Effectiveness of a mixed lifestyle program in couples undergoing assisted reproductive technology: a study protocol.

BACKGROUND: The desire for fertility is the manifestation of yearning for immortality. Infertility and assisted reproductive technology (ART) expose couples to great affective, anxiety, stress, and financial burden. Increasing evidence emphasize the impact of lifestyle on infertility. One of the most crucial factors affecting the fertility process is the nutrition patterns, the amount and quality of physical activities, emotional problems management; modulate stressors, relief from anxiety, and the living conditions of couples. Most ART treatment interventions in Iran are not integrated into lifestyle programs. Therefore, this research will investigate the impact of mixed fertility health-promoting programs in couples who use ARTs. METHODOLOGY/DESIGN: This study entails three steps. The first step includes the systematic review of literature on a health-promoting lifestyle in infertile couples undergoing ARTs, a systematic review of observational studies and interventions in couple's lifestyle, then, a systematic review of qualitative studies on infertility in couples and their lifestyle, and in the final step couple's life style literature systematically will evaluate in Iran. In case of failure to obtain the required results from systematic reviews, cross-sectional studies will be carried out to determine the lifestyle of infertile couples receiving ARTs. In the second stage, by holding a panel of experts, an intervention is planned based on the results of the previous stages in order to improve the lifestyle of couples. In the final step, the designed intervention will be administered as a random clinical trial-on ART candidates, in intervention or control groups in one of Iran University of Medical Sciences hospitals. Afterward, the data's will be evaluated by using standard questionnaires, that include health-promoting lifestyle questionnaire (HPLII), Beck's depression inventory (BDI), international physical activity questionnaire-short form (IPAQ-SF), and food frequency questionnaire (FFQ). The statistical analysis will be carried out in SPSS software. During the study, subjects meeting the inclusion criteria were randomly selected and randomized into the intervention and control groups. The health-promoting lifestyle training program will be executed for the intervention group while the standard care program is administered to the control group. The content of this program will be obtained from the consensus opinions of the expert panel. The program includes diet recommendations, physical activity, and stress management. Appropriate time, frequency, duration and number of activities will be considered. Communication with subjects will be possible through private meeting special comfort room. Support to the participants will also be through clinical visits social media, SMS and phone calls. Nutritional changes, physical activity amount, anxiety and stress level, abdominal circumference (AC), and body mass index (BMI) will be measured after the completion of the specified time interval. The initial outcome includes examining chemical pregnancy (2 weeks after the transmission) and clinical pregnancy by ultrasound (6 weeks after). The secondary outcome will be live birth rate. Retrieved oocyte and embryo numbers will also be reported. DISCUSSION: Health-promoting lifestyle programs are essential in assisted reproductive technologies to improve pregnancy results and live birth. These programs in association with in-vitro fertilization (IVF) influence the outcome of fertilization. In addition, enhancing parental health leads to healthy pregnancy outcome. Despite the frequency of lifestyle risk factors, employing proper methods helps reduce anxiety and stress, modify dietary patterns, and perform qualitatively and quantitatively balanced physical activities. In addition, having coping skills and mental health management methods, in nowadays modern world challenges seems crucial and effective in solving fertility problems and reducing them before pregnancy.

For most people, children are the meaning of life. In some cultures, children are regarded as a family function and thus infertility is displeasing problem. In public believes, children are divine blessings. Not having children signifies a sick body and incomplete identity, which give rise to psychological and socio-economic consequences. Studies show that fertility and childbearing are biomarkers of survival and affect infertile men and women subconsciously. Since childbearing is one of the most crucial pillars of human marital life, an increase in infertile cases and use of ARTs by infertile couples, the lack of physical activity, sedentary lifestyle, unhealthy diet, stress, anxiety, and psychological problems caused by infertility problems, and the side effects of using ARTs preoccupy couples and distract their attention from healthy lifestyle and well-being issues. Despite the crucial importance of prevention in the modern world and the cost-effectiveness of prevention till treatment, numerous research findings expressing the importance of health education and disease ameliorates. These dimensions are still overlooked. Considering the importance of the issue, to the reduction of damages caused by chronic diseases, such as preventable NCDs problems including infertility, to promote fertility results, improving before conception. Oocyte retrieving time and in window period could improve embryo-maternal outcomes. Ensures couples' health, increases individuals' life satisfaction, and promotes health and lifespan of individuals, which is the ultimate goal of the healthcare system are the other purpose of health promoting process. It seems that health promotion lifestyle programs in Iran for infertile couples have not yet been integrated. Therefore, the combination of these programs with ART can be effective in achieving the goals of improving reproductive health. This research seeks to promote programs based on improving the health of infertile couples, increasing childbearing and increasing live births in people who are candidates for ART. A mixed study in the first step will be carried out by a systematic review of studies on ART candidate couples 'lifestyles. If the desired results are not achieved, a cross-sectional study will be conducted. In the second step, an intervention will be designed and developed to execute the lifestyle program following the specialists' opinions concerning nutrition, physical activity, and stress management. The next step will be carried out by implementing RCT. This intervention will be executed and evaluated at the end.

Cognitive behavioral counselling in post abortion grief: A randomized controlled trial.

BACKGROUND: Abortion is can led to certain psychological problems that may decreased self-esteem, and concerns about future fertility. Abortions have multiple psychological consequences such as grief, anxiety, depression, and post-traumatic stress. The purpose of this study is to examine the effect of cognitive behavioral counseling intervention on women in post-abortion period. MATERIAL AND METHODS: This research was a randomized, controlled trial study that was conducted on 168 women during the post-abortion period at the Khalill Azad Center of Larestan (Iran), where the women were selected randomly from February 2019 to January 2020. Data were collected using post-abortion grief questionnaire. All women in the post-abortion period answered the perinatal grief scale questions at the beginning of the intervention, immediately after the intervention and three months after the end of the intervention. Data were analyzed through descriptive statistics and repeated measures analysis of variance (ANOVA) with time and group were used to evaluate the effect of intervention. RESULTS: By using repeated measures ANOVA, the comparison of the mean score of grief in the two groups indicated that the scores decreased over time and it was lower in the intervention group. The mean score of grief between the intervention and control groups at the end of the intervention was 67.59 ± 13.21 and 75.42 ± 12.7, respectively (P < 0.001). Mean post-abortion grief score in the intervention and control groups three months after the intervention were 59.41 ± 13.71 and 69.32 ± 12.45, respectively (P < 0.001). CONCLUSION: According to results of this study, it can be concluded that the use of cognitive behavioral counselling can reduce post-abortion grief intensity or prevent the occurrence of complicated grief. Therefore, this method can be used as a preventive or therapeutic approach to control post-abortion grief and other psychological disorders.

The effect of e-health interventions on meeting the needs of individuals with infertility: a narrative review.

Background: The mental health and well-being of millions of people worldwide are negatively impacted by infertility. A promising solution to meet the needs of people suffering from infertility is e-health interventions, such as online counseling and support groups. This study aims to review the current literature on e-health interventions and how they impact people with infertility. Main body of the abstract: Relevant studies were searched in PubMed, Web of Science, and Scopus databases. Articles were entered into the EndNote software and screened for duplicates and relevance. Two authors then reviewed full-text articles independently, with a third person resolving any disagreements. Thirteen studies conducted between 2007 and 2022 were identified. The interventions aimed to meet various needs, including training on drug use (n = 23), lifestyle modifications (n = 1), periconceptional behavior modifications (n = 1), drug management (n = 1), IVF training (n = 4), psychological support to reduce distress (n = 4), and promoting a positive sexual self-concept (n = 1). Short conclusion: The limited number of e-health interventions for infertile patients, the heterogeneity of interventions, and the lack of long-term effectiveness data make it challenging to compare e-health interventions to nonelectronic alternatives. However, the increasing use of technology in healthcare, especially during and after the Covid-19 pandemic, suggests that e-health educational interventions such as those using the Internet, psychological support, and patient interaction will continue to play a crucial role in healthcare. Supplementary Information: The online version contains supplementary material available at 10.1186/s43043-023-00137-7.

Socioeconomic inequalities in employees' health-enhancing physical activity: Evidence from the SHAHWAR cohort study in Iran.

BACKGROUND: Increasing level of physical activity (PA) among working population is of particular importance, because of the high return of investment on employees' PA. This study was aimed to investigate socioeconomic inequalities in Health-Enhancing Physical Activity (HEPA) among employees of a Medical Sciences University in Iran. METHODS: Data were extracted from the SHAHWAR Cohort study in Iran. Concentration index (C) and Wagstaff decomposition techniques were applied to determine socioeconomic inequality in the study outcomes and its contributors, respectively. RESULTS: Nearly half of the university employees (44.6%) had poor HEPA, and employees with high socioeconomic status (SES) suffered more from it (C = 0.109; 95% CI: 0.075, 0.143). Also, we found while poor work-related PA (C = 0.175; 95% CI: 0.142, 0.209) and poor transport-related PA (C = 0.081, 95% CI: 0.047, 0.115) were more concentrated among high-SES employees, low-SES employees more affected by the poor PA at leisure time (C = -0.180; 95% CI: -0.213, -0.146). Shift working, and having higher SES and subjective social status were the main factors that positively contributed to the measured inequality in employees' poor HEPA by 33%, 31.7%, and 29%, respectively, whereas, having a married life had a negative contribution of -39.1%. The measured inequality in poor leisure-time PA was mainly attributable to SES, having a married life, urban residency, and female gender by 58.1%, 32.5%, 28.5%, and -32.6%, respectively. SES, urban residency, shift working, and female gender, with the contributions of 42%, 33.5%, 21.6%, and -17.3%, respectively, were the main contributors of poor work-related PA inequality. Urban residency, having a married life, SES, and subjective social status mainly contributed to the inequality of poor transport-related PA by 82.9%, -58.7%, 36.3%, and 33.5%, respectively, followed by using a personal car (12.3%) and female gender (11.3%). CONCLUSIONS: To reduce the measured inequalities in employees' PA, workplace health promotion programs should aim to educate and support male, urban resident, high-SES, high-social-class, and non-shift work employees to increase their PA at workplace, and female, married, rural resident, and low-SES employees to increase their leisure-time PA. Active transportation can be promoted among female, married, urban resident, high-SES, and high-social-class employees and those use a personal car.

Reactogenicity within the first week after Sinopharm, Sputnik V, AZD1222, and COVIran Barekat vaccines: findings from the Iranian active vaccine surveillance system.

BACKGROUND: This study aimed to evaluate the reactogenicity effects of COVID-19 vaccines, used in Iran. METHODS: At least 1000 people were followed up with phone calls or self-report in a mobile application within 7 days after vaccination. Local and systemic reactogenicities were reported overall and by subgroups. RESULTS: The presence of one or more local and systemic adverse effects after the first dose of vaccines was 58.9% [(95% Confidence Intervals): 57.5-60.3)] and 60.5% (59.1-61.9), respectively. These rates were reduced to 53.8% (51.2-55.0) and 50.8% (48.8-52.7) for the second dose. The most common local adverse effect reported for all vaccines was pain in the injection site. During the first week after the first dose of vaccines, the frequency of the pain for Sinopharm, AZD1222, Sputnik V, and Barekat was 35.5%, 86.0%, 77.6%, and 30.9%, respectively. The same rates after the second dose were 27.3%, 66.5%, 63.9%, and 49.0%. The most common systemic adverse effect was fatigue. In the first dose, it was 30.3% for Sinopharm, 67.4% for AZD1222, 47.6% for Sputnik V, and 17.1% for Barekat. These rates were reduced to 24.6%, 37.1%, 36.5%, and 19.5%, in the second dose of vaccines. AZD1222 had the highest local and systemic adverse effects rates. The odds ratio of local adverse effects of the AZD1222 vaccine compared to the Sinopharm vaccine were 8.73 (95% CI 6.93-10.99) in the first dose and 4.14 (95% CI 3.32-5.17) in the second dose. Barekat and Sinopharm had the lowest frequency of local and systemic adverse effects. Compared to Sinopharm, systemic adverse effects were lower after the first dose of Barekat (OR = 0.56; 95% CI 0.46-0.67). Reactogenicity events were higher in women and younger people. Prior COVID-19 infection increased the odds of adverse effects only after the first dose of vaccines. CONCLUSIONS: Pain and fatigue were the most common reactogenicities of COVID-19 vaccination. Reactogenicities were less common after the second dose of the vaccines. The adverse effects of AZD1222 were greater than those of other vaccines.

The Impact of COVID-19 Pandemic on Physical Activity Levels Among Health Care Workers: Longitudinal Results From the SHAHWAR Study.

OBJECTIVE: The aim of the present study was to investigate physical activity (PA) changes during the COVID-19 pandemic among health care workers. METHODS: In a follow-up study, staff PA was compared before and during the COVID-19 pandemic. Logistic regression model was used to determine the related factors with PA changes. RESULTS: Total PA (MET minutes a week) among participants (n = 449) showed a statistically significant decrease during the pandemic compared with before the pandemic: 3785.5 ± 2237.09 versus 2363 ± 2452.90, P < 0.0001. Although transport-related PA decreased in medical and administrative department staff (3851 ± 22.83.4 vs 2446.7 ± 2477.6, P < 0.0001 and 3593.8 ± 2094.3 vs 2122.6 ± 2373.8, P < 0.0001, respectively), the decrease was associated with employment in the administrative and nonshift sectors with odds ratios of 2.37 (1.38 to 4.08) and 2.04 (1.28 to 3.26), respectively. CONCLUSION: Promoting PA at home and leisure is especially recommended to achieve the recommended PA levels.

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 epidemic effects on sleep quality among health sector workers: A follow up study.

Health care workers (HCWs) were vulnerable to sleep disturbances in normal circumstances. Poor sleep quality (PSQ) is common during the coronavirus disease 2019 (COVID-19) epidemic. The aim of this study is evaluation of sleep quality among healthcare workers during COVID-19 epidemic in a cohort study. In a follow-up study, we assessed sleep quality in 453 Iranian HCW participants in late-April 2021, after approximately 8 weeks of the epidemic of COVID-19. In order to compare the sleep quality in the two time intervals, during and before COVID-19, we used the recorded data of the same group of participants who were enrolled in a study named SHAHWAR (SHAhroud Health care Workers Associated Research) cohort that is focused on the health of HCWs who work at the Shahroud university of medical sciences. Data collection process in the SHAHWAR study started on October 2, 2019 and continued until February 19, 2020. Our results showed sleep quality worsened among shift-workers during COVID-19 outbreak; however, it was improved among non-shift staff. Sleep quality was more likely to be worsening if HCWs had shift-working roles [OR: 1.84(1.11-3.06), and if they experienced death in their families [OR: 5.06(1.60-12.80)]; however, having a paramedical role was a protective effect [OR: 0.52(0.27-092)], for poor quality sleep. Sleep quality worsened during the epidemic among HCWs. A greater impact, in terms of higher PSQI index, in this group of workers was seen in shift working staff.

Long-Term Persistence of Anti-SARS-COV-2 IgG Antibodies.

Antibodies against severe acute respiratory syndrome coronavirus-2 (Anti-SARS-COV-2) can be detected in patients with COVID-19 in 7 to 10 days post onset of symptoms (POS). However, there is no firm evidence of the long-term persistence of these antibodies in recovered COVID-19 patients. Therefore, this study aimed to evaluate the stability of anti-SARS-COV-2 IgG in recovered COVID-19 patients in a 15-month follow-up testing. Thirty hospitalized patients with real-time PCR-confirmed SARS-COV-2 infections were included in the study and five serum samples (1st, 2nd, 3rd, 4th, and 5th) were collected from each participant. The serum levels of N and S specific anti-SARS-COV-2 IgG and IgM antibodies were evaluated by the immunoassay technique at the same time. To determine the correlation between levels of anti-SARS-CoV-2 IgG/IgM with severity of disease, neutrophil-to-lymphocyte ratio (NLR %), and the serum levels of C-reactive protein were evaluated using an automated analyzer and turbidimetry assays, respectively. The mean serum level of anti-SARS-CoV-2 IgG antibody was at the highest level up to 90 days and then decreased significantly 1 year POS (P < 0.0001). However, it was still detectable in a 15-month follow-up testing. There were no significant differences in the mean levels of IgG antibody in patients with mild, moderate, and severe diseases. The results from this study suggest that the titer of anti-SARS-COV-2 IgG antibody is detectable at high levels up to 3 months and then decreases over time. However, these antibodies can be reliably detected in up to 15 months, and they may persist for a long time.

Prevalence of Sexual Transmitted Infections (STIs) and Un-Protected Sex in Temporary Marriage in Iran: A Systematic Review and Meta-Analysis.

BACKGROUND: Temporary marriage (TM) is legitimate sexual relations without social, moral approval, which can be a threat to individuals' health, it is a risk factor for spread of Sexual Transmitted Infections (STIs). Therefore, it is necessary to identify and control STIs in TM-individuals and subsequent save of "society health". In this meat-analysis, we examined the prevalence of STIs in TM in Iran. We further examined un-protected sex among TM-individuals. METHOD: Up to Feb 2020, we searched international and national electronic databases identify to published studies on the prevalence of STIs in TM. We estimated the prevalence of STIs in TM using a random-effect pooled estimate analysis approach. RESULTS: Totally, we retrieved 1616 studies from the previously mentioned databases, of which, 18 met the eligibility criteria, published from 1995 to 2020 in different provinces. The total sample size of the included studied contained 2056 TM-individuals, of which 368 were found with STIs and 955 with unprotected sex. The pooled prevalence of STIs and unprotected sex among TM women was 39% (95%CI: 24% to 54%), 55% (95%CI: 40% to 70%). CONCLUSION: STI and unprotected sex are high among TM-individuals which call an urgent need for community and health care providers to provide especially designed medical and psycho-social supportive care services in a safe and unprejudiced environment for TM-individuals. Furthermore, untrained health care providers for TM-individuals, under reporting, social stigma should be taken in to account. Denying the presence of such realities, does not eradicate the facts but results in catastrophic public health problems.

Impact of Maternity Support Program on the Stress of Mothers in the First Encounter with the Preterm Infants.

BACKGROUND: Mothers of premature infants experience a high level of stress. The current study was conducted aiming at investigating the impact of maternity support program on the stress of mothers in the first encounter with infants. METHODS: This experimental study began in neonatal intensive care units (NICUs) of two hospitals of Tehran; that is, Mahdieh (intervention) and Shahid Akbar-Abadi (control), from Feb 14, 2016, to May 14, 2016. Both are educational and referral centers including three levels of NICU that were randomly allocated to intervention and control sites. In the span of study period all 75 infants and mothers with inclusion/exclusion criteria in the Mahdieh hospital were included in the intervention group and vis-à -vis all 68 infants and mothers in Shahid-Akbar-Abadi were enrolled in the control group. The designed intervention was conducted based on the support system pattern of mothers with premature infants in the interventional group. In the first stage of intervention, in the intervention group, mothers were provided informational, emotional, and spiritual support before and during the first exposure and were empowered for comfortable interactions. The control group received routine care. After the first exposure, the mothers' stress was measured by the Parental Stressor Scale: Neonatal Intensive Care Unit (PSS: NICU). The data were analyzed by STATA software as well as t-test, Chi-square, and average treatment effects (ATEs) were estimated using inverse probability treatment weights (IPTW). RESULTS: After adjusting pre-treatment variables by IPTW, the adjusted average difference in the stress score over the NICU environment, infant's behavior and appearance, the special treatments on him/her, and the change in the parental role and total stress were 1.47 (1.19-1.75), 1.06 (0.73-1.14), 1.21 (0.93-1.49), and 1.18 (0.93-1.44), which were lower than the control group (P < 0.001). CONCLUSIONS: The intervention reduced significantly the stress of mothers. The policy-makers are suggested to conduct this method.

Sexual and Reproductive Health Challenges in Temporary Marriage: A Systematic Review.

BACKGROUND: Temporary marriage is a legal form of marriage in Shia Islam allowing a man and a woman to become married in a fixed period of time. This review was conducted to identify the potential effects of temporary marriage on the sexual and reproductive health of women. STUDY DESIGN: A systematic review . METHODS: Electronic databases, including Web of Knowledge, Embase, PubMed, Scopus, ScienceDirect, PsycINFO, ProQuest, IranMedex, Scientific Information Database (SID), and Magiran, were searched up to October 2020 to identify the studies carried out on sexual and reproductive health challenges in temporary marriage. All the selected articles were assessed for eligibility according to their titles and abstracts. RESULTS: During the search on articles published within 1995 to October 2020, 1,802 relevant records were identified, and after evaluation 30 full-text papers were included in the present systematic review. Out of the 34,085 study participants in the selected studies, 3,547 subjects had temporary marriage who were studied under six different categories, namely (1) sexually transmitted infections (STIs)/human immunodeficiency viruses, (2) early child marriage, (3) unplanned pregnancy and induced abortion, (4) violence, (5) psychosocial disorders, and (6) other issues. Individuals with temporary marriage are vulnerable and need to have easy access to health education and sexual and reproductive health services in a safe and unprejudiced environment. Ignoring the aforementioned facts will cause serious public health problems, especially for women from a lower socioeconomic background. CONCLUSION: In the current situation with under-reporting of temporary marriage-related events due to social stigma and absence of quality services in sexual and reproductive health, women with temporary marriage are under the additional risk of STIs, unwanted pregnancy, abortion, and violence.

Epidemiological patterns of syndromic symptoms in suspected patients with COVID-19 in Iran: A Latent Class Analysis.

BACKGROUND: Early diagnosis and supportive treatments are essential to patients with coronavirus disease 2019 (COVID-19). Therefore, the current study aimed to determine different patterns of syndromic symptoms and sensitivity and specificity of each of them in the diagnosis of COVID-19 in suspected patients. STUDY DESIGN: Cross-sectional study . METHODS: In this study, the retrospective data of 1,539 patients suspected of COVID-19 were obtained from a local registry under the supervision of the officials at Shahroud University of Medical Sciences, Shahroud, Iran. A Latent Class Analysis (LCA) was carried out on syndromic symptoms, and the associations of some risk factors and latent subclasses were accessed using one-way analysis of variance and Chi-square test. RESULTS: The LCA indicated that there were three distinct subclasses of syndromic symptoms among the COVID-19 suspected patients. The age, former smoking status, and body mass index were associated with the categorization of individuals into different subclasses. In addition, the sensitivity and specificity of class 2 (labeled as "High probability of polymerase chain reaction [PCR]+") in the diagnosis of COVID-19 were 67.43% and 76.17%, respectively. Furthermore, the sensitivity and specificity of class 3 (labeled as "Moderate probability of PCR+") in the diagnosis of COVID-19 were 75.92% and 50.23%, respectively. CONCLUSION: The findings of the present study showed that syndromic symptoms, such as dry cough, dyspnea, myalgia, fatigue, and anorexia, might be helpful in the diagnosis of suspected COVID-19 patients.

COVID-19 re-infection in Shahroud, Iran: a follow-up study.

Although many people became infected and recovered during the COVID-19 epidemic, the immunity duration and re-infection in recovered patients have recently attracted many researchers. The aim of this study was to evaluate the recurrence of the infection in recovered individuals over a 9-month period after the onset of the COVID-19 epidemic. In this study, data related to COVID-19 patients in Shahroud city were collected using the electronic system for registering suspicious patients and also by checking patients' hospital records. In this study, from 20 March 2020 to 20 November 2020 (9 months), a total of 8734 suspected patients with respiratory symptoms were observed and followed up. RT-PCR was positive for 4039 patients. During this period, out of the total number of positive cases of COVID-19, 10 cases became re-infected after complete recovery. The risk of re-infection was 2.5 per thousand (0.95 CI 1.2-4.5). The mean time interval between the first infection and re-infection was 134.4 ± 64.5 days (range 41-234 days). The risk of re-infection between male and females was not statistically different (1.98 per 1000 women and 2.96 per 1000 men). Exposure to COVID-19 may not establish long-term protective immunity to all patients and may predispose them to re-infection. This fact can be reminded that the use of masks, social distancing and other preventive measures are very important in recovered patients and should be emphasised especially in health care personnel who are more exposed to the virus.

More reliability of suspicious symptoms plus chest CT-scan than RT_PCR test for the diagnosis of COVID-19 in an 18-days-old neonate.

The present study investigated an 18-days-old neonate who was referred to the hospital with suspected respiratory symptoms of COVID-19. Results of CT-Scan and blood tests were highly suspicious, but result of the first RT-PCR test was negative on March 1. The second RT-PCR test reported positive on March 12. The neonate's medical history indicated no close contact except with family members and hospital treatment staffs, but the RT-PCR test results of all family members were also negative.

Creativity and its determinants among medical students.

INTRODUCTION: The ultimate goal of education at all levels is the ability to generate and foster students' creativity. This study aimed at determining and comparing creativity and its influencing factors among medical students. SUBJECTS AND METHODS: In this cross-sectional study conducted in 2019, 720 medical students in Shahroud public and private universities were selected and studied through stratified cluster random sampling. Data were collected using the Guilford Creativity Questionnaire. The data were analyzed using Chi-square, Pearson correlation coefficient, t-test, and multiple logistic regression with a significance level of 0.05. RESULTS: The mean creativity score of the students was 131.4 ± 13.8. The mean creativity scores on the fluency, elaboration, originality, and flexibility dimensions were 49.2 ± 5.3, 22.1 ± 3.4, 34.8 ± 4.7, and 25.4 ± 3.5, respectively. In terms of creativity levels, 75.2% of the students (n = 542) had moderate creativity and 23.8% (n = 171) had high creativity. A significant relationship was observed between creativity and educational level (P = 0.006). Multiple logistic regression results showed that educational level with an odds ratio of 0.59 was associated with a decreased chance of creativity. CONCLUSION: Most of the students had moderate creativity. Moreover, among the factors examined in this study, variables other than the field of the study and educational level had no significant effect on students' creativity. Therefore, using collaborative and cooperative learning and problem-based learning strategies, teachers' critical thinking styles, establishing teamwork groups, concept mapping, and using innovative and creative teaching methods can help to enhance students' creativity.

The Relationship Between Health-Promoting Lifestyle and Its Related Factors with Self-Efficacy and Well-Being of Students.

OBJECTIVES: Unhealthy lifestyles among young people are seriously related to incapacity and health problems in adulthood. The aim of this study was to determine the importance of a health-promoting lifestyle and its association with self-efficacy and well-being. METHODS: In this cross-sectional study, a sample of 500 students from Shahroud University of Medical Sciences (Shahroud, Iran) were randomly selected in 2017. The Persian versions of Health-Promoting Lifestyle Profile, Self-Efficacy Scale, and WHO-5 Well-Being Index were used. RESULTS: Among the participants, 34% of students had an abnormal imaginable well-being, and 68% of students had high self-efficacy. The mean score of a health-promoting lifestyle was 127.47 ± 19.78, which is interpreted as moderate, and the mean score of physical activity was 14.10 ± 4.95, which is poor. There was a significant relationship between well-being, and self-efficacy with health-promoting lifestyle. Age, gender, educational level, place of residence, student employment, self-efficacy, and well-being were associated with students' lifestyles. CONCLUSION: A health-promoting lifestyle of students in this study was moderate and they did not have an acceptable level of physical activity. The direct effect of well-being, and self-efficacy on lifestyle, revising students' curriculums to improve their health behaviors, and general health indicators, can all lead to the enhancement of health-promoting lifestyles.

Estimation of Mean Intelligence Quotient with Wechsler Scale in Iran: Systematic Review and Meta-Analysis.

The low intelligence quotient (IQ) level is one of the most common and important medical, social, and familial problems in all countries. The current study aimed to estimate mean IQ with the Wechsler scale in Iran by performing a systematic review and meta-analysis. In the current meta-analysis, all articles related to IQ conducted in Iran using the Wechsler scale were deeply searched by reviewing citation databases including Science Direct, PubMed, Scopus, Web of Science, Springer, SID, Magiran, Iranmedex, Medlib, and Google Scholar motor search and using valid keywords without time limits. Due to heterogeneity between studies, a random effects model was used to combine the results of studies. To investigate the heterogeneity of the studies, the I2 index was used. All statistical analyses were performed using STATA software version 11.1. The number of participants in the 51 studies was 5352. The mean total IQ score in Iran was estimated 97.12 (95% confidence interval [CI]: 88.71-105.52), the practical intelligence was 92.84 (95% CI: 79.14-106.55), and the verbal intelligence was 94.50 (95% CI: 83.90-105.10). The total IQ score in the northern, southern, central, eastern, and western regions of Iran was 97.08, 108.90, 92.31, 101.76, and 96.45, respectively. The mean IQ score in Iran in subjects under 20 years of age is 97.73 and in subjects over 20 years of age is 105.61. There is also no significant relationship between the mean total IQ in Iran and two parameters of the year of research and number of research samples. For prevention of decrease IQ and given that proper nutrition and breastfeeding directly contribute to increase IQ, nutrition should be provided free of charge in poorer areas during pregnancy until baby born. Moreover, the media should provide adequate education for breastfeeding and nutrition, because IQ affects people's academic, occupational, personal, and social performance, and also prevents elite immigration with suitable planning and provides conditions for elites to return to the country.

Heterogeneity in risk factors for ductal and lobular breast carcinomas: A case-control study.

Invasive ductal carcinoma (IDC) and invasive lobular carcinoma (ILC) of the breast are the most common histological subtypes of breast cancer. However, the associations and heterogeneity between histological subtypes and their risk factors are not well established. This study aimed to investigate risk factors for IDC and ILC. This case-control study included 1,009 incident breast cancer cases and 1,009 hospital controls, frequency-matched by age. Data were obtained from the patients' medical files and an interview administered via a questionnaire. Multinomial logistic regression was used and odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. The heterogeneity of the associations was assessed using the Wald test. Family history of breast cancer was associated with IDC (OR 2.64, 95% CI: 1.97-3.55) but not ILC (OR 0.81, 95% CI: 0.42-1.57; p for heterogeneity <0.001). Conversely, a history of miscarriage was associated with ILC (OR 1.71, 95% CI: 1.17-2.51) but not IDC (OR 1.18, 95% CI: 0.95-1.46; p for heterogeneity = 0.04). Similarly, type 2 diabetes was associated with ILC but not IDC (p for heterogeneity = 0.02). Age at first delivery and breastfeeding were significantly associated with IDC but not ILC, though p values for heterogeneity did not reach the significance level. Deliberate weight loss and age at menarche were significantly associated with ILC but not IDC (p for heterogeneity ≥0.27). Smoking, history of benign breast disease and BMI were associated with both subtypes. The present study supports the hypothesis that IDC and ILC are etiologically distinct tumours.