Adaptation of mental health first aid guidelines for eating disorders for Iran.

BACKGROUND: This study aimed to adapt mental health first aid guidelines to support individuals with or at risk of developing eating disorders in Iran. This adaptation seeks to enhance the support available for the Iranian population dealing with these disorders. METHODS: We employed the Delphi expert consensus method, utilizing two panels: health professionals (n = 37 in the first round; n = 29 in the second) and individuals with lived experience (n = 20 in the first round; n = 18 in the second). The health professionals panel was selected from the graduates of various eating disorders associated scientific fields who had a history of providing services to or conducting research on people with eating disorders, and the lived experience panel had a history of eating disorders themselves or in their family. The panel of individuals with lived experience included those who had personal or familial histories of eating disorders. Efforts were made to ensure cultural, gender, and age diversity in the selection of panel members. Panellists rated the importance of each item for inclusion in the guidelines for Iran based on the English-language Mental Health First Aid guidelines for eating disorders. Items deemed essential by at least 80% of both panels were included in the final guideline. Additionally, panel members were invited to suggest any missing items. RESULTS: A total of 57 participants took part in the first round of the survey, and 47 participated in the second round. In the first round, 204 items across 11 categories were assessed, with 174 items endorsed by the panels. Thirteen items were re-scored in the second round, and 17 items were rejected. Participants suggested 11 new items in the first round. In the second round, 18 out of 24 items were endorsed, while six were rejected. Ultimately, 192 items were incorporated into the Iranian guidelines. CONCLUSIONS: The adaptation process considered Iran's social and cultural characteristics, including the stigma associated with mental health disorders, religious beliefs and rituals such as fasting, linguistic differences between English and Farsi, distrust of strangers, the influence of friends and family, differences in food access, and low mental health literacy. We recommend piloting the adapted guidelines in high schools, universities, and non-governmental organizations to evaluate their feasibility and effectiveness in real-world settings. Furthermore, it is essential to establish mechanisms for feedback, update content based on the latest evidence, and collaborate with the media to promote educational programs and public participation.

Iranian medical students' tendency to migrate and its associated factors.

BACKGROUND: Medical staff migration is one of the challenges for both developed and developing countries affecting society's health and welfare, which limits access to equity. Therefore, this study was designed and conducted to investigate the tendency to migrate and the factors affecting it among medical students of the Tehran University of medical sciences, Tehran, Iran, in 2019. METHODS: This cross-sectional study was performed among 472 medical students using a valid questionnaire which was designed after reviewing the literature and using the opinions of experts. The tendency to migrate and its associated factors were analyzed and reported using the Pearson correlation test, independent t-test, one-way ANOVA test, Tukey post-hock test, and Kruskal-Wallis non-parametric test. RESULTS: According to this study, the tendency to migrate was 6.13 ± 2.82 out of 10. While there was no significant relationship between age, marital status, medical educational phase and the tendency to migrate (p > 0.05); There was a significant relationship between willingness to migrate with variables of gender (p = 0.027), pre-university study region (p < 0.001), father's academic degree (p = 0.007), mother's academic degree (p < 0.001), having the relative abroad (p < 0.001), foreign trip experience (p < 0.001), foreign language skills (p < 0.001), number of published articles (p = 0.005) and Iran's National Elite Foundation membership (p = 0.039). CONCLUSIONS: Females, elites, and those with higher socioeconomic state, previous exposure to foreign countries, the ability to speak foreign languages, and research activity are more likely to migrate. Considering the high tendency to migrate among Iranian medical students, urgent and severe strategies must be undertaken to solve this social and health problem.

Identifying the non-governmental organizations' activities and challenges in response to the COVID-19 pandemic in Iran.

BACKGROUND: The spread and severity of the COVID-19 pandemic have been to such an extent that to shape an effective, collective response, governments need the participation of society and the cooperation of a wide range of civil society organizations and institutions. The objective of this study was to identify the activities of non-governmental organizations (NGOs) in response to the covid-19 pandemic in Iran and the challenges they confronted. METHODS: We conducted a qualitative analysis based on twenty-two individual, virtual, and semi-structured interviews. Interviewees were selected through purposeful and snowball sampling. All interviews were performed with active health-related NGO representatives willing to participate in the study and continued until data saturation. Data analysis was performed using qualitative content analysis. RESULTS: The activities and challenges raised by NGO representatives were identified in 6 main categories, including the need for the participation of NGOs in the fight against pandemics, response to the COVID-19 crisis in the society, challenges in providing services to the target group in the COVID-19 crisis, NGOs challenges in interacting with governmental and non-governmental institutions, information sources used by NGOs in the COVID-19 crisis and strategies to support NGOs in their efforts. CONCLUSION: Considering the crucial challenges for their participation, such as the NGO access to the target groups, lack of communication network, and constructive interaction between government institutions and the NGOs, it is recommended to increase the capacity of these institutions and intervene to establish a constructive and long-term relationship with the government.

Reflection on near-peer shadowing program: impact on operating room student's perception of their future profession.

BACKGROUND: Reflection is a key element in learning from observation and experience of future profession's roles and responsibilities in clinical encounters. Moreover, reflection helps students cope with the challenges, complexities, and uncertainties of professional development. Students' written reflections on clinical exposure offer valuable information, and their analysis provides instructors with invaluable insight into students' experiences. This study evaluated Operating Room students' written reflections on their first clinical exposure experiences towards their future profession through the shadowing program. METHODS: This study was a qualitative analysis on Operating Room freshmen's reflections in the undergraduate program of Zahedan and Zabol University of Medical Sciences in Iran. After the shadowing program, all participants were asked to write an unstructured written reflection, and these fifty written reflections were de-identified and independently analyzed using the thematic analysis approach. RESULTS: Qualitative analysis extracted 10 subthemes and four main themes including (i) Moving towards the guiding realities of future profession, (ii) Discovering milestones of realizing professional identity, (iii) Managing the emotions affecting the perception of future profession's desirability, and (iv) Excellence in professional growth and development. CONCLUSION: Reflecting on the experience of the shadowing program, the participants described being in the OR environment as a stimulating and valuable learning opportunity. Moreover, this experience helped improve their perception of future profession's realities, as well as initiate realization of professional identity and planning for professional developments.

Insights on my future job: implementing near-peer shadowing program for operating room freshmen.

BACKGROUND: As a main challenge in paramedical faculties of medical sciences, freshmen lose interest in their academic field of study and then job motivation. Lack of developed knowledge about their academic field and unfamiliarity with their future job's tasks and roles contribute to freshmen's job motivation loss. Various interventional programs have been implemented to improve students' job motivation by familiarizing them with their future job's duties and responsibilities. METHODS: This was one-group pretest-posttest design study in 2019-2020. Students grouped into pairs of a freshman (shadowee) with a senior (shadower) in a clinical setting during shadowing program. This program helps freshmen to comprehend and discover realities of their academic field and can help them change their perspectives regarding their future job's duties and responsibilities. The shadowees' main task was reflective observation on operating room events and interactions and to be active in the program, several tasks e.g., how to wear gloves, guns, and disinfect equipment were assigned to them exclusively under the supervision of senior students. The Hackman and Oldham's Job Diagnostic Survey (JDS) questionnaire and a novel Job Motivation Survey (JMS) questionnaire were distributed among participants. RESULTS: Fifty freshmen majoring in operating room participated in the shadowing program from November 2019 to January 2020. Before and after the program, they completed Hackman and Oldham's job diagnostic survey and researcher-made job motivation survey questionnaires. Results were indicative of a significant difference in job diagnostic survey questionnaire score, where overall pre-test and post-test scores before and after the intervention were 57.78 (±9.78) and 68.58 (±5.02), respectively; the score difference was statistically significant (P < 0.001). Moreover, the overall pre-test and post-test scores of the job motivation survey questionnaire were 25.16 (± 9.75) and 39.80 (±5.18), respectively; this score difference was statistically significant (P < 0.001). CONCLUSION: Shadowing program improved freshmen's realistic perception of their future job's duties and responsibility, and hence enhancing their job motivation and job recognition. As future work, in various disciplines, further studies need to evaluate the impact of such interventional programs in providing early insights for freshmen as well as in providing guidance on their plans for education, and future job.

Challenges of Clinical Practice Guidelines Adaptation in Iran: Lesson learned for Low and Middle-Income Countries.

Background: Developing a clinical practice guideline (CPG) is very time-consuming, expensive, and requires specialized knowledge; therefore, when an up-to-date and quality CPG is available, it is logical to adapt it according to local conditions. So this study aimed to identify the challenges of CPGs adaptation in Iran to help improve it and provide lessons for low and middle-income countries (LMICs). Methods: This was a qualitative study that was conducted in 2019. Semi-structured interviews were conducted with 17 participants from two levels, groups involved in the CPGs adaptation process, from research centers and specialized medical associations and policymakers and planners in CPG development and adaptation from the Ministry of Health and Medical Education (MoHME). Results: The identified challenges were classified into two basic and operational categories. Basic challenges include believing the need for CPGs adaptation, attention to CPGs adaptation in evaluation and reward systems, access to financial resources, and supervision of the adaptation process. Also, operational challenges were adaptation methodology, forming an adaptation team, consensus on interdisciplinary issues, changing programs and priorities, and external barriers in the work progress path. Conclusion: The main challenges of CPGs adaptation in Iran, as one of the LMICs, are related to education, financing, and supervision of adaptation process steps. The most significant proposed interventions to overcome the current obstacles in countries with similar contexts are holding new training courses and programs for these CPG users at different headquarters' and environmental levels, establishing an appropriate motivating system, designing an integrated adaptation system focusing on organizing related supervision affairs like planning, policy-making, and supervision at the MoHME and universities level.

Better monitoring of abused children by designing a child abuse surveillance system: Determining national child abuse minimum data set.

BACKGROUND: Monitoring the trend of child abuse can significantly help in measuring the magnitude of the problem and understanding its recurrence. The minimum data set (MDS) is a set of elements of each domain that provides the basis for decision-making. This study was conducted to determine the comprehensive national minimum data set for child abuse surveillance system (CASS) in Iran. METHODS: This is a cross-sectional descriptive study. Data were gathered from the selected countries and child abuse registry and surveillance systems. The MDS questionnaire was designed based on a review of the publications and experts' opinions. The final data elements of the CASS were determined using the Delphi technique by visiting pediatricians. RESULTS: In total, 147 data elements were included in the Delphi survey. The data elements of the CASS were classified into seven categories as follows: demographic data, incident related data, medical history, diagnostic tests, incident nature, therapeutic measures, and other required data. CONCLUSION: The existence of national MDS as the core of the child abuse surveillance program is essential and leads to appropriate decisions in this regard. The MDS can meet the needs of professionals, decision makers, researchers, and policymakers who decide on reducing the incidence of child abuse.

Assessment of Vitamin D Status and Response to Vitamin D3 in Obese and Non-Obese Iranian Children.

BACKGROUND: Obesity seems to be a critical issue nowadays because of its high prevalence and its adverse effects on health. There is some evidence indicating the relationship between obesity and lower serum 25-hydroxyvitamin D [25(OH)D] concentration. The aim of the present study was to examine serum 25(OH)D status of obese and non-obese Iranian children and compare their therapeutic response with identical oral vitamin D3 treatment. METHODS: In a non-randomized clinical trial, serum 25(OH)D level of 45 obese and 45 non-obese Iranian children aged 2-14 years was measured. Those with serum 25(OH)D status <30 ng/ml (73 cases) were treated with one pearl of vitamin D3 (50 000 International Units) once a week for 6 weeks. Serum vitamin D was measured once more 2 weeks after treatment. RESULTS: The frequency of hypovitaminosis D was 43/45 (95.6%) in obese and 30/45 (66.7%) in non-obese children at baseline (p < 0.001). After treatment of 73 cases (43 obese, 30 non-obese), the above percentages were decreased to 24/43 (55.8%) and 1/30 (3.3%), respectively (p < 0.001). CONCLUSION: Our study demonstrated a high frequency of vitamin D deficiency among Iranian children, particularly the obese ones. Moreover, low therapeutic response in the obese group is witnessed.

Ultrasound-guided fascia iliaca compartment block in orthopedic fractures: Bupivacaine 0.2% or 0.3%?

Background: Postoperative pain is one of the major problems in patients with femoral or hip fracture. Current study investigates the effect of 0.2% and 0.3% bupivacaine in ultrasound-guided fascia iliaca compartment block (FICB) on postoperative pain. Methods: This randomized clinical trial study was conducted in Rasoul Akram Hospital of Iran University of Medical Sciences. Forty-eight patients with femoral or hip fractures who were candidates for surgery underwent FICB, divided into two groups receiving bupivacaine in 0.2% and 0.3% concentrations. Pain was evaluated with Visual Analog Scale (VAS) at times 2, 6, 12, 24, and 48 hours after surgery. Need for opioids, nausea and vomiting after surgery, patients' satisfaction with pain control and motor block were also recorded. T-test or Mann- Whitney U test and Repeated measure ANOVA was used for analysis. Results: Pain score after surgery was significantly lower in groups receiving 0.3% than the group receiving 0.2% concentration. Patients' satisfaction with pain control in 0.2% group was significantly higher (p=0.04). Time to analgesic onset in both groups had no significant differences (p=0.5). The incidence of nausea and vomiting (p=0.5) and opioid consumption (p=0.1) between the two groups showed no significant difference. Conclusion: In femoral or hip fracture, bupivacaine with 0.3% concentration in fascia iliaca compartment block can cause lower pain score compared to bupivacaine with 0.2% concentration, but patients' satisfaction with pain control and severity of motor block is higher in bupivacaine 0.2%.

Assessing mental health literacy: What medical sciences students' know about depression.

BACKGROUND: Mental health literacy is an individual's knowledge and belief about mental disorders which aid their recognition, management and prevention. The aim of this study was to investigate mental health literacy among students of Tehran University of Medical Sciences. METHODS: In this cross-sectional study, data were collected by the anonymous self-administered questionnaires and finally 324 students participated in the study. Random cluster sampling was used. Questions were in different areas of the mental health literacy for depression include recognition of disorder, intended actions to seek help and perceived barriers, beliefs about interventions, prevention, stigmatization and impact of media. T-test was used for statistical analysis. RESULTS: The mean (±SD) age was 23.5±2.8. The participants were 188 (58.1%) females and 136 (41.9%) males. In response to the recognition of the disorder 115 (35.6%) students mentioned the correct answer. In help-seeking area, 208 (64.3%) gave positive answer. The majority of affected students sought for help from their friends and parents. Stigma was the greatest barrier for seeking help. Television and Internet were the most common sources of information related to mental health. CONCLUSION: Generally students' mental health literacy on depression was low in some areas. Appropriate educational programs specifically for reducing mental disorders stigma seems necessary. Organizing networks of co-helper students for mental health could be considered.

Challenges for Better thesis supervision.

BACKGROUND: Conduction of thesis by the students is one of their major academic activities. Thesis quality and acquired experiences are highly dependent on the supervision. Our study is aimed at identifing the challenges in thesis supervision from both students and faculty members point of view. METHODS: This study was conducted using individual in-depth interviews and Focus Group Discussions (FGD). The participants were 43 students and faculty members selected by purposive sampling. It was carried out in Tehran University of Medical Sciences in 2012. Data analysis was done concurrently with data gathering using content analysis method. RESULTS: Our data analysis resulted in 162 codes, 17 subcategories and 4 major categories, "supervisory knowledge and skills", "atmosphere", "bylaws and regulations relating to supervision" and "monitoring and evaluation". CONCLUSION: This study showed that more attention and planning in needed for modifying related rules and regulations, qualitative and quantitative improvement in mentorship training, research atmosphere improvement and effective monitoring and evaluation in supervisory area.

Important Systemic Factors for Improving Adolescent Mental Health Literacy.

Objective: Mental health literacy is especially important during adolescence and youth, because the peak of the onset of mental disorders occurs in this period. The present study aimed to identify the effective systemic factors for improving Iranian adolescent mental health literacy from the Perspective of policymakers and experts. Method : This qualitative study was performed on 21 policymakers and health literacy/mental health experts since May 2020 to September 2020 in the workplace of the interviewees in Tehran. Purposive sampling (snowball method) was conducted based on experience, expertise, and the willingness to participate in an interview. All interviews were conducted with the presence of the interviewer at the interviewees' workplace in Tehran. The data were collected through semi-structured interviews and analyzed via the conventional content analysis method. Results: Five themes were extracted as systemic factors for improving adolescent mental health literacy. Themes were "mental health literacy training", "integration and coordination of stakeholder organizations", "resources and facilities", "continuous assessment" and "provision of information." Conclusion: Before policy-making and planning to enhance adolescents' knowledge and awareness of mental health issues, it is necessary to attract policymakers' attention to the macro level and identify direct and indirect strategies for the correct implementation of policies adopted in this field.

High School Students' Depression Literacy about Interventions and Prevention: A Survey in Tehran.

Background: Given the high prevalence of depressive disorders in the present world and the lack of adequate awareness about prevention and appropriate interventions, increasing mental health literacy is vital for promoting mental health to reduce depression and its consequences. Methods: In this descriptive cross-sectional study, participants were recruited among the second high school students in the 2018-2019 academic year. The sample size was 2038, and samples were selected by multistage cluster sampling from different areas of Tehran. Demographic variables like age, gender, level of education, and parents' characteristics and mental health literacy questions in treatment and prevention areas were evaluated. Results: Analyses showed that of high school students, 83% considered getting help from psychiatrists and 80% considered learning stress management as the best preventive measures, while as the best treatment measures, 79.5% considered counseling the best place to refer for visiting a professional and 45% selected general counseling centers. Conclusion: The study results showed that high school students have a positive attitude toward preventing and treating depressive disorders, getting help from specialists, and useful measures for depressed people. But they did not know enough about preventive measures, including learning effective coping skills, reading self-help books, and continuing to take psychiatric medications. Planning and providing the necessary training are important, especially for high school students.

Determination of Bone Density by DEXA Method Based on Bone Age and its Comparison with Chronological Age in Chronic Patients.

Background and Objective: Given the growing awareness about the important role of children's age in building bone for a person's life, physicians need to assess bone health in high-risk children for bone density disorders more than before to optimize their bones' density and prevent osteoporosis in future. The aim of this study was to evaluate bone density based on chronological and bone age. Materials and Methods: In this cross-sectional study, 80 Patients who have been referred for bone density to the Osteoporosis Centre of the Children's Medical Centre over a one-year period (spring 98 to spring 99) were studied. Bone density was performed for all patients by using DEXA method. Results: The z-score mean chronological age for the lumbar spine was -0.8± 1.85 years and bone age was -0.58±1.64 years. The z-score mean chronological age for femoral bone was -1.6±1.02 years and bone age was -1.32± 1.4 years. Conclusion: Results showed that in all patients, the difference in the mean Z score of chronological age and bone age of the spine between patients was not significant but for femur was significant. Also, use of corticosteroids leads to significant difference between the two age groups' z-score in femur and spine.

Evaluation of beliefs and attitudes among caregivers of child labor about mental disorders first aid and stigma.

BACKGROUND: The beliefs and attitudes of caregivers of working children about mental health issues and first aid and their attitudes about the stigma of mental health problems can affect their motivation to seek professional help for affected children. This study aimed to assess the mental health literacy among caregivers of child labor about first aid for mental health and their attitudes about the stigma of mental disorders. METHODS: The Depression Health Literacy Questionnaire has been used in this cross-sectional study. All caregivers of working children who were willing to participate were included in the study. This group is covered by a Non-Governmental Organization (NGO) located in the 17th district of Tehran. RESULTS: Questionnaires completed by 131 caregivers were analyzed. The average age of the participants was 32.6 (± 7.9) years. Of which 130 (99.2%) were mothers. Amongst, only 37 individuals (28.2%) were confident in their ability to help their children in case of depression symptoms. A majority of participants, 109 (83.2%), believed that asking a depressed child about suicidal ideation was harmful. CONCLUSION: According to the findings of this study, the literacy among caregivers of child labor about mental health first aid in our study needs to be improved. There is also a need for educational and community-based programs to reduce the stigma about mental health disorders, including depression.

Development and validation of the Neonatal Abstinence Syndrome Minimum Data Set (NAS-MDS): a systematic review, focus group discussion, and Delphi technique.

OBJECTIVES: Neonatal abstinence syndrome (NAS) is a combination of symptoms in infants exposed to any variety of substances in utero. Information systems and registries help to collect information about these patients; however, there is always a deep gap between complete and accurate information to be collected, understood, and applied in the health care system; thus, defining a minimum data sets (MDS) as one of the primarily steps of designing a registry system is essential. The aim of this study was to develop an MDS of the registry for infants with NAS in Iran. METHODS: This research is a descriptive cross-sectional study. In this study, three steps were carried out to develop the MDS including systematic review, Delphi technique, and focus group discussion. A systematic review was conducted in relevant databases to identify appropriate related data. In the second phase, a focus group discussion was used to classify the extracted data elements by contributing neonatologists. Finally, data elements were chosen through the decision Delphi technique in two distinct rounds. Collected data were analyzed using SPSS 22 (SPSS Inc., Chicago, IL). RESULTS: By reviewing related papers and available NAS registries in other countries, 145 essential data elements were identified. They were classified into two main categories based on the eight experts' opinions including maternal with two sections and infant with two sections. After applying two rounds of Delphi technique, the final data elements for maternal and infant categories were 42 and 31, respectively. Thus, on completion of the survey, 73 data elements were approved. CONCLUSION: The proposed MDS for NAS can help to store an accurate and comprehensive data, document medical records, integrate them with other information systems and registries, and communicate with other healthcare providers and healthcare centers. This MDS can contribute to the provision of high-quality care and better clinical decisions.

Interventions to increase participation of NGOs in preventive care: A scoping review.

Background and Aims: Nongovernmental organizations (NGOs) have enormous potential to effectively prevent and manage diseases; however, little research is available on interventions used to improve NGOs' participation in this area. A scoping review was conducted to identify options proposed or implemented to improve the participation of the NGOs in preventive care. Methods: Pubmed, Web of Science, and ProQuest were extensively searched. Google Scholar was also searched to find potential studies related to the subject. Relevant keywords were used in the English language. The reference list of relevant studies was also scanned. Studies were screened with defined inclusion and exclusion criteria. Relevant data were then extracted. Two individuals independently screened and extracted studies. The interventions implemented or proposed to promote the participation of the NGOs in the implementation of preventive interventions were deductively identified and classified. Results: Eighteen articles were included in our review. We identified 31 interventions and categorized them into 11 strategies, including (1) building strong collaboration among NGOs and with governments; (2) expanding networks and sustained relations among NGOs; (3) evaluating the NGOs' performance; (4) increasing intersectoral collaboration; (5) advocating for the role of NGOs; (6) supporting NGOs from the side of government; (7) empowering the abilities and capabilities of NGOs; (8) defining the precise roles and responsibilities of the parties; (9) strengthening the health system governance; (10) increasing the health literacy of the community; and (11) developing required regulations, rules, and policies. None of the interventions identified had evidence of its effectiveness. Conclusion: The current evidence on effective interventions to strengthen NGOs' participation in implementing health care is scanty. It means there is an information gap in the effect of interventions to improve NGOs' participation in health.

Molecular and clinical characterization of autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy syndrome (APECED) in Iranian non-Jewish patients: report of two novel AIRE gene pathogenic variants.

OBJECTIVE: Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy syndrome (APECED) is a rare autosomal recessive systemic autoimmune disease caused by mutations in the autoimmune regulator (AIRE) gene. Incidence of this genetic disorder is estimated at 1/90,000-200,000 worldwide and 1/6500-9000 in genetically isolated populations such as Iran. Here, we investigated AIRE gene mutations in eight independent Iranian non-Jewish families. METHODS: We sequenced the coding regions of the AIRE gene and documented mutations which were further confirmed in respective parents. RESULTS: In total, 11 cases from 8 independent families were recruited. Mucosal candidiasis, Addison's disease and hypoparathyroidism were the most common clinical manifestations in these patients. One novel homozygous splice acceptor mutation (c.308-1G>C), and one novel heterozygous stop-gain mutation (c.1496delC) combined with a known heterozygous c.232T>C missense mutation were found. Moreover, we observed previously described splice donor (c.1095+2T>A), frameshift (c.967-979del), stop-gain (c.415C>T), and missense (c.62C>T) mutations among the patients. All results were co-segregated in parents. CONCLUSION: Here, we reported two novel mutations in the AIRE gene leading to APECED. Our data could provide insight into the phenotypic and genotypic spectrum of APECED in the non-Jewish Iranian population. These findings, in addition to future functional assays, can elucidate disease-causing mechanisms related to the AIRE gene and assist in genetic counseling and diagnosis.

Noninvasive markers for esophageal varices in children with cirrhosis.

BACKGROUND: The diagnosis of esophageal varices (EV) is based on the findings of esophagogastroduodenoscopy (EGD), biopsy, and serum markers. Thus, noninvasive cost-effective tests through which high-risk EV children can be diagnosed are needed. PURPOSE: This cross-sectional study aimed to identify the noninvasive markers for EV in children with liver cirrhosis. METHODS: A total of 98 children with liver cirrhosis were evaluated in this study. The spleen size, platelet count, serum albumin, liver function test results, and risk scores were evaluated prior to endoscopy. The endoscopic investigations aimed to identify the presence of EV and red signs, and determine varices sizes. RESULTS: Endoscopy revealed varices in 43 subjects (43.9%). The spleen size, platelet count, international normalized ratio, aspartate aminotransferase to platelet ratio index (APRI), platelet count to spleen size ratio, and risk score differed significantly between patients with and without EV on univariate analysis; however, the logistic regression analysis showed no differences, indicating that none of these parameters were independently associated with the presence of EV. CONCLUSION: Platelet count, risk score, platelet count to spleen size, and APRI can be useful tools for the identification of highrisk patients with EV and might reduce the need for invasive methods like EGD.

Nurses' attitudes toward caring for terminally ill neonates and their families in Iran: a cross-sectional study.

Providing care for terminally ill neonates is an important issue in NICUs. This research aimed to determine nurses' attitudes toward providing care for terminally ill neonates and their families. A total of 138 nurses working in neonatal intensive care units (NICUs) affiliated to Tehran University of Medical Sciences participated in this cross-sectional study via convenience sampling in 2019. The Data collection tool was the Frommelt attitudes toward caring for terminally ill persons and their families scale. The nurses in this study had the most positive attitudes toward the items "nursing care should include the family of the terminally ill patient, too" (4.2 ± 0.6) and "the care provider can prepare the patient or his/her family for death" (4.1 ± 0.7). The nurses had the least positive attitude toward the item "the time spent on caring for terminally ill patients creates a sense of frustration in me" (1.06 ± 1). The mean score of the attitudes of NICU nurses toward caring for terminally ill neonates and their families indicates the necessity of improving this attitude.