Medical ethics in childbirth: a structural equation modeling approach in south of Iran.

BACKGROUND: The existence of a valid instrument to evaluate the attitude of mothers towards compliance with medical ethics during childbirth can lead to appropriate interventions to create a positive attitude. The purpose of this study is to determine the construct validity of the MEAVDQ (Medical Ethics Attitude in Vaginal Delivery Questionnaire). METHODS: The study was carried out with 350 women. The main research instrument was MEAVDQ. This 59-item questionnaire comprises three parts A, B, J. Part A is concerned with the first principles. Part B deals with the second and third principles and part J addresses the fourth principle of medical ethics. Structural Equations Modeling (SEM) was used to determine the construct validity of MEAVDQ. RESULTS: The results of SEM revealed that there was a positive correlation between structures A and B. The relationship between structures B and J was also positive and significant. On the other hand, there was a direct and indirect relationship between structures A and J. One-unit increase in structure A led to 0.16 (95% CI: 0.01, 0.33) direct increase in structure J. Also, one-unit increase score increases in structure A caused 0.39 indirect rise (95% CI: 0.26, 0.53) in structure J with the mediating role of the structure B. CONCLUSIONS: It can be suggested to midwifery policy maker and midwives that respect for the first principle of medical ethics and autonomy is the most important principle of medical ethics in childbirth. By respecting the autonomy of mothers, a positive birth experience can be created for them.

Evaluation of the effect of corrective exercise intervention on musculoskeletal disorders, fatigue and working memory of office workers.

Objectives: The present study aimed to investigate the effect of corrective exercise intervention (corrective exercise reminding and training software) on musculoskeletal disorders (MSDs), fatigue, posture and working memory among office workers. Methods: A total of 66 office workers participated in the present study. Data collection was carried out using questionnaires (including the Nordic musculoskeletal questionnaire, multidimensional fatigue inventory and Borg rating scale), direct observations of work postures using rapid upper limb assessment (RULA) and rapid office strain assessment, and the n-back test. Results: There was a significant difference between the two groups (intervention and control) in terms of the severity of musculoskeletal discomfort after the intervention. There was a significant decrease in the mean score of trunk posture and the total RULA score in the intervention group after the intervention. The severity of perceived discomfort in all areas except the knee declined during the intervention. There was also a significant difference in physical and mental fatigue scores before and after the intervention. There was a significant difference in the accuracy score of office workers after the intervention compared to before the intervention. Conclusions: Overall, the results confirm the effectiveness of this low-cost, simple and easy-to-use ergonomic intervention.

Comparing the Emergency Care of Iranian and Afghan Patients During the COVID-19 Pandemic.

BACKGROUND: This study investigated the quality of inpatient care provided to Afghan immigrants in Iran during the COVID-19 pandemic (February 2019 to March 2021). For this purpose, the services received by Afghan immigrants were compared with those received by Iranian citizens. METHODS: Two emergency services (traumas with 8080 victims and 8,686 patients hospitalized with severe COVID-19 infection) were taken into consideration. The records of all patients, including the Afghan immigrants, in two referral hospitals in Kerman were reviewed, and the main variables were the length of hospitalization (LoH), intensive care unit (ICU) admission rate, and death rate. Quantile regression, multiple logistic regression, and Cox regression were used to analyze the data. RESULTS: The median and interquartile range of LoH for Afghan and Iranian nationals admitted due to traumas were 3.0±4.0 and 2.0±4.0, respectively (P<0.01). Moreover, the chance of Afghan nationals being admitted to the ICU (38%, odds ratio=1.38; 95% confidence interval [CI]=1.12; 1.69) and the hazard of death (60%, hazard rate=1.60; 95% CI=1.03; 2.49) were higher compared to Iranian nationals, which is statistically significant. However, no significant differences were observed between the COVID-19 patients from the two nationalities in terms of the median LoH, the odds of being admitted to the ICU, and the hazard of death due to COVID-19. CONCLUSION: Afghan nationals admitted to the hospital due to traumas were more likely to be admitted to ICUs or die compared to Iranian citizens. It seems that Afghan patients who had traumas went to the hospitals with more serious injuries. There was no difference between Afghan and Iranian patients in terms of COVID-19 consequences. Following the findings of this study, it seems that justice in treatment has been fully established for Afghan patients in Iran.

Reverse shock index (RSI) as a predictor of post-intubation cardiac arrest (PICA).

BACKGROUND: Endotracheal intubation (ETI) in critically ill patients is a high-risk procedure due to the increased risk of cardiac arrest, and several factors may predict poor outcomes in these patients. The aim of this study was to investigate the role of some factors, especially newly introduced vital signs such as the reverse shock index (RSI), in predicting post-intubation cardiac arrest (PICA) in critically ill adult patients. METHODS: This cross-sectional study was conducted on critically ill patients over 18 years of age who were admitted to the emergency department (ED) and underwent ETI within 1 year. Patients who developed PICA and those without this event were included in the study, and their features were compared. The primary outcome was cardiac arrest. RESULTS: Of 394 patients, 127 patients were included, of whom 95 (74.8%) developed PICA, and 32 (25.2%) did not experience cardiac arrest after intubation. In multivariate analysis, age, RSI, oxygen saturation, and total bilirubin were significantly associated with PICA. In addition, patients with RSI < 1 had a significantly higher risk of developing PICA (odds ratio = 5.22, 95% CI 1.83-14.86, p = 0.002). The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for predicting PICA were 51.11%, 83.33%, 90.2%, 36.23%, and 59.17%, respectively. The ROC curve for RSI showed an area under the curve (AUC) of 0.66. CONCLUSION: RSI may be useful in predicting PICA with higher diagnostic accuracy compared to the shock index. Furthermore, advanced age, hypoxia, and hyperbilirubinemia may increase the risk of PICA in patients admitted to the ED.

Comparison of Oral Health-Related Quality of Life in Partial and Complete Denture Wearers: A Propensity Score Analysis.

Background: Dentures, both partial and complete, have been shown to have the same impact on one's quality of life. Due to the impossibility of randomization in these studies, they are prone to selection bias. This study aimed to compare the effect of partial and complete dentures on oral health-related quality of life (OHRQoL) by propensity score to overcome selection bias. Methods: This is a cross-sectional descriptive-analytic study. A total of 1376 people participated in this study. Age, sex, marital status, education level, smoking, smoking opium and its derivatives, and dental visit was collected by a checklist. OHRQoL was measured by the OHIP-14 questionnaire. The generalized boosted model was used to estimate the propensity score. Missing data were imputed using multiple imputations with mixed models. The assumptions of multivariable regression analysis and propensity score method were first examined, and then the quality of life related to oral health was compared between the two groups. Results: The regression model's assumptions were not verified due to high skewness and collinearity. The results of the normality test (P < 0.001) and goodness fit test (P < 0.001) revealed that the regression model did not fit the data. The propensity score method reduced at least 76% of the bias resulting from the distribution difference between the confounding variables and was used for analysis. In the regression and propensity score method, the results showed that the total OHIP-14 score of the complete prosthesis group was higher than the partial prosthesis group at 3.92 (95% CI = (2.18,5.65)) and 3.64 (95% CI = (1.93,4.53)), respectively. This difference was clinically and statistically significant (P < 0.001). In addition, there is a significant difference in the two groups based on propensity in all seven areas (P < 0.001). But there is no significant difference in the regression adjustment of the Functional limitation of the two groups (P = 0.035). Conclusion: The propensity score has fewer assumptions than the regression method and may be more reliable for OHIP scores. The propensity score analysis revealed that despite the costs and repair issues associated with partial dentures, complete denture wearers have lower OHRQoL than partial denture wearers.

Blood Glucose Level as a Predictor of Abnormal Brain Computed Tomography Scan Findings in Patients with Mild Traumatic Brain Injury.

Objective: This study aimed to investigate blood glucose levels in patients with brain injury caused by mild traumatic brain injury (TBI) as a foundation for determining whether these patients need a brain CT scan or not. Methods: This cross-sectional study was conducted on patients with mild TBI, who were referred to the emergency department from March 1, 2022, to September 1, 2022. After the confirmation of mild TBI by an emergency medicine specialist, blood samples were taken from the patients to measure blood glucose levels. Then a brain CT scan was performed, and blood glucose levels were compared between patients with and without CT indications of brain injury. A checklist was used to collect data, and the data were analyzed using SPSS software (version 23). Results: In the CT scans of the 157 patients included in the study, 30 patients (19.2%) had a brain injury in the CT scan. The mean blood glucose level was significantly higher in patients with brain injury, especially in the presence of vertigo and ataxia, than patients without brain injury in the CT scan (p<0.0001). There was a significant positive correlation between age and blood glucose level (r=0.315, p<0.0001). Conclusion: Patients with mild TBI who had signs of brain injury in the CT scan had significantly higher blood glucose levels than patients with normal CT scan findings. Although indications for performing a brain CT scan are usually based on clinical criteria, blood glucose levels can be helpful in determining the requirement for a brain CT scan in patients with mild TBI.

Human occupational exposure to microplastics: A cross-sectional study in a plastic products manufacturing plant.

Microplastics are ubiquitous in the natural environment, and their potential impact on health is a key issue of concern. Investigating exposure routes in humans and other living organisms is among the major challenges of microplastics. This study aims to examine the exposure level of plastic factory staff to microplastic particles before and after work shifts through body receptors (hand and facial skin, saliva and hair) in Sirjan, southeast of Iran. Moreover, the effect of face masks, gloves, cosmetics (e.g: face powder cream, lipstick and eye makeup products) and appearance on the exposure level is investigated. In total, 19 individuals are selected during six working days. Then, the collected samples are transferred to the laboratory for filtration, extraction, identification and counting of microplastic particles. Moreover, 4802 microplastic particles (100-5000 µm in size) in strand, polyhedral and spherical shapes and color spectra of white/transparent, black, blue/green, red and purple are observed. The nature of most of the observed samples is fiber with a size ≥1000 µm. Analyzing the selected samples using micro-Raman spectroscopy indicate polyester and nylon are the main identified fibers. Hair and saliva samples have the highest and lowest number of microplastics, respectively. Using gloves and sunscreen among all the participants, wearing a scarf and hair size among women and having a beard and mustache among men could have an effective role in the exposure level to microplastics. Results of this study could reveal the exposure route to microplastic particles in the human body and highlight the importance of providing higher protection to reduce exposure.

The role of repeated brain computed tomography based on ultrasound monitoring of optic nerve sheath diameter after moderate traumatic brain injury.

OBJECTIVE: This study was conducted to evaluate the association between changes in repeated brain computed tomography (CT) findings and the optic nerve sheath diameter (ONSD) determined by ocular ultrasonography in patients with moderate blunt traumatic brain injury (TBI). METHODS: This cross-sectional study was performed on patients with moderate blunt TBI (Glasgow Coma Scale, 9-12) who were referred to the emergency department during a 1-year period. Initially, all patients underwent a brain CT scan and primary ocular ultrasonography. Patients who were candidates for a second brain CT scan under observation in the emergency department also underwent a second ocular ultrasound. The primary outcome was the progression of brain lesions on repeated brain CT scans. Logistic regression and the area under receiver operating characteristic curve (AUC) were used. RESULTS: Overall, 204 patients with a mean age of 43±13.4 years were enrolled in the study. The study detected expanding changes in brain CT scans from 29 patients (14.2%). The progression of lesion on CT scan were significantly associated with changes in the Glasgow Coma Scale. In the second brain CT scan, there were significant associations between the progression of lesion on CT scan and the increased size of the ONSD measured on both axial and coronal sections (odds ratio, 17.3-47.5; AUC, 0.88-0.93). CONCLUSION: Among patients with moderate TBI, an increase in ONSD on ocular ultrasound seems to be an appropriate criterion for repeating a brain CT scan to select a suitable therapeutic intervention.

A Cluster-wise Linear Regression Model to Investigate the Effect of Demographical and Clinical Variables on the Average Depression Score.

Background: Depression is a prevalent illness in the world. Given the importance of mental disorders, many researchers have investigated the effects of different variables on average depression scores. In this study, we decided to investigate the effect of some explanatory variables on the average depression score. Methods: The data were provided from the second phase of the Kerman Coronary Artery Diseases Risk Factors study (KERCADRS), which took place between 2014 and 2018. To obtain more precise connections between depression ratings and predictor variables, we employed a cluster-wise linear regression model. Results: The total number of the participants in this study was 9811, out of whom 2144 were allocated to cluster 1, 4540 to cluster 2, and 3127 to cluster 3. The average depression score was 13.76 ± 7.6 in cluster 1, 4.39 ± 4.7 in cluster 2, and 10.83 ± 6.7 in cluster 3. However, the average depression score for all the data was 8.5 ± 7.2. In all the clusters, the average depression score of females was significantly greater than that of men (P < 0.001). In cluster 1, the age category of 35-54 years, in cluster 2, the age category of 55-80 years, and in cluster 3, the age category of 15-34 years had a maximum average depression score. Conclusion: We may classify the 3 clusters as having a low (cluster 2), moderate (cluster 3), or high (cluster 1) depression score, according to the age group with the highest artery diseases risk. The patients were 55-80 years, 15-34 years, and 35-54 years in cluster 2 (low), cluster 3 (moderate), and cluster 1 (high), respectively.

Determinants of oral-health-related quality of life among adult people in Iran.

Background: Oral health-related quality of life (OHRQoL) assesses the subjective perception of oral health and its impact on the quality of life. The aim of this study is to measure the OHRQoL and its determinants among adult people living in Kerman, Iran. Materials and Methods: In this cross-sectional study, a total of 5657 adult people (18-64 years) residing in the Kerman district, both in the rural and urban areas, were enrolled in the study between September 2014 and April 2018. The Oral Health Impact Profile (OHIP-14) and the oral health indices, such as the total decayed, missing, filled teeth (DMFT), community periodontal index (CPI), gingival index (GI), and xerostomia, were measured by an experienced dentist. The demographic variables of gender, age, educational status, and marital status were also recorded. The impact of the studied variables on OHRQoL was evaluated with multiple logistic regression. Results: Participants were 2239 (39.58%) men, and average age was 45.39. The mean scores for OHRQoL, DMFT, CPI and GI were respectively: 24.07 (7.76), 10.7 (6.86), 0.76 (0.96), 0.63 (0.8). The frequency of people with xerostomia was 37.4. 301 (53.3%) of people had poor quality of life related to oral health. In multivariable analysis, there was a statistically significant increase in OHRQoL with an increase in the DMFT (P < 0.001), xerostomia (P < 0.001), CPI, (P < 0.001). Men had a significantly higher OHIP score than women (P < 0.001). Conclusion: According to the results of this study, DMFT, xerostomia, and CPI scores are strongly related to OHIP scores. In addition, between CPI and GI scores, the CPI score is the better predictor.

Spiritual Well-being in Patients with Chronic Diseases: A Systematic Review and Meta-analysis.

As a significant health challenge, chronic disease can have critical spiritual consequences for patients. Therefore, the study of spiritual well-being as an aspect of health is essential but has been less considered with regard to chronic diseases. Thus, this systematic review and meta-analysis were conducted to investigate spiritual well-being in patients with chronic diseases. For this purpose, in the initial search that was performed of valid databases, a total of 615 descriptive studies published between 2000 and 2018 were found. After carefully assessing these, only 24 studies were included in the review. Overall, the spiritual well-being of 3289 patients with chronic disease was investigated. This study showed that the total mean score of the spiritual well-being of patients with chronic diseases was 86.65 (P < 0.001, 95%, CI: 80.34-92.96), indicating a moderate level of spiritual well-being in these patients. Thus, patients with chronic diseases are recommended to consider spiritual consultation programs.

Measurement of Urinary Triclocarban and 2,4-Dichlorophenol Concentration and Their Relationship with Obesity and Predictors of Cardiovascular Diseases among Children and Adolescents in Kerman, Iran.

Exposure to Endocrine-Disrupting Chemicals (EDCs) at an early age can lead to chronic diseases. 2,4-Dichlorophenol (2,4-DCP) and Triclocarban (TCC) are among EDCs that disrupt the endocrine system and alter the body's metabolism. In the present study, the hypothesis that exposure to 2,4-DCP and TCC affects obesity and predictors of cardiovascular diseases was investigated. Fasting Blood Sugar (FBS), Total Cholesterol (TC), Triglyceride (TG), Low-Density Lipoprotein (LDL), High-Density Lipoprotein (HDL (tests were performed on 79 children and adolescents. Also, blood pressure, Body Mass Index (BMI), and BMI z-score were measured to examine the hypothesis. Urinary concentrations of TCC and 2,4-DCP were measured by Gas Chromatography-Mass Spectrometry (GC/MS). Mean concentrations of TCC and 2,4-DCP (µg/L) were higher in obese individuals (5.50 ± 2.35, 0.29 ± 0.13, respectively). After adjusting for possible confounding factors, the results showed an increase in TCC concentration among girls and a decrease in 2,4-DCP among boys with increasing age. The 2,4-DCP concentration among girls increased by 0.007 and 0.01 units with a one-unit increase in Diastolic Blood Pressure (DBP) and FBS, respectively. There was a significant relationship between TCC and TG (Odds Ratio (OR) = 1.02, p-value = 0.007), LDL (OR = 1.05, p-value = 0.003), and HDL (OR = 0.88, p-value = 0.002). There was also a significant relationship between 2,4-DCP and TG (OR = 1.02, p-value = 0.002), LDL (OR = 1.12, p-value = 0.007), and HDL (OR = 0.92, p-value = 0.02). Exposure to TCC and 2,4-DCP can increase some heart risk factors and increase the risk of cardiovascular diseases and obesity. However, to confirm the results of the present study, it is necessary to conduct further studies, such as cohort and case-control studies, with a larger sample size to examine the causal relationships.

Forecasts of cardiac and respiratory mortality in Tehran, Iran, using ARIMAX and CNN-LSTM models.

Cardiovascular diseases belong to the leading causes of disability and premature death worldwide, including in Iran. It is predicted that the burden of the disease in Iran in 2025 will be more than doubled compared to 2005. Therefore, many forecasting models have been used to predict disease progression, estimate mortality rates, and assess risk factors. Our study focused on two time series prediction on models: autoregressive integrated moving average with exogenous variable (ARIMAX) and Convolutional neural network-long short-term memory network (CNN-LSTM). ARIMAX (6,1,6) had the best MSE of 0.655 among time series regression models. The prediction of this model shows a significant association in lag 4 and lag 6. Nitrogen dioxide (NO2) was also significant in lag 6, while CNN-LSTM had a much better MSE of 0.21. For the time series analysis and forecasts studied in this paper, deep learning models provided more accurate results than classical methods such as ARIMAX.

Association of urinary triclosan, methyl triclosan, triclocarban, and 2,4-dichlorophenol levels with anthropometric and demographic parameters in children and adolescents in 2020 (case study: Kerman, Iran).

Endocrine-disrupting chemicals (EDCs) can be a major risk factor for noncommunicable illnesses, especially when children are exposed to them. The purpose of this study was to assess the urine concentrations of triclosan (TCS), methyl triclosan (MTCS), triclocarban (TCC), and 2,4-dichlorophenol (2,4-DCP) and its association with anthropometric and demographic parameters in children and adolescents aged 6-18 living in Kerman, Iran, in 2020. A GC/MS instrument was used to measure the concentrations of the analytes. TCS, MTCS, TCC, and 2,4-DCP geometric mean concentrations (µg/L) were 4.32 ± 2.08, 1.73 ± 0.88, 4.66 ± 10.25, and 0.19 ± 0.14, respectively. TCS, MTCS, TCC, and 2,4-DCP were shown to have a positive and significant association with BMI z-score and BMI (p-value < 0.01). TCS and MTCS have a positive, strong, and substantial association (p-value < 0.01, r = 0.74). There was no significant association between the waist circumference (WC) and the analytes studied. In addition, there was a close association between analyte concentration and demographic parameters (smoking, education, income, etc.) overall. In Kerman, Iran, the current study was the first to look into the association between TCS, MTCS, TCC, and 2,4-DCP analytes and anthropometric and demographic data. The levels of urinary TCS, MTCS, TCC, 2,4-DCP, and anthropometric parameters in children and adolescents are shown to have a significant association in this study. However, because the current study is cross-sectional and it is uncertain if a single experiment accurately reflects long-term exposure to these analytes, more research is needed to determine the impact of these analyses on the health of children and adolescents.

The Evaluation of Survival Rate in Patients with Prostate Cancer by Bayesian Weibull Parametric Accelerated Failure-Time Model.

Background: Prostate cancer is the most prevalent malignancy in men. This study was carried out to determine effective factors on the survival rate of patients diagnosed with prostate cancer in Kerman, Iran. Methods: The present study was conducted as a retrospective cohort of 238 patients diagnosed with prostate cancer from 2011 to 2019 in Kerman, Iran. First, the demographic and clinical information of patients were collected. Then, the information on patient survival up to June 2019 was tracked, and their latest statuses of death or survival were recorded. Kaplan-Meier method, log-rank test, and Bayesian Weibull parametric accelerated failure-time model were used for data analysis. Data analysis was carried out by Stata and SAS. Results: The mean age of patients in the diagnosis was 73.28±10.08 year. The patient's 1, 2, 3 and 5-years of overall survival rates were equal to 78.54%, 65.97%, 56.64% and 49.30, respectively. Patients under surgical therapy relatively held longer survival times compared to the rest of the therapies. Patients under chemotherapy had shorter survival times. Age at diagnosis, occupation, chemotherapy, surgery, education, and smoking variables significantly affected patients' survival (P<0.05). Conclusion: Patients' survival duration increases if the disease is diagnosed at younger ages and its preliminary development stages. Smoking cessation is strongly recommended after diagnosis, as it is associated with a lower survival rate. Patients who underwent radical prostatectomy surgery showed higher survival rates than radiotherapy, hormone ablation, or chemotherapy. Moreover, patients with higher education had more prolonged survival.

A Study of Associations Between rs9349379 (PHACTR1), rs2891168 (CDKN2B-AS), rs11838776 (COL4A2) and rs4880 (SOD2) Polymorphic Variants and Coronary Artery Disease in Iranian Population.

Recent genome-wide association studies reported the association of polymorphic alleles of PHACTR1 (rs9349379 (G)), CDDKN2B-AS1 (rs2891168 (G)), COL4A2 (rs11838776 (A)) and SOD2 (rs4880 (T)) with increased risk of coronary artery disease (CAD). The aim of our study was to assess the association of genetic variants with risk of CAD and its severity and in Southeast Iranian population. This study was examined in 250 CAD-suspected patients (mean age 53.49 ± 6.9 years) and 250 healthy individuals (mean age 52.96 ± 5.9 years). The Taqman SNP genotyping assay was used for genotyping of rs9349379 and rs2891168 variants. Tetra-primer Amplified refractory mutation system-PCR (Tetra-primer ARMS-PCR) was employed for rs11838776 and rs4880. Multivariate logistic regression analyses indicated that the G allele of rs9349379 and rs2891168 were associated with increased risk of CAD. The GG homozygous genotype of rs9349379 and rs2891168 had also been associated with risk of CAD. Additionally, the AG genotype of rs2891168 was associated with CAD. The significance of association of rs2891168 (G, GG, AG) increases with severity of CAD; but the rs9349379 (G, GG) have shown reverse association with severity of CAD. The genetic variants of COL4A2 (rs11838776) and SOD2 (rs4880) reflected no association with CAD in Southeast Iranian population. The findings of this study revealed that the PHACTR1 (rs9349379) and CDKN2B-AS1 (rs2891168) genetic variants might serve as genetic risk factor in CAD.

Effectiveness of Counseling for Infertile Couples on Women's Emotional Disturbance: A Randomized Clinical Trial.

OBJECTIVE: The psychosocial burden of infertility among couples can be one of the most important reasons for women's emotional disturbance. The goal of the present study was to investigate the effect of counseling on different emotional aspects of infertile women. METHODS: The present randomized clinical trial was performed on 60 couples with primary infertility who were referred for treatment for the first time and did not receive psychiatric or psychological treatment. Samples were allocated to an intervention group (30 couples) and a control group (30 couples) by simple randomization. The intervention group received infertility counseling for 6 45-minute sessions twice a week, and the control group received routine care. The Screening on Distress in Fertility Treatment (SCREENIVF) questionnaire was completed before and after the intervention. Samples were collected from November to December 2016 for 3 months. For the data analysis, we used the Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Armonk, NY, United States) software, version 19.0, and the paired t-test, the independent t-test, the Mann-Whitney test, the Wilcoxon test, and the Chi-squared test. RESULTS: The mean age of the participants was 33.39 ± 5.67 years. All studied couples had primary infertility and no children. The mean duration of the couples' infertility was 3 years. There was a significant difference regarding depression (1.55 ± 1.92; p < 0.0001), social support (15.73 ± 3.41; p < 0.0001), and cognitions regarding domains of fertility problems (26.48 ± 3.05; p = 0.001) between the 2 groups after the intervention, but there was no significant difference regarding anxiety (25.03 ± 3.09; p = 0.35). CONCLUSION: The findings showed that infertility counseling did not affect the total score of infertile women' emotional status, but improved the domains of it except, anxiety.

OBJETIVO: A carga psicossocial da infertilidade entre casais pode ser uma das razões mais importantes para os distúrbios emocionais em mulheres. O objetivo deste estudo foi investigar o efeito do aconselhamento em diferentes aspectos emocionais de mulheres inférteis. MéTODOS: Este ensaio clínico randomizado foi realizado com 60 casais com infertilidade primária indicados para tratamento pela primeira vez mas que não receberam tratamento psiquiátrico ou psicológico. As amostras foram alocadas em um grupo de intervenção (30 casais) e um grupo de controle (30 casais) por randomização simples. O grupo de intervenção recebeu aconselhamento sobre infertilidade por 6 sessões de 45 minutos 2 vezes por semana e o grupo controle recebeu cuidados de rotina. O questionário de Triagem por Aflição no Tratamento da Infertilidade (Screening on Distress in Fertility Treatment SCREENIVF em inglês) foi preenchido antes e após a intervenção. As amostras foram coletadas de novembro a dezembro de 2016 durante 3 meses. Para a análise dos dados usamos o programa Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows IBM Corp. Armonk NY Estados Unidos) versão 19.0 e os testes-t pareado e independente e os testes de Mann-Whitney de Wilcoxon e do qui quadrado. RESULTADOS: A média de idade dos participantes foi de 33 39 ± 5 67 anos. Todos os casais estudados tinham infertilidade primária e não tinham filhos. A duração média da infertilidade dos casais era de 3 anos. Houve diferença significativa quanto à depressão (1 55 ± 1 92; p < 0 0001) ao apoio social (15 73 ± 3 41; p <0 0001) e às cognições em relação aos campos dos problemas de fertilidade (26 48 ± 3 05; p = 0 001) entre dois grupos após a intervenção mas não houve diferença significativa com relação à ansiedade (25 03 ± 3 09; p = 0 35). CONCLUSãO: Os achados mostraram que o aconselhamento sobre infertilidade não afetou a pontuação total do estado emocional de mulheres inférteis mas melhorou seus campos exceto a ansiedade.

Effectiveness of Counseling for Infertile Couples on Women's Emotional Disturbance: A Randomized Clinical Trial / Eficácia do aconselhamento a casais inférteis nos distúrbios emocionais das mulheres: um ensaio clínico randomizado

Abstract Objective The psychosocial burden of infertility among couples can be one of the most important reasons for women's emotional disturbance. The goal of the present study was to investigate the effect of counseling on different emotional aspects of infertile women. Methods The present randomized clinical trial was performed on 60 couples with primary infertility who were referred for treatment for the first time and did not receive psychiatric or psychological treatment. Samples were allocated to an intervention group (30 couples) and a control group (30 couples) by simple randomization. The intervention group received infertility counseling for 6 45-minute sessions twice a week, and the control group received routine care. The Screening on Distress in Fertility Treatment (SCREENIVF) questionnaire was completed before and after the intervention. Samples were collected from November to December 2016 for 3 months. For the data analysis, we used the Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Armonk, NY, United States) software, version 19.0, and the paired t-test, the independent t-test, the Mann-Whitney test, the Wilcoxon test, and the Chi-squared test. Results The mean age of the participants was 33.39±5.67 years. All studied couples had primary infertility and no children. The mean duration of the couples' infertilitywas 3 years. There was a significant difference regarding depression (1.55±1.92; p<0.0001), social support (15.73±3.41; p<0.0001), and cognitions regarding domains of fertility problems (26.48±3.05; p=0.001) between the 2 groups after the intervention, but there was no significant difference regarding anxiety (25.03±3.09; p=0.35). Conclusion The findings showed that infertility counseling did not affect the total score of infertile women' emotional status, but improved the domains of it except, anxiety.

Resumo Objetivo A carga psicossocial da infertilidade entre casais pode ser uma das razões mais importantes para os distúrbios emocionais emmulheres. O objetivo deste estudo foi investigar o efeito do aconselhamento em diferentes aspectos emocionais de mulheres inférteis. Métodos Este ensaio clínico randomizado foi realizado com 60 casais com infertilidade primária indicados para tratamento pela primeira vez mas que não receberam tratamento psiquiátrico ou psicológico. As amostras foram alocadas em um grupo de intervenção (30 casais) e um grupo de controle (30 casais) por randomização simples. O grupo de intervenção recebeu aconselhamento sobre infertilidade por 6 sessões de 45 minutos 2 vezes por semana e o grupo controle recebeu cuidados de rotina. O questionário de Triagem por Aflição no Tratamento da Infertilidade (Screening on Distress in Fertility Treatment SCREENIVF em inglês) foi preenchido antes e após a intervenção. As amostras foramcoletadas de novembro a dezembro de 2016 durante 3 meses. Para a análise dos dados usamos o programa Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows IBMCorp. Armonk NY Estados Unidos) versão 19.0 e os testes-t pareado e independente e os testes de Mann-Whitney de Wilcoxon e do qui quadrado. Resultados A média de idade dos participantes foi de 33 39 ± 5 67 anos. Todos os casais estudados tinham infertilidade primária e não tinham filhos. A duraçãomédia da infertilidade dos casais era de 3 anos. Houve diferença significativa quanto à depressão (1 55±1 92; p<0 0001) ao apoio social (15 73±3 41; p <0 0001) e às cognições em relação aos campos dos problemas de fertilidade (26 48±3 05; p=0 001) entre dois grupos após a intervenção mas não houve diferença significativa com relação à ansiedade (25 03±3 09; p=0 35). Conclusão Os achados mostraram que o aconselhamento sobre infertilidade não afetou a pontuação total do estado emocional de mulheres inférteis mas melhorou seus campos exceto a ansiedade.

Opium and Cigarette Smoking are Independently Associated with Bladder Cancer: The Findings of a Matched Case - Control Study.

BACKGROUND: Bladder cancer disproportionally affects the communities. While it is the ninth most common cancer in the world, in some parts of Iran including Kerman province it is the most common cancer among men. This study aimed to determine potential risk factors of bladder cancer in Kerman province, Iran. METHODS: During February to July 2020, in this matched hospital-based case-control study, 100 patients with bladder cancer and 200 healthy individuals (matched in age and sex) were recruited. Socio-demographics status, occupational exposures, common diet, history of drug use and family history of cancer, were collected using a structured questionnaire. Bivariable and multivariable logistic regression were applied and crude and adjusted odds ratios (AOR) along with their 95% confidence intervals (95%CI) were calculated. Data were analyzed using Stata version 14 software. RESULTS: Opium consumption, cigarette smoking and low level of income were associated with increased chance of bladder cancer. Compared to never use, use of opium up to 18000 Gram -year was associated with increased chance of bladder cancer (AOR: 6; 95% CI =2.3, 15.5). The chance was higher among those who used opium more than 18,000 Gram - year (AOR: 11.3; 95% CI =2.3, 15.5). In comparison with never smokers, the chance of bladder cancer increased among those who smoked up to 20 pack-year cigarette) (AOR: 3.4; 95%CI= 1.3, 8.9) and those who smoke ≥ 20 pack-year (AOR: 15.8; 95% CI= 5.9, 42.4). CONCLUSIONS: The observed strong dose-response association between opium consumption, cigarette smoking and bladder cancer highlights the need for extension of harm reduction programs especially in regions with high burden of disease.