Exploring the practice of Iranian adolescent females during menstruation and related beliefs: a qualitative study.

BACKGROUND: Menstruation is a natural occurrence that women experience during their reproductive years and may encounter many years throughout their lifespan. Many adolescent females lack accurate knowledge about menstruation, so they may face issues from receiving incorrect information from unreliable sources. Our study aimed to investigate the practices and beliefs surrounding menstruation among Iranian adolescent females. METHODS: This qualitative study was conducted using conventional content analysis. A purposeful sampling method was used to select 18 adolescent females from secondary and high schools located in the three regions of Neyshabur City-Iran. Data were collected through in-depth, semi-structured interviews. RESULTS: Three main themes were extracted, consisting of lifestyle and related beliefs, lake of support, and awareness and information. CONCLUSIONS: misconceptions and wrong behaviors during menstruation indicate that the lake of knowledge an traditional factors influence adolescent girls' health. The study provides the basis for intervention planning in this regard and different levels (individual, intrapersonal, health systems, and community).

Comparative Study of the Effect of Lidocaine Spray and Ice Spray on the Pain Intensity During Intramuscular Injection: A Randomized Clinical Trial.

BACKGROUND: Intramuscular injection is one of the most common, invasive, and painful ways to deliver medicine to the body. AIM: Since one of the nurse's duties is to employ different methods to reduce pain caused by treatment procedures, this study was conducted to determine the effect of lidocaine spray and ice spray on pain intensity at the muscle injection site. METHOD: A clinical trial was performed on 90 patients presenting to outpatient clinics of Neyshabur hospitals. The samples were selected using a computerized table of random numbers, and each participant was randomly assigned to one of the control, lidocaine spray, and ice spray groups. Pain severity was measured immediately after intramuscular injection using a numerical pain scale. Descriptive statistics along with statistical tests (chi-square, Fisher, etc.) were used to analyze the data in the R environment version 3.6.2. Ordinal logistic regression was used to compare pain intensity in the three groups by adjusting the effect of age variables and sensory disorders. RESULTS: The mean pain intensity was 3.44 without intervention, 2.63 with lidocaine spray, and 2.27 with ice spray. Statistical tests indicated a significant difference in pain intensity of intramuscular injection between the ice group and the control group (p = .010). Although lidocaine spray reduced the pain intensity, its effect was insignificant compared with the control group. CONCLUSIONS: Both ice and lidocaine spray can be effectively used to reduce the intensity of intramuscular injection pain; however, it seems that ice spray is a more effective, safe, and affordable method.

Metabolic Syndrome and Body Composition Among People Aged 50 Years and Over: Results from The Neyshabur Longitudinal Study on Ageing (NeLSA).

There are few studies regarding body composition and metabolic syndrome (MetS) association in older adults. To evaluate the association between MetS and body composition indices in a large-scale population of subjects with an age of 50 and up. This study was based on the data from Neyshabur Longitudinal Study on Ageing (NeLSA) in a total of 7462 people of Neyshabur city in IRAN. The best cut-off scores and AUC value of body composition variables for having association with likelihood of MetS were determined by using a receiver operating curve analysis. Each unit increase in the Waist/Hip ratio, the odds of having MetS increase 3-6 times (OR: 4.937, 95%CI: 3.930, 6.203 in men; OR: 3.322, 95%CI: 2.259, 4.884 in women). In addition, in the case of BMI (OR: 1.256, 95% Cl: 1.226, 1.286 in men; OR: 1.104, 95% Cl: 1.086, 1.121 in women) and BFM (OR: 1.119, 95% Cl: 1.105, 1.133 in men; OR: 1.050, 95% Cl: 1.041, 1.060 in women), the chance of having MetS increases with increasing these variables. Totally, BMI and BFM showed the best AUC values. The optimal cut-off values for BMI in men was 26.45 and in women was 27.35 and for BFM in men was 23.35 and in women was 26.85. These results suggest that adiposity measures such as BMI and BFM are associated with likelihood of having MetS in subjects with an age of 50 and up, and that avoiding high adiposity is important to prevent MetS incidence.

Sex-specific prevalence of metabolic syndrome in older adults: results from the Neyshabur longitudinal study on aging, Iran.

Purpose: The prevalence of metabolic syndrome (MetS) and associated diseases grows as the population ages. This study aimed to investigate sex differences in the prevalence of MetS and its components among people aged 50 years and older in Iran. Methods: Data were drawn from the Neyshabur Longitudinal Study on Ageing (NeLSA), which is an ageing component of the Prospective Epidemiological Research Studies in IraAn (PERSIAN). The NCEP ATP III and IDF criteria were used to identify the prevalence of MetS among 3383 men and 3873 women aged 50 years and older. Sociodemographic information, lifestyle and clinical factors were collected via an interview-based questionnaire. Weight and height, waist circumferences and blood pressure were measured. Laboratory measures such as fasting blood sugar, triglycerides and high-density cholesterol were also assessed. Results: The overall prevalence of the MetS according to the NCEP ATP III and IDF definitions were 45% and 47%, respectively. The prevalence of the MetS in men and women was 37% and 63% according to the NCEP ATP III definition, 33% and 67% by the IDF definition, respectively. The prevalence of MetS components was significantly higher in women than in men. Conclusion: In the current study, the prevalence of MetS and its components was significantly higher among women than men. We also observed good concordance between IDF and NCEP ATP III criteria.

Predicting the Survival of AIDS Patients Using Two Frameworks of Statistical Joint Modeling and Comparing Their Predictive Accuracy.

BACKGROUND: The present study aimed to estimate the survival of HIV-positive patients and compare the accuracy of two commonly used models, Shared Random-Effect Model (SREM) and Joint Latent Class Model (JLCM) for the analysis of time to death among these patients. METHODS: Data on a retrospective survey among HIV-positive patients diagnosed during 1989-2014 who referred to the Behavioral Diseases Consultation Center of Mashhad University of Medical Sciences was used in this study. Participants consisted of HIV-positive high-risk volunteers, referrals of new HIV cases from prisons, blood transfusion organization and hospitals. Subjects were followed from diagnosis until death or the end of study. SREM and JLCM were used to predict the survival of HIV/AIDS patients. In both models age, sex and addiction were included as covariates. To compare the accuracy of these alternative models, dynamic predictions were calculated at specific time points. The receiver operating characteristic (ROC) curve was used to select the more accurate model. RESULTS: Overall, 213 patients were eligible that met entry conditions for the present analysis. Based on BIC criteria, three heterogeneous sub-populations of patients were identified by JLCM and individuals were categorized in these classes ("High Risk", "Moderate Risk" and "Low Risk") according to their health status. JLCM had a better predictive accuracy than SREM. The average area under ROC curve for JLCM and SREM was 0.75 and 0.64 respectively. In both models CD4 count decreased with time. Based on the result of JLCM, men had higher hazard rate than women and the CD4 counts levels of patients decreased with increasing age. CONCLUSION: Predicting risk of death (or survival) is vital for patients care in most medical research. In a heterogeneous population, such as HIV-positive patients fitting JLCM can significantly improve the accuracy of the risk prediction. Therefore, this model is preferred for these populations.

Oral versus written feedback delivery to nursing students in clinical education: A randomized controlled trial.

BACKGROUND: Feedback delivery is deemed as a key element during a students' clinical education. It keeps students on track to meet their goal and increase students' motivation and confidence. OBJECTIVE: The aim of this study was to compare the quality of feedback delivery in oral versus written feedback delivery to nursing students in clinical education. METHODS: A randomized controlled trial was conducted between February and August 2012 in the city of Bojnurd in Iran. Using purposive sampling, last semester's nursing students (n=44) had been randomly assigned to oral and written feedback delivery groups. Three Instructors received orientation and training on methods of feedback delivery before study initiation. Then, they gave necessary oral and written feedback to the students. Clinical settings of the study included coronary care, surgical, and neonatal units of hospitals. Data collection tools were quality of feedback delivery, students' satisfaction questionnaire and students' reactions checklist. Data were analyzed using SPSS version 11.5 with chi-square test and the t-test. RESULTS: Most of the students (52%, n=23) were male. There were no significant differences between the scores of quality of oral and written feedback delivery (p>0.05). The study did not show a difference of satisfaction level between the oral and written feedback groups. The relationship between students' reactions and feedback type at the confidence level of 90% was significant, so that students who received oral feedback showed more severe reactions as compared to the written feedback group. CONCLUSION: According to the results, the type of feedback is not an important factor in clinical education quality and satisfaction level. They may achieve a better outcome by focusing on the other aspects of quality of feedback delivery rather than feedback type. TRIAL REGISTRATION: The trial was registered at the Iranian Registration Center for Clinical Trials with the Irct id: (IRCT: 201111128076N1). FUNDING: North Khorasan University of Medical Sciences (permission no. 89/p/209).

PhD programs in nursing in Iran and Canada: A qualitative study.

OBJECTIVE: To compare doctoral programmes of nursing in Iran and Canada. METHODS: This qualitative study was conducted in Mashhad, Iran, in April 2014. It was based on Beredy's model, including description, interpretation, juxtaposition and comparison. The validity of the related documents was assessed by internal validity, importance and accuracy of documents. Critique on the external validity and core of documents were reviewed. Then, they were interpreted, juxtaposed and compared. RESULTS: Both the countries had significant differences in fundamental elements of their curricula, including mission, vision, aim, objectives, roles and tasks of graduates. Consequently, academic units, final comprehensive exam, and research courses were also different. CONCLUSIONS: Doctoral programmes in Canada focussed on competency-based, community-based, task-based and student-centred approaches. These approaches were ignored in the Iranian curriculum.

Determinants of Social Accountability in Iranian Nursing and Midwifery Schools: A Delphi Study.

BACKGROUND: Revising the medical education programs to meet the needs of society has become both a necessity and an important priority due to the considerable increase of population, changing patterns of diseases, and new health priorities. While this necessity has been highlighted in Iran's Fifth Development Plan as well as its National 2025 Vision Plan, the determinants of social accountability have not been explained yet. This study aimed to develop determinants of social accountability in the Iranian Nursing and Midwifery Schools. METHODS: This classic Delphi study included thirty experts in Nursing and Midwifery Education, Research and Services selected based on purposive sampling and three rounds of Delphi technique and conducted in Nursing and Midwifery School of Mashhad University of Medical Sciences. The primary data were collected using an initial structured questionnaire prepared through extensive review of literature. SPSS 11.5 software was used to analyze the data. The interquartile deviation and percentage of agreement were also used to study the consensus of opinion by experts. RESULTS: Finding obtained from the rounds of Delphi resulted in selecting 69 determinants out of the initial pool of 128 primary determinants of social accountability. The items were selected based on experts' consensus and categorized under three main activities of Nursing and Midwifery School, namely education, research, and service. CONCLUSION: Social accountability determinants were explained by 69 items for Schools of Nursing and Midwifery in Iran. The proposed determinants can be used by managers and authorities of Nursing and Midwifery School, policy makers, and evaluating institutions associated with them to ensure realizing social accountability goals.

Development of Islamic Spiritual Health Scale (ISHS).

OBJECTIVE: To develop and psychometrically assess spiritual health scale based on Islamic view in Iran. METHODS: The cross-sectional study was conducted at Imam Ali and Quem hospitals in Mashhad and Imam Ali and Imam Reza hospitals in Bojnurd, Iran, from 2015 to 2016 In the first stage, an 81-item Likert-type scale was developed using a qualitative approach. The second stage comprised quantitative component. The scale's impact factor, content validity ratio, content validity index, face validity and exploratory factor analysis were calculated. Test-retest and internal consistency was used to examine the reliability of the instrument. Data analysis was done using SPSS 11. RESULTS: Of 81 items in the scale, those with impact factor above 1.5, content validity ratio above 0.62, and content validity index above 0.79 were considered valid and the rest were discarded, resulting in a 61-item scale. Exploratory factor analysis reduced the list of items to 30, which were divided into seven groups with a minimum eigen value of 1 for each factor. But according to scatter plot, attributes of the concept of spiritual health included love to creator, duty-based life, religious rationality, psychological balance, and attention to afterlife. Internal reliability of the scale was calculated by alpha Cronbach coefficient as 0.91. CONCLUSIONS: There was solid evidence of the strength factor structure and reliability of the Islamic Spiritual Health Scale which provides a unique way for spiritual health assessment of Muslims.

Spiritual Health in Nursing From the Viewpoint of Islam.

CONTEXT: In order to gain a more detailed insight into the concept of spiritual health, a hybrid model of concept analysis was used to remove some of the ambiguity surrounding the conceptual meaning of spiritual health in Islamic and Iranian contexts. The purpose of this study was to clarify the meaning and nature of the spiritual health concept in the context of the practice of Islam among Iranian patients. EVIDENCE ACQUISITION: The current concept analysis was undertaken according to the modified traditional hybrid model, which consists of five phases: theoretical phase, initial fieldwork phase, initial analytical phase, and final fieldwork and final analytical phase. In the theoretical phases of the study, the concept of spiritual health was described based on a literature review of publications dealing with the Islamic viewpoint (years: from 2013 to 2014, Databases and search engines: Pubmed, SID, Magiran, Noormax, Google Scholar, Google and IranMex, Languages: English and Persian, Keywords: spiritual health AND (Islam OR Quran), spirituality AND (Islam OR Quran), complete human AND Islam, healthy heart (Galb Salim) AND Islam, healthy life (Hayat tayebeh) AND Islam, calm soul (Nafse motmaeneh) And Islam and healthy wisdom (Aghle Salim) AND Islam). Purposive sampling was conducted and nine participants were selected. Semi-structured interviews and observations were conducted periodically for data collection after obtaining informed consent. Observational, theoretical, and methodological notes were made. Then, using MAXQUDA 7 software, the data were analyzed using qualitative content analysis. RESULTS: The relevant literature in the theoretical phase uncovered the attributes of the concept of spiritual health, including love of the Creator, duty-based life, religious rationality, psychological balance, and attention to afterlife. These attributes were explored in depth in later stages. Finally, the definition of spiritual health was developed. CONCLUSIONS: Islam has a unique perspective on spiritual health as it encompasses all aspects of human beings. Thus, it is necessary to carefully study the difference between the Islamic concept of spiritual health and that of other religions and ideologies to design suitable and useful nursing care for Iranian patients that satisfy their spiritual needs.

Malondialdehyde-Modified LDL IgG Antibody Levels and Indices of Cardiac Function in Valvular Heart and Coronary Artery Disease Patients.

OBJECTIVE: To compare the changes in anti-malondialdehyde-modified low-density lipoprotein (MDA-LDL) IgG levels among patients undergoing off-pump and on-pump coronary artery bypass grafting (CABG) or valvuloplasty. SUBJECTS AND METHODS: A total of 38, 39 and 34 patients who underwent off-pump CABG, on-pump CABG and valvuloplasty, respectively, were enrolled in this study. Serum anti-MDA-LDL IgG values were measured 24 h before and after the operative procedures and at discharge. Echocardiography was also done before surgery and before discharge. The results were compared with values from 50 healthy controls. RESULTS: In all patients, a reduction in antibody titers was observed post-operatively. However, the decrease was significant only in the off-pump CABG - before surgery: 42.33 (25.83-58.51), after surgery: 30.86 (16.36-51.33) and at discharge: 10.96 (6.82-23.57; p = 0.027). There was a significant positive association between anti-MDA-LDL IgG levels and ejection fraction (r = 0.248, p = 0.036) and a negative association with E/E', a marker of pulmonary capillary wedge pressure, in the coronary patients (r = -0.345, p = 0.012), but no significant associations were found in patients with valvular heart disease. CONCLUSIONS: Serum anti-MDA-LDL IgG levels were associated with cardiac function indices in coronary patients undergoing CABG.

A structural equation model to predict the social-cognitive determinants related to physical activity in Iranian women with diabetes mellitus.

BACKGROUND: Lifestyle-modification programs including physical activity are essential for both treatment and prevention of Type 2 Diabetes Mellitus (T2DM). However, factors associated with physical activity among patients are poorly understood. This study applied Social-Cognitive Theory (SCT) for predicting determinants of physical activity among women with T2DM in Iran, 2013. METHODS: In this cross-sectional study, partial least square path modeling (PLS-PM) was used as an estimation technique for structural equation model. This model specified hypotheses between components of Social-cognitive Theory on physical activity behavior. A random sample of 300 women with T2DM was selected, and completed SCT constructs instrument. Data were analyzed using statistical software WarpPLS Ver. 4.0. RESULTS: The model explained 26% of the variance in physical activity. Self-regulation, task self-efficacy and barrier self-efficacy were significantly direct predictors of physical activity among women with T2DM. Task self-efficacy, social support and modeling had significantly indirect effects on physical activity behavior (P<0.001). CONCLUSIONS: Our findings showed evidence for adequacy of a theoretical framework that could be used to predict physical activity behavior among women with T2DM.

Pender's health promotion model in medical research.

This review shows how researchers use pander's health promotion model. We included all articles in which Pender's health promotion has been used for theoretical framework. Eligible articles were selected according to review of abstracts. Search was conducted using the electronic database from 1990 to 2012. Based on our search, 74 articles with various methodologies were relevant for review. Their aims of these studies were to predict effective factors/barriers in health promotion behaviours, to detect effects of intervention programme for improving health promotion behaviours, test the model, identify quality of life and health promotion behaviour, predict stage of change in related factors that affect health promotion behaviour, prevent the events that interfere with health promotion behaviour, develop another model similar to this model, compare this model with another model, determine the relationship of variables associated to health promotion behaviours.

Prooxidant-antioxidant balance and cardiac function in patients with cardiovascular disease following cardiac surgery.

BACKGROUND AND AIM OF THE STUDY: Cardiopulmonary bypass (CPB) is used during on-pump coronary artery bypass grafting (CABG) and heart valvular replacement surgery, and is associated with the induction of oxidative stress. The aim of the study was to assess the association between indices of cardiac function and prooxidant-antioxidant balance (PAB) values in patients undergoing valve replacement surgery and on-or off-pump CABG. METHODS: Data were obtained from 44, 33, and 41 patients undergoing off-pump CABG, on-pump CABG, and valve replacement surgery, respectively. The PAB values were measured 24 h before and after the operative procedure, and at the time of discharge. Echocardiography was performed before surgery and before discharge. RESULTS: The changes in E/E', end-diastolic volume, end-systolic volume, left ventricular diastolic and systolic diameter were significantly related to baseline PAB values. In the valve replacement group, neither baseline nor changes in PAB values were associated with echocardiographic measurements. Also, neither off-pump nor on-pump CABG were significantly different in inducing oxidative stress (p = 0.596). When PAB values were measured in CABG patients, there was a significant difference in values between the three time points (p = 0.013). In the valve replacement group, PAB values were not significantly different between the preoperative and postoperative samples. CONCLUSION: The inverse association between the level of oxidative stress and cardiac function measurement may indicate that high levels of oxidative stress may be a predictor of the deterioration of cardiac function in CABG patients. However, in valvular heart disease patients the serum PAB value was not associated with changes in cardiac function. Levels of oxidative stress, as assessed by the PAB assay, were not significantly different for patients undergoing surgery with or without CPB.

Changes in anti-heat shock protein 27 antibody and C-reactive protein levels following cardiac surgery and their association with cardiac function in patients with cardiovascular disease.

The relationship between serum anti-heat shock protein (Hsp)27 antibody and high sensitive C-reactive protein (hs-CRP) levels and indices of cardiac function were investigated in patients undergoing coronary artery bypass grafting (CABG) or heart valve replacement. The changes in anti-Hsp27 antibody titers and hs-CRP levels were compared among patients undergoing off-pump and on-pump CABG or valvular heart replacement. Fifty-three patients underwent off-pump, on-pump CABG, and heart valvular replacement in each group. Serum anti-Hsp27 titers and hs-CRP values were measured 24 h before and after the operation and at discharge. Echocardiography was performed before surgery and before discharge. The results were compared with values from 83 healthy controls. hs-CRP levels increased and anti-Hsp27 antibody decreased following surgery (P < 0.001 and P < 0.05, respectively), although these changes were independent of operative procedure (P = 0.361 and P = 0.120, respectively). Anti-Hsp27 antibody levels were higher at the time of discharge (P = 0.016). Only in coronary patients were anti-Hsp27 antibody levels negatively associated with E/E' (r = -0.268, P = 0.022), a marker of pulmonary capillary wedge pressure. In conclusions, anti-Hsp27 antibody levels are associated with indices of cardiac function in coronary patients. Cardiopulmonary bypass had no significant effect on the induction of changes in anti-Hsp27 levels. Moreover, anti-Hsp27 antibody levels fell in all groups postoperatively; this may be due to the formation of immune complexes of antigen-antibody, and antibody levels were higher at the time of discharge.

Prooxidant-antioxidant balance and antioxidized LDL antibody level values and cardiac function in patients with coronary artery disease.

OBJECTIVES: We studied the association between the prooxidant-antioxidant balance (PAB), anti-malondialdehyde-modified low-density lipoprotein (oxidized LDL, ox-LDL) IgG antibody and indices of cardiac function (systolic and diastolic function) in patients with coronary artery disease (CAD). METHODS: Fifty-five patients with established CAD were selected, and serum levels of anti-ox-LDL IgG and PAB values were measured and compared with 40 matched healthy controls. Systolic and diastolic functions were determined for all patients. RESULTS: PAB values were significantly higher in patients than in controls (p < 0.001), whilst serum anti-ox-LDL concentrations were not statistically different between the 2 groups (p = 0.821). However, after adjustment for high-density lipoprotein cholesterol, the patients had higher anti-ox-LDL levels (p = 0.04). Total PAB values were inversely associated with ejection fraction (r = -0.326, p = 0.031), but this was not the case for anti-ox-LDL in either group (p > 0.05). CONCLUSION: Serum concentrations of a marker of oxidative stress (PAB values) are inversely associated with cardiac function. PAB is a relatively simple index that could be incorporated into risk assessment in CAD patients. Anti-ox-LDL IgG antibody concentration does not appear to reflect total oxidative stress as assessed by PAB.

Association between indices of body mass and antibody titers to heat-shock protein-27 in healthy subjects.

OBJECTIVES: We have assessed the relationship between indices of adiposity and antibody titers to Hsp-27 in healthy subjects. DESIGN: Two-hundred and fifty subjects were studied, including 50 normal-weight subjects (body-mass-index (BMI) 25 kg/m(2)), 100 overweight subjects (BMI 25 to 30 kg/m(2)) (n=100) and 100 obese subjects (BMI ≥ 30 kg/m(2)). RESULTS: Anti-Hsp27-antibody levels in obese subjects were [0.34 (0.20-0.39) absorbency unit], being significantly higher than overweight and normal-weight groups (P<0.05). Anti-Hsp27-antibody levels in overweight subjects [0.29 (0.15-0.34) absorbency unit] were statistically higher than controls [0.18 (0.10-0.23) absorbency unit] (P<0.05). CONCLUSION: High anti-Hsp-27-antibody levels in obese-subjects without established coronary disease may be related to a heightened state of immunoactivation associated with obesity.

Prooxidant-anti-oxidant balance is not associated with extent of coronary artery disease.

OBJECTIVE: We have measured the pro-oxidant-antioxidant-balance (PAB) levels in patients with defined coronary artery disease (CAD) and compared them with concentrations in healthy subjects. DESIGN AND METHODS: Based on angiography results, 400 patients with stable CAD were divided into CAD- and CAD+, this being further subcategorized into groups with single-, double- and triple-vessel disease (VD). RESULTS: The mean PAB values in the healthy subjects, was significantly lower than for other groups (P<0.001). In CAD- patients, PAB levels were 123.2 ± 43.9, which was not statistically different compared to groups with SVD, 2VD and 3VD (P>0.05). In the CAD+ group, PAB values in 1VD, 2VD and 3VD were not significantly different among patients with SVD, 2VD and 3VD (P>0.05). CONCLUSIONS: In conclusion, we found higher levels of oxidative stress in CAD+ patients compared to healthy subjects. The oxidation level was not related to measures of the extent of CAD such as number of stenosed vessels.