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Colorectal cancer is a prevalent disease with a poor prognosis and is known as a heterogeneous disease with many differences in clinical Symptoms and molecular profiles. The present study aimed to systematically evaluate the association of SNPs in miRNA binding sites of target genes that are involved in CRC angiogenesis, epithelial to mesenchymal transition, and cytoskeleton organization with tumorigenesis and metastasis of CRC.A case-control study was performed on 146 samples of CRC patients and 132 healthy samples. After that, the DNA of all samples was isolated by the salting-out method. Finally, the genotypes for EFNA1 SNP (rs12904) were identified by HRM (High-resolution melting analysis) method. In order to evaluate the results of genotyping, two samples from each genotype were sequenced using the sanger sequencing method.The frequency of AA genotype and the frequency of GG for rs12904 in satge4 and other stages are different from each other (P-value0.0001) (P-value = 0.008). Also, the frequency of AA genotype in patients with different grades is different from each other (P-value = 0.035), while the frequency of AG genotype and the frequency of GG genotype is not significantly different in patients with different grades (P-value = 0.377) (P-value = 0.284).Results of this study indicated that patients carrying the GA and GG genotypes reduced the risk of disease progression compared to the AA genotype. As a result, this polymorphism plays a key role in CRC pathogenesis and metastasis and could be used as a biomarker in molecular diagnosis and metastatic state prediction in the near future after further study of its signaling pathways and molecular mechanism.

Unfortunately, most patients with colorectal cancer (CRC) are diagnosed late in advanced stages. Genetic alterations due to a person's behavior or environment, such as miRNA dysregulation and methylation, occur in the initial phases of tumorigenesis. This study investigated the disease causing role of methylation of the miR-138-5p gene and its target protein, PDL1, in CRC as well as their potential ability to be used in the early diagnosis of this cancer. Using molecular techniques, higher methylated miR-138-5p as well as a higher PDL1 concentration were found in patients. This suggested a link between PDL1 protein and hyper methylation of the miR-138-5p gene. On the other hand, the hypermethylation of miR-138-5p happened before the increase of PDL1 protein, which resulted in decreased miR-138-5p and as a result decreased PDL1 protein. Compared with other biomarkers, miR-138-5p methylation and PDL1 had high diagnostic accuracy (acceptable sensitivity and specificity). Thus, the methylated miR-138-5p and PDL1 are proposed as diagnostic biomarkers for CRC.

Previous studies have shown the effect of hydroxychloroquine in the treatment and prevention of recurrence of brucellosis. The aim of this study was to compare the effect of 4 and 6 week regimen containing hydroxychloroquine in the treatment of brucellosis.In a single-blind randomized clinical trial, 92 patients with acute brucellosis were randomly divided in two treatment groups who received a triple drug regimen including doxycycline, streptomycin, and hydroxychloroquine (DSH] for 4 and 6 weeks. All patients were followed up for up to 6 months. Response to treatment, relapse rate, complications, and results of serological tests were compared in both groups. Data were analyzed by SPSS software version 16.Of the 92 patients studied, 46 received a 4 week course and 46 received a 6 week course of therapy. There were no significant differences between the two groups in terms of age and sex distribution. The response rate, treatment failure, and relapse in the 4 week treatment group were 82.6%, 17.3%, and 7.89%, respectively, and in the 6 week treatment group were 91.3%, 8.7%, and 9.52%. The frequency of negative 2ME test at 24 weeks after treatment was 11.1% in the 4 week group and 8.7% in the 6 week group. No significant differences were found between the two groups in terms of response to treatment, treatment failure, relapse, and negative 2ME test.The 4 week and 6 week courses of the combination of DSH are equally effective in treating brucellosis. We recommend further studies to support the use of the short-course 4 week regimen for the treatment of uncomplicated brucellosis.

Semi-continuous data characterized by an excessive proportion of zeros and right-skewed continuous positive values appear frequently in medical research. One example would be the pharmaceutical expenditure (PE) data for which a substantial proportion of subjects investigated may report zero. Two-part mixed-effects models have been developed to analyse clustered measures of semi-continuous data from multilevel studies. In this study, we propose a new flexible two-part mixed-effects model with skew distributions for nested semi-continuous cost data under the framework of a Bayesian approach. The proposed model specification consists of two mixed-effects models linked by the correlated random effects: Part I) a model on the occurrence of positive values using a generalized logistic mixed model; and Part II) a model on the magnitude of positive values using a linear mixed model where the model errors follow skew distributions including beta-prime (BP). The proposed method is illustrated with pharmaceutical expenditure data from a multilevel observational study and the analytic results are reported by comparing potential models under different skew distributions. Simulation studies are conducted to assess the performance of the proposed model. The DIC3, LPML, WAIC, and LOO as the Bayesian model selection criteria and measures of divergence used to compare the models.

PURPOSE: Since cancer patients are at higher risk of COVID-19, the present study was conducted to investigate the epidemiology of these patients and identify the affecting risk factors on their mortality. METHODS: The present retrospective cohort study was conducted on 66 hospitalized patients with cancer and COVID-19 in Hamadan in 2020. In the present study, demographic, clinical, and laboratory information and patients' outcome were collected through a checklist and its impact on death was assessed. Data were analyzed in SPSS-24 software and the significance level of the tests was considered at 5%. RESULTS: The mean (standard deviation (SD)) age of patients was 61.6 (13.5) years. Forty patients (60.6%) were male. Twenty and five patients (37.9%) died at the end of study. The results of logistic regression model revealed that the nausea, mechanical ventilation, admission to ICU, and length of hospital stay in the ward had a significant impact on the odds of death among cancer patients with COVID-19 (p < 0.05). CONCLUSION: Owing to high mortality rate in cancer patients with COVID-19 and due to underlying diseases and more severe clinical symptoms than other patients with coronavirus, these patients need intensive care and specific treatments. However, screening these patients and early identifying and vaccinating of them can reduce the mortality rate in these patients.

Situation awareness is the main reason behind different patterns of unsafe behavior among workers and can play a mediating role in the relationship between predictive situational variables and human error. This questionnaire-based study carried out with Iranian workers investigated the direct and indirect effects of work pressure, mental workload, human-systems interaction and environmental distractions on three types of human error (i.e., slips, lapses and mistakes). The results of path analysis showed that, based on model fit indexes, the model is appropriately fit (

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.

Objective:Crisis management in major accidents requires the collaboration among different organizations. One of the most important problems of crisis management is the lack of coordination between executive organizations. The aim of this study was to examine the structural characters and problems of interorganizational network during crisis in the petrochemical industry and provide solutions to achieve the highest performance in crisis management.Methods:The organizations involved in crisis management were identified through interviews and questionnaires. Gephi (0.9.1) software was used to examine interorganizational relationships.Results:In this study, the crisis management team consisted of 25 public and private organizations and non-governmental organizations. The highest betweenness centrality was observed in Crisis Management of Provincial Government (CMPG) (142.16) and Fire Department of Petrochemical Complex (FDC) (89.3). The highest closeness centrality was observed in FDC (0.77), CMPG (0.7), Shazand Governorate (0.7), and Crisis Management of University of Medical Sciences (0.7).Conclusions:Coordination between organizations plays an important role in crisis and emergency management, and social network analysis helps identify strengths and weaknesses of organizations involved in crisis management, overcome those weaknesses, and consequently achieve the best performance in crisis management.

Background The Theory of Planned Behavior (TPB) is proposed to predict behavioral intention. We conducted this study aimed to investigate the effects of Suicidal Ideation (SI) and constructs of TPB on suicidal intention. Methods This cross-sectional study was conducted with 923 married women selected by multi-stage sampling method from Gilan-e Gharb County, the west part of Iran, in 2018. Data gathering tools were a questionnaire on demographic characteristics, the Beck Scale for Suicidal Ideation, and a four-part questionnaire based on constructs of TPB, including Attitude, Subjective Norms, Perceived Behavioral Control (PBC), and Intention. Data were analyzed by SPSS 19 and AMOS using Structural Equation Modeling (SEM). Results Out of 923 participants, 345 women (37.4%) had some degree of suicidal ideation. The mean score of suicidal ideation in all of participants was 5.98 ± 7.79, while in the 345 individuals with suicidal ideation was 15.53 ± 3.65. Suicidal ideation had the strongest positive total effect on suicide intent, while PBC and attitude had the negative effect on suicide intent. Conclusions Since suicidal ideation had the strongest direct effect on suicidal intent, it is suggested that this variable be used for risk assessment in all suicide prevention programs and counseling measures be implemented to reduce suicidal thoughts. Also, undesirable attitudes toward suicide and perceived behavioral control on suicide intention can be considered and emphasized in planning future interventions.

Background Due to the high mortality of COVID-19 patients, the use of a high-precision classification model of patient’s mortality that is also interpretable, could help reduce mortality and take appropriate action urgently. In this study, the random forest method was used to select the effective features in COVID-19 mortality and the classification was performed using logistic model tree (LMT), classification and regression tree (CART), C4.5, and C5.0 tree based on important features. Methods In this retrospective study, the data of 2470 COVID-19 patients admitted to hospitals in Hamadan, west Iran, were used, of which 75.02% recovered and 24.98% died. To classify, at first among the 25 demographic, clinical, and laboratory findings, features with a relative importance more than 6% were selected by random forest. Then LMT, C4.5, C5.0, and CART trees were developed and the accuracy of classification performance was evaluated with recall, accuracy, and F1-score criteria for training, test, and total datasets. At last, the best tree was developed and the receiver operating characteristic curve and area under the curve (AUC) value were reported. Results The results of this study showed that among demographic and clinical features gender and age, and among laboratory findings blood urea nitrogen, partial thromboplastin time, serum glutamic-oxaloacetic transaminase, and erythrocyte sedimentation rate had more than 6% relative importance. Developing the trees using the above features revealed that the CART with the values of F1-score, Accuracy, and Recall, 0.8681, 0.7824, and 0.955, respectively, for the test dataset and 0.8667, 0.7834, and 0.9385, respectively, for the total dataset had the best performance. The AUC value obtained for the CART was 79.5%. Conclusions Finding a highly accurate and qualified model for interpreting the classification of a response that is considered clinically consequential is critical at all stages, including treatment and immediate decision making. In this study, the CART with its high accuracy for diagnosing and classifying mortality of COVID-19 patients as well as prioritizing important demographic, clinical, and laboratory findings in an interpretable format, risk factors for prognosis of COVID-19 patients mortality identify and enable immediate and appropriate decisions for health professionals and physicians.

Background The high number of COVID-19 deaths is a serious threat to the world. Demographic and clinical biomarkers are significantly associated with the mortality risk of this disease. This study aimed to implement Generalized Neural Additive Model (GNAM) as an interpretable machine learning method to predict the COVID-19 mortality of patients. Methods This cohort study included 2181 COVID-19 patients admitted from February 2020 to July 2021 in Sina and Besat hospitals in Hamadan, west of Iran. A total of 22 baseline features including patients' demographic information and clinical biomarkers were collected. Four strategies including removing missing values, mean, K-Nearest Neighbor (KNN), and Multivariate Imputation by Chained Equations (MICE) imputation methods were used to deal with missing data. Firstly, the important features for predicting binary outcome (1: death, 0: recovery) were selected using the Random Forest (RF) method. Also, synthetic minority over-sampling technique (SMOTE) method was used for handling imbalanced data. Next, considering the selected features, the predictive performance of GNAM for predicting mortality outcome was compared with logistic regression, RF, generalized additive model (GAMs), gradient boosting decision tree (GBDT), and deep neural networks (DNNs) classification models. Each model trained on fifty different subsets of a train-test dataset to ensure a model performance. The average accuracy, F1-score and area under the curve (AUC) evaluation indices were used for comparison of the predictive performance of the models. Results Out of the 2181 COVID-19 patients, 624 died during hospitalization and 1557 recovered. The missing rate was 3 percent for each patient. The mean age of dead patients (71.17 ± 14.44 years) was statistically significant higher than recovered patients (58.25 ± 16.52 years). Based on RF, 10 features with the highest relative importance were selected as the best influential features; including blood urea nitrogen (BUN), lymphocytes (Lym), age, blood sugar (BS), serum glutamic-oxaloacetic transaminase (SGOT), monocytes (Mono), blood creatinine (CR), neutrophils (NUT), alkaline phosphatase (ALP) and hematocrit (HCT). The results of predictive performance comparisons showed GNAM with the mean accuracy, F1-score, and mean AUC in the test dataset of 0.847, 0.691, and 0.774, respectively, had the best performance. The smooth function graphs learned from the GNAM were descending for the Lym and ascending for the other important features. Conclusions Interpretable GNAM can perform well in predicting the mortality of COVID-19 patients. Therefore, the use of such a reliable model can help physicians to prioritize some important demographic and clinical biomarkers by identifying the effective features and the type of predictive trend in disease progression.

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.

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.

BACKGROUND: Finding the best practices for accident prevention is possible by identifying the influential factors affecting accident occurrence and their interactions as well as implementing corrective actions for the root cause factors. OBJECTIVE: This study was aimed to determine the cause-effect relationships and the interaction of the influential factors affecting accident occurrence and determine the critical root factors. METHODS: This study was carried out based on the opinions of a panel of experts and used the fuzzy DEMATEL method. RESULTS: The results showed that “organization safety attitude”, “safety communication”, “work and safety training” and “safe design of systems” are root cause variables. Also, “work and safety knowledge” and “experience in the job” are individual cause variables. CONCLUSIONS: Organizational factors and some of individual variables are the critical factors that affect the occurrence of accidents. Therefore, corrective actions for accident prevention should primarily focus on the correction of these variables.

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.

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.

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 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: The determination of the rate of social distancing compliance and mask-wearing adherence is essential to address the health aspects of COVID-19. The present study aimed to estimate the adherence to mask-wearing and maintaining the social distancing in public passengers in Hamadan, west of Iran, during the COVID-19 pandemic. Study design: The present study was conducted based on a cross-sectional design. Methods: The current study included 72 images from 12 areas in Hamadan as clusters in January 2021. The images were extracted from the traffic control center of Hamadan Municipality. The mean of social distancing and percentage of mask-wearing in all clusters were obtained based on cluster sampling. Results: In this research, the majority of people(68%) in public passengers were men and 32% women. The mean±SD of social distancing in all public passengers in Hamadan was obtained at 65.27 ±73.37 cm (95% CI: 38.48-92.08 cm). The percentage of men who wore masks correctly was higher than that of women (57% vs. 51%). Moreover, mask-wearing adherence was not recognizable in about 34% of people in the images (28% of men versus 48% of women). Among the people whose images were recognizable, all the women were wearing masks, while about 13% of men were not (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.

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.

BACKGROUND Brushing teeth with fluoride-containing toothpaste and flossing are considered as effective solutions for preventing dental caries and periodontal diseases. AIM The aim of this study was to use the promoted social cognitive theory (SCT) to investigate factors influencing adherence to oral hygiene behaviors by elementary school children. DESIGN In this cross-sectional study, 988 elementary school children were chosen using the multistage cluster sampling method. Data were collected using the SCT scale, and its validity and reliability were confirmed. Theoretical models were examined using the structural equation modeling. RESULTS The SCT explained 50% of the variance in brushing with fluoridated toothpaste and 55.6% of the variance in flossing behaviors. The total effect of family environment (β = .60, P

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.

OBJECTIVES: Occupational injuries are known to be the main adverse outcome of occupational accidents. The purpose of the current study was to identify control strategies to reduce the severity of occupational injuries in the mining industry using Bayesian network (BN) analysis.METHODS: The BN structure was created using a focus group technique. Data on 425 mining accidents was collected, and the required information was extracted. The expectation-maximization algorithm was used to estimate the conditional probability tables. Belief updating was used to determine which factors had the greatest effect on severity of accidents.RESULTS: Based on sensitivity analyses of the BN, training, type of accident, and activity type of workers were the most important factors influencing the severity of accidents. Of individual factors, workers’ experience had the strongest influence on the severity of accidents.CONCLUSIONS: Among the examined factors, safety training was the most important factor influencing the severity of accidents. Organizations may be able to reduce the severity of occupational injuries by holding safety training courses prepared based on the activity type of workers.

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

Background: Depression is a serious mental health illness among adolescents especially girls. Web-based treatment can possibly become a solution for reducing mental health problems in adolescents. This study is one of the first trials aimed to evaluate the efficiency of web-based depression improvement program among female adolescents based on the Social Cognitive Theory (SCT). Study design: Randomized Controlled Trial. Methods: A six-month randomized controlled trial based on the SCT was implemented in female schools in Hamadan City, west of Iran in 2018 on 128 female students with mild to moderate depressive symptoms (CES-D =10-45). They were randomly assigned to either intervention or control group (n= 64 in each group). Depression improvement program was implemented through the website via short videos, animations and Power-Point slides. Depression was evaluated using Center for Epidemiologic Depression Scale. A researcher-made questionnaire based on the sheerer and Perceived-Social-Support-Scale-Revised (PSSS-R) questionnaires were used to evaluate the SCT constructs. The data were analyzed using SPSS software. Results: The intervention program resulted in the improvement of depression in 12 wk based on Intent-to-treat analyses. Nevertheless, these achievements seem to have decreased by 24 wk in intervention group. The intervention increased the mean scores of the constructs of social support and self-regulation from baseline to 12 wk in the intervention group (P0.05). Conclusion: The web-based intervention improved depression in female students. Future training using strategies for the sustainable improvement of depression in female students are needed.

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.

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.

Car crashes are an unfortunate event that occurs unpredictably and involuntarily, typically resulting in damage.1 According to “the global status report” of the World Health Organization (WHO) on road safety in 2015, there were 1.25 million road traffic deaths globally,2 90% of which occurred in low-income and middle-income countries.3 Iran is among the countries with high road traffic crashes (RTCs),4 which is a leading cause of death and disability among the Iranian population.5 It is estimated that more than 20,000 to 80,000 individuals in Iran have been killed or injured due to RTCs each year.4 Human factors play a key role in the occurrence of RTCs.6 Sleep deprivation is one of the main human factors that can affect driving and lead to RTCs.7 The most common result of RTCs in urban areas of Iran is related to the human factors. In addition, sleep deprivation has been identified as the most crucial risk factor in this regard.8 Some studies have shown that as a consequence of drowsiness, the probability of RTCs may increase by 1.6-3.8%.9 Even in some studies conducted in the United States, France, and New Zealand, the possibility of RTCs exceeds this figure with the statistics ranging from 3.9% to 33%.10-12 Accordingly, it can be stated that sleep deprivation can lead to motor vehicle crash death. According to a study, the reason for 10%-20% of RTCs fatalities is sleep deprivation during driving.11 Based on the Pittsburgh Sleep Quality Index (PSQI), sleep quality is comprised of seven components: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medications, and daytime dysfunction over the last month.13 Sleep problems may be due to a variety of reasons such as sleep-related illnesses like sleep apnea; lifestyle factors; and occupational characteristics such as rotating shift schedules.11 According to some studies, the risk of RTCs increases in people who sleep less than 6 hours per day.14 Moreover, concentration in driving significantly declines in people working at night shift such as nurses and other hospital workers.15 Furthermore, the risk of RTCs increases in people suffering from poor-quality sleep and taking sleeping medication. 16 To prevent RTCs, providing adequate information on the causes of RTCs is essential. The rate of RTCs is growing and sleep quality has been considered the most significant human factor in countries such as Iran.17 In this regard, a limited number of studies have been performed to determine the association between sleep deprivation and RTCS in urban areas. Therefore, this study aimed at determining the relationship between sleep quality and RTCs of drivers in Hamadan.

Background: Hospital staffs are at high risk of Novel Coronavirus ( 2019 - nCoV preventive behaviors play a peculiar role in the reduction of the incidence and mortality of this infection. Therefore, the present study aimed to assess the prevention behaviors of COVID-19 among health staff based on the Extended Parallel Model (EPPM) in western Iran. Study design: It was a cross-sectional study. Methods: The present study was performed in the west of Iran in April 2020. In total, 1,664 cases were enrolled in this study via multi-stage sampling . The data were collected using a questionnaire, including the demographic characteristics of participants and EPPM constructs. All analyses were conducted in Stata software (version 14) at a 5% significant level. Results: As evidenced by the obtained results, 1,523 (91.53%), 1,226 (73.68%), 1,526 (91.71%), 893 (53.67%), and 862 (51.86%) of health staff wear gloves, use masks, avoid contact with others, maintain a good distance from other people, and wash their hands frequently with water and soap, respectively. In terms of using gloves and avoiding contacts with others, participants with high perceived threat had higher odds of observing health behaviors (OR= 3.14, 95% CI: 2.08, 4.73; P

This study evaluated operators' mental workload while monitoring traffic density in a city traffic control center. To determine the mental workload, physiological signals (ECG, EMG) were recorded and the NASA-Task Load Index (TLX) was administered for 16 operators. The results showed that the operators experienced a larger mental workload during high traffic density than during low traffic density. The traffic control center stressors caused changes in heart rate variability features and EMG amplitude, although the average workload score was significantly higher in HTD conditions than in LTD conditions. The findings indicated that increasing traffic congestion had a significant effect on HR, RMSSD, SDNN, LF/HF ratio, and EMG amplitude. The results suggested that when operators' workload increases, their mental fatigue and stress level increase and their mental health deteriorate. Therefore, it maybe necessary to implement an ergonomic program to manage mental health. Furthermore, by evaluating mental workload, the traffic control center director can organize the center's traffic congestion operators to sustain the appropriate mental workload and improve traffic control management.

The Support Vector Regression (SVR) model has been broadly used for response prediction. However, few researchers have used SVR for survival analysis. In this study, a new SVR model is proposed and SVR with different kernels and the traditional Cox model are trained. The models are compared based on different performance measures. We also select the best subset of features using three feature selection methods: combination of SVR and statistical tests, univariate feature selection based on concordance index, and recursive feature elimination. The evaluations are performed using available medical datasets and also a Breast Cancer (BC) dataset consisting of 573 patients who visited the Oncology Clinic of Hamadan province in Iran. Results show that, for the BC dataset, survival time can be predicted more accurately by linear SVR than nonlinear SVR. Based on the three feature selection methods, metastasis status, progesterone receptor status, and human epidermal growth factor receptor 2 status are the best features associated to survival. Also, according to the obtained results, performance of linear and nonlinear kernels is comparable. The proposed SVR model performs similar to or slightly better than other models. Also, SVR performs similar to or better than Cox when all features are included in model.

Background: Human error is one of the major causes of accidents in the petrochemical industry. Under critical situation, human error is affected by complex factors. Managing such a situation is important to prevent losses and injury. This study aimed to develop a dynamic model of human error assessment in emergencies in the petrochemical industry. Study design: A cross-sectional study. Methods: Fuzzy Bayesian network was used to improve the capabilities of the method for determining the control mode. Fuzzy-AHP-TOPSIS method was also used to prioritize emergency scenarios and human error assessment was applied for the most important emergency condition. Results: Fire in a chemical storage unit was recognized as the most important emergency condition. Common Performance Conditions (CPCs) were determined based on the opinions of a panel of 30 experts and specialists and 7 CPCs were selected for emergencies; then, based on the results of AHP method the relative weights were determined. Finally, membership functions, inputs, and outputs of fuzzy sets, CPC values in 8 emergency response tasks, and the probability of control modes were determined using Bayesian Cognitive Reliability and Error Analysis Method (CREAM) method. Conclusion: This method could be applied to overcome the weaknesses of traditional methods, provide a repeatable method for human error assessment, and manage human error in an emergency.

To examine if the application of Orem’s self-care model could improve self-care knowledge, attitudes, practices, and respiratory conditions of trauma patients with chest tubes, a quasi-experimental study was conducted. The participants were assigned to two groups—namely, Orem’s model and routine care. Although the patients’ self-care knowledge, attitudes, and practices were improved in both groups over the course of 3 days since the initial assessments, there was a greater degree of improvement in the experimental group than that in the control group. However, there were no differences in the improvement of the chest parameters between the two groups. Orem’s model was effective in improving self-care in patients with chest tube.

OBJECTIVES Throughout the world, mines are dangerous workplaces with high accident rates. According to the Statistical Center of Iran, the number of occupational accidents in Iranian mines has increased in recent years. This study investigated and analyzed the human and organizational deficiencies that influenced Iranian mining accidents. METHODS In this study, the data associated with 305 mining accidents were analyzed using a systems analysis approach to identify critical deficiencies in organizational influences, unsafe supervision, preconditions for unsafe acts, and workers' unsafe acts. Partial least square structural equation modeling (PLS-SEM) was utilized to model the interactions among these deficiencies. RESULTS Organizational deficiencies had a direct positive effect on workers' violations (path coefficient, 0.16) and workers' errors (path coefficient, 0.23). The effect of unsafe supervision on workers' violations and workers' errors was also significant, with path coefficients of 0.14 and 0.20, respectively. Likewise, preconditions for unsafe acts had a significant effect on both workers' violations (path coefficient, 0.16) and workers' errors (path coefficient, 0.21). Moreover, organizational deficiencies had an indirect positive effect on workers' unsafe acts, mediated by unsafe supervision and preconditions for unsafe acts. Among the variables examined in the current study, organizational influences had the strongest impact on workers' unsafe acts. CONCLUSIONS Organizational deficiencies were found to be the main cause of accidents in the mining sector, as they affected all other aspects of system safety. In order to prevent occupational accidents, organizational deficiencies should be modified first.

Bladder irrigation can be performed to prevent catheter-associated urinary tract infections (CAUTI), but its efficacy has been not reported in short-term indwelling urinary catheterization. This clinical trial aimed to examine the efficacy of bladder irrigation with normal saline solution in preventing CAUTI in comatose patients admitted to intensive care units.Eligible patients were randomized to the experimental group or control group. The experimental group received daily bladder irrigation with 450 cc sterile normal saline, in 3 150-mL doses, for 3 consecutive days. Data on signs of CAUTI, including urine culture, axillary body temperature (primary outcomes), and other urine and blood parameters (secondary outcomes) were obtained at baseline and 5 days later.Results of group comparisons and logistic regression analysis that controlled for fluid intake showed that the risk of CAUTI decreased by 99% in the experimental group compared with the control group (odds ratio, 0.01; P .001). Additional findings indicated a decrease in axillary body temperature and improvements in urine appearance, urinary red cells and white cells, and erythrocyte sedimentation rates and white-cell counts in the blood following bladder irrigation.Daily bladder irrigation with normal saline during 3 days demonstrated efficacy in preventing CAUTI in comatose patients.

Objective Gingivitis and poor oral hygiene status are the most prevalent oral diseases among primary school students. Poor oral hygiene status, gingivitis and socio-demographic determinants have been shown to be associated with periodontal diseases. There is limited information on the gingivitis and oral hygiene status among Iranian children. In the present study, the status of gingivitis, oral hygiene status, and their association with socio-demographic determinants among schoolchildren aged 7–12 years old in Hamadan were investigated. Methods In this cross-sectional study, 988 primary school students aged 7–12 years old were selected. The oral hygiene status was measured through Simplified Oral Hygiene Index (OHI-S) and Community Periodontal Index (CPI) was used to evaluate gingival bleeding and calculus. CPI was measured using a standardized protocol to investigate gum bleeding and calculus. The oral hygiene was classified as good, fair or poor based on calculus and debris measurements. Age, gender, educational level, occupation and residence district of parents, dental pain experience in the last year and whether parents supervised their children while brushing were assessed by the questionnaires. The collected data were analyzed using descriptive statistics and logistic regression analysis. Results The oral hygiene status was good in 644 students (65.20), fair in 341 (34.50) and poor in three (0.30). Moreover, the results of CPI depicted that 639 students (64.07) had healthy periodontium, 320 (32.40) had periodontal bleeding and 29 (2.9) were with calculus. Higher percentage of the boys in the age group of 12 years old had periodontal bleeding and fewer good oral hygiene. The results of CPI and OHI-S scores depicted that more than half of the primary school students had healthy gums and periodontium (64.1) and good oral hygiene status (65.2). There were significant statistical associations between age and residence district with calculus measured by the CPI, also between gender, age, residence district, and mother’s occupation with the gingival bleeding measured by the CPI. Furthermore, age and mother’s occupation were significantly associated with OHI-S index. Conclusions In general, the periodontal health status is poorer in students attending suburban schools compared to those in urban schools in Hamadan. Since there are significant associations between gender, school districts and mother’s occupation with oral hygiene index among schoolchildren in primary schools, considering them in schools’ oral health program design might be useful. © 2018 Bashirian et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

OBJECTIVES To identify the most important demographic risk factors for a diagnosis of type 2 diabetes mellitus (T2DM) using a neural network model. METHODS This study was conducted on a sample of 234 individuals, in whom T2DM was diagnosed using hemoglobin A1c levels. A multilayer perceptron artificial neural network was used to identify demographic risk factors for T2DM and their importance. The DeLong method was used to compare the models by fitting in sequential steps. RESULTS Variables found to be significant at a level of p

The aim of the study was to compare the viability of periodontal ligament-derived stem/progenitor cells (PDLSCs) from 2 different sources.Periodontal ligament (PDL) tissue was obtained from 20 surgically extracted human third molars and 20 healthy premolars extracted for orthodontic reasons. Periodontal ligament-derived stem/progenitor cells were isolated from 2 different PDL tissue sources and characterized by colony forming unit assay, cell surface marker characterizations, and their osteogenic differentiation potential. To determine cell viability within 2 groups, the colorimetric 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyl tetrazolium bromide (MTT) metabolic activity assay was used. Data were statistically analyzed using independent t-test by SPSS 16 software (SPSS Inc, Chicago, IL).According to the MTT assay, the mean viability rate ± standard deviation of PDLSCs in the impacted third molar sample cells was 0.355 ± 0.411 and for erupted premolar sample cells was 0.331 ± 0.556. Based on One-Sample Kolmogorov-Smirnov test, P value for impacted and erupted teeth was 0.954 and 0.863, respectively. No statistical difference was seen between 2 groups. (P value0.05) CONCLUSIONS: Our results demonstrated that if surgical aseptic technique is a method employed to maintain asepsis, PDLSCs obtained from impacted and erupted tooth root would have the same viability rate.

There is no reliable estimate of the size of female sex workers (FSWs). This study aimed to estimate the size of FSWs in south of Tehran, Iran in 2016 using direct capture-recapture method. In the capture phase, the hangouts of FSWs were mapped as their meeting places. FSWs who agreed to participate in the study tagged with a T-shirt. The recapture phase was implemented at the same places tagging FSWs with a blue bracelet. The total estimated size of FSWs was 690 (95% CI 633, 747). About 89.43% of FSWs experienced sexual intercourse prior to age 20. The prevalence of human immunodeficiency virus infection among FSWs was 4.60%. The estimated population size of FSWs was much more than our expectation. This issue must be the focus of special attention for planning prevention strategies. However, alternative estimates require to estimating the number FSWs, reliably.