaijan province; however, the low number of TT homozygous genotypes affected the precision of the results. Also, the deviation from HWE affected the results. It is recommended to perform further studies to establish Hardy-Weinberg equilibrium. The inconsistency in the results may be due to the ignorance of this equilibrium.

Training nursing students in older patient education may be facilitated by the student elderly simulated-patient strategy. The purpose of this study was to determine the effects of simulation-based learning on students' skills in providing education to older patients. A quasi-experimental design with repeated measures was used. Nursing students enrolled in clinical courses in their semesters 7 and 8 of the program were randomly assigned to simulation-based learning (SBL) group (n = 35) or lecture-based learning (LBL) group (n = 35). In SBL, the student simulated-elderly patients equipped with devices for the age-related hearing loss, vision impairment, and neck, finger, and arm joint stiffness was trained to present the educational content to the students. Outcome (knowledge, attitudes, and skills) data were collected at pre-test, post-test, and one-month follow-up, using reliable measures. Data were analyzed with repeated measures analysis of variance. Students in the SBL and LBL groups were comparable at pre-test. All students demonstrated improvement in knowledge and skills in older patient education over time; however, students in the SBL group had larger and more durable improvements in these outcomes than those in the LBL group (all p's .001). SBL is a promising instructional method, with long term benefits in improving students' skills.

Background Due to the prevalence of low physical activity (PA) among women, especially during the postpartum period, this study was conducted to investigate the effect of an educational program based on BASNEF (beliefs, attitudes, subjective norms, and enabling factors) model in promoting the postpartum PA among mothers. Methods This quasi-experimental study was carried out on 68 women of Kermanshah City in Western Iran during 2015 who were recruited through cluster random sampling method. Participants were randomly divided into two groups: intervention ( n = 33) and control ( n = 35). The subjects in the intervention group received the five educational sessions. The assessment of the participants was performed before and 6 weeks after the intervention. The researcher-made questionnaire based on the structures of the BASNEF model and the standard PA questionnaire was used to collect the data. Data were analyzed using SPSS-24 software. Results After educational intervention, there was a significant difference between the mean scores of knowledge, attitude, subjective norms, behavioral intention, enabling factors, number of steps, and the intensity of PA ( p Conclusion Based on the results, training the PA based on the BASNEF model can be effective in promoting the PA in the postpartum period; therefore, it is recommended that the educational programs be applied for all these mothers in postpartum period. In addition, if the theories and behavior change models be correctly applied in educational programs, the useful results will be obtained.

Background Across the globe, depression is a common psychiatric disorder and is the main cause of disability among adolescents. To this end, this study was conducted to screen for the prevalence of depression among secondary school female students in the city of Hamadan, in western Iran. Methods In this cross-sectional study, a total of 670 secondary school female students, within the age range of 15–18 years were investigated using multistage random sampling method. Moreover, the Persian version of Center for Epidemiologic Studies Depression Scale (CES-D) and a researcher-designed questionnaire containing demographic variables were employed as research instruments. Analyses of the findings were made using SPSS version 16 software followed by stratified logistic regression model, which was performed for correlation analysis. Results The mean (standard deviation) age of students was 16.2 (0.68) years. The prevalence of severe depression in female students estimated by the Center for Epidemiologic Studies Depression Scale (CES-D) was equal to 52.6%. A statistically significant relationship was also observed to exist between prevalence of depression and type of school (P

The researchers conducted this study as a phenomenological research to understand the individual and social factors related to attempted suicide phenomenon among women of Gilan-e Gharb. Participants of the study are comprised of 17 women survivors of attempted suicide selected by purposive sampling or snowball method. To gather the data, we conducted semi-structured interviews in face-to-face and audio-recorded methods from February to April 2017. Researchers transcribed verbatim and analyzed the content of the interviews thematically. The main issues in this study were three main themes including the "personal factors", "social factors", and "other issues related to attempted suicide" with seven sub-themes. We concluded that both personal and social factors contribute to the suicide attempts in female subjects. Also, we found that the majority of participants did not want to die by the attempted suicide.

Background: The standard precautions (SPs) should be disseminated and implemented by healthcare providers. This study aimed to examine the effects of a multi-component educational intervention on nurses’ knowledge and adherence to the SP guidelines in intensive care units (ICUs). Methods: This small-scale study consisted of a cluster randomised trial. Two ICUs, located in different hospitals, participated in the study. Nurses (n = 15) in one ICU received the multi-component educational intervention. The intervention involved an educational (with multiple instructional media) and a behavioural (with hands-on practice) component. Nurses’ knowledge and adherence were assessed at pre-test and two and six weeks after the intervention. Results: Results showed significant group by time interaction effects for both outcomes: a large improvement was found in the experimental group over time, but not in the control group. The experimental nurses’ knowledge improved from 15 ± 2.47 at pre-test to 19 ± 2.65 and 19.53 ± 0.92 at follow-ups. Similarly, their adherence increased from 19.87 ± 4.44 at pre-test to 29.20 ± 5.00 and 28.40 ± 4.37 at two and six weeks post-test, respectively. Conclusions: The multi-component educational interventions had demonstrated initial effectiveness in enhancing ICU nurses’ knowledge and adherence to the SPs guidelines. The intervention is a promising approach for designing effective continuing education initiatives aimed to improve nurses’ practice.

Objective: To investigate the relationship between biofilm formation and antibiotic resistance patterns in meticillin-resistant and meticillin-sensitive Staphylococcus aureus, isolated from burns. Methods: In a cross-sectional study, pus/wound swab samples were obtained from burns. Presence of Staphylococcus aureus was confirmed, and biofilm formation-related icaABCDR and eta, etb genes were detected by polymerase chain reaction. Biofilm formation assay was assessed using the microtiter plate method. Antibiotic resistance was performed using the disk diffusion method and minimum inhibitory concentration. Results: A total of 95 patients with burns were recruited. Of the 95 wounds swabbed, Staphylococcus aureus was identified in 50 (62.5%), and 47 (94%) isolates capable of producing biofilm. Biofilm production levels were classed as ‘strong’ (n=29; 58%), ‘moderate’ (n=11; 22%), ‘weak’ (n=7; 14%) and ‘non-biofilm forming’ (n=3; 6%). There was an almost even split between isolates identified as meticillin-resistant Staphylococcus aureus (MRSA), n=24 (48%), and meticillin-sensitive Staphylococcus aureus (MSSA) n=26 (52%). The prevalence of the icaA, icaB, icaC, icaD and icaR genes among the studied isolates were 96%, 80%, 80%, 96% and 84%, respectively. The prevalence of eta and etb genes in isolates were 84% and 92%, respectively. Conclusion: Biofilm producing isolates of Staphylococcus aureus showed greater multidrug resistance than non-biofilm producers. In our study, a high rate of biofilm formation and antimicrobial drug resistance was seen. Our results highlight the alarming levels of antimicrobial resistance among MRSA strains and important data about the prevalence of eta and etb genes in Staphylococcus aureus strains isolated from burn patients in this study.

Background: Individuals with lichen planopilaris (LPP) typically present with hair loss and an irritated scalp, with signs and symptoms such as itching, erythema, scaling, and burning. Both hair loss and reddened skin may be visible also for other people. Therefore, it is conceivable that individuals with LPP might report a lower mental health status. Accordingly, in the present study, we compared dimensions of mental health between individuals with LPP and healthy controls. Method: A total of 38 individuals with LPP (mean age: 38.24 years, 47.4% females) and 58 gender- and age-matched controls took part in this study. They completed questionnaires covering dimensions of quality of life and self-esteem; experts rated participants’ symptoms of depression and anxiety. Furthermore, dermatologists reported on the illness duration, the LPP activity index, and the severity of alopecia. Results: Compared to healthy controls, individuals with LPP reported lower scores of self-esteem, physical functioning, and mental health and higher scores of role limitations (physical and emotional). Likewise, experts rated higher depression scores in individuals with LPP compared to controls. In individuals with LPP, a higher LPP disease activity and a higher severity of hair loss were associated with higher depression and lower quality-of-life scores. Further, a higher LPP activity index, a lower self-esteem, and higher anxiety scores predicted a poorer quality of life, while illness duration was statistically unrelated. Conclusions: Compared to controls, and irrespectively of the illness duration, individuals with LPP reported a lower quality of life and a lower self-esteem, and experts’ ratings observed higher scores of depression. Experts treating individuals with LPP might pay special attention to the individuals’ mental health status.

Large amounts of research efforts have been focused on learning gene regulatory networks (GRNs) based on gene expression data to understand the functional basis of a living organism. Under the assumption that the joint distribution of the gene expressions of interest is a multivariate normal distribution, such networks can be constructed by assessing the nonzero elements of the inverse covariance matrix, the so-called precision matrix or concentration matrix. This may not reflect the true connectivity between genes by considering just pairwise linear correlations. To relax this limitative constraint, we employ Gaussian process (GP) model which is well known as computationally efficient non-parametric Bayesian machine learning technique. GPs are among a class of methods known as kernel machines which can be used to approximate complex problems by tuning their hyperparameters. In fact, GP creates the ability to use the capacity and potential of different kernels in constructing precision matrix and GRNs. In this paper, in the first step, we choose the GP with appropriate kernel to learn the considered GRNs from the observed genetic data, and then we estimate kernel hyperparameters using rule-of-thumb technique. Using these hyperparameters, we can also control the degree of sparseness in the precision matrix. Then we obtain kernel-based precision matrix similar to GLASSO to construct kernel-based GRN. The findings of our research are used to construct GRNs with high performance, for different species of Drosophila fly rather than simply using the assumption of multivariate normal distribution, and the GPs, despite the use of the kernels capacity, have a much better performance than the multivariate Gaussian distribution assumption.