The Arg/Arg genotype of leptin receptor gene Gln223Arg polymorphism may be an independent risk factor for nonalcoholic fatty liver disease.

BACKGROUND: Given that obesity and insulin resistance play key roles in the pathogenesis of nonalcoholic fatty liver disease (NAFLD) and the connection between leptin and these metabolic diseases, the association between NAFLD and a leptin receptor gene (LEPR) polymorphism was examined. METHODS: In this genetic case-control association study, 144 biopsy-proven NAFLD patients and 144 controls were genotyped for the LEPR gene Gln223Arg (rs1137101) polymorphism using the polymerase chain reaction-restriction fragment length polymorphism method. RESULTS: The distributions of genotypes and alleles of Gln223Arg variant were in accordance with the Hardy-Weinberg equilibrium in the study groups (P > .05). Multivariate logistic regression analysis showed that the LEPR Gln223Arg Arg/Arg genotype was an independent risk factor for NAFLD; the Arg/Arg genotype, compared with the Gln/Gln genotype, was associated with a 2.09-fold increased risk for NAFLD (P = .036, odds ratio = 2.09 [95% CI = 1.31-5.95]). CONCLUSIONS: We found that the LEPR Gln223Arg Arg/Arg genotype was independently associated with a more than 2-fold rise in biopsy-proven NAFLD risk. Our findings, however, need to be corroborated by further studies.

Microfluidic sperm sorting selects a subpopulation of high-quality sperm with a higher potential for fertilization.

STUDY QUESTION: Is a microfluidic sperm sorter (MSS) able to select higher quality sperm compared to conventional methods? SUMMARY ANSWER: The MSS selects sperm with improved parameters, lower DNA fragmentation, and higher fertilizing potential. WHAT IS KNOWN ALREADY: To date, the few studies that have compared microfluidics sperm selection with conventional methods have used heterogeneous study population and have lacked molecular investigations. STUDY DESIGN, SIZE, DURATION: The efficiency of a newly designed MSS in isolating high-quality sperm was compared to the density-gradient centrifugation (DGC) and swim-up (SU) methods, using 100 semen samples in two groups, during 2023-2024. PARTICIPANTS/MATERIALS, SETTING, METHODS: Semen specimens from 50 normozoospermic and 50 non-normozoospermic men were sorted using MSS, DGC, and SU methods to compare parameters related to the quality and fertilizing potential of sperm. The fertilizing potential of sperm was determined by measurement of phospholipase C zeta (PLCζ) and post-acrosomal sheath WW domain-binding protein (PAWP) expression using flow cytometry, and the chromatin dispersion test was used to assess sperm DNA damage. MAIN RESULTS AND THE ROLE OF CHANCE: In both normozoospermic and non-normozoospermic groups, the MSS-selected sperm with the highest progressive motility, PLCζ positive expression and PLCζ and PAWP fluorescence intensity the lowest non-progressive motility, and minimal DNA fragmentation, compared to sperm selected by DGC and SU methods (P < 0.05). LIMITATION, REASONS FOR CAUTION: The major limitations of our study were the low yield of sperm in the MSS chips and intentional exclusion of severe male factor infertility to yield a sufficient sperm count for molecular experiments; thus testing with severe oligozoospermic semen and samples with low count and motility is still required. In addition, due to ethical considerations, at present, it was impossible to use the sperm achieved from MSS in the clinic to assess the fertilization rate and further outcomes. WIDER IMPLICATIONS OF THE FINDINGS: Our research presents new evidence that microfluidic sperm sorting may result in the selection of high-quality sperm from raw semen. This novel technology might be a key to improving clinical outcomes of assisted reproduction in infertile patients. STUDY FUNDING/COMPETING INTEREST(S): The study is funded by the Iran University of Medical Sciences and no competing interest exists. TRIAL REGISTRATION NUMBER: N/A.

Efficacy of mobile-based educational intervention using Instructional Systems Design in promoting preventive behaviors for sexually transmitted infections among Iranian women: a randomized controlled trial.

BACKGROUND: Women who are sexually active are at risk of sexually transmitted infections (STIs), which can cause serious difficulties for their reproductive health. However, despite the high global burden of STIs, most infections are preventable with education for behavioral change. The purpose of this study is to investigate the Efficacy of Mobile-Based Educational Intervention Using Instructional Systems Design in Promoting Preventive Behaviors for Sexually Transmitted Infections among Iranian Women. METHODS: This randomized controlled trial aimed at promoting preventive behaviors related to STIs in Iranian women with an educational intervention based on the Instructional Systems Design (ISD) in 2022. The participants in this study were recruited from a single center, specifically the Health House No. 3 located in District 11 of Tehran Municipality. Two instruments were used in the present study: a) a valid scale titled: "Four-Scale of STI Preventive Behaviors", and b) a researcher-made Questionnaire titled: "Social perception affecting sexually transmitted infections (SOPESTI)". These tools contain 8 demographic items and specific questions with a total of 68 five-point Likert scales. The intervention comprised three phases: a pre-test (baseline), a training program, and two follow-up assessments (4 and 12 weeks after the start of the training program). The experimental group received education through a mobile app, while the control group received no intervention. SPSS v.26 was used, with a significance level of P < 0.05. The chi-square test, Fisher's exact test, independent t-tests, analysis of covariance (ANCOVA), and repeated measures ANOVA were used to analyze the data. RESULTS: A total of 80 women, with a mean age of 36.524 ± 6.91 (experiment group) and 34.78 ± 8.20 (control group), respectively, participated in the trial. The study revealed a statistically significant difference in the mean score for eight domains, including STIs Knowledge, STIs Vulnerability, STIs Preventive Self-efficacy, STIs Prevention intentions, STIs Perceived social exclusion, STIs Perceived cognitive barriers, STIs Perceived social support, and STIs Perceived risks in the experiment group following the intervention compared to before the intervention (p < 0.05). CONCLUSION: The results of this study showed that a mobile-based educational intervention based on the ISD model had a significant effect on the preventive behaviors of STIs in Iranian women. These results highlight the potential benefit of mobile health in enhancing reproductive health. TRIAL REGISTRATION: ClinicalTrials.gov IRCT20200602047638N1. Registered on 22 May 2021 with the IRCTID, V1.0. https://www.irct.ir/trial/55632.

Interplay of self-care, self-efficacy, and health deviation self-care requisites: a study on type 2 diabetes patients through the lens of Orem's self-care theory.

BACKGROUND: This study aimed to examine the relationship between Self-Care, Self-Efficacy, and Health Deviation Self-Care Requisites in patients with type 2 diabetes based on Orem's Self-Care Theory. METHODS: The research involved 341 patients with type 2 diabetes in Rasht, Iran, using a descriptive-analytical cross-sectional design. The data collection included questionnaires assessing Self-Care Behaviors, Self-Efficacy, and Health Deviation Self-Care Requisites based on Orem's model. RESULTS: Demographic factors such as gender, marital status, employment, education, age, duration of disease, and oral treatment and insulin had no consistent effect on self-care behaviors. Self-efficacy was a key factor influencing Self-Care Behaviors in diabetic patients. There was a strong and direct correlation between Self-Care Behaviors and Self-Efficacy, indicating the role of individuals' confidence in managing diabetes. Health Deviation Self-Care Requisites had both positive and negative correlations with different domains of Self-Care Behaviors.The physical exercise construct of self-efficacy was the most significant predictor of Self-Care Behaviors. CONCLUSIONS: This study provides valuable insights into the complex relationship between Self-Care, Self-Efficacy, and Health Deviation Self-Care Requisites in patients with type 2 diabetes. The findings underscore the importance of addressing Self-Efficacy and specific self-care domains, such as physical activity and foot care, in diabetes management strategies. This research contributes to the existing knowledge base and may inform healthcare professionals and policymakers in developing targeted interventions to improve self-care practices in diabetic patients.

Bursts of communication increase opinion diversity in the temporal Deffuant model.

Human interactions create social networks forming the backbone of societies. Individuals adjust their opinions by exchanging information through social interactions. Two recurrent questions are whether social structures promote opinion polarisation or consensus and whether polarisation can be avoided, particularly on social media. In this paper, we hypothesise that not only network structure but also the timings of social interactions regulate the emergence of opinion clusters. We devise a temporal version of the Deffuant opinion model where pairwise social interactions follow temporal patterns. Individuals may self-organise into a multi-partisan society due to network clustering promoting the reinforcement of local opinions. Burstiness has a similar effect and is alone sufficient to refrain the population from consensus and polarisation by also promoting the reinforcement of local opinions. The diversity of opinions in socially clustered networks thus increases with burstiness, particularly, and counter-intuitively, when individuals have low tolerance and prefer to adjust to similar peers. The emergent opinion landscape is well-balanced regarding groups' size, with relatively short differences between groups, and a small fraction of extremists. We argue that polarisation is more likely to emerge in social media than offline social networks because of the relatively low social clustering observed online, despite the observed online burstiness being sufficient to promote more diversity than would be expected offline. Increasing the variance of burst activation times, e.g. by being less active on social media, could be a venue to reduce polarisation. Furthermore, strengthening online social networks by increasing social redundancy, i.e. triangles, may also promote diversity.

Insulin-like growth factor binding protein 3 promoter variant (rs2854744) is associated with nonalcoholic fatty liver disease

ABSTRACT Objective: Nonalcoholic fatty liver disease (NAFLD) is a chronic liver disease and a growing global epidemic. In NAFLD, liver fat surpasses 5% of hepatocytes without the secondary causes of lipid accumulation or excessive alcohol consumption. Given the link between NAFLD and insulin resistance, the possible association between the rs2854744 (−202 G>T) promoter polymorphism of insulin-like growth factor binding protein 3 (IGFBP3) gene and NAFLD was investigated in this study. Materials and methods: In this genetic case-control association study, the IGFBP3 rs2854744 genotypes of 315 unrelated individuals, including 156 patients with biopsy-proven NAFLD and 159 controls, were determined using polymerase chain reaction/restriction fragment length polymorphism analyses. Results: The "GT+TT" genotype of the IGFBP3 rs2854744 polymorphism, compared with the "GG" genotype, was associated with a 2.7-fold increased risk of NAFLD after adjustment for confounding factors (P = 0.009; odds ratio [OR] = 2.71; 95% confidence interval [CI] = 1.19-3.18). Additionally, the IGFBP3 rs2854744 "T" allele, in comparison with the "G" allele, was significantly overrepresented in NAFLD patients than the controls (P = 0.008; OR = 1.85; 95%CI = 1.23-2.94). Conclusion: Our findings first indicated that the IGFBP3 rs2854744 "GT+TT" genotype is a marker of increased NAFLD susceptibility; however, it needs to be supported by further investigations in other populations.

Insulin-like growth factor binding protein 3 promoter variant (rs2854744) is associated with nonalcoholic fatty liver disease.

Objective: Nonalcoholic fatty liver disease (NAFLD) is a chronic liver disease and a growing global epidemic. In NAFLD, liver fat surpasses 5% of hepatocytes without the secondary causes of lipid accumulation or excessive alcohol consumption. Given the link between NAFLD and insulin resistance, the possible association between the rs2854744 (-202 G>T) promoter polymorphism of insulin-like growth factor binding protein 3 (IGFBP3) gene and NAFLD was investigated in this study. Materials and methods: In this genetic case-control association study, the IGFBP3 rs2854744 genotypes of 315 unrelated individuals, including 156 patients with biopsy-proven NAFLD and 159 controls, were determined using polymerase chain reaction/restriction fragment length polymorphism analyses. Results: The "GT+TT" genotype of the IGFBP3 rs2854744 polymorphism, compared with the "GG" genotype, was associated with a 2.7-fold increased risk of NAFLD after adjustment for confounding factors (P = 0.009; odds ratio [OR] = 2.71; 95% confidence interval [CI] = 1.19-3.18). Additionally, the IGFBP3 rs2854744 "T" allele, in comparison with the "G" allele, was significantly overrepresented in NAFLD patients than the controls (P = 0.008; OR = 1.85; 95%CI = 1.23-2.94). Conclusion: Our findings first indicated that the IGFBP3 rs2854744 "GT+TT" genotype is a marker of increased NAFLD susceptibility; however, it needs to be supported by further investigations in other populations.

Evaluation of a mobile-application educational intervention on the knowledge, attitude, and practice of patients in postoperative care for lumbar disk herniation surgery: A randomized control trial.

Objective: We aimed to evaluate the impact of a mobile-based educational program on patients' postoperative care for lumbar disk herniation surgery. Methods: A randomized controlled trial was conducted at Fayaz-Bakhsh Hospital, Tehran, Iran. Patients with lumbar disc herniation surgery experience were randomized to the intervention and control groups (learning with the LUmbar CAring Training-app). Participants' knowledge, attitudes, and practices of postoperative care for lumbar disc herniation surgery were assessed using a validated questionnaire at three-time points: pre-test (baseline), post-test one (immediately after program completion), and post-test two (8 weeks after program completion). The primary outcome measures were knowledge, attitudes, and practices scores variations. Secondary outcomes were not considered in our study. Results: In total, 150 patients were enrolled, with 75 patients in each group. Patients in the intervention group demonstrated increased knowledge, modified attitudes, and practice than those in the control group (p < 0.05). The post-test knowledge, attitudes, and practices scores in the intervention group were significantly higher than those in the control group (p < 0.05). Conclusion: Mobile-application-based education was a practical and feasible approach to improve patients' postoperative care for lumbar disc herniation surgery in Iran.

A mobile-based educational intervention on media health literacy: A quasi-experimental study.

Background: Health misinformation on social media is a persistent public health concern that requires the proper skill set for interpreting and evaluating accurate information. This study aimed to determine the effects of a mobile app-based educational intervention on media health literacy (MHL) development among Iranian adults. Methods: This study was a quasi-experimental design conducted in 2022 that included 100 Iranian adults aged 18 to 65 years old. The inclusion criteria for participation were ownership of an Android smartphone, no prior training in MHL, and membership in at least one virtual social media app. As the primary outcome of the study, MHL was assessed using the validated MeHLit questionnaire with two follow-up time points (immediately after program completion and 12 weeks after program completion) in addition to a pre-test. Participants were divided into an experimental group that received the mobile app-based training program and a control group that received none. Results: The repeated measures test revealed a significant effect of the group-time interaction on the mean MHL score in both the intervention and control groups. Within the intervention group, the follow-up test indicated a significant increase in mean MHL scores for post-test 1 (63.54±12.57) and post-test 2 (65.72±7.97) compared to the pre-test phase (55.14±12.04), with these increases being statistically significant (P<0.001). No significant difference was observed within the control group. Conclusion: The results of this study suggest that the mobile app-based educational intervention was effective in improving MHL among Iranian adults. These findings highlight the potential of mobile app-based interventions for promoting MHL and addressing health misinformation on social media.

Factors predicting oral health behaviors among students age 13-15 years in Shushtar city, Iran.

BACKGROUND: Tooth decay and other oral health (periodontal) diseases are highly prevalent worldwide and present a significant economic burden. Oral health is particularly important for adolescents, as the World Health Organization has identified tooth decay as one of the most pressing global health issues. This study aims to identify predictors of oral health behaviors among students aged 13-15 years in the city of Shushtar, Iran. METHODS: The present research is a cross-sectional study that was conducted during the summer of 2022 on 415 adolescents from the first secondary school in Shushtar. Two standard questionnaires were used to collect data, consisting of demographic information and questions related to measuring awareness, attitude, performance, and self-efficacy regarding oral health behaviors among adolescents. The collected data was analyzed using SPSS 22 statistical software through descriptive statistics, Pearson correlation, and regression analysis. RESULTS: The average scores for awareness, attitude, self-efficacy in brushing teeth, self-efficacy in flossing, self-efficacy in going to the dentist, and adolescents' performance on oral health behaviors are 5.72 ± 2.06, 36.40 ± 6.36, 25.40 ± 7.49, 14.15 ± 6.06, 15.80 ± 5.59, and 14.01 ± 4.02, respectively. CONCLUSION: Based on the results of this study, it can be concluded that adolescents have low levels of awareness, performance, self-efficacy, and a positive attitude towards oral health. Considering the significance of adolescence as a stage for shaping oral health behaviors and their impact on adulthood, it is recommended to increase awareness among adolescents and improve their health behaviors by conducting educational classes in schools.

The challenges of urban family physician program over the past decade in Iran: a scoping review and qualitative study with policy-makers.

Introduction: Despite all the advantages of urban family physician program (UFPP), there is still a gap between UFPP and what is actually achieved by the community after its implementation in Iran. In response, this study attempted to review published studies related to the barriers to the implementation of the UFPP in Iran as well as potential solutions to improve it. Further, a qualitative study was conducted to learn the perspectives of experts at the national level and in the Fars province in order to better understand the program's challenges. Methods: This study was conducted in two phases. First, a scoping review was done, aiming to identify the common barriers and potential solutions to implementing UFPP in Iran. Second, a qualitative study using semi-structured interviews was conducted to investigate the views of decision- and policy-makers regarding barriers to and solutions for implementing the UFPP in the Fars province over the last decade. The findings were classified using the five control knobs framework (organization, financing, payment, regulation, and behavior). Results: The most common barriers to UFPP were: 1) organization (ununited stewardship function of the Ministry of Health, weak management and planning, inadequate training of human resources, and a weak referral system); 2) financing (fragmented insurance funds, insufficient financial resources, and instability of financial resources); 3) payment (inappropriate payment mechanisms and delay in payments); 4) regulation (cumbersome laws and unclear laws); and 5) behavior (cultural problems and conflict of interests). On the other hand, several solutions were identified to improve the implementation of UFPP, including: enhancing the role of government; improving the referral system; providing comprehensive training for UFPP providers; considering sustainable financial resources; moving towards mixed-payment mechanisms; employing appropriate legal and regulatory frameworks; enhancing community awareness; and elevating incentive mechanisms. Conclusion: Our research found that, despite the UFPP having been in place for a decade in Iran, there are still significant challenges in all five components. Therefore, the promotion of this program requires solving the existing implementation challenges in order to achieve the predetermined goals. The ideas in this study can be used to improve the current program in Fars Province and bring it to other cities in Iran.

The effects of kindling during pregnancy on long-term potentiation (LTP) induction and M1 muscarinic acetylcholine receptors in male rat offspring.

Background and purpose: Neonates of pregnant women with epilepsy may compromise normal neurodevelopment and hippocampal morphology. Memory and learning disorders and a decrease in verbal IQ scores are seen in these children later in life. In the previous study, we suggested that the central muscarinic cholinergic receptors had an important role in learning and memory deficits induced by prenatal pentylenetetrazol-kindling in pups born to kindled mothers. This study aimed to investigate the effects of kindling during pregnancy on long-term potentiation (LTP) induction and the role of M1 muscarinic acetylcholine receptors in the hippocampus of male offspring. Experimental approach: Twenty female Wistar rats were divided into two groups on the 13th day of their gestation (kindled and control; n = 10). Animals in the first group were kindled by i.p. injections of 25 mg/kg body weight pentylenetetrazol every 15 min until seizures occurred and the control group received normal saline. The effect of maternal seizures and perfusion of specific M1 muscarinic receptors antagonist (telenzepine at doses of 0.01, 0.1, and 1 nmol) on the LTP induction of 80 pups were tested at 12 weeks of age by field potential recordings. Findings/Results: The results of the electrophysiological study revealed that recurrent seizures during pregnancy impaired field excitatory postsynaptic potentials (fEPSP)-LTP induction and normal development of M1 muscarinic receptors in the hippocampus of male offspring. Also, the results demonstrated that maternal seizure did not significantly affect the paired-pulse indexes and population spike-LTP in the hippocampus of male offspring. Conclusion and implications: Our study showed that recurrent seizures during pregnancy cause impaired fEPSP-LTP induction and abnormal development of the M1 muscarinic receptor in the hippocampus.

Design and psychometric properties of a tool to assess the knowledge, attitude and practice of health care workers for infodemic management (KAPIM-Tool).

BACKGROUND: Infodemics, defined as the rapid spread of misinformation during an epidemic or pandemic, can have serious public health consequences. Healthcare workers(HCWs) play a critical role in managing infodemics, but their knowledge, attitudes, and practices(KAP) related to infodemic management are not well understood. This study aimed to design and validate a tool to assess healthcare workers' KAP related to infodemic management. METHODS: The knowledge, attitude, and practice of HCWs for the infodemic management assessment tool were designed through exploratory factor analysis. At first, primary items were extracted through two separate studies (face-to-face interviews with 17 participants and a systematic review). Then Face validity, Content validity, and Construct validity were done with the 15 participants of healthcare workers who had sufficient knowledge and experience. The content validity ratio (CVR) and content validity index (CVI) was checked for each item. The construct validity of the tool was also calculated through exploratory factor analysis with the participation of 250 healthcare workers (6.25 participants per item). The intraclass correlation coefficient (ICC), and Cronbach's alpha was calculated to evaluate the reliability of the findings using IBM SPSS Statistics V21.0. RESULTS: The primary KAPIM (Knowledge, Attitude, and Practice) of healthcare workers in (the Infodemics Management) tool has 53 items, in content, face, and construct validity 13 items were removed. Factor analysis revealed three factors: knowledge (24 items), attitudes (8 items), and practice (8 items). The overall reliability of the tool was reported as adequate with a Cronbach's alpha of 0.905. The ICC of the entire tool was calculated as 0.827. CONCLUSION: The KAPIM tool is a valid and reliable tool for assessing healthcare workers' knowledge, attitudes, and practices related to infodemic management with 40 items. The tool can inform targeted interventions to improve healthcare workers' preparedness and response to infodemics.

Prerequisites of sexual health literacy promoting service: a qualitative study in Iran.

BACKGROUND: Sexual health literacy is one of the determinants of the rate, factors, and outcomes of problems associated with sexual health and reproductive. The prerequisite of having and promoting this type of literacy is the appropriate organization and access to sexual health services. The current study was conducted with the objective of describing the perceptions and experiences of health care providers and recipients of sexual health literacy promoting services. METHODS: The current qualitative study was conducted on 37 individuals in the form of 3 individual in-depth and semi-structured interviews and 4 focus group discussions (26 individuals) with service recipients (women of reproductive age), and 8 in-depth and semi-structured interviews with service providers in Amol from September 2019 to March 2020. The recorded interviews were transcribed and analyzed through content analysis. RESULTS: Data analysis resulted in the extraction of the theme titled "prerequisites of sexual health literacy promoting service" which consisted of two subthemes 'client-oriented service' and 'efficient service'. In the client-oriented service attention must be paid to the client's age, sex, needs and socio-cultural background. Efficient service is a service which is based on continuing sexual education, can reconstruct sexual attitudes, is professional, team-based, integrated into other services, and has a follow-up structure. CONCLUSIONS: The results outline the requirements for sexual health literacy promoting services which should be taken into consideration during the policymaking, planning and design of relevant health programs.

Activation of androgen receptors alters hippocampal synaptic plasticity and memory retention through modulation of L-type calcium channels.

AIMS: It has been revealed that membrane androgen receptor activation modulates avoidance memory and synaptic plasticity. In a previous study, we showed that Calcineurin, a calcium dependent phosphatase, could be a potential mediator of these AR effects. Also, it is reported that AR activation leads to L-type calcium channel activation. The aim of the current study is to test whether L-type calcium channels are downstream of AR and whether this signal pathway mediates the impairment effect of androgenic steroids on passive avoidance memory and synaptic plasticity. MATERIALS AND METHODS: We measured the effect of Nandrolone Decanoate (AR agonist), AR antagonist (Nilutamide) plus ND or L-type calcium channel inhibitor (Nifedipine) plus ND on passive avoidance performance of adolescent male rats. For extracellular field potential recordings hippocampal slices were perfused with ND, Nilutamide-ND or Nifedipine-ND. KEY FINDINGS: Our results clarified that AR activation by ND could impair avoidance behavior as step through latency decreased in ND-treated group while application of both Nilutamide and Nifedipine reestablished normal avoidance behavior. Also, LTP induction in the CA1 area of hippocampus was diminished by ND perfusion and both AR antagonist and L-type calcium channel inhibitor application lead to normal LTP. These findings support our hypothesis that activation of L-type calcium channels are involved in ARs mechanism effects on both avoidance behavior and hippocampal synaptic plasticity. SIGNIFICANCE: Understanding the biological effects of AR agonists on cognitive processes and its cellular mechanism may be a new/supplementary way to treating fear-related disorders.

The Relationship Between Perception of Good Death With Clinical Competence of End-Of-Life Care in Critical Care Nurses.

Providing a good death can be one of the most important goals of end-of-life care. This study aimed to investigate the relationship between the concept of good death with clinical end-of-life care competence among intensive care nurses. The participants were 279 nurses in southeast Iran. The data were collected using the Nurses' Concept of Good Death Questionnaire and the Clinical Competency of End-of-Life Care Questionnaire. There was a positive, moderate, and significant correlation between nurses' concept of good death and their clinical competence in end-of-life care. Nurses who got higher scores on the concept of good death showed higher levels of clinical competence in end-of-life care. It is possible to take steps to improve nurses' concepts and knowledge through specialized educational interventions.

Educational interventions to improve women's preventive behavior of sexually transmitted infections (STIs): study protocol for a randomized controlled trial.

BACKGROUND: Sexually active women aged 18 to 48 are within the population at risk for acquiring sexually transmitted infections. Some STIs can cause serious complications in women's reproductive health. Accordingly, this practical randomized trial aims to evaluate the effect of an interventional education based on the ISD model on improving preventive behaviors for Iranian women. METHODS: Women aged 18-48 years that refer to Tehran Municipality Health Houses will be invited to join the study. Recruitment will continue until a sample of 150 women participants. The study will be conducted using a mixed-methods protocol in three phases. In the first phase, women's educational and learning needs about STIs will be identified using a qualitative approach. In the second phase, the results from the qualitative approach will be used to design a training program based on an ISD model. The educational intervention will be performed in the third phase. Participants will be randomly allocated into two groups: (1) the intervention group and (2) the control group. Data will be collected using STI Four-Scale of Preventive Behaviors at baseline, immediately, 1-month, and 3-month follow-up assessments. The impact of the intervention on the promotion of preventive behaviors from STIs will then be evaluated. DISCUSSION: This study provides an educational program for empowering and promoting behaviors that prevent STIs. If the designed interventions in the present study are effective, it has practical potential to be generalized for Iranian women at risk of STIs. TRIAL REGISTRATION: ClinicalTrials.gov IRCT20200602047638N1 . Registered on 22 May 2021 with the IRCTID, V1.0.

Improve the cervical cancer prevention behaviors through mobile-based educational intervention based on I-CHANGE model: study protocol for a randomized controlled trial.

BACKGROUND: Applications of mobile technologies (mHealth) have the potential to reduce health inequalities, give patients more control over their health, and improve health care's cost-effectiveness. The widespread use of mobile phones offers us a new way to prevent cervical cancer. The objective of the study was to design and develop a mobile phone application (app) that aims to conduct a behavioral intervention for women and to evaluate the efficacy of the app-based intervention. METHODS: This study involves 5 phases. In the first phase, understanding women's perspectives will be identified using a qualitative approach based on the I-Change model. In phase 2, the results from the qualitative approach and requirement prioritization through providing experts' perspectives will be done. The main outputs of this phase will be resulted in prioritizing the main measurable effective variables of the I-Change model. Phase 3 will be processed for the development and psychometric of an assessment tool regarding selected constructs. In phase 4, the App framework and content development will be performed. In phase 5, a three-armed, parallel-design randomized controlled trial will be conducted on women. Two hundred ten women will be randomly assigned to three groups including two intervention groups and one control group. The intervention groups included the following: (1) a mobile application and (2) a digital book. The data will be evaluated using tools designed and constructed in phase 3 of the study at baseline in 3-month follow-up assessments. The impact of the two interventions on cervical cancer prevention behaviors through mobile-based educational intervention will then be evaluated. DISCUSSION: A theory-based health education program using a mobile app to improve cervical cancer-preventive behaviors will be implemented for the first time in Iran. With an effective health mobile-based educational design, it is very important to determine whether Iranian women will be motivated to adhere to preventive behavior related to CC. TRIAL REGISTRATION: Iranian Clinical Trial Register IRCT20181205041861N3. Registered V2.0 on 26 October 2021.

Development and psychometric properties of a tool to assess Media Health Literacy (MeHLit).

BACKGROUND: Media play an important role in shaping and changing the attitudes, thoughts, and behaviors of their audiences regarding health issues. Therefore, there is a need to explore and identify media health literacy concepts and domains. METHODS: This is a cross-sectional study to design and psychometry an instrument to assess Media Health Literacy (MeHLit) from June to Septemper 2021. Relevant literature was reviewed to identify an item pool, and an expert panel was convened to choose items that might be included in the scale. The validity of the questionnaire was assessed through face validity (qualitative and quantitative),content validity (qualitative and quantitative) and construct validity (exploratory and confirmatory factor analysis) in 213 adults. Internal consistency of the scale was assessed by Cronbach's alpha. RESULTS: The content validity and reliability were demonstrated by CVR = 0.87 and CVI = 0.93, Cronbach's α = 0.91. Exploratory factor analysis showed 5 factors including "Goal appraisal skill"; "Content appraisal skill" "Implicit message appraisal skill"; "Visual Comprehension skill"; "Audience appraisal skill"; which explained 60.25 of the variance. CONCLUSION: MeHLit is a valid and reliable questionnaire, with 21-item and 5 domains to assess media health literacy. To replicate the results obtained here, this measurement should be translated and maintained in other settings.