Approaches for boosting self-confidence of clinical nursing students: A systematic review and meta-analysis.

Background: Self-confidence is a key element in successfully promoting achievement strivings among the healthcare workforce. Targeted interventions can strengthen this characteristic in nursing students, thus improving the quality of hospital services. Objectives: We evaluated the effect of educational interventions on boosting self-confidence in nursing students using systematic review and meta-analysis. Methods: A comprehensive search was used to screen the related studies in Scopus, PubMed, Embase, Web of Science, and PsycINFO. Peer-reviewed literature in English until June 2023 was reviewed. Inclusion criteria were controlled trials, either non-randomized studies of intervention (NRSI) or randomized (RCTs). Studies were assessed for methodological quality by the Cochrane Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) and the Cochrane "Risk of Bias" tool for RCTs (RoB 2.0) and quality assessment tool for before-after (pre-post) studies with no control group. The main outcome was the self-confidence score of nursing students because of educational methods or intervention/s. Using the inverse variance weights method, a pooled standardized mean difference (SMD) estimate with a corresponding 95% confidence interval (CI) was determined. Random-effects meta-analysis was used to assess conceptual heterogeneity using Stata. Results: Twenty-two studies were selected involving 1758 participants and 940 cases of nursing students in the intervention group on boosting self-confidence (Fourteen Randomized controlled trials, Five Quasi-experimental, and three Before-After studies). The post-intervention self-confidence results in the nursing student's intervention group were significantly greater (SMD) (SMD for Controlled experimental design = 0.51; 95% CI = 0.14-0.89), (SMD for Quasi-experimental = 0.04; 95% CI = -0.33-0.41), (SMD for Before-After (Pre-Post) = 2.74; 95% CI = 1.85-3.63). The random-effect meta-analysis of 22 interventional studies determined that educational interventions are significantly associated with the improving self-confidence of nursing students. The intervention showed a moderate impact on the research units, according to Cohen's d results. Also, the results of simulation learning intervention (SMD = 0.42; 95% CI = 0.03-0.81) showed a significant relationship between intervention and outcome in studies. Conclusions: Analysis of our findings revealed the successful impact of most interventional approaches in boosting self-confidence, especially in the long term. It can be concluded that self-confidence is a multifactorial concept that can be improved by using targeted combination intervention strategies.

Integrated care competencies and their association with cross-cultural competence among registered nurses: A cross-sectional questionnaire survey.

AIM: To examine the association between the integrated care competencies and cross-cultural competence of registered nurses prior to the integration of social and healthcare services in Finland. DESIGN: A descriptive correlational cross-sectional questionnaire survey was conducted. METHODS: A simple random sample of 10,000 registered nurses was drawn from the Finnish Central Register of Valvira (National Supervisory Authority for Welfare and Health); 7000 of them were sent the online questionnaire, and a total of 1232 registered nurses participated in the study. We collected data using background questions, revised versions of the Competent Workforce for the Future tool in the four domains of client orientation, responsibility for personal or relative's welfare, fluency and clarity of services and access to the services and of the Cross-Cultural Competence of Healthcare Professional tool in the four domains of motivation/curiosity, attitude, skill and emotion/empathy. RESULTS: Participants demonstrated a high level of integrated care competencies (mean = 4.00, SD ± 0.49). An association was observed between integrated care competencies and their domains of skills, motivation/curiosity, emotions/empathy, and cross-cultural competence (p < 0.001). Female sex, older age, more working experience, employment in the private sector, and higher self-rated competence for working in a multicultural environment were positively associated with higher integrated care competencies. CONCLUSION: It is recommended that nurse managers and nurse educators emphasize the development of registered nurses' cross-cultural competence alongside integrated care competencies to meet the needs of different individuals and communities when providing integrated care. PATIENT OR PUBLIC CONTRIBUTION: Finnish registered nurses including all types of nurses, midwives and paramedics working the public and private healthcare, were involved in this study by responding to the online survey.

The effect of maternal diabetes on the expression of gamma-aminobutyric acid and metabotropic glutamate receptors in male newborn rats' inferior colliculi.

OBJECTIVES: Few studies have examined the molecular alterations in the auditory pathway of infants of diabetic mothers, notwithstanding the fact that maternal diabetes may have an impact on the development of the neonatal peripheral and central nervous systems. Male newborn rats were studied to determine how maternal diabetes affected the expression of gamma-aminobutyric acid (GABAAα1 and GABAB1) and metabotropic glutamate (mGlu2) receptors in the inferior colliculus (IC) in this research. METHODS: Female rats were given a single intraperitoneal injection of streptozotocin (STZ) at a 65 mg/kg dose to develop a model of diabetic mothers. The study population was split into sham, diabetes without treatment, and diabetes with insulin groups. Their male neonatal rats were anesthetized on P0, P7, and P14 after mating and delivery. The receptors' distribution pattern was studied using immunohistochemistry (IHC). RESULTS: Pairwise comparison in the groups revealed that the GABA receptors (Aα1 and B1) were significantly downregulated in the diabetes without treatment group (p<0.001). Furthermore, pairwise comparison in the groups indicated significant mGlu2 upregulation in the diabetes without treatment group (p<0.001). Regarding the concentration of all receptors, there was no discernible distinction between the diabetes with insulin and sham groups. CONCLUSIONS: This investigation showed that the concentration of GABAAα1 and GABAB1 receptors decreased significantly over time, whereas the concentration of mGlu2 receptors increased significantly over time in male neonatal rats born to streptozotocin-induced diabetic mothers.

Effect of Platelet-rich Plasma on the Clinical Success of Alveolar Grafts in Patients With Cleft Lip and Palate: A Systematic Review and Meta-Analysis.

OBJECTIVES: This study assessed the effect of platelet-rich plasma (PRP) on the clinical success of alveolar grafts in patients with cleft lip and palate. MATERIALS AND METHODS: In this meta-analysis, a search of the literature was conducted in Medline, Scopus, ISI Web of Science, and Cochrane Central Register of Controlled Trials for randomized clinical trials using PRP or platelet-rich fibrin (PRF) along with autogenous bone for alveolar ridge grafts in patients with cleft lip and palate. The methodological quality of the studies was analyzed using Cochrane's risk of the bias assessment tool. The extracted data underwent meta-analysis using the random-effects model. RESULTS: Of a total of 2256 articles retrieved, 12 met the eligibility criteria and were enrolled; out of which 6 did not undergo meta-analysis due to heterogeneous data. The percentage of defects filled by bone graft was 0.648% (95% confidence interval: -0.15 to 1.45), which was not statistically significant ( P =0.115). Subgroup analysis showed no significant difference based on the use of PRF or PRP ( P =0.28), type of cleft (unilateral/bilateral; P =0.56), or type of radiographic modality (3D/2D; P =0.190). Meta-regression analysis showed that the duration of follow-up and the difference in the mean age of patients did not have a significant effect on the results (R=0, I2: high). CONCLUSION: The application of PRP/PRF in combination with autogenous bone graft did not have a significant effect on the percentage of alveolar cleft filled by a bone graft. Future clinical studies are required to further elucidate the effect of PRP in the regeneration of alveolar clefts.

Sexual function after childbirth: a meta-analysis based on mode of delivery.

Although many women report sexual dysfunction in the postpartum period, controversial research has been reported the relationship between delivery mode and sexual function. This meta-analysis aimed to investigate the sexual function after childbirth and identify the difference of sexual function based on the female sexual function index (FSFI) questionnaire in women with elective cesarean section, vaginal delivery with episiotomy and vaginal delivery without episiotomy. Studies were found by searching in Medline, PubMed, Web of Science, Scopus and considering the references of the related papers from their start dates until September 2021. All observational studies in English that reported the mean and SD of score of sexual function and its domains based on the mode of delivery were included in this meta-analysis. Random effect model was used to combine the results of included studies on female sexual function and its subdomains. Finally, 17 articles with a total population of 3410 were included in the meta-analysis. Total mean (95 percent CI) of sexual function was 24.27 (22.82, 25.72) with substantial heterogeneity among studies (χ2 = 7487.63, P < .001; I2 = 99.45). In subgroup analyses, the mean score of sexual function was significantly differed in terms of time elapsed since delivery (P = .04) and studied country (P < .001). But, the mode of delivery has no significant effect on postpartum sexual function and subdomains. The result indicated that elective cesarean section, vaginal delivery with episiotomy, vaginal delivery without episiotomy are not associated with the female sexual function.

Determination of toxic metal burden and related risk factors in pregnant women: a biological monitoring in Sabzevar, Iran.

Nowadays, the adverse effect of toxic metals on humans is well known, especially in the fetal period such as preventing cognitive development and congenital abnormalities of the central nervous system. Hence, this study aims to evaluate the toxic metal burden in mothers and newborns in Sabzevar. Obtained data can be useful for authorities in public health issues. To determine heavy metals in placental blood and umbilical cord blood, one hundred eighty blood samples were taken from ninety mothers referred to Shahidan Mobini Hospital for delivery. The amount of metals in samples was analyzed using inductively coupled plasma optical emission spectrometry (ICP OES). The results of this study revealed that 21.52%, 26.19%, and 60.71% of maternal blood samples (placental blood) and 16.47%, 56.47%, and 20% of umbilical cord blood samples were higher than the US center for disease control (CDC) recommended levels for Pb, Cd, and As respectively. According to the multiple linear regression analysis, the Pb (p = 0.054), As (p < 0.001), and Se (p < 0.001) levels had an association with the mother's living area. Also, there was a significant association between Se (0.021) and the age of the mother. However, the Se values in its optimum concentrations in the blood (60-140 µg/L) can decrease the adverse effects of toxic metals, 72.5% of the pregnant women had Se values below the 60 µg/L and only 6% of pregnant women had Se levels higher than 140 µg/L. We concluded that the mothers inhabiting the rural areas need more Se sources in their diets.

Prevalence of Diabetes Mellitus and its Related Factors in Patients with Tuberculosis.

BACKGROUND: Considering the high prevalence of tuberculosis (TB) in developing countries and the fact that comorbidity with diabetes mellitus (DM) imposes a higher burden on the society, this study was carried out to assess the prevalence of diabetes and its related factors in patients with TB in Mashhad, Iran. METHODS: In this study, we enrolled 405 patients over the age of 18 who had been diagnosed with TB between the years 2015 and 2016 according to the documents of the ministry of health. The participants were selected randomly from five health center domains based on the stratified sampling method. The patients were screened for diabetes according to HbA1c over 6.5% or a fasting blood sugar (FBS) level over 126 mg/dL at different time points and the patient's self-report of having DM. RESULTS: The mean age of participants was 51.14±20.52 (19-92 years). The prevalence of DM in patients with TB was 21.2%, of whom 3.5% were newly diagnosed. Among potential factors, age with OR=3.786 (1.183, 12.113), body mass index with OR=9.149 (3.182, 26.302), nationality with OR=2.149 (1.122, 4.117) and TB type with 3.328 (1.44, 7.689) were associated with DM in patients with TB. CONCLUSION: The prevalence of DM in our study was higher than that observed in other countries. Our study showed associated factors like age, body mass index, and TB type to be very important. Also, the prevalence of DM was different in patients with different nationality.

Postpartum depression in women with maternal near miss: a systematic review and meta-analysis.

BACKGROUND: postpartum depression (PPD) is one of the psychological complications of mothers who have experienced severe maternal morbidity/maternal near miss (SMM/MNM) which can adversely affect the wellbeing of mothers, new born infants and other family members, but the risk level in this group is unclear. Therefore, we did a meta-analysis to ascertain the relationship PPD with MNM/SMM. MATERIAL AND METHODS: The authors searched relevant studies in databases (Web of Science, PubMed, EMBASE, Clinikalkey, Scopus).The summary odds ratio (OR) along with 95% confidence interval (CI) was calculated by use of random or fixed effects models. RESULTS: Four studies were included in qualitative synthesis. The pooled analysis revealed that PPD was significantly associated with an increased risk of MNM/SMM (OR = 1.83; 95% CI 1.37-2.44, p = 0.027). CONCLUSION: The results show that the risk of PPD in the MNM mothers are twice as likely as women without MNM. Therefore, more attention should be paid to psychological symptoms such as depression in MNM in order to reduce the long-term burden of maternal morbidity.

The relationship between global gender equality with maternal and neonatal health indicators: an ecological study.

PURPOSE: Achieving the millennium development goals (MDGs) and sustainable development goals (SDGs) including gender equality, reducing maternal, neonatal, and under 5 mortality rates are still considered a major global challenge. This study was performed with the aim of investigating the relationship between global gender equality and maternal as well as neonatal, and under 5 children health indicators. MATERIALS AND METHODS: The present study is an ecological study performed through credible secondary data published in 2017 for each country. Then, the Gender Equality Index along with its four areas, maternal mortality, neonatal mortality, and under 5 mortality rates were extracted. Data analysis was performed by SPSS 24 via descriptive-analytical statistics and linear regression. RESULTS: There was a significant and direct correlation between all of the three variables of maternal mortality, neonatal, as well as under 5 mortality and Gender Equality Index. Correlation analysis between the above-mentioned indicators and the areas of Gender Equality Index showed that there is no significant correlation between the "economic opportunities and participation" index and none of the maternal, neonatal, and under 5 mortality indicators. The "educational attainment" index had an inverse significant correlation with the above-mentioned variables. The "survival and health" index had only an inverse significant correlation with neonatal mortality, and "political empowerment" had such a correlation with neonatal and under 5 mortality rates. CONCLUSIONS: Panning and policymaking for reducing gender equality barriers should be among the top priorities of primary healthcare in order to achieve maternal, neonatal, and under 5 health universally.

The association of mode of delivery and dyspareunia: a systematic review and meta-analysis.

This meta-analysis aimed to examine the association between the mode of delivery and dyspareunia worldwide. Epidemiologic studies evaluating the link between the mode of delivery and dyspareunia (published up to July 2019) were included in this research. These studies were selected by searching several databases such as MEDLINE, ClinicalTraial.gov, PubMed, Web of Science, Scopus and Google Scholar and considering the list of selected articles extracted from references. Then, meta-analyses, subgroup analyses and meta-regressions of the studies were conducted to evaluate the association between the mode of delivery and dyspareunia. In this study, 23 out of 1099 articles were identified and used in the final analysis. Dyspareunia differed according to the mode of delivery although this difference was not statistically significant. In terms of the mode of delivery, a difference was found between instrumental vaginal delivery and caesarean section, but it was not significant. It seems that more studies with a larger sample size should be considered to determine the difference.

Role of SALL4 and Nodal in the prognosis and tamoxifen resistance of estrogen receptor-positive breast cancer.

Despite the discovery of a number of different mechanisms underlying tamoxifen resistance, its molecular pathway is not completely clear. The upregulation of SALL4 and Nodal has been reported in breast cancer. Nevertheless, their role in tamoxifen resistance has not been investigated. In the present study, we compared Nodal and SALL4 expression in 72 tamoxifen sensitive (TAMS) and tamoxifen-resistant (TAMR) patients. Afterward, the correlation of expression data with clinicopathological features and survival of patients was studied. Results showed that both SALL4 and Nodal were significantly upregulated in TAMR compared to TAMS patients. Besides, there was a positive association between Nodal and SALL4 expression. Furthermore, we evaluated their correlation with the expression of Oct4, Nanog and Sox2 stemness markers. The results demonstrated that in most tissue samples there was a positive correlation between Nodal and SALL4 expression with these stemness markers. Besides, the overexpression of SALL4 and Nodal significantly correlated with the N stage. Moreover, the overexpression of SALL4 was associated with extracapsular invasion and lymphatic invasion. High level expressions of SALL4 and Nodal had a significant association with worse disease-free survival (DFS) rates. In addition, increased level of Nodal expression provides a superior predictor factor for DFS. The multivariate Cox regression analysis also revealed that for DFS, perineural invasion (PNI) was independently an unfavorable prognostic value. These findings suggest that the high expression of SALL4 and Nodal could contribute to tamoxifen resistance and worse survival rates in tamoxifen-treated ER+ breast cancer patients.

Association of knowledge and attitudes with practices of misuse of tranquilizers: A cohort study in Spain.

BACKGROUND: Tranquilizer misuse represents a growing international public health problem with heavy social and economic consequences. We aimed to identify the psychosocial determinants of this misuse practice, focusing on modifiable factors including knowledge and attitudes towards these medications. METHODS: A prospective cohort study involving 847 adults accompanying children in primary care clinics was carried out in Spain. A validated Knowledge, Attitudes and Practices (KAP) questionnaire on tranquilizer use was self-administered at baseline, and then participants were followed-up bimonthly. A misuse event was defined as unprescribed intake of tranquilizers, storing/sharing leftovers of tranquilizers, and/or not adhering to the prescribed treatment period, timing or dosage. Poisson regression models were applied to estimate adjusted Incidence Rate Ratios (IRRs) of misuse and their 95 % Confidence Intervals (CIs). FINDINGS: Individuals' personal attitudes towards tranquilizers and treating physicians are strongly associated with the misuse of these drugs. These attitudes include: individuals' acceptance of taking tranquilizers to improve sleeping [IRR: 5.10 (95 %CI: 2.74-9.48)], to work better [IRR: 2.04 (95 %CI: 1.05-3.99)], or for recreational purposes [IRR: 1.85 (95 %CI: 1.04-3.32)]; willingness to prolong the course of tranquilizer treatment without medical consultation [IRR: 2.45 (95 %CI: 1.46-4.13)]; agreeing on storing tranquilizers for possible future need [IRR: 5.07 (95 %CI: 2.73-9.40)]; and untrusting the physician's decision about tranquilizer prescription [IRR: 1.92 (95 %CI: 1.12-3.30)]. The level of knowledge is marginally associated with tranquilizer misuse. CONCLUSIONS: There is a strong association between individuals' attitudes towards tranquilizers and the misuse practices of these drugs. Educational interventional studies could help reduce the incidence of tranquilizer misuse.

Effects of Rhus coriaria L. hydroalcoholic extract on the lipid and antioxidant profile in high fat diet-induced hepatic steatosis in rats.

Oxidative stress is related to increased fat deposition in the liver, known as hepatic steatosis. The present study is an evaluation of the anti-oxidative and antihyperlipidemic effects of the hydroalcoholic extract of Rhus coriaria L. (HARE) in rats on a high-fat diet (HFD). Twenty male Wistar rats were divided into four groups: control, HFD, HFD + HARE 50 mg/kg/day, and HFD + HARE 250 mg/kg/day for 12 weeks. Animals were weighed weekly and treated with the HARE extract for 12 weeks by gavage. Subsequently, the histopathological changes, oxidative markers, and lipid profile were evaluated. Statistical analysis was performed using the one-way analysis of variance (ANOVA) for multiple comparisons. First, the active ingredients of the extract were determined by HPLC. Then, the levels in the serum lipid profile (TG, cholesterol, HDL, and LDL) in rats fed with the HFD + HARE were analyzed where a significant reduction was observed. The HFD proved to increase the activity of the liver enzymes, the serum lipid levels, and the malondialdehyde (MDA) level. The ferric-reducing antioxidant activity power (FRAP), catalase (CAT), and superoxide dismutase (SOD) catalytic activity were reduced in the liver homogenate of HFD rats compared to the controls. Additionally, the aforementioned liver enzymes activities were reduced in response to HARE. Evaluation of oxidative stress determined a reduction in the MDA level while a raised FRAP was confirmed. In accordance with the present results, histopathological observations have also demonstrated that HARE ameliorated grade-1 hepatic steatosis induced by HFD. Taken together, the findings of this study introduce HARE as a future potential therapeutic agent in treating hepatic steatosis and reducing oxidative damages of an HFD in the liver.

The effectiveness of bright light exposure in shift-worker nurses: A systematic review and meta-analysis.

Bright light exposure is as one of the non-pharmacological measures to sleep management in shift-worker. This study was conducted to determine the effectiveness of bright light exposure in shift-worker nurses. We performed a systematic review and meta-analysis according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement and using existing literature in the following databases: Cochrane Library, Embase, PubMed, Scopus, Web of Science, to examine any eligible and relevant interventional (randomized controlled trial, experimental and quasi-experimental studies) which were published by December 31, 2018. The obtained documents were analyzed using Stata 14.1 and Cochrane Collaboration's RevMan 5.3. Five studies met eligibility criteria. Results from fixed-effect meta-analysis of the included studies revealed that the exposure could decrease the sleepiness levels, complaints related to shift-work, insomnia and increased the psychomotor error (95% confidence interval (CI): -0.87,-0.43, p=0.000, I2=98.6%), alertness and daytime sleep duration following night shifts (95% CI: 0.08,0.99, p=0.000, I2=92.7%). However, in the random effects model, none of them were statistically significant. Although the results of fixed-effect are in favor of beneficial effects of bright light exposure in shift-worker nurses, the random effects could not approve these findings. Maybe because of either large heterogeneity or insufficiency of the number of studies. Besides, because of the low number of studies, it was impossible to deal with high amount of heterogeneity using subgroup analysis or meta-regression. So the controversy on this topic continues to persist, which highlights the need for more well-designed randomized control trials with larger sample sizes in the future.

Risk of relapse and death from colorectal cancer and its related factors using non-Markovian Multi-State model.

AIM: This study aimed at modeling the risk of local relapse and death from colorectal cancer after the first treatment and its related factors using multi-state models. BACKGROUND: In cancer studies modeling the course of disease regarding events which happen to patients is of great importance. By considering death as the final endpoint while incorporating the intermediate events, multi-state models have been developed. METHODS: This was a historical cohort study in which 235 patients with colorectal cancer, who referred to Omid Hospital in Mashhad between 2006 and 2011, were studied and followed up until 2017. The transition probabilities to death due to metastasis with or without experiencing local relapse and variables related to them were determined using the non-Markovian multi-state model in three states of disease, local relapse and death. RESULTS: The probability of not experiencing either of the events, just relapse and death in the first 5 years were 0.45, 0.09 and 0.46 respectively. If patients did not experience any event in the first year of treatment, the probability of relapse and death before the fifth year were 0.04 and 0.33 respectively and if they did experience relapse during this time, the probability of death by the fifth year was 0.62. The stage of cancer was associated with relapse and death, while ethnicity and history of addiction were related to death without relapse and BMI had a significant relationship with death after relapse (p<0.05). CONCLUSION: Risk of death in patients with colorectal cancer depends on local relapse and the time between them.

Biomonitoring of maternal and fetal exposure to mercury in Sabzevar and its affecting risk factors.

Fetuses and young children are sensitive to even low levels of exposure to Hg, which can damage their brain and adversely affect their central nervous system and cognitive development. This study was conducted to determine the maternal and fetal mercury burden levels in mothers presenting to Shahidan Mobini Hospital for delivery. Eighty-nine mothers were included in this study and 360 samples were taken from their placental tissue and blood (maternal blood) as well as their umbilical cord tissue blood (infant blood). Findings revealed a significant strong correlation (r = 0.890, p < 0.001) in blood mercury between mothers and their infants. According to multiple linear regression analysis, there was a significant positive association between living in rural areas and the level of mercury in the placental tissue (ß = 11.09, p < 0.001). This positive association was also found in other samples. In addition, there was a significant association between maternal age and mercury level in the placental tissue (ß = 5.56, p = 0.049), placental blood (ß = 11.67, p = 0.003), umbilical cord tissue (ß = 8.33, p = 0.004) and umbilical cord blood (ß = 9.51, p < 0.001).

The global prevalence of maternal near miss: a systematic review and meta-analysis.

Background: Improving the maternal health is one of the world's most challenging problems. Despite significant movements over the past decades, maternal health has been still considered as a central goal for sustainable development. Maternal near miss (MNM) cases experience long-term physical and psychological effects. To present a clear portrait of the current situation, we performed a systematic review and meta-analysis with the purpose to assess the worldwide prevalence of MNM. Methods: We conducted a systematic review on PubMed, Scopus and Web of Science electronic databases to find published papers in English, before March 2019 and regardless of the type of study. We, then, assessed the prevalence of MNM according to the World Health Organization(WHO) criteria. Finally, 49 papers were included in the study. Random effects meta-analysis was used to pool the available prevalence. The quality of studies was also evaluated. Results: The weighted pooled worldwide prevalence of MNM, was 18.67/1000 (95% CI: 16.28-21.06). Heterogeneity was explored using subgroup analyses based on the continent and the country. We used meta-regression of MNM on MD which resulted in adjusted R-squared as78.88%. Conclusion: The prevalence of MNM was considerable. Low- and middle-income countries should develop systematic approaches to improve quality of care in the facilities and to reducethe risk of MNM events, with the hope to women's health.

Geographical Patterning of Physical Activity Prevalence in Iran: Spatial Analysis of 4 Pooled National Health Surveys Among 119,560 Adults.

BACKGROUND: To investigate the geographical distribution of physical activity (PA) prevalence among adults aged 15-64 years old across Iran provinces using geographic maps. METHODS: Data from 4 consecutive national surveys conducted between 2007 and 2010 were pooled to determine the geographical distribution. Prevalence of low PA with 95% confidence interval was estimated by sociodemographic subpopulations over provinces using complex survey design. RESULTS: In total, 119,560 participants (49.9% females) were included in the analyses. The mean (SD) age of participants was 39.5 (14.3) years. The prevalence of the low PA in the pooled 2007-2010 was 35.8% (95% confidence interval, 34.1-37.6). The 3 provinces with the highest prevalence of low PA were Sistan and Baluchestan, Yazd, and Hormozgan. The results of hot spot analysis showed that the Kerman province was a hot spot, and Ilam, Kermanshah, Hamedan, and Markazi were cold spots for low PA. Ilam, Kohgiluyeh and Boyer-Ahmad, and Mazandaran had the highest total PA volume (metabolic equivalent minutes per week). Hot spot analysis showed that Ilam and Khuzestan provinces were hot spots for the total PA volume. CONCLUSIONS: The regions with low and high PA are predominately situated in the near center/southeast and west, respectively.

The Effect of Mother-Infant Skin to Skin Contact after Birth on Third Stage of Labor: A Systematic Review and Meta-Analysis.

BACKGROUND: One of the causes of postpartum hemorrhage is prolongation of third stage of labor. Mother-infant skin to skin contact (SSC) immediately after delivery is one of the non-pharmacological interventions to reduce this stage. Studies which assessed the effect of mother-infant SSC after delivery on duration of the third stage of labor reported controversial results on this issue. Therefore, this study investigated the effect of mother-infant SSC immediately after birth on the duration of third stage of labor. METHODS: In this systematic review and meta-analysis, the databases of PubMed, Scopus, Cochrane, SID, Magiran IranDoc and Google Scholar were searched from 2000 to 2018, using the keywords related to the objectives of this review to access randomized control trials published in Persian or English. The quality of papers was examined using Cochran's Risk of bias tool. Data was analyzed using Stata software. We used I2 index and Chi-square test to investigate heterogeneity and Egger's and Begg's tests to assess publications bias. Random effects model was used to combine the data. RESULTS: Six studies were entered into the meta-analysis. The third stage of labor in SSC group was shorter than that of control group with a mean difference of -1.33 and 95% CI (-2.31 to -0.36) and this difference was statistically significant (P=0.007). CONCLUSION: Mother-infant SSC decreases the duration of third stage of labor. Therefore, the current study provides some evidences to use this non-pharmacological method in order to accelerate the third stage of labor and ultimately prevent postpartum hemorrhage.

The impact of strain and feed intake on egg toxic trace elements deposition in laying hens and its health risk assessment.

The impact of strain or feed intake on food trace elements and its health risk assessment is still ambiguous, and therefore, available facts are rare. Therefore, this study aimed to assess the effects of both strains and feed intake on trace elements depositions to egg, toxic heavy metals concentration, and health risk assessment of egg consumption. In the current cross-sectional study, the selected strains, including Shaver White, Hy-Line W36, Bovanse White, Lohman LSL-Lite, and Native laying hens of Khorasan Razavi province, were examined. A total number of 50 samples of eggs and 15 samples of their feed was purchased from poultry farms. Yolk and white were separately analyzed. Sample preparation was performed by wet digestion followed by Inductively Coupled Plasma Mass Spectrometry. Trace metals Pb, As, Cd, Hg, Cr, and Ni were detected. Statistical analysis was performed in Stata11.2 portable software. Although there was a significant difference in strains and feed, no significant difference was observed in trace elements in egg contents (weight of egg white and egg yolk). Mercury concentration in all the samples was below the instrument detection limit. In this study, the target hazardous quotients were below one for all trace elements. Therefore, Iranian does not experience the adverse health effects due to the consumption of egg.