The effect of exercise on sleep habits of children with type 1 diabetic: a randomized clinical trial.

BACKGROUND: Adequate sleep and exercise are important components of the human lifestyle. Paying attention to these two factors is very important to improve the condition of children with type 1 diabetes. Therefore, this study aimed to investigate the effect of exercise on sleep habits in children with type 1 diabetes. MATERIAL & METHODS: 62 children with type 1 diabetes participated in this clinical trial. They will be divided into the intervention group (31) and the control group (31). Sleep habits were measured using the Children's Sleep Habits Questionnaire (CSHQ). All children's parents completed the CSHQ. The intervention for the experimental group consisted of 8 weeks of regular exercise program. The exercise program was prepared as an educational video and provided to parents. Paired sample t-test and ANCOVA test were used with SPSS 23. RESULTS: 62 children with an average age of 9.32 ± 2.02 were studied. Fifty-four and eight% of the children were girls and the rest were boys. The analysis of the variance test showed a significant difference (F = 144.72, P ≤ 0.01) between the average score of the sleep habits of the control group (62.45 ± 5.12) and the experimental group (47.06 ± 4.39). CONCLUSION: Sleep habits in the experimental group improved after 8 weeks of exercise training using educational videos. Exercise as a non-pharmacological treatment is an effective way to manage diabetes and improve sleep quality in diabetic children.

Risk Factors Associated with Severity and Death from COVID-19 in Iran: A Systematic Review and Meta-Analysis Study.

Objectives: This study aims to investigate the risk factors associated with severity and death from COVID-19 through a systematic review and meta-analysis of the published documents in Iran. Methods: A systematic search was performed based on all articles indexed in Scopus, Embase, Web of Science (WOS), PubMed, and Google Scholar in English and Scientific Information Database (SID) and Iranian Research Institute for Information Science and Technology (IRA)NDOC indexes in Persian. To assess quality, we used the Newcastle Ottawa Scale. Publication bias was assessed using Egger's tests. Forest plots were used for a graphical description of the results. We used HRs, and ORs reported for the association between risk factors and COVID-19 severity and death. Results: Sixty-nine studies were included in the meta-analysis, of which 62 and 13 had assessed risk factors for death and severity, respectively. The results showed a significant association between death from COVID-19 and age, male gender, diabetes, hypertension, cardiovascular disease (CVD), cerebrovascular disease, chronic kidney disease (CKD), Headache, and Dyspnea. We observed a significant association between increased white blood cell (WBC), decreased Lymphocyte, increased blood urea nitrogen (BUN), increased creatinine, vitamin D deficiency, and death from COVID-19. There was only a significant relationship between CVD and disease severity. Conclusion: It is recommended that the predictive risk factors of COVID-19 severity and death mentioned in this study to be used for therapeutic and health interventions, to update clinical guidelines and determine patients' prognoses.

SARS-COV-2 RBD (Receptor binding domain) mutations and variants (A sectional-analytical study).

An essential step in SARS-CoV-2 infection is binding the receptor-binding domain (RBD) of the SARS-CoV-2 spike protein to the ACE2 receptor on the surface of host cells. Therefore, variation in this region can have crucial effects on clinical outcomes and the emergence of variants of concern (VOCs) and variants of interest (VOIs). In this cross-sectional descriptive study, 54 patients with SARS-COV-2 infection were enrolled. After collecting samples and identifying the virus using the One-Step Real-Time qRT-PCR technique and confirming the viral infection, the region containing the RBD region for detection of any mutations was amplified using the Nested-PCR method. Finally, to identify probable mutations, the Nested-PCR product was sequenced. Our data show that the most mutant strains in circulation in our population are the delta variant (90.74%), alpha variant (5.56%), and omicron variant (3.70%), respectively. Pangolin Lineages strains were B.1.1.7(Alpha variant), B.1.617.2(Delta variant) and B.1.1.529(Omicron variant). Also, the mutation profile of variants suggests that N501Y, T478K, and D614G amino acid substitutions, are the significant mutations in the alpha and delta variants that are common with the Omicron variant. The highest frequency of clinical signs in the patients were: lung involvement (42.59%); fever, chills (40.74%); body pain (15%), and other signs (1.67%). Our data revealed that SARS-COV-2 RBD region variation results in substituting essential amino acids and the emergence of the new variant. We can consider it as a predictor for monitoring the emergence of variants of concerns and viral outcomes.

Is neurofeedback effective in children with ADHD? A systematic review and meta-analysis.

To evaluate the evidences related to the effectiveness of neurofeedback treatment for children and adolescent with attention-deficit/hyperactivity disorder (ADHD) based on the most-proximal raters. A systematic review of randomized control trials (RCTs) was carried out across multiple databases. the primary outcome measure was the most proximal ratings of ADHD symptoms in subjects. Conner's Parent Rating Scale (CPRS), Conner's Teacher Rating Scale (CTRS), and ADHD Rating Scale (ADHD-RS- are considered as primary outcomes. Seventeen trials met inclusion criteria (including 1211 patients). Analysis showed that there was no significant benefit of neurofeedback treatment compared with other treatments or control conditions [weighted mean difference/CI = HI-P: -0.02 (-0.26, 0.21), HI-T: 0.01 (-0.46, 0.48), weighted mean difference/CI = I-P: 0.00 (-0.23, 0.23), I-P: 0.12 (-0.14, 0.38)]. The results provide preliminary evidence that neurofeedback treatment is no efficacious clinical method for ADHD and suggest that more RTCs are needed to compare common treatment .

The effect of the online flipped classroom on self-directed learning readiness and metacognitive awareness in nursing students during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has initiated digital developments in higher education while closing in-person university classes. As this crisis continues, the need to revive virtual learning opportunities was seriously felt. The present study was conducted to determine the online flipped classroom's effect on nursing students' self-directed learning readiness and metacognitive awareness. METHODS: This quasi-experimental single-group study with pretest-posttest design recruited 34 sophomore students of a nursing school in Lorestan province, Western Iran selected by census according to the inclusion criteria. Online asynchronous learning and online flipped classrooms were used during the semester's first and second eight weeks, respectively. Students filled out self-directed learning readiness scale and metacognitive awareness inventory online before, in the middle of, and at the end of the semester. Data were analyzed using paired t-test in Stata-14 software. RESULTS: There was no significant difference between the mean score of metacognitive awareness before and after Online asynchronous learning (P=0.15), but the mean score of self-directed learning readiness increased significantly after OA (P=0.0004). After applying online flipped classrooms, students' mean (SD) scores of metacognitive awareness and self-directed learning readiness were 272.03 (53.03) and 162.03 (21.77), respectively, which confirmed their significant improvement compared to before the intervention. A comparison of the mean score changes of both methods indicated that their implementation did not lead to significant differences between the mean total score of metacognitive awareness (P=0.15) and the mean total score of self-directed learning readiness (P=0.07). DISCUSSION: Online flipped classroom approach can be used as an effective method in nursing education by improving self-directed learning and metacognitive awareness, which are essential in online education for nursing students.

Epidemiologic Parameters for COVID-19: A Systematic Review and Meta-Analysis.

Background: The World Health Organization (WHO) declared the coronavirus disease 2019 (COVID-19) outbreak to be a public health emergency and international concern and recognized it as a pandemic. This study aimed to estimate the epidemiologic parameters of the COVID-19 pandemic for clinical and epidemiological help. Methods: In this systematic review and meta-analysis study, 4 electronic databases, including Web of Science, PubMed, Scopus, and Google Scholar were searched for the literature published from early December 2019 up to 23 March 2020. After screening, we selected 76 articles based on epidemiological parameters, including basic reproduction number, serial interval, incubation period, doubling time, growth rate, case-fatality rate, and the onset of symptom to hospitalization as eligibility criteria. For the estimation of overall pooled epidemiologic parameters, fixed and random effect models with 95% CI were used based on the value of between-study heterogeneity (I2). Results: A total of 76 observational studies were included in the analysis. The pooled estimate for R0 was 2.99 (95% CI, 2.71-3.27) for COVID-19. The overall R0 was 3.23, 1.19, 3.6, and 2.35 for China, Singapore, Iran, and Japan, respectively. The overall serial interval, doubling time, and incubation period were 4.45 (95% CI, 4.03-4.87), 4.14 (95% CI, 2.67-5.62), and 4.24 (95% CI, 3.03-5.44) days for COVID-19. In addition, the overall estimation for the growth rate and the case fatality rate for COVID-19 was 0.38% and 3.29%, respectively. Conclusion: The epidemiological characteristics of COVID-19 as an emerging disease may be revealed by computing the pooled estimate of the epidemiological parameters, opening the door for health policymakers to consider additional control measures.

Estimation of the basic reproduction number (𝑠0) of the COVID-19 epidemic in Iran.

Background: Estimation of the basic reproduction number of an infectious disease is an important issue for controlling the infection. Here, we aimed to estimate the basic reproduction number (𝑅0) of COVID-19 in Iran. Methods: To estimate 𝑅0 in Iran and Tehran, the capital, we used 3 different methods: exponential growth rate, maximum likelihood, and Bayesian time-dependent. Daily number of confirmed cases and serial intervals with a mean of 4.27 days and a standard deviation of 3.44 days with gamma distribution were used. Sensitivity analysis was performed to show the importance of generation time in estimating 𝑅0. Results: The epidemic was in its exponential growth 11 days after the beginning of the epidemic (Feb 19, 2020) with doubling time of 1.74 (CI: 1.58-1.93) days in Iran and 1.83 (CI: 1.39-2.71) in Tehran. Nationwide, the value of 𝑅0 from February 19 to 29 using exponential growth method, maximum likelihood, and Bayesian time-dependent methods was 4.70 (95% CI: 4.23-5.23), 3.90 (95% CI: 3.47- 4.36), and 3.23 (95% CI: 2.94-3.51), respectively. In addition, in Tehran, 𝑅0 was 5.14 (95% CI: 4.15-6.37), 4.20 (95% CI: 3.38-5.14), and 3.94 (95% CI: 3.45-4.40) for exponential growth, maximum likelihood, and Bayesian time-dependent methods, respectively. Bayesian time dependent methods usually provide less biased estimates. The results of sensitivity analyses demonstrated that changes in the mean generation time affect estimates of 𝑅0. Conclusion: The estimate of 𝑅0 for the COVID-19 ranged from 3.94 to 5.14 in Tehran and from 3.23 to 4.70 in nationwide using different methods, which were significantly larger than 1, indicating the potential of COVID-19 to cause an outbreak.

Effects of Hypothetical Interventions on Ischemic Stroke Using Parametric G-Formula.

Background and Purpose- Standard analytic approaches (eg, logistic regression) fail to adequately control for time-dependent confounding and, therefore, may yield biased estimates of the total effect of the exposure on the outcome. In the present study, we estimate the effect of body mass index, intentional physical activity, HDL (high-density lipoprotein) cholesterol, LDL (low-density lipoprotein) cholesterol, hypertension, and cigarette smoking on the 11-year risk of ischemic stroke by sex using the parametric g-formula to control time-dependent confounders. Methods- Using data from the MESA (Multi-Ethnic Study of Atherosclerosis), we followed 6809 men and women aged 45 to 84 years. We estimated the risk of stroke under 6 hypothetical interventions: maintaining body mass index <25 kg/m2, maintaining normotension (systolic blood pressure <140 and diastolic <90 mm Hg), quitting smoking, maintaining HDL >1.55 mmol/L, maintaining LDL <3.11 mmol/L, and exercising at least 210 minutes per week. The effects of joint hypothetical interventions were also simulated. Results- In men, the 11-year risk of ischemic stroke would be reduced by 85% (95% CI, 66-96) for all 6 hypothetical interventions. In women, this same effect was estimated as 55% (95% CI, 6-82). Conclusions- The hypothetical interventions explored in our study resulted in risk reduction in both men and women.

The role of psychological theories in oral health interventions: A systematic review and meta-analysis.

OBJECTIVE: In the present study, we attempted to assess how psychological theories (health belief model [HBM], theory of planned behaviour [TPB], social cognitive theory [SCT], clinical theories [CT] and other theories [OT]) influence oral health interventions. METHODS: PubMed, Scopus, Cochrane and Web of Knowledge databases from 2000 to 2017 were searched. We defined psychological theories based on five subgroups: (A) HBM, (B) TPB, (C) SCT, (E) CT and (F) OT. RESULTS: From the 156 identified studies, 19 studies based on PICO were included. Our findings indicated that the standardized mean difference (SMD) of HBM was 0.37 (95% CI: 0.24, 0.51), which was statistically significant in improving oral health. The SMD of SCT was not significant (0.05 [95% CI: -0.33, 0.44]) in improving oral health. The SMD of TPB was significant (1.66 [95% CI: 1.06, 2.27]) in improving oral health. The SMD of CT (-4.6 [95% CI: -6.49, -2.71]) and OT (2.93 [95% CI: 1.55, 4.32]) revealed significant differences in improving oral health. CONCLUSION: The current meta-analysis showed that in general, psychological interventions that used OT, CT, HBM and TPB were effective in enhancing oral health status, and interventions that used SCT did not have an effect on improving oral health status. Oral health care providers who work with patients to take methods and improve behaviours that are related to appropriate oral health need to comprehend their applicability and strengths.

How within-city socioeconomic disparities affect life expectancy? Results of Urban HEART in Tehran, Iran.

BACKGROUND: There is substantial lack of knowledge about the role of socioeconomic status (SES) indicators on life expectancy (LE) within-cities, especially within mega-cities. We aimed to investigate the disparities of LE within city districts of Tehran, Iran, and specify how SES inequalities play role on LE. METHODS: The death and population data for 2010 by different age, gender, and residency district were obtained from the main cemetery of Tehran and statistical centre of Iran, respectively. Age-specific mortality rates and consequently LE were calculated for all 22 districts by different genders. Finally, based on the results of first Tehran's Urban Health Equity Assessment and Response Tool (Urban HEART) project in 2008, the influence of social classes (SCs), total costs, and education indicators were analyzed on LE at birth (e0). RESULTS: The e0 for total males and females in Tehran were calculated as 74.6 and 78.4 years for 2010, respectively. The maximum LE of 80 years was observed in females of northern part with higher SES, and the minimum e0 of 72.7 years observed in males of southern part with lower SES. The e0 gender gap among districts was 5.5 years for females and 3.7 years for males. The highest and lowest mean of e0 observed in SC1 (highest class) and SC5 (lowest class), were 77.6 and 76.0 years, respectively. The lowest mean of e0 observed in the first group of total costs indicator and was 76.2 years. In addition, the lowest observed mean of e0 was in the first category of education indicator (illiterate) and was 76.0 years. CONCLUSION: RESULTS indicate substantial disparities in LE within city districts. This confirms that SES disparities within-cities would have direct influences on LE.

Effects of balance training on cognitive function and activities of daily living in older adult patients with heart failure: a randomized controlled trial.

BACKGROUND: The potential of the effect of balance training on improving cognitive functions and functional activities in vulnerable groups, including the older adults with heart failure (HF), is unknown. AIM: The aim of the present study was to determine the effect of a simple balance training supervised by nurses on cognitive functions and activities of daily living (ADLs) of the older adults with HF. METHODS: In this clinical trial study, 75 older adults with HF were allocated to two groups of balance training (BT) and usual care (UC) using stratified block randomization. The intervention consisted of a set of dynamic and static BT, 4 times/session per week, each session lasting 30 min, for 8 weeks, which was performed at the participant's home under the supervision of a nurse. For the control group, UC was provided. The outcomes of the study, including cognitive function, basic ADLs, and instrumental ADLs (IADLs), were measured by the Montreal cognitive assessment-basic (MoCA-B), Barthel index-ADL, and Lawton scale-IADL before and after the intervention. RESULTS: The between-group analysis showed, in two groups, a statistically significant difference between the changes in the mean scores: all subscales of cognitive function and MoCA-B total score (P < 0.001), as well as basic ADLs and IADLs (P < 0.001), before and after the intervention. Compared with the control group/UC, the cognitive function, basic ADL, and IADL of the intervention group/BT were improved significantly at 8 weeks. CONCLUSION: The results suggested that home-based balance training led by nurse can improve global cognitive function and basic ADL and IADL in the older adults with HF. TRIAL REGISTRATION: Clinical trials registration number IRCT20150919024080N18.

Effects of Satureja Khuzestanica supplementation on glycemic indices and lipid profile in type 2 diabetes patients: a randomized controlled clinical-trial.

BACKGROUND: Several studies showed the hypoglycemic and hypolipidemic effects of Satureja Khuzestanica (SK) in animal models. This study aimed to determine the effect of SK supplementation on glycemic and lipid outcomes of patients with type 2 diabetes mellitus (T2DM). METHODS: The study was designed as a double-blind, placebo-controlled, randomized clinical trial using block randomization. Seventy-eight T2DM patients were randomly assigned to intervention (n = 39) or placebo (n = 39) groups. They received SK or placebo in 500 mg capsules daily for 12 weeks. Anthropometric, blood pressure, liver enzymes, glycemic, and lipid outcomes were measured before and after the intervention. RESULTS: At baseline, there were no significant differences in age, sex, or glycated hemoglobin (HbA1c) levels between the groups. SK supplementation led to a significant decrease in FBS (-12.6 ± 20.7 mg/dl in the intervention group versus 3.5 ± 31.9 mg/dl; p = 0.007), HbA1c (-0.28 ± 0.45 in the intervention group versus 0.11 ± 0.54% in the placebo group; p = < 0.001), insulin (-1.65 ± 6.18 in the intervention group versus 2.09 ± 5.90 mIU/L in the placebo group; p = 0.03), total cholesterol (-14.6 ± 21.1 mg/dl in the intervention group versus 8.2 ± 30.9 mg/dl in the placebo group; p < 0.001), LDL-cholesterol (-4.6 ± 15.2 mg/dl in the intervention group versus 5.8 ± 14.6 mg/dl in placebo group; p < 0.001) levels, and significant increase in HDL-cholesterol (3.9 ± 4.9 mg/dl in the intervention group versus 0.9 ± 5.2 mg/dl in placebo group; p = 0.005). CONCLUSION: Based on the study results, SK supplementation may improve glycemic indices and lipid profile of patients with T2DM. Our findings may provide novel complementary treatments without adverse effects for diabetes complications. These results need to be further confirmed in clinical trials. REGISTRATION: This trial has been registered in the Iranian Registry of Clinical Trials (IRCT ID: IRCT20190715044214N1, registration date: 21/02/2021).

Gender disparity and risk of noncommunicable disease among adults in Islamic Republic of Iran.

Background: The relationship between gender disparity and the risk of developing noncommunicable disease and other social health determinants has not been well researched in the Islamic Republic of Iran. Aims: To assess how gender disparity contributes to the overall risk of noncommunicable disease in the Islamic Republic of Iran. Methods: This was a secondary analysis of data on about 11 000 adults aged 15-69 years from the 2011 WHO STEPwise approach to NCD risk factor surveillance (STEPS) survey in the Islamic Republic of Iran. The outcome variable in our analysis was the noncommunicable disease risk factor index. We used an extension of the Blinder-Oaxaca decomposition model to decompose the predicted mean difference in this index. Sampling method, study design and sex were considered in the analysis. The predictor variables were age, household assets index, education, employment status, ethnicity, and residence. Results: The overall mean (standard deviation) noncommunicable disease risk score was 39.26 (22.4). The risk score for women was significantly higher than for men (41.75 versus 36.84; P < 0.001). About 35% of gender disparity in risk score was due to the differences in distribution of the predictor variables (explained component); of these, age contributed the most (23.79%), followed by education (7.82%). The different gender effects on work status and age made the largest contributions to the unexplained component of the disparity, 36.40% and 14.82%, respectively. Conclusions: Policies to reduce the risk of noncommunicable diseases need to consider gender groups and how gender affects social determinants such as employment status to make some gender subgroups more vulnerable than others.

Intensive care unit admission and associated factors in patients hospitalised for COVID-19: A national retrospective cohort study in Iran.

OBJECTIVES: This study aimed to determine factors associated with intensive care unit (ICU) admission in patients hospitalised due to COVID-19. DESIGN: Retrospective cohort. SETTING: Confirmed hospitalised patients from all over Iran were considered for the study. PARTICIPANTS: All patients with COVID-19 admitted to the hospital from March 2020 to May 2021 were included by census. ICU admission was defined by the following criteria: (1) admission to the ICU ward; (2) level of consciousness (loss of consciousness); and (3) use of invasive ventilation. METHODS: This is a secondary data analysis from the Medical Care Monitoring Center. The association between different variables and ICU admission was assessed by forward Logistic regression and restricted cubic spline method. RESULTS: The mean age of the 1 469 620 patients with COVID-19 was 54.49±20.58 years old, and 51.32% of the patients were male. The prevalence of ICU admission was 19.19%. The mean age of patients admitted to the ICU was higher than that of other hospitalised patients (62.49±19.73 vs 52.59±20.31 years). The prevalence of ICU admission was 17.17% in the first, 21.52% in the second, 19.72% in the third, 21.43 in the fourth and 17.4% in the fifth wave. In the multivariable model, age groups, sex, waves of the epidemic, comorbidities and saturation of peripheral oxygen (SpO2) <93% and acute respiratory distress syndrome (ARDS) were associated with an increased odds of ICU admission. The OR for ICU admission indicates a significant protective effect at a young age and then a significant risk factor for admission to the ICU ward at an old age. CONCLUSIONS: Men, older adults, people who suffer from ARDS, patients with SpO2 levels of less than 93% and cases with comorbidities had the highest odds of ICU admission. Therefore, these groups should take all necessary precautions to avoid contracting COVID-19.

Does weight mediate the effect of smoking on coronary heart disease? Parametric mediational g-formula analysis.

BACKGROUND: In settings in which there are time-varying confounders affected by previous exposure and a time-varying mediator, natural direct and indirect effects cannot generally be estimated unbiasedly. In the present study, we estimate interventional direct effect and interventional indirect effect of cigarette smoking as a time-varying exposure on coronary heart disease while considering body weight as a time-varying mediator. METHODS: To address this problem, the parametric mediational g-formula was proposed to estimate interventional direct effect and interventional indirect effect. We used data from the Multi-Ethnic Study of Atherosclerosis to estimate effect of cigarette smoking on coronary heart disease, considering body weight as time-varying mediator. RESULTS: Over a 11-years period, smoking 20 cigarettes per day compared to no smoking directly (not through weight) increased risk of coronary heart disease by an absolute difference of 1.91% (95% CI: 0.49%, 4.14%), and indirectly decreased coronary heart disease risk by -0.02% (95% CI: -0.05%, 0.04%) via change in weight. The total effect was estimated as an absolute 1.89% increase (95% CI: 0.49%, 4.13%). CONCLUSION: The overall absolute impact of smoking to incident coronary heart disease is modest, and we did not discern any important contribution to this effect relayed through changes to bodyweight. In fact, changes in weight because of smoking have no meaningful mediating effect on CHD risk.

Comparison of the effects of the time of home-based cardiac rehabilitation program on the changes in cardiometabolic risk factors in patients with phase-IV myocardial infarction: A randomized controlled trial.

BACKGROUND: It seems that the time of performing cardiac rehabilitation is important in determining the risk of cardiac complications in patients with myocardial infarction (MI). The present study aimed to investigate the effects of a home-based cardiac rehabilitation program (HCRP) conducted in either the morning or evening on cardiometabolic risk factors in phase IV (maintenance) MI patients. METHODS: In this randomized controlled clinical trial, 80 patients with MI were divided into 2 groups of intervention and control (40 individuals per group). Patients in each group were categorized into morning and evening subgroups (20 individuals per subgroup). The therapeutic regimen in the intervention group included HCRP, routine medications, and exercise and walking programs for 8 weeks. Patients in the control group received routine treatments for 8 weeks. Cardiovascular risk factors comprising of cardiac troponin I (cTnI), mean platelet volume (MPV), C-reactive protein (CRP), and cardiometabolic indicators including cholesterol (Cho), high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglyceride (TG), and the maximum rate of oxygen consumption (VO2 max) were measured for all patients before and after the intervention. RESULTS: Our results showed significant reductions in Cho, TG, HDL, LDL, VO2 max, CRP, and MPV (P < 0.05) in the group performing HCRP in the evening compared with the morning group. CONCLUSION: Performing HCRP in the evening, compared with morning, can be significantly more effective in improving the levels of cardiometabolic risk factors in patients with MI. Therefore, it is recommended that rehabilitation programs be implemented in these patients in evening shifts.

Management of students' uncivil behaviors in academic environments: A context-based educational intervention.

BACKGROUND: Incivility has been raised as a growing concern and a hot topic in nursing education. The aim of this study was to determine the effect of a context-based educational intervention on the nursing students' civility index and their perception of uncivil behaviors. MATERIALS AND METHODS: This quasi-experimental study was done from 2019 to 2020 in Khorramabad, Iran. A context-based educational intervention focusing on problem-based scenarios was conducted for 4 weeks. Clark Civility Index for Students and Classmates (2017) and Clark Incivility Scale in the University Environment (2014) were used. Data were analyzed using Stata, descriptive statistics, and paired t-test. RESULTS: There was a significant difference between the mean score of students' civility index before and after the intervention (8.31 points increase, P = 0.004). However, there was no significant difference between the mean score of the civility index for classmates before and after the intervention. Furthermore, the mean score of students' perception of incivility after the intervention increased by 5.88 points, which confirmed the significant effect of the intervention in improving students' understanding of uncivil behaviors (P = 0.018). CONCLUSIONS: Considering the effectiveness of the problem-based scenario along with other strategies such as journal club and self-learning in increasing the awareness of civility and improving the civility index, the use of these strategies is recommended in order to reduce incivility.

Dose-response meta-analysis of arsenic exposure in drinking water and hypertension.

BACKGROUND: Based on the cross-sectional and cohort studies, exposure to As via drinking water can cause hypertension. METHODS: We searched PubMed, ISI WOS, and Scopus for relevant studies up to 1 January 2018 using related keywords. The meta-analysis was done on 10 studies (n = 28255) that report Odds Ratio for hypertension. The extracted ORs between As concentration and hypertension were pooled using random effect models. Study heterogeneity was analyzed using I 2. RESULTS: The estimated adjusted OR for association between As and hypertension was 1.44 (95% CI: 1.12, 1.84) with I 2 = 71%. Dose-Response analysis showed a linear relationship between As and hypertension (OR = 1.0008 95% CI: 1.0003, 1.001). In general, by increase of each unit in arsenic concentration, odds of the hypertension would increase as 0.08%. CONCLUSION: There was a significant relationship between As exposure and hypertension.

Nine-month Trend of Time-Varying Reproduction Numbers of COVID-19 in West of Iran.

BACKGROUND: The basic reproduction number (R0) is an important concept in infectious disease epidemiology and the most important parameter to determine the transmissibility of a pathogen. This study aimed to estimate the nine-month trend of time-varying R of COVID-19 epidemic using the serial interval (SI) and Markov Chain Monte Carlo in Lorestan, west of Iran. STUDY DESIGN: Descriptive study. METHODS: This study was conducted based on a cross-sectional method. The SI distribution was extracted from data and log-normal, Weibull, and Gamma models were fitted. The estimation of time-varying R0, a likelihood-based model was applied, which uses pairs of cases to estimate relative likelihood. RESULTS: In this study, Rt was estimated for SI 7-day and 14-day time-lapses from 27 February-14 November 2020. To check the robustness of the R0 estimations, sensitivity analysis was performed using different SI distributions to estimate the reproduction number in 7-day and 14-day time-lapses. The R0 ranged from 0.56 to 4.97 and 0.76 to 2.47 for 7-day and 14-day time-lapses. The doubling time was estimated to be 75.51 days (95% CI: 70.41, 81.41). CONCLUSION: Low R0 of COVID-19 in some periods in Lorestan, west of Iran, could be an indication of preventive interventions, namely quarantine and isolation. To control the spread of the disease, the reproduction number should be reduced by decreasing the transmission and contact rates and shortening the infectious period.

Up-regulation of chemokine receptor type 4 expression in the ischemic reperfused heart by alcoholic extract of Cichorium intybus rescue the heart from ischemia injury in male rat.

OBJECTIVES: Cichorium intybus is used in traditional medicine for various diseases including heart disease. This study aimed at evaluating the chemokine receptor type 4 up-regulation and cardioprotective effects of hydroalcoholic extract of C. intybus in a rat model of ischemic reperfusion. METHODS: Animals in four groups of eight rats each received vehicle or one of three doses of C. intybus (50, 100 or 200 mg/kg/d) for 14 days. Then they were subjected to 30 min of ischemia followed by 7 days of reperfusion. At the end of the experiment, blood specimens were prepared for serum assays. The level of myocardium chemokine receptor type 4 was also measured using RT-PCR. KEY FINDINGS: Cichorium intybus (CI-50) improved infarct size, episodes of the ventricular ectopic beat, ventricular tachycardia, and duration of ventricular tachycardia, QTc shortening. It also stabilized the ST segment changes and increased heart rate during ischemia. The blood pressure decreased in CI-50 group in comparison to the control and CI-200 group. C. intybus increased serum superoxide dismutase and reduced lactate dehydrogenase activity, Cardiac Troponin I and malondialdehyde levels. C. intybus led to an increase in the expression of chemokine receptor type 4. CONCLUSIONS: These findings suggest that C. intybus administration before ischemia is able to induce cardioprotective effect against ischemic reperfusion injury, probably through chemokine receptor type 4 over-expression and antioxidant activity.