Job satisfaction and the role of self-esteem and self-efficacy: A cross-sectional study among Iranian nurses.

AIM: This study aims to investigate the relationship between nurses' self-efficacy and self-esteem, and their job satisfaction. DESIGN: A cross-sectional study was conducted. METHODS: Employing a random sampling method that included 234 nurses from three hospitals in Iran enrolled. This study utilized the General Self-Efficacy Questionnaire, Coppersmith Self-Esteem Inventory, and Minnesota Job Satisfaction Questionnaire. Descriptive analysis, independent t-tests, Pearson correlation analyses, and linear regression were employed for data analysis. RESULTS: The mean self-efficacy score for nurses was 26.73 ± 5.62 (out of 40), while self-esteem and job satisfaction scored 37.13 ± 6.87 (out of 50) and 68.27 ± 12.65 (out of 100), respectively. Significant correlations were found between self-efficacy, self-esteem, and job satisfaction. Moreover, self-esteem and the age group >40 years were identified as important predictors of nurses' job satisfaction. This study highlights the influential role of self-esteem in determining nurses' job satisfaction.

Cross-cultural adaptation and psychometric properties of the Persian version of the Geriatric Sleep Questionnaire (P-GSQ).

OBJECTIVE: This study aimed to validate the Geriatric Sleep Questionnaire (GSQ) for assessing subjective sleep quality among elderly individuals in Iran. METHODS: The GSQ underwent evaluation for face and content validity. Participants were selected via convenience sampling from five healthcare centers. Sociodemographic variables, including gender, number of children, recreational activities, budget deficits, and family conflicts were analyzed. Confirmatory factor analysis was conducted to verify the results. Internal consistency was assessed using Cronbach's α, and test-retest reliability was evaluated using the intraclass correlation coefficient (ICC). RESULTS: 200 older adults (mean age 66.8 years) completed the questionnaires. Face and content validity were confirmed by 30 experts (S-CVI/average = 0.96). The final model exhibited good fit indices (χ2/df = 2.89, CFI = 0.96). The scale demonstrated acceptable internal consistency (α = 0.81) and test-retest reliability (ICC = 0.98). CONCLUSION: The Persian GSQ demonstrates high reliability and validity for assessing sleep quality in older adults, aiding research in this field.

Time interval between the onset of symptoms and diagnosis of multiple sclerosis and the influential factors: A national registry-based study.

OBJECTIVE: The time to diagnosis of multiple sclerosis (MS) is of great importance for early treatment, thereby reducing the disability and burden of the disease. The purpose of this study was to determine the time from the onset of clinical symptoms to the diagnosis of MS and to evaluate the factors associated with a late diagnosis in Iranian MS patients. METHODS: The present cross-sectional study was conducted on patients with MS who were registered in the National MS Registry System of Iran (NMSRI). RESULTS: Overall, 23291 MS patients registered in 18 provinces of Iran were included in this study. The mean (standard deviation) interval between the onset of the disease and diagnosis of MS was 13.42 (32.40) months, and the median was one month. The diagnostic interval of 41.6% of patients was less than one month, and 14.8% of them had a one-month time to diagnosis. Patients with an age of onset below 18 years and those diagnosed after the age of 50 years had a longer time to diagnosis (P<0.001). Patients with primary progressive MS (PPMS) had the longest time to diagnose and those with relapsing-remitting MS (RRMS) had the shortest time (P<0.001). The results of negative binominal regression showed that the average rate of delay in diagnosis in women was 12% less than that in men. The average delay in diagnosis in patients with a positive family history of MS was 23% more than that in others. The rate of delay in the diagnosis of patients with PPMS and secondary progressive MS was 2.22 and 1.66 times higher, respectively, compared with RRMS. CONCLUSION: The findings of the present study revealed that more than half of the MS patients were diagnosed within a one-month interval from the symptom onset, which is an acceptable period. More attention should be paid to patients' access to medical facilities and MS specialists.

Evaluation of caffeic acid mucoadhesive tablets on minor recurrent aphthous stomatitis: a randomized, double-blind, placebo-controlled clinical trial.

BACKGROUND: Oral aphthous stomatitis is a chronic inflammatory condition. Numerous medications have been investigated to treat the symptoms of the disease. However, these days patients prefer herbal medicines due to lower side effects. Considering the anti-inflammatory, analgesic, and anti-oxidant properties of Caffeic acid and its few side effects, the aim of this study was to assess the impact of Caffeic acid on recurrent aphthous stomatitis (RAS). investigating the effect of caffeic acid mucoadhesive tablets on the size and pain intensity of the aphthous lesions. METHODS: in this double-blinded clinical trial study, 47 patients who met the inclusion criteria were selected by convenient sampling method. The patients were assigned to two groups randomly; the control group (placebo recipients) and the intervention group (Caffeic acid recipients). Patients were followed up for 7 days following the intervention. The diameter of the inflammatory lesion was measured in millimeters, and the pain intensity was recorded based on the VAS scale (Visual Analogue Scale). This trial was approved by the medical ethics committee of Mazandaran University of Medical Sciences (Ethical code: IR.MAZUMS.REC.1401.261) and received IRCT code of IRCT20220815055700N1on 03/09/2022. RESULTS: the diameter of the lesion in both groups decreased over time, and there was no significant difference between the intervention and control groups, except on the fifth day when the diameter of the lesion was significantly greater in the control group (P = 0.012). From the second day, the control group's average pain intensity was significantly higher than the intervention group's pain intensity (P < 0.05). CONCLUSIONS: when comparing mucoadhesive tablets containing Caffeic acid and placebo, the findings demonstrated that Caffeic acid has a significant efficacy in reducing aphthous lesions' diameter and pain intensity of the patients and are suggested for palliative oral aphthous lesions treatment since they showed significant anti-inflammatory and analgesic effects on recurrent aphthous stomatitis.

Factors associated with the number of months of delaying in multiple sclerosis diagnosis: Comparison of count regression models.

Background: It may take a long time to diagnose multiple sclerosis (MS) since the emergence of primary symptoms. This study aimed to use count regression models to compare their fit and to identify factors affecting delay in the diagnosis of MS. Methods: Data were collected from the Nationwide MS Registry of Iran (NMSRI) for Mazandaran Province, Iran, using census sampling until April 2022. The four models of Poisson regression, negative binomial (NB) regression, zero-inflated Poisson (ZIP) regression, and zero-inflated negative binomial (ZINB) regression were used in this study. Results: In this study on 2894 patients, 74.0% were women, and 8.5% had a family history of MS. The mean ± standard deviation (SD) of the patients' age was 34.96 ± 9.41 years, and the mean delay in diagnosis was 12.32 ± 33.26 months, with a median of 0 (Q1-Q3: 0-9). The NB regression model showed the best performance, and factors, including a history of hospitalization and the year of symptom onset, had significant effects on a delayed diagnosis. Besides, the Expanded Disability Status Scale (EDSS) score was significantly different before and after 2017; it was also associated with sex, type of MS, and history of hospitalization. Conclusion: The mean diagnostic delay and the mean age of MS diagnosis are critical in Mazandaran Province. Patients with MS develop the disease at an early age and are diagnosed with a long delay. The time of symptom onset is a significant factor in the diagnosis of MS, and in recent years, there have been improvements in the diagnostic process.

The Effect of Music Therapy on the Pain and Anxiety Levels of Patients Experiencing Wound Healing by Suturing in the Emergency Wards.

Background: A patient experiences high pain and anxiety during laceration healing. One of the non-pharmacological methods of pain and anxiety relief is using music. Objectives: This study was outlined to examine the impact of music therapy on the pain and anxiety levels of patients experiencing wound healing by suturing in the emergency wards. Methods: The study population for this randomized controlled clinical trial was all patients aged 18 - 65 years who were referred to the Emergency Ward of Imam Khomeini and Buali Sina hospitals, Sari, Iran, to suture the hand or foot. Thirty people were included from each group in the study. In the intervention group, traditional Iranian wordless music (Peyk Sahar track) was played with headphones from when the patient was placed on the bed for suturing to the end, and the duration was recorded. In the control group, sutures were made according to the usual procedure. The pain level was measured by a visual analog scale in two stages before washing and immediately after the anesthetic injection. Moreover, the anxiety level was assessed in three steps, before washing the wound, after the end of the anesthetic injection, and immediately after suturing. Data were analyzed by the SPSS software version 22. Descriptive statistics, including mean and standard deviation, and inferential statistics, such as Exact Fisher's test, Mann-Whitney test, and Wilcoxon, were used to describe and analyze the variables. Results: The mean pain before washing the wound (before music therapy) and after the end of the anesthetic injection was not significantly different between the intervention group (5.38 ± 1.31 and 3.71 ± 1.98, respectively) and the control group (5.31 ± 1.69 and 4.60 ± 2.31, respectively) (P = 0.27 and 0.057, respectively). The mean anxiety before washing the wound, after the end of anesthesia injection, and immediately after finishing the suture was 3.37 ± 0.89, 2.73 ± 1.23, and 1.27 ± 0.52 in the intervention group, and 3.50 ± 0.97, 3.07 ± 1.33, and 2.07 ± 1.14 in the control group, respectively. The mean anxiety at all three times was significantly different between the two groups (P < 0.001). Conclusions: The study results indicated that music therapy lowered pain without a statistically significant difference. However, music therapy significantly reduced anxiety. Therefore, it is recommended to use music therapy to reduce pain and anxiety in patients.

Evaluating the effect of using anti-stress balls as a distraction technique in reducing pain during inferior alveolar nerve block injection: a randomized clinical trial.

OBJECTIVE: The aim of this study is to evaluate the effect of using anti-stress balls in reducing patients' pain during injection of the inferior alveolar nerve block (IANB). MATERIALS AND METHODS: In this randomized clinical trial, 32 individuals were divided into two groups. The conventional method of anesthesia injection was performed using IANB conventional injection technique. During the injection, individuals in the anti-stress ball group were asked to use the anti-stress ball as a distraction technique. For the control group, no supersede methods were used for pain control. Finally, both groups were asked to record their pain utilizing the numerical rating scale (NRS). The participants' vital signs were monitored before and after injection. Kolmogorov-Smirnov test, independent T-test, and Fisher's exact chi-square test were performed for statistical analysis (α = 0.05). RESULTS: Sixteen females and 16 males in the age range of 40 to 20 years old participated in this study. The mean pain score in the anti-stress ball group was significantly lower (p < 0.001). In both sexes, the pain score in the anti-stress ball group was significantly lower (males p < 0.001 and females p = 0.001). In addition, in all age ranges, the pain score in the control group was higher except for the above 35 years old participants (p = 0.078). Moreover, there were no significant differences in individuals' vital signs (p > 0.05). CONCLUSION AND CLINICAL RELEVANCE: Utilizing an anti-stress ball reduces patients' pain significantly during IANB in both sexes and individuals who are below 35 years without changing vital signs. CLINICAL REGISTRATION NUMBER: IRCT20220815055704N1.

Does a New Modification of the Two-Step Injection Technique for Inferior Alveolar Nerve Block Reduce Pain Compared to the Conventional Technique? A Randomized Clinical Trial.

Background: The ability to control pain is an essential part of dental procedures and the need for optimal pain control and reduction of discomfort is the primary concern of every dentist. This study aims to compare the pain and vital signs during inferior alveolar nerve block between conventional and a new modification of the two-step injection techniques. Methods: In this institutional single-blind randomized clinical trial, attendees of dental school at Mazandaran University of Medical Sciences from February to May 2022 were included. Inclusion criteria were 20-60 years old and healthy (ASA1) individuals who were willing to participate in this study. Individuals who were taking medications affecting their understanding of pain and patients with active infections at the injection site were excluded. These individuals were divided into two groups. First, superficial anesthesia was performed and afterward, conventional and two-step injection techniques were performed. For the two-step injection method, 6 mm of the needle was injected into the mucosa and one-third of the local anesthetic solution was released from the computer-controlled injection toolkit. Afterward, a 25 mm 30-gauge needle was reinserted into the previous hole delivering the remaining local anesthetic. The pain during injection was measured by a patient-reported numerical rating scale (NRS). Moreover, vital signs were monitored immediately before and after the injection. Kolmogorov-Smirnov test, Mann-Whitney U test, independent T-test, and Fisher's exact χ 2 test were performed for statistical analysis (α = 0.05). Results: This study involved 32 adults aged between 20 and 50 years old with 1 : 1 female/male sex distribution. The pain score was significantly higher in the conventional injection technique compared to the two-step injection technique in all sex and age groups. There were no significant differences in vital signs between the conventional and two-step injection techniques. There was no significant difference in the mean pain scores of females and males, regardless of their injection techniques. Conclusion: Utilizing the two-step injection technique in patients for inferior alveolar block reduces pain during injection without altering patients' vital signs significantly. This trial is registered with IRCT20220106053646N1.

The Relationship between Resilience and Moral Distress among Iranian Critical Care Nurses: A Cross-sectional Correlational Study.

Background: Critical care nurses usually experience high levels of moral distress due to the nature of their work. Resilience in critical care nurses can potentially facilitate effective adaptation to physical and emotional burden of caring for critically ill patients. The present study aimed to evaluate the relationship between resilience and moral distress among Iranian critical care nurses. Methods: In this cross-sectional correlational study, 144 critical care nurses working in intensive care units (ICUs) of five teaching hospitals affiliated to Mazandaran University of Medical Sciences, were selected randomly, from July to October 2020. Data were collected using a 36-item moral distress questionnaire and a 25-item Connor-Davidson Resilience Scale (CD-RISC) questionnaire. Data were analyzed using independent t-test, ANOVA and Pearson correlation coefficient using SPSS 21 software. Results: The mean score of moral distress in nurses was 66.93±2.47 and 95.8% of nurses had low-level moral distress. The mean score of resilience in nurses was 90.66±10.92 and 73.6% of nurses had high levels of resilience. There was a statistically significant relationship between the scores of moral distress and resilience. Also, there was a significant positive relationship between work experience and two subscales of resilience as "trust in individual instincts, tolerance of negative emotions" and "impact of spirituality" (p<0.001). Conclusion: The results of the present study indicated a positive correlation between resilience and moral distress in nurses working in ICUs. It seems that when moral distress increases, critical care nurses increasingly use the mechanism of resilience for better permanence and active presence in the organization.

The Effects of COVID-19 on Patients with Acute Ischemic and Hemorrhagic Stroke.

OBJECTIVE: The objective of this study was to evaluate how COVID-19 affects patients with acute ischemic or hemorrhagic stroke outcome. MATERIALS AND METHODS: This retrospective study was performed on adult patients (> 18 years old) with stroke (ischemic or hemorrhagic) who were admitted to hospital with or without COVID-19. The primary outcome was stroke-related disability, which was measured by mRS at baseline and discharge. Hospital duration, intensive care unit (ICU) admission, and mortality were considered the secondary outcomes. RESULTS: From February 2019 until August 2020, we recruited and analyzed 151 patients, 42 of whom had COVID-19 based on RT-PCR tests or lung CT scan findings. COVID-19 positive patients had higher baseline and final mRS scores than the control group (4.46 ± 0.67 vs 4.79 ± 0.61, P: 0.001, 3.83 ± 1.22 vs 4.46 ± 0.67, P: 0.001). Moreover, stroke patients with COVID-19 experienced a more severe disease and required a higher rate of ICU admission (17 vs 0, P:0.001) and longer hospitalization compared to those without COVID-19 (8.50 ± 7.86 vs 7.5 ± 11.20, P: 0.021). Also, mortality was higher in the COVID-19 group (19 vs 13, P:0.001). There was not any significant differences between the two groups in terms of the involvement of cerebral arteries and type of stroke. Male sex, COVID-19, and ICU admission were the main independent risk factors for death. CONCLUSION: The results of the study showed stroke patients (ischemic or hemorrhagic) with COVID-19 can have more disabilities and incur more hospital complications and mortality than non-COVID-19 patients.

Mortality risk factors in patients with gastric cancer using Bayesian and ordinary Lasso logistic models: a study in the Southeast of Iran.

AIM: The aim of this study was to apply two types of statistical models to determine the factors that influence the mortality rate in patients with gastric cancer. BACKGROUND: In Iran, gastric cancer ranks the first and second most prevalent among men and women, respectively. It is the first cause of death in Iran in both gendersival. METHODS: In this retrospective study, data were obtained from 339 (216 male) patients diagnosed with gastric cancer in the city of Kerman (South-East of Iran) during 2001-2015. In this study, ordinary and Bayesian Lasso (least absolute shrinkage and selection operator) logistic regression models, with goodness-of-fit indices, were compared and the models' risk factors were also determined. RESULTS: The mean age of the participants was 62.84 ±14.53 years, and 12.4% of them were younger than 45 years. Also, the mortality rate was 57.7%. Gender, morphology of the tumor, and time of diagnosis were found to be significant factors in the mortality of the patients in both models. This study found that the Bayesian Lasso model had better fitness. CONCLUSION: The high mortality rate of gastric cancer and its high prevalence at age below 45 years are alarming. Thus, great attention should be paid to prevention, early diagnosis, especially in females, and adenocarcinoma to improve the survival of patients with gastric cancer.

Comparison of methods to Estimate Basic Reproduction Number (R 0) of influenza, Using Canada 2009 and 2017-18 A (H1N1) Data.

BACKGROUND: The basic reproduction number (R 0) has a key role in epidemics and can be utilized for preventing epidemics. In this study, different methods are used for estimating R 0's and their vaccination coverage to find the formula with the best performance. MATERIALS AND METHODS: We estimated R 0 for cumulative cases count data from April 18 to July 6, 2009 and 35-2017 to 34-2018 weeks in Canada: maximum likelihood (ML), exponential growth rate (EG), time-dependent reproduction numbers (TD), attack rate (AR), gamma-distributed generation time (GT), and the final size of the epidemic. Gamma distribution with mean and standard deviation 3.6 ± 1.4 is used as GT. RESULTS: The AR method obtained a R 0 (95% confidence interval [CI]) value of 1.116 (1.1163, 1.1165) and an EG (95%CI) value of 1.46 (1.41, 1.52). The R 0 (95%CI) estimate was 1.42 (1.27, 1.57) for the obtained ML, 1.71 (1.12, 2.03) for the obtained TD, 1.49 (1.0, 1.97) for the gamma-distributed GT, and 1.00 (0.91, 1.09) for the final size of the epidemic. The minimum and maximum vaccination coverage were related to AR and TD methods, respectively, where the TD method has minimum mean squared error (MSE). Finally, the R 0 (95%CI) for 2018 data was 1.52 (1.11, 1.94) by TD method, and vaccination coverage was estimated as 34.2%. CONCLUSION: For the purposes of our study, the estimation of TD was the most useful tool for computing the R 0, because it has the minimum MSE. The estimation R 0 > 1 indicating that the epidemic has occurred. Thus, it is required to vaccinate at least 41.5% to prevent and control the next epidemic.

Correlates of Alcohol Consumption and Drug Injection among Homeless Youth: A Case Study in the Southeast of Iran.

BACKGROUND: Alcohol use and drug injection are prevalent among homeless youths. The aim of this study was to identify the associated factors of alcohol consumption and drug injection among homeless youths aged 18-29 years. METHODS: Data on 202 homeless youths (111 males and 91 females) were collected using a standardized questionnaire and face-to-face interview. Lasso logistic regression was applied to determine the impact of associated factors on alcohol consumption and drug injection. FINDINGS: The mean age of the participants was 26.30 ± 3.19 years. Also, the prevalence of alcohol consumption and drug injection was 33.0% [95% confidence interval (CI): 30-36] and 4.0% (95% CI: 0-8), respectively; 6 people (3.0%) consumed alcohol and injected drugs at the same time. Correlates of alcohol consumption and drug injection were male sex [odds ratio (OR)Alc = 5.7], age (ORAlc = 0.96 and ORDI = 0.98), bachelor or higher education level (ORAlc = 1.34), non-Iranian nationality (ORAlc = 0.05 and ORDI = 0.18), food score (ORDI = 0.92), smoking (ORAlc = 2.05), substance use (ORAlc = 1.12), opposite sex relationship (ORAlc = 1.6), homosexual relationship (ORAlc = 3.56 and ORDI = 2.69), and mental disorder (ORAlc = 0.99). CONCLUSION: Based on our findings, it seems that the homeless youth are more desired to use alcohol and drug injection, whereas the prevalence of alcohol consumption and drug injection in homeless youth was higher than general youth population in Iran. Therefore, some suitable solutions are needed to prevent the homelessness. Also, the effective variables that were identified in this study for alcohol use and drug injection can help design and implement beneficial interventions.