Kidney stones and dietary intake in adults: a population-based study in southwest Iran.

BACKGROUND: The prevalence of kidney stones is on the rise globally. Several risk factors, including lifestyle, contribute to the formation of kidney stones. Nevertheless, there is a contentious debate about the relationship between diet and kidney stones. Therefore, our study aimed to assess the relationship between macronutrients and micronutrients and the formation of kidney stones. METHODS: This population-based cross-sectional study was conducted in the baseline phase of the Hoveyzeh Cohort Study, focusing on adults aged 35-70 in southwest Iran. The information on demographic characteristics, anthropometrics, kidney stone history, and food frequency was collected. Chi-square and t-tests were utilized to assess the relationship between categorical and numerical variables with kidney stones. The ANCOVA and logistic regression models were used to evaluate the relationships while controlling for confounding factors. RESULTS: Among 10,009 participants, the overall prevalence of kidney stones was 18.77% (95% CI: 17.99-19.53). A higher intake of carbohydrates [OR = 1.02 (95% CI:1.002-1.03), p = 0.026] and copper [OR = 1.04 (95% CI:1.01-1.09), p = 0.025] were found to be associated with kidney stones. No associations were found between the other assessed macronutrients or micronutrients and kidney stones (p-tvalues > 0.05). CONCLUSION: Our study's findings indicate a correlation between diet and the formation of kidney stones. However, the relationship between dietary factors and kidney stones is complex, and further research is needed.

The effect of black seed raisin on some cardiovascular risk factors, serum malondialdehyde, and total antioxidant capacity in hyperlipidemic patients: a randomized controlled trials.

BACKGROUND: The lipid-lowering properties and antioxidants of the raisins may reduce the risk factors of cardiovascular diseases. This study aimed to investigate the effect of black seeded raisin consumption on blood pressure (BP), lipid profile, high-sensitivity C-reactive protein (hs-CRP), malondialdehyde (MDA), and serum total antioxidant capacity (TAC) in hyperlipidemic patients. METHODS: Thirty-eight hyperlipidemic patients aged 41.05 ± 10.4 years were recruited to this two-armed, randomized, controlled intervention trial. Participants were instructed to consume 90 g per day black seed raisin in the intervention group, and control group received no intervention. BP, lipid profile, and plasma levels of TAC, MDA, hs-CRP, and FBS were determined at baseline and week 5. RESULTS: After 5 weeks, the diastolic BP reduced significantly in raisin group compared with baseline (81.80 ± 10.22 vs 77.05 ± 11.03, P = 0.001) and TAC was significantly increased in raisin group compared with the control group (394 ± 116.93 vs 479 ± 122.31, P = 0.001). The serum level of MDA in the raisin group was significantly lower compared with the control group (1.35 ± 0.88 vs 1.39 ± 0.67, P = 0.039). No significant changes were found in lipid profile, SBP, hs-CRP, and FBS. CONCLUSION: These results suggest that consumption of black raisin which is rich in polyphenolic compounds has beneficial effects on some cardiovascular risk factors especially blood pressure and serum antioxidant capacity in patients with hyperlipidemia. TRIAL REGISTRATION: Trial registration number: IRCT2015091624049N1. This study was registered in the Iranian Registry of Clinical Trials (IRCT). URL of trial registry record: https://www.irct.ir/trial/20395.

Diagnostic performance of classification trees and hematological functions in hematologic disorders: an application of multidimensional scaling and cluster analysis.

BACKGROUND: Several hematological indices have been already proposed to discriminate between iron deficiency anemia (IDA) and ß-thalassemia trait (ßTT). This study compared the diagnostic performance of different hematological discrimination indices with decision trees and support vector machines, so as to discriminate IDA from ßTT using multidimensional scaling and cluster analysis. In addition, decision trees were used to determine the diagnostic classification scheme of patients. METHODS: Consisting of 1178 patients with hypochromic microcytic anemia (708 patients with ßTT and 470 patients with IDA), this cross-sectional study compared the diagnostic performance of 43 hematological discrimination indices with classification tree algorithms and support vector machines in order to discriminate IDA from ßTT. Moreover, multidimensional scaling and cluster analysis were used to identify the homogeneous subgroups of discrimination methods with similar performance. RESULTS: All the classification tree algorithms except the LOTUS tree algorithm showed acceptable accuracy measures for discrimination between IDA and ßTT in comparison with other hematological discrimination indices. The results indicated that the CRUISE and C5.0 tree algorithms had better diagnostic performance and efficiency among other discrimination methods. Moreover, the AUC of CRUISE and C5.0 tree algorithms indicated more precise classification with values of 0.940 and 0.999, indicating excellent diagnostic accuracy of such models. Moreover, the CRUISE and C5.0 tree algorithms showed that mean corpuscular volume can be considered as the main variable in discrimination between IDA and ßTT. CONCLUSIONS: CRUISE and C5.0 tree algorithms as powerful methods in data mining techniques can be used to develop accurate differential methods along with other laboratory parameters for the discrimination of IDA and ßTT. In addition, the multidimensional scaling method and cluster analysis can be considered as the most appropriate techniques to determine the discrimination indices with similar performance for future hematological studies.

The association between various indicators of hospital capacity, age category, and the number of screening tests performed with case fatality rate and recovery rate during the COVID-19 disease pandemic.

BACKGROUND: The COVID-19-related deaths are growing rapidly around the world, especially in Europe and the United States. PURPOSE: In this study we attempt to measure the association of these variables with case fatality rate (CFR) and recovery rate (RR) using up-to-date data from around the world. METHODS: Data were collected from eight global databases. According to the raw data of countries, the CFR and RR and their relationship with different predictors was compared for countries with 1,000 or more cases of COVID-19 confirmed cases. RESULTS: There were no significant correlation between the CFR and number of hospital beds per 1,000 people, proportion of population aged 65 and older ages, and the number of computed tomography per one million inhabitants. Furthermore, based on the continents-based subgroup univariate regression analysis, the population (R2 = 0.37, P = 0.047), GPD (R2 = 0.80, P < 0.001), number of ICU Beds per 100,000 people (R2 = 0.93, P = 0.04), and number of CT per one million inhabitants (R2 = 0.78, P = 0.04) were significantly correlated with CFR in America. Moreover, the income-based subgroups analysis showed that the gross domestic product (R2 = 0.30, P = 0.001), number of ICU Beds per 100,000 people (R2 = 0.23, P = 0.008), and the number of ventilator (R2 = 0.46, P = 0.01) had significant correlation with CFR in high-income countries. CONCLUSIONS: The level of country's preparedness, testing capacity, and health care system capacities also are among the important predictors of both COVID-19 associated mortality and recovery. Thus, providing up-to-date information on the main predictors of COVID-19 associated mortality and recovery will hopefully improve various countries hospital resource allocation, testing capacities, and level of preparedness.

Slow-Stroke Back Massage Compared With Music Therapy for Leukemia-Related Pain and Fatigue: A Randomized Controlled Trial.

PURPOSE: Comparison of two safe complementary medicine methods to treat cancer-related pain and fatigue in adult patients with acute leukemia during active treatment with chemotherapy. METHODS: A randomized trial with three groups (light massage, music therapy, and standard care) in Ahvaz, Iran, between 2018 and 2019. A total of 104 participants of the massage and music therapy groups received 15-minute intervention sessions, thrice weekly for 4 weeks, and participants of the control group received standard care. Cancer-related pain and fatigue intensity were measured by numeric self-report rating scales. During the 4 weeks of the interventions, pain and fatigue intensity were measured weekly. All the groups were followed up for 2 weeks after the end of the intervention. RESULTS: Pain and fatigue intensity decreased significantly over time between the intervention groups compared with the standard care group. In the massage and music therapy groups, a progressive reduction of pain and fatigue intensity over time (from the baseline to the fourth week) was observed. Fatigue intensity did not differ between the two intervention groups. Pain intensity decreased more in the massage group compared with the music therapy group. The durable effects of the massage therapy were greater compared with the music therapy 2 weeks after the intervention was completed. CONCLUSION: Light massage was more effective and persisted longer than the music therapy for controlling leukemia-related pain and fatigue in adult patients with acute leukemia.

COVID-19 Patients: A Systematic Review and Meta-Analysis of Laboratory Findings, Comorbidities, and Clinical Outcomes Comparing Medical Staff versus the General Population.

This review compared coronavirus disease 2019 (COVID-19) laboratory findings, comorbidities, and clinical outcomes in patients from the general population versus medical staff to aid diagnosis of COVID-19 in a more timely, efficient, and accurate way. Electronic databases were searched up to 23rd March, 2020. The initial search yielded 6,527 studies. Following screening, 24 studies were included [18 studies (11,564 cases) of confirmed COVID-19 cases in the general public, and 6 studies (394 cases) in medical staff] in this review. Significant differences were observed in white blood cell counts (p < 0.001), lymphocyte counts (p < 0.001), platelet counts (p = 0.04), procalcitonin levels (p < 0.001), lactate dehydrogenase levels (p < 0.001), and creatinine levels (p = 0.03) when comparing infected medical staff with the general public. The mortality rate was higher in the general population than in medical staff (8% versus 2%). This review showed that during the early stages of COVID-19, laboratory findings alone may not be significant predictors of infection and may just accompany increasing C-reactive protein levels, erythrocyte sedimentation rates, and lactate dehydrogenase levels. In the symptomatic stage, the lymphocyte and platelet counts tended to decrease. Elevated D-dimer fibrin degradation product was associated with poor prognosis.

Diagnostic performance of hematological discrimination indices to discriminate between ßeta thalassemia trait and iron deficiency anemia and using cluster analysis: Introducing two new indices tested in Iranian population.

Although the discrimination between ß-thalassemia trait (ßTT) and Iron deficiency anemia (IDA) is important clinically, but it is challenging and normally difficult; so if a patient with IDA is diagnosed as ßTT, then it is deprived of iron therapy. This study purpose was to evaluate the 26 different discriminating indices diagnostic function in patients with microcytic anemia by using accuracy measures, and also recommending two distinct new discriminating indices as well. In this study, 907 patients were enrolled with the ages over 18-year-old with either ßTT or IDA. Twenty-six discrimination indices diagnostic performance presented in earlier studies, and two new indices were introduced in this study (CRUISE index and index26) in order to evaluate the differential between ßTT and IDA by using accuracy measures. 537 (59%) patients with ßTT (299 (56%) women, and 238 (44%) men), and also 370 (41%) patients with IDA (293 (79%) women, and 77 (21%) men) were participated in this study for evaluating the 28 discrimination indices diagnostic performance. Two new introduced indices (CRUISE index and index26) have better performance than some discrimination indices. Indices with the amount of AUC higher than 0.8 had very appropriate diagnostic accuracy in discrimination between ßTT and IDA, and also CRUISE index has good diagnostic accuracy, too. The present study was also the first cluster analysis application in order to identify the homogeneous subgroups of different indices with similar diagnostic function. In addition, new indices that offered in this study have presented a relatively closed diagnostic performance by using cluster analysis for the different indices described in earlier studies. Thus, we suggest the using of cluster analysis in order to determine differential indices with similar diagnostic performances.

The Effect of a Training Program Based on the PRECEDE-PROCEED Model on Lifestyle of Adolescents with Beta-Thalassemia: A Randomized Controlled Clinical Trial.

Background: Lifestyle is a key issue in the concept of health promotion. Lifestyle includes all activities that encourage optimum physical, spiritual, and mental functions. The aim of this study was to determine the effect of a training program based on PRECEDE-PROCEED Model on lifestyle of adolescents with beta thalassemia. Materials and Methods: In this clinical trial study, 64 adolescents (age 16-20) who referred to the Thalassemia Center of Ahvaz (2015) were selected and randomly divided into two groups: experimental and control group. The components of the PRECEDE-PROCEED Model were used for planning, implementation and evaluation of the program. Changes in predisposing, reinforcing, enabling factors and lifestyle were immediately and a month after the intervention were assessed by a questionnaire based on PRECEDE-PROCEED Model and the Health-Promoting Lifestyle Profile. Results: The intervention had significantly positive effect on predisposing, enabling and reinforcing factors immediately and a month after the intervention (P < 0.05). Repeated measures analysis of variance showed a significant positive increase in the six dimensions of lifestyle score in the experimental group from baseline to one-month follow-up (P < 0.05). Conclusion: This study showed that the theory-based training program in adolescents suffered from beta thalassemia disease could improve the adolescent's awareness and attitude of healthy lifestyle.

Investigation of Nursing Student Satisfaction with the First Clinical Education Experience in Universities of Medical Sciences in Iran.

Satisfaction with the experience gained in clinical settings is of great significance to nursing students and novice first-year students in particular and contributes significantly to developing basic clinical skills and competence. Accordingly, the present study aimed to examine nursing student satisfaction with the first clinical education experience. A total of 390 second- and third-semester nursing students gaining clinical experience in general surgery, internal medicine, gynecological surgery, orthopedics, emergency, obstetrics and gynecology, ophthalmology, andrological surgery, post-CCU, and otorhinolaryngology departments participated in this analytical cross-sectional study from March to June 2017. The research instrument included the "Assessment of nursing student's Satisfaction with First Clinical Practical Education Questionnaire: Modified Version", consisting of three parts: demographic characteristics, 37 items, and a 10-degree visual analog scale to assess student satisfaction. Descriptive statistics were used to hypothesis test in SPSS 22. The highest rate of student satisfaction was related to the third domain labeled "Instructor's behavior", and the lowest rate of student satisfaction was related to the fifth and seventh domains labeled "Emotional atmosphere and learning in the clinical setting" and "Creating appropriate learning opportunities", respectively. The results of statistical tests suggested a statistically significant relationship between the mean satisfaction score (based on the 10-degree scale) and gender (p=0.01). However, no statistically significant relationship was observed between the mean satisfaction score and other demographic characteristics such as age, grade point average (GPA), and university type. Student satisfaction rate varies in different domains of the questionnaire. Accordingly, it is recommended that schools of nursing and midwifery incorporate the findings of this study into their first clinical, educational experience planning and take into account the educational needs of students to bring greater satisfaction.

Predicting the outcome of occupational accidents by CART and CHAID methods at a steel factory in Iran.

Background: A large number of occupational accidents happen at steel industries in Iran. The information about these accidents is recorded by safety offices. Data mining methods are one of the suitable ways for using these databases to create useful information. Classification and regression trees (CART) and chisquare automatic interaction detection (CHAID) are two types of a decision tree which are used in data mining for creating predictions. These predictions could show characteristics of susceptible people exposed to occupational accidents. This study was aimed to predict the outcome of occupational accidents by CART and CHAID methods at a steel factory in Iran. Design and methods: In this study, the data of 12 variables for 2127 cases of occupational injuries (including three categories of minor, severe and fatal) from 2001 to 2014 were collected. CART and CHAID algorithms in IBM SPSS Modeler version 18 were used to create decision trees and predictions. Results: Five predictions for the outcome of occupational accidents were created for each method. The most important predictor variables for CART method included age, the cause of accident and level of education respectively. For CHAID method, age, place of accident and level of education were the most important predictor variables respectively. Furthermore the accuracy of CART and CHAID methods were 81.78% and 80.73%, respectively for predictions. Conclusions: CART and CHAID methods can be used to predict the outcome of occupational accidents in the steel industry. Thus the rate of injuries can be reduced by using the predictions for employing preventive measures and training in the steel industry.

The Relationship between Gestational Weight Gain and Postpartum Depression in Normal and Overweight Pregnant Women.

OBJECTIVE: To investigate the relationship between weight gain in pregnancy and postpartum depression (PPD) in normal and overweight pregnant women. METHODS: The participants of this prospective cohort study were 223 healthy pregnant women with the first trimester body mass index (BMI) between 18.5 and 30 and the gestational age of 10-14 weeks and depressed women were excluded with Beck questionnaire in the first trimester. The evaluation included weight gain at the end of the second and third trimesters and the screening of PPD in 6-8 weeks after delivery by Edinburgh scale. RESULTS: 49 participants were excluded from the study and data from 174 people were analyzed. 32.2% of mothers were scored above 12 in the Edinburgh scale. The only variable associated with depression was the third trimester weight gain (OR 1.17, 95%CI 1.04-1.32). CONCLUSION: In addition to considering other risk factors for postpartum depression, health care providers should consider the higher probability of PPD in prepregnancy normal and overweight women who have excessive weight gain especially in the third trimester of pregnancy.

Evaluation of an educational intervention based on health belief model on beta thalassemia carrier and final suspects couples.

INTRODUCTION: Beta-thalassemia is the most severe form of thalassemia major in which where the person needs regular blood transfusions and medical cares. The genetic experiment of prenatal diagnosis (PND) has been effective in the diagnosis of fetus with thalassemia major. This study was aimed to evaluate educational interventions on perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action and self-efficacy in beta-thalassemia carriers and suspected couples on doing a PND genetic test in Andimeshk. MATERIALS AND METHODS: In this quasi-experimental study, 224 beta-thalassemia carriers and suspected couples were randomly assigned to intervention and control groups. The data were collected using a researcher-made validated questionnaire using the self-administrated method. Before the intervention, questionnaires for both groups were completed, and then, an educational intervention was done for the intervention group during a month in four sessions for 30 min. After 2 months, the questionnaire was completed again by both groups. Data were analyzed using SPSS software version 20. RESULTS: There was no significant difference in the mean score of health belief model (HBM) variables and behavior between intervention and control groups before intervention (P < 0.05). However, after the educational intervention, the significant statistical difference in the mean score of perceived sensitivity, perceived severity, perceived benefits, perceived barriers, guidance for action, self-efficacy, and behavior of PND ß-thalassemia genetic tests was observed between the intervention and control groups. (P < 0.001). CONCLUSION: Educational programs based on HBM can increase HBM constructs, behavior, and self-efficacy of beta-thalassemia carrier couples for doing beta-thalassemia PND.

Co-exposure to endocrine disruptors: effect of bisphenol A and soy extract on glucose homeostasis and related metabolic disorders in male mice.

OBJECTIVES: Bisphenol A (BPA) is a xenoestrogen, which is commonly used as a monomer of polycarbonate plastics food containers and epoxy resins. Little is known about the interaction effects between xeno- and phyto- estrogens on glucose homeostasis or other metabolic disorders. The aim of this study was to examine effects of individual or combined exposure to low doses of BPA and soy extract on glucose metabolism in mice with the goal to establish its potential mechanisms. METHODS: Fifty-four male mice were randomly divided into six groups. Mice were treated with soy extract at 60 or 150 mg/kg by daily gavage with or without subcutaneously administration of BPA (100 µg/kg/day) for four weeks at the same time, while the control group received a vehicle. Serum levels of fasting glucose, insulin, adiponectin, testosterone, malondialdehyde (MDA), and total antioxidant capacity (TAC) were measured. Homeostatic model assessment-ß cell function (HOMA-ß) index was also determined. RESULTS: BPA exposure induced hyperglycemia and significantly reduced HOMA-ß, serum levels of insulin, adiponectin, testosterone, and TAC and noticeably enhanced MDA in BPA group compared to control one. While treatment with soy extract in high dose (150 mg/kg) significantly decreased the levels of fasting blood glucose and MDA and notably improved the serum levels of insulin, HOMA-ß, and TAC compared to BPA group. CONCLUSION: Soy extract may protect against some adverse effects of BPA. These findings represent the first report suggesting a potential effect between soy extract and BPA in low doses, however, further studies are needed to confirm these results.

Effect of Education Based on Health Belief Model on the Behavior of Breast Cancer Screening in Women.

OBJECTIVE: The purpose of this study was to determine the effect of education based on health belief model (HBM) on the behavior of breast cancer screening (bCS) in women. METHODS: This quasi-experimental study was conducted on 226 women who were selected with cluster sampling method from those referred to Dezful health centers. Data collection tool was a researcher-made questionnaire. Demographic questionnaire bCS- scale, and the Knowledge about questionnaire, all given before and 3 months after the intervention. RESULTS: According to the findings of the study, there was a significant relationship between women's performance and variables of knowledge, perceived sensitivity, perceived benefits, perceived barriers, self-efficacy, and cues to action. CONCLUSIONS: Poor knowledge of women indicates a crucial need for formal educational programs to sensitize women regarding the importance of bCS. These educational programs should consider factors affecting bCS behaviors.

The relationship between pain, fatigue, sleep disorders and quality of life in adult patients with acute leukaemia: During the first year after diagnosis.

The aim of this study was to investigate the relationship between pain, fatigue, sleep disorders and quality of life and assess the most powerful predictor of quality of life in patients with acute leukaemia. In this cross-sectional multicentre study, 406 patients were recruited. Data were collected using the Iranian Short-Form 36-item Health Survey, the Pittsburgh Sleep Quality Index, and the Numeric Rating Scale for Pain and Fatigue Intensity. It was found that pain and fatigue had direct relationship with sleep disorders. Statistically significant relationships were reported between pain, fatigue, sleep disorders and QoL. Also, a statistically significant relationship was found between pain and QoL (p < .001). Pain, fatigue and sleep disorders in total had the predictive power for quality of life (R2  = 36%). The most powerful predictor of quality of life was pain. It is suggested that healthcare professionals note the importance of patients' symptoms in clinical investigations and take appropriate measures for their management. The assessment of pain as the most powerful predictor of quality of life can be considered a basis for the improvement of quality of life, fatigue and sleep quality in patients with acute leukaemia.

Comparison of Statistical Models of Predict the Factors Affecting the Length of Stay (LOS) in the Intensive Care Unit (ICU) of a Teaching Hospital.

INTRODUCTION: Modeling can be a useful tool to find out how the distributions of hospital length of stay (LOS) and the factors affecting the length of stay. The present study aims to determine factors affecting the length of stay and selecting suitable statistical models. MATERIAL AND METHOD: this is a cross - sectional study of 565 patients who were treated in the intensive care unit of Imam Khomeini hospital in Ahwaz. Preliminary data were collected retrospectively through the medical records of all patients admitted on intensive care units of Ahwaz Imam Khomeini Hospital in 2015. Statistical analysis and multivariate regression models were done using of SPSS 21 and STATA 7 software. RESULTS: Average length of stay in ICU was 8.16±0.75 days. The Mean and Median age of patients were 58.61±20 and 61 respectively, The Mean LOS for females (16.44±9.37 days) was more than the men (11.5±5.35 days) (p<0.01). The maximum and minimum lengths of stay belonged to patients with endocrine disorders (14.7±3.1 days) and patients with gastrointestinal disorders (5.53±1.1 days) respectively (p<0.01). The goodness of fit for Gamma model showed that this model was more suitable and powerful than Log-normal model to predict the factors affecting the patient's length of stay in intensive care units of hospital. CONCLUSION: Gamma regression model was more robust to predict factors regarding the hospital length of stay. According to Gamma model the key factor in predicting the length of stay in ICU was the type of disease diagnosis. The result of statistical modeling can help managers and policy makers to estimate hospital resources and allocate them for different hospital services.

Impact of theory-based educational intervention on explaining preventive pediculosis infestation behavior among primary school students.

BACKGROUND: Despite the fact that improved health, social, and economic situations have significantly affected the reduction of its infestation, pediculosis is still spreading worldwide. AIM: This study is conducted to evaluate the explanatory power of health belief model constructs in adoption of preventive pediculosis infestation behavior in female primary school students. METHODS: This study involves two stages. First, a cross-sectional study was conducted. In the second stage, a quasi-experimental intervention was performed. One hundred eighty female elementary school students in Omidiyeh County were randomly selected in two 90-subject groups (experimental and control). Samples were matched in two groups in terms of demographic variables. A group of educational intervention was based on the most effective construct of the first stage; and the educational intervention of control group was based on the low-effective construct. The path analysis and LISREL 8.5 software was utilized to compare the fit and the variance cover percentage of adopting preventive pediculosis infestation behaviors. RESULTS: According to the pre-intervention findings, there was no significant difference between experimental and control groups in terms of factors affecting the adoption of preventive pediculosis infestation behavior. This model had a weaker fit in the experimental than the control group, but these indices had better status after intervention in the experimental than the control group. Meanwhile, the cover percentage of explained variance for the experimental group after educational intervention was higher than pre-intervention, but it was lower in the control group. Finally, health belief model constructs (including the knowledge, cue to action, perceived susceptibility and severity, perceived benefits and barriers, and self-efficacy) in the experimental group, had better fit after the educational intervention compared with pre-intervention. CONCLUSION: Efficiency of the health belief model was approved for adopting preventive pediculosis infestation behavior in female primary school students. The future intervention studies should utilize the structural equation modeling approach separately in experimental and control groups to compare the changes in behavior between different demographic groups in the field of pediculosis infestation behavior.

Validation of Medical Tourism Service Quality Questionnaire (MTSQQ) for Iranian Hospitals.

INTRODUCTION: Assessing service quality is one of the basic requirements to develop the medical tourism industry. There is no valid and reliable tool to measure service quality of medical tourism. This study aimed to determine the reliability and validity of a Persian version of medical tourism service quality questionnaire for Iranian hospitals. METHODS: To validate the medical tourism service quality questionnaire (MTSQQ), a cross-sectional study was conducted on 250 Iraqi patients referred to hospitals in Ahvaz (Iran) from 2015. To design a questionnaire and determine its content validity, the Delphi Technique (3 rounds) with the participation of 20 medical tourism experts was used. Construct validity of the questionnaire was assessed through exploratory and confirmatory factor analysis. Reliability was assessed using Cronbach's alpha coefficient. Data were analyzed by Excel 2007, SPSS version18, and Lisrel l8.0 software. RESULTS: The content validity of the questionnaire with CVI=0.775 was confirmed. According to exploratory factor analysis, the MTSQQ included 31 items and 8 dimensions (tangibility, reliability, responsiveness, assurance, empathy, exchange and travel facilities, technical and infrastructure facilities and safety and security). Construct validity of the questionnaire was confirmed, based on the goodness of fit quantities of model (RMSEA=0.032, CFI= 0.98, GFI=0.88). Cronbach's alpha coefficient was 0.837 and 0.919 for expectation and perception questionnaire. CONCLUSION: The results of the study showed that the medical tourism SERVQUAL questionnaire with 31 items and 8 dimensions was a valid and reliable tool to measure service quality of medical tourism in Iranian hospitals.

Effects of Slow-Stroke Back Massage on Symptom Cluster in Adult Patients With Acute Leukemia: Supportive Care in Cancer Nursing.

BACKGROUND: Patients with acute leukemia usually experience pain, fatigue, and sleep disorders, which affect their quality of life. Massage therapy, as a nondrug approach, can be useful in controlling such problems. However, very few studies have been conducted on the effects of massage therapy on the complications of leukemia. OBJECTIVE: The aim of this study was to examine the effects of slow-stroke back massage (SSBM) on the symptom cluster in acute leukemia adult patients undergoing chemotherapy. METHODS: In this randomized controlled trial, 60 patients with acute leukemia were allocated randomly to either the intervention or control group. The intervention group received SSBM 3 times a week (every other day for 10 minutes) for 4 weeks. The pain, fatigue, and sleep disorder intensities were measured using the numeric rating scale. The sleep quality was measured using the Pittsburgh Sleep Quality Index. Statistical tests of χ, t test, and the repeated-measure analysis of variance were used for data analysis. RESULTS: Results showed that the SSBM intervention significantly reduced the progressive sleep disorder, pain, fatigue, and improved sleep quality over time. CONCLUSIONS: Slow-stroke back massage, as a simple, noninvasive, and cost-effective approach, along with routine nursing care, can be used to improve the symptom cluster of pain, fatigue, and sleep disorders in leukemia patients. IMPLICATIONS FOR PRACTICE: Oncology nurses can increase their knowledge regarding this symptom cluster and work to diminish the cluster components by using SSBM in adult leukemia patients.

Predicator of Pregnant Women's Self-care Behavior against Air Pollution: An explanation based on the Extended Parallel Process Model (EPPM).

INTRODUCTION: Air pollution is one of the most important problems of metropolitan cities. The level of air pollution in the city of Ahvaz is so much higher than the standard level, that it can create risks, particularly for pregnant women in the area. The aim of the study was to examine the predictors of self-care behavior of pregnant women against air pollution according to Extended Parallel Process Model (EPPM) in Ahvaz. METHODS: In this cross-sectional study, 330 pregnant women who were referred to health care centers in western Ahvaz in 2015 were examined. The data collection tool was a reliable and valid researcher-made questionnaire consisting of three parts: The first part was demographic information, the second part according to the extended parallel process model, included perceived susceptibility, perceived severity, response efficacy, and self-efficacy. The third part examined self-care behavior. Then, the collected data was analyzed by using the software SPSS 16. Data analysis was done by using Spearman's correlation coefficient and linear regression. RESULTS: The average age of study subjects was 26.07 ± 2.3 years, and most (45.5%) were in the second trimester of pregnancy. These findings showed that self-efficacy constructs (ß = 0.41) and response efficacy (ß= 0.15) have predictive power of self-care behavior (p < 0.05). CONCLUSION: The findings showed that self-efficacy and response efficacy, are important factors to predict air pollution self-care behavior. Therefore, to develop a theory-based behavioral modification program for pregnant women, more emphasis on these constructs is recommended.