Articular Cartilage Injury; Current Status and Future Direction.

Today, treatments of cartilage and osteochondral lesions are routine clinical procedures. The avascular and hard-to-self-repair nature of cartilage tissue has posed a clinical challenge for the replacement and reconstruction of damaged cartilage. Treatment of large articular cartilage defects is technically difficult and complex, often accompanied by failure. Articular cartilage cannot repair itself after injury due to a lack of blood vessels, lymph, and nerves. Various treatments for cartilage regeneration have shown encouraging results, but unfortunately, none have been the perfect solution. New minimally invasive and effective techniques are being developed. The development of tissue engineering technology has created hope for articular cartilage reconstruction. This technology mainly supplies stem cells with various sources of pluripotent and mesenchymal stem cells. This article describes the treatments in detail, including types, grades of cartilage lesions, and immune mechanisms in cartilage injuries.

Gender and Physical Activity: What We Can Learn from The Ottawa Charter for Health Promotion?

Physical activity is a modifiable risk factor for non-communicable disease. This study used the Ottawa Charter as a framework to explore responses for low physical activity caused by gender inequity. The researchers examined factors related to physical activity in women based on Ottawa Charter strategies. Promote the knowledge, beliefs, and attitudes of women about health issues, as well as work in socio-demographic factors as social support. The community level corresponds to the physical settings that affect physical activity. Lack of suitable places and facilities, absence of walking paths, neighborhood hazards, insufficient sports campaigns for women, shortage of government financial support for female athletes, and religious legislation in Islamic countries are the barriers to ensure physical activity in women. This review provides a comprehensive understanding of the relevant advantages of physical activity in women across the Ottawa Charter declaration.

Association between red blood cell distribution width and the prognosis of brain death in patients with a Glasgow Coma Scale < 6.

Red blood cell distribution width (RDW) has been reported as a meaningful prognostic factor in various diseases. Our study compared patients' RDW levels and prognosis at admission and discharge time. A total of 128 patients 77 patients who suffered brain death (subject group), and 51 patients who were discharged from the hospital (control group) with GCS ≤ 6 were recruited from 60 hospitals for this study. Demographical data and RDW measurements in these patients at admission time and brain death/discharge time were extracted into two groups. 46 (35.9%) patients were females and 82 patients (64.1%) were males with a median age of 36 years old. A significant difference in baseline characteristics of GCS (P < 0.001), RDW at admission time (P < 0.001), and RDW at discharge or brain death time (P < 0.001) were noted between the two groups. In the overall population, RDW at admission time had a median value of 13.75% and was positively correlated with gender (P < 0.04, rs = 0.582) and age (P < 0.023, rs = - 0.201). Initially, there were no significant differences in RDW upon admission. However, upon discharge, although the RDW in the control group was not significant (P < 0. 1), the RDW level at the time of brain death was notably 0.45 fold higher (P = 0.001) compared to the time of admission. The standardized residuals at the two-time points showed an approximately normal distribution. The most effective RDW cut-off in Brain death was determined as 14.55. Based on the findings, using RDW as a prognostic factor has a sensitivity of 0.468 and a specificity of 0.137 in diagnosing brain death. RDW biomarker is a simple and inexpensive laboratory test that may be seen as a valuable perspective for initial patient evaluation. RDW is a powerful marker for the prognosis of brain death in patients with a GCS ≤ 6 at admission time, in order to identify a subset of patients who may require more aggressive management in the trauma center.

The Impact of Heparin Therapy in Deceased Donors on Early Graft Survival for Kidney and Liver Recipients: A Clinical Trial Study.

BACKGROUND: Significant hemodynamic, hormonal, and metabolic impairment of a brain-dead organ donor is often associated with the deterioration of graft viability. This study aimed to compare the effect of heparin therapy as a therapeutic dose after brain death confirmation on early graft survival in kidney and liver recipients. METHOD AND MATERIALS: The deceased donors were sorted into two groups based on their D-dimer level. After confirming brain death, one group was given a heparin injection (case group), while the other group did not receive any heparin (control group). A total of 71 brain death donors and matched kidney and liver transplants were included in the case group. A total of 43 brain death donors and matched kidney and liver transplants were included in the control group. A total of 5000 units of heparin were administered every 6 hours to the deceased donor case group. RESULTS: The mean age of the case and control groups were 36.27 ± 16.13 and 36.15 ± 18.45, respectively. An independent t test showed that there were no differences between the number of procured organs in both groups (p = 0.29). There was no significant difference between the graft survival rate and the doses of heparin injection to the liver recipients (p = 0.06). However, a significant difference was revealed between the graft survival rate and the dose of heparin injection (p = 0.004) in kidney recipients. CONCLUSIONS: The data suggest that administering low therapeutic doses of heparin to donors before organ donation may potentially prevent thrombosis and provide a protective benefit. We showed that heparin therapy had no significant effect on the number of donated organs and graft survival.

Protection Motivation Theory and Prevention of Breast Cancer: A Systematic Review.

Breast cancer is a global health problem with a high rate of incidence and annual death. The protection motivation model (PMT) is a health psychology theory that has been introduced to motivate health behaviors using coping appraisal and threat appraisal. We aimed to systematically review the applicability of PMT to predict and improve the knowledge and intention (the patient's intent to undergo breast cancer screening with self/clinical breast exam or mammography) for protective behaviors among women. A systematic search was performed in May 2022 in electronic databases to investigate the role of PMT in the prediction of protection behaviors in addition to improving the knowledge about the prevention of breast cancer using specific keywords. The relevant studies were then included for data extraction. Seventeen articles including 7 interventional and 10 prediction studies were selected for data assessment. Findings demonstrated that PMT could be used to predict the rate of knowledge and intention about breast cancer risk among women. It was also shown that PMT could be considered as a framework for the prevention of breast cancer by changing the behaviors of individuals by training the participants. Fear arousal, response efficacy, and response cost were found as the main determinants of knowledge and intention rate. PMT can provide a useful framework to evaluate the factors associated with women's intentions about breast cancer. Periodical educational programs should be implemented to improve protection behaviors by increasing the intention of women to regular self-examination.

Quality improvement tools to manage deceased organ donation processes: a scoping review.

OBJECTIVE: To collate and summarise the literature on the quality improvement tools that have been developed for deceased organ donation processes after circulatory determination of death and neurological determination of death. DESIGN: Scoping review using the Joanna Briggs Institute framework. DATA SOURCES: We searched for published (MEDLINE, Embase, PsycINFO, CINAHL, Web of Science) and unpublished literature (organ donation organisation websites worldwide). The search was initially conducted on 17 July 2021 and updated on 1 June 2022. Included articles discussed the creation and/or use of quality improvement tools to manage deceased organ donation processes. Two independent reviewers screened the references, extracted and analysed the data. RESULTS: 40 references were included in this review, and most records were written in English (n=38), originated in Canada (n=21), published between 2016 and 2022 (n=22), and were specific for donation after neurological determination of death (n=20). The tools identified included checklists, algorithms, flow charts, charts, pathways, decision tree maps and mobile apps. These tools were applied in the following phases of the organ donation process: (1) potential donor identification, (2) donor referral, (3) donor assessment and risk, (4) donor management, (5) withdrawal of life-sustaining measures, (6) death determination, (7) organ retrieval and (8) overall organ donation process. CONCLUSIONS: We conducted a thorough investigation of the available quality improvement tools for deceased organ donation processes. The existing evidence lacks details in the report of methods used for development, testing and impact of these tools, and we could not locate tools specific for some phases of the organ donation process. Lastly, by mapping existing tools, we aim to facilitate both clinician choices among available tools, as well as research work building on existing knowledge.

Is there any relationship between red blood cell distribution width and prognosis of brain death?

Background: Accumulating evidence has demonstrated that RDW (red blood cell distribution width) may independently predict clinically important outcomes in many populations. However, the role of RDW has not been elucidated in brain death. We conducted this study with the aim of evaluating the predictive value of RDW in brain death. Methods: A retrospective study of seventy-seven of brain death cases during 36 months were evaluated at university hospitals, affiliated in Tehran, Iran. Demographical data include age, sex, BMI and cause of brain death, also laboratory results (red blood cell distribution, mean corpuscular volume, hemoglobin) collected by checklists from patient records. Having the three RDW measurements (days of hospital admission, day of brain death, and day of cardiac arrest) required. Results: Time interval from hospital admission until brain death was 5.27±4.07. The mean age of brain death cases was 32.65±16.53. The mean RDW values on days of hospital admission, the day of brain death, and the day of cardiac arrest were 14.53±1.98, 15.12±1.93 and 15.18±2.07, respectively. Results of the repeated-measures ANOVA test reveal that RDW level was constantly higher in the traumatic patient group compared to the non-traumatic ones (P=0.008). Conclusion: The frequency of brain death was high in patients with high RDW values. RDW might be a prognostic biomarker for brain death. More prospective studies with large sample size and long follow-up period should be carried out to determine the prognostic significance of RDW and brain death in future.

Trends in organ donation and transplantation over the past eighteen years in Iran.

BACKGROUND: This article will review the trends in organ donation over the past 18 years in Iran. MATERIAL AND METHODS: All donation and transplantation statistics were extracted by reviewing the Organ Procurement and Transplantation database of the Ministry of Health of Iran from 2002 to 2019. RESULTS: Iran's national deceased donation rate from 2002 to 2019 increased 19.06-fold from .75 to 14.3 per million population (PMP). After the beginning of the COVID-19 pandemic, the rate of organ donation in Iran decreased significantly. Although 1 year after the onset of the pandemic, due to the widespread adoption of COVID19 vaccination, the rate of organ donation began to increase again, this system is still under performing. During the years under examination, the rate of deceased kidney donation increased significantly compared to living kidney donation and reached up to 2001 kidney transplantations in 2021. From 2002 to 2019, the rate of liver transplants increased to 12.8. Likewise, the rate of heart transplants increased 8.4-fold, from 15 to 126 cases during the same time. CONCLUSSION: Although a personal choice, the process of organ donation involves medical, legal, ethical, organizational, and social aspects. The trend in increasing donation rates over the past years can be attributed to multiple influences, which include rigorous team efforts in the organ donation and transplantation systems, in addition to creating a donation culture and promoting donation through media platforms. Moreover, we can say that the rising rates of deceased donor transplantation also can drive down rates of commercial living donor transplantation.

The outcomes of marginal donor hearts compared with ideal donors: a single-center experience in Iran.

Background: Heart transplantation has been considered the gold-standard treatment for patients with end-stage heart failure. This study assessed the survival outcomes of marginal donor hearts compared with ideal donor hearts in Iran. Methods: This retrospective study is based on the follow-up data of heart donors and recipients in the Sina Hospital Organ Procurement Unit. Among the 93 participants, 75 were categorized as ideal donors (group A) and 18 as marginal donors (group B). Group C included heart recipients who received a standard organ, and group D included heart recipients who received a marginal one. To analyze differences in patient characteristics among the groups, posttransplant heart survival was assessed in all groups. All data were obtained from the hospital records. Results: The mean age of the donors was 26.27±11.44 years (median age, 28 years). The marginal age showed a significant association with donor age. The age of recipients had a significant effect on survival days in the ideal group. Most patients survived for at least 1 year, with a median of 645 days in recipients from marginal donors and 689 days in recipients from ideal donors. Conclusions: Considering the lack of organ availability in Iran, it may be possible to use marginal donors for marginal recipients, therefore reducing the number of people on the waitlist. We also recommend establishing a national marginal donor system specifically for Iranian patients to extend the donor pool.

The influence of socioeconomic factors on deceased organ donation in Iran.

Background: There is a large gap between the number of patients on organ waiting lists and the number of available organs for donation. This study investigated the socioeconomic factors in Iran that influenced decisions for organ donation among the families of brain-dead donors. Methods: This retrospective cross-sectional study was performed among the families of 333 organ donors in Iran. Two trained researchers interviewed family members about the donor's age, sex, cause of brain death, education level, marital status, number of children, history of addiction, the financial status of the donor's family, and reasons for which they considered refusing organ donation. Results: The mean age of the donors was 37.23±16.59 years. During 2017-2019, significant differences were found according to income (P<0.001), marital status (P<0.001), sex (P=0.04), and occupation (P=0.04). More than half of the organ donors were of low socioeconomic status, and nearly half were the sole income earners of large families. Trauma was the most common cause of death (44.6%). The most common reasons for which the families considered refusing organ donation were unfamiliarity with the concept of brain death, denial, and the expectation of a miracle. Conclusions: The donor's socioeconomic status and availability of social services, such as insurance coverage, psychological services, and mourning therapy courses, play an important role in organ donation. Adequate support for the deceased's family after organ donation is imperative.

Choriocarcinoma transmitted with the transplant: Case study.

Choriocarcinoma is a rare kind of cancer, which may be either gestational or non-gestational. Choriocarcinoma is responsible for about a quarter of all documented neoplastic aneurysms. It is a descriptive case report of choriocarcinoma transmission from a donor, following kidney donation. A 45-year-old woman got a kidney from a 25-year-old woman who was taken to the hospital due to a non-traumatic cerebral hemorrhage. She delivered a healthy baby 48 days before her brain death. The transplant was successfully done. Five weeks' post-transplantation, the recipient had pain and erythema in the surgical area. Regarding the high level of beta-human chorionic gonadotropin in her blood, diagnostic tests were performed. Following the confirmation of the cancer, a five-phase chemotherapy plan with various pharmaceutical regimens was initiated. Liver function test values rose after the final round of chemotherapy, and the patient developed hepatic encephalopathy. Considering the thrombocytopenia, dialysis, or hemoperfusion, which are normally performed to reduce liver enzymes, were not initiated. Finally, she died due to the hepatic failure and disseminated intravascular coagulation. Although the nephrologists disagree on the optimal course of treatment, it seems that nephrectomy would be helpful in such instances. Physicians should be aware of the possibility of transplant-related choriocarcinoma in female donors of reproductive age who die because of intracerebral brain hemorrhage for unclear reasons. Every donor must undergo a thorough examination. It is critical to get documents, clarify history, and interview relatives.

Quality improvement tools to manage deceased organ donation processes: A scoping review protocol.

AIM: To collate and summarize the literature on what quality improvement tools have been developed on safety of deceased organ donation processes for donation after circulatory determination of death and neurological determination of death. BACKGROUND: The increasing organ shortage requires that organ donation organizations take preventive measures to improve their processes and maximize organ donation opportunities. Quality improvement tools can be used to facilitate daily activities, prevent errors and enhance organ donation processes. Still, there is a paucity of comprehensive evidence around the use of these strategies to manage organ donation processes. METHODS: Scoping review methodology according to the Joanna Briggs Institute framework. We will search MEDLINE, Embase, PsycINFO, CINAHL, Web of Science - Science Citation Index and Social Science Citation Index and Academic Search Complete. We will also conduct a web search of Google and request unpublished material (e.g., institutional protocols and quality improvement tools) from key stakeholders in the organ donation field worldwide and we will consider reports dated after 2000. Two independent reviewers will screen the literature against the inclusion criteria, extract data according to the data extraction tool and perform descriptive analysis. Results will be assembled, summarized and presented through tabular form accompanied by a narrative summary to answer the review question. EXPECTED RESULTS: Results from this scoping review will be used to develop and update quality improvement tools in decease organ donation, will be used to guide the second phase of a study aiming at developing a set of quality improvement tools to decease organ donation process, as well as these results can be used to inform future policy development in deceased organ donation.

COVID-19 Infection in Kidney Transplant Recipients From a Single Center in Iran.

OBJECTIVES: COVID-19 has been spreading rapidly throughout the world, with nearly every country thus far documenting this infection. In this study, our aim was to evaluate the risk factors for increased mortality in deceased donor kidney transplant recipients with COVID-19 at a single center in Iran. MATERIALS AND METHODS: This was a retrospective study in a single center. During the 17-month ongoing COVID19 pandemic in Iran, there were 153 deceased donor kidney recipients at our center with suspected COVID19 symptoms. Of these patients, 138 had positive COVID-19 tests, and thus a therapeutic regimen was commenced for these patients. Data were analyzed with SPSS version 16 software. RESULTS: The patients were predominantly male (83, 60.1%) with a median age of 47.09 ± 13.75 years and a median time since transplant of 51 months (IQR, 1-276 months). Among these patients, 84 (60.8%) had hypertension and 43 (31.2%) had diabetes mellitus. We observed a significant relationship between disease severity and mortality (P < .001). After risk adjustments for age, presence of diabetes mellitus and hypertension and blood group type were factors that showed a significantly higher risk of death. CONCLUSIONS: Deceased donor kidney transplant recipients with confirmed COVID-19 experienced less fever as an initial symptom. However, recipients with COVID-19 and an underlying disease had a higher rate of mortality, severity of infection, and progression of disease. Appropriate management of renal complications and vaccinations in deceased donor kidney transplant recipients may help lead to more favorable outcomes.

Using Social Marketing to Promote Preventive Behaviors Related to COVID-19.

Coronavirus disease 2019 (COVID-19), is an infectious disease caused by SARS-CoV-2 virus, a newly discovered coronavirus, the best strategy to deal with the infection is prevention aimed at reducing transmission in the community. This article aimed to using effective behavior change strategies are needed to control COVID-19. Social marketing facilitates the acceptance, rejection, modification, abandonment, or maintenance of particular behaviors by groups of individuals, often referred to as the target audience. The six-benchmark criteria for social marketing interventions include Behavior change, Customer research, Audience segmentation Marketing mix, Exchange, Competition. Social marketing can promote healthy behaviors. Perceived benefits of the preventive behaviors can be considered. Besides, media, advertising, and other methods to reach out to the consumers to inform and encourage them should be considered. For this purpose, a slogan and a logo should be designed and installed in all educational interventions and media such as posters, pamphlets, face-to-face training sessions, group discussion sessions, telephone counseling, and videos. Advertising using celebrities covering their faces with masks can persuade people to wear face mask. To promote health behaviors, professionals should pay attention to the segmentation of the target audience before providing any service. All plans should be piloted before implementation. Besides, information sources should be organized, and media that should be used to inform the target audience should be identified.

Application of theory of planned behavior on organ donation behavior: A systematic review.

Organ donation saves lives and improves the quality of life. There is a shortage of organ donors worldwide. Behavior theories, such as the theory of planned behavior (TPB), help identify the antecedents of organ donation behavior and design effective interventions. The TPB suggests that intention is driven by constructs: attitude, subjective norm, perceived behavioral control (PBC), and intention. TPB can help improve organ donation behavior. This study aimed to analyze TPB-based interventions on Organ donation. Relevant studies were identified searching electronic databases, i.e., PubMed, Scopus, Science Direct, and Google Scholar from January 1, 2000 to February 30, 2020. None MeSH terms in title or abstract were searched, including: "theory of planned behavior*" and "Tissue donation" or "Tissue procurement" or "Organ procurement system" or "Organ procurement" or "Organ donation." Two authors independently reviewed the full texts and extracted all critical data from the included studies. Seventeen studies were assessed as having a reasonable methodology design. Studies show that TPB-based interventions can improve organ donation. Among TPB's constructs, PBC is the moderator and the determinant of organ donation behavior which its determination is different in different cultures. Attitude, subjective norms, moral norms, and anticipated regret should be considered in related interventions plus PBC. Increasing knowledge can facilitate organ donation behavior. Removing related cultural issues, removing fear due to misunderstanding of Brain death, improving trust, and improving moral values have effects on the behavior of organ donating.

The role of psychological theories in oral health interventions: A systematic review and meta-analysis.

OBJECTIVE: In the present study, we attempted to assess how psychological theories (health belief model [HBM], theory of planned behaviour [TPB], social cognitive theory [SCT], clinical theories [CT] and other theories [OT]) influence oral health interventions. METHODS: PubMed, Scopus, Cochrane and Web of Knowledge databases from 2000 to 2017 were searched. We defined psychological theories based on five subgroups: (A) HBM, (B) TPB, (C) SCT, (E) CT and (F) OT. RESULTS: From the 156 identified studies, 19 studies based on PICO were included. Our findings indicated that the standardized mean difference (SMD) of HBM was 0.37 (95% CI: 0.24, 0.51), which was statistically significant in improving oral health. The SMD of SCT was not significant (0.05 [95% CI: -0.33, 0.44]) in improving oral health. The SMD of TPB was significant (1.66 [95% CI: 1.06, 2.27]) in improving oral health. The SMD of CT (-4.6 [95% CI: -6.49, -2.71]) and OT (2.93 [95% CI: 1.55, 4.32]) revealed significant differences in improving oral health. CONCLUSION: The current meta-analysis showed that in general, psychological interventions that used OT, CT, HBM and TPB were effective in enhancing oral health status, and interventions that used SCT did not have an effect on improving oral health status. Oral health care providers who work with patients to take methods and improve behaviours that are related to appropriate oral health need to comprehend their applicability and strengths.

Determinants of medical students for intention to organ donation: Application of theory of planned behavior.

Organ donation and transplantation save thousands of lives in the world. The aim of this study was identifying determinants of organ donation intention based on the Theory of Planned Behavior (TPB) among Iranian Medical Students. This cross-sectional study was performed during 2017 in Shahid Beheshti University of Medical Sciences. A sample of 438 students of Shahid Beheshti University of Medical Sciences was selected using multi-stage sampling method including stratified and random sampling. Data were collected by using a reliable and valid TPB-based questionnaire. All the participants filled the questionnaires and the data were extracted according to the previously described method. Data were analyzed by using the Statistical Package for the Social Sciences version 16.0 software. Descriptive statistic and Spearman correlation and Logistic regression were used for analyzing the data. Mean age of the participants was 20.92 ± 1.98 years. There was a significant linear positive correlation between behavioral intention and attitude, subjective norms, and perceived behavior control. Logistic regression analysis for assessing relation of TPB variables with behavioral intention showed that perceived behavioral control was more correlate with students' intention for getting organ donation card (odds ratio: 1.049, confidence interval: 1.062, P <0.000) perceived behavioral control, explain student's willingness to register as an organ donor. We must provide facilities so that students could register for organ donation easily.

The impact of educational intervention based on empowerment model in preventing violence against women.

BACKGROUND: One of the most obvious forms of violence in today's society is violence against women. In Iran, along with other countries, violence against women has become a problematic issue. OBJECTIVES: The present research aims to investigate the impact of educational intervention based on empowerment model in preventing violent behaviors against women. PATIENTS AND METHODS: The present study is an intervention research done through the random selection of 91 women under the aegis of Imam Khomeini Relief Foundation in Gorgan. Tools for data gathering included demographics checklist, Rosenberg Self-Esteem, general self-efficacy, awareness and attitude questionnaires. Three ninety-minute educational sessions were held for each group to enhance their awareness, change their attitudes, and train them life skills to increase self-esteem so that they can express their vicarious experiences to increase their self-efficacy toward violent behavior. Following the post-test, data were analyzed with SPSS software (version 20). Tests for analyzing data included descriptive and analytical tests (chi-square, Pearson's correlation, independent samples t-test, One-way ANOVA and paired t test). RESULTS: Results indicated that the frequency of domestic violence against participating women was significant after educational intervention, as compared to pre-intervention period. Paired t-test showed that average scores of awareness, attitude, self-esteem, and self-efficacy constructs, and total power were statistically higher after educational intervention as compared to the period prior to intervention. CONCLUSIONS: As one of the manifestations and the moving force of empowerment, education is the first major strategy in codifying, designing, and implementing empowerment programs. For women to be empowered, the active participation of all people in education is required.

Determining the factors contributing to quality of life of patients at the last stage of life: a qualitative study.

BACKGROUND: Quality- of- life of patients at their last stage of their life are different from that of other people. OBJECTIVES: The aim of this study was to determine the factors contributing to the quality- of- life of patients at their last stage of their life and provide good cares for these patients. PATIENTS AND METHODS: This qualitative study was performed by the thematic- framework method of analysis. Twenty three participants including patients, their families, nurses, physicians, psychologists and clergymen were selected sampling. Data were collected by semi - structured interview. We used the thematic framework method to analyze qualitative data. RESULTS: Seven factors which needed to be considered in the patients' at last stage quality of life included stress reduction, participation, homecare, education, independency, support, recourses and facilities. According to the findings, the number of these factors may be more than what was mentioned above. CONCLUSIONS: Paying attention to the quality of life at the last stage can be helpful for patients and their families and the special care can be taken for them.