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Background: Increasing hospital capacity to cover the service demands is an important priority during an epidemic or a pandemic. The aim of this study was to increase hospital capacity using the Six Sigma method to improve the patient discharge process. Methods: This was a quantitative study. The Pre- and post-intervention study was conducted in a big hospital designated for COVID-19 patients. The patient discharge process was evaluated and improved based on seven sub-processes and following the Six Sigma model, including defining the problem, measuring time in each of the discharge stations, analysis times and process, improvement process, and control. Results: Implementation of the electronic patient discharge led to a 51.9% decrease in discharge time from 7.3 h during the pre-intervention period to 3.8 h post-intervention (P

Hepatitis C virus (HCV) is a serious global health issue. Nearly 20% of HCV patients spontaneous clear the virus. While some studies have shown the association of spontaneous clearance (SC) of the virus with Interleukin (IL) 28B single nucleotide polymorphisms (SNPs), others didn't show such a relationship. Thus, the purpose of the present study was to investigate the association of IL28B polymorphisms (12979860 SNP) and SC of HCV infection. Upon initial screening of the databases, a total of 545 articles were retrieved, of which 22 studies that met predefined eligibility criteria were entered into the meta-analysis. Odds ratios (OR) with its confidence intervals (95% CI), heterogeneity, publication bias, and sensitivity analysis were assessed. According to the meta-analysis results, a significant association was observed between the rs12979860 SNP and SC of HCV infection. The results indicated that the ORs of SC from hepatitis C virus infection were 2.75 times higher in those with cytokine gene polymorphisms, 95% CI (2.23 to 3.38). Moreover, it was found that the prevalence of rs12979860 CC was 0.33 with 95 CI (0.28–0.38) in genotype one and was 0.40 with 95 CI (0.34–0.47) in other genotypes. Our meta-analysis results suggest that IL28B rs12979860 CC is a strong predictor for SC of hepatitis C infection in PEG IFN-a/RBV-treated patients.

postpartum depression (PPD) is one of the psychological complications of mothers who have experienced severe maternal morbidity/maternal near miss (SMM/MNM) which can adversely affect the wellbeing of mothers, new born infants and other family members, but the risk level in this group is unclear. Therefore, we did a meta-analysis to ascertain the relationship PPD with MNM/SMM.The authors searched relevant studies in databases (Web of Science, PubMed, EMBASE, Clinikalkey, Scopus).The summary odds ratio (OR) along with 95% confidence interval (CI) was calculated by use of random or fixed effects models.Four studies were included in qualitative synthesis. The pooled analysis revealed that PPD was significantly associated with an increased risk of MNM/SMM (OR = 1.83; 95% CI 1.37-2.44,The results show that the risk of PPD in the MNM mothers are twice as likely as women without MNM. Therefore, more attention should be paid to psychological symptoms such as depression in MNM in order to reduce the long-term burden of maternal morbidity.

Background: Early Discharge is one of the most well-known strategies to increase hospital capacity during disasters, which is applicable by recognizing the patients appropriate for early discharge. Therefore, the current study was conducted to estimate a model for predicting hospitalized children appropriate for early discharge during disasters based on the attending physician’s opinion. Materials and Methods: This cross-sectional study was conducted on 210 pediatric patients hospitalized in the emergency and pediatrics wards of the hospitals covered by Mashhad University of Medical Sciences. A researcher-made questionnaire was used to collect data. Questionnaires were completed at the patient’s bedside by a trained questioner. The logistic regression was used to analyze the data. Results: Five variables, such as consciousness level (OR=4.677), dehydration status (2.596), ability to take milk/swallow (OR=1.930), blood oxygen saturation level (OR=1.186), and body temperature (OR=0.530) were determined as predictors for children appropriate for early discharge during disasters. The area under the ROC curve was calculated 0.848, which indicated a good curve fit of the estimated model. Conclusion: The model presented in the current study can help clinical staff identify hospitalized children appropriate for early discharge during disasters.

Background: Infertility has deep psychological impacts on the sexual function of women such as a sense of fear, failure, and incompetence. It can also result in reduced sexual desire, unattained orgasm, and other sexual disorders. However, sexual education is assumed to improve the sexual function in these cases. Therefore, we study the effect of sexual education based on Sexual Health Model (SHM) on sexual function disorders in women with infertility. Materials and Methods: A singleblind, randomized controlled trial was conducted on 108 women with infertility (54 intervention group and 54 control group) aged between 18 and 40 years at the Milad Infertility Center of Mashhad in 2016. The intervention comprised three 90‑min sessions administered during 1 week. At first, a pretest (Female Sexual Function Index [FSFI]) was completed, and 1 month after the end of the intervention, the posttest (FSFI) was completed. To analyze the data, independent t ‑test, Mann–Whitney test, and Wilcoxon test were run. Results: The mean (Standard Deviation [SD]) age of women and their spouses was 30.61 (5.42) and 34.42 (5.73)years, respectively. Results of Mann–Whitney test showed that after 1 month of intervention, there was a significant difference between intervention and control groups ( Z = −4.87, p < 0.001). Moreover, results of Wilcoxon test showed a significant difference in the sexual function in the intervention group before and after the intervention ( Z = 2.81, p < 0.001). Conclusions: Given the positive effects of SHM‑based sexual education, this method could be considered as a subset of sexual education materials used for women with infertility suffering from sexual disorders.

Oxidative stress is related to increased fat deposition in the liver, known as hepatic steatosis. The present study is an evaluation of the anti-oxidative and antihyperlipidemic effects of the hydr...

Background: Obesity is a chronic disease and threatening factors of public health. Obese people have negative body image, and low self-confidence can lead to sexual dysfunction. Objectives: This study aimed to investigate the relationship between obesity and sexual function in women referred to health centers of Birjand in Iran. Methods: This cross-sectional study was conducted on 126 married women who were selected via a multi-stage sampling method from Birjand Health centers in 2014. The participants were categorized into three groups according to BMI (normal (BMI: 18.5 - 24.9), overweight (BMI: 25 - 29.9), and obese (BMI ≥ 30)). Then, demographic and female sexual function index (FSFI) questionnaires were completed in the groups by the self-administrative method. For data analysis, STATA version 14.1 software was used in this study. Data were analyzed using descriptive and inferential statistics tests, and multiple linear regression models. The significance level was considered 0.05. Results: The study showed a significant difference between the three groups in total score of sexual function (P < 0.001). In addition, a statistically significant difference was observed in desire, arousal lubrication, orgasm, and sexual satisfaction scores between the groups (P < 0.001). The results of the regression model showed that the sexual function score of obese people was lower by 15.87 units than normal people. Moreover, the sexual function score of overweight people was 4.67 units lower than normal people. Also, the variables of age, salary, duration of marriage, and the age at first pregnancy are effective factors in female sexual function (P < 0.05). Conclusions: Obesity can affect female sexual function. Therefore, efforts to promote sexual function in obese women are considered as one of the most important topics in women’s health care. This requires more attention to identifying various aspects of sexual life and finding effective ways to promote and improve these persons’ sexual function.

There is controversial evidence from the literature regarding the protective effect of folic acid supplementation during pregnancy against orofacial clefts. The authors undertook this meta-analysis to assess whether folate supplementation during pregnancy can reduce the risk of nonsyndromic cleft lip with or without cleft palate (CL/P) and cleft palate only (CPO) in infants.Eligible articles were identified by searching databases, including PubMed, Medline, Scopus, ISI (Web of Knowledge) to September 2017. A meta-analysis was performed to evaluate the effects of maternal supplementation on oral clefts. Odds ratios (ORs) and 95% confidence intervals (CIs) were pooled using Stata software. Publication bias was assessed by the Begg and Egger test. (Registration ID: CRD42018083922) RESULTS:: Out of the 1630 articles found in the authors' initial literature searches, 6 cohort studies, and 31 case-control studies were included in the authors' final meta-analysis. The results of the main analysis revealed that maternal folate supplementation was associated with a modest but statically significant decreased risk of all cleft subtypes (OR = 0.69, 95% CI: 0.60, 0.78). Folic acid intake alone was inversely associated with CL/P (OR = 0.73, 95% CI: 0.62-0.85,) but to a lesser extent than CPO (OR = 0.75, 95% CI = 053-1.04). Multivitamin intake had a significant protective effect for CL/P (OR = 0.65 95% CI = 0.55-0.80) as well as CPO (OR = 0.69, 95% CI = 0.53-0.90).Our results indicate that maternal supplementation in early pregnancy reduces the risk of nonsyndromic CL/P and CPO in infants. These data can serve to reassure women planning a pregnancy to consume multivitamins during the periconception period to protect against oral clefts.

To assess the prevalence and correlates of low physical activity among Iranian population aged 15-64 years. We used the data collected in National Surveillance of Risk Factors of Non-Communicable Diseases in Iran, 2011. Physical activity was categorized in 3 levels of low, moderate, and high based on a Persian version of Global Physical Activity Questionnaire. The multistage cluster sampling design was accounted for using complex survey analysis method. The sample included 10016 individuals; 41.7% (n = 4178) were men and 58.3% (n = 5837) were women. The mean (SD) age of participants was 38.8 (14.9) years also, and 69.8% (n = 6991) of the participants were from urban areas. The prevalence of low physical activity in the whole population was estimated to be 44.8% (95% CI: 41.7, 48.1). The odds of lower physical activity in the women were 3 times greater than men (OR = 3.14; 95% CI: 2.64, 3.57); in the wealthiest people was 25% lower than the poorest people (OR = 0.75; 95% CI: 0.60, 0.94). The odds of lower physical activity in the age groups 55-64 years were 44% greater than the youngest age groups 15-24 years (OR = 1.44; 95% CI: 1.23, 1.68). The odds of lower physical activity in the obese participants were 18% greater than normal-weight people (OR = 1.18; 95% CI: 1.01, 1.38).). The odds of lower physical activity in diabetic patients were 30% greater than healthy people (OR: 1.30; 95% CI: 1.07, 1.57). The prevalence of low physical activity in Iran, 2011 was high. The correlates of low physical activity in Iran are different to those of Western populations. The main associated factors with low physical activity were female gender, urban area, low socioeconomic status, obesity, diabetes, and older age. Public health policies should target the groups at highest risk of low physical activity.

Background Missing values in data are found in a large number of studies in the field of medical sciences, especially longitudinal ones, in which repeated measurements are taken from each person during the study. In this regard, several statistical endeavors have been performed on the concepts, issues, and theoretical methods during the past few decades. Methods Herein, we focused on the missing data related to patients excluded from longitudinal studies. To this end, two statistical parameters of similarity and correlation coefficient were employed. In addition, metaheuristic algorithms were applied to achieve an optimal solution. The selected metaheuristic algorithm, which has a great search functionality, was the Cuckoo search algorithm. Results Profiles of subjects with cervical dystonia (CD) were used to evaluate the proposed model after applying missingness. It was concluded that the algorithm used in this study had a higher accuracy (98.48%), compared with similar approaches. Conclusion Concomitant use of similar parameters and correlation coefficients led to a significant increase in accuracy of missing data imputation.

Fetuses and young children are sensitive to even low levels of exposure to Hg, which can damage their brain and adversely affect their central nervous system and cognitive development. This study was conducted to determine the maternal and fetal mercury burden levels in mothers presenting to Shahidan Mobini Hospital for delivery. Eighty-nine mothers were included in this study and 360 samples were taken from their placental tissue and blood (maternal blood) as well as their umbilical cord tissue blood (infant blood). Findings revealed a significant strong correlation (r = 0.890, p

Background and Purpose: Serum total cholesterol (TC) concentrations are affected by several factors including ethnicity, diet, geographic, and environmental determinants, and are related to another disease, including hypothyroidism, and renal and liver disease. It is associated with an increased risk of cardiovascular disease, particularly if associated with high levels of serum low-density lipoprotein (LDL). The distribution of TC levels within populations may be useful, and the current study aimed to determine the reference values and specific cut points in a population sample from Mashhad, Iran.Methods: A cross-sectional study was conducted, and data was collected from 6518 individuals (2483 men and 4035 women) aged 25–64 year-old living in Mashhad city using a stratified cluster random sampling design.Reference values for borderline and high TC levels in three age groups were obtained using a percentile regression model. Data were analyzed using Quantreg Software Package and R Ver. 3.1.2 Software.Results: Within the population sample, 38% of the subjects were male and 62% of them were female. The mean and standard deviation for age were found to be 47.07±9 years and 45.28±9 years for men and women, respectively. Percentile regression showed that borderline TC levels for men and women aged 25-64 years were 198-216 mg/dl and 176-243mg/dl, respectively. The values for defining high TC levels were also 226-239 mg/dl in men and 202 - 271 mg/dl in women.Conclusion: Our study estimated reference values and cut points for borderline and high TC separately in both men and women, and age-related sub-groups for a population derived from Mashhad. These findings could be used in local policy plans to allocate health resources.

On January 2020, WHO confirmed the epidemic outbreak of SARS-CoV-2 as a Health Emergency of International Concern. The aim of this meta-meta-analysis is quantifying meta-analytic findings on the association of cardiovascular disease (CVD) comorbidities and COVID-19 severity. Findings suggest that chances of getting severe COVID-19 disease in patients with CVD is greater than those without CVD. Also, prevalence of CVD in patents with COVID-19 is 0.08 (95% CI = 0.07–0.08). The OR as 3.44 indicates that the odds of getting severe COVID-19 is more than 3 times higher in those with CVD. Also, prevalence of hypertension in patient with COVID-19 is 0.27 (95%CI = 0.27–0.28) and the OR as 2.68 indicates that the odds of getting severe COVID-19 in cases with high blood pressure is more than 2.5 times higher than those without hypertension. It is rational to suppose that persons with coronary artery disease are prone to severe viral infection thereby, guideline-directed diagnosis and medical therapy is vital in CVD patients., Graphical abstract Image 1, Highlights • Studies demonstrates thatthe association of CVD comorbidities and COVID-19 severity. • Persons with coronary artery disease are prone to severe viral infection such as COVID-19. • Underlying basic diseases such as hypertension and CVD are risk factors for disease progression and development.

Splicing factor 3B subunit 1 (SF3B1) is a complex takes part in intron splicing of pre-mRNA and mutations within it have been reported frequently in myeloid malignancies including myelodysplastic syndromes (MDS). However, its prognostic value has been controversial. Hence, we aimed this meta-analysis to investigate the prognostic effect of SF3B1 mutations in patients with MDS. Several electronic databases were searched in of EMBASE, PubMed, the Cochrane Library and Web of Science (published up to November 2017) to obtain eligible studies. The pooled Hazard Ratio (HRs) and 95% confidence interval (CI) for overall survival (OS) and leukemia-free survival (LFS) as the primary and secondary endpoint, respectively, were chosen and extracted to determine the prognostic impact of SF3B1 mutations and to compare SF3B1 mutations to those with wild-type. Nine cohort studies with a total of 2259 patients were obtained, and the pooled HRs for OS was 0.93 (95% CI: 0.56-1.52, p-value = 0.78) and revealed no significant effect on overall survival of MDS patients by random effect models. Our meta-analysis suggested that SF3B1 has no impact on OS of patients with MDS, however, an adequately designed prospective study with a large number of patients with different type of SF3B1 mutations is needed to confirm these results. Additionally, Begg’s and Egger’s tests did not show any publication bias.

Background: Urological cancers represent a major public problem associated with high mortality and morbidity. The pattern of these cancers varies markedly according to era, region and ethnic groups, but increasing incidence trends overall makes focused epidemiological studies important. The aim of the present study was to assess the incidence of most prevalent urological cancers in Iran from 2003 to 2009. Materials and Methods: The data for this study were obtained from the population-based Cancer Registry Center of the Iran Ministry of Health and Medical Education. Differences of mean age and age distributions of each cancer were compared between 2003 and 2009 in men and women. Results: Bladder cancer was the most common urologic cancer in both genders. The rate difference of age standardized ratio (ASR) of bladder and renal cell carcinoma in women were 1.54 and 2.01 percent per 100,000 population from 2003 to the 2009, respectively. In men, the rate difference of age standardized ratio of prostate, testis, kidney and bladder cancer was also 2.23, 1.2, 1.8 and 1.5 percent per 100,000 population from 2003 to 2009, respectively. The mean ages of patients in all cancers in both genders did not differ significantly through time (p value>0.05) but the distribution of ages of patients with bladder and prostate cancer changed significantly from 2003 to 2009 (p value

Purpose The last study that had a representative sample of the Iranian population and examined the association between sociodemographic and lifestyle factors with obesity used data from the 1999 to 2000 National Health Survey in Iran. Concern about the increased prevalence of obesity has heightened interest in the association between varieties of these factors with obesity among Iranian households. Methods Data (20,917 adults) were taken from the 2009 STEPwise approach to Surveillance survey in Iran that was conducted under the supervision of World Health Organization. Using quadratic inference function, we evaluated the relation of age, sex, physical activity, serving of fruit and vegetable, employment status, smoking, and place of residence with obesity. Results Using 20–30 years as the reference group, the obesity odds ratios (ORs) were 2.48, 3.79, 3.52, and 3.15 for ages 30–40, 40–50, 50–60, and 60+ years, respectively. Obesity OR for female was 2.63, compared with male. Obesity ORs for smokers and ex-smokers were 0.64 and 1.18, respectively, compared with nonsmokers. Among Iranian adult, obesity ORs for the moderate and vigorous physical activity were 0.99 and 0.90, respectively, compared with low level. The estimated odds of obesity were 46% higher for rural adults. Obesity ORs for public and private employed were 0.79 and 0.76, respectively, compared with unemployed. Conclusions Our results may provide better insights of the factors associated with obesity and can be used as a basis to reinforce health programs to prevent obesity in Iran.