Evaluating Heavy Metals in Human Breast Milk: a Cross-Sectional Study from Mining and Agricultural Areas in Northwestern Iran.

This study aimed to assess the levels of heavy metals in the breast milk of women residing in the mining and agricultural areas of East Azerbaijan province in Iran. This cross-sectional study analyzed 68 lactating mothers from mining (n = 28) and agricultural (n = 40) areas of East Azerbaijan province in Iran between June 2022 and March 2023. The study used an Inductively Coupled Plasma Optical Emission Spectroscopy (ICP-OES) to measure the concentrations of heavy metals, including arsenic (As), chromium (Cr), copper (Cu), and iron (Fe). A semi-quantitative food frequency questionnaire (SQ-FFQ) was used to collect data on the dietary and sociodemographic characteristics of the mothers. Although the concentration of arsenic (As) was below the limit of detection (LOD), the mean concentrations of chromium (Cr), copper (Cu), and iron (Fe) were 1.11, 0.87, and 13.25 mg/L in agricultural areas and 0.83, 0.93, and 11.35 mg/L in mining areas, respectively. The concentrations of Cr (p < 0.001) and Fe (p = 0.019) were significantly higher in the breast milk of women residing in agricultural areas. However, the concentration of Cu was significantly higher (p = 0.085) in the breast milk of women living in mining areas. Additionally, lactation age had a significant effect on Cu levels (p = 0.015), with a negative coefficient of -0.011. The study indicates that the levels of heavy metals in breast milk can be influenced by the exposure to pesticides, fertilizers, volcanic soil, and disparities in access to post-natal care and iron supplements.

Critical care nurses' experiences of caring challenges during post-resuscitation period: a qualitative content analysis.

BACKGROUND: Patients in the post-resuscitation period experience critical conditions and require high-quality care. Identifying the challenges that critical care nurses encounter when caring for resuscitated patients is essential for improving the quality of their care. AIM: This study aimed to identify the challenges encountered by critical care nurses in providing care during the post-resuscitation period. METHODS: A qualitative study was conducted using semi-structured interviews. Sixteen nurses working in the intensive care units of three teaching hospitals were selected through purposive sampling. The Data collected were analyzed using qualitative content analysis. RESULTS: Participants experienced individual, interpersonal, and organizational challenges when providing post-resuscitation care. The most significant challenges include inadequate clinical knowledge and experience, poor management and communication skills, lack of support from nurse managers, role ambiguity, risk of violence, and inappropriate attitudes of physicians towards nurses' roles. Additionally, nurses expressed a negative attitude towards resuscitated patients. CONCLUSION: Critical care nurses face several challenges in providing care for resuscitated patients. To enhance the quality of post-resuscitation care, address the challenges effectively and improve long-time survival it is crucial to implement interventions such as In-service education, post-resuscitation briefing, promotion of interprofessional collaboration among healthcare teams, providing sufficient human resources, clarifying nurses' roles in the post-resuscitation period and increasing support from nursing managers.

Factors associated with sexual dysfunction in patients with colorectal cancer in Iran: a cross-sectional study.

Sexual dysfunction is a prevalent issue among individuals diagnosed with colorectal cancer (CRC), significantly impacting their quality of life. However, limited research has explored the factors associated with sexual dysfunction in CRC patients in Iran. This cross-sectional study aimed to identify the demographic factors that may contribute to sexual dysfunction in this population. A cross-sectional study involving CRC patients was conducted from April 1, 2022, to May 1, 2022, in Tabriz, Iran. Ethical approvals were obtained, and convenience sampling was employed at outpatient chemotherapy centers in five Tabriz hospitals. Validated questionnaires, including participants characteristics form, the Female Sexual Function Index (FSFI) for females and International Index of Erectile Function (IIEF) for males, were utilized. Data were analyzed using IBM SPSS Statistics version 24, employing descriptive statistics and stepwise linear regression to assess association between mentioned factors and sexual function. Among 256 participants, 50.4% were males, 49.6% were females, and 80.5% were married. The predominant age range was 50-60 years. The study findings revealed a high prevalence of sexual dysfunction among both female (Mean ± SD: 10.91 ± 8.67, Min-Max: 3.20-33.00) and male (Mean ± SD: 27.64 ± 16.28, Min-Max: 11-62) CRC patients. Factors such as the presence of a colostomy for FSFI (P < 0.001), type of treatment received for both FSFI and IIEF (P < 0.001), type of housing for both FSFI and IIEF (P < 0.001), occupation for FSFI (P < 0.001), presence of other diseases for FSFI (P = 0.047), and time since the last chemotherapy session for FSFI (P = 0.018), Education for IIEF (P = 0.026), and Age for IIEF (P = 0.002) were identified as significant factors of sexual dysfunction. These demographic factors demonstrated varying effects on sexual function, underscoring the complexity of this issue. The results underscore the significance of addressing sexual health concerns in CRC patients and highlight the necessity for tailored interventions to enhance their overall well-being. Healthcare providers should recognize the influence of demographic factors on sexual function and contemplate integrating sexual health assessments and interventions into the care of CRC patients. Further research is needed to comprehend better the underlying mechanisms and devise effective strategies for managing sexual dysfunction in this population.

Nursing core competencies for postresuscitation care in Iran: a qualitative study.

OBJECTIVE: This study explored nurses' perceptions of the core competencies required for providing postresuscitation care in both in-hospital and out-of-hospital cardiac arrest. DESIGN: Qualitative conventional content analysis. PARTICIPANTS: 17 nurses selected with purposeful sampling method. SETTING: Three educational hospitals in northwest of Iran. DATA COLLECTION AND ANALYSIS: Semi-structured interviews were used for data collection and they were analysed using conventional content analysis. RESULTS: Seven main categories have emerged from the data. The core competencies for nurses providing postresuscitation were identified as: quality assurance, providing evidence-based care, monitoring and presence, situation management, professionalism, positive attitude and providing family centred care. CONCLUSIONS: The postresuscitation period is a unique and critical time requiring highly competent nursing care. Several core competencies for providing high-quality nursing care during postresuscitation period were identified through nurses' experience in caring for patients postresuscitation.

Lifestyle patterns, nutritional, and metabolic syndrome determinants in a sample of the older Iranian population.

BACKGROUND: Chronic diseases and metabolic disorders are prevalent health concerns that often escalate with increasing age and thus affect older individuals. The proportion of the elderly population in Iran increased from 7.22% in 2006 to 12.0% in 2023. The current study aimed to evaluate lifestyle patterns and lifestyle risk factors among patients with metabolic syndrome (MetS) based on dietary, physical activity, and smoking, as well as MetS components. METHODS: This cross-sectional study included 582 older people with MetS living in Yazd, Iran. Latent class analysis (LCA) was used to determine the lifestyle behaviors of diet patterns, smoking, and physical activity. Dietary intake was measured using a validated food frequency questionnaire, and dietary patterns were identified using principal component analysis (PCA). Clinical measurements of MetS components were examined using relevant guidelines. RESULTS: The mean age of the participants was 72.71 years (SD = 5.57). Using PCA, two dietary patterns were identified: traditional patterns (e.g., fruits, fish, poultry, vegetables, meats, salt, and sugar sweetened beverages) and high-fat patterns (e.g., high-fat dairy). Applying LCA identified two classes of lifestyle patterns. About 35% (n = 204) of the participants were categorized in a low-risk class (I) and characterized by physical activity (0.93%, n = 190), a traditional pattern for diet (61%, n = 122), and zero probability of smoking. About 65% (n = 378) of the patients were categorized in high-risk class (II) and characterized by low physical activity levels (69%, n = 261), cigarette smoking (71.6%, n = 271), and a high-fat dietary pattern (56.9%, n = 215). CONCLUSION: The results of our study indicated two distinct classes within the patients. In class I, aging patients with MetS exhibited characteristics such as engagement in physical activity and having a traditional pattern for diet. Class II, with a higher prevalence of lifestyle risk factors, included individuals who engaged in cigarette smoking, displayed low physical activity (69%), and having a high-fat diet. The combination of these lifestyle factors exposed them to a heightened risk of developing MetS. The findings could guide healthcare professionals to be aware of the associations between different lifestyle risk factors and to focus on multiple behaviors at the same time.

Nurses' Perceptions Towards Resuscitated Patients: A Qualitative Study.

Nurses' perceptions of resuscitated patients may affect their care, and this has not been investigated in previous literature. The aim of this study was to explore nurses' perceptions towards resuscitated patients. In this descriptive-qualitative study seventeen clinical nurses participated using purposive sampling. In-depth, semi-structured interviews were conducted and data were analyzed by conventional content analysis. Four main categories emerged: Injured, undervalued, problematic, and destroyer of resources. Participants considered resuscitated patients to have multiple physical injuries, which are an important source of legal problems and workplace violence, and they believed that these patients will eventually die. Resuscitated patients are considered forgotten and educational cases. Iranian nurses have a strong negative perception towards resuscitated patients. Improving the quality of cardiopulmonary resuscitation, improving the knowledge and skills of personnel in performing resuscitation, and supporting managers and doctors to nurses in the post-resuscitation period can change the attitude of nurses and improve post-resuscitation care.

Identifying potential circulating miRNA biomarkers for the diagnosis and prediction of ovarian cancer using machine-learning approach: application of Boruta.

Introduction: In gynecologic oncology, ovarian cancer is a great clinical challenge. Because of the lack of typical symptoms and effective biomarkers for noninvasive screening, most patients develop advanced-stage ovarian cancer by the time of diagnosis. MicroRNAs (miRNAs) are a type of non-coding RNA molecule that has been linked to human cancers. Specifying diagnostic biomarkers to determine non-cancer and cancer samples is difficult. Methods: By using Boruta, a novel random forest-based feature selection in the machine-learning techniques, we aimed to identify biomarkers associated with ovarian cancer using cancerous and non-cancer samples from the Gene Expression Omnibus (GEO) database: GSE106817. In this study, we used two independent GEO data sets as external validation, including GSE113486 and GSE113740. We utilized five state-of-the-art machine-learning algorithms for classification: logistic regression, random forest, decision trees, artificial neural networks, and XGBoost. Results: Four models discovered in GSE113486 had an AUC of 100%, three in GSE113740 with AUC of over 94%, and four in GSE113486 with AUC of over 94%. We identified 10 miRNAs to distinguish ovarian cancer cases from normal controls: hsa-miR-1290, hsa-miR-1233-5p, hsa-miR-1914-5p, hsa-miR-1469, hsa-miR-4675, hsa-miR-1228-5p, hsa-miR-3184-5p, hsa-miR-6784-5p, hsa-miR-6800-5p, and hsa-miR-5100. Our findings suggest that miRNAs could be used as possible biomarkers for ovarian cancer screening, for possible intervention.

Nurses' experiences of provision family-centred care in the postresuscitation period: A qualitative study.

AIM: This study aimed to explore nurses' experiences of providing family-centred care in the postresuscitation period. DESIGN: An exploratory-descriptive qualitative design was used. METHODS: In this qualitative study, in-depth, semi-structured interviews were conducted with 22 nurses in three educational hospitals. There were six participants who completed follow-up interviews to resolve questions generated during initial interviews. Data were analysed using conventional content analysis. RESULTS: Five main categories were extracted: continuous monitoring, facilitation of attendance, involvement in care, informing and emotional support. Despite the lack of organizational policies and guidelines, nurses explained how they work to provide family-centred care for families, especially those they assessed as having less possibility of aggressive behaviour and those with a better understanding of their loved one's condition. To provide postresuscitation family-centred care, nurses facilitated family attendance, involved them in some basic nursing care, and provided information and emotional support to the family members. CONCLUSION: Nurses attempted to follow the basic principles of family-centred care in the postresuscitation period. However, to improve the provision of care by nurses, it is necessary to embed family-centred care principles in institutional policies and guidelines and to conduct training for nurses. IMPLICATIONS FOR THE PROFESSION: Iranian nurses are interested in engaged families in the postresuscitation period. Correct implementations of such care that include all families need institutional policies and guidelines. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Comparison of sexual function of people with colorectal cancer with and without colostomy bag in Iran: a comparative cross-sectional study.

The aim of this study was to investigate and compare sexual function in individuals with colorectal cancer, with and without a colostomy bag. A quantitative, descriptive-comparative design was employed, and a cluster random sampling method was used to recruit 252 patients with colorectal cancer. Data collection tools included a participants characteristics form, the International Index of Erectile Function (IIEF) for men, and the Female Sexual Function Index (FSFI) for women. The mean IIEF total score for men with a colostomy was 26.17 ± 15.30, and for men without a colostomy, it was 29.05 ± 17.14. The mean FSFI total score for women with a colostomy was 6.40 ± 7.21, and for women without a colostomy, it was 9.10 ± 14.67. There was no statistically difference in IIEF scores between men with and without colostomy bags (p > 0.05). However, women with colostomy bags had significantly lower FSFI scores compared to women without colostomy bags (p < 0.05). Addressing sexual concerns in individuals with colorectal cancer is crucial for enhancing their sexual well-being and overall quality of life. Comprehensive support, timely interventions, and targeted services are essential to help patients navigate the challenges and improve their overall well-being.

Patterns and Predictors of Multimorbidity in the Azar Cohort.

BACKGROUND: The co-existence of chronic diseases (CDs), a condition defined as multimorbidity (MM), is becoming a major public health issue. Therefore, we aimed to determine the patterns and predictors of MM in the Azar Cohort. METHODS: We evaluated the prevalence of MM in 15,006 (35-70-year old) subjects of the Azar Cohort Study. MM was defined as the co-existence of two or more CDs. Data on the subjects' socioeconomic status, demographics, sleeping habits, and physical activity were collected using questionnaires. RESULTS: The overall prevalence of MM was 28.1%. The most prevalent CDs, in decreasing order, were obesity, hypertension, depression, and diabetes. Obesity, depression, and diabetes were the most co-occurring CDs. The MM risk increased significantly with age, illiteracy, and in females. Also, the subjects within the lowest tertile of physical activity level (OR=1.89; 95% CI: 1.75-2.05) showed higher MM risk than those with the highest level of physical activity. Findings regarding current smoking status indicated that being an ex-smoker or smoker of other types of tobacco significantly increased the risk of MM. CONCLUSION: The reduction of MM is possible by promoting public health from an early age among people of various socioeconomic conditions. It is vital to offer the necessary health support to the aging population of Iran.

The Relationship between COVID-19 Exposure Risk and Burnout in Prehospital Emergency Medical Technicians.

Introduction: Exposure to coronavirus disease 2019 (COVID-19) has caused many physical and psychological effects on front-line healthcare workers (HCWs). This study aimed to assess the relationship between the exposure risk to COVID-19 disease and burnout in prehospital emergency medical technicians (EMTs). Methods: In this correlational study, 335 prehospital EMTs were selected by random sampling method from the 49 stations of emergency medical services in the northwest of Iran. Data were collected using a questionnaire developed by the world health organization for the risk assessment and management of exposure of health care workers to COVID-19. Moreover, Pines burnout measure was used for the assessment of participants' burnout. Data were analyzed using SPSS version 13. Results: Results showed that 30.7 % of prehospital EMTs had a high burnout score against COVID-19 disease. The prehospital EMTs who had a high occupational exposure risk experienced a high risk of burnout (P=0.03). The results of the linear regression analysis showed that prehospital EMTs who had a low exposure risk of COVID-19 had a low burnout score (ß=-9.30; P<0.001), and those who had less than 10 years of work experience showed less burnout (ß=-10.54; P<0.001). Conclusion: According to the results, the exposure risk to COVID-19 increases the prehospital EMT's burnout. As a result, reducing the exposure risk to COVID-19 by providing adequate access to personal protective equipment (PPE), development of training and following standards and protocols can be effective in controlling burnout in HCWs.

Predictors of fear control related to COVID-19 among older population: an investigation on COVID-19 risk perception and health related quality of life during the pandemic.

BACKGROUND: The aim of this study was to examine the role of demographic characteristics, general health and health related quality of life on the fear control. Also, the aim of study was to explore how older people percept the COVID-19 pandemic by using the component of the expanded parallel process model (EPPM), and how the possible perception may contribute to probable behavior responses to prevention and control of COVID-19. METHODS: The present study is a cross-sectional study that was conducted in Tabriz, a city in north of Iran from February to April 2021, the period that correspond with the fourth wave of COVID-19. To collect information, the Covid-19 risk perception questionnaire (based on EPPM model including efficacy, defensive responses, and perceived threat) and health related quality of life (HQOL) Short Form-36 questionnaire were used. Discriminate value was calculated to estimate fear control and danger control. Univariate and multivariable logistic regression were calculated to examine the effect of demographic characteristics, general health and health-related quality of life on the fear control. RESULTS: The mean age of the 350 participants was 67.9 (6.4) years. A total of 83.1% of participants were engaged in danger control processes and 16.9% in fear control processes. According to the multivariable results, significant predictors for fear control were: gender 1.57 (95% CI 1.05-2.34, 0.025), education 7.38 (1.42-38.35, p = 0.017), economic status 1.31 (0.4-0.63, p = 0.029), and significant protective factors for fear control were: body pain 0.97 (0.94-0.99, p = 0.041), general health 0.96 (0.93-0.98, p = 0.032), physical health 0.94 (0.90-0.98) and total quality of life 0.024 (0.89-0.98). CONCLUSIONS: Strong associations of fear control were found with being female, being illiterate, and having a good economic status and also body pain, general health, physical health and total HQOL were significantly associated with danger control. Since, most of elderly populations have adequately higher perceptions of efficacy to counteract their threat perceptions to continue motivating these older people to engage in COVID-19 self-protective behaviors, it is necessary to emphasis on the susceptibility of target population and the severity of the COVID-19 threats.

Indices/Indicators Developed to Evaluate the "Creating Supportive Environments" Mechanism of the Ottawa Charter for Health Promotion: A Setting-Based Review on Healthy Environment Indices/ Indicators.

This study aimed to identify the indices/indicators used for evaluating the "creating supportive environments" mechanism of the Ottawa Charter for Health Promotion, with a focus on built environments, in different settings. A search for literature with no time limit constraint was performed across Medline (via PubMed), Scopus, and Embase databases. Search terms included "Ottawa Charter," "health promotion," "supportive environments," "built environments," "index," and "indicator." we included the studies conducted on developing, identifying, and/or measuring health promotion indices/indicators associated with "built environments" in different settings. The review articles were excluded. Extracted data included the type of instrument used for measuring the index/indicator, the number of items, participants, settings, the purpose of indices/indicators, and a minimum of two associated examples of the indices domains/indicators. The key definitions and summarized information from studies are presented in tables. In total, 281 studies were included in the review, within which 36 indices/indicators associated with "built environment" were identified. The majority of the studies (77%) were performed in developed countries. Based on their application in different settings, the indices/indicators were categorized into seven groups: (1) Healthy Cities (n=5), (2) Healthy Municipalities and Communities (n=18), (3) Healthy Markets (n=3), (4) Healthy Villages (n=1), (5) Healthy Workplaces (n=4), (6) Health-Promoting Schools (n=3), and (7) Healthy Hospitals (n=3). Health promotion specialists, health policymakers, and social health researchers can use this collection of indices/indicators while designing/evaluating interventions to create supportive environments for health in various settings.

Are oral health behaviors associated with metabolic syndrome in the Azar cohort population?

OBJECTIVE: Considering the rising prevalence of metabolic syndrome (MetS), this study aimed to investigate the relationship between MetS and its components with oral and dental health in the adult population of the Azar cohort. METHODS: In this cross-sectional study oral health care behaviors, DMFT (decayed, missing, and filled teeth) index, and demographic data related to 15,006 patients (5112 in the MetS group and 9894 in the healthy group) of the Azar Cohort population aging from 35 to 70 were collected using appropriate questionnaires. The definition of MetS was based on the National Cholesterol Education Program Adult Treatment Panel III (ATP III) criteria. Then, the risk factors of MetS related to oral health behaviors were determined by proper statistical analysis. RESULTS: The majority of MetS patients were female (66%) and uneducated (23%) (P < 0.001). In the MetS group, the DMFT index (22.15 ± 8.89) was significantly (p < 0.001) higher (20.81 ± 8.94) than the no MetS group. Not brushing at all was associated with increased odds of MetS (unadjusted OR = 1.12, adjusted OR = 1.18). Flossing less than once a day was associated with increased odds of abdominal obesity (unadjusted OR = 1.17, 95%CI = 1.03-1.32) and hyperglycemia (unadjusted OR = 1.88, 95%CI = 1.61-2.20). CONCLUSIONS: This study showed that in MetS patients of the Azar cohort study, oral hygiene was worse compared to that in the no MetS group. Further studies are suggested to encourage oral hygiene among the general population which has more beneficiary effects than has been known before.

Effectiveness of implementing of an infection control link nurse program to improve compliance with standard precautions and hand hygiene among nurses: a quasi-experimental study.

BACKGROUND: Standard precautions (SPs) including hand hygiene are considered fundamental protective measures to manage health care-associated infections (HCAIs) and to reduce occupational health hazards. The purpose of this research was to examine the effectiveness of an infection control link nurse (ICLN) program on compliance with SPs and hand hygiene among nurses. METHODS: A quasi-experimental study with a pretest-post-test design was conducted with participating of 154 clinical nurses who worked in different wards of a tertiary referral teaching hospital in Iran. The intervention group (n = 77) had 16 infection control link nurses nominated. The control group (n = 77) received only the standard multimodal approach used in the hospital. Pre- and post-test assessment of compliance with standard precautions and hand hygiene compliance was performed via the Compliance with Standard Precautions Scale (CSPS) and the World Health Organization observational hand hygiene form. Two independent sample t-tests were used to examine differences between Compliance with Standard Precautions and hand hygiene Compliance among nurses in intervention and control group. Multiple linear regression analysis was used to assess the effect size. RESULTS: After developing and implementing the infection control link nurse program, no statistically significant improvement was found in the Compliance with Standard Precautions (ß = 5.18; 95% CI= -0.3-10.65, p = 0.064). An improvement in hand hygiene compliance was observed among nurses in the intervention group that improved statistically significant from 18.80% before the program to 37.32% 6 months after the program (ß = 20.82; 95% CI 16.40-25.25, p < 0.001). CONCLUSIONS: Given the continuing level of interest that exists in improving health care workers' hand hygiene practices, the findings of this study provide significant practical implications for hospitals seeking to improve compliance with hand hygiene among nurses, showing the effectiveness of using infection control link nurse program. Further research is needed to assess effectiveness of using infection control link nurse program to improve compliance with standard precautions.

Nurses' knowledge, attitudes, and practice with regards to nutritional management of diabetes mellitus.

BACKGROUND: The prevalence of diabetes is increasing rapidly worldwide. Nurses work collaboratively with multidisciplinary teams to improve diabetes management. Yet, little is known about nurses' role in nutritional management of diabetes. This study aimed to evaluate nurses' knowledge, attitudes, and practice (KAP) toward nutritional management of diabetes. METHODS: This cross-sectional study was conducted with 160 nurses, who were recruited between July 4 and July 18, 2021 from two referral tertiary teaching hospitals in Iran. A validated paper-based self-reported questionnaire was used to assess nurses' KAP. Data were analyzed using descriptive statistics and multiple linear regression analysis. RESULTS: The mean knowledge score of nurses about nutritional management of diabetes was 12.16 ± 2.83, and 61.2% showing a moderate knowledge level on nutritional management of diabetes. The mean attitudes score was 60.68 ± 6.11, with 86.92% of participants demonstrating positive attitudes. The mean practice score of study participants was 44.74 ± 7.81, with 51.9% having a moderate level of practice. Higher knowledge scores were observed among male nurses (B = -7.55, p = 0.009) and those with blended learning as a preferred learning method (B = 7.28, p = 0.029). Having an opportunity to provide education to patients with diabetes during shifts affected nurses' attitudes positively (B = -7.59, p = 0.017). Practice scores were higher among nurses who perceived themselves competent in the nutritional management of diabetes (B = -18.05, p = 0.008). CONCLUSION: Nurses' knowledge and practice in the nutritional management of diabetes should be increased to help improve the quality of the dietary care and patient education they provide these patients. Further studies are needed to confirm the results of this study both in Iran and internationally.

Economic Burden of Asthma in Northwest Iran.

Background: The economic burden of asthma is a major public health concern. This study estimates the economic burden of asthma in Northwest of Iran. Methods: A longitudinal study was conducted between 2017 and 2018 in Tabriz (Iran) using the Persian version of the Work Productivity and Activity Impairment (WPAI) questionnaire. Direct and indirect costs associated with asthma were estimated based on the societal perspective, prevalence-based approach, and bottom-up method. Annual indirect costs were estimated using the human capital (HC) method. The structural equation model was used to evaluate the relationship between costs, sex, and asthma severity. Results: A total of 621 patients with asthma were enrolled in the study. Significant differences were found between female and male patients for the mean cost of radiology (P=0.006), laboratory (P=0.028), and diagnostic (P=0.017) tests at baseline, and for laboratory (P=0.012), and diagnostic (P=0.027) tests at one-year follow-up. The more severe asthma, the more significant the costs for annual physician office visits (P=0.040) and medications (P=0.013). As asthma severity increased, significantly higher expenditures were observed in women for days lost from work at baseline (P=0.009) and one-year follow-up (P=0.001), and in men for productivity loss at work due to impairment at baseline (P=0.045). A significant association between indirect costs and the cost of impairment-related lost productivity at work (ß=3.29, P<0.001), and between severe asthma and indirect costs (ß=32.36, P<0.001) was observed. Conclusion: High costs are incurred by Iranian asthma patients, especially because of impairment-related productivity loss at work associated with asthma exacerbation.

Male-biased association of endothelial nitric oxide synthase Asp298Glu substitution (NOS3-c.894G/T) with asthma risk and severity.

OBJECTIVE: The nitric-oxide pathway plays a crucial role in the pathogeneses of asthma and NOS3-encoded endothelial nitric oxide synthase is one of the main components of the pathway. Variants of NOS3 are known to contribute to asthma development and pathophysiology. METHODS: We investigated the association of NOS3-c.894G/T (rs1799983) with asthma risk and severity by studying frequencies of its genotypes and alleles in 555 asthmatics (93 intermittent, 240 mild, 158 moderate, and 64 severe asthma cases) and 351 control participants using the PCR-FRLP method, logistic regression analysis and generalized ordered logit estimates. RESULTS: GT genotype (ORadj: 1.39; CI: 1.04-1.85; p = 0.026), dominant model GT + TT (ORadj: 1.41; CI: 1.07-1.87; p = 0.015), and T allele (ORadj: 1.32; CI: 1.05-1.67; p = 0.018) was associated with increased ORs in asthmatics. Also, the frequency of GT + TT (ORadj: 1.55; CI: 1.01-2.38; p = 0.044) was significantly higher in males. Furthermore, GT genotype (ORadj: 1.39; CI: 1.04-1.85; p = 0.024), GT + TT (ORadj: 1.42; CI: 1.07-1.87; p = 0.014), and T allele (ORadj: 1.32; CI: 1.05-1.66; p = 0.018) in total population and GT + TT (ORadj: 1.56; CI: 1.02-2.37; p = 0.04) in males were significantly associated with increased risk of severe, moderate, mild, intermittent asthma vs. controls. Also, GT genotype (ORadj: 1.39; CI: 1.02-1.91; p = 0.039) was significantly more frequent in severe, moderate grades vs. lower severity grades in the total population. Frequencies of GT genotype (ORadj: 1.77; CI: 1.05-3.00; p = 0.032) and GT + TT (ORadj: 1.74; CI: 1.04-2.90; p = 0.036) in total population and GT genotype (ORadj: 2.40; CI: 1.16-4.97; p = 0.018) and GT + TT (ORadj: 2.30; CI: 1.12-4.74; p = 0.023) in male subpopulation were significantly higher in severe cases compared to lower grades. CONCLUSIONS: NOS3-c.894G/T may be associated with asthma risk and its severer grades, with greater effects in men.

Assessing the growth-inhibitory activity of postbiotics of Lactobacillus spp. against Staphylococcus aureus under in vitro circumstances and food model.

Postbiotics are soluble metabolites that are liberated from the structure of lysing bacteria or are produced by live bacteria; these byproducts give the host increased biological activity and certain physiological effects. In the current study, the anti-Staphylococcus properties of postbiotics isolated from Lactobacillus acidophilus,L.paracasei,and L.plantarum were investigated in vitro, and pasteurized milk. Potential activity of postbiotics was performed via agar-disk diffusion method. Besides, the effect of heat and pH on the postbiotics antibacterial activity was measured via the agar-well diffusion method. To determine the antioxidant effect and the free radical scavenging potential of the postbiotics, 1,1-Diphenyl-2-picrylhydrazyl (DPPH) method was utilized. The postbiotics chemical composition was identified via gas chromatography-mass spectrometry. The antibacterial activity was mainly associated with lactic acid, laurostearic acid, and isopropylidene-3,3-dimethyl. Also, postbiotics showed strong antioxidant activity. Postbiotics derived from L.plantarum showed the highest antioxidant properties compared to L.paracasei and L.acidophilus. Lower minimum effective concentrations of postbiotic were altered in food model, and substantially, a low minimum effective( MEC) concentrations index (15 mg/mL) was identified for postbiotic of L.plantarum. The Lactobacillus spp. postbiotic, in particular L.plantarum, may have useful functional characteristics (possible antibacterial and antioxidant) in in vitro and food model.

Female-biased association of NOS2-c.1823C>T (rs2297518) with co-susceptibility to metabolic syndrome and asthma.

The nitric oxide (NO) pathway contributes to the pathogeneses of metabolic syndrome (MetS) and asthma. NOS2 encodes inducible-NO synthase, which is an important enzyme of the pathway, and its variations could affect the risk of asthma and MetS and thereby co-susceptibility to them. This study aims to estimate the association of NOS2-c.1823C>T with risk of asthma, MetS, and asthma with MetS condition (ASMetS), and with asthma stages: intermittent, mild, moderate, and severe asthma. The study included asthmatics (n = 555), MetS (n = 334), and ASMetS cases (n = 232) and 351 controls, which were genotyped by the PCR-RFLP method. The T allele was significantly associated with an increased risk of asthma and MetS in the sample population and females. CT genotype and CT+TT model were significantly associated with increased risk of ASMetS in females. A significant association between CT genotype and increased risk of ASMetS in the sample population and females was found in ASMetS versus MetS. In the sample population and among females, the T allele was significantly associated with severe asthma. The rs2297518 single nucleotide polymorphism of NOS2 contributes to the risk of MetS, asthma, and co-susceptibility to them, and this contribution may be stronger in females compared to males.