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

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

Background: Identifying the epidemiological aspects of central nervous system (CNS) tumors is the first step in implementing management protocols to control the condition of these tumors. We aimed to examine the epidemiology and histopathology of both benign and malignant tumors of the CNS in one of the referral and university centers in the east of Iran. Methods: This cross-sectional study was conducted on all files of patients admitted to Qaem Hospital in Mashhad City, Iran, in a period of 10 years from March 2009 to February 2018 with a definitive diagnosis of benign or malignant tumors of the CNS, including tumors of the brain, cerebellum, spinal cord, or meningeal membranes. Information sources included the patients' physical files and the hospital information system (HIS). The statistical software SPSS version 28.0 for Windows (IBM SPSS, Armonk, New York, USA) was used for the statistical analysis. Results: In total, 775 patients with benign and 771 patients with malignant CNS tumors were included in the study. Regarding epidemiological aspects of benign tumors, the incidence rate of women was almost twice that of men (68.47% versus 31.53%), with an overall average age of 45.31±19.81 years. The most common benign tumors were meningioma (72.77%), followed by schwannoma (13.67%). Regarding malignant brain tumors, the mean age of affected patients was 36.64±19.67 years, with males accounting for 53.04% of cases and females for 46.96%. The most frequent type of tumor was glioblastoma (32.68%), followed by diffuse astrocytoma (16.47%). Both benign and malignant CNS tumors were associated with significant hospital mortality; in-hospital mortality rates for benign and malignant tumors were 10.1% and 17.5%, respectively. Tumor type and its grade were the main determinants of early death in malignant CNS tumors. Conclusion: The epidemiological characteristics of benign and malignant tumors in our study community were similar to the reports presented in other communities. Knowledge of these characteristics provides the possibility of managing patients and reducing morbidity and mortality related to these tumors.

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

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

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

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

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

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

Background: The patients undergoing kidney transplantation are exposed to Intra-Abdominal Pressure (IAP) elevation following a surgery.Aim: The present study aimed to evaluate the diagnostic accuracy of the IAP measurement method via bladder in the prediction of renal dysfunction after kidney transplantation.Method: This longitudinal study was conducted on 135 kidney transplant patients in two hospitals in Iran/Afghanistan from February 2019 to the end of October 2019. The patients' IAP was measured by nurses every 6 h up to 24 h after the surgery. The indices of renal dysfunction were utilized, including creatinine increase and urine reduction. Doppler ultrasound was used as a golden standard diagnostic test. Data were analyzed in STATA 14.Results: Out of 135 patients, an increase in IAP>10 mmHg was observed in 9.5% of cases. Urinary loss and creatinine decrease more than 25% of baseline indicated a significant correlation with IAP mean difference (P=0.001) (4-1). Therefore, IAP could predict renal dysfunction based on the reduction of urinary volume and a decrease in creatinine of more than 25% of baseline. Finally, a comparison between the diagnostic power of the IAP measurement method and Doppler ultrasound indicated 90% of sensitivity and 94% of negative predictive value in predicting renal dysfunction.Implications for Practice: As evidenced by the obtained results, the IAP measurement via bladder catheter might be a primary test to predict renal dysfunction before Doppler ultrasound; nonetheless, further research is required.

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

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

Objectives: The present study aimed to develop and validate a quick repetition test using familiar and culture-based words for assessing Persian-speaking children with Speech Sound Disorders (SSDs). Methods: The study sample was divided into two groups, including 419 participants without any clinical signs of speech impairment and 36 cases with SSD. The psychometric properties of the single word quick repetition test, including reliability (inter-rater and test-retest reliability) and validity (construct, discriminant, convergent, clinical and concurrent validity) were examined. Moreover, the descriptive data for children without SSD were reported. Results: The obtained test-retest and inter-rater reliability data were satisfactory with Intraclass correlation coefficient (ICC): >0.7. There was a positive correlation between the results of the quick repetition test and phonetic test, indicating the scale’s acceptable convergence validity. Using inflated beta-binomial regression, statistically significant improvement in test score was found with age (discriminant validity). Comparing the correct responses of the control and case groups (clinical validity) revealed a significant difference in responses between the study groups. Results of Bland–Altman plot suggested an acceptable agreement between quick repetition test and phonetic test (construct validity). Discussion: The Persian quick repetition test is a valid and reliable instrument facilitating the screening of speech sound abilities in 3-8-year-olds. Moreover, this test’s conciseness makes it easily applicable in clinical practice and epidemiologic investigations. Establishing descriptive data from a large sample facilitated comparing children’s speech ability to the speech development standards.

Background: Health- Labour Questionnaire (SF-HLQ) is a measurement instrument for collecting the quantitative data on the relationship between disease and functional status of individuals of productivity losses related to health problems in individuals with paid or unpaid work. Since road traffic injuries are the leading cause of death for disability in the world. In this regard, we aimed to report on validity and reliability of the Persian version of Health- Labour questionnaire in assessing Productivity losses of the Road Traffic Injuries. Methods: In this cross-sectional study, a sample of 30 injured of traffic accident referring to hospitals affiliated with Mashhad University of Medical Sciences were randomly selected. Samples were evaluated in 2 stages and have been interviewed following 1 month by using the health- labour questionnaire and their loss of productivity was calculated by telephone. Face and content validity was performed by 5 health management and economics specialists and 10 students of Masterchr('39')s Degree of Health Services Management and their opinions were applied. To determine the content validity of the questionnaire, content validity ratio (CVR) and content validity index (CVI) were used, and to determine reliability, Coefficient Correlation Interclass (ICC) for quantitative variables and kappa coefficient of agreement were used to evaluate the reliability of the nominal questions and SPSS 21 software used for data analysis. Results: CVI and CVR were calculated at 0.79- 0.49, Respectively, which is acceptable for this questionnaire. Intra-class Correlation Coefficient and Confidence interval in both lost productivity and lost working day variables were 0.99 (0.98-0.99) and 0.96 (0.93-0.98) respectively. Kappa coefficient of agreement for nominal questions was 0.99. Conclusion: The results of this study showed that the translated version of the health-labour questionnaire had presented excellent validity and reliability in assessing productivity loss in traffic incident patients.

Background: Among different factors, self-efficacy is one of the most suitable components for predicting smoking behavior among adolescents. Therefore, it is essential to design a native tool to measure this high-risk behavior in adolescents and implement prevention programs in this age group. Aim: This study aimed to design and validate a smoking abstinence self-efficacy questionnaire in female adolescents. Method: In this methodological study, a comprehensive literature review was conducted, and the available similar questionnaires were used to prepare the items. In total, 351 female schoolchildren were selected by convenience sampling in Mashhad, Iran, between October 2017 and January 2018. Face and content validity and construct validity were applied for psychometric evaluation of the developed tool. The reliability of the tool was tested by internal consistency. Results: The final version of the smoking abstinence self-efficacy scale in Iranian female adolescents includes 16 items after a psychometric evaluation. The content validity of the tool was obtained at 0.99. Moreover, exploratory factor analysis explored three factors of emotional, social, and high-risk situations explaining 60% of the variance. Cronbach's alpha coefficient of the questionnaire was estimated at 0.94. Implications for Practice: The smoking abstinence self-efficacy scale is a valid and reliable tool among Iranian female adolescents derived from the native context of this group of people which can examine smoking abstinence self-efficacy in three dimensions of emotional, social, and high-risk situations. Moreover, it can identify adolescents with different levels of smoking abstinence self-efficacy.

Background and Aim: Vulvovaginal candidiasis (VVC) is one of the most common gynecologic problems among the women of childbearing age. Considering the adverse effects of chemical therapies, we performed this systematic review and meta-analysis to assess the effect of honey and yogurt on vaginal candidiasis. Material and Methods: In this systematic review and meta-analysis we searched databases of PubMed, ISI Web of science, Scopus, Cochrane, SID, Magiran ,Irandoc , Google Scholar, using the following sets of keywords: (Vulvovaginal candidiasis, Genital vulvovaginal Candidiasis, Candidiasis, genital vulvovaginal, Candida albicans, Monilial vaginitis, Vaginal yeast infections, Yeast infections, Vaginal, Genital candidiasis, Vulvovaginal moniliasis), (Treatment, Azole, Antifungal agents, Antifungal fungicides, Therapeutic fungicides, clotrimazole, clotrimazole),(honey, Bee-honey),yogurt,(controlled trial, clinical trial) and their Persian equivalent .Data were analyzed by Stata software. Heterogeneity was assessed by chi-square and I2 index and we used the random effects models to pool the data. Results: Heterogeneity analysis showed no heterogeneity between the results of studies in regard to complaints of itching, redness and vaginal inflammation and vaginal discharge caused by candida vulvovaginitis. After comparing honey & yogurt group with control group we found (95% CI: 0.09-0.99, p = 0.002, OR = 0.22) for clinical symptom of pruritus and (95% CI: 0.11-0.87; p = 0.026, OR=0.95) for clinical symptoms of redness and inflammation of vulva and vagina and and (95% CI: 0.13-0.82, OR = 0.32, p= 0.018) for vaginal discharge, which were statistically significant. Conclusion: The results of meta-analysis showed that the effect of honey and yogurt on vaginal candidiasis was statistically significant. Therefore, honey and yogurt can be used as an alternative treatment or in addition to the chemical antifungal drugs in the treatment of vaginal candidiasis. Keywords: Honey, Yogurt, Vaginal candidiasis, Systematic review, Meta- analysis

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

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: Improving the maternal health is one of the world’s most challenging problems. Despite significant movements over the past decades, maternal health has been still considered as a central goal for sustainable development. Maternal near miss (MNM) cases experience long-term physical and psychological effects. To present a clear portrait of the current situation, we performed a systematic review and meta-analysis with the purpose to assess the worldwide prevalence of MNM. Methods: We conducted a systematic review on PubMed, Scopus and Web of Science electronic databases to find published papers in English, before March 2019 and regardless of the type of study. We, then, assessed the prevalence of MNM according to the World Health Organization(WHO) criteria. Finally, 49 papers were included in the study. Random effects meta-analysis was used to pool the available prevalence. The quality of studies was also evaluated. Results: The weighted pooled worldwide prevalence of MNM, was 18.67/1000 (95% CI: 16.28-21.06). Heterogeneity was explored using subgroup analyses based on the continent and the country. We used meta-regression of MNM on MD which resulted in adjusted R-squared as78.88%. Conclusion: The prevalence of MNM was considerable. Low- and middle-income countries should develop systematic approaches to improve quality of care in the facilities and to reducethe risk of MNM events, with the hope to women’s health.

Introduction: One of the physiologic factors affecting orgasms and sexual satisfaction is the strength of the pelvic floor muscles. The weakness of these muscles may lead to female orgasmic disruption, anorgasmia, and, in turn, to decreased sexual satisfaction. This study aimed to determine the effect of pomegranate peel gel on women's orgasm and sexual satisfaction during their reproductive age. Methods: This randomized triple blind clinical trial was conducted on 110 women aged 18-45 years old admitted to the women's clinic of Imam Reza Hospital in Mashhad in 2018. The participants were randomly assigned to two groups of control and intervention. The subjects in intervention and control group were recommended to use peel gel and placebo, respectively for 8 weeks. The orgasms and sexual satisfaction of the women in both groups were evaluated at the baseline, as well as 4 and 8 weeks after the intervention. The data were analyzed in Stata software, using T_test, Mann_whitney, T_paird, Wilcoxom & Friedman. p < 0.05 was considered statistically significant. Result: At the beginning of the study, the two groups were not different in terms of orgasms (p=0/748), sexual satisfaction (p=0/922), and sexual function. However, the mean scores of these two domains were significantly higher in study group after 4 and 8 weeks of intervention (p < 0.001). Conclusion: The use of pomegranate peel gel can effectively increase women's sexual satisfaction by improving orgasms.

Background: Type 1 diabetes is known as the most common endocrine disorder in children which requires strict adherence to self-care regimen. Accordingly, children’s exposure to educational video games can be a strategy for promoting adherence to such regimens. Aim: The main purpose of this study was to investigate the effect of an educational video game for diabetes self-management on adherence to self-care regimens in children with type 1 diabetes. Method: This two-group randomized clinical trial was conducted on 68 children aged 8-12 years affected with type 1 diabetes and admitted to Akbar Children’s Hospital in Mashhad, Iran, during 2018. A self-care package for children with type 1 diabetes was extracted using a review method. The intervention group played the designed interactive video game. Data were analyzed in SPSS software (version 16) through independent t-test and Mann Whitney U test. Results: Both study groups were homogeneous in terms of demographic characteristics. Based on the results of independent t-test, no significant difference was observed between the intervention (77.5±10.1) and control groups (78.7±7.4) regarding mean self-care scores before intervention (P=0.57). However, mean self-care score in the intervention group (82.9±7.8) was significantly higher than that in control group (77.3±7.7) after the intervention (P=0.57). Intra-group comparisons also confirmed the above-mentioned findings. Implications for Practice: The designed educational video game could significantly improve children’s self-care scores. Given that Internet-based video games can be manipulated and quickly updated, it was suggested to compare online and offline video games in future studies.

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.

Background: Maternal near miss (MNM) is one of the important criteria for checking the quality of care in maternal health. This systematic review and meta-analysis study was conducted in 2017 to evaluate the incidence ratio of MNM using the World Health Organization approach in Iran. Materials and Methods: This study was designed based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist for systematic reviews, and Web of Science and PubMed databases were searched systematically, which, respectively, yielded 171 and 137 papers published before June 9, 2017. To include papers written in Persian by Iranian scholars, Google Scholar database was searched and 542 papers were retrieved. Finally, 12 papers which had covered the topic more appropriately were included in the study. Random-effects meta-analysis was used to pool the incidence ratio. Heterogeneity was explored using formal tests and subgroup analyses, then the study quality was also explored. Results: The pooling of overall potentially life-threatening conditions ratio was I2 (97.60%, p < 0.001, ratio = 2.50/1000 live births [LBs] [95% CI: 2.00-3.00]), which is divided into two indicators: severe complication ratio (2.40/1000 LBs) and critical intervention ratio (2.54/1000 LBs). The pooling of overall life-threatening conditions ratio was I2 (95.10%, p < 0.001, ratio = 0.86/1000 LBs [95% CI: 0.64-1.07]). Conclusions: The incidence ratio of MNM needs more attention in Iran. Therefore, it is necessary to identify the factors related to MNM and then implement suitable strategies to reduce the risk factors of the maternal morbidity and improve the quality of maternal care in facilities.

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.

Background: This study was aimed to evaluate five Multiple Imputation (MI) methods in the context of STEP-wise Approach to Surveillance (STEPS) surveys. Methods: We selected a complete subsample of STEPS survey data set and devised an experimental design consisted of 45 states (3 × 3 × 5), which differed by rate of simulated missing data, variable transformation, and MI method. In each state, the process of simulation of missing data and then MI were repeated 50 times. Evaluation was based on Relative Bias (RB) as well as five other measurements that were averaged over 50 repetitions. Results: In estimation of mean, Predictive Mean Matching (PMM) and Multiple Imputation by Chained Equation (MICE) could compensate for the nonresponse bias. Ln and Box–Cox (BC) transformation should be applied when the nonresponse rate reaches 40% and 60%, respectively. In estimation of proportion, PMM, MICE, bootstrap expectation maximization algorithm (BEM), and linear regression accompanied by BC transformation could correct for the nonresponse bias. Our findings show that even with 60% of nonresponse rate some of the MI methods could satisfactorily result in estimates with negligible RB. Conclusion: Decision on MI method and variable transformation should be taken with caution. It is not possible to regard one method as totally the worst or the best and each method could outperform the others if it is applied in its right situation. Even in a certain situation, one method could be the best in terms of validity but the other method could be the best in terms of precision.

smoking. Self-efficacy can be assumed as the best predictor of smoking behavior in adolescents. Aim: The present study aimed to investigate the effects of a school-based interventional program on smoking refusal self-efficacy in adolescent females. Method: This randomized controlled trial was conducted on 53 adolescent females in 2017. The participants were randomly divided into two groups of intervention (n=27) and control (n=26). The intervention group was provided with a smoking prevention program implemented five sessions a week in their school classrooms. On the other hand, the control group received the routine interventions. A researcher-made Smoking Refusal Self-Efficacy Questionnaire was completed before and one month after the intervention. Statistical analysis was performed in SPSS software (version 20.0) using Fisher’s exact test, t-test, and Mann-Whitney U test. Results: According to the results, 9 (34.6%) and 7 (25.9%) individuals in the control and intervention groups had smoking fathers, respectively. The two study groups were homogeneous in terms of smoking refusal self-efficacy before the intervention. Following the intervention, the mean self-efficacy scores in the intervention and control groups were estimated as 111.55±13.1 and 93.53±25.02, respectively. There was a significant difference between the two groups regarding this variable after the intervention (P=0.02). Implications for Practice: The school-based interventional program for smoking prevention in accordance with social skills training could effectively increase the level of smoking refusal self-efficacy in adolescent females.

Introduction: Systemic lupus erythematosus (SLE) is an inflammatory, autoimmune, chronic disease with multi-organ involvement with a remitting and relapsing course that mainly affects women. One of the most important challenges for women affected by SLE is the adverse impacts of the disease on Sexual function. This systematic review and meta-analysis was conducted with am to investigate the effects of lupus on women's sexual function. Methods: In this systematic review and meta-analysis study, both Persian and English articles were searched in databases of PubMed, Magiran, Scopus, SID, Google scholar using the keywords of "Systemic Lupus Erythematosus", "Sexual functioning", "sexual activity", "sexual disorder" and their Persian equivalents during 2000 up to December 2017. Data analysis was performed with STATA software (version 14.1). I2 test was used to assess the heterogeneitybetween studies and the random effects model was applied to pool data and perform meta-analysis. Results: A total of 8 articles of 515 studies about the impact of lupus on women's sexual function were extracted, of which 4 studies were included in the quantitative analysis. The findings of included studies into meta-analysis showed that based on the random effects model, systemic lupus erythematosus decreased women's sexual function )RR= 1.58; 95% CI: 1.10-2.25; p=0.001). Conclusion: Considering the negative impact of lupus on women's sexual function, findings of this study can be a basis for designing and implementation of sexual health programs for this group of women so that lead to promotion of their sexual health.

Abstract Background Technological advances have caused poor mobility and lower physical activity among humankind. This study was conducted to assess the impact of a digital media-based (multi-media, internet, and mobile phone) health intervention on promotion of women’s physical activity. Methods In this quasi-experimental study, 360 women were divided into case and control groups. The digital media-based educational intervention was conducted in two months in the case group electronically, using mail and Internet and telephone platforms. Physical activity was measured using International Physical Activity Questionnaire (IPAQ) that estimated women’s physical activity rate in the previous week. Data was analyzed using descriptive and analytical statistics (ANOVA, chi-square, paired and independent t-tests) using SPSS 20. Results The mean score of knowledge, attitude and level of physical activity in the control group were not significantly different before and after the intervention. While in the case group, this difference before and after the intervention was significant (p

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.

Background: One of the causes of postpartum hemorrhage is prolongation of third stage of labor. Mother-infant skin to skin contact (SSC) immediately after delivery is one of the non-pharmacological interventions to reduce this stage. Studies which assessed the effect of mother-infant SSC after delivery on duration of the third stage of labor reported controversial results on this issue. Therefore, this study investigated the effect of mother-infant SSC immediately after birth on the duration of third stage of labor Methods: In this systematic review and meta-analysis, the databases of PubMed, Scopus, Cochrane, SID, Magiran IranDoc and Google Scholar were searched from 2000 to 2018, using the keywords related to the objectives of this review to access randomized control trials published in Persian or English. The quality of papers was examined using Cochran's Risk of bias tool. Data was analyzed using Stata software. We used I2 index and Chi-square test to investigate heterogeneity and Egger’s and Begg’s tests to assess publications bias. Random effects model was used to combine the data. Results: Six studies were entered into the meta-analysis. The third stage of labor in SSC group was shorter than that of control group with a mean difference of -1.33 and 95% CI (-2.31 to -0.36) and this difference was statistically significant (P=0.007). Conclusion: Mother-infant SSC decreases the duration of third stage of labor. Therefore, the current study provides some evidences to use this non-pharmacological method in order to accelerate the third stage of labor and ultimately prevent postpartum hemorrhage.

Background: High cholesterol levels are associated with increased risk of coronary heart disease and stroke. Understanding the distribution of serum cholesterol levels in each country is valuable index for use in public health planning. This study aimed to construct nomograms of total cholesterol (TC) levels and establish the cut-points specific to Iranian population.Methods: Data on serum TC levels of 19,630 non-institutionalized individuals aged 25-64 years from third national survey on non-communicable diseases (SuRFNCD) in 2007 were used to construct cholesterol nomograms. We proposed cutoff values for borderline and high TC levels based on rounded 75th and 90th percentiles in three age groups (25-34, 35-44 and 45-64) respectively.Results: Average yearly increase of TC for males up to the age of 45 and females up to 64 were 1.15 and 1.03 mg/dl, respectively. TC levels were higher in females. In males, cutoff values for "borderline and high" TC levels were 195 and 220 mg/dl in 25-34, 210 and 240 mg/d in 35-44 and 215 and 245 mg/dl in 45-64 years old individuals. In women, these values were 200 and 225 mg/dl in 25-34,215 and 240 mg/dl in 35-44 and 235 and 265 mg/dl in 45-64 years old individuals respectively.Conclusion: Since TC levels are different in two sexes and change with age, we proposed different cutoffs for sex and age group. We think these cutoffs could be used in national public health planning.

Trends in cholesterol level of different populations have been investigated in several studies. This study is conducted to determine the trend of cholesterol level of Iranian adults from 1990 to 2007. Data on cholesterol measurements of four national health surveys that have been carried out in Iran used in this study. Cholesterol level of 12728 adults aged 25-64 were measured in 1990-1 survey. Also in 1999, 2005, and 2007 surveys, blood cholesterol level of 18398, 52344 and 19630 have been sampled, respectively. The median of cholesterol were modeled with age for men and women separately for the four surveys using fractional polynomials. Then, trends in the median of cholesterol across these four surveys were studied. The analysis of cholesterol data over four national health surveys showed that the change in males' cholesterol level had a decreasing trend. This decreasing trend was more pronounced in ages younger than 45 years. However, the medians of cholesterol of females during 16 years of four national surveys had a varying trend. It was decreasing in ages younger than 45; but increasing in ages over 45 years. The median of the cholesterol level of males and females in 2005 survey was on average about 10 mg/dl higher in comparison with the other surveys. Our findings showed that the pattern of trend in cholesterol level of Iranian men and women adults have a considerable difference with those of the other developing and developed countries.