Development and psychometric properties of the Reproductive Health Assessment in Systemic Lupus Erythematosus: Mixed-Methods study.

OBJECTIVES: Systemic lupus erythematosus (SLE) with a high morbidity rate (7% in general and 325/100.000 in reproductive period) was known as "the mother of autoimmune diseases." But healthcare providers hadn't reliable scales to measure the effectiveness of interventions to improve reproductive health. Women with systemic lupus erythematosus (SLE) express concern about a significant gap in their reproductive and sexual health during medical care due to the lack of a specific scale to measure this concept. This study developed psychometrically specific scale to evaluate this concept in Iranian women. METHODS: The study utilized a sequential-exploratory mixed-methods design, wherein the concept of reproductive health was clarified during the qualitative phase using conventional content analysis (inductive-deductive) to create a pool of RHASLE (Reproductive Health Assessment in SLE) items. During the psychometric process, the face, content, and construct validities of the RHASLE were checked with 650 individuals (320 using exploratory factor analysis [EFA] and 330 using confirmatory factor analysis [CFA]) through interviews and completion of the questionnaire. Convergent and divergent validities were then checked, and the reliability was assessed through stability and internal consistency. Finally, the measurement error, responsiveness, and interpretability of the scale were evaluated and confirmed. RESULTS: The study's findings revealed that the RHASLE consisted of 5 factors (33 items): physical-psychological disorder (13 items), relaxing feeling (6 items), spirituality (3 items), high-risk pregnancies (5 items), and sexual satisfaction (6 items). These factors explained a total of 99.97% of the variance in the concept of reproductive health. Confirmatory factor analysis confirmed the good model fit, and its validity and reliability were deemed acceptable. CONCLUSION: The RHASLE consisted of 27 items with high internal consistency, stability, responsiveness, and interpretability. That was able to get approval of Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. Based on the results, RHASLE is a valid and reliable multidimensional scale that encompasses various aspects of reproductive health (physical, sexual, psychological, social, and spiritual).

Examining the mediating role of personality traits in the relationship between psychological empowerment and mental health in soldiers.

PURPOSE: Paying attention to the psychological characteristics of soldiers is a matter of concern for planners and senior commanders. Therefore, this study was conducted to investigate the mediating role of personality traits in the relationship between psychological empowerment and mental health in soldiers stationed in the Kerman Province barracks. METHOD: In this cross-sectional study, 604 soldiers serving in Kerman Province barracks in the year 2021 were examined. The soldiers were selected from a cluster sampling of two barracks. Data were collected using a demographic information checklist, the Sportzier Psychological Empowerment Questionnaire (PEQ), the General Health Questionnaire (GHQ), and the NEO Personality traits (NEO). Pearson's correlation coefficient and structural equation modeling were used for data analysis. The Judd and Kenny's framework was also employed to investigate the mediating role. RESULTS: Of these individuals, 390 (46.6%) had completed their military training, while 433 (71.7%) were single. The correlation between PEQ and GHQ was inverse and non-significant (P = 0.348), between PEQ and NEO was direct and significant (P = 0.002), and between NEO and GHQ was inverse and significant (P < 0.001). In the structural equation model, the PEQ variable had a significant impact on NEO (P = 0.002), but it did not significantly affect the GHQ variable (P = 0.850). The NEO variable also had a significant impact on GHQ. CONCLUSION: The NEO variable has a full mediation effect on the relationship between PEQ and GHQ. Therefore, the use of psychologists and clinical physicians for appropriate interventions to enhance mental health, such as education, counseling, and psychotherapy, appears to be necessary.

Intimate partner violence after childbirth: an explanatory sequential mixed-methods study protocol.

BACKGROUND: Intimate partner violence (IPV) is the most common form of violence against women. Postpartum IPV refers to any type of IPV that occurs up to one year after childbirth and has many adverse impacts on mothers and their children. Considering the lack of sufficient information on the prevalence and factors related to IPV after childbirth in Iran, this study aimed to evaluate the frequency and severity of IPV, its different forms, and psychosocial factors related to IPV, as well as to explore how IPV is perceived among mothers one year after childbirth. METHODS: An explanatory sequential mixed-methods design was used to conduct this study in two phases. The first phase is a cross-sectional study that will be performed on postpartum mothers who have a one-year-old child referred to health care centers in the southern region of Tehran, Iran, with the aim of determining the prevalence of IPV and its related factors. The second phase is a qualitative conventional content analysis study with the purpose of exploring women's experiences and perceptions of IPV and its preventive or protective factors. Purposive sampling will be used. Based on the results of the quantitative phase, mothers who are at the two ends of the IPV spectrum (based on their total Conflict Tactics Scale (CTS-2) scores) will be selected, and in-depth and semistructured interviews will be conducted with them. Finally, the researchers will provide an interpretation of the quantitative results using qualitative data. DISCUSSION: This is the first study that uses a mixed methods approach to explain different dimensions of IPV, its related factors, and mothers' perceptions of it. By providing a better understanding of this phenomenon, it is hoped that the results of this research will be used by policymakers and officials of educational and cultural systems to plan and provide effective interventions, enact laws, and present educational and cultural programs to prevent IPV after childbirth. ETHICAL CODE: IR.TUMS.FNM.REC1400.200.

Intimate partner violence is the most common form of violence against women, with a higher prevalence in Asian and Eastern Mediterranean countries, including Iran. The period after childbirth is a stressful and anxiety-provoking event due to the increased physical, psychological, social, and economic needs of parents, leading to intimate partner violence. Studies show that women who experience violence after childbirth face many physical, sexual, and emotional problems. Additionally, it will have a negative impact on their baby. Many factors can lead to intimate partner violence, among which psychological factors are among the most important. Therefore, we decided to perform a study in two phases with the aim of determining the prevalence and factors related to intimate partner violence. In the first phase, we will study Iranian women who have a one-year child living in southern Tehran city and ask them to complete questionnaires related to intimate partner violence. In the second phase, we will conduct an interview with women who have experienced violence after childbirth to obtain more information about the factors involved.

Development and psychometric properties of Iranian Women's Quality of Life Instrument (IWQOLI): mixed exploratory study.

BACKGROUND: To determine the health needs and promote women's health, their quality of life should be investigated. For this purpose, a valid tool is needed, that has credible validity and reliability, and its concepts are clearly defined and culturally appropriate. This study aimed to develop and assess the psychometric properties of "Iranian Women's Quality of Life Instrument (IWQOLI)". METHODS: The items of "IWQOLI" were generated from themes extracted (150 items) from a content analysis approach with the participation of 40 women. Face validity of the questionnaire with the participation of 10 women and content validity by 10 experts was approved. To determine the domains of the questionnaire, exploratory factor analysis (principal component extraction method) was performed. Internal consistency and test-retest reliability methods with 14-day intervals (30 women) were used to assess the reliability of WQOLI. RESULTS: After performing the face and content validity, 32 items were deleted. S-CVI/Ave was obtained for the instrument (0.93). The factor structure of the inventory was identified by undertaking a principal component analysis in a sample of 590 women. Five factors were extracted with a total variance account of 56.24% and 28 items dropped at this point. The IWQOLI score was significantly correlated with the SF-36 (r = 0.717, p < 0.001). Reliability was demonstrated with Cronbach's alpha coefficient of 0.919 for the entire scale (90-item). Consistency of the instrument was established with test-retest reliability with an interval of 2 weeks (intra-cluster correlation = 0.889, P < 0.001). CONCLUSIONS: The Iranian women's Quality of life Instrument "IWQOLI", consisting of 90 items representing 5 domains (sense of peace in life, sense of security, health responsibility, pleasant communication, received comprehensive support), demonstrated excellent psychometric properties, so it may be used for measuring women's QOL in practical research.

Designing and psychometric properties of the hospitalized patients' spiritual needs questionnaire (HPSNQ) in the medical-surgical hospital setting.

BACKGROUND: The evaluation of spiritual requirements in patients can facilitate the delivery of spiritual care as an essential element of holistic healthcare. The objective of this research was to develop and evaluate the psychometric properties of a questionnaire on patients' spiritual needs in medical-surgical hospital settings. METHODS: This research utilized an exploratory sequential design, involving the creation of a pool of items through both inductive and deductive methods. The questionnaire's psychometric properties were then assessed using various techniques, such as face and content validity, item analysis, construct validity, internal consistency, stability, confirmatory factor analysis, and the Gradual Response Model of Samejima. The data analysis was conducted using MPLUS software, version 5.1. RESULTS: The study's results showed that a four-factor structure (interpersonal connectedness, relationship with God, transcendence, and peaceful environment) with 43 items was successfully extracted through exploratory factor analysis. The confirmatory factor analysis supported the findings of the exploratory factor analysis. The Cronbach's alpha coefficients for the scale and factors ranged between 0.83 and 0.95. Furthermore, the interclass correlation coefficients for the scale and factors were between 0.89 and 0.96. CONCLUSIONS: The questionnaire designed in this study is a reliable and valid instrument that can be utilized by healthcare, educational, and research institutions to evaluate the spiritual needs of patients in medical-surgical hospital settings.

Experiences of operating room nurses in disaster preparedness of a great disaster in Iran: a qualitative study.

BACKGROUND: In recent years, Iran has encountered a growing frequency of earthquake disasters. Given that nurses constitute the largest group of healthcare providers, it is imperative that they possess adequate disaster preparedness skills, irrespective of the location or time. Despite the operating room nurses' roles in disasters, their experiences and challenges in disaster preparedness have been overlooked. Consequently, this study aimed to investigate the experiences, challenges, perspectives, and factors influencing the disaster preparedness of operating room nurses during the 2017 earthquake in Kermanshah, Iran. METHODS: The present qualitative research was carried out in Iran In 2022 utilizing conventional content analysis. The study involved conducting semi-structured interviews with 16 operating room nurses who had participated in disaster preparedness during the Kermanshah earthquake. The participants were selected using a purposive sampling approach that aimed to achieve maximum diversity. The interviews were continued until the point of data saturation was reached, and the verbatim transcripts were analyzed using conventional content analysis in MAXQDA software. To ensure the rigor of the research, Guba and Lincoln's criteria were employed. RESULTS: The study conducted data analysis to identify the main theme as "insufficient disaster preparedness due to a faded preparedness", along with six major categories and eighteen subcategories related to earthquake disaster preparedness. The major categories included: knowledge and perception of preparedness for disasters; educational and training programs for disaster preparedness; equipment preparedness for disasters; managerial-organizational preparedness for disasters; clinical skills for responding to disasters; and resilient ability in disaster response situations. CONCLUSION: The findings of the study provide valuable insights into the dimensions of disaster preparedness in earthquake disasters among operating room nurses. Nursing managers can utilize these findings to develop effective strategies and provide support in areas such as improving knowledge and educational level, equipment preparedness, strengthening plans and managerial structures, enhancing skills, and explaining resilience strategies to improve the disaster preparedness of operating room nurses and medical organizations' disaster response teams.

Heat waves and adaptation: A global systematic review.

BACKGROUND: Given the increasing trend of global warming and extreme weather conditions, including heat waves and its effects on health, the present study was done to investigate adaptive behaviors of communities in the world for combating heat waves. METHOD: ology: In this systematic review, out of 1529 results, 57 relevant and authoritative English papers on adaptation to heat waves hazard were extracted and evaluated using valid keywords from valid databases (PubMed, WOS, EMBASE, and Scopus). In addition, multiple screening steps were done and then, the selected papers were qualitatively assessed. Evaluation results were summarized using an Extraction Table. RESULTS: In this paper, the adaptive behaviors for combating heat waves hazard were summarized into 11 categories: Education and awareness raising, Adaptation of critical infrastructure, Governments measures, Health-related measures, Application of early warning system, Protective behaviors in workplace, Physical condition, Adaptive individual behaviors, Design and architecture of the building, Green infrastructure (green cover), and Urban design. CONCLUSION: The findings of this study showed that community actions have significant effects on adaptation to heat wave. Therefore, for reducing heat wave-related negative health effects and vulnerability, more attention should be paid to the above-mentioned actions for mitigation, preparation, and responding regarding heat waves. PROSPERO REGISTRATION NUMBER: CRD42021257747.

Domains of competence in midwifery students: a basis for developing a competence assessment tool for iranian undergraduate midwifery students.

BACKGROUND: Current study was conducted with the aim of explaining domains of clinical competence in undergraduate midwifery students so that it addresses the challenges in midwifery curriculum and improving clinical assessment methods in Iranian undergraduate midwifery students. METHODS: Qualitative approach and conventional content analysis were used in the design of the present study. The research setting included midwifery and nursing schools and hospitals and health centers affiliated to Tehran and Guilan universities of medical sciences in Iran. The target population consisted of undergraduate midwifery students in the fourth to eighth semesters of school, midwives working in hospitals and health centers, midwifery faculty members, and obstetricians. The participants were selected through purposive maximum variation sampling, which continued until data saturation. After in-depth semi-structured interviews, the content of the interviews was analyzed according to the steps proposed by Zhang & Wildemuth. RESULTS: Twenty-four people participated in this study, including seven midwifery students, seven midwives, nine midwifery and reproductive and sexual health faculty members, and one obstetrician. The participants were aged 20-56 years and their mean age was 39.75 years. Their level of education varied from midwifery student to PhD. The mean work experience of the participants was 13.62 years and the mean duration of the interviews was 48 min. The analysis of the data obtained from the experiences of the participants led to the formation of the four categories of ethical and professional function in midwifery, holistic midwifery care, effective interaction, and personal and professional development, along with ten subcategories. CONCLUSION: The findings of the present study showed that clinical competence in midwifery students involves different domains that correspond well overall to the general definitions of clinical competence in different sources. These findings can be used as a basis for the design and psychometric assessment of a clinical competence assessment tool for undergraduate midwifery students.

The Effect of Self-Determination Activities on Communication and Interaction Skills and Academic Success (Grade Point Average) of Students at Risk of Emotional-Behavioral Disorders: A Randomized Controlled Trial.

Background: Students with emotional and behavioral disorders (EBD) have lower academic efficiency than students with other disabilities and exhibit high levels of problematic behaviors and low levels of social functioning. This research aims to investigate the impact of self-determination activities on communication skills and scholastic achievement of students at risk of emotional-behavioral disorders. Methods: The study was conducted through a randomized controlled trial during the academic year 2018-2019. The samples included 54 female students (14 to 16 years) at risk of emotional-behavioral disorders from secondary schools in Tehran, Iran. The sampling was conducted through a random cluster method. The applied tools encompass Youth Self-report and Assessment of Communication and Interaction Skills. Academic success was measured by students' grade point average (GPA) in two terms. The intervention was held in 8 sessions of 90 minutes, once a week, after the first term of academic of students for the intervention group and the control group did not receive any intervention during this period. The data were analyzed by SPSS-22, MANCOVA, T-test, and Chi-Square tests. Results: The results of the multivariate analysis of covariance analysis showed self-determination has an impact on communication skills (physicality, information exchange and relations) of students at risk of emotional-behavioral disorders (p<0.05). Comparing the difference between the averages of the two students' means, it was found that there was a significant difference in the two groups after the intervention (p<0.001). Also, after the intervention, there was no significant difference between the two groups but the GPA of students in the intervention group increased from 13.19 to 15.61. Conclusion: The findings suggested self-determination is effective for academic success and communication skills of students at risk of emotional-behavioral disorders and can be used in educational programs for these students.

Women empowerment in reproductive health: a systematic review of measurement properties.

INTRODUCTION: There is a considerable dearth of official metrics for women empowerment, which is pivotal to observe universal progress towards Sustainable Development Goals 5, targeting "achieve gender equality and empower all women and girls." This study aimed to introduce, critically appraise, and summarize the measurement properties of women empowerment scales in sexual and reproductive health. METHODS: A comprehensive systematic literature search through several international electronic databases, including PubMed, Scopus, Embase, ProQuest, and Science Direct was performed on September 2020, without a time limit. All studies aimed to develop and validate a measurement of women empowerment in sexual and reproductive health were included. The quality assessment was performed through a rating scale addressing the six criteria, including: a priori explicit theoretical framework, evaluating content validity, internal consistency, and factor analysis to assess structural validity. RESULTS: Of 5234 identified studies, fifteen were included. The majority of the studies were conducted in the United States. All studies but one used a standardized measure. Total items of each scale ranged from 8 to 23. The most common domains investigated were decision-making, freedom of coercion, and communication with the partner. Four studies did not use any conceptual framework. The individual agency followed by immediate relational agency were the main focus of included studies. Of the included studies, seven applied either literature review, expert panels, or empirical methods to develop the item pool. Cronbach's alpha coefficient reported in nine studies ranged from α = 0.56 to 0.87. Most of the studies but three lack reporting test-retest reliability ranging r = 0.69-0.87. Nine studies proved content validity. Six criteria were applied to scoring the scales, by which nine of fifteen articles were rated as medium quality, two rated as poor quality, and four rated as high quality. CONCLUSION: Most scales assessed various types of validity and Internal consistency for the reliability. Applying a theoretical framework, more rigorous validation of scales, and assessing the various dimensions of women empowerment in diverse contexts and different levels, namely structural agency, are needed to develop effective and representing scales.

Factors affecting the quality of diagnosis coding data with a triangulation view: A qualitative study.

OBJECTIVE: The most important challenge in utilizing medical record codes is the quality of coding data. The present study aims to investigate factors affecting the quality of diagnosis coding from different aspects covering different stakeholders in a multi-dimensional approach. METHODS: First, we used Conventional Content Analysis to maximally gather all effective factors. As such, semi-structured interviews were conducted with medical record coders (N = 32) at the referral hospitals in Mashhad, Iran. Second, 86 hospital staff members from 25 provinces were surveyed using a web-based questionnaire. Finally, a focus group discussion was conducted among coders (N = 18) in different hospitals across the country. RESULTS: In general, the barriers to quality of inpatient record coding can be classified into three categories: (I) physician-related, (II) coder-related, and (III) managerial, financial and administrative factors. CONCLUSION: A triangulation view (related to coders, physicians as well as managerial, financial and administrative dimensions) could be used to identify the barriers affecting the quality of diagnosis coding data. The results of this study may help policymakers in development and implementation of appropriate strategies and effective interventions to improve the quality of clinical coding.

Fair prioritization of casualties in disaster triage: a qualitative study.

BACKGROUND: Disasters may result in mass casualties and an imbalance between health care demands and supplies. This imbalance necessitates the prioritization of the victims based on the severity of their condition. Contributing factors and their effect on decision-making is a challenging issue in disaster triage. The present study seeks to address criteria for ethical decision-making in the prioritization of patients in disaster triage. METHODS: This conventional content analysis study was conducted in 2017. Subjects were selected from among Iranian experts using purposeful and snowball sampling methods. Data were collected using semi-structured interviews and were analyzed by the content analysis. RESULTS: Efficient and effective triage and priority-oriented triage were the main categories. These categories summarized a number of medical and nonmedical factors that should be considered in the prioritization of the victims in disaster triage. CONCLUSION: A combination of measures should be considered to maximize the benefits of the prioritization of causalities in disasters. None of these measures alone would suffice to explain all aspects of ethical decision-making in disaster triage. Further investigations are needed to elaborate on these criteria in decision-making.

Impact of endometriosis on reproductive health: an integrative review.

Endometriosis is a debilitating chronic disease that affects 10% of the general female population, with a frequency of 38% in infertile women. This review aims to provide an overview of the impact of endometriosis on different aspects of reproductive health. A literature search was performed in four international databases, including PubMed, Science Direct, Scopus, and Google scholar, from January 1995 to December 2019 to identify the potentially relevant articles. We included all relevant articles published in English and identified 46 studies on health issues in women with endometriosis. The research suggests that women with endometriosis are at risk for physical, psychosocial, social, and sexual disturbances and obstetrical complications. More research is needed to clarify better understanding of endometriosis complications specifically obstetrical consequences.

Effect of occupational therapy on self-determination skills of adolescents at risk of emotional and behavioral disorders: A randomized controlled trial.

Background: Self-determination skills enable to support an individual's needs and make decisions to function independently. Improvement of self-determination skills has had a positive result for adolescents at risk of Emotional and Behavioral Disorders (EBD). The aim of this study was to investigate the effect of occupational therapy interventions on the self-determination skills of adolescent girls at risk of emotional-behavioral disorders. Methods: In this single-blind control trial study, 14-16-years-old girl students (n=54) at risk of EBD were recruited by cluster sampling from secondary high schools of Tehran, Iran. Youth self-report Questionnaire (YSR) was used to include adolescents at risk of EBD in the study and were randomized into the intervention (n=27) and control group (n=27) by block randomization. The Student Self-Determination Scale (SDSS) and the Self-determination Parent Perception Scale (SDPPS) were used to collect data. Students in the intervention group participated in 8 - once a week- sessions of occupational therapy and the control group received no training. Data were analyzed by repeated-measures analysis of variance (RMANOVA), Bonferroni test and SPSS 16.0 version. The significance level was set at 0.05. Results: The score of self-determinations (SDSS) increased significantly in the intervention group after the intervention (p<0.001). Although the mean scores of self-determination at follow-up have increased in the intervention group compared to the post-test. No significant differences were found (p>0.05); also, the score of parents' perception of student self-determination (SDPPS) increased but there were not significantly different (p=0.064). Conclusion: The findings indicated self-determination skills could be taught to adolescents at risk of EBD in OT sessions. Since self-determination has been identified as the necessary skills for adolescents at-risk to transition into adulthood, occupational therapists have an important role in promoting self-determination skills in adolescents at risk of EBD.

Obstetric triage systems: a systematic review of measurement properties (Clinimetric).

BACKGROUND: Since labor and delivery units often serve as emergency units for pregnant women, the use of obstetric triage systems with poor or inadequate quality can lead to unintended consequences such as over and under-triage and so a waste of humans and financial resources. Therefore, this systematic review was conducted to evaluate the measurement properties of obstetric triage tools. METHODS: PubMed, EMBASE, and Medline were searched to identify studies in October 2018 and were updated in May 2019. The risk of bias COSMIN checklist was used to evaluate the quality of the studies. The quality of every measurement property was appraised by the update criteria of COSMIN. Evidence quality was judged using the modified GRADE approach. RESULTS: A total of 444 studies were retrieved in initial search. Six studies evaluating 4 tools were included in this study. All the included studies reported only content validity and reliability. The quality of evidence varied from very low to moderate. The quality of content validity and reliability of the included tools was sufficient except for the reliability of the maternal-fetal triage index. The obstetric triage acuity scale (OTAS) was found to have higher reliability than other tools. CONCLUSIONS: Due to insufficient evidence, the conclusions about the quality of measurement properties of each obstetric triage tool may be uncertain. This review emphasizes the necessity for further studies with robust methodological quality on the measurement properties of obstetric triage tools.

Designing and psychometric of reproductive health related behaviors assessment tool in Iranian males: an exploratory mixed method study protocol.

BACKGROUND: Male reproductive health is a relatively new concept, and most men are neglected in reproductive health discussions. Therefore, it appears that there is insufficient information about the male reproductive health. This study aims to design a psychometric instrument for assessing the male reproductive health-related behavior. METHODS/DESIGN: This is a sequential exploratory mixed-method study with a classical instrument development design. It will be conducted in two qualitative and quantitative phases on the studied units including the men living in Tehran. In the first phase, a qualitative study of a contractual content analysis approach will be conducted in order to perceive the concept of male reproductive health-related behavior, determine the dimensions of the questionnaire, and explore the items. In the second phase, a quantitative study will be carried out to evaluate the psychometric properties as well as (form, content, and construct) validity and reliability of the instrument designed in the first phase. Finally, the instrument will be scored and interpreted. DISCUSSION: Discovering men's perception of concept of reproductive health-related behavior can help design a valid and reliable questionnaire which can be used in studies evaluating the male reproductive health-related behavior. ETHICAL CODE: IR.TUMS.FNM.REC.1397.157.

Garlic (Allium sativum) as an antidote or a protective agent against natural or chemical toxicities: A comprehensive update review.

Garlic (Allium sativum, Liliaceae) is used widely as a spice and medicinal herb not only in its native region (Central Asia and northeastern Iran) but also all around the world. Garlic has abundance chemical compounds such as allicin, alliin, S-allyl cysteines, thiacremonone, diallyl-disulfide, diallylsulfide, and others. This medicinal plant and its constituents offer a lot of benefits including free-radical scavenging, anti-inflammatory, anticholesterolemic, anti-gastric ulcer, antimicrobial, anticancer, and antioxidant properties. Garlic also modulates the activity of several metabolizing enzymes. This review summarizes various in vitro and animal studies on the protective effects of garlic against natural and chemical toxicities. It has been shown that garlic and its major components can ameliorate the toxicity of different agents in brain, kidney, blood, liver, embryo, spleen, pancreas, heart, reproductive system in part through radical scavenging, antioxidant effect, reducing lipid peroxidation, anti-inflammatory, chelating agent, cytoprotective activities, increase protein synthesis in damaged tissues, suppressing apoptosis, modulation of p53, phosphoinositide 3-kinase, Akt, nuclear factor (erythroid-derived 2)-like 2, antioxidant responsive element, p38 MAPK, inducible nitric oxide synthase, cyclooxygenase-2, cytosolic phospholipases A2, cleaved-caspase-9, cleaved-caspase-3 Bcl-2, Bcl-2-associated X, peroxisome proliferator-activated receptor gamma, NF-jB, nuclear factor-kappaB signaling pathways and cytochrome P450 enzymes. With controlled clinical trials, garlic may be introduced as a universal antidote or protective plant against many toxic agents.

Exploring the concept and structure of obstetric triage: a qualitative content analysis.

BACKGROUND: Obstetric triage is a new idea, so the design and implementation of it requires identification of its concept and structure. The aim of this qualitative study was to explore the concept and structure of the obstetric triage in Iran. METHODS: The purposive sampling was done and it continued until reaching the theoretical saturation. Thirty-seven semi-structured interviews were conducted individually and face-to-face. Interviews were audio recorded, transcribed, and analyzed using conventional content analysis. RESULTS: Two themes, 8 main categories, and 16 subcategories emerged from the content analysis of the interviews and observations. The themes were the concept and structure of obstetric triage. The concept of obstetric triage consisted of three categories of nature, process, and philosophy of obstetric triage. The structure of obstetric triage included five categories of assessment criteria, emergency grading, determining the appropriate location for patient guidance, initiation of diagnostic and therapeutic measures, and timeframe for initial assessment and reassessment. CONCLUSION: Findings highlighted that obstetric triage is a process with a dual and dynamic nature. This process involves clinical decision making to prioritize the pregnant mother and her fetus based on the severity and acuity of the disease in order to allocate medical resources and care for providing appropriate treatment at the right time and place to the right patient. The results of this study could be used for the design and implementation of the obstetric triage system.

Reproductive health issues in female patients with beta-thalassaemia major: a narrative literature review.

ß-thalassaemia major (BTM) has a high prevalence worldwide and is associated with considerable morbidity and mortality. The aim of this review is to provide an illustrative overview of the reproductive health and pregnancy related issues in females with ß-thalassaemia. A literature search was performed in four international databases (1980-2018) to identify the potentially relevant articles. Common reproductive health disorders are hypo-gonadotrophic hypogonadism, infertility, delayed or absent sexual development, diabetes, hypothyroidism, hypoparathyroidism, osteopenia, preeclampsia, gestational hypertension, polyhydramnios, oligohydramnios, thrombosis, renal failure, peripheral vascular resistance, placenta previa, pleural effusion and pulmonary hypertension. Many of those aspects are related to iron overload and to ineffective erythropoiesis. Foetal complications include neural tube defects, abnormalities in different organs, spontaneous abortion, foetal loss, preterm birth, foetal growth restriction and low birth weight. Antenatal screening and accurate genetic prenatal examinations are effective measures to early diagnosis of thalassaemia and a detailed plan for management of pregnancies in BTM is important for favourable maternal and foetal outcome.

The Persian Handwriting Assessment Tool for Primary School-Aged Children: Further Validation.

BACKGROUND: Handwriting problems are one of the common problems among students in the early years of education. The current study aimed to determine further validation aspects of the Persian Handwriting Assessment Tool (PHAT) in primary school-aged children. METHODS: The current methodological study was conducted on 452 healthy 8-10-year-old students in Tehran, Iran, selected via random cluster sampling method. Inclusion criteria were native Persian-speaking and no documented physical and mental impairments. Construct and structural validities were established by exploratory factor analysis (EFA) using principal axis factoring with Promax rotation and confirmatory factor analysis (CFA), respectively. Criterion validity was examined by expert opinion as the gold standard using Pearson correlation test. Internal consistency, test-retest, and inter-rater reliability were examined using Cronbach's alpha and intra-class correlation (ICC). Test-retest had a seven-day interval. RESULTS: The EFA results indicated two separate factors in the copying and dictation domains. Speed and orthographic error and size were considered as separate items. The CFA confirmed the factor structure. Criterion validity revealed low to moderate correlation (formation: 0.548, P<0.001; 0.503, P<0.001, spacing: 0.553, P<0.001; 0.307, P=0.030, alignment: 0.442, P<0.001; 0.358, P=0.011, size: -0.376, P=0.007; -0.445, P<0.001, and slant: 0.360, P=0.010; 0.372, P=0.008) in copying and dictation domain, respectively. Acceptable internal consistency (Cronbach's alpha: 0.72-0.99), excellent test-retest (ICC: 0.76-0.99), excellent inter-rater reliability between teachers (ICC: 0.86-0.95), and good to excellent inter-rater reliability between teachers and the occupational therapist (ICC: 0.60-0.95) were reported. CONCLUSION: The results indicated that the PHAT was a valid and reliable tool for assessing handwriting in primary school-aged children.