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Objectives Planning for active aging to manage the conditions of old age is one of the inevitable priorities that requires knowing its facilitators and barriers from the perspectives of beneficiaries. In this regard, this study aims to identify the facilitators and barriers to active aging in Iran from the perspective of older adults and geriatric experts. Methods & Materials This is a qualitative study that was conducted in 2022 using the content analysis method. Participants were 20 older adults and 21 experts in geriatrics who were selected using a purposive sampling method based on the inclusion criteria. Semi-structured, in-depth interviews and focus groups were used for data collection. Data were analyzed using Graneheim and Lundman’s content analysis method. Lincoln and Guba’s criteria were used to determine the credibility, transferability, dependability, and confirmability of the data. Results Four main categories were extracted for barriers to active aging (individual, family, structural, and health system-related) and four main categories for facilitators of active aging (older adults’ existential capacity, family capacity, community capacity, and health system capacity). Conclusion Health system-related barrier is one of the barriers to planning for active aging in Iran. The results of this study provide valuable information to experts in geriatrics, scholars, and elderly care centers for developing interventions to promote active aging in Iran.

Abstract Background Dramatic body changes in pregnancy cause severe concerns among pregnant women about their appearance. Therefore, this study aimed to explore body perception in pregnant women. Materials and methods The qualitative study, using the conventional content analysis approach, was conducted on Iranian pregnant women who were in their second or third trimester of pregnancy. Participants were selected through purposeful sampling method. In-depth and semi-structured interviews were held with 18 pregnant women aged 22 to 36 years, using open-ended questions. Sampling was performed until data saturation was reached. Results Three main categories were extracted from 18 interviews: (1) “symbols,” with two subcategories, including ‘motherhood’ and ‘vulnerability,’ (2) “feelings toward body changes,” with five subcategories, including ‘negative feelings toward skin changes,’ ‘feeling unfit,’ ‘attention-drawing body shape,’ ‘the ridiculous body shape’ and ‘obesity,’ and (3) “attraction and beauty,” with two subcategories, including ‘sexual attraction’ and ‘facial beauty.’ Conclusion The results showed that pregnant women’s body perception could be described as maternal feelings and feminine attitudes toward changes during pregnancy compared to mental ideals of facial and body beauty. It is recommended that Iranian women’s body perception during pregnancy be evaluated using this study results and that counseling interventions be implemented for women with negative body perceptions.

Background: The objective is to summarize evidence from systematic reviews, scoping reviews, and meta-analyses evaluating the effects of any format of Internet-based, mobile-, or telephone-based intervention as a technology-based intervention in suicide prevention. Materials and Methods: This is an umbrella review, that followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement guidelines. An electronic search was done on September 29, 2022. Data were extracted by reviewers and then methodological quality and risk of bias were assessed by A Measurement Tool to Assess Systematic Reviews-2. Statistical analysis was done by STATA version 17. Standard mean difference was extracted from these studies and by random effect model, the overall pooled effect size (ES) was calculated. I2 statistic was used to assess the heterogeneity between studies. For publication bias, the Egger test was used. Results: Six reviews were included in our study, all with moderate quality. The overall sample size was 24631. The ES for standard mean differences of the studies is calculated as − 0.20 with a confidence interval of (−0.26, −0.14). The heterogeneity is found as 58.14%, indicating a moderate-to-substantial one. The Egger test shows publication bias. Conclusion: Our results show that technology-based interventions are effective. We propose more rigorous randomized controlled trials with different control groups to assess the effectiveness of these interventions.

Background: Polycystic Ovary Syndrome (PCOS) is the most common endocrine disorder among women of reproductive years. In addition to multiple physical problems, this syndrome has many psychological complications. Thus, the present study attempted to explore the psychological experiences of women with PCOS in Iran's sociocultural context. Materials and Methods: The study was carried out in Isfahan, Iran, using a qualitative content analysis method. The participants were selected through purposive sampling from women with PCOS, their spouses, and healthcare providers in hospitals, clinics, workplaces, universities, and physicians' offices between September 2018 and November 2019. Data collection was performed through semi-structured interviews until data saturation. Data analysis was based on conventional content analysis. The interviews were transcribed and coded. Afterward, categories and concepts were extracted by grouping similar codes. Results: A total of 13 women with PCOS, four spouses, and 13 healthcare providers participated in this study. Data analysis yielded five main categories, including the patient's psychological reactions following infertility and its probability, psychological issues following menstrual disorders, patients' fear and concerns about the probability of developing chronic diseases, psychological problems following the disease, and psychological problems resulting from body appearance. Conclusions: The results of this study showed that women with PCOS were exposed to multiple psychological problems. Therefore, preventing and controlling the psychological consequences of PCOS and its complications requires healthcare providers' support and comprehensive and long-term planning to promote the mental health of these women.

Background: Chronic lymphocytic leukemia (CLL) can transform into fast growing lymphoma for diffuse large B-cell lymphoma (DLBCL) called Richter's syndrome (RS), which is commonly related to an existence of large B-cells with equal or larger size than macrophage nuclei or more than twice those of normal lymphocyte. We conducted a systematic review of the existing literature to assess the clinical efficacy of auto-HCT for patients with RS. Methods: We searched 4 main databases; EMBASE, Google Scholar, Scopus, PubMed and Web of Science and was done on December 26,2021. All analyses in this study were performed by Stata software and this review was reported in accordance with PRISMA 2020. Results: Data was extracted from 4 articles; the total number of patients was reported to be 110. Based on the meta-analysis findings, pooled overall survival rate was 56.36% (95%CI= (46.98 – 65.31). In figure 2, the forest plot of combined results is shown. Conclusion: Despite the use of common treatment regimens such as chemo immunotherapy and the availability of novel therapies including B-cell receptor inhibitors and rituximab-cyclophosphamide-hydroxydaunorubicin-Oncovin-prednisone (CHOP-R) regimen, the status of disease progression and recovery in RS cases is still not strong enough.

Abstract Lifestyle modification in women with polycystic ovary syndrome (PCOS) could be associated with increased psychological symptoms. This study aimed to evaluate the effect of lifestyle modification counseling using 5A’s model on the psychological symptoms of women with PCOS. This double-blind, randomized field trial was performed on 70 women with PCOS in two groups of lifestyle modification counseling based on 5A’s model and counseling without using the model. The intervention was performed based on five stages of the 5A’s model (Assess, Advise, Agree, Assist, Arrange) during a week, and psychological symptoms were assessed using Symptom Checklist-90-R before the intervention and one and three months after the intervention. The results showed that one and three months after the intervention, the level of psychological symptoms, except obsessive–compulsive level, were significantly lower in the intervention group than in the control group (p

IntroductionWith an increasing rate of population aging and its consequences, preparation for active aging based on older adults' needs is an unavoidable priority. Active aging needs must be identified to help strategic planning for older adults' health and wellbeing. This study aimed to explore the active aging needs from the perspectives of older adults and geriatric experts.MethodsThis exploratory-descriptive qualitative study was conducted in four provinces with the oldest populations in Iran. Semi-structured and focus group interviews were conducted with 41 participants (20 older adults and 21 geriatric experts), who were chosen through purposive and snowball sampling. Data were analyzed using the conventional content analysis.ResultsThis study identified three themes and thirteen categories from the data: (1) basic individual needs with three categories of physiological, psycho-emotional, and spiritual needs; and (2) managerial needs with seven categories of political-legal, socio-economic, and cultural-spiritual infrastructures, academic strategies, an age-friendly environment; technological services, and provision of specialized services and daycare for older adults, and (3) educational needs with three categories of training self-care and self-efficacy, empowering the health care workers; and empowering the family.ConclusionThe results revealed personal, managerial, and educational needs for active aging and could assist policymakers and geriatric experts to promote and meet active aging needs successfully.

Background: Castor oil is used in some countries to induce labor, but results on its effectiveness and safety is controversial. This systematic review and meta-analysis aimed to evaluate the effect of castor oil on labor induction and prevalence of vaginal delivery along with investigating its safety. Materials and Methods: PubMed, Scopus, Web of Science, and Google Scholar were searched systematically up to September 2020. Observational studies and Randomized Clinical Trials (RCTs), which assessed the effect of castor oil on labor induction in English and Persian languages using different combinations of the related key terms and Medical Subject Headings (MeSH) terms were collected and analyzed independently by two authors. Random effect model was used for meta-analysis. The studies were included in which the Relative Risk (RR) had been reported with 95% Confidence Intervals (CIs). Results: A total of 12 studies consisting 1653 pregnant women were included. The mean age of women who used castor oil was 24.72 years and in control group was 24.67 years. Results showed that labor induction was significantly higher in castor oil group than control group (RR: 3.27; 95% CI (1.96, 5.46)). Prevalence of vaginal delivery was 81% in the castor oil group and 69% in the control group. Conclusions: It can be concluded that use of castor oil has positive effect on labor induction and increases the prevalence of vaginal delivery. None of the studies considered in this meta-analysis reported any serious harmful effects for the use of castor oil.

Background: Psychosomatic medicine is a systemic model of care based on the biopsychosocial model in which the physical, emotional, and social aspects of clinical conditions are considered. Family Medicine (FM) and psychosomatic medicine have many similarities in their community-based and family-based approaches. Studies have shown the necessity and effectiveness of psychosomatic medicine training for general practitioners ‎(GPs) and family physicians. Methods: We designed a psychosomatic course for FM residents. This semi-experimental study was performed at Isfahan University of Medical Sciences, Iran, in 2018. The target population included 11 FM residents. A compact 20-hour module (4 days, 5 hours each) was designed for the training. The Knowledge and Practice of Psychosomatic Medicine Questionnaire (self-administered) for the concepts and skills of psychosomatic medicine was filled out by each of the FM residents before and after the intervention. For each resident, caring for patients was monitored and a Performance Appraisal Checklist was completed by the supervisor. Finally, the questionnaire scores before and after the intervention were compared using paired t-test. Results: The total knowledge and practice score increased significantly after the intervention (258.5 ± 40.3 vs. 174.6 ± 62.9; P = 0.002). There was also a significant increase in the mean psychosomatic care performance scores after the intervention (28.65 ± 3.52) compared with baseline (21.18 ± 5.94) (P = 0.001). Conclusion: This study showed that basic psychosomatic care training for family physician residents, even in short courses, can have a positive effect on their clinical knowledge and performance.

Plain English summary Married adolescent girls have unique sexual and reproductive health needs; however, the appropriate services have not always been provided. This was a qualitative study conducted in Iran to explore married adolescent girls’ reproductive and sexual needs. We found that married adolescent girls were not prepared for marriage and had limited awareness and decision-making power on sexual and reproductive issues. There is a need to develop adolescent-friendly sexual and reproductive services. It is essential to give tailored pregnancy and childbirth services and prepare adolescents for motherhood. Adolescents step into marital life without the required life skills and physical and mental preparedness. They do not have the proper knowledge and ability to decide on sexuality and reproductive issues. Therefore, families, education, and health system should prepare the necessary foundation to support and empower these adolescents, and provide tailored and comprehensive sexual and reproductive health services.

Background: Surrogate mothers assist infertile couple by caring their baby. Assessments show differences on various aspects of reproductive health matters compared to normative pregnancy. The aim of this study was to develop a reproductive health care program for surrogate mothers. Methods: This was an exploratory study with the qualitative-quantitative sequencing design. Primarily, through a qualitative approach, surrogate mothers, care providers, and policymakers of reproductive health services were selected purposefully. The data were gathered through semi-designed interviews. Then, the researcher explained surrogate mothers’ needs about reproductive health care, and a care program draft was designed by integrating results of the qualitative study and reviewing the literature and guidelines. At the end of the study, reproductive and sexual health care program was designed using Delphi method. Findings: The surrogate mothers' reproductive health needs were summarized in four main categories: surrogate mothers' extra-care, educational needs, psychological support, and protecting against surrogacy social and familial consequences. The reproductive health care program for surrogate mothers was developed in six sections: primary screenings of surrogacy volunteer, pre-pregnancy, during embryo transfer, during pregnancy counseling and training, and follow-up postpartum care. Conclusion: Providing reproductive health care for surrogate mothers involves

Objective: In this study, we evaluated the predictive factors for the occurrence of metabolic acidosis in patients with multi-drug poisoning, including antidepressants (Ad)/antipsychotics (Ap). Methods: This cross-sectional study was carried out in the referral poisoning center, Khorshid University Hospital, affiliated with Isfahan University of Medical Sciences. All patients with multi-drug ingestion, including Ad/Ap, were included in the study. Patients were divided into two groups with and without metabolic acidosis. Demographic factors, time from ingestion to admission, clinical manifestations, length of hospital stay, and outcome were compared in two groups. Binary logistic regression was used to identify factors associated with the risk of metabolic acidosis occurrence. Findings: Among the 206 evaluated patients, 45 patients (21.8%) had metabolic acidosis whom the majority were female (73.3%) with intentional purposes (77.8%). 31.1% of the patients with metabolic acidosis had tachycardia on admission (P = 0.03). Among all variables, time from ingestion to admission (P = 0.02) and lengths of hospital stay (P = 0.002) were significantly different between patients with and without metabolic acidosis. Tachycardia on admission (adjusted odds ratio [OR], 2.24; 95% confidence interval [CI]: 1.05–4.76; P = 0.036) and time from ingestion to admission (adjusted OR, 1.06; 95% CI: 1.00–1.13; P = 0.04) were also the predictive factors in occurrence of metabolic acidosis. Most of the patients survived without any complications (94.6%), of whom 72.3% had no previous underlying somatic diseases (P = 0.05). Conclusion: Admission tachycardia and the time elapsed from ingestion to admission may be considered important factors for predicting metabolic acidosis in multi-drug poisoning, including Ad/Ap.

Abstract Background Men’s participation in perinatal care is one of the key factors in promoting maternal and neonatal health. The effects of various methods of training on men’s knowledge and attitude about participation in perinatal care can be different. So, this study aimed to compare the effect of two methods of training on men’s knowledge and attitude about participation in perinatal care. Methods This cluster randomized control trial was conducted in three midwifery clinics in Tabriz, Iran between May and August 2018. Each clinic was randomly assigned to intervention (group- based training along with text messaging and CD- based training) and control groups. Seventy-five men were enrolled in three groups and evaluated for their knowledge and attitude about participation in perinatal care. Before and 3 months after the intervention, a researcher-made questionnaire was completed by the participants. Data were analyzed using descriptive and inferential statistics (paired t-test, one-way ANOVA, ANCOVA, chi-square, Kruskal-Wallis and Fisher exact tests). Results The mean (SD) score of men, s knowledge and attitude about participation in perinatal care had a significant increase in group- based training along with text messaging after the intervention compared to the score of before the intervention (p

Background and purpose: Educational levels shape the socioeconomic status of the family and the behavioral development of children. This study investigated the relationship between parental education and violence in adolescent students in Isfahan province. Materials and methods: This cross-sectional study was conducted in 2800 high school students in Isfahan province using cluster sampling. Data were collected using a researcher-made questionnaire that included demographic information, parental educational level, and students' violent behaviors (verbal, physical and psychological violence, Yes/No questions). Data analysis was done in SPSS v.24 applying Chi-square test and logistic regression test. Results: After adjusting for variables, the results revealed no significant correlation between frequency distribution of violent behaviors and parental education (P> 0.05) and the frequency distribution of these behaviors in the boys was found to be 1.4 times more that of the girls (P< 0.001). Conclusion: According to this study, there was no significant relationship between parents' educational level and the frequency of violent acts in their children.

Objective: Opioids poisoning is of the most important cause of mortality. The objective of the study was to compare the demographic factors, clinical manifestations, and outcomes of the most common opioids involved in drug overdose presenting to the Emergency Department. Methods: This cross-sectional study was conducted from October 2016 to March 2017 in the Clinical Toxicology Department of the main referral center of the university. All poisoning cases with common opioids were included in the study. Demographic factors, clinical manifestations, and outcome were recorded in a check list. ANOVA, Chi-square or Fisher's exact test, and binary logistic regression analysis were used for outcome prediction. Findings: Two hundred and thirty six patients with opioids poisoning were evaluated during the study period. The most common opioids involved in poisoning were methadone (47.9%), tramadol (24.2%), and opium (21.6%). Patients with opium poisoning were older than others (P < 0.0001). The rate of suicide was more in the tramadol group, while the past history of psychological problems was more observed in the methadone group (P < 0.0001). Increasing age (odds ratio [OR], 1.05; 95% confidence interval [CI]: 1.02–1.09; P = 0.05) and addiction (P = 0.01; OR, 7; 95% CI: 1.55–31.52) was associated with an increased complications or death. Also patients with somatic disease had more chance of complications/death (P = 0.04; OR, 3.71; 95% CI: 1.06–12.97). Kind of opioids was not a predictive factor in the outcome of the patients with acute poisoning. Conclusion: Age, addiction, and somatic disease should be considered as more important factors in outcome prediction with opioids poisoning, including opium, tramadol, and methadone.

Materials and Methods: The aim of the present systematic review and meta-analysis was to evaluate the therapeutic efficacy of bosentan, a dual endothelin receptor antagonist, for systemic sclerosis (SSc) patients with digital ulcers (DUs). Methods: A systematic search of MEDLINE, Embase, Web of Science, and Scopus was done using appropriate keywords till September 2021. Weighted mean difference (WMD) as the effect of therapeutic efficacy of bosentan on continuous outcomes was an estimate. Furthermore, the pooled prevalence of diffuse SSc and limited SSc was computed. Fixed or random effects models when appropriate were used for data synthesis. Results: Totally, 469 patients, with a mean age ranging from 48.1 to 63.7 years, from 8 studies were included in the systematic review and meta-analysis. The pooled frequency of diffuse SSc and limited SSc was 56% (95% confidence interval [CI]: 39%, 73%) and 44% (95% CI: 27%, 61%). The pooled prevalence of new DUs following bosentan treatment was 21% (95% CI: 10%, 33%). The results of the meta-analysis showed a pooled mean decrease of WMD: −0.09 (95% CI: −0.020, 0.02, P= 0.10), WMD: −2.82 (95% CI: −5.91, 0.27, P= 0.07), and WMD: −6.65 (95% CI: −9.49, −3.82, P< 0.001) in mean SSc-Health Assessment Questionnaire, pain, and Rodnan score, respectively. Our meta-analysis also indicated a significant pooled decrease in the number of new DUs in SSc patients compared to placebo subjects (WMD: −0.89 [95% CI: −1.40, −0.37; P= 0.001]) and baseline values (WMD: −1.34 (95% CI: −1.95, −0.73; P< 0.001). Conclusion: Bosentan possibly is an efficacious treatment option for SSc-related DUs. Although further large-scale randomized clinical trials are required to confirm the preliminary finding and underlying mechanisms of action.

Background: Increased rate of accidents among students on a hand, and progression of technology on the other hand, demonstrate the necessity of individual health assessment among them. The current study aimed to assess the frequency of accident (traffic and non-traffic) occurrence and its associated risk factors among 11-14-year-old students in Isfahan Province, Iran, in year 2015. Methods: The current study was part of a grant plan (coded 188169) done as a cross-sectional descriptive study on 3242 students who were selected using multi-stage cluster sampling method. The data were recruited using a questionnaire conducted by the Deputy of Health, Isfahan University of Medical Sciences, which was filled by a trained interviewer. Findings: The incidence of traffic and non-traffic accidents was 29.8% over a year. Accident occurrence was in association with male gender (P = 0.01). The limbs were the most injured organs (80.6%), and accidents mostly took place at school yard (19.2%) following falling (52.0%). Throwing object toward each other [odds ratio (OR): 5.29; P = 0.02) or lame taking in the way to school (OR: 4.30; P = 0.04) were the most prevalent causes of accidents. Conclusion: Our findings showed that the incidence of accidents (traffic and non-traffic) was about twice as much as the incidence in one year in China, and of course less than the national level in Iran. The incidence was significantly higher in boys. Therefore, it is recommended to pay special attention to students, especially boys, to reduce accidents, and to give them appropriate behavioral education for healthy and low-risk activities.

Background: Feeding difficulties are common and important in premature infants. In order to identify neonatal feeding difficulties, clinicians and nurses require assessment tools to conduct an objective evaluation of infant oral feeding (breast/bottle-feeding). Early identification of infants with feeding difficulty is critical to implement appropriate therapies and optimize the infant’s nutrition and oral feeding skill development. The aim of this study was to validate the Early Feeding Skills (EFS) Instrument for the Evaluation of Oral Feeding in Premature Infants. Methods: In this descriptive cross-sectional study, the researcher initially got permission from the designer of the tool through email. Then, the main version of this tool was translated into Persian using the standard backward/forward method. Subsequently, the formal and content validity of the questionnaire was confirmed. After visiting a neonatal specialist, the assessment of preterm infants' oral feeding skills was performed using the EFS Instrument by observing the infants (n=180) during feeding. The exploratory factor analysis and Cronbach’s alpha were utilized to determine the construct validity and assess the reliability of the instrument, respectively. Results: All items of the EFS Instrument had formal validity. Two items were removed from the instrument, based on content validity. On the basis of factor analysis, the items with a minimum factor load of 0.4 were evaluated and according to the factor load of all items (above 0.4), EFS Instrument had the appropriate construct validity. The Cronbach's coefficient of the instrument was obtained 0.88. Conclusion: The EFS Instrument obtained the required reliability and validity for the evaluation of preterm infants oral feeding.

Background: The aim of this study was to determine the correlation between the sense of coherence and quality of life in women with breast cancer after chemotherapy. Methods: In a cross-sectional study, 80 women with breast cancer who underwent chemotherapy were selected. The quality of life and sense of coherence were measures using the Quality of Life Questionnaire-Breast Cancer 23 (BR23) and the Sense of Coherence 13 (SOC13) questionnaires standardized, respectively. The correlation between them was measured using linear regression and Pearson correlation tests. Findings: 11.3% of the participants had low, 73.8% had moderate, and 15% had high quality of life. 41.2% of participants had moderate coherence and 58.8% had a high degree of coherence. There was a direct and significant correlation between the sense of coherence and quality of life (0.7) (P < 0.001). Conclusion: There is a direct and significant correlation between quality of life and sense of coherence in women with breast cancer; and it seems that supportive and psychological treatments can be effective in improving the quality of life of women with breast cancer.

Abstract Background Gestational surrogacy is one of the options for women whom pregnancy is contraindicated. Despite of increasing demand for gestational surrogacy, its various aspects are controversial. The unique nature of surrogacy causes surrogate mothers to face a variety of problems such as, ethical confusion, psychological disturbance and reproductive health matters. Therefore, it is necessary to develop a comprehensive care program for reproductive and sexual health providing specific care at prenatal and pregnancy as well as delivery and postpartum period in socio- cultural context of Iran. Methods This research is an exploratory study with the qualitative-quantitative sequencing design (mixed) that is consisted of three sequential phases. In the first phase, following a qualitative approach, the researcher will explain needs of reproductive and sexual health in surrogate mothers. In the second phase, a primary reproductive and sexual health care program is designed for surrogate mothers in which, in addition to using the qualitative study results, related papers and texts will be also used. In the third phase of the study, reproductive and sexual health care program will be evaluated by RAND method (RAM). Discussion The results of this mixed method study are expected to lead to the development of a reproductive and sexual health care program meeting the needs of surrogate mothers and are in accordance with the cultural conditions of the research community, ultimately leading to improvement in reproductive and sexual health of surrogate mothers.

Abstract Background The role of men’s participation in prenatal, delivery and postpartum care is very important, well defined and cannot be over emphasized. Very few studies exist about men’s role in promoting the health of the mother and barriers to their participation in perinatal care in Iran; hence, the present study was conducted to determine the barriers to men’s participation in perinatal care. Methods The present qualitative study was carried out on 45 participants who were selected employing purposeful sampling technique. Data were collected through in-depth semi-structured interviews, focused group discussions and field notes. Data were analyzed using conventional content analysis. Results After data analysis, four main categories extracted were: “cultural barriers”, “personal and interpersonal barriers”, “health system-related barriers” and “socio-economic barriers”. Conclusion The results of this study, by presenting the barriers to and challenges for men’s participation in perinatal care, could be helpful in designing culture-based strategies to overcome these barriers and improve men’s participation.

Abstract Background Investing in adolescent’s health, especially, the role of girls in community health and future generations is one of the most important strategies of the Millennium Development Goals. In this regard, supplying adolescents’ special needs including access to educational, health and counseling services for promoting reproductive health have been emphasized. About 36% of registered marriages in Iran are under the age of 19 though, reproductive health services based on married adolescent girls` needs in social-cultural context were not predicted in national health system. Therefore, this study aim was designing a guideline for empowering married adolescents in reproductive health. Methods This is a sequential exploratory Mixed-method study conducted in three consecutive phases. The first phase, with a qualitative approach, explores needs, barriers and strategies for empowering married adolescent girls in reproductive health. In the second phase, a systematic review will be conducted to identify the recommendation and strategies for empowering married adolescent girls in reproductive health in other countries. Finally, in third phase, data from qualitative study and systematic review are emerged and the most important solutions and recommendations related to the issue are extracted and the final guideline is adapted by the experts. Discussion This study is attempting to provide a guideline containing comprehensive recommendations for health system` policy makers and providers in order to empowering adolescent girls in reproductive health.

Introduction: Concomitant onset of active systemic lupus erythematosus (SLE) and psoriasis is rare; however, due to the common skin involvement in both and exacerbation of psoriasis with antimalarial medications used for SLE, it is crucial to investigate the concomitant occurrence of both diseases. Objectives: The present study aims to investigate the incidence of psoriasis in people with active SLE. Patients and Methods: The present cross-sectional study was performed on 148 patients with active SLE from 2015 to 2017. Lupus activity was evaluated based on systemic lupus erythematosus disease activity index-2K (SLEDAI-2K), and then, the incidence of psoriasis in patients was investigated. Patients’ demographic information was recorded in the relevant checklist. Results: The mean score of SLEDAI-2K was 14.10±19.77. The duration of SLE was significantly associated with the SLEDAI-2K score (P=0.001, r = 0.294). Psoriasis incidence was remarkably correlated with the gender of patients with SLE (P=0.019). An insignificant association was found between the coincidences of SLE with psoriasis considering the factors, including age, SLE duration, and mean SLEDAI-2K score. Conclusion: Patients’ mean age, SLE duration, and disease activity score were not correlated with concomitant psoriasis among SLE patients; however, we found that males were more prone to concomitant SLE and psoriasis.

Background: This meta-analysis was performed to investigate the effect of serum lipids on the risk of breast cancer incidence. Methods: PubMed, Web of Science, Scopus, and EMBASE were searched systematically from January 1998 to April 2019. Inclusion criteria were English observational studies (cohort or case-control) and the concentration of at least one of the lipid profile components (total cholesterol/triglycerides/low-density lipoprotein cholesterol/high-density lipoprotein cholesterol) measured before a diagnosis of breast cancer (BC). The studies were included in which the relative risk (RR) had been reported with 95% confidence intervals (CIs). A random-effects model was used. Results: A total of 25 studies were found, including 2,882,789 participants in cohort studies with 45,481 cases with BC, and 1983 BC cases and 2963 case-control studies. Combined RR of cohort studies for the highest versus lowest for the BC was LDL-C: 0.95 (95% CI: 0.89–1.01), triglycerides (TG): 0.95 (95% CI: 0.91–0.99; P = 0.02), total cholesterol (TC): 0.98 (95% CI: 0.91–1.05), and HDL-C: 0.86 (95% CI: 0.63–1.18). Combined RR of case-control studies for the highest versus lowest was LDL-C: 1.08 (95% CI: 0.78–1.48), TG: 1.73 (95% CI: 0.94–3.18), TC: 1.02 (95% CI: 0.80–1.29), and HDL-C: 0.79 (95% CI: 0.65–0.97). Conclusions: Based on the results, it can be concluded that only TG but not TC and/or LDL-C had a significant inverse association with the risk of BC incidence. HDL-C showed a significant protective effect against breast cancer in postmenopausal women and case-control studies.

BACKGROUND: Surrogacy has become an alternative family formation option for women who are unable to carry a pregnancy. There is no comprehensive care program despite the different nature of this pregnancy. The present study aimed to develop a reproductive health-care program for surrogate mothers within the cultural and social context of Iran. MATERIALS AND METHODS: In the present sequential exploratory mixed methods study, first through a qualitative approach surrogate mothers, care providers, and policy makers of reproductive health services were selected purposefully. Data were collected by using the in-depth semi-structured interviews and analyzed. A care program draft was designed by integrating results of the qualitative study and reviewing the literature and guidelines, then appropriateness of each proposed care was assessed by a two-Rounds Delphi technique (RAM), and the final reproductive health-care program for surrogate mothers was developed. RESULTS: The surrogate mothers' reproductive health needs were summarized in four main categories: surrogate mothers' extra care, educational training, psychological support, and protecting against surrogacy's social and familial consequences. The reproductive health-care program for surrogate mothers were developed in four sections: prepregnancy health screenings and legal counseling; special care during embryo transfer until pregnancy confirmation; psychological support and prenatal care of surrogacy until delivery and follow-up postpartum care. CONCLUSION: Women face many challenges in surrogacy and need special care such as legal counseling, reproductive health care, and psychological support. Implementation of this care program seems to help improve the reproductive health of these mothers.

Background: The aim of this study was to evaluate the prevalence of positional obstructive apnea among the patients with obstructive sleep apnea (OSA) and its difference in terms of clinical and baseline factors in patients. Methods: This prospective cross-sectional study was conducted on 130 patients with OSA referred to Bamdad Respiratory and Sleep Research Center, Isfahan, Iran, during the years 2016-17. The demographics and clinical data and apnea type (positional or non-positional), as well as polysomnography test results were recorded using a checklist and statistically analyzed. Findings: From 130 patients with OSA, 70.8% had non-positional apnea, and 29.2% had positional apnea, 4 (1.3%) in subgroup 1, 12 (9.2%) in subgroup 2, and 22 ones (16.9%) in subgroup 3. Factors such as body mass index (BMI) (P = 0.026), supine and non-supine apnea hypopnea index (AHI) (P < 0.001), number of apnea during sleep (P = 033.03), and frequency of decrease in O2 saturation (P = 0.017) among the three subgroups of positional apnea were statistically different from the group with non-positional apnea. Conclusion: According to the results of this study, it can be concluded that total and supine and non-supine AHI were higher in patients with positional obstructive sleep apnea (POSA) rather than those with non-POSA. As patients with severe OSA were more likely to have POSA. Therefore, with early detection of the disease, it can be controlled and treated at an early stage with convenient and applicable treatments such as changing sleep position.

Abstract Background The inclusion of fathers’ participation during the perinatal period is an important strategy for improving mothers’ health. No studies have yet been conducted in Iran to explain the concept, obstacles and facilitators of fathers’ participation during the perinatal period. Thus, this study will be carried out to provide a comprehensive interventional program for promoting fathers’ participation in the perinatal care. Methods This study is a sequential exploratory (qualitative – quantitative) mixed methods design that consists of three consecutive phases. In this study, following a qualitative approach, the researchers will explain the concept, obstacles, facilitators and strategies related to promoting fathers’ participation in perinatal care. In the second phase, researchers will design an appropriate and comprehensive interventional program for promoting fathers’ participation in perinatal care by using the results of the qualitative phase and literature reviews. The proposed interventional program is designed by a panel of experts based on prioritization guidelines and will be finalized for execution. In the third stage, the effectiveness of interventional program on the awareness, attitude and practice of fathers about participation in perinatal care will be investigated in a semi-experimental study. Discussion It is expected that from the results of the present mixed methods study, by presenting an interventional culturally sensitive program which is appropriate for the conditions of the society for expectant fathers, the participation of fathers in the perinatal period will increase and thus lead to improvements in the health of the mother and the infant. If this interventional program is effective, it could be included in the perinatal health care guidelines. Trial registration IRCT20160224026756N4 Registered 27 May 2018.

Background: Substance abuse in adolescence could affect this period of life, as well as individual rest life. In this research, we studied the attitude of high-school student towards drug abuse, and the effect of some social determinants of heath associated with it. Methods: 3223 high-school students residing Isfahan Province, Iran, in 2015 were included in the study. Data were collected using the researcher-made questionnaire of assessment of knowledge, attitude, and action of urban and rural high-school students in Isfahan Province. Findings: In students’ opinion, momentary tipsiness and depression were the side-effects of drug abuse. Divorce of parents, and seeking pleasure were the most important factors associated with inclination to drugs albeit scored higher by girls. Moreover, girls expressed inability in dealing with daily difficulties as a factor in tendency to drug abuse. Whereas, boys claimed that factors such as too free time, and inadequate recreational facilities were more important. Among social determinants of health, education level of parents, father’s job, and residential area had significant effects on tendency to drug abuse. Conclusion: Besides preventive and educational policies, policy makers and parents should pay attention to improving their children’s self-esteem and self-management abilities, and provide homes as favorable and welcome places for them.

Abstract Background The participation of the father during the perinatal period is an important strategy for improving the mother’s health. Very few studies exist about the father’s role in promoting the health of the mother in Iran; thus, the present study was conducted to examine the role of fathers in perinatal care. Methods The present study was a qualitative research. Participants were selected using purposeful sampling with maximum variation and the data was collected through in-depth interviews, focus group discussions and field notes. The data was analyzed using conventional content analysis. Results After data analysis, the main categories extracted were: “help in maintaining the health of the mother and fetus”, “emotional support of mother”, “comprehensive participation of father in married life”, “preparing for safe delivery” and “postpartum support”. Conclusions The results of the present study provide different perspectives on the participation of fathers when designing culture-based intervention for their participation in perinatal care.

مقدمه: چاقي كودكان و نوجوانان يك مشكل بهداشتي پيچيده است كه سبب بروز عوارض جدی نظیر دیابت و بیماری‌های قلبی می‌شود. چاقی در سنین پایین به عوامل متعددي بستگی دارد. بنابراین، هدف از انجام این مطالعه، بررسی عوامل پیش‌گویی کننده‌ی شاخص‌های انتروپومتریک در پسران 11-9 ساله‌ی شهر اصفهان بود. روش‌ها: این مطالعه، بر روی 282 دانش‌آموز در سنین 11-9 سال انجام گرفت. پس از اخذ رضایت از دانش‌آموزان و ثبت اطلاعات دموگرافیک، قد و وزن آن‌ها اندازه‌گیری و شاخص توده‌ی بدنی (Body mass index یا BMI) آن‌ها ثبت شد. همچنین، شاخص‌های فعالیت فیزیکی، وضعیت اقتصادی- اجتماعی و وضعیت تغذیه در آن‌ها نیز بررسی شد. یافته‌ها: 41 نفر (5/14 درصد) دارای BMI کمتر از صدک 5 بودند، 171 نفر (6/60 درصد) دارای BMI در صدک‌های 85-5 بودند، 42 نفر (9/14 درصد) دارای BMI در صدک‌های 95-85 (اضافه وزن) بودند و 28 نفر (9/9 درصد) دارای BMI در صدک بالای 95 (چاق) بودند. همچنین، مشخص شد که تنها سطح اقتصادی و اجتماعی بالا و تحصیلات بالای پدر و مادر و نیز شغل آزاد پدران با چاقی و اضافه وزن کودکان در ارتباط می‌باشد (050/0 > P). نتیجه‌گیری: با توجه شیوع بالای چاقی و اضافه وزن در کودکان 11-9 سال، شناسایی و غربالگری عوامل خطر در کودکان از اهمیت بالایی برخوردار می‌باشد تا از این طریق بتوان اقدامات پیش‌گیرانه برای کودکان دارای عامل خطر انجام داد و از بروز چاقی و اضافه وزن در آن‌ها پیش‌گیری نمود.

Abstract Background Long-term postpartum follow-up is of great importance since women with preeclampsia history are at high risk of upcoming health complications. However, postpartum follow-up rates are poor. According to evidences, preeclampsia is not just a transient health problem; rather it causes short term and long term complications, which affect women’s life for years after delivery. Although it seems the problem is solved by the end of pregnancy, the follow-up of subjects should not be stopped after delivery. Postpartum is the best possible time to provide necessary care to these women who are at the risk of future complications. Due to importance of well-designed follow-up plan for women suffering preeclampsia, this study will carry out to provide a postpartum follow-up health care program for subjected women. Methods This study is a qualitative-quantitative mixed sequencing exploratory study that consists of three consecutive phases. In this study, following a qualitative approach, the researcher will explain the needs and strategies related to promoting the health of women with preeclampsia history in the postpartum period. By entering the second phase, the researcher will design a comprehensive follow-up health care program in the postpartum period in which, in addition to using the qualitative study results, related papers and texts will be also used. The proposed program is designed by a panel of experts based on prioritization guidelines. Finally, after passing different stages of program finalizing, its effectiveness on the lifestyle of women with preeclampsia history will be investigated in a semi-experimental study in the third phase of the study. Discussion It is expected conducting a mixed method study to design and execute an interventional program to follow up women with preeclampsia history improve their health status and well-being, while reducing their health care costs through prevention in various levels within the current structure of health care services. If this program is effective, it could be included in the postpartum health care guidelines. Trial registration IRCT20170927036445N2 Registered 10 March 2018.

Abstract Background Psychological health is related to the management of polycystic ovary syndrome (PCOS) and is an essential component of self-efficacy and enjoying a healthy lifestyle. Need assessment and plans to improve the psychological health of these women provides significantly valuable information to design an advantageous intervention program to reach that goal. Therefore, this study will conduct to improve the psychological health for women with PCOS through a designed comprehensive care. Methods This is an exploratory mixed method study using consecutive qualitative-quantitative methods, including three consecutive phases. In the first phase, a qualitative study will be conducted to assess their needs and will design a care protocol for improving mental health of women with PCOS. Participants in this phase will select by purposive sampling method and data will collect using semi-structured interviews by taking notes at same time. Data will analyze using conventional content analysis method. At second phase, according the information obtained from previous phase and a literature review a comprehensive program to mental health care will be proposed. Then multidisciplinary team will review and finalize it according to priorities. The third phase will follow a quantitative approach using quasi-experimental study with two groups to measure the effectiveness of this program on the women’s psychological health. Discussion Designing a program based on a qualitative study and a review article and updated evidences can lead to improving of these women’s psychological health and quality of life. Consequently, we expect to show that mental health program provided by a multidisciplinary team improves reproductive outcomes while at the same time being cost-effective in women with PCOS.

Background: Inappropriate nutrition, and obesity in children have become a global problem. Eating behaviors are considered as one of the factors affecting childhood obesity. Breakfast and snack meals are among the important eating behaviors. This study aimed to assess eating behaviors among children and adolescents in Isfahan Province, Iran, in the year 2015. Methods: In this study, 2305 students of elementary and guidance schools were evaluated using questionnaires about their eating behaviors. Findings: 92.3% of students had breakfast meals. 91.8% of the students consume snack meals in addition to breakfast meal. Different routes of snack meals preparation consisted of home supplied (78.5%), school store (12.1%), near-school shops (7%), and huckster (about 1%). Students’ mothers were the major responsible for providing snacks. Conclusion: Our findings indicate inappropriate quality of eating behaviors among children and adolescents in Isfahan Province, especially for snack meals, despite acceptable knowledge among families. Families play a key role in selecting these behaviors, showing the necessity to pay more attention to the role of the family in this field.

Background: Domestic violence (DV) can threaten women's health. Healthcare providers (HCPs) may be the first to come into contact with a victim of DV. Their appropriate performance regarding a DV victim can decrease its complications. The aim of the present study was to investigate HCPs' performance regarding women experiencing DV in emergency and maternity wards of hospitals in Isfahan, Iran. Materials and Methods: The present descriptive, cross-sectional study was conducted among 300 HCPs working in emergency and maternity wards in hospitals in Isfahan. The participants were selected using quota random sampling from February to May 2016. A researcher-made questionnaire containing the five items of HCPs performance regarding DV (assessment, intervention, documentation, reference, and follow-up) was used to collect data. The reliability and validity of the questionnaire were confirmed, and the collected data were analyzed using SPSS software. Cronbach's alpha was used to assess the reliability of the questionnaires. To present a general description of the data (variables, mean, and standard deviation), the table of frequencies was designed. Results: The performance of the participants regarding DV in the assessment (mean = 64.22), intervention (mean = 68.55), and reference stages (mean = 68.32) were average. However, in the documentation (mean = 72.55) and follow-up stages (mean = 23.10), their performance was good and weak respectively (criterion from 100). Conclusions: Based on the results, because of defects in providing services for women experiencing DV, a practical indigenous guideline should be provided to treat and support these women.

Objective: Pruritus is a prevalent skin condition in end-stage renal disease patients. Omega-3 fatty acids have been shown to reduce pruritus in hemodialysis patients. Our objective was to assess the effect of 3 g/day omega-3 supplementation on pruritus among continuous ambulatory peritoneal dialysis (CAPD) patients. Methods: In this two-period, two-sequence crossover randomized clinical trial, 40 eligible subjects (CAPD patients who complained of pruritus for more than 8 weeks) were randomized to 3 g of omega-3 (n = 20) or identical placebo capsules (n = 20) for 4 weeks. After a wash-out period of 6 weeks, patients were crossed over to the alternate treatment option. Pruritus intensity was assessed using the visual analog scale (VAS) at baseline, 2-and 4-weeks post-intervention in each study period. Both patients and investigators were blinded to the study protocol. Findings: No significant carry-over effect was detected. The mean pruritus score (VAS) in the omega-3 group compared with placebo group after the first (−3.02 vs. −0.48, P < 0.001) and second (−4.09 vs. −0.43, P < 0.001) intervention periods showed higher significant decrease. Conclusion: In summary, omega-3 supplementation is an effective treatment for pruritus alleviation in CAPD patients. Further studies are needed to determine the mechanisms underlying antipruritic effects of omega-3.

Introduction: Elevated intracranial pressure (ICP) is a major and potentially lethal disorder in patients admitted to the emergency department (ED). Several methods are being used to investigate for elevated ICP. Here we assessed and compared the diagnostic accuracy of two existing tools of ophthalmoscopy and optic nerve ultrasonography in detection of elevated ICP. Methods: 131 participants with probable elevation of ICP referred to the emergency department of Al-Zahra Hospital, Isfahan, Iran, from 2012 to 2014, were enrolled. Brain computed tomography (CT) scan, ultrasonography of optic nerve sheath, and ophthalmoscopy were performed for them. The optic nerves sheath with diameter more than 5 millimeters was considered as elevated ICP. Widening of optic nerve, ocular venous engorgement, blurring, hemorrhage over optic disk, elevation of optic disk, and retinal venous tortuosity were recorded as evidences of ICP rising in ophthalmoscopy. Diagnostic accuracy of the two tools in prediction of ICP rising were compared with the results of brain CT scan as a gold standard. Results: The mean age of participants was 46.29 ± 10 years (77% male). The number of diagnosed elevated ICPs with ophthalmoscopy and ultrasound were 98 (74.8%) and 102 (77.9%) cases, respectively. The calculated sensitivity and specificity of ophthalmoscopy and ultrasonography in detection of ICP rising were 100.0% (95% CI: 88.6-100.0) and 35.4% (95% CI: 26.0-46.2), 100.0% (95% CI: 84.0-100.0) and 31.9% (95% CI: 23.0-41.7), respectively. Conclusion: The present study reveals that bedside ultrasonography of optic nerve sheath and ophthalmoscopy have enough accuracy for screening of patients with probable elevation of ICP. Of course, it should be considered that despite of high sensitivity of both tools, their specificity is low.

Background: The cardiovascular mortality rate in Iran has been reported 65% of all death recently. Despite the high prevalence of cardiovascular diseases (CVD) risk factors and its burden in developing countries, public awareness of CVD symptoms and its risk factors are very low, leading to poor control of these risk factors. Methods: Our study is a cross-sectional study that was conducted in an undefined sample of 163 individuals who participated in a public health campaign. We used a validated questionnaire containing demographic, cardiovascular history, family history, lifestyle (exercise, smoking, alcohol, and environment), stress, sleep, bowel toxicity, blood sugar, inflammation/pain, and diet parts for estimating total cardiovascular risk factor. Results: 52.7% of our participants were male. The mean age of our participants was 42.6 ± 47.27 years. Half of our participants (50.3%) were between 30 and 60 years. 12.3% of the participants were diagnosed with CVD. 12.8% were smokers and 25.8% were passive smokers. 73% of our participants had a high level of stress in their individual and work life. 35.5% of participants sleep less than 6 h per night. Half of them complained of initial or intermittent insomnia. 51.5% of our participants were at high or very high risk for CVD with three or more relative risks. There was a significant association between total cardiovascular risk and blood pressure, weight, sleep, and lifestyle in our population. Conclusions: More than half of our participants were on high or very high risk for CVD. The most common risk of CVD events in our participants is attributed to hypertension. Weight, sleep, and lifestyle were other modifiable risks that had a significant association with CVD in our study.

Objective: A randomized, double-blind, placebo-controlled clinical trial was performed to assess the effect of omega-3 supplementation (3 g/day) on atherosclerosis progression by measuring carotid intima-media thickness (cIMT) in hemodialysis (HD) patients. Methods: A total of 54 HD patients were randomized into two groups: Intervention group (n = 27), in which patients were given 3 g/day omega-3 for 6 months and placebo group (n = 27), in which patients received placebo using the same administration protocol. All patients underwent a carotid artery ultrasound scan to measure cIMT at baseline and at 6 months. Findings: cIMT decreased significantly in omega-3 group (0.79 ± 0.21 mm at baseline vs. 0.65 ± 0.18 mm at 6 months, P< 0.001). On the other hand, a nonsignificant increase in cIMT was seen in placebo group (0.75 ± 0.17 mm at baseline vs. 0.79 ± 0.17 mm at 6 months, P = 0.12). Moreover, cIMT was statistically significantly different between omega-3 and placebo groups at 6 months (P < 0.001). After 6 months, a statistically significant increase was observed in high-density lipoprotein level in omega-3 group compared to placebo group (P = 0.03). Urea reduction ratio was also statistically significantly higher in omega-3 than placebo group at 6 months (P = 0.03). No significant difference was observed in terms of other variables between the two groups. Conclusion: These data suggested that omega-3 supplementation plays a protective role in the progression of atherosclerosis in HD patients.

مقدمه: نظر به اهمیت موضوع خوب بودن (Well-being) در علم روان‌شناسی نوین و با توجه به اهمیت سلامت روانی مادران پس از زایمان و اثری كه روی سلامت بهداشت روانی خانواده، فرزندان و جامعه می‌گذارد و با توجه به این كه رضایتمندی فرد پس از زایمان در انتخاب شیوه‌ی زایمانی در بارداری‌های بعدی فرد و اطرافیان او و شیوه‌ی مراقبت از نوزاد اثر به سزایی دارد، بررسی مقوله‌ی Well-being پس از زایمان از اهمیت قابل توجهی برخوردار می‌باشد. از این رو، مطالعه‌ی حاضر با هدف تعیین تأثیر نوع زایمان بر احساس خوب بودن به انجام رسید. روش‌ها: طی یک مطالعه‌ی هم‌گروهی آینده‌نگر، 100 زن باردار کاندیدای سزارین و 100 زن باردار کاندیدای زایمان طبیعی با استفاده از پرسش‌نامه‌ی استاندارد شده‌ی Well-being، در قبل و بعد از زایمان مورد مصاحبه قرار گرفتند و تأثیر شیوه‌ی زایمان و متغیرهای مربوط به بارداری بر احساس خوب بودن بعد از زایمان بررسی شد. داده‌های به دست آمده با نرم‌افزار SPSS تجزیه و تحلیل گردید. یافته‌ها: میانگین نمره‌ی احساس خوب بودن در قبل از زایمان در دو گروه تحت زایمان طبیعی و سزارین به ترتیب 88/17 ± 40/65 و 86/14 ± 24/66 و در بعد از زایمان به ترتیب 82/26 ± 11/63 و 24/22 ± 52/64 بود و تفاوت معنی‌داری بین دو گروه مشاهده نشد. بر حسب آزمون Regression خطی، جهت پیش‌بینی میزان خوب بودن بعد از زایمان، از بین متغیرهای مورد بررسی، دو متغیر سابقه‌ی فوت فرزند (030/0 = P، 150/0- = Beta) و میزان خوب بودن قبل از زایمان (002/0 = P، 220/0 = Beta) تنها متغیرهایی بودند که میزان خوب بودن بعد از زایمان را پیش‌گویی می‌کردند و سایر متغیرها شامل سن مادر، جنس نوزاد، رتبه‌ی تولد، حاملگی ناخواسته، سابقه‌ی حاملگی خارج رحمی، سابقه‌ی سقط جنین و تعداد فرزند زنده، پیش‌گویی کننده‌ی این نمره نبودند. نتیجه‌گیری: شیوه‌ی زایمان در نمره‌ی احساس خوب بودن قبل و بعد از زایمان تأثیر معنی‌داری ندارد. از طرف دیگر، سابقه‌ی فوت فرزند و نمره‌ی احساس خوب بودن در قبل از زایمان، در نمره‌ی احساس خوب بودن بعد از زایمان تأثیر معنی‌دار داشتند. بنابراین، به دست اندر کاران امور بهداشتی توصیه می‌شود در مراقبت‌های مربوط به بارداری و زایمان به جنبه‌های تقویت احساس نشاط و شادمانی مادران توجه داشته باشند.

Introduction: Elevated intracranial pressure (ICP) is a major and potentially lethal disorder in patients admitted to the emergency department (ED). Several methods are being used to investigate for elevated ICP. Here we assessed and compared the diagnostic accuracy of two existing tools of ophthalmoscopy and optic nerve ultrasonography in detection of elevated ICP. Methods: 131 participants with probable elevation of ICP referred to the emergency department of Al-Zahra Hospital, Isfahan, Iran, from 2012 to 2014, were enrolled. Brain computed tomography (CT) scan, ultrasonography of optic nerve sheath, and ophthalmoscopy were performed for them. The optic nerves sheath with diameter more than 5 millimeters was considered as elevated ICP. Widening of optic nerve, ocular venous engorgement, blurring, hemorrhage over optic disk, elevation of optic disk, and retinal venous tortuosity were recorded as evidences of ICP rising in ophthalmoscopy. Diagnostic accuracy of the two tools in prediction of ICP rising were compared with the results of brain CT scan as a gold standard. Results: The mean age of participants was 46.29 ± 10 years (77% male). The number of diagnosed elevated ICPs with ophthalmoscopy and ultrasound were 98 (74.8%) and 102 (77.9%) cases, respectively. The calculated sensitivity and specificity of ophthalmoscopy and ultrasonography in detection of ICP rising were 100.0% (95% CI: 88.6-100.0) and 35.4% (95% CI: 26.0-46.2), 100.0% (95% CI: 84.0-100.0) and 31.9% (95% CI: 23.0-41.7), respectively. Conclusion: The present study reveals that bedside ultrasonography of optic nerve sheath and ophthalmoscopy have enough accuracy for screening of patients with probable elevation of ICP. Of course, it should be considered that despite of high sensitivity of both tools, their specificity is low.

Background: Breast cancer (BC) is a common malignancy among women. BC is a stressor in life that affects coping strategies and quality of life. This study performed to improve the quality of life in women with maladaptive coping style. Methods: A randomized clinical trial, held in 2011. Patients with maladaptive coping strategy were included in the study. 62 patients were randomized into two groups. Before and after 8 weeks of coping therapy, the quality of life was measured. General linear model was used for analysis. Results: The mean age in the intervention and control group was 45.10±7.34, 46.52±6.20 respectively (P-value>0.5). Functional health significantly improved after the intervention (p-value(p-value=0.128). Problem-focused coping strategies in the intervention group improved markedly (p-value= 0.003) whereas, the control group did not reveal significant differences (p-value=0.196). Conclusion: The results showed that the coping skill training program can improve the overall quality of life of breast cancer in women, and indicated that the care of breast cancer should address psychological issues and the finding points to the importance of taking individual coping strategies into account when evaluating the impact of breast cancer on psychosocial well-being.

Introduction: The intrauterine device (IUD) is one of the modern contraception methods that is reversible, safe, effective, and with long-term efficacy. The problem of using this method is early discontinuation. The survival of the IUD use has been reported differently in different studies. In this meta-analysis, we estimated average time of surviving in Iranian women. Materials and Methods: We evaluated the incident of IUD removed in the Iranian women with a broad systematic review of the literature regarding MOOSES criteria. ISI, Scopus, Medline, WHO, Cochrane, Web of Science, Biological abstracts, Google Scholar and DARE and Iran Medex, SID, Magiran and IranDoc were searched. We defined inclusion and exclusion criteria for selection of articles. All chosen articles were appraised using Critical Appraisal Skills Programme checklist. Data were extracted regarding prepared sheets. We used a Cochrane Q-test with a significance 75% as high heterogeneity. We applied both fix and random effect model by comprehensive meta-analysis software. Results: A total of 14 articles was included in the systematic review. These were obtained from screening 63 potentially relevant citations and reviewing 17 full-text study articles. One-year survival of IUD, for the random effects model was 78.4% (69.8-85.1%). Three-year survival for the random effects model was 69.4% (53.3-81.9%). Five years for the random effects model was 49.7% (36-63.4%). Conclusion: Above half of Iranian IUD users discontinued it within 5 years after insertion, it means half of IUD expected lifetime was used and make additional costs to the state and the consumer. To reduce these costs, it is recommended for Iranian women to use the IUD with 5-year survival, and they should be consulted before insertion.

Background: Lifestyle factors such as weight, salt intake, and physical activity have shown to be important in treating hypertension. The object of this study was to describe feasibility and to assess the effectiveness of a multicomponent lifestyle intervention on high blood pressure (BP) of Iranian women. Materials and Methods: This randomized controlled trial was conducted in four health centers by recruiting 161 women aged 35-65 years with high BP and randomizing them to a 4-week lifestyle modification (n = 80) or control group (n = 81). BP level and other health behavioral factors were assessed before and after the 4-week intervention and also after 6 months. Results: The mean systolic BP changed from 158.8 (±8.1) mmHg to 153.2 (±6.4) mmHg during 4-week and to 145.5 (±4.6)) mmHg after 6 months in the intervention group (P < 0.001). There was a significant difference between two groups of study after 4-week mean = 5.6 (confidence interval [CI] = 5.1-6.6) and 6 months follow mean (CI = 12.3-14.6).(P < 0.001) A significant correlation was detected between systolic BP (SBP) and diastolic BP (DBP) with weight, body mass index, waist circumference, salt intake, and physical activity level (P < 0.001). Stepwise regression analyses indicated that the weight, dietary salt intake, and physical activity level were significant predictors of SBP and DBP. Conclusion: The results of this study suggest that lifestyle modification program is associated with improvements in BP level in Iranian women.

Introduction: Nowadays researchers widely believe that there are differences in the effectiveness of problem-based training compared to traditional methods such as lecture. This study was done in order to compare academic achievement in lecture-based learning versus problem-based learning among medical students through a systematic review. Methods: This study is a secondary research done using a systematic review method. In this study, all published articles related to comparing academic achievement of medical students through lecture and problem-based methods were analyzed. These studies were conducted from 1998 to 2013. At first, the question of study was defined and search strategy was specified. The related articles were searched through international data bases such as, Pubmed, SCOPUS, Wiley, Springer, Ovid, EMBASE and internal resources such as, Iranmedex, Irandoc, SID, Magiran and related journals using the proper keywords and mixing them. Articles that met the inclusion criteria were assessed using the relevant checklists. Results: Out of the total 95 articles found in the primary search of resources, eight met the inclusion criteria. In most studies comparing these two methods, academic achievement was higher in groups with problem-based learning, and in none of the reviewed studies, academic achievement was found to be less in problem-based group compared with the group receiving traditional or lecture-based methods. Conclusion: The results of this study showed that using a problem-based learning method can increase cognitive abilities of medical students and can be effective in improving their academic achievement.

مقدمه: پرسش‌نامه‌ی 29EORTC QLQ-CR توسط کارگروه کیفیت زندگی EORTC (European organisation for research and treatment of cancer) به طور اختصاصی برای بررسی کیفیت زندگی بیماران مبتلا به سرطان کولورکتال (CRC یا Colorectal cancer) طراحی شده است. مطالعه‌ی حاضر با هدف اعتبارسازی زبان شناختی پرسش‌نامه‌ی 29QLQ-CR (29Quality of life questionnaires-colorectal) و تعیین خصوصیات سایکومتریک آن در جامعه‌ی ایرانی فارسی زبان انجام شد.. روش‌ها: این مطالعه از نوع اعتباریابی زبانشناختی بود. ترجمه‌ی پرسش‌نامه‌ی 29QLQ-CR طبق روش استاندارد Forward-backward translation انجام شد. پس از انجام مطالعه‌ی راهنما در 15 بیمار، پرسش‌نامه‌ی 29QLQ-CR به همراه پرسش‌نامه‌های 30 EORTC QLQ-C و فهرست علایم ام. دی. اندرسون (MDASI یا M.D. Anderson symptom inventory) توسط 100 بیمار مبتلا به CRC تکمیل شد و خصوصیات سایکومتریک آن مورد بررسی قرار گرفت. یافته‌ها: تعداد 100 بیمار مبتلا به CRC در مطالعه‌ی اصلی شرکت کردند؛ میانگین سنی آن‌ها 9/13 ± 4/60 سال بود و 64 درصد آنان مذکر بودند. Cronbach's alpha کل پرسش‌نامه‌ی 29QLQ-CR برابر با 89/0 و Cronbach's alpha ابعاد پرسش‌نامه از 65/0 تا 98/0 متغیر بود. در تمامی شاخص‌های چند موردی، ضریب همبستگی هر مورد با شاخص مربوط بیش از 4/0 (9/0-7/0) بود. بین شاخص‌های عملکردی پرسش‌نامه‌ی 30QLQ-CR و 11 شاخص پرسش‌نامه‌ی 29QLQ-CR رابطه‌ی متوسط تا قوی و معنی‌داری وجود داشت (667/0 ≥ r ≥ 301/0). همچنین در بسیاری از موارد، بین شاخص‌های پرسش‌نامه‌ی 29QLQ-CR و نمره‌ی شدت علایم و نمره‌ی اثر علایم بر کیفیت زندگی از پرسش‌نامه‌ی MDASI رابطه وجود داشت (585/0 ≥ r ≥ 265/0). نتیجه‌گیری: طبق نتایج مطالعه‌ی حاضر، خصوصیات سایکومتریک نسخه‌ی فارسی ضمیمه‌ی 29EORTC QLQ-CR در جامعه‌ی ایرانی قابل قبول است و این پرسش‌نامه می‌تواند در مطالعات آینده جهت بررسی دقیق‌تر کیفیت زندگی بیماران مبتلا به CRC مورد استفاده قرار گیرد.

Background: Considering the importance of anger, aggression, violence and other misbehaviours in schoolchildren education, the present study was conducted to evaluate the knowledge and practice of students in Isfahan province regarding violence, in order to figure out the required interventions for violence-reduction. Methods: In a survey during 2008-2009, 5500 junior and senior high school students of Isfahan province were assessed in a multistage sampling process to determine their level of knowledge about various types of violent behaviors, causes of violence, its consequences, and preventive behaviors. Validity and reliability of the data collection tool (questionnaire) were assessed. Results: The study revealed that the mean scores of violent behaviors knowledge, knowledge of violent behavior outcomes, and knowledge of violence preventive behaviors, were 6.6 ± 2.1, 5.5 ± 1.9, and 4.7 ± 1.3, respectively. Sources of violent behaviors in 92% of urban students and 89% of rural students were personal reasons and family behaviors, and 85% of urban and 88% of rural students considered mass media and computer games blameworthy, and the differences were statistically significant in all cases (P < 0.0001). In terms of practice, overall, 69.7% of girls and 84.2% of boys had violent behaviors. Physical and verbal violence were 31.3% and 40.7%in girls, and 66% and 52.8% in boys, respectively (intersexes P values were P < 0.001 and P = 0.7 respectively, and intra-sex P value was P < 0.0001). Conclusions: Results showed that girls and city dwellers were more aware of recognizing violent behaviors, outcomes, and causes, compared with boys and villagers, and in terms of general practice, violence was observed among boys more than girls. Further complementary studies in this area seem required.

Background: Osteoporosis is a serious public health. Since the majority of bone mass occurs during adolescence, primary prevention is important. Probably mother′s participation in health education interventions leads to promote health behaviors in children. Aims: To assess a lifestyle modification intervention focused on mothers and students has an impact on osteoporosis preventive behaviors in adolescent girls. Materials and Methods: It is a randomized field trial in female high schools. 210 girls aged between 11 and 15 were randomly selected. Students in groups A and C and mothers in group B were selected Through the sampling frame. Our lifestyle modification was based on group based education in the public girls′ high schools. Subjects in the intervention groups participated in three educational sessions. Students′ osteoporosis preventive behaviors were measured by using a lifestyle questionnaire consisting of items assessing nutrition, physical activity and sun exposure. Repeated measure ANOVA at baseline, 4 week, 2 months and 6 months and were used to analyze the data. Results: After 1 month, diet and sun exposure scores increased significantly (P < 0.001) but it was higher in group B compared with group A. (About diet P < 0.001 and sun exposure = 0. 001). After 6 months, diet and sun exposure status in the group A approximately decreased to baseline, while in group B, diet components were significantly different compared to baseline (P < 0.001). There was no change in physical activity. Conclusion: Osteoporosis prevention intervention of adolescent can be effective when parents or girls participate in training sessions, but education is associated with better outcomes when focused on mothers.