Effect of the COVID-19 pandemic on utilization of essential health services in Iran evidence from an interrupted time series analysis.

BACKGROUND: The COVID-19 disrupted the provision of essential health services in numerous countries, potentially leading to outbreaks of deadly diseases. This study aims to investigate the effect of the COVID-19 pandemic on the utilization of essential health services in Iran. METHODS: An analytical cross-sectional study was conducted using interrupted time series (ITS) analysis. Data about five indicators, including 'childhood vaccination, infant care, hypertension screening, diabetes screening, and breast cancer screening,' were obtained from the electronic health record System in two-time intervals: 15 months before (November 2018 to January 2020) and 15 months after (January 2020 to May 2021) the onset of the COVID-19 pandemic. The data were analyzed by utilizing ITS. In addition, a Poisson model was employed due to the usage of count data. The Durbin-Watson (DW) test was used to identify the presence of lag-1 autocorrelation in the time series data. All statistical analysis was performed using R 4.3.1 software, considering a 5% significance level. RESULTS: The ITS analysis showed that the COVID-19 pandemic significantly affected the utilization of all essential health services (P < 0.0001). The utilization of hypertension screening (RR = 0.51, p < 0.001), diabetes screening (RR = 0.884, p < 0.001), breast cancer screening (RR = 0.435, p < 0.001), childhood vaccination (IRR = 0.947, p < 0.001), and infant care (RR = 1.666, p < 0.001), exhibited a significant decrease in the short term following the pandemic (P < 0.0001). However, the long-term trend for all service utilization, except breast cancer screening (IRR = 0.952, p < 0.001), demonstrated a significant increase. CONCLUSIONS: The COVID-19 pandemic affected utilization of essential health care in Iran. It is imperative to utilize this evidence to develop policies that will be translated into targeted planning and implementation to sustain provision and utilization of essential health services during public health emergencies. It is also vital to raise awareness and public knowledge regarding the consequences of interruptions in essential health services. In addition, it is important to identify the supply- and demand-side factors contributing to these disruptions.

Empirically derived dietary patterns and postpartum depression symptoms in a large sample of Iranian women.

BACKGROUND: Postpartum Depression (PPD) is a major depressive disorder that mainly begins within one month after delivery. The present study aimed to determine the relationship between dietary patterns and the occurrence of high PPD symptoms in women participating in the initial phase of the Maternal and Child Health cohort study, Yazd, Iran. METHODS: This cross-sectional study was carried out in the years 2017-2019 included 1028 women after childbirth The Food Frequency Questionnaire (FFQ) and the Edinburgh Postnatal Depression Scale (EPDS) were study tools. The EPDS questionnaire was used to measure postpartum depression symptoms and a cut-off score of 13 was considered to indicate high PPD symptoms. The baseline data related to dietary intake was collected at the beginning of the study at the first visit after pregnancy diagnosis and the data related to depression, were collected in the second month after delivery. Dietary patterns were extracted by exploratory factor analysis (EFA). Frequency (percentage) and mean (SD) were used for description. Chi-square test, Fisher's exact test, independent sample t-test, and multiple logistic regression (MLR) were used for data analysis. RESULTS: The incidence of high PPD symptoms was 24%. Four posterior patterns were extracted including prudent pattern, sweet and dessert pattern, junk food pattern and western pattern. A high adherence to the western pattern was associated with a higher risk of high PPD symptoms than a low adherence (ORT3/T1: 2.67; p < 0.001). A high adherence to the Prudent pattern was associated with a lower risk of high PPD symptoms than a low adherence (ORT3/T1: 0.55; p = 0.001). There are not any significant association between sweet and dessert and junk food patterns and high PPD symptoms risk (p > 0.05). CONCLUSION: High adherence to prudent patterns was characterized by high intake of vegetables, fruit and juice, nuts and beans, low-fat dairy products, liquid oil, olive, eggs, fish, whole grains had a protective effect against high PPD symptoms, but the effect of western pattern was characterized by high intake of red and processed meats and organs was reverse. Therefore, it is suggested that health care providers have a particular emphasis on the healthy food patterns such as the prudent pattern.

Interaction between CETP Taq1B polymorphism and dietary patterns on lipid profile and severity of coronary arteries stenosis in patients under coronary angiography: a cross-sectional study.

AIM: Evidence indicates there are still conflicts regarding CETP Taq1B polymorphism and coronary artery disease risk factors. Current findings about whether dietary patterns can change the relationship of the Taq1B on lipid profile and the severity of coronary arteries stenosis appears to be limited. The present research made an attempt to investigate this possible relationship. METHODS: This cross-sectional study involved 453 male and female participants with a mean age of 57 years. A validated 178-item food frequency questionnaire (FFQ) was used to assess dietary usual intake. Dietary patterns were extracted through principal component analysis (PCA). Taq1B variant was genotyped by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Two-way ANOVA was used to test the interaction between Taq1B polymorphism and dietary patterns. RESULTS: Two dietary patterns were detected: the western dietary pattern (WDP) and the traditional dietary pattern (TDP). The frequency of Taq1B genotypes turned out to be 10.4, 72.4, and 17.2% for B1B1, B1B2, and B2B2, respectively. A significant difference was observed in TG and TG/HDL-C levels among TaqIB genotypes in higher adherence to TDP (P = 0.01 and P = 0.03, respectively). Taq1B showed a significant interaction with TDP for modulating TG levels and TG/HDL-C ratio (P = 0.02 and P = 0.04, respectively). Greater compliance to WDP demonstrated a significant difference in TG and TG/HDL-C levels across rs708272 genotypes (P = 0.03) after adjusting for confounding factors. Other lipid components and coronary arteries stenosis scores failed to show any relationship or significant difference across Taq1B genotypes or dietary patterns. CONCLUSION: Adherence to TDP may adjust the association between the Taq1B variant and TG and TG/HDL-C levels in patients undergoing coronary angiography. To better understand the relationships, we suggest prospective studies in different race groups with multivariate approaches.

Translation and validation of the Persian version of diabetic foot ulcer scaleshort form (DFS-SF).

Foot ulcer in diabetic patients could often result in significantly impaired quality of life. This study aimed to translate and validate the DFS-SF in Iran. The DFS-SF was translated into Persian, and then its validity and reliability were tested in 262 patients with DFUs. Content validity was evaluated using content validity ratio (CVR) and content validity index (CVI), and criterion validity was assessed through Spearman's correlation between dimensions of the DFS-SF and the EQ-5D-5L. Construct validity was measured using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), and convergent-discriminant validity was examined by calculating the average variance extracted (AVE) and composite reliability (CR). Cronbach's alpha and intraclass correlation coefficient (ICC) were calculated to evaluate the reliability of the measure. CVR ≥0.66 and CVI = 0.81 were calculated. Spearman's correlation ranged from 0.23 to 0.78 across all dimensions. The results of EFA showed that all six dimensions of the DFS-SF had an eigenvalue more than 1; accounting for 68.88% of the total variance. CFA confirmed the DFS-SF as a six-dimension structure with good fit indices of χ2/df = 2.15 < 5, RMSEA = 0.06 < 0.08, CFI = 0.91 ≥ 0.90, TLI = 0.90 ≥ 0.90, and RMR = 0.04, as well as with adequate fit indices of GFI = 0.84 ≤ 0.90, NFI = 0.86 ≤ 0.90. Estimates of ≥0.50 for AVE were not observed in two of the six dimensions and CR ≥0.70 was obtained for all dimensions. The reliability was calculated with a Cronbach's alpha of 0.89 and ICC >0.69 for all dimensions. Our findings confirmed the validity and reliability of the Persian DFS-SF; therefore, it can be used to assess QoL in patients with DFSs in clinical and research settings in Iran.

Utility Values in Colorectal Cancer Patients Treated with Chemotherapy.

Calculating utility values in colorectal cancer (CRC) patients under chemotherapy treatment is important for studies of economic evaluations. The EQ-5D-5L and composite time trade-off (cTTO) were used to calculate utility values in 105 patients with CRC in Iran. The mean EQ-5D-5L index and cTTO values were 0.45 ± 0.03 and 0.51 ± 0.02, respectively. Anxiety and pain were the most common problems reported by the patients. The BetaMix showed that lower mean utility values were significantly associated with females, aging, a low level of income, a greater number of comorbidities, and an advanced stage of cancer.

Assessing the prevalence and severity of asthma, rhinitis, and eczema among schoolchildren (6-7 and 13-14 years old) in Khuzestan, Iran: a cross-sectional survey.

BACKGROUND: Asthma and allergic complications are the most common chronic disorders in children and adolescents. This study aimed to determine the prevalence and severity of asthma, allergic rhinitis, eczema among schoolchildren, and some related risk factors. METHODS: The cross-sectional study was performed in 2019 and involved 4000 students aged 6-7 years and 4000 students aged 13-14 years (both girls and boys) from urban schools in Khuzestan Province, southwestern Iran. We used the multi-stage sampling method. Data were collected using the Persian version of the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. RESULTS: The prevalence of current wheeze, wheeze ever and asthma ever in the age group of 6-7 years was 3.8, 4.5, and 1.8%, respectively; in the age group of 13-14 years, it was 4.4, 5.9, and 3.4, respectively. In terms of gender, males (4.9, 6.0, and 2.7 percent, respectively) had substantially higher rates of current wheeze, wheeze ever, and asthma ever compared to the girls (2.8, 3.6, and 2.0 percent, respectively) (p < 0.001). The prevalence of rhinitis, Hay fever, and eczema among young people was 5.3%, 3.5%, and 1.0%, respectively. Current wheeze was more common in children with allergic rhinitis in the last 12 months (30.3% vs. 2.7%, p < 0.001), Hay fever (32.8% vs. 0.3%, p < 0.001) and eczema (27.8% vs 3.8%, p < 0.001), compared to children who did not. CONCLUSIONS: The prevalence and severity of asthma symptoms were significantly associated with allergic rhinitis, eczema, and gender.

Effect of an aged wearing suit on nursing student's knowledge and attitude.

BACKGROUND: The knowledge and attitude of health care providers are important and influential factors in providing care services to the elderly and need to be considered during the training course. Simulation in geriatric nursing education can be an opportunity for learners to experience the restrictions of the elderly. The present study was conducted to determine the effect of training through simulation on the attitude and knowledge of nursing students in elderly care. METHODS: This study was quasi-experimental with two experimental and control groups of pre and post-test, which was conducted on 70 nursing students of the 5th semester (two groups of 35 people). For the experimental group, the elderly simulation suit was worn for two hours, which was designed by the researcher and created sensory, physical, and motor restrictions similar to the elderly for students. Before and after the study, Kogan's attitudes toward older people scale and Palmore's "facts on aging quiz" were completed by students. The data were analyzed using an independent t-test and paired t-test using SPSS version 16 software. RESULTS: The mean scores of students' knowledge in the experimental and control groups had no significant difference at the beginning of the study (p < 0.05). But the mean scores of knowledge in the experimental group before and after the intervention was (9.2 ± 2.6) and (15.3 ± 3.5), respectively, and in the control group before and after the intervention was (10.4 ± 2.9) and (11.3 ± 2.6), respectively, which had a statistically significant difference (p = 0.0001). The mean scores of students' attitudes in the experimental and control groups had no significant difference at the beginning of the study (p < 0.05). The mean scores of attitude in the experimental group before and after the intervention was (114.69 ± 8.4) and (157.31 ± 10.7), respectively and in the control group before and after the intervention was (113.34 ± 13.6) and (108.5 ± 16.6), respectively, which was significantly different (p = 0.0001). CONCLUSIONS: Based on the findings, the experience of aging restrictions through simulation has improved the knowledge and attitude of nursing students towards the elderly. Nursing education requires the growth of attitudinal skills, individuals' beliefs, and creating empathy among them, so creating simulation opportunities can assist nursing students in the educational processes.

Prevalence of asthma and other allergic conditions in adults in Khuzestan, southwest Iran, 2018.

BACKGROUND: Health information on the dimensions of asthma and allergic conditions in Khuzestan Province, as a major industrial and polluted area in Iran as and the Middle East, is inadequate. This study was performed to measure the prevalence of asthma and other allergic conditions in adults in Khuzestan Province. METHODS: This population-based cross-sectional study was carried out in 17 villages and 27 cities of Khuzestan Province during the years 2017-2018 on 20 to 65 year old respondents. Two-stage cluster sampling was used. The ECRHS (European Community Respiratory Health Survey) questionnaire was completed for individuals with additional questions regarding other allergic conditions. RESULTS: In the study, 5720 questionnaires were distributed of which 5708 were returned. The prevalence of current asthma was 8.5% and that of asthma-like symptoms was 19.0%. The most common symptoms of asthma were nocturnal cough (13.6%), chest tightness (12.3%) and wheezing (13.1%). The prevalence of allergic rhinitis (AR), eczema and airway hyperresponsiveness were 27.2, 10.7, and 38.7%, respectively. The prevalence of current asthma was strongly correlated with age, current location (city, village), and the smoking status of respondents (p < 0.05). CONCLUSION: The prevalence of current asthma and asthma-like symptoms in Khuzestan Province is almost twice as high as in Iran. Given the high prevalence of symptoms of airway hyperresponsiveness in the entire province, it is necessary to take environmental measures to mitigate the emergence of new cases of asthma among the residents. In addition, surveillance studies are necessary to monitor the trends in the prevalence of asthma in this province.

Cross-cultural adaptation, reliability, and validity of the Persian version of the overactive bladder questionnaire (OAB-V8).

Background and objectives: Overactive bladder (OAB) is characterized by urinary frequency and is recognized as a disorder. Various tools are available for diagnosing this condition. This study aimed to evaluate the reliability and validity of the Persian version of the 8-item Overactive Bladder Scale (OAB-V8). Methods: This analytical cross-sectional study was conducted on a sample of 150 OAB patients. The OAB-V8 scale was translated and culturally adapted following established guidelines. Face and content validity were assessed using the Impact Score (IS), Content Validity Index (CVI), and Content Validity Ratio (CVR) indices. Reliability was evaluated by calculating Cronbach's alpha (α) and utilizing the test-retest method (Intra-class correlation coefficients (ICC)). Construct validity was explored through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). All statistical analyses were carried out using SPSS version 24 and AMOS version 24, with a significance level set at 5 %. Results: The face validity was confirmed, with all items having an IS value greater than 1.5. Content validity was also confirmed, as most items had a Content Validity Index (CVI) higher than 0.79, and the average Content Validity Ratio (CVR) value was 0.96. In the initial phase of Exploratory Factor Analysis (EFA), the sample adequacy and suitability of the exploratory analysis were confirmed (Kaiser-Meyer-Olkin (KMO) test value = 0.784, Bartlett's Test p-value <0.05). Two dimensions explaining 61.87 % of the variance were then extracted. In the Confirmatory Factor Analysis (CFA), the fit indices were deemed acceptable (χ^2/df = 2.006, CFI = 0.96, GFI = 0.95, AGFI = 0.89, TLI = 0.93, RMSEA = 0.08). The reliability was confirmed with an alpha coefficient of 0.81 and an Intraclass Correlation Coefficient (ICC) of 0.98. Conclusion: The Persian version of the OAB-V8 questionnaire demonstrated good validity and reliability, indicating its suitability for use in Persian-speaking countries.

Translation and cross-cultural adaptation of Persian version of Evidence Based Medicine Questionnaire (EBMQ) in postgraduate medical students in Iran.

BACKGROUND: Evidence Based Medicine Questionnaire (EBMQ) was developed to assess the knowledge, practice and barriers towards the implementation of Evidence-Based Medicine (EBM). This study aimed to translate, cross-culturally adapt and psychometrically validate the Persian version of EBMQ. METHODS: This was an analytical cross sectional study. The EBMQ underwent translation and cross-cultural adaptation following best practices. Face validity was assessed by a panel of five experts. The content validity index (CVI) and content validity ratio (CVR) were evaluated by 15 experts who were familiar with EBM. The tool's internal consistency and test-retest reliability over a 2-week period were evaluated using Cronbach's α and intra-class correlation (ICC), respectively. To assess construct validity, the questionnaire was completed by 400 medical students. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used for construct validity assessment. All analyses were carried out using IBM SPSS v.24 and AMOS v.24. A significance level of 5% was considered. RESULTS: The CVR for 40 items was higher than 0.62, and their CVI score was 1.0, indicating good content validity. The scale demonstrated acceptable internal consistency and test-retest reliability (n = 30) with an ICC of 0.909 (95% CI: 0.866 to 0.941), and an overall alpha coefficient of 0.957. The structural validity was established through exploratory factor analysis (Bartlett's test p<0.001; the Kaiser-Meyer-Olkin index = 0.862), and it was further confirmed by confirmatory factor analysis. A three-factor solution with 40 items, explaining 51.610% of the variance, exhibited the best fit indices Chi-square statistics/df = 4.23; RMSEA = 0.08; CFI = 0.95; NFI = 0.93; TLI = 0.92). CONCLUSION: The Persian version of the EBMQ was a reliable and valid tool that could be utilized to assess the knowledge, practice and barriers of EBM for physicians in Persian language countries.

Psychometric properties of the COVID-19 safety measures questionnaire in the employees of the radiation therapy center.

BACKGROUND: Due to the effect of coronavirus disease 2019 (COVID-19) outbreak on the continuation, schedule, and efficiency of radiation therapy, this study aimed to investigate the reliability and validity of the COVID-19 Safety Measures (CSM) questionnaire at the radiation therapy center. MATERIALS AND METHODS: In this analytical cross-sectional study, which all personnel of the radiation therapy center (20 people) participated, the validity and reliability of the 16-item CSM questionnaire were investigated. Cultural adaptation, face validity, content validity, test-retest reliability, and internal consistency were evaluated. For face and content validity, impact score, content validity ratio, and content validity index (CVR and CVI) were calculated, respectively. Also, internal consistency and stability reliability were calculated with Kuder-Richardson (KR20) alpha and Pearson correlation coefficient and intraclass correlation (ICC), respectively. Data analysis was performed using Statistical Package for the Social Sciences (SPSS) 24 with a significant level of 5%. RESULTS: Out of 20 employees, 70% (14 people) were female, 75% (15 people) were married and the mean age (SD) was 32.4 (6.35) years. Scale-based Kuder-Richardson alpha, S-CVI, ICC, and confidence interval were 0.79, 0.97, 0.68, and 0.38-0.89, respectively. CONCLUSION: The validity and reliability of the 16-item CSM questionnaire were confirmed. Therefore, the application of this scale is recommended.

The association between dietary meal intake habits and coronary artery stenosis and cardio-metabolic risk factors.

BACKGROUND AND OBJECTIVE: We are not aware of studies examining the association between dietary meal intake habits (DMIH) and severity of coronary artery stenosis (CAS). This study was conducted to investigate the relationship between DMIH and the severity of CAS as well as cardiometabolic risk factors in adults undergoing coronary angiography. METHODS: This cross-sectional study was done on 720 patients undergoing coronary angiography (aged 35-75 years) who were admitted to Afshar Hospital, a referral hospital for cardiovascular diseases in Yazd, Iran. Data on DMIH were gathered by interview. Blood samples were taken for biochemical analysis. Blood pressure, anthropometric indices, and body composition were also evaluated. The relationship between DMIH and the severity of CAS [examined by angiography based on Gensini Score (GS) and Syntax Score (SS)] and cardiometabolic risk factors were assessed using logistic regression and the analysis of covariance (ANCOVA), respectively, in crude and multivariable adjusted models. RESULTS: After adjustment for all possible confounding variables, the study revealed that people who ate 3 meals/day had a lower risk of severe CAS compared to people who ate 2 or fewer meals (OR = 0.48, 95% CI: 0.26, 0.88, P-trend = 0.02). There was an inverse association between the number of snacks /day and the severity of CAS (OR = 0.43, 95% CI: 0.22, 0.87, P-trend = 0.02). There was also an inverse relationship between breakfast frequency/week and the severity of CAS based on both GS and SS (P < 0.05). Breakfast consumption, meal frequency, lunch consumption, snack frequency, and more food consumption on holidays were also associated with different cardiometabolic markers and anthropometric measures (P < 0.05). CONCLUSION: According to the results of the present study, meal frequency and breakfast consumption might be inversely associated with CAS and cardiometabolic risk factors.

Cholesterol Ester Transfer Protein Taq1B Polymorphism and Its Association with Cardiovascular Risk Factors in Patients Undergoing Angiography in Yazd, Eastern Iran: A Cross-Sectional Study.

Background: Several studies assessed the relationship between the cholesterol ester transfer protein (CETP) Taq1B gene polymorphism (rs708272) with risk factors of cardiovascular diseases (CVDs). However, their findings were inconsistent. The present study investigated the relationship between CVD risk factors and the Taq1B variant in patients undergoing coronary angiography. Methods: This cross-sectional study was conducted on 476 patients aged 30-76 years old of both sexes from 2020-2021, in Yazd (Iran). The Taq1B polymorphism genotypes were evaluated using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) on DNA extracted from whole blood. Standard protocols were used to measure cardio-metabolic markers. To determine the association between CVDs risk factors and the rs708272 variant, binary logistic regression was used in crude and adjusted models. Results: Taq1B polymorphism genotype frequencies were 10.7% for B1B1, 72.3% for B1B2, and 17% for B2B2. There was no significant association between abnormal levels of CVDs risk factors and different genotypes of the Taq1B variant, Gensini score (P=0.64), Syntax score (P=0.79), systolic blood pressure (P=0.55), diastolic blood pressure (P=0.58), and waist circumference (P=0.79). There was no significant association between genotypes of the rs708272 variant and any abnormal serum lipid levels. After adjusting for confounders, the results remained non-significant. Conclusion: There was no significant association between CVDs risk factors and CETP rs708272 polymorphism. The relationship between CETP gene variants and CVD occurrences varied across groups, implying that more research in different regions is required.A preprint version of this manuscript is available at https://www.researchsquare.com/article/rs-2575215/v1 with doi: 10.21203/rs.3.rs-2575215/v1.

Dietary antioxidant status indices may not interact with CETP Taq1B polymorphism on lipid profile and severity of coronary artery stenosis in patients under coronary angiography.

The association of CETP Taq1B polymorphism with some metabolic traits is still controversial. The interaction of adherence to dietary indices with this polymorphism on the severity of coronary artery stenosis and serum lipid parameters needs to be investigated. This study aimed to test this hypothesis. This cross-sectional study included 453 patients who were referred from Afshar Hospital of Yazd and undergoing coronary angiography from 2020 to 2021. Dietary intake was evaluated by a 178-item validated and reliable dietary questionnaire. Dietary indices such as dietary antioxidant index (DAI), dietary antioxidant quality score (DAQS), and dietary phytochemical index (DPI) are determined according to dietary guidelines. The Taq1B variant was genotyped by the polymerase chain reaction-restriction fragment length polymorphism method (PCR-RFLP). Two-way ANOVA was used to test the interaction between Taq1B polymorphism and dietary indices. The results of the frequency analysis of Taq1B genotypes showed that 10.4% were B1B1, 72.4% B1B2, and 17.2% B2B2. No significant interaction was found between the Taq1B variant with high adherence to DAQS, DAI, and DPI on total cholesterol (TC), high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), triglyceride (TG) levels, and Gensini score (GS) and Syntax score (SS). In high-adherence dietary indices, lipid profile and coronary artery stenosis scores did not differ significantly in Taq1B genotypes. Due to the insignificant results in this research, further studies are needed to investigate the role of Taq1B SNP in modulating dyslipidemia and the severity of the CAD in interaction with dietary indices.

Tutorial on statistical data reduction methods for exploring dietary patterns.

Diet is one of the most important factors affecting human health and it is different for each person. Examining individual foods in the diet does not provide sufficient information to the researcher, so we need food patterns to obtain more complete information. Food pattern analysis is also a complementary approach that is carried out by statistical methods and provides additional evidence in this regard. In this tutorial article, we have tried to briefly explain all statistical analyses which can used for dietary pattern analysis.

Adaptation of the standardized plant analysis-risk human reliability analysis technique for the surgical setting: expert judgment approach.

Objectives. Application of human reliability analysis (HRA) techniques originally developed for industrial settings to the healthcare sector may be controversial in terms of reliability and methodological level. The aim of the present study was to adapt a standardized plant analysis risk-human reliability analysis (SPAR-H) technique for application in surgical settings through suggesting more context-specific definitions for performance shaping factors (PSFs), designing precise levels and elicitation of multipliers through a domain expert judgment approach. Methods. A ratio magnitude estimation approach was used for carrying out domain expert judgment for multiplier elicitation. Experts from four teaching hospitals participated in the present study. Intra-class correlation was used in order to examine the inter-rater reliability of the estimated multipliers for each level of diagnosis and action task type. Results. Available time, threat stress, task complexity, experience/training, procedures, working conditions, human-machine interface, fatigue and teamwork were the nine suggested PSFs for the adapted SPAR-H technique. Conclusion. Context-specific definitions of the PSFs can enhance the reliability of human error probability assessments. Eventually, it could be concluded that multiplier elicitation through domain expert judgment is an efficient approach for adaptation of the HRA techniques for application in specific contexts.

Evaluation of rheological and optical properties plus stability of beverage cloud emulsions prepared with corn oil, gum rosin, and modified starch.

Rheological and optical properties as well as stability of beverage cloud emulsion prepared with corn oil, gum rosin (EG), and modified starch were evaluated in model juices. The emulsions were prepared with three levels of modified starch (6%, 12%, and 18% w/w), corn oil (5%, 7%, and 9% w/w), and gum rosin (1%, 3%, and 5% w/w). Experiments were designed using the Box-Behnken design. The analysis of variance (ANOVA) was used to evaluate the significance of the experimental factors and the factors were then optimized using response surface methodology (RSM). The stability of emulsions was measured through ring formation in both the primary emulsion and the model beverage as a function of storage time. Also, the effect of heat treatment was examined on the stability of emulsions in model beverages. The results revealed that heat treatment did not cause the formation of an observable ring in the model juice containing stabilized starch emulsion. Rheological examinations of the stable emulsion samples showed a pseudoplastic and time-independent non-Newtonian behavior. The optimum emulsion sample consistency coefficient was 0.46 Pa.sn and the flow behavior index was 0.88. The apparent viscosity of the optimum emulsion sample based on Herschel-Bulkley model at shear rate of 100 s-1 was 0.0439 Pa.s. The results indicated that the concentration of modified starch, gum rosin, and corn oil has a significant effect on the stability and creaminess of the emulsion. In general, with an increase in the percentage of modified starch, the stability rises while the rate of creaminess decreases (p < 0.05). Furthermore, elevation of the concentration of corn oil had a significant effect on the opacity of emulsions and the final product (p < 0.05).

The trend of marriage, childbearing, and divorce and its determinants of socio-economic factors on divorce in Yazd province 2016-2021: A cross-sectional study.

Background: In recent decades, families and their stability as an important social institution have changed significantly. Objective: This study aimed to investigate the marriage trends, childbearing, and divorce changes in Yazd province from 2016 to 2021 to estimate the effect of socioeconomic factors on divorce. Materials and Methods: A cross-sectional study was done in 2 phases. In the first phase, an ecological (time trend) was conducted to investigate the 5 yr trend in the occurrence of marriage, childbearing, and divorce, as well as the factors affecting the occurrence of divorce in the second phase. For the second phase of the study, 600 participants were selected. 300 divorced and 300 married applicants were chosen between 2016 and 2021. A binary logistic regression model was used to find the related factors affecting the occurrence of divorce. Results: The results showed a declining marriage (p = 0.05) and childbearing trend (p = 0.84), as well as an increasing trend in divorces (p = 0.02) in Yazd. Logistic regression analysis showed that college education (OR = 0.22, CI: 0.116-0.430, p < 0.001) and being self-employed (OR = 0.48, CI: 0.255-0.934, p = 0.03) could reduce the odds of divorce. In addition, nonresidents (OR = 2.1, CI: 1.314-3.562, p < 0.001), with > 10-yr age differences (OR = 3.8, CI: 1.803-8.213, p < 0.001) or the woman being older than her husband (OR = 3.4, CI: 1.981-5.848, p < 0.001) could increase the odds of divorce. Conclusion: Our results confirmed that a combination of socioeconomic characteristics affects the stability of family institutions.

Quinoa dough fermentation by Saccharomyces cerevisiae and lactic acid bacteria: Changes in saponin, phytic acid content, and antioxidant capacity.

The effects of two fermentation processes (common fermentation with Saccharomyces cerevisiae and fermentation by Lacticaseibacillus casei subsp. casei PTCC 1608 and Lactiplantibacillus plantarum subsp. plantarum PTCC 1745) on pH, titratable acidity, total phenolic and flavonoid contents, antioxidant capacity, saponin content, as well as phytic acid content of quinoa dough were investigated during the 24-h fermentation (4-h interval). According to the results, the highest titratable acidity was observed in the samples fermented by L. casei subsp. casei. Moreover, the highest antioxidant capacity was observed after 12 h of fermentation by L. plantarum subsp. plantarum (31.22% for DPPH, 104.67% for FRAP) due to a higher concentration of phenolic compounds produced (170.5% for total phenolic content). Also, all samples have been able to reduce saponin by 67% on average. Furthermore, the samples fermented by L. plantarum subsp. plantarum showed the most significant decrease in phytic acid content (64.64%) during 24-h fermentation. By considering the reduction of the antinutritional compounds and improvement in the antioxidant properties of quinoa flour, the Lactiplantibacillus plantarum strain was recommended.

The effect of the dietary approaches to stop hypertension diet on total antioxidant capacity, superoxide dismutase, catalase, and body composition in patients with non-alcoholic fatty liver disease: a randomized controlled trial.

Aim: Non-alcoholic fatty liver disease (NAFLD) is a condition characterized by the accumulation of fat in the liver without excessive alcohol consumption. Lifestyle modifications, such as adopting a healthy diet, represent the standard treatment for NAFLD. However, the impact of the Dietary Approaches to Stop Hypertension (DASH) diet on oxidative stress biomarkers in patients with NAFLD remains unclear. Therefore, this study aimed to determine the effect of the DASH diet on total antioxidant capacity (TAC), catalase (CAT), superoxide dismutase (SOD) levels, and body composition in overweight and obese patients with NAFLD. Methods: A total of 70 overweight and obese patients aged 1870 years were randomly assigned to either the intervention (DASH diet, n = 35) or the control group (control diet, n = 35) for 12 weeks, with both groups following a calorie-restricted diet. Results: The mean age of participants was 43.1 ± 8.1 years in the DASH group and 45.1 ± 8.6 years in the control group. At the end of the study, a significant difference was observed in the mean TAC and SOD levels between the two groups (p = 0.02). After adjusting for potential confounding factors, such as age, sex, diabetes, smoking, physical activity, and baseline values, the DASH diet maintained its significant effects on TAC and SOD compared to the control diet (p = 0.03). However, there were no significant differences in CAT levels between the two groups. Moreover, a significant reduction in visceral fat (p = 0.01) and a marginally significant decrease in BMI (p = 0.06) were observed in the DASH group compared to the control group after adjusting for potential confounders. Conclusion: In conclusion, our study showed that following the DASH diet for 12 weeks in overweight and obese patients with NAFLD has beneficial effects on TAC, SOD, and visceral fat. These findings support the use of the DASH diet as a potential therapeutic intervention for the improvement of oxidative biomarkers in patients with NAFLD. Clinical trial registration: www.irct.ir/, identifier IRCT20170117032026N3.