COVID-19 cases, hospitalizations and deaths after vaccination: a cohort event monitoring study, Islamic Republic of Iran.

Objective: To investigate the incidence of coronavirus disease 2019 (COVID-19) cases, hospitalizations and deaths in Iranians vaccinated with either AZD1222 Vaxzevria, CovIran® vaccine, SARS-CoV-2 Vaccine (Vero Cell), Inactivated (lnCoV) or Sputnik V. Methods: We enrolled individuals 18 years or older receiving their first COVID-19 vaccine dose between April 2021 and January 2022 in seven Iranian cities. Participants completed weekly follow-up surveys for 17 weeks (25 weeks for AZD1222) to report their COVID-19 status and hospitalization. We used Cox regression models to assess risk factors for contracting COVID-19, hospitalization and death. Findings: Of 89 783 participants enrolled, incidence rates per 1 000 000 person-days were: 528.2 (95% confidence interval, CI: 514.0-542.7) for contracting COVID-19; 55.8 (95% CI: 51.4-60.5) for hospitalization; and 4.1 (95% CI: 3.0-5.5) for death. Compared with SARS-CoV-2 Vaccine (Vero Cell), hazard ratios (HR) for contracting COVID-19 were: 0.70 (95% CI: 0.61-0.80) with AZD1222; 0.73 (95% CI: 0.62-0.86) with Sputnik V; and 0.73 (95% CI: 0.63-0.86) with CovIran®. For hospitalization and death, all vaccines provided similar protection 14 days after the second dose. History of COVID-19 protected against contracting COVID-19 again (HR: 0.76; 95% CI: 0.69-0.84). Diabetes and respiratory, cardiac and renal disease were associated with higher risks of contracting COVID-19 after vaccination. Conclusion: The rates of contracting COVID-19 after vaccination were relatively high. SARS-CoV-2 Vaccine (Vero Cell) provided lower protection against COVID-19 than other vaccines. People with comorbidities had higher risks of contracting COVID-19 and hospitalization and should be prioritized for preventive interventions.

Covid-19 outbreak associated with demographic-meteorological factors in the arid and semi-arid region Iran: case study Gonabad city, 2020-2021.

Since the (Covid-19) pandemic outbreak, questioning regarding climate and incident of Covid-19 infection rates has been debated, while there is no clear research evidence until now in Iran. This study has focused on investigating the association between Covid-19 cases and demographic -meteorological factors in arid and semi-arid zones of Iran (from March 1, 2020, to January 31, 2022) by analyzing with Via Poisson and negative binomial regression. As a result, the incidence rate of both Covid-19 hospitalization and mortality cases reached peaks in the summer followed by the autumn. Interestingly, Covid-19 hospitalization cases are associated with humidity, temperature, and wind factors seasonally and monthly, but mortality cases are just associated with wind. In conclusion, the result demonstrated that demographicand meteorological factorsare positively and negatively associated with Covid-19 cases. Therefore, identifying the environmental factors contributing to the excess Covid-19 can help to prevent future pandemic waves in Iranian arid and semi-arid zone.

Investigating the status of marital burnout and related factors in married women referred to health centers.

BACKGROUND: Marital burnout is an important issue in marriage and many factors play an important role in this phenomenon. The aim of this study was to determine the status of marital burnout and the factors affecting married women who were referred to health centers because of it. METHODS: In this study, 936 women were selected by multistage sampling and data collection was performed using questionnaires of demographic and couple burnout. Data analysis was performed using SPSS software version 24. RESULTS: The mean (± SD) of marital burnout, in this study, was 55.46 (± 18.03) (out of 147 score). There was a significant relationship between the level of women's education with total marital burnout, and the subscales of somatic and emotional burnout (P < 0.05). A significant relationship was also observed between mandatory marriage and total marital burnout, as well as subscales of somatic, emotional, and psychological burnout (P < 0.05). A significant relationship was detected and observed between women's participation in training courses of communication skills and total marital burnout, inclusive of the subscales regarding psychological burnout (P < 0.05). The results of linear regression showed a significant relationship between mandatory in marriage, marital satisfaction, marriage duration, and husband's level of education with women's marital burnout. The variables were finally able to predict 12% of marital burnout variance. It should be noted that marital satisfaction had a higher effect on predicting marital burnout (P < 0.001). CONCLUSIONS: Marital satisfaction was one of the effective factors in predicting marital burnout, so it can be concluded that it is necessary to pay more attention to this issue. Educational programs and examining the factors that enhance marital satisfaction are needed to prevent and reduce marital burnout in married couples.

The impact of effective communication skills training on the status of marital burnout among married women.

BACKGROUND: This study aimed to determine the impact of effective communication skills training intervention on the marital burnout among married women referring to health centers. METHODS: In this quasi-experimental study, 94 participants were selected from a descriptive study from among 936 married women referring to health centers who had a high rate of marital burnout and were randomly divided to the experimental group (n = 47) and control group (n = 47). The educational intervention was designed and performed in 7 sessions of 45 min for the experimental group. In the two stages before and after the intervention, the demographic sections, the Pines Marital Burnout Scale and effective communication skills were used to collect data. Data were analyzed using SPSS software version 24 and inferential test of Chi-square, Paired sample t-test and Wilcoxon test. RESULTS: There was no significant difference between the two groups before the intervention (p > 0.05). Performing the intervention in the experimental group significantly reduced the mean score of total marital burnout from 60.51 (± 14.96) to 51.82 (± 11.90), and reduced the mean score of marital burnout subscales, including physical, mental and emotional burnout. Also, in this study, the educational intervention of the experimental group significantly improved effective communication skills, and the mean score of effective communication skills increased from 85.12 (± 15.86) to 97.95 (± 14.53) (p < 0.001). CONCLUSION: Based on the positive impact of effective communication skills on reducing marital burnout, it is recommended that more attention should be paid to enhancing these skills in spouses and pre-marital programs.

The effects of a supportive-educational intervention on women with type 2 diabetes and diabetic peripheral neuropathy: a randomized controlled trial.

PURPOSE: To determine the effect of a supportive educational intervention based on the Orem self-care model on women with type 2 diabetes and diabetic peripheral neuropathy. DESIGN: A randomized controlled trial. SETTING: Hospital outpatient diabetes clinic. SUBJECTS: Adult women with type 2 diabetes and mild-to-moderate diabetic peripheral neuropathy. Out of 410 patients, 120 diabetic patients were recruited and randomly assigned to trial group (N = 60) and control group (N = 60). INTERVENTION: The trial group received a designed intervention consist of one-month supportive educational program with three months of follow-up (totally four months), based on self-care requisites according to the Orem self-care regarding diabetic peripheral neuropathy. The control group only received a routine care program in the diabetes clinic. MAIN MEASUREMENTS: The main outcomes were symptoms and severity of diabetic neuropathy. Further outcomes were fasting blood sugar and glycosylated hemoglobin. RESULTS: By the end of the intervention, the number of participants reduced from 60 to 58 in the trial group and to 57 in the control group (totally 115). The intervention significantly decreased mean score of diabetic neuropathy symptoms (trial group: 3.26 vs. control group: 9.57, P = 0.001), severity (trial group: 5.86 vs. control group: 9.02, P = 0.001), fasting blood sugar (trial group: 151 vs. control group: 204, P = 0.001), and glycosylated hemoglobin (trial group: 7.85 vs. control group: 8.62, P = 0.004). CONCLUSION: Delivering a supportive-educational intervention based on the Orem self-care model on outpatient diabetes clinic can decrease the symptoms and severity of diabetic peripheral neuropathy. TRIAL REGISTRATION: It was registered in the Iranian Registry of Clinical Trials (IRCT2015021521095N1).

Adherence to Self-isolation measures by older adults during coronavirus disease 2019 (COVID-19) epidemic: A phone survey in Iran.

Background: Older adults are at higher risk for severe illness and death associated with coronavirus disease 2019 (COVID-19). As Iran was affected by COVID-19 pandemic, the elderly population soon were told to self-isolate for a very long time. We aimed to identify the coverage, efficacy, and integrity of self-isolation and its predictors in the Iranian older adults (≥60 years) from February 19 to 19 March 2020. Methods: Quota sampling was performed to recruit respondents from 16 cities that were selected based on their population size (4, 7, and 5 cities for localities with ≤500 000, 500 000-1 000 000, and ≥1 000 000 populations) and geographical direction (West = 4 cities; North, East, South, Center = 3 each). At least 30 respondents per locality were selected. Phone interviews of 558 respondents (out of 560; response rate = 99.6%) were performed by local trained interviewers using a validated interview form. Association between age, sex, and living condition (with family vs alone) was assessed with Pearson Chi Square and logistic regression analyses. Results: Complete self-isolation was reported by 61% of the respondents. In 72%, self-isolation led to 80%-100% contact reduction. Self-isolation was broken by 26% of the respondents. Females had better self-isolation behaviors (OR adjusted: 2.3, 95% CI: 1.5, 3.3) and higher contact reduction rates (p: 0.067). They kept the integrity of self-isolation better (OR adjusted: 1.8; 95% CI: 1.2, 2.7). Those aged older than 80 years were 2.3-folds more likely to completely self-isolate than younger elderly (95% CI adjusted: 1.2, 4.3). Living alone did not significantly predict self-isolation features in the elderly. Conclusion: About one third of the interviewed Iranian older adults did not adhere to important self-isolation measures, with males and younger ages showing lower adherence. With the relaxation of social distancing measures, protection measures of the elderly should be strengthened. Given that prolonged self-isolation adversely affects physical and mental health status of the elderly, it is highly recommended to think of creative and gender-specific methods that best tailor the needs of this population in Iran.

Factors that influence dietary behavior toward iron and vitamin D consumption based on the theory of planned behavior in Iranian adolescent girls.

BACKGROUND: The impact of iron and vitamin D supplements among adolescent is not well understood. The prevalence of supplement use, and the behavioral intentions of adolescents was studied to better understand the data on supplement intake. We used the theory of Planned Behavior (TPB) to explore the determinants that influence supplement intake, and its potential constructs to examine determinants that influence dietary supplement behavior towards the use of iron and vitamin D supplements amongst a sample of Iranian schoolgirl. METHODS: This was a cross-sectional study of 485 adolescent girls aged 12-17 years. Multiple analytical models including hierarchical regression and structural equation modeling (SEM) were used to examine the association between TPB constructs and adolescent's behavioral intentions to consume dietary supplements. RESULTS: Based on the results of SEM, constructs of TPB and knowledge were found to predict 74% of the variation in the behavioral intentions of the schoolgirls. SEM indicated that perceived behavioral control (PBC) and knowledge had significant associations with intention behaviors to take nutritional supplements. CONCLUSION: TPB and its constructs were used to establish the determinants of iron and vitamin D intake among schoolgirls in Iran. This outcome indicates that efforts to promote behavioral intentions through targeting subjective norms, attitude, and PBC may promote supplement use.

Feasibility of applying the LED-UV-induced TiO2/ZnO-supported H3PMo12O40 nanoparticles in photocatalytic degradation of aniline.

In the present study, TiO2/ZnO-supported phosphomolybdic acid nanoparticles are investigated by the impregnation method, followed by analyzing their photocatalytic activity under UV-LED light and degradation kinetics degrading aniline as an organic pollutant model. Nanoparticle characteristics and the remaining Keggin structure in the nanocomposites were confirmed by means of FESEM, FTIR, and XRD analyses. Heterogenization of phosphomolybdic acid on TiO2 and ZnO nanoparticles resulted in the improved light absorption intensity and decreased band gap of nanocomposites. Photocatalytic degradation of aniline was also improved for composite nanoparticles and reached to 25.62, 43.48, and 38.25% for TiO2/HPMo, ZnO/HPMo, and TiO2/ZnO/HPMo, respectively. Overall, the results showed a good fit to the Langmuir-Hinshelwood kinetic model.

The Effect of Topical Use of Petroselinum Crispum (Parsley) Versus That of Hydroquinone Cream on Reduction of Epidermal Melasma: A Randomized Clinical Trial.

Melasma disfigures the skin and thus influences people's self-image and self-concept. Therefore, melasma influences emotional and psychosocial health in addition to physical health. This clinical trial was performed to assess the effect of the topical use of Petroselinum crispum (parsley) on reduction of the severity of epidermal melasma.

The effect of a supportive educational intervention developed based on the Orem's self-care theory on the self-care ability of patients with myocardial infarction: a randomised controlled trial.

AIMS AND OBJECTIVES: The aim of this study was to assess the effect of a supportive educational intervention developed based on the Orem's self-care theory on the self-care ability of patients with myocardial infarction. BACKGROUND: Patients with cardiovascular disease suffer from the lack of knowledge about the disease and consequently are not able to fulfil their own self-care needs. DESIGN: This was a randomised controlled trial conducted in 2012. METHODS: We recruited a random sample of 66 patients with myocardial infarction who had been recently discharged from coronary care unit. The study setting was two university hospitals located in Khorasan, Iran. Patients were randomly allocated to either the experimental or the control groups. Patients in the experimental group received education, support, and counselling while patients in the control group received no intervention. We employed a demographic questionnaire and the Myocardial Infarction Self-Care Ability Questionnaire for data collection and spss version 16.00 for data analysis. FINDINGS: After the study, patients in the experimental group had higher levels of self-care knowledge, motivation and skills compared to the prestudy readings and the control group. CONCLUSION: The supportive educational intervention developed based on the Orem's self-care theory can improve nonhospitalised patients' self-care ability and positively affect public health outcomes. Consequently, using the developed programme for providing follow-up care to nonhospitalised patients is recommended. RELEVANCE TO CLINICAL PRACTICE: Having the ability to develop caring systems based on the nursing theories is a prerequisite to standard nursing practice. Identifying patients' educational needs is a fundamental prerequisite to patient education. Our findings revealed that the supportive educational intervention developed based on the Orem's self-care theory can help health care providers identify and fulfil patients' self-care needs.

Comparing the effectiveness of airway management devices in pre-hospital emergency care: A randomized clinical trial.

OBJECTIVE: To assess the effectiveness of laryngeal mask airway, endotracheal tube and oropharyngeal airway for airway management in prehospital emergency care. METHODS: The study sample of this randomized clinical trial was 54 patients needing pre-hospital airway management. All cases of intubation (ETI); after two failed attempts (37 patients), were randomly assigned to the oropharyngeal airway (OPA), and the laryngeal mask airway (LMA) groups. Patients' hemodynamic, SaO2 and airway management parameters, were compared in three groups. The study data were analyzed by the Chi-square and one-way ANOVA, Bonferroni post-hoc, using SPSS, v. 18.0. RESULTS: The results demonstrated that before and after the study, there was no significant difference among the study groups in terms of hemodynamic variables (P > 0.05) expect SaO2 (P < 0.001). The results also revealed that in the ETI group (n=17), the number of attempts and the time spent on inserting the airway device was significantly more than other two groups (P < 0.05). CONCLUSION: Laryngeal mask airway is as effective as oropharyngial airway for pre-hospital airway management by paramedics.

Comparing Different Epinephrine Concentrations for Spinal Anesthesia in Cesarean Section: A Double-Blind Randomized Clinical Trial.

BACKGROUND: Although various anesthetic techniques can be used in different kinds of surgeries, spinal anesthesia has received considerable attention for the lower abdomen and lower extremities surgeries and cesarean section. This study aimed at comparing the effect of adding epinephrine 1:1000 and 1:10000 to lidocaine and fentanyl in spinal anesthesia on the prolongation of paralysis, analgesia and hemodynamic changes in pregnant women candidate for cesarean section. METHODS: A double blind randomized clinical trial was carried out on 66 pregnant women (equally sized control and treatment groups of 33) in 2011. After randomizing the participants into two groups of recipients of epinephrine 1:1000 plus lidocaine 5% and fentanyl (control group) and recipients of epinephrine 1:10000 with lidocaine 5% and fentanyl, (treatment group), the participants' systolic and diastolic blood pressure and heart rate were recorded before and 1, 3, 5, 10, 15 minutes after procedure. Besides the prolongation of paralysis and analgesia, the presence of postoperative nausea and vomiting were evaluated. The outcome of the study was analyzed using SPSS software and via t test, χ2 test and RMANOVA. RESULTS: The mean age (standard deviation) of the participants was 29.3 (4.4) and 28.2 (4.5) in the treatment and control groups, respectively. There were no statistical significance between the participants' prolongation of paralysis, analgesia, the frequency of nausea and vomiting, and the average values of hemodynamic variables between the two groups. CONCLUSION: The use of epinephrine 1:10000 along with lidocaine and fentanyl is recommended in spinal anesthesia in pregnant women candidate for cesarean section. TRIAL REGISTRATION NUMBER: IRCT201012225445N1.

How can we establish more successful knowledge networks in developing countries? Lessons learnt from knowledge networks in Iran.

BACKGROUND: Formal knowledge networks are considered among the solutions for strengthening knowledge translation and one of the elements of innovative systems in developing and developed countries. In the year 2000, knowledge networks were established in Iran's health system to organize, lead, empower, and coordinate efforts made by health-related research centers in the country. Since the assessment of a knowledge network is one of the main requirements for its success, the current study was designed in two qualitative and quantitative sections to identify the strengths and weaknesses of the established knowledge networks and to assess their efficiency. METHODS: In the qualitative section, semi-structured, in-depth interviews were held with network directors and secretaries. The interviews were analyzed through the framework approach. To analyze effectiveness, social network analysis approach was used. That is, by considering the networks' research council members as 'nodes', and the numbers of their joint articles--before and after the network establishments--as 'relations or ties', indices of density, clique, and centrality were calculated for each network. In the qualitative section, non-transparency of management, lack of goals, administrative problems were among the most prevalent issues observed. RESULTS: Currently, the most important challenges are the policies related to them and their management. In the quantitative section, we observed that density and clique indices had risen for some networks; however, the centrality index for the same networks was not as high. Consequently the attribution of density and clique indices to these networks was not possible. CONCLUSION: Therefore, consolidating and revising policies relevant to the networks and preparing a guide for establishing managing networks could prove helpful. To develop knowledge and technology in a country, networks need to solve the problems they face in management and governance. That is, the first step towards the realization of true knowledge networks in health system.

Analysis of trace elements in processed products of grapes and potential health risk assessment.

Raisins and grape pekmez are consumed commonly by human all over the globe. Consumption of contaminated foods may be the likely pathway of heavy metal exposure. Therefore, the objectives of the present research were to quantify trace elements concentration in raisins and grape pekmez produced from locally grown grapes in Gonabad and to assess non-carcinogenic (HQ and HI) and carcinogenic (total cancer risk, CRt) health risks caused by trace elements exposure via oral intake of these products for children, teenagers, and adults. For this purpose, a totally 30 (15 raisins and 15 grape pekmez) samples were purchased from the vineyard gardeners and examined for ten trace elements including As, Cd, Co, Cr, Cu, Fe, Mn, Ni, Pb, and Zn. The HI values signaled that the studied population consuming these products is at risk. The HQ, HI, and CRt values of the elements were in order of children > teenagers > adults. The highest cancer risk contribution was attributed to As and Ni for all the studied age groups in both raisins and grape pekmez samples. However, it is recommended that the concentration of trace elements in the soil and crops of the study area and its related health risks be regularly monitored to avoid significant health risks in the future.

Knowledge translation in Iranian universities: need for serious interventions.

BACKGROUND: The aim of this study was to assess the status of knowledge translation (KT) in Iranian medical science universities in order to assess the strengths and weaknesses of the most important organizations responsible for producing knowledge in the country. METHODS: The KT activities were assessed qualitatively and quantitatively in nine universities using the Self-Assessment Tool for Research Institutes. RESULTS: The strengths and weaknesses of universities were determined using seven main themes: priority setting; research quality and timeliness; researchers' KT capacities; interaction with research users; the facilities and prerequisites of KT; the processes and regulations supporting KT; and promoting and evaluating the use of evidence.The quantitative and qualitative results showed that the Iranian universities did not have an appropriate context for KT. There were significant shortcomings in supportive regulations, facilities for KT activities, and the level of interaction between the researchers and research users. CONCLUSIONS: The shortcomings in KT were mostly in the area of stewardship and policymaking (macro level), followed by planning and implementation at the universities. In order to strengthen KT in Iran, it should occupy a prominent and focused role in the strategies of the country's health research system.

EYE RADIATION DOSE SAVING IN HEAD CT EXAMINATIONS USING COPPER-BISMUTH RADIATION SHIELD.

The aim of the present study is to fabricate a new shield with an optimal combination of copper and bismuth to protect the eyes in the head computed tomography (CT) examinations without compromising image quality. Radiation shields with different compositions were constructed. Computed Tomography Dose Index phantom was used to evaluate the effectiveness of shields in dose reduction and their impact on image quality quantitatively. The shield that caused the least noise in the phantom study was selected for human study. The 10%Bi-90%Cu shield had the least effect on increasing the image noise, and also no remarkable artifact was seen in the CT image of the phantom. The patient study showed that only in 25% of the study group the artifact was observed so that it did not distort the interpretation of the image. It can be concluded that the 10%Bi-90%Cu shield is flexible and durable and would be safely used in the clinic to reduce the eye radiation dose in head CT imaging without compromising image quality.

Determination of Concentration of Metals in Grapes Grown in Gonabad Vineyards and Assessment of Associated Health Risks.

Metals are considered major public health hazards, and they are known to accumulate in fruits, which are consumed by humans because of their unique sweet taste and potential health benefits. Therefore, the aims of this study were to determine the concentration of ten metals, namely arsenic (As), cadmium (Cd), cobalt (Co), chromium (Cr), copper (Cu), iron (Fe), manganese (Mn), nickel (Ni), lead (Pb), and zinc (Zn) in red grape samples grown in Gonabad vineyards and to estimate the associated health risks of metals in terms of chronic daily intake (CDI), carcinogenic and non-carcinogenic risks by hazard quotient (HQ), hazard index (HI), and cancer risk (CR) for children, teenagers, and adults. The overall concentrations of the metals in red grapes were in the range 0.07-0.5 (mean 0.14), 0.08-0.13 (mean 0.10), 0.07-0.13 (mean 0.09), 0.06-1.49 (mean 0.29), 0.52-4.12 (mean 1.65), 6.43-42.17 (mean 19.01), 0.89-4.04 (mean 1.89), 0.07-9.23 (mean 0.71), 0.07-0.37 (mean 0.18), and 0.40-4.13 (mean 1.05) mg/kg dry weight for As, Cd, Co, Cr, Cu, Fe, Mn, Ni, Pb, and Zn, respectively. Based on the results, As in 11.76% and Zn in 5.88% of the samples exceeded the FAO/WHO permissible limits. The estimated non-carcinogenic and carcinogenic risk indices for children, teenagers, and adults showed that the results were lower than the critical value (1) and were in acceptable range. Therefore, red grape is safe for consumption with no impact on the human health. However, red grape consumption was just one part of fruit consumption, and the potential health hazards for inhabitants might actually be higher than in this research when other routes of heavy metal intake and also other fruits are considered.

Evaluation of the barriers and facilitators of iron supplementation program among adolescent females.

BACKGROUND & AIMS: Iron deficiency anemia is a major health problem in female adolescents; so, the iron supplementation program has been implemented in Iranian female high school students for nearly two decades. This study aimed to assess the barriers and facilitators of the program. METHODS: This cross-sectional study was conducted by cluster random sampling with a sample size of 399 high school girls from the northern, southern, eastern, western and central regions of Iran. To collect data, we applied valid and reliable researcher-made questionnaires. Data were analyzed by SPSS version 22 software using the chi-squared test. RESULTS: From the students' point of view, the most important reasons for not taking iron supplements were the bad taste of iron supplements, nausea after consumption, and not prescription of the iron supplement by physicians. Most the students believed that inviting health care professionals and movies or clips had the greatest impact on encouraging students to take supplements. About 45% of students reported that educational programs were not held for them, and only 28% of students received educational content/educational media about iron supplement. Also, 71% of students reported that there are not enough glasses for the consumption of supplement iron. There were significant relationships between iron supplements distributors (deputy assistant: 22.6% vs. 14.1%, P = 0.045), allocated enough time to intake iron supplements (72.0% vs. 37.1%, P < 0.001), implemented the educational program in schools (61.8% vs. 33%, P < 0.001), and the educator person of the program (health teachers: 42.7% vs. 35.7%, P = 0.039) with consumption of iron supplement by the students. CONCLUSION: To achieve the goals of the program, it is necessary paying attention to various aspects of the program such as providing better quality iron supplements, providing more appropriate environmental conditions, designing more attractive training programs, strengthening general announcement, and employing more experienced executive staff.

Midwives' Perception Regarding Conditions Influencing the Implementation of the Natural Childbirth Promotion Program in Iran: A Qualitative Study.

Background: In Iran, the Natural Childbirth Promotion Program (NCPP) has been implemented as a component of the Health Transformation Plan (HTP) since 2014 and as an attempt to encourage natural childbirth practices and reduce cesarean section rates. The purpose of this qualitative study was to explore the perceptions of midwives about conditions influencing the implementation of NCPP. Methods: In this qualitative study, data were collected through 21 in-depth semi-structured individual interviews with expert midwives who were selected using purposive sampling mainly from one medical university in Eastern Iran from October 2019 to February 2020. Based on the framework method as a thematic analysis approach, the data were analyzed manually. To enhance the rigor of the study, we followed Lincoln and Guba's criteria. Results: Data analysis yielded 546 open codes. After the codes were reviewed and similar codes were removed, there remained 195 codes. Further analysis led to extraction of 81 sub-sub themes, 19 sub-themes, and eight main themes. These themes included: Responsive staff; Characteristics of the parturient; Recognition of midwifery role; Teamwork; The birthing environment; Effective management; Institutional and social context; and Social education. Conclusion: Based on the perceptions of the studied midwives, the success of the NCPP is guaranteed by a set of conditions identified in this study. In practice, these conditions are complementary and interrelated, and they cover a wide range of staff and parturient characteristics to the social context. It seems that effective implementation of the NCPP also calls for the accountability of all stakeholders, from policymakers to maternity care providers.

Diagnostic accuracy of anti-DGP (IgG) for celiac disease.

Background: Celiac disease (CD) is an autoimmune enteropathy that is caused by the intake of gluten-containing grains in genetically susceptible humans. The gliadin and glutenin parts of wheat gluten are the essential factors that cause intestinal damage. Objectives: We analyzed the performance of a time-resolved immunofluorometric assay (TR-IFMA) in the diagnosis of CD in children. For this purpose, we compared the performance of IgA anti-tissue transglutaminase antibodies (IgA anti-TTG) and IgG antibodies against deamidated gliadin peptides (IgG anti-DGP) for the diagnosis of CD. Materials and Methods: In this cross-sectional study conducted in 2021 for a duration of about 6 months, 200 patients with suspected CD symptoms, children who needed screening due to Down syndrome or Turner syndrome, and the first-degree relatives of CD patients who underwent diagnostic evaluation were enrolled in a census study. Results: This study compares existing point-of-care anti-DGP Ab (IgG) and anti-TTG Ab (IgA) tests against each other using the gold standard of duodenal biopsy and pathology. Serology as a screening test was acceptable (93.6% for anti-DGP vs. 94.2% for anti-TTG) for both of them. This equivalent sensitivity of serum TTG and the DGP tests validates its potential as a basic tool for serological testing. Furthermore, endoscopy is carried out in patients positive for both. Conclusions: Our study showed that for the diagnosis of CD, anti-DGP antibodies had comparable characteristics with anti-TTG (IgA) in terms of diagnostic specificity and sensitivity. Specify of anti-DGP was higher than that of anti-TTG.