The effect of pomegranate consumption on cardiovascular risk factors in hemodialysis patients: A systematic review of clinical trials.

Patients undergoing maintenance dialysis have a significantly higher incidence of cardiovascular disease (CVD) compared with the general population. CVD is the most common cause of morbidity and mortality among hemodialysis patients, and has been attributed, among other causes, to increased oxidative stress, inflammation, hypertension and dyslipidemia. Pomegranate, a popular fruit worldwide, has demonstrated health benefits such as antioxidative, antidiabetic, antihypertensive, antihyperlipidemic and anti-inflammatory effects. In this systematic review of clinical trials, we aim to summarize the effect of different parts of pomegranate and the effects of its use on CVD risk factors in hemodialysis patients. PubMed/MEDLINE, EMBASE, Scopus, and Web of Science were searched to identify eligible clinical trials up to December 2021. Ultimately, seven clinical trials were included in this study. Different parts of pomegranate used in these trials were pomegranate juice, pomegranate extract and pomegranate peel extract. The duration of the studies varied from one dialysis session to 1 year. Our results showed that different parts of pomegranate may have anti-hypertensive, antioxidant, anti-inflammatory effects and improve lipid profile by decreasing TG (triglycerides) and increasing HDL-C (high-density lipoprotein cholesterol) in hemodialysis patients. However, due to limited number of studies, more clinical trials need to be performed.

Underpinning Learning Theories of Medical Educational Games: A Scoping Review.

Background: Gamification is the process of game thinking and game mechanics to attract learners and solve problems. It is a unique growing phenomenon in education and training programs. Educational games, by application of game design and game elements in learning environments, motivate students to learn and improve the teaching and learning process. Herein, this scoping review presents an overview of the theoretical underpinnings of gamification that is crucial in understanding the theoretical pillar of successful educational games. Methods: This scoping review follows Arksey and O'Malley's stages of scoping review. In this review, the gamification in medical education articles that implicitly or explicitly presented underpinning learning theories of gamification in medical education was retrieved. So, keywords such as gamification, learning theories, higher education, and medical education were searched in Scopus, PubMed, WEB OF SCIENCE, EMBASE, ERIC, and Cochrane Library from 1998 to March 2019. Results: The search indicated 5416 articles which were narrowed down by title and abstract relatedness. 464 articles entered the second phase of the study and after reviewing their full text, finally, 10 articles which were explicitly and implicitly reported the underpinning learning theories remained. Conclusion: Gamification is a strategy using game design techniques for non-game experiences for more effective learning and provides a more attractive environment for teaching and learning. Designing gamification based on learning theories (behavioral, cognitive, and constructivist), makes them more efficient, and the application of learning theories in designing gamification is recommended.

Comparison of the key modifiable factors in the first 1000 days predicting subsequent overweight and obesity in pre-school children in Tehran: a case-control study.

The identification of paediatric obesity predictors in the early stages of life is warranted, as it can influence the development of effective strategies to prevent metabolic disorders. In this case-control study, we assessed nine risk factors for paediatric obesity, namely a birth weight > 4000 g, an exclusive breast-feeding period < 4 months, the introduction of solid food at < 4 months, maternal overweight or obesity before pregnancy, maternal smoking during pregnancy, the presence of gestational diabetes, paternal overweight and obesity and paternal smoking. In order to identify the most relevant predictors of paediatric obesity, we employed a multiple logistic regression model with R2 Cox Snell by adjusting confounders. In the randomly selected 509 preschool children from Tehran, children exposed to gestational diabetes had the maximum predicted probability of obesity (4·36 (1·94, 9·80) %) among the analysed risk factors %. The introduction of solid food at < 4 months of age increased the risk of obesity by 2·98 (1·77, 4·97 %). The OR of childhood obesity was associated with maternal overweight and obesity (2·72(1·60-4·60) %), maternal smoking (2·21 (1·18, 4·11) %) and excessive gestational weight gain (1·89 (1·23, 2·91) %). Paternal smoking and high birth weight increased the risk of paediatrics obesity > 1·8 times (1·15-2·94) and > 1·5 times (1·015-2·43), respectively. There was no association between the paternal BMI, the exclusive breast-feeding time and the risk of paediatric obesity. Among early risk factors, probably gestational diabetes can be considered as the most important predictor for the risk of paediatric obesity.

Development and evaluation of a teleoncology system for breast cancer during the COVID-19 pandemic.

Background: The present study describes the steps of developing a hybrid teleoncology system to provide treatment plans for breast cancer patients. Materials & methods: This research was conducted in four stages, including developing a proposal for experts, identifying and analyzing system requirements, designing a prototype and implementing and evaluating the final version of the hybrid teleoncology system. Results: The results of the usability evaluation showed that the users evaluated the system at a good level and, in practice, the implemented system was perceived to be useful by specialists in providing treatment plans for cancer patients. Conclusion: The hybrid teleoncology system is a practical alternative to traditional methods for providing treatment plans to breast cancer patients.

Factors influencing adoption of e-learning in healthcare: integration of UTAUT and TTF model.

BACKGROUND: The importance of successful implementation of e-learning, especially since the emergence of the Covid-19 pandemic, has become increasingly apparent to universities. Thus, identifying the effective factors in adopting e-learning in the Covid-19 pandemic is crucial. This study was conducted to identify determining factors in adopting E-learning in healthcare. METHOD: This was a descriptive-analytical study in which 143 faculty members from Iran were randomly selected. The faculty members' intentions, concerning the adoption of e-learning, were assessed by the conceptual path model of integration of unified theory of acceptance and use of technology (UTAUT) and The Task-Technology Fit (TTF). RESULTS: The results showed that the combination of the two classical theories, UTAUT and TTF, was an appropriate model to explain faculty members' intention in adopting e-learning. Moreover, the findings showed that technology and task characteristics, task- technology fit, social influences, effort expectancy, performance expectancy and facilitating conditions had direct and significant effect on e-learning adoption. CONCLUSION: By presenting a conceptual path model to elucidate users' behavior in adopting e-learning, this study investigated and identified the key determining factors in adopting e-learning. The findings of the present study can contribute to the design and implementation of e-learning by practitioners, policy makers, and curriculum designers.

The impact of probiotic yogurt versus ordinary yogurt on serum sTWEAK, sCD163, ADMA, LCAT and BUN in patients with chronic heart failure: a randomized, triple-blind, controlled trial.

BACKGROUND: To date, no study has investigated the effects of probiotic yogurt as a functional food in patients with chronic heart failure (CHF). Therefore, the aim of this study was to compare the impact of probiotic yogurt versus ordinary yogurt on inflammatory, endothelial, lipid and renal indices in CHF patients. In this randomized, triple-blind clinical trial, 90 patients with CHF were randomly allocated into two groups to take either probiotic or ordinary yogurt for 10 weeks. Serum levels of soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK), soluble cluster of differentiation 163 (sCD163), asymmetric dimethylarginine (ADMA), and lecithin cholesterol acyltransferase (LCAT) were measured by using ELISA kits, and blood urea nitrogen (BUN) was measured by calorimetry method at baseline and at the end of trial. The P-value <0.05 was defined as statistically significant. RESULTS: Seventy-eight patients completed the study. At the end of the intervention, the levels of sTWEAK in both groups increased significantly, and this increase was greater in the probiotic yogurt group [691.84 (335.60, 866.95)] compared to control group [581.96 (444.99, 929.40)], and the difference between the groups was statistically significant after adjusting for confounders (P-value: 0.257, adjusted P-value: 0.038). However, no significant differences were found between the groups in the cases of other study indices. CONCLUSION: Probiotic yogurt may be useful for improving the inflammatory status in patients with CHF through increasing sTWEAK levels, however, further studies are needed in this area. © 2022 Society of Chemical Industry.

Effects of body weight regain on leptin levels: A systematic review and meta-analysis.

BACKGROUND: There are different changes observed before and after diet therapy, and also after weight regain. However, there is not sufficient information regarding weight regain and hormonal changes. PURPOSE: The purpose of this study was to review the connection between weight regain and leptin concentration levels. METHODS: MEDLINE, SCOPUS, Web of Science, and the Cochrane Library were searched for interventional articles published from January 1, 1980, to June 30, 2020. Randomized clinical trials with parallel or cross over design assessing leptin concentrations at the baseline and at the end of study were reviewed. Two independent reviewers extracted data related to study design, year of publication, country, age, gender, body mass index (BMI), duration of the following up period and mean ± SD of other intended variables. RESULTS: Four articles were included, published between 2004 and 2016. Three of them were conducted in the US and one of them in Netherland. Sample size of the studies ranged between 25 and 148 participants. The range of following up period was from13 to 48 weeks. The age range of participants was from 34 to 44 years. Our analysis shows that weight regain could reduce leptin levels, but this change is not statistically significant. CONCLUSION: This review suggests that weight regain may induce a non-significant reduction in leptin level. However, the limited number and great heterogeneity between the included studies may affect the presented results and there are still need to well-designed, large population studies to determine the relationship between weight regain and leptin levels.

Effect of Portulaca Oleracea (purslane) extract on liver enzymes, lipid profile, and glycemic status in nonalcoholic fatty liver disease: A randomized, double-blind clinical trial.

Purslane (Portulaca oleracea L.) is the richest green leafy vegetable source of omega-3, especially alpha linolenic acid (ALA). Experimental studies have shown beneficial effects of purslane extract on liver enzymes. The aim of the present study was to examine the effect of purslane hydroalcohoic extract in patients with non-alcoholic fatty liver disease (NAFLD). In a randomized double-blinded clinical trial, 74 patients were randomly assigned to receive either 300 mg purslane extract or placebo capsules for 12 weeks. Compared with baseline, alanine aminotransferase (ALT) (-9 [-17, 0.50] mg/dl; p = .007), aspartate aminotransferase (AST) (-4 [-10, -0.50] mg/dl; p = .001), gamma glutamyltransferase (GGT) (-6.21 ± 9.85 mg/dL; p < .001), fasting blood glucose (FBG) (-8 [-11, -1.50] mg/dl; p < .001) insulin resistance (-0.95 ± 2.23; p = .020), triglyceride (-20 [-67.50, 3.50] mg/dl; p = .010), and low-density lipoprotein cholesterol (LDL-C) (-5 [-12, -1] mg/dl; p < .001) decreased significantly in the purslane group. At the end of study, no significant changes were observed in liver steatosis grade, insulin, liver enzymes, total bilirubin, lipid profile, and blood pressure between the two groups. The findings of our study show that purslane extract at the dose of 300 mg/day for 12 weeks has no significant effects on liver enzymes, lipid profile, and glycemic indices in patients with NAFLD.

Students' view on supportive co-teaching in medical sciences: a systematic review.

BACKGROUND: Supportive co-teaching (SCT) is the practice of employing two or more experts whose knowledge and experiences are needed simultaneously to make a connection across different disciplines in a classroom. Although this interdisciplinary approach seems to be beneficial, there are many features which need further examination. This study was conducted to systematically review studies addressing the use of this approach and learners' views on SCT in medical sciences. METHODS: We searched for the studies addressing students' views on SCT in medical sciences from January1st 2000 to June 31st, 2019. All the studies, both quantitative and qualitative published in English language, investigating the students' views on SCT, in non-clinical courses in the setting of medical sciences were included. We searched electronic databases of PubMed, Scopus, Embase, Web of Science, WHO Global Health Library, Health Systems Evidence, and ERIC with the keywords and phrases related to the topic which were: "co-teaching", "team teaching", "collaborative teaching", "peer-to-peer co-teaching", "partnership teaching", and" teacher collaboration". RESULTS: By the initial search, 9806 studies were found and after deletion of duplicates and screening, 111 remained for selection. Upon the independent review by two researchers, we were able to discern 12 studies eligible to be included for data extraction. All the studies reported positive views of the students towards SCT although some identified concerns and drawbacks. The students stated that they could better perceive the relationship between basic and clinical sciences, were more engaged in the learning process, and their learning experience was optimized in a course directed by SCT. CONCLUSION: Overall, the students showed positive views of this approach of teaching, and their grades indicated they learned better than expected. However, mismatch and lack of coordination between instructors would make the class distracting, confusing and even disturbing. Further studies investigating different variables related to teachers and students in SCT classes are suggested.

The worldwide prevalence of anxiety in acquired immune deficiency syndrome patients: A systematic review and meta-analysis.

Background: Anxiety affects social, economic, and physical aspects of daily life in patients with AIDS. Therefore, it is necessary to take preventive measures and design plans to maintain their general health. The present study was the first comprehensive systematic literature review research that examined the worldwide prevalence rate of anxiety in patients with AIDS. Methods: We searched for papers published in the English language in the major databases including Embase, PubMed, Web of Science, Scopus, Cochrane, and Google Scholar from 2000 to October 2018. There were 40 studies which found to be eligible. These studies were independently evaluated and the collected data were entered in a data extraction form, which was then analyzed by two authors and a third author if necessary. Der Simonian-Laird model was used to estimate the prevalence rate on a Forest plot at the interval confidence of 95%. Results: The total sample size was 24111, and the total number of people with anxiety was 5546. The results based on the random-effects model showed that the rate of anxiety prevalence in the patients was 25% (CI: 95%, 21% -30%) with heterogeneity of 97.9% and a significance level of p<0.001. The South America continent with a prevalence of 38% (95% CI, 34%-42%) had the highest anxiety prevalence rates and Africa with 19% (95% CI, 12% -29%) had the lowest anxiety prevalence rates. Conclusion: Based on findings, the prevalence of anxiety in developed countries was partially higher than in underdeveloped countries and the obtained mean in the present study. It can be a significant point for policymakers. Therefore, WHO and the world community should have special plans for these countries.

The impact of probiotic yogurt consumption on lipid profiles in subjects with mild to moderate hypercholesterolemia: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND AND AIMS: Potential beneficial effect of probiotic yogurt on the lipid profile has raised much interest. However, the results are inconsistent in this regard. The aim of the study is to determine the effects of probiotic yogurt on serum lipid profile in individuals with mild to moderate hypercholesterolemia. METHODS AND RESULTS: Online databases including PubMed, Scopus, ISI Web of Science, Cochrane Central Register of Controlled Trials, Science Direct, Google Scholar and Igaku Chuo Zasshi were searched until March 19th 2019. The effect sizes were expressed as the weighted mean difference (WMD) with 95% confidence interval (CI). Seven eligible trials with 274 participants were included in this systematic review. Pooling of 9 effect sizes from these seven articles revealed a significant reduction in total cholesterol and low density lipoprotein cholesterol levels following probiotic yogurt consumption (mean difference: -8.73 mg/dl, 95% CI: -15.98, -1.48, p-value = 0.018 and mean difference: -10.611 mg/dl, 95% CI: -16.529, -4.693, p-value = 0.000, respectively) without significant heterogeneity among the studies (I2 = 40.6%, p-value = 0.1 and I2 = 24.2%, p-value = 0.229, respectively). The results showed no significant changes in high density lipoprotein cholesterol and triglyceride levels. Also, none of the variables showed a significant change for sensitivity analysis. CONCLUSION: Available evidence suggests that probiotic yogurt can significantly reduce total cholesterol and LDL-c in subjects with mild to moderate hypercholesterolemia without a significant effect on HDL-c and triglyceride levels.

Exploring the features of mobile phone application of anatomy in basic medical sciences: a qualitative study.

BACKGROUND: The importance of mobile phones has become one of the new research topics in health professions education due to the ease of access and flexibility. Although novel approaches to health professions education recommend the use of educational technologies, such as mobile applications, a limited number of studies have been conducted with regard to learning anatomy through mobile applications. Considering the increasing needs of medical students for mobile technology to meet their educational needs, wants and desires, we decided to explore the features of an anatomy mobile application. METHODS: This qualitative study was conducted in two stages of holding focus groups, and an expert panel session. Students of basic Medical sciences, and faculty members of anatomy at Iran University of Medical Sciences formed the research participants. Semi-structured interviews and note-taking were used to collect the data. Moreover, Brown and Clark methods were used for thematic analysis. Finally, four criteria presented by Lincoln and Guba for qualitative studies were used to ensure the credibility, confirmability, trustworthiness and transferability of the data. RESULTS: Based on the data analysis, 37 codes that could be used to design anatomy mobile content for medical students were extracted. These features were categorized into eight main themes of "visual richness", "scientific comprehensiveness", "auditory richness", "affordability", "user-friendliness", "self-assessment", "interactive content" and "user support". CONCLUSION: This study explored the features of an anatomy application that can be used by educational app developers. Anatomy departments at Medical Universities, policymakers, and curriculum planners in the field of medical education can also adopt the findings of the present study.

Factors influencing the adoption of E-learning in Tabriz University of Medical Sciences.

Background: Electronic Learning (E-learning), is the use of electronic technology in education via computer and the internet. Despite its slow adoption by faculty members, e-learning provides several benefits to individuals and organizations. This study was conducted to determine the factors influencing the adoption of e-learning by faculty members in Tabriz University of Medical Sciences. Methods: This was a cross- sectional study, in which a sample of 190 faculty members of Tabriz University of Medical Sciences was randomly selected, using stratified sampling. A Conceptual Path Model of Unified Theory of Acceptance and Use of Technology (UTAUT) was applied to assess the faculty members' attitude towards e-learning. The collected data were analyzed by SPSS16, using descriptive statistics and regression analysis. The model was tested by structural equation modeling (SEM) and was finally represented by Analysis of Moment Structures. Results: The results evidenced that UTAUT model explains about 56% of the variance for adoption of elearning. The findings also revealed that performance expectancy, effort expectancy, social influences and behavior indentation had direct and significant effects on faculty members' behavior towards the use of e-learning. However, facilitated condition had no significant effects on the use of e-learning. Conclusion: The authorized model provides considerable insight for perception and anticipation of faculty members' behaviors in adopting e-learning. The survey clearly identified significant and non-significant factors that may affect the adoption of e-learning. The results of this study could help the policy makers when successful adoption of e-learning is in their agenda.

Validity and reliability of activities coaching context questionnaire.

BACKGROUND: Learning in a clinical environment is an inseparable part of a training program in medical education. To evaluate the quality of training in a clinical environment, a comprehensive questionnaire which is adjusted for local purposes is essential. This study was conducted to determine the validity and reliability of Activities Coaching Context (ACC)-questionnaire from the perspective of residents and students in a clinical learning environment. METHODS: This was a cross-sectional study conducted with 65 residents and students of Semnan University of Medical Sciences. The Content Validity of the questionnaire was confirmed by the judgment of a panel of ten experts in medical education. The construct validity of the questionnaire was determined by factor analysis. Data were collected and analyzed by SPSS16. RESULTS: The ratio and index of content validity calculated by experts' view were quite acceptable (0.31 and 0.7, respectively). Construct validity was examined by factor analysis which confirmed seven first order factors. Cronbach's Alfa coefficient revealed a high degree of internal consistency (0.932). The reliability of the questionnaire was measured by test - retest (0.9). CONCLUSIONS: The ACC questionnaire appeared to be a valid, reliable and also appropriate tool to evaluate the educational quality of a clinical learning environment.

A Deep Learning-Based Ensemble Method for Early Diagnosis of Alzheimer's Disease using MRI Images.

Recently, the early diagnosis of Alzheimer's disease has gained major attention due to the growing prevalence of the disease and the resulting costs imposed on individuals and society. The main objective of this study was to propose an ensemble method based on deep learning for the early diagnosis of AD using MRI images. The methodology of this study consisted of collecting the dataset, preprocessing, creating the individual and ensemble models, evaluating the models based on ADNI data, and validating the trained model based on the local dataset. The proposed method was an ensemble approach selected through a comparative analysis of various ensemble scenarios. Finally, the six best individual CNN-based classifiers were selected to combine and constitute the ensemble model. The evaluation showed an accuracy rate of 98.57, 96.37, 94.22, 99.83, 93.88, and 93.92 for NC/AD, NC/EMCI, EMCI/LMCI, LMCI/AD, four-way and three-way classification groups, respectively. The validation results on the local dataset revealed an accuracy of 88.46 for three-way classification. Our performance results were higher than most reviewed studies and comparable with others. Although comparative analysis showed superior results of ensemble methods against individual architectures, there were no significant differences among various ensemble approaches. The validation results revealed the low performance of individual models in practice. In contrast, the ensemble method showed promising results. However, further studies on various and larger datasets are required to validate the generalizability of the model.

The impact of synbiotic on serum sCD163/sTWEAK, paraoxonase 1, and lipoproteins in patients with chronic heart failure: a randomized, triple-blind, controlled trial.

Cardiovascular disease is one of the leading causes of death worldwide. Evidence suggests that alterations in the gut microbiome could play a role in cardiovascular diseases, including heart failure. The purpose of this study was to evaluate the effect of synbiotics on serum paraoxonase 1(PON1), soluble CD163/soluble TNF-like weak inducer of apoptosis (sCD163/sTWEAK), and lipid profile, which are involved in heart failure in patients with chronic heart failure. In this triple-blind randomized clinical trial, 90 eligible patients were included in the study. They were randomly assigned to receive one capsule (500 mg) of synbiotics or a placebo daily for ten weeks. Serum PON1, sCD163/sTWEAK, and lipid profiles were measured at the beginning and end of the study. The data were analyzed by SPSS 24, and the p-value < 0.05 was considered statistically significant. Among 90 patients who met the inclusion criteria, 80 completed the study. The primary outcomes showed a small effect on sTWEAK, with an adjusted standard mean difference (SMD) of 0.2. However, no significant changes were observed in sCD163/sTWEAK (SMD: 0.16). Secondary outcomes indicated no changes in PON1, total cholesterol (TC), or LDL-C levels. However, there was an increase in HDL-C levels (adjusted SMD: 0.46, 95% CI: 0.02-0.91) and a decrease in TG and TC/HDL levels (adjusted SMD: - 0.5 and - 0.3, respectively) in the synbiotic group. A favorable effect of synbiotics on sTWEAK, HDL, TG, and TC/HDL of patients with heart failure was observed, but no statistically significant effect was found on sCD163/sTWEAK, PON1, LDL, and TC factors.

Effects of a low FODMAP diet on the symptom management of patients with irritable bowel syndrome: a systematic umbrella review with the meta-analysis of clinical trials.

A low FODMAP diet (LFD) is a common restrictive diet to manage the symptoms of irritable bowel syndrome (IBS). However, there is no consensus on the alleviating effects of this diet. Herein, a systematic umbrella review with meta-analysis was conducted to investigate the effect of an LFD on IBS symptoms and its secondary outcomes in patients, which were not reported in previous meta-analyses. We performed a systematic literature search in PubMed, Scopus, and ISI Web of Science up to December 2023. The methodological quality of systematic reviews and their included trials was evaluated using AMSTAR 2 and the Cochrane risk of bias, respectively. The certainty of the evidence tool was evaluated using the GRADE approach. The data related to IBS symptoms, quality of life (QoL), microbiome diversity, and stool short-chain fatty acids were extracted. A random-effect (if RCTs ≥ 6) or fixed-effect model (if RCTs < 5) was used to recalculate effect sizes and 95% CIs and report them in both qualitative and quantitative terms (pooled risk ratio, Hedges' g, and weighted mean difference). A total of 658 articles were initially identified, with 11 meta-analyses and 24 RCTs reporting 28 outcomes with 1646 participants included. An LFD significantly affected the clinical improvement of total symptoms according to the IBS-SSS questionnaire (RR: 1.42; 95% CI: 1.02, 1.97; P = 0.04) in all the subtypes of IBS and also had favorable effects on stool consistency (WMD: -0.48; 95% CI: -0.902, -0.07) and frequency (WMD: -0.36; 95% CI: -0.61, -0.10) and some other GI symptoms in both less and more than 4 weeks of diet intervention except for stool consistency, which needed more than 4 weeks of LFD implementation. A significant QoL improvement was observed but not in the anxiety and depression state. Furthermore, some studies showed that an LFD may increase fecal pH and dysbiosis and reduce SCFA and the abundance of Bifidobacterium. In conclusion, an LFD can alleviate symptoms and QoL in IBS patients, although dysbiosis may occur. Considering the low certainty of evidence, strong RCTs with more appropriate designs are needed.

Systematic review and meta-analysis of the quality-of-life of patients with Parkinson's disease.

Background: Parkinson's disease can adversely affect the quality-of-life. Aims: We conducted a systematic review and meta-analysis of global literature on the quality-of-life of patients with Parkinson's disease and examined the association between patient characteristics and quality-of-life. Methods: We searched Embase, PubMed, Scopus and Web of Science from January 2000 to January 2020. We included articles published in English that used the Parkinson's disease questionnaire to estimate the quality-of-life score and to identify the determinants of quality-of-life in patients with Parkinson's disease. Results: In total, 41 studies with data from 4060 patients who had Parkinson's disease met our inclusion criteria. The overall quality-of-life score was 32.37 (95% confidence intervals (CI): 28.72-36.01). Age and duration of disease were inversely related to quality-of-life (P < 0.001). South America had the highest score on the questionnaire (39.73, 95% CI: 28.66-50.79, P < 0.001), indicating the lowest quality-of-life of patients with Parkinson's disease. Of the 6 World Health Organization regions, the Eastern Mediterranean Region had the highest score (36.28, 95% CI: 23.44-49.13, P < 0.001). Conclusion: Although the global score in patients with Parkinson's disease indicated an acceptable quality-of-life, there is a possibility for improvements. The findings of this study can inform evidence-based strategies by health policymakers and clinicians to enhance the quality-of-life of patients with Parkinson's disease.

Anxiety during the COVID-19 pandemic in hospital staff: systematic review plus meta-analysis.

BACKGROUND: This study was conducted to systematically review the existing literature examining the prevalence of anxiety among hospital staff and identifying the contributing factors to address the complications of this disorder and develop effective programmes for reducing the complications of this mental health problem. METHODS: We searched the electronic databases including PubMed, EMBASE, Scopus, Web of Science and Google Scholar from January 2020 to February 2021. To perform meta-analysis, the random effects model was used. To assess the statistical heterogeneity of the included studies, the I2 index was used, and 95% CI was estimated. Data analysis was performed by R software. RESULTS: In the final analysis, 46 articles with the total sample size of 61 551 hospital staff members were included. Accordingly, anxiety prevalence among healthcare workers (HCWs) was 26.1% (95% CI 19% to 34.6%). The prevalence rates of anxiety in health technicians and medical students were 39% (95% CI 13% to 73%) and 36% (95% CI 15% to 65%), respectively, indicating a much higher prevalence than other hospital staff members. Furthermore, a positive significant relationship between prevalence of anxiety among HCWs and their age was approved (p<0.001). The prevalence rate of anxiety was higher among women 37.7% (95% CI 25.4% to 51.8%) than men 27.2% (95% CI 18.2% to 38.6%). CONCLUSION: The findings show a moderately high prevalence rate of anxiety in hospital staff. Due to the high prevalence of this mental health problem in health technicians, medical students and frontline health workers, it is highly suggested that healthcare institutions offer mental health programmes for these working groups in order to appropriately manage anxiety during the COVID-19 pandemic.

Early diagnosis of Alzheimer's disease based on deep learning: A systematic review.

BACKGROUND: The improvement of health indicators and life expectancy, especially in developed countries, has led to population growth and increased age-related diseases, including Alzheimer's disease (AD). Thus, the early detection of AD is valuable to stop its progress at an early stage. METHOD: This study systematically reviewed the current state of using deep learning methods on neuroimaging data for timely diagnose of AD. We reviewed different deep models, modalities, feature extraction strategies, and parameter initialization methods to find out which model or strategy could offer better performance. RESULTS: Our search in eight different databases resulted in 736 studies, from which 74 studies were included to be reviewed for data analysis. Most studies have reported the normal control (NC)/AD classification and have shown desirable results. Although recent studies showed promising results of utilizing deep models on the NC/mild cognitive impairment (MCI) and NC/early MCI (eMCI), other classification groups should be taken into consideration and improved. DISCUSSION: The results of our review indicate that the comparative analysis is challenging in this area due to the lack of a benchmark platform; however, convolutional neural network (CNN)-based models, especially in an ensemble way, seem to perform better than other deep models. The transfer learning approach also could efficiently improve the performance and time complexity. Further research on designing a benchmark platform to facilitate the comparative analysis is recommended.