Definition and characteristics of climate-adaptive cities: a systematic review.

BACKGROUND: Cities, as frontline responders to climate change, necessitate a precise understanding of climate-adaptive features. This systematic review aims to define and outline the characteristics of climate-adaptive cities, contributing vital insights for resilient urban planning. METHODS: This systematic review, initiated on March 6, 2018, and concluded on August 26, 2021, involved reviewing multiple electronic databases based on the study's objectives. The Critical Appraisal Skills Program (CASP) tool was used for quality assessment and critical evaluation of articles retrieved through a comprehensive and systematic text search. Descriptive and thematic analyses were conducted to extract definitions, features, and characteristics of climate-adaptive cities. RESULTS: Out of 6104 identified articles, 38 articles met the inclusion criteria. In total, 20 definitions and 55 features for climate-adaptive cities were identified in this review. Codes were categorized into two categories and ten subcategories. The categories included definitions and features or characteristics of climate-adaptive cities. CONCLUSION: A climate-adaptive city, as derived from the findings of this study, is a city that, through effective resource management, future-oriented planning, education, knowledge utilization, innovation in governance and industry, decentralized management, and low-carbon economy, leads to the adaptability, resilience, sustainability, and flexibility of the capacity of individuals, communities, institutions, businesses, and systems within a city against all climate change impacts and reduces their negative consequences.

Effects of hydrolyzed collagen alone or in combination with fish oil on the gut microbiome in patients with major burns.

Burns are associated with gut dysbiosis. Collagen peptides and omega-3 fatty acids (FAs) are suggested to improve wound healing and the inflammatory response. These are also correlated with microbiome colonization. Therefore, the present study aimed to investigate the effect of hydrolyzed collagen alone or in combination with fish oil on specific species of the gut microbiome in patients with major burns. In this randomized double-blind clinical trial, 57 adults (aged 18-60 years) with 20-45% total body surface area burns were randomised into three groups to receive either 40 gr hydrolyzed collagen +10 ml sunflower oil, 40 g hydrolyzed collagen +10 ml fish oil or placebo, divided into two daily drinks, for two weeks. Gut bacteria were measured using the real-time quantitative polymerase chain reaction (qPCR) method. The mean concentration of Bifidobacterium was significantly reduced in the control (P = 0.002) and collagen (P = 0.005) groups compared with the baseline values, whereas no significant change was observed in the collagen omega-3 group. The Firmicutes to Bacteroidetes ratio decreased significantly in the collagen group (p = 0.002) after supplementation compared to baseline . No significant changes in concentration of Lactobacillus, Enterobacteriaceae, and F.prausnitzii were observed between or within the study groups. Two weeks of supplementation with collagen and omega-3 FAs in patients with major burns did not result in a significant difference in the concentration of bacteria measured between the study groups. However, the addition of omega-3 FAs prevented a significant reduction in gut Bifidobacterium. Future studies are suggested to investigate the potential efficacy of these nutrients in improving the gut microbiota and clinical outcomes in major burns. REGISTRATION NUMBER: IRCT20131125015536N9.

Inflammatory dilated cardiomyopathy associated with psoriasis: a case report.

BACKGROUND: Psoriasis is a chronic inflammatory skin disease with a genetic basis. Psoriasis is accepted as a systemic, immune-mediated disease. Hypertension, obesity, metabolic disorders including diabetes mellitus and hyperlipidemia, and psychiatric disorders are more prevalent among children with psoriasis compared to children without psoriasis. In this study, we report a case of dramatic response of inflammatory cardiomyopathy to anti-inflammatory treatment of psoriasis; which might reveal similar pathogenesis basis of these two diseases. CASE PRESENTATION: A 9-year-old Caucasian boy presenting with signs and symptoms of heart failure refractory to conventional therapies was admitted to our pediatric cardiology service. As the patient also had psoriasis, and considering the fact that there might be an association between the two conditions, immunosuppressive drugs were administered, which led to a dramatic improvement in heart function. CONCLUSIONS: The results of this study add to evidence linking psoriasis with inflammatory dilated cardiomyopathy. Clinicians, particularly cardiologists, must pay special attention to the cardiac complications of systemic diseases.

Effect of a collagen-enriched beverage with or without omega-3 fatty acids on wound healing, metabolic biomarkers, and adipokines in patients with major burns.

BACKGROUND & AIMS: This study investigated the effects of collagen hydrolysate and omega-3 fatty acids (FAs) on the rate and quality of wound healing, metabolic disorders, and adipose-derived peptides in patients with major burns. METHODS: In this randomized clinical trial, 66 patients with 20-45% deep partial or full-thickness burns were randomly assigned to three groups to receive either a beverage containing collagen (40 gr/d), collagen (40 gr/d) plus 3 gr/d omega-3 (ω-3) FAs, or placebo for four weeks. Wound healing rate, Vancouver scar scale (VSS), as well as baseline, weeks two and three serum concentrations of adiponectin, fibroblast growth factor 21 (FGF21), neuregulin 4 (NRG4), transforming growth factor (TGF)-ß1, and pre-albumin/hs-CRP ratio were assessed. RESULTS: The wound healing rate during the weeks post-burn (p = 0.006 and p = 0.01), and days of 95% (21.3 ± 6.8 and 22.9 ± 8.7 vs. 34.3 ± 14.8 days, p = 0.003 and p = 0.03) and complete (26 ± 7.7 and 27.4 ± 9.4 vs. 41.1 ± 16.6 days, p = 0.003 and p = 0.01) wound healing were significantly better with Collagen and Collagen. ω-3 compared to the placebo group. The VSS was significantly lower, indicated better scar status, in the both intervention groups compared to the placebo (p = 0.02 and p = 0.01). Wound healing outcomes were not statistically different between the Collagen and Collagen. ω-3 groups. Hs-CRP/pre-albumin ratio was significantly lower in the Collagen. ω-3 than the placebo group at week three (1.2 ± 1.9 vs. 4.8 ± 7.7 dl/l, p = 0.03). The significant decrease in serum adiponectin seen during the trial course within the placebo (10 ± 8.8 to 5.8 ± 4.9 mg/l, p = 0.03) and Collagen (11.8 ± 14 to 8.6 ± 11.7 mg/l, p = 0.03) groups was prevented in the Collagen. ω-3 group (p = 0.4). Circulating FGF21 decreased significantly within the Collagen (p = 0.005) and Collagen. ω-3 (p = 0.02) groups at the end of week three compared to the baseline. CONCLUSIONS: Adding collagen hydrolysate as part of adjunctive therapy improved wound healing rate and quality. These findings as well as the efficacy of omega-3 FAs need to be further confirmed in larger populations. This study was registered with the Iranian Registry of Clinical Trials (IRCT20090901002394N42).

Strategies and experiences for sand and dust storm adaptation: A qualitative study in Iran.

BACKGROUND AND PURPOSE: Sand and Dust storms (SDS) are meteorological hazards that are increasing due to climate change. Mitigation and adaptation are two main strategies that help to deal with this global concern. In the recent decades, Iran has been prone to SDS. Therefore, this study was conducted in 2018 in order to explore the SDS adaptation experiences and strategies in the Iranian community. METHODS: Using content analysis approach and purposive sampling, three groups (including 14 experts, 8 authorities, and 23 individuals) were selected. Data were collected through semi-structured interviews. Data analysis was performed using Graneheim and Lundman's method. Finally, Gaba and Lincoln's scientific criteria were used for data validity. RESULTS: Two major categories emerged from the analysis. The first category was related to the adaptation experiences and included two subcategories: "citizens' experiences" and "experts'/ authorities' experiences". The second was related to SDS adaptation strategies and included five subcategories: "educational development", "public participation", "inter-sectorial coordination", "institutional development", and "environment preservation". CONCLUSIONS: Identifying the experiences and strategies that are implemented by a community to adapt to SDS is the core stone for developing a comprehensive local and national adaptation plan. This study suggests strategies and action plans for SDS adaptation that can be used in policy making.

Effect of Collagen Hydrolysate and Fish Oil on High-Sensitivity C-Reactive Protein and Glucose Homeostasis in Patients with severe Burn; a Randomized Clinical Trial.

INTRODUCTION: Collagen and omega-3 fatty acids (FAs) are suggested to have anti-inflammatory, anti-oxidant, and insulin-sensitizing properties. The aim of this study was to investigate the effect of collagen hydrolysate and omega-3 FAs on inflammation and insulin resistance in patients with major burns. METHODS: In this double-blind randomized clinical trial, 66 patients with 20-45% burns were assigned to either of the three groups of collagen (40 gr/d), collagen (40 gr/d) plus fish oil (10 ml/d), or control. High-sensitivity C-reactive protein (hs-CRP), fasting blood glucose (FBG) and insulin concentrations, and homeostatic model assessment for insulin resistance (HOMA-IR) were assessed at baseline, as well as end of weeks two and three. RESULTS: Based on post-hoc analyses, hs-CRP levels were significantly lower in the collagen (p=0.026) and collagen+omega-3 (p=0.044) groups compared to the control group, at week three. However, pre- to post- (week three) changes of hs-CRP were significantly higher only in the collagen+omega-3 group compared to the control group (173.2 vs. 103.7 mg/l, p=0.024). After three weeks of the intervention, insulin (11.3 and 11.9 vs. 22.8 µIU/ml) and HOMA-IR (2.9 and 2.8 vs. 7.9) values seemed to be clinically, but not statistically, lower in both intervention groups compared to the control group. Pre- to post- (week three) values of FBG decreased significantly in the collagen (p=0.002) and collagen+omega-3 (p=0.036) groups. Insulin (p=0.008) and HOMA-IR (p=0.001) decreased significantly only in the collagen+omega-3 group at week three compared to the baseline. CONCLUSIONS: Supplementation with collagen hydrolysate and omega-3 FAs can improve hs-CRP concentration and probably insulin resistance in patients with severe burns. Omega-3 FAs had additional effects on modulating inflammation. Larger clinical trials are needed to confirm the current findings especially in terms of glucose homeostasis.

Association of obesity with mortality and clinical outcomes in children and adolescents with transplantation: A systematic review and meta-analysis.

Obesity might be associated with mortality and clinical outcomes following transplantation; however, the direction of this relationship has not been well-recognized in youth. The aim of this systematic review and meta-analysis was to investigate the association of obesity with post-transplant mortality and clinical outcomes in children and adolescents. Following a systematic search of observational studies published by December 2018 in PubMed, Scopus, Embase, and Cochrane library, 15 articles with total sample size of 50,498 patients were included in the meta-analysis. The main outcome was mortality and secondary outcomes included acute graft versus host disease (GVHD), acute rejection, and overall graft loss. The pooled data analyses showed significantly higher odds of long term mortality (OR 1.30, 95% CI 1.15-1.48, P < 0.001, I2 = 50.3%), short term mortality (OR 1.79, 95% CI 1.19-2.70, P = 0.005, I2 = 59.6%), and acute GVHD (OR 2.13, 95% CI 1.5-3.02, P < 0.001, I2 = 1.7%) in children with obesity. There were no significant differences between patients with and without obesity in terms of acute rejection (OR 1.07, 95% CI 0.98-1.16, P = 0.132, I2 = 7.5%) or overall graft loss (OR 1.04, 95% CI 0.84-1.28, P = 0.740, I2 = 51.6%). This systematic review and meta-analysis has stated higher post-transplant risk of short and long term mortality and higher risk of acute GVHD in children with obesity compared to those without obesity. Future clinical trials are required to investigate the effect of pre-transplant weight management on post-transplant outcomes to provide insights into the clinical application of these findings. This may in turn lead to establish guidelines for the management of childhood obesity in transplantations.

Conceptual definition and framework of climate change and dust storm adaptation: a qualitative study.

Climate Change Adaptation (CCA) is a complex, multi-disciplinary, and culture-dependent concept. This study aims to explore a conceptual definition, the subjective framework of CCA including its domains, attributes, and consequences. The approach of qualitative conventional content analysis was considered for the explanation of the subjective concept, and at the same time as the collection process, data analysis was performed using Zhang and Wildemuth's method. The interview method was semi-structured and sampling was targeted and with maximum diversity. The interview was conducted with 22 qualified experts. The accuracy and validity of the data were ensured using Guba and Lincoln scientific accuracy criteria. Six main categories including "sustainability, productivity, stability, empowerment, transformation, and flexibility" were conceptualized in the theme of adaptation characteristics. "Sustainable development, life improvement, response coordination and integration, creativity and innovation, resilience promotion, vulnerability reduction, effective management, and independence" were the main categories in the theme of the adaptation consequences. According to the results, the following conceptual-functional definition can be presented for adaptation to climate change: "CCA refers to the ability of system instability, sustainability, empowerment, productivity, flexibility, and transformation to climate change through the optimal use of resources, resistance, and coping, capacity building and opportunity creation". This definition is conceptual, it means that includes the main features of climate-adaptation and is also functional that is, includes adaptation strategies for climate change.

The Effect of Emotion Regulation Training on Occupational Stress of Critical Care Nurses.

INTRODUCTION: Occupational stress is a common, serious and costly health problem in work environment. Nursing is a very stressful job high level of stress in this job affects nurses' physical and mental health. AIM: To investigate the effect of emotion regulation training of occupational stress on critical care nurses in two teaching hospitals in Sanandaj, Iran. MATERIALS AND METHODS: This interventional study was conducted on 60 nurses working in the Intensive Care Unit (ICU) and Critical Care Unit (CCU) in two teaching hospitals in Sanandaj, Iran. Data were collected using Expanded Nursing Stress Scale (ENSS) questionnaire. The questionnaire in both intervention and control groups before and after the training sessions of emotion regulation training were completed. Data were analysed using SPSS Version 20. Statistical indices such as frequency, percentage, mean and standard deviation and also t-test, Chi-square test and paired t-test were used. RESULTS: Mean occupation stress score in the intervention group before emotion regulation training was 136.6±24.6 and after training was 113.02±16.2 (p = 0.001). Occupational stress dimensions including; conflict with physicians, problems with peers, workload, uncertainty concerning treatment and problems related to patients and their families in the intervention group compared with the control group was statistically significant (p <0.05). CONCLUSION: Emotion regulation training is effective in reducing occupation stress of critical care nurses.