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Abstract The study aimed to identify risk factors for childhood wasting in 1–2 year-olds in Hamadan city, focusing on this age group due to infection and malnutrition risks. Unlike previous cross-sectional studies on children under 5 years old, this longitudinal study tracked weight-to-height changes over time. Data were analyzed from 455 mother-child pairs, aged 1–2 years, collected from health centers and recorded in the Integrated Electronic Health System (SIB). The weight-for-height index, an ordinal response with three categories (wasting, normal, and overweight), was measured several times. A two-level longitudinal ordinal model was used to identify factors associated with wasting. The analysis of data from 230 girls and 225 boys identified several factors associated with wasting: lower birth weight (Adjusted Odds Ratio (AOR) = 0.77), age 12–15 months (AOR = 1.15), lack of health insurance (AOR = 3.09), mother-child residence (AOR = 3.80), maternal height (AOR = 0.92), and age at pregnancy

Abstract Introduction Myocardial infarction (MI) is a critical emergency condition that affects all aspects of health. Patients with MI need specialized care in the Coronary care unit (CCU). The main goal of care is to ensure their comfort, which can be significantly affected by their illness and hospitalization. This study aims to explore MI patients’ perceptions of support network challenges to ensure comfort in the CCU. Methods A qualitative approach was adopted, and semi-structured interviews and notes were used for collecting data between 2020 and mid-2021. The participants were 27 MI patients in our country who had been hospitalized in the CCU of the University Heart Hospital. They were selected using purposive sampling. The data were analyzed using conventional content analysis by Graneheim and Lundman. Findings The results of this research were revealed in the form of a “support network” theme comprising five categories: “Physical support”, “Mental occupations”, “Presence of peers”, “relatives support “and “Spiritual strategies”. Conclusion The study results showed that MI patients, in critical condition, receiving care, and hospitalized in the CCU require continuity in their support network to ensure comfort. The inconsistency between the components of each dimension leads to the challenge of ensuring comfort.

Abstract Background Underweight is a prevalent health issue in children. This study aimed to identify factors associated with underweight in children aged 1–2 years in Hamadan city. Unlike the studies conducted in this field, which are cross-sectional and do not provide information on the effect of age changes on underweight, our longitudinal approach provides insights into weight changes over time. On the other hand, this study focuses on the high-risk age group of 1 to 2 years, which has only been addressed in a few studies. Methods In this longitudinal study, 414 mothers with 1 to 2 year-old children referred to the health centers of Hamadan city, whose information is in the SIB system, a comprehensive electronic system, were examined to identify factors related to underweight. The response variable was weight-for-age criteria classified into three categories: underweight, normal weight, and overweight. A two-level longitudinal ordinal model was used to determine the factors associated with underweight. Results Of the children studied, 201 (48.6%) were girls and 213 (51.4%) were boys. Significant risk factors for underweight included low maternal education (AOR = 3.56, 95% CI: 1.10–11.47), maternal unemployment (AOR = 3.38, 95% CI: 1.05–10.91), maternal height (AOR = 0.85, 95% CI: 0.79–0.92), lack of health insurance (AOR = 2.85, 95% CI: 1.04–7.84), gestational age less than 24 years (AOR = 3.17, 95% CI: 16.28–0.97), child age 12–15 months (AOR = 2.27, 95% CI: 1.37–3.74), and child's birth weight (AOR = 0.63, 95% CI: 0.70–0.58). Conclusion Based on the results of the present study, it seems that the possibility of being underweight among children is more related to the characteristics of mothers; therefore, taking care of mothers can control some of the weight loss of children.

Background: Severe oligoasthenoteratozoospermia (OAT), characterized by a reduced sperm count, motility, andaltered morphology, presents a significant challenge in the field of male infertility. Platelet-rich plasma (PRP), renownedfor its regenerative capabilities, emerges as a potential intervention for this condition. This study aims toexplore the impact of PRP on male infertility, focusing specifically on individuals with severe OAT.Materials and Methods: The clinical trial study involved 88 infertile men diagnosed with OAT and devoid of underlyingdiseases. These participants were referred to the infertility center and subsequently divided into two cohorts: acontrol (44 individuals) and an intervention group (44 individuals). Patients in the intervention group received 2 ccof PRP in each testicle, prepared by centrifuging the patients autologous blood samples. Sperm parameters and DNAfragmentation index (DFI) of the patients were measured before and after the procedure. Statistical analysis usedSPSS version 16 software, with a significance level set at less than 5%.Results: The statistical analysis revealed a significant difference in concentration (11.32 ± 8.44 vs. 16.06 ± 15.16,P=0.030), progressive motility (8.86 ± 7.79 vs. 11.97 ± 11.82%, P=0.014) and DNA fragmentation (25.62 ± 12.84 vs.17.23 ± 9.15%, P

Abstract Identifying diabetic patients at risk of developing foot ulcers, as one of the most significant complications of diabetes, is a crucial healthcare concern. This study aimed to develop an associative classification model (CBA) using the Apriori algorithm to predict diabetic foot ulcers (DFU). This retrospective cohort study included 666 patients with type 2 diabetes referred to Shahid Beheshti Hospital in Iran between April 2020 and August 2022, of which 279 (42%) had DFU. Data on 29 specific baseline features were collected, which were preprocessed by discretizing numerical variables based on medical cutoffs. The target variable was the occurrence of DFU, and the minimum support, confidence, and lift thresholds were set to 0.01, 0.7, and 1, respectively. After data preparation and cleaning, a CBA model was created using the Apriori algorithm, with 80% of the data used as a training set and 20% as a testing set. The accuracy and AUC (area under the roc curve) measure were used to evaluate the performance of the model. The CBA model discovered a total of 146 rules for two patient groups. Several factors, such as longer duration of diabetes over 10 years, insulin therapy, male sex, older age, smoking, addiction to other drugs, family history of diabetes, higher body mass index, physical inactivity, and diabetes complications such as proliferative and non-proliferative retinopathy and nephropathy, were identified as major risk factors contributing to the development of DFU. The CBA model achieved an overall accuracy of 96%. Also, the AUC value was 0.962 (95%CI 0.924, 1.000). The developed model has a high accuracy in predicting the risk of DFU in patients with type 2 diabetes. The creation of accurate predictive models for DFU has the potential to significantly reduce the burden of managing recurring ulcers and the need for amputation, which are significant health concerns associated with diabetes.

Abstract Background The aim of the present study was to determine the effect of oral health education programs on the oral health of primary school students. Methods In this randomized controlled trial study, 190 elementary fifth-grade female students were chosen using the multistage cluster sampling method. In this study, the Plaque Index (PI), Simplified Oral Hygiene Index (OHI-S), Community Periodontal Index (CPI), tooth brushing using fluoride toothpaste, dental flossing frequency and factors affecting them were determined according to social cognitive theory (SCT). Interventions were implemented using the play method and with the help of three pamphlets, five posters, a celebration of oral health, and the creation of a Telegram group. Data were analyzed using descriptive statistics indexes, t tests, paired sample t tests, chi-square tests, and Pearson correlation tests. Results The results showed that 3 months after the intervention, compared to before the intervention, the percentage of participants in the intervention group who brushed their teeth twice or more per day increased by 48.5%, and the percentage of participants who used dental floss at least once per day increased by 64.2%. The rate of gum bleeding decreased by 6.3%. The good OHI-S rate increased by 44.4%. Dental plaque decreased by 38.1%. Conclusion The results demonstrated that a gamification design can be effective and useful in promoting the oral health of students. Trial registration registration timing: retrospective, registration date: 18/10/2022, registration number: IRCT20141128020129N2.

Objective: From the perspective of etiology, borderline personality disorder (BPD) is a multifactorial and complexdisorder, hence our understanding about the molecular basis and signaling of this disorder is extremely limited.The purpose of this study was evaluating the relationship between BPD and the Monoacylglycerol lipase (MGLL)polymorphism rs782440 in the population of Hamadan, Iran.Materials and Methods: In this case-control study, 106 participants including 53 patients with BPD and 53healthy control subjects were selected by psychiatrists in the Department of Psychiatry at Farshchian SinaHospital in Hamadan. The BPD patients were selected based on the Diagnostic and Statistical Manual of MentalDisorders (DSM-5) form for diagnosing BPD patients. For genotyping, polymerase chain reaction (PCR) wasused to amplify the desired region including the MGLL intronic C>T single nucleotide polymorphism (SNP)(rs782440) and afterward the amplicon was sequenced using the Sanger sequencing method. To determine thegenotype of these patients, their sequences were aligned with the reference sequence of MGLL through the CLCgenomic workbench software.Results: The results indicated that the frequency of TT in comparison to the CC genotype was significantly different(P=0.003) and the risk of BPD in change from the TT genotype to CC genotype was increased by 6.679%. Regardingthe frequency of allele in this group, no significant difference was observed.Conclusion: This paper, has studied and reports for the first time, the association between MGLL SNP (rs782440) withBPD. The findings of the current research revealed that the TT genotype increases the risk of BPD compared to the CCgenotype. Considering the lack of a suitable diagnostic biomarker for BPD, using this potential biomarker in the nearfuture can be promising.

Abstract Background The start of the COVID-19 pandemic was an emergency situation that led each country to adopt specific regional strategies to control it. Given the spread of COVID-19 disease, it is crucial to evaluate which policy is more effective in reducing disease transmission. The purpose of this study was to determine the impact of policies made by COVID-19 Disease Control Committee (CDCC) to reduce the risk of the disease in Hamadan province. Methods In the observational study, the data were extracted from three sources in Hamadan, west of Iran; first, the session reports of CDCC; second, information on periodic evaluations conducted by the primary health care directory in Hamadan from April to August 2021 and third, expert panel opinion. Bayes network analysis was used to determine the effect of each policy on mortality rate by GeNIe software version 2.2. Results Among the policies adopted by CDCC in Hamadan, seven policies, i.e., vaccination, limiting gatherings, social distancing, wearing a mask, job closure, travel restriction, and personal hygiene had the most impact to prevent the spread of COVID-19, respectively. In this study, the prevalence of the disease was 17.64% with the implementation of these policies. Now, if all these policies are observed 30% more, the prevalence will decrease to 14.18%. Conclusion This study showed that if the seven policies (i.e., vaccination, limiting gatherings, social distancing, wearing a mask, job closure, travel restriction, and personal hygiene) are followed simultaneously in the community, the risk of contracting the disease will be greatly reduced. Therefore, in the pandemic of infectious diseases, such policies can help prevent the spread of the disease.

Background and Objective: Considering the high prevalence of thyroid nodules and the increased incidence of malignancy of this gland, the present study aimed to assess the clinical characteristics and pathology results following surgery in patients with nodular goiter and referred to the endocrinology clinic in Hamadan, Iran. Materials and Methods: This study was conducted as case series from 2011 to 2021. All patients diagnosed with thyroid nodules who underwent thyroidectomy according to the indication and whose pathology was benign or malignant were included in the study. The patients' information was collected by reviewing the files, which included demographic, clinical, and pathology results. The data was analyzed in SPSS software (version 26), and the significance level was considered less than 0.05. Results: Among the 507 patients studied, 88.2% were female, and 11.8% were male. The mean age of the patients was 41.93 years. Pathology result was malignant in 57% of cases and benign in 43% of subjects. Most patients with malignant pathology were under 35 years of age, and those with benign pathology were older (P

Abstract Aim The study aimed to explain the acute coronary syndrome (ACS) patients' perception of the nurse's healing presence in their comfort in the critical care unit. Design This descriptive qualitative study was conducted from December 2020 to September 2021. Methods Twenty‐seven ACS patients were purposively selected from a cardiovascular university Hospital, Iran. Data were collected through semi‐structured interviews (45–60 min). Data analysis was performed based on the contractual content analysis method of Graneheim and Lundman. Results In the data analysis, the main theme ‘nurses' healing presence’ includes two categories: ‘Nurse–patient communication’ with two subcategories and the category ‘Compassionate care’ with three subcategories.

Introduction: Sleep disorders represent a significant health concern among individuals diagnosed with type 2 diabetes. Identifying the prevalence and underlying factors contributing to these disorders is crucial for devising effective interventions to mitigate or resolve this issue. Methods: This cross-sectional study was undertaken, involving 320 patients diagnosed with type 2 diabetes, who were attendees of the Hamadan Diabetes Clinic in 2023. Data collection was done using the demographic information checklist and the Pittsburgh Sleep Quality Index. Furthermore, the study examined the associations between sleep quality and demographic parameters, hemoglobin A1C levels, body mass index, and duration of diabetes by the t-test, chi-square test and logistic regression analysis. Poor sleep quality was defined as a sleep quality score exceeding 5. Results: 70.3 % of participants exhibited poor sleep quality. Female gender, hemoglobin A1c levels exceeding 7.5 %, a body mass index exceeding 30 kg/m2, and advancing age were associated with an increased likelihood of poor sleep quality. Higher levels of education were correlated with a decreased likelihood of poor sleep quality (P

Objective: In microarray datasets, hundreds and thousands of genes are measured in a small number of samples,and sometimes due to problems that occur during the experiment, the expression value of some genes is recorded asmissing. It is a difficult task to determine the genes that cause disease or cancer from a large number of genes. Thisstudy aimed to find effective genes in pancreatic cancer (PC). First, the K-nearest neighbor (KNN) imputation methodwas used to solve the problem of missing values (MVs) of gene expression. Then, the random forest algorithm wasused to identify the genes associated with PC.Materials and Methods: In this retrospective study, 24 samples from the GSE14245 dataset were examined. Twelvesamples were from patients with PC, and 12 samples were from healthy control. After preprocessing and applying thefold-change technique, 29482 genes were used. We used the KNN imputation method to impute when a particulargene had MVs. Then, the genes most strongly associated with PC were selected using the random forest algorithm. Weclassified the dataset using support vector machine (SVM) and naïve bayes (NB) classifiers, and F-score and Jaccardindices were reported.Results: Out of the 29482 genes, 1185 genes with fold-changes greater than 3 were selected. After selecting the mostassociated genes, 21 genes with the most important value were identified. S100P and GPX3 had the highest andlowest importance values, respectively. The F-score and Jaccard value of the SVM and NB classifiers were 95.5, 93,92, and 92 percent, respectively.Conclusion: This study is based on the application of the fold change technique, imputation method, and randomforest algorithm and could find the most associated genes that were not identified in many studies. We thereforesuggest researchers use the random forest algorithm to detect the related genes within the disease of interest.

Aim To investigate the efficacy of a new low-profile catheter on incidence of the catheter-associated urinary tract infections (CAUTI) in comatose patients admitted to the intensive care unit. Background Catheter-induced urothelial injury is a key component in the development of urinary tract infections in catheterized patients. Methods In this prospective randomized blinded clinical trial, 80 patients requiring indwelling urinary catheterization were equally randomized to either the standard Foley catheter (control) or the low-profile catheter (experimental) group. The signs of urinary tract infection for comatose patients were considered (ie, ≥10 5 of colony-forming unit/milliliter of urine, hematuria, serum leukocytes, and body temperature) and recorded at baseline and on days 3 and 5 after catheterization. The analysis of covariance was applied by the SPSS-20 software at a 95% confidence level. Results An increasing proportion of patients with elevated urinary colony counts were seen in the Foley catheter group compared with the low-profile catheter group (12.5% vs 5%). However, there were no between-group differences in the urinary colony counts and body temperature after controlling for antibiotic doses and fluid intake. Patients in the low-profile catheter group had significantly lower rates of hematuria and serum leukocytes than those in the Foley catheter group. Conclusion A newly designed low-profile urinary catheter has demonstrated a trend toward reducing the incidence of CAUTI in patients with indwelling urinary catheters. Further studies with larger sample sizes and follow-up are needed to confirm the benefits.

Introduction: One of the essential and critical elements for efficient and effective management of emergencies is anticipation and identification of possible types of emergencies. As such, a framework for anticipating and identifying emergencies was designed and tested in two process industries in the form of a case study. Material and Methods: At first, methods for identifying emergency preparedness and their evaluation criteria were extracted and prioritized with a two-stage fuzzy approach. A fuzzy inference system was then used to calculate the weight of the experts’ opinions. To prioritize the methods, the inputs related to the second fuzzy system were estimated and the final score of the methods was calculated by entering the mentioned variables into the fuzzy system. Results: The findings pertaining to the final ranking of the methods indicated that, “list of catastrophic accidents and near-misses of the organization’s lifespan”, “MIMAH” and “risk assessment and management” had the highest scores among the identified methods with the final scores of 0.754, 0.750 and 0.725, respectively. Conclusion: Using this approach will help in more accurate identification of potential emergencies. Consequently, this will lead to the prevention of imposed damages caused by the situation as well as making the wrong investments by eliminating low-priority emergencies.

Abstract 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: Governments adopt different policies and strategies to control and reduce the mortality rate of COVID-19. In order to investigate the effect of the adopted policies on the reduction of mortality caused by this disease, the policies implemented by the Regional Headquarter for the Control of COVID-19 Epidemic in Hamedan Province were evaluated. Materials and Methods: The required information was obtained from the Vice-Chancellor of Health of Hamadan University of Medical Sciences and the minutes of the meetings of the Headquarter for the Control of COVID-19 Epidemic in Hamadan Governorate. All the information obtained dates to the period from April to August 2021. A Bayesian network model was used in GeNIe software version 2.2 for the analysis of the information. Results: In this study, seven models were used to evaluate the impact of the adopted strategies. The first model included social distancing, including travel restriction and limiting gatherings, and the mortality rate was estimated to reach 4.72% by implementing the model. The second model includes observing personal hygiene, wearing masks, and vaccination, and the mortality rate was estimated to reach 4.92% by its implementation. The third model encompassed both travel restrictions and business closures, and the mortality rate reached 6.41% after its implementation. Models 4, 5, and 6, which are a combination of the first, second, and third models, have estimated the mortality rate to reach 1.95%, 2.77%, and 2.26%, respectively. In addition, model 7, which combines the above conditions, made the mortality rate reach 2.35%. In the present study, model 6 was selected as the most suitable model with five policies and RMES=0.03005. Conclusion: According to the results obtained in this study, the simultaneous implementation of five policies, including travel restrictions, business closures, personal hygiene, wearing masks and vaccination, can greatly reduce the risk of mortality.

Abstract 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.

Background: The present study examines the various complications and impurities of alcoholbased hand sanitizers during COVID-19 among health workers in Hamadan City, Iran.Methods: This cross-sectional study was conducted on 178 healthcare workers in different hospitals affiliated with the Hamadan University of Medical Sciences. The inclusion criteria included health personnel working in hospitals dedicated to the care and treatment of patients with COVID-19 in Hamadan City. A researcher-made questionnaire was used to collect data. Afterward, to evaluate the quality and impurities of the alcohol-based hand sanitizers used by healthcare workers, various samples were collected and analyzed using gas chromatographymass spectrometry (GC-MS). Stata software version 14-2 was used to analyze the data.Results: The highest and the lowest percentages of ethanol in washing solutions and gels were 68.24% and 60.71%, respectively. Among them, the frequency of using gel, solution, and spray was 93.82%, 42.13%, and 49.44%, respectively. Skin and breathing sensitivity were the most common symptoms in 44.38% and 27.68% of the health workers, respectively. Skin dryness (50%) and sore throat (25.84%) were the most common complications observed in skin and respiratory symptoms among health workers, respectively.Conclusion: Our findings implied that the prevalence of various complications related to the use of alcohol-based hand sanitizers is high among health workers, which highlights the role of using appropriate alcohol-based hand rubs with suitable formulations in the hospital environment to reduce the adverse health effects caused by their long-term and extensive use among health workers.

Abstract Background Accurate information on the cost determinants in the COVID-19 patients could provide policymakers a valuable planning tool for dealing with the future COVID-19 crises especially in the health systems with limited resources. Objectives This study aimed to determine the factors affecting direct medical cost of COVID-19 patients in Hamadan, the west of Iran. Methods This study considered 909 confirmed COVID-19 patients with positive real-time reverse-transcriptase polymerase-chain-reaction test which were hospitalized from 1 March to 31 January 2021 in Farshchian (Sina) hospital in Hamadan, Iran. A checklist was utilized to assess the relationship of demographic characteristics, clinical presentation, medical laboratory findings and the length of hospitalization to the direct hospitalization costs in two groups of patients (patients with hospitalization ≤ 9 days and > 9 days). Statistical analysis was performed using chi-square, median test and multivariable quantile regression model at 0.05 significance levels with Stata 14 software program. Results The median cost of hospitalization in patients was totally 134.48 dollars (Range: 19.19–2397.54) and respectively 95.87 (Range: 19.19–856.63) and 507.30 dollars (Range: 68.94–2397.54) in patients with hospitalization ≤ 9 days and > 9 days. The adjusted estimates presented that in patients with 9 or less hospitalization days history of cardiovascular disease, wheezing pulmonary lung, SPO2 lower than 90%, positive CRP, LDH higher than 942 U/L, NA lower than 136 mEq/L, lymphosite lower than 20% and patients with ICU experience had significantly positive relationship to the median of cost. Moreover, in patients with more than 9 hospitalization days, history of cardiovascular disease and ICU experience was statistically positive association and age older than 60 years and WBC lower than 4.5 mg/dL had statistically negative relationship to the median of hospitalization cost. Conclusion As the length of hospital stay, which can be associated with the severity of the disease, increases, health systems become more vulnerable in terms of resource utilization, which in turn can challenge their responsiveness and readiness to meet the specialized treatment needs of individuals.

Background: One of the important actions for enhancing human reliability in any industry is assessing human error probability (HEP). The HEART technique is a robust tool for calculating HEP in various industries. The traditional HEART has some weaknesses due to expert judgment. For these reasons, a hybrid model is presented in this study to integrate HEART with Best-Worst Method. Materials Method: In this study, the blasting process in an iron ore mine was investigated as a case study. The proposed HEART-BWM was used to increase the sensitivity of APOA calculation. Then the HEP was calculated using conventional HEART formula. A consistency ratio was calculated using BWM. Finally, for verification of the HEART-BWM, HEP calculation was done by traditional HEART and HEART-BWM. Results: In the view of determined HEPs, the results showed that the mean of HEP in the blasting of the iron ore process was 2.57E-01. Checking the full blast of all the holes after the blasting sub-task was the most dangerous task due to the highest HEP value, and it was found 9.646E-01. On the other side, obtaining a permit to receive and transport materials was the most reliable task, and the HEP was 8.54E-04. Conclusion: The results showed a good consistency for the proposed technique. Comparing the two techniques confirmed that the BWM makes the traditional HEART faster and more reliable by performing the basic comparisons.

Abstract 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.

Introduction: Emergencies are unforeseen and unpredictable situations. In these situations, people’s performance is affected by various factors that cause stress. People’s performance in such situations can also affect human error probability. The purpose of this study was to evaluate human error in emergency situations based on the fuzzy CREAM and Fuzzy Analytical Hierarchy Process (FAHP). Material and Methods: This descriptive-analytical study was performed in a petrochemical industry in Markazi province in 2019. The FAHP was used to prioritize emergency situations. To evaluate human error in these conditions, the weights of Common Performance Conditions (CPC) was determined using Analytical Hierarchy Process (AHP) method. Human error probability was calculated using a fuzzy CREAM method in the most important emergency situations. Results: The results of the FAHP showed that “Hydrogen leak from the cylinder joints in the olefin unit” was the most important emergency. The highest relative weight was related to crew collaboration quality (0.06) in the emergency situation. Conclusion: This method can also be used to identify the important factors in human error occurrence and high weighted CPCs and plan to control them.

Background There is evidence of a relationship between prenatal excess androgen exposure and central nervous developmental problems and attention-deficit/hyperactivity disorder (ADHD) in the offspring of mothers with polycystic ovary syndrome (PCOS). Purpose Here we aimed to use a meta-analysis to investigate whether the offspring of mothers with PCOS are at an increased chance of developing ADHD. Methods Three main English databases were searched for articles published through December 2020. The NewcastleOttawa Scale was used to assess study quality. Study heterogeneity was determined using I2 statistics and publication bias was assessed using Begg and Egger tests. The results are presented as odds ratio (OR) and relative ratio (RR) estimates with 95% confidence intervals (CIs) using a random-effects model. Results Six articles (3 cohort and 3 case-control studies; 401,413 total ADHD cases) met the study criteria. Maternal PCOS was associated with an increased risk of ADHD in the offspring based on OR and RR (OR, 1.42; 95% CI, 1.27–1.57) and (RR, 1.43; 95% CI, 1.35–1.51), respectively. There was no heterogeneity among the included articles based on OR (I2=0.0%, P=0.588) and RR (I2=0.0%, P=0.878). Conclusion Our study showed that maternal PCOS is a risk factor for ADHD. Therefore, screening their offspring for ADHD should be considered part of the comprehensive clinical care of women with PCOS.

Abstract Background Image segmentation is considered an important step in image processing. Fuzzy c-means clustering is one of the common methods of image segmentation. However, this method suffers from drawbacks, such as sensitivity to initial values, entrapment in local optima, and the inability to distinguish objects with similar color intensity. This paper proposes the hybrid Fuzzy c-means clustering and Gray wolf optimization for image segmentation to overcome the shortcomings of Fuzzy c-means clustering. The Gray wolf optimization has a high exploration capability in finding the best solution to the problem, which prevents the entrapment of the algorithm in local optima. In this study, breast cytology images were used to validate the methods, and the results of the proposed method were compared to those of c-means clustering. Results FCMGWO has performed better than FCM in separating the nucleus from the other dark objects in the cell. The clustering was validated using Vpc, Vpe, Davies-Bouldin, and Calinski Harabasz criteria. The FCM and FCMGWO methods have a significant difference with respect to the Vpc and Vpe indexes. However, there is no significant difference between the performances of the two clustering methods with respect to the Calinski-Harabasz and Davies-Bouldin indices. The results indicate the better efficacy of the proposed method. Conclusions The hybrid FCMGWO algorithm distinguishes the cells better in images with less detail than in images with high detail. However, FCM exhibits unacceptable performance in both low- and high-detail images.

Background: The coronavirus disease 2019 (COVID-19) pandemic as an emergency public health concern has caused hundreds of thousands of deaths in the world. Identifying predictors of death in COVID-19 patients are a key to improve survival and help patients triage, better management, and assist physicians and health care. Study design: Retrospective observational study Methods: The present study conducted on 512 positive COVID-19 patients confirmed by real-time PCR hospitalized in Sina Hospital, Hamadan in 2020. The data of demographic characteristics, clinical manifestations, laboratory findings, chest examination and disease outcome were collected. Logistic regression model was performed to explore the predictors of in-hospital mortality. Results: Among 512 patients 57 (11.1%) deaths were occurred. the adjusted odds ratios (OR) estimate of death in COVID-19 for patients with age more than 60 years versus those lower than 60 years was 3.15 (95% CI: 1.06, 9.37). The adjusted OR estimate of death in patients with hypertension comorbidity versus those with no comorbidity was 3.84 (95% CI: 1.27, 11.59). In addition, the adjusted OR estimate (95% CI) of death in patients with respiratory rate above 30 per minute, BUN > 20 mg/dL, LDH > 942 U/L and SGOT > 45 U/L against lower than those values was respectively 10.72 (1.99, 57.68), 5.85 (2.19, 15.63), 13.42 (2.17, 83.22) and 2.86 (1.02, 8.05). The risk of death was higher among the patients with multiple comorbidity diseases, systolic BP lower than 90 mmHg, SPO2 lower than 88 and more than ten days hospitalization in comparison with COVID-19 patients with no comorbidity disease (P=0.002), systolic BP higher than 90 mmHg (P=0.002), SPO2 higher than 88 (P

Background: Response variables in most medical and health-related research have an ordinal nature. Conventional modeling methods assume predictor variables to be independent, and consider a large number of samples (n) compared to the number of covariates (p). Therefore, it is not possible to use conventional models for high dimensional genetic data in which p > n. The present study compared the predictive performance of decision trees, ordinal forest, and L1 penalized continuation ratio regression. Materials and Methods: In the present study, three data sets were used. The B-cell data contained 12,625 gene expression data related to 128 patients with four ordinal levels of response variables. The HCC data related to liver cancer included 1469 genes of 56 patients with three ordinal levels of response variables. The Heart data contained information of five variables in 294 patients undergoing angiography with five ordinal levels of response variables. The performance of the methods was compared based on the same training and test datasets using indicators such as accuracy, gamma, and kappa. Results: For two high-dimensional data sets, the ordinal forest model had a higher predictive ability while for the low-dimensional data set, the L1 penalized continuation ratio model had a better predictive performance. Conclusion: The selection of the best prediction model depends on the data set, and for each data, different methods should be considered to achieve the best model.

Objective: Colorectal cancer (CRC) is the fourth most common and the second most lethal cancer worldwide. CRC mortality is increasing in Iran. In the current study, we aimed to investigate association between rs11614913 polymorphism of the miR-196-a2 gene and CRC. Materials and Methods: In this case-control study, we assessed association of the rs11614913 polymorphism in 194 patients with CRC (case) and 286 healthy individuals (control). The expectation-maximization (EM) algorithm method was used to adjust deviation from Hardy-Weinberg equilibrium (HWE). Results: There was no significant difference between genotypic frequencies of rs11614913 polymorphism in the control and case groups. Genotypic frequencies differed in the adjusted and unadjusted deviations from the HWE. Analysis of unadjusted and adjusted independent variables showed that age, sex, alcohol consumption, and drug use were statistically significant. Conclusion: Our findings showed that rs11614913 polymorphism was not associated with CRC risk. Deviation from HWE affected the results. It is recommended to perform further studies to establish HWE. Ignoring the equilibrium can cause in consistencies in the results of studies.

Introduction: Safety situation awareness is an important element affecting operatorchr('39')s reliability and safety performance, which is influenced by various variables. Identification of these variables and their relationship will play a major role in optimizing control measures. The present study was conducted for this purpose. Material and Methods: This study was based on the situation awareness, expert’s opinions and use of a Fuzzy multi-criteria decision-making method. Triangular fuzzy numbers was used to quantify the expertschr('39') judgments and to reduce the errors that result from theirs’ subjective evaluation on the relationships between the variables. Results: The results showed that the studied organizational variables together with "safety/g knowledge" and "experience in job/specific task” are the most important predictive variables of situation awareness. Among the organizational variables, "Organizational Safety Attitudes", "Safe System Design" and "Education" are the most important determinants of safety situation awareness. Conclusion: Fuzzy logic was used to aggregate expert opinions to determine the most important variables affecting situation awareness and their cause-effect relationships. Organizational variables are the main determinants of situation awareness. To improve situation awareness, the best results are obtained by modifying effective root variables, i.e., organizational variables and some individual variables.

Background: β-Thalassemia (βT) is one of the most common genetic diseases. The specific mutation profile of that region can be identified by determining the specific mutations of each region and ethnicity. Objectives: This study investigated the β-globin mutations in patients with βT in Hamadan. Methods: This cross-sectional study was performed on 47 βT carriers. In the present study, the polymerase chain reaction (PCR)-sequencing technique was used to confirm βT carriers, and data were analyzed with SPSS-16 at a 95% confidence level. Results: In general, 164 individuals (81 men and 83 women) suspected of having thalassemia were examined, where 28.7 % (n=47) of them were identified by PCR-sequencing with βT carriers (48.8% male and 53.2% females). Hemoglobin beta (HBβ): c.251 del, HBβ: c.27dupG, and HBβ: c.92+5G>A mutations had the greatest effect on mean corpuscular volume (MCV) reduction, mean corpuscular HB (MCH) reduction, and HbA2 increment, respectively. The most common mutation in both males and females was the same (HBβ: c.315+1G>A). Conclusion: According to the results, the most common mutations in the diagnosis of βT in Hamadan were serially HBβ: c.315+1G>A mutation and HBβ: c.25-26del, HBβ: c.112del, HBβ: c.20A>T, HBβ: 92+6T>C, and HBβ: c.316-106C>G.

This study sought to assess the internal anatomy of the maxillary sinuses and their septa using cone-beam computed tomography (CBCT) in an Iranian population. Materials and Methods: Resorption of alveolar bone decreases the height of the maxillary alveolar ridge. This height reduction may be so severe that it warrants ridge augmentation by a sinus lift. Manipulation of the maxillary sinuses, as in sinus lift surgery, requires adequate knowledge about the sinus anatomy. Results: Maxillary sinus septum, as an anatomical variation, may complicate the surgical procedures and increase the risk of complications such as sinus membrane perforation. In this retrospective study, 366 sinuses, 190 from females and 176 from males, aged between 10 and 65 years old presenting to the Oral and Maxillofacial Radiology Department of School of Dentistry at Hamadan University of Medical Sciences were evaluated by two oral radiologists. The extension of the maxillary sinuses, presence of septa, number of septa and their location were determined. Data were analyzed using the chi square test (level of significance p≤0.001). The coefficient of agreement between the two oral radiologists was calculated based on Cohen kappa. Septa were present in 40.5% of the maxillary sinuses, out of which, 31.6% had one, 7.9% had two and 1% had three or more septa; 38% of the septa were horizontal while 62% had an oblique orientation. In total, 184 septa were found in 183 patients; out of which, 91 septa were 2 to 5 mm long while 93 septa were longer than 5mm. Conclusions: Comprehensive knowledge about the three-dimensional internal anatomy of the maxillary sinuses acquired by CBCT prior to surgical procedures can greatly help to prevent postoperative complications.

Abstract 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: Petrochemical industry has experienced a variety of accidents and the number of emergency situation in this industry is high. Therefore, prioritizing these situations is important. The aim of this study was to determine the effective criteria for the selection of emergency scenario and prioritize them for corrective actions. Subjects and Methods: Delphi technique was used to determine and prioritize the appropriate criteria for the selection of high-risk emergency scenarios. Then, the weights of selected criteria were obtained using fuzzy hierarchical analysis and finally, using the fuzzy TOPSIS technique, the criteria for emergency scenarios were prioritized for corrective actions. Results: The most important criteria for the selection of dangerous emergencies included the amount of loss, damage, and probability. According to the weight of these criteria, emergency situations were prioritized. The most important emergencies included fire in the chemical storage, hydrogen leakage at the cylinder fitting in the Alfin unit, and extreme gas leakage in one of the power plant turbines. Conclusions: Using this approach, high-priority emergencies can be identified, and it is suggested that planning for controlling these situations and preventing crises should be prioritized by managers.

Abstract 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.

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

Improving ethical practice needs recognizing the relationship between moral reasoning and moral courage among nurses. We examined factors (moral reasoning, practical consideration, moral dilemmas familiarity, and demographic and work characteristics) associated with moral courage among nurses. A cross-sectional design was run at all five hospitals affiliated to Hamadan University of Medical Sciences in west of Iran. A proportionate random sampling due to the total size of the nurse population in each hospital, 224 eligible nurses were completed the study questionnaires: demographic-work characteristics, Professional Moral Courage (PMC), and Nursing Dilemma Test. The relationships were examined by multiple regression analysis. Participants reported a more than moderate level of moral reasoning and PMC (43.21±5.98 and 56.16±10.18 respectively). The multivariate model showed the nurses’ PMC is positively predisposed with moral reasoning (β=0.21, p

Background: This study aimed to assess the fracture resistance of zirconia restorations fabricated with rapid layer (RL group) technique and zirconia computer-aided design/computer-aided manufacturing (zir/CAD/CAM) system (ZC group). Methods:This study evaluated 30 all-ceramic crowns in two groups of 15. After fabricating the metal dies and scanning them by the CAD/CAM scanner, the crowns in RL group were anatomically designed and divided into two parts of the core and the veneering. Each part was milled separately by the machine. The core and the veneering were fabricated and cemented. An index was obtained from the restorations and used for the fabrication of samples in the ZC group. In the latter group, the metal dies were scanned and zirconia cores were milled by the machine. The veneering porcelain powder was then applied. Samples in both groups were cemented over metal dies using a glass ionomer cement. The fracture resistance of the complex was measured by a universal testing machine. Data were analyzed using SPSS software version 16. Results:The mean fracture resistance of RL and ZC groups was not significantly different (P>0.05). The mode of failure was adhesive in all samples in RL group and cohesive in 85% of samples in ZC group. The remaining samples in ZC group showed a total fracture in the core and the veneering. Conclusion: The fracture resistance of restorations fabricated by the zir/CAD/CAM and RL systems is not significantly different.

Background: Despite the growing epidemic of problematic Internet use (PIU), little information is available on PIU and related factors in Iran. Methods: This cross-sectional study was conducted on 4261 university students among 13universities throughout the country in 2017. The data collection tool included demographic characteristics, the status of using the Internet, social media, computer games, tobacco, alcohol, and illicit drugs, suicide ideation and attempt, and unprotected sex. PIU was measured using the15-item PIU questionnaire. The status of general health was evaluated using the 28-item general health questionnaire (GHQ) questionnaire. The simple and multiple logistic regression analysis were used to measure the crude and adjusted associations between various factors and PIU. Results: Of 4261 university students, 55.9% were female, 13.5% were smokers, 4.9% were drug abusers, 7.9% were alcohol abusers, 7.8% had unprotected sex in the past year, 7.4%had suicidal ideation in the past month, 1.7% had attempted suicide in the past year, and27.3% suffered from PIU. Only 61.1% had normal health. In contrast, 30.9%, 7.2%, and 0.8%had mild, moderate, and severe general health problems, respectively. There were significant relationships between PIU and age group 20-24 vs.

Abstract 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: Numerous molecular changes are involved in the development andprogression of bladder cancer. Regular follow-up of patients is crucial due to the highrecurrence rate of bladder cancer. The aim of this study is to determine the role ofB-Raf proto-oncogene, serine/threonine kinase and ZEB2 expressions in onset andprogression of bladder cancer. We have also investigated their relationships topathological characteristics.Methods: We conducted this case-control study on bladder cancer and its healthyadjacent tissue, and normal bladder tissue from patients with benign prostatic hyperplasia.After extraction of total RNA and cDNA synthesis, quantitative expression analysis wasperformed in duplicate using real-time PCR. Changes in the gene expression werecalculated according to the 2(-ΔΔCt) equation. The products were confirmed by 1% agarosegel electrophoresis and sequenced by Bioneer Company. Data was analyzed using theSPSS software (version 16).Results: There was significantly greater B-Raf proto-oncogene, serine/threoninekinase expression in 82% of bladder tumor samples compared to the adjacent tissues.In 91.1% of tumor samples, the gene expression was also significantly higher than healthybladder tissues from patients with benign prostatic hyperplasia. We observedoverexpression of B-Raf proto-oncogene, serine/threonine kinase in 61.7% of thehealthy margin tissue samples compared to healthy bladder tissues of patients with benignprostatic hyperplasia (Psamples was significantly higher than healthy peripheral tissues. This increase wasobserved in 94.1% of tumor samples compared to healthy bladder tissues of patientswith benign prostatic hyperplasia (Pa positive relationship between B-Raf proto-oncogene, serine/threonine kinase and ZEB2in cancerous samples (r = 0.75) and healthy margin tissue samples (r = 0.49).Conclusion: During the carcinogenesis process, molecular changes are seen inhealthy margin tissue. These molecular changes may be the reason for the highrecurrence rate of bladder cancer. B-Raf proto-oncogene, serine/threonine kinase canpotentially be a target cancer therapy in antisense technologies.

Introduction: Nausea and vomiting can reduce the quality of life of pregnant women. Identifying the related factors and how we can relieve them can play an important role in the care of pregnant women. Therefore, the present study was conducted with aim to determine the factors affecting the severity of nausea and vomiting during pregnancy and how it is controlled by mothers. Methods: This descriptive study was performed on 160 pregnant women with gestational age of 6-20 weeks and single pregnancy who had referred to Hamadan health centers in 2014. Data were collected by using the researcher-made questionnaire including the questions about demographic characteristics, fertility, how to control nausea and vomiting, and the questionnaire of assessing nausea and vomiting in pregnancy. Data were analyzed by SPSS software (version 16) and Fisher Exact test. P < 0.05 was considered significant. Results: According to the results of the study, the severity of nausea and vomiting was mild in 79 cases (49.4%), moderate in 75(46.9%) and severe in 6 (3.7%). Maternal age, mother's occupation, gestational age and time of day were associated with severity of nausea and vomiting (P

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

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

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

Objective We sought to apply Shannon’s entropy to determine colorectal cancer genes in a microarray dataset. Materials And Methods In the retrospective study, 36 samples were analysed, 18 colorectal carcinoma and 18 paired normal tissue samples. After identification of the gene fold-changes, we used the entropy theory to identify an effective gene set. These genes were subsequently categorised into homogenous clusters. Results We assessed 36 tissue samples. The entropy theory was used to select a set of 29 genes from 3128 genes that had fold-changes greater than one, which provided the most information on colorectal cancer. This study shows that all genes fall into a cluster, except for the R08183 gene. Conclusion This study has identified several genes associated with colon cancer using the entropy method, which were not detected by custom methods. Therefore, we suggest that the entropy theory should be used to identify genes associated with cancers in a microarray dataset.

Introduction: Practicing health promotion behaviours is one of the best ways to maintain health. Modification of health promoting behaviors is essential for students and peer education can be an effective way. Therefore, the present study was conducted to evaluate the effect of peer education on nursing students' health promoting behaviors. Methods: In this quasi-experimental study , 80 nursing and midwifery students were selected by covenience sampling method in 2016-2017. Data gathering tool was Pender Health Promotion Standard Questionnaire. Before education, health promoting behaviors were examined. Then, the first and second semester nursing students were educated in a 4 sessions (each session was 1.5-hour), with lecture and peer education methods, respectively. Two months after education, post-test was done. The data were analyzed using statistical test by SPSS 16 Results: There were no significant differences between the two groups in terms of the mean score of health promotion behaviors (P=0.29) and their related dimensions including spiritual growth (P=0.776), responsibility (P=0.44), interpersonal relationships (P=0.556), stress management (P=0.238), exercise (P=0.704), and nutrition (P=0.06) before education. However, after education, the mean score of health promotion behaviors and their dimensions in the lecture group had a statistically significant increase compared to that of peer education group (P

Abstract 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

Introduction Poor nutrition is the underlying cause of many diseases in the elderly and imposes enormous costs to the governments. Education of proper nutrition has an important role in health promotion of elderly persons. This study is conducted to assess the effect of education based on the BASNEF model on promotion of healthy nutritional behaviors in elderly, Sanandaj. Materials and Methods This was a quasi-experimental study that conducted on 110 elderly people in health centers, Sanandaj. Data collected through a researcher-made questionnaire consisted of two parts: the basic and demographic questions and questions related to the BASNEF model. After selecting two groups of Intervention and control randomly, questionnaires were completed and required data received. Then, intervention was administered to the control group. The control group received no intervention. 6 weeks after the intervention, the questionnaire was completed by two groups. Finally, information received from the two groups was compared before and 6 weeks after the intervention. The data obtained was analyzed by SPSS16. The results in less than 0.05 were considered as significant results. Results Based on the findings of this study, after the intervention, the mean score of knowledge, behavioral beliefs, attitude toward the behavior, and subjective norms significantly increased in the intervention groups compared to the control, however, mean score of normative Beliefs, enabling factors and intention in the intervention groups was not significantly than the control group. Conclusion The results of this study showed that nutritional education based on the BASNEF model can be effective on promote healthy nutritional behaviors in elderly.

Background: Changes in lifestyle and eating habits have put women at risk of obesity and overweight more than ever. This aim of this study was to investigate the effect of Pender’s Health Promotion Model (HPM) to improve the nutritional behavior of overweight and obese women admitted to Fatemiyeh Hospital clinics in Hamadan, west Iran in 2015. Methods: n this quasi-experimental study, 108 eligible women were selected and randomly assigned to two groups: one experimental and one control. Data were gathered using three questionnaires: demographics, Pender’s HPM constructs, and nutritional behavior. The questionnaires were filled out by both groups as pre-test and two months later. A Pender’s HPM-based intervention was conducted for the experimental group. The data were analyzed by paired and independent t-tests, ANCOVA, and Spearmans’ correlation coefficient in SPSS/16. The level of significance was considered to be

Background and Objectives: Training brucellosis preventive behaviors is mandatory to reduce the incidence of this disease in at-risk groups. Thus, the aim of this study was to determine the effectiveness of an educational program based on Health Belief Model (HBM) on brucellosis preventive behaviors among traditional ranchers in rural areas of Hamadan Province, Iran. Materials and Methods: This interventional study was performed with a pretest-posttest design and a control group in 2016. The participants were traditional ranchers of the villages of Hamadan Province, who are identified at high risk for brucellosis. In this study, 70 ranchers were randomly selected and divided into experimental and control groups. The data was collected using a questionnaire consisting of demographic information, knowledge, behavior checklist, and HBM constructs. The experimental group received the educational intervention during 4 sessions with film screening and the use of video and text messages. Data was analyzed using chi-square, Fisher’s exact test, independent t-test, and paired t-test in SPSS. Results: After the intervention, the mean scores of knowledge, perceived susceptibility, perceived severity, perceived benefits, perceived self-efficacy, and cues to action and prevention of brucellosis in the experimental group had significantly increased in comparison to the control group (P