Publications by authors named "Mohammad Asghari Jafarabadi"

316 Publications

The effect of a lifestyle training package on physical activity and nutritional status in obese and overweight pregnant women: A randomized controlled clinical trial.

Int J Nurs Pract 2021 Jul 27:e12992. Epub 2021 Jul 27.

Social Determinants of Health Research Center, Nursing and Midwifery Faculty, Midwifery Department, Tabriz University of Medical Sciences, Tabriz, Iran.

Aim: The aim of this study was to determine the effect of a lifestyle training package that consisted of a 60- to 90-min session of group training, educational booklet and text messages on physical activity and nutritional status in obese and overweight pregnant women.

Methods: In this randomized controlled trial, 140 obese or overweight women (gestational age: 16-20 weeks) covered by health centres in Tehran, Iran, were equally randomized into two parallel groups using block randomization and stratified by the body mass index. Participants completed the Food Frequency Questionnaire and International Physical Activity Questionnaire at baseline and fourth and eighth weeks after intervention. Participants were 38 obese and 102 overweight women who were later followed-up.

Results: After the intervention, the mean weekly intake of the vegetable and fruit subgroups was significantly higher; and intake of fats and oils and the confections subgroups were significantly lower in the intervention compared with the control group (p  < 0.05). Although physical activity was higher in the intervention group, 8 weeks after the intervention, this difference was not statistically significant (p > 0.05).

Conclusions: The training package appears to offer a suitable strategy for adjusting the intake of the recommended food subgroups in obese and overweight pregnant women.
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http://dx.doi.org/10.1111/ijn.12992DOI Listing
July 2021

Recommendations for improving primiparous women's childbirth experience: results from a multiphase study in Iran.

Reprod Health 2021 Jul 6;18(1):146. Epub 2021 Jul 6.

Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.

Background: Women's satisfaction with childbirth experience is considered as one of the quality indicators of the maternity services across the world. However, there is no guideline for improving the experience of childbirth in Iran that is suitable for women with different cultural, economic, and social statuses. The aim of this study is to make recommendations for practice and propose a clinical guideline for improving the experience of women with vaginal births.

Methods/design: The study design was a mixed method study with a sequential explanatory approach consisting of three phases. The first phase of the study was a cross-sectional study to identify the predictors of traumatic vaginal childbirth experience among 800 primiparous women from Tabriz health centers who had vaginal birth. Data collection tools in this phase were Childbirth Experience Questionnaire (CEQ) and Support and Control in Birth (SCIB). Both tools were validated for Farsi language. The second phase was a qualitative study with 17 in-depth individual interviews among women who took part in the first phase to better understand their reasons that influenced their childbirth experience either positively or negatively. The third phase of the study was to develop recommendations for a proposed clinical guideline through a Delphi study where maternal health experts were selected and invited to take part in the panel. They first rated the proposed recommendations individually and provided written responses on their own agreement or disagreement with each statement in terms of its impact on childbirth experience, feasibility, acceptability, and cost-effectiveness. After three confirmation rounds, the final conscience was reached by the panel members.

Results: The results of the quantitative phase showed that the probability of negative experience of childbirth was increased when physical exercise was not implemented during pregnancy, lacking pain relief options, having fear of childbirth, lacking skin to skin contact with the newborn and being unable to initiate breastfeeding in the first hour after birth (P < 0.05). The analysis of qualitative data revealed 13 major theme categories which were related to women's sense of internal control, external control and support. In the third phase of the study, culturally appropriate recommendations were made and an evidence-based clinical guideline was proposed. The proposed guideline was based on the combination of the quantitative and qualitative phases, a review of the literature, and the opinions of Iranian experts using the Delphi technique.

Conclusion: Given the high prevalence of negative childbirth experience among Iranian primiparous women, the present study may be of great interest for managers, leaders, policymakers, and care providers to improve the quality of the maternity services. However, further studies are required to translate the recommendations into practice and identify enablers and barriers during the implementation of the proposed guideline. To adopt the recommendations at national level, there is a need to further studies to assess the effectiveness of the proposed guideline within different communities across the region and the country.
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http://dx.doi.org/10.1186/s12978-021-01196-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8259137PMC
July 2021

Differentiating between girls and boys in transition through smoking stages: A sex-specific growth mixture modeling.

Health Promot Perspect 2021 19;11(2):202-209. Epub 2021 May 19.

Department of Statistics and Epidemiology, Tabriz University of Medical Sciences, Tabriz, Iran.

Smoking is a complex process, and adolescents pass through a number of different stages on the way to become smokers and it is sex-dependent. In this cohort study, the illustrative samples of 10th-grade students (2241 girls and 2956 boys) were assessed using a multistage sampling in Tabriz, Iran. The main variables of the study were smoking status, intention to start smoking, and smoking during the past week/ month, which were collected using a valid and reliable instrument. Sex-specific GMMs were fitted to assess the transition through smoking stages. GMMs lead in a 2-class optimal model: "Occasional/Intending smokers" and "Non-smokers". GMMs indicated that girls had lower levels of smoking status, intention to start smoking, smoking during the past week/month in both classes (significant and negative intercepts: -8.5 to -0.6). In addition, transitions toward higher levels of smoking status, intention to start smoking, smoking during the past week/month were observed in both classes for boys, but in the second class for girls (significant and positive slopes: 0.2 to 2.7). This study highlighted the importance of stopping the initiation and avoiding transition through smoking stages with special sex-specific planning in the future.
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http://dx.doi.org/10.34172/hpp.2021.25DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8233669PMC
May 2021

Improved couple satisfaction and communication with marriage and relationship programs: are there gender differences?-a systematic review and meta-analysis.

Syst Rev 2021 06 21;10(1):178. Epub 2021 Jun 21.

Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.

Background: The aspects of marriage and relationship and their effect on couples' satisfaction are essential and critical aspects to be explored in this globalized and contemporary world. Since there are no reported meta-analysis and systematic reviews conducted in the last two decades in this area, we aimed to investigate the effect of marriage and relationship programs (MRP) on couples' relationship satisfaction (CRS) and couples' relationship communication (CRC) and also to determine the gender differences if any.

Method: In this systematic review and meta-analysis, the randomized clinical trials (RCTs) published between 2000 and July 26, 2019, were retrieved from several online electronic databases such as Medline, Embase, ProQuest, and Cochrane Library. Inclusion and exclusion criteria were developed using the PICO (Population, Intervention, Comparison, Outcome) framework of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The mean differences (MDs) and 95% confidence intervals (CIs) were calculated. The reported summary statistics were calculated as random effects models based on the heterogeneity between the studies model. Funnel plots and the Egger regression test was used to confirm the presence of any publication bias.

Results: Of the total 12 intervention studies included, five (5) are education/communication skills programs, three (3) enrichment programs, and four (4) therapy programs. The impact of these programs was investigated on CRS and CRC. Therapy programs had a larger effect than other programs (pooled MD: 0.53 (95% CI = 0.35 to 0.71, I = 71.5% p = 0.0001) and had a larger effect size on wives (pooled MD: 0.53 (95% CI 0.25 to 0.80, I = 74.1% p = 0.0001) than husbands RS (pooled MD: 0.26 (95% CI 0.25 to 0.76, I = 72.4% p = 0.0001). In RC (relationship communication) area, the Enhancement programs showed the small to large effect on CRC (pooled MD: 1.31 (95% CI = 0.13 to 2.50, I = 94.7% p = 0.0001)) and educational programs showed small to medium effect (pooled MD: 0.32 (95% CI = 0.13 to 0.50, I = 74.5% p = 0.0001) on women and no effect on men.

Conclusion: Due to the high effect of the therapy programs on CRS and enhancement program on CRC in the current meta-analysis, the priority of their utilizations in interventions, especially by psychologists and mental health professionals, should be emphasized. Therefore, mental health planning in communities to develop MRP and care for couples' health should be given special attention to men's health. Due to the high heterogeneity of the results and with scanty literature in this specific domain, we are uncertain about their actual effect. However, well-designed RCTs with a larger sample size would be beneficial in closely examining the effect of MRPs on CRS and CRC.
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http://dx.doi.org/10.1186/s13643-021-01719-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8215832PMC
June 2021

Metabolic and hormonal effects of melatonin and/or magnesium supplementation in women with polycystic ovary syndrome: a randomized, double-blind, placebo-controlled trial.

Nutr Metab (Lond) 2021 Jun 6;18(1):57. Epub 2021 Jun 6.

Department of Nutrition, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Background: Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders among women of reproductive age. This study was designed to investigate the effects of melatonin and/or magnesium supplementation on metabolic profile and levels of sex hormones in PCOS women.

Methods: In an 8-week randomized double-blind placebo-controlled trial, 84 subjects with PCOS aged 18-40 years were randomly assigned based on the random block procedure to take magnesium, melatonin, magnesium plus melatonin, and placebo. Fasting blood samples were obtained at the beginning and end of the study.

Results: After intervention, the mean Pittsburg Sleep Quality Index score decreased significantly in both co-supplementation and melatonin groups (P < 0.001). Magnesium supplementation in combination with melatonin resulted in a significant greater decrease in testosterone concentrations compared with the placebo (P < 0.05). Co-supplementation of magnesium-melatonin had significantly reduced serum insulin levels (geometric means difference: - 1.11 (mIU/mL) (percent change: - 15.99)), homeostasis model of assessment-insulin resistance (HOMA-IR) (- 0.28 (- 18.66)), serum cholesterol (mean difference: - 16.08 (mg/dl) [95% CI - 24.24, - 7.92]), low-density lipoprotein cholesterol (LDL-C) - 18.96 (mg/dl) [- 28.73, - 9.20]) and testosterone levels (- 0.09 (ng/ml) (- 25.00)), as compared to the baseline values (P < 0.05). An increase in serum high-density lipoprotein cholesterol (HDL-C) levels was also observed following the administration of the melatonin alone (2.76 (mg/dl) [0.57, 4.95]) or in combination with magnesium (2.19 (mg/dl) [0.61, 3.77]) (P < 0.05).

Conclusions: Co-supplementation with magnesium and melatonin had beneficial effects on sleep quality and total testosterone. Additionally, melatonin supplementation alone was found to be associated with a significant reduction in PSQI score. Moreover, combined melatonin and magnesium supplementation was more effective in improving serum levels of cholesterol, LDL-C, HDL-C and insulin, and HOMA-IR.

Trial Registration: Iranian Registry of Clinical Trial. http://www.irct.ir : IRCT20191130045556N1, January 2020.
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http://dx.doi.org/10.1186/s12986-021-00586-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8183043PMC
June 2021

Effect of smartphone-based education on knowledge and self-care of reproductive health in married students.

J Educ Health Promot 2021 31;10:89. Epub 2021 Mar 31.

Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran.

Background: Education by smartphone-based software is a new method among the world's educational practices. Due to the lack of studies on the effect of this education on promoting knowledge and self-care behaviors of students' reproductive health this study aimed to determine the effect of smartphone-based software education on knowledge and self-care behaviors in the field of reproductive health.

Materials And Methods: This RCT with 164 married female students (82 in each group) conducted from October 2019 to January 2020, in Tabriz University and Tabriz medical University. Participants were randomly allocated to two groups of educational intervention and control. Smartphone-based software education designed in four areas of reproductive health. Intervention group was trained for 4 weeks. The score of knowledge and self-care behaviors of participants in both groups were compared at baseline and 8 weeks after intervention. Data were analyzed by SPSS-23 software using Chi-square, independent -tests, and analysis of covariance tests.

Results: Eight weeks after the intervention, a significant increase was observed in the mean (standard deviation [SD]) score of overall knowledge for reproductive health and all its subdomains ( < 0.001), as well as in in the mean (SD) self-care score of reproductive health and all subdomains ( < 0.05), except for the family planning in the education group compared to the control group.

Conclusion: The findings indicate a significant effect of smartphone-based software on increasing students' knowledge and self-care in all areas of reproductive health except for family planning subdomain of self-care.
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http://dx.doi.org/10.4103/jehp.jehp_548_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8150067PMC
March 2021

Air pollution-related asthma profiles among children/adolescents: A multi-group latent class analysis.

Ecotoxicol Environ Saf 2021 Aug 20;219:112344. Epub 2021 May 20.

Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.

Background: This study aimed to investigate the asthma profile among children/adolescents and the relationship of the prevalence of air pollution profiles using latent class analysis (LCA).

Objectives: In this cross-sectional study, a case rural community was selected in an industrial area, and two rural control communities were selected in unexposed areas.

Methods: Hourly concentrations of PM, SO, NO and total volatile organic compounds were obtained from the records of a fixed air quality monitoring station, and the concentrations of benzene, toluene, xylenes styrene were measured during six campaigns. Asthma data was collected using the International Study of Asthma and Allergies in Childhood in 7-18 years old children/adolescents. The modeling was conducted using LCA.

Results: A higher amount of air pollution indices were observed in the case than both control communities. LCA divided the participants into three clusters; "healthy" (92.8%), "moderate" (2.8%), and "severe" (4.4%). A higher probability of severe asthma (6.8%) was observed in the case than control communities (2.6% and 1.8%). Additionally, after adjusting for possible confounders, the odds of asthma was lower in the control communities than the case in both moderate and sever classes (Odds Ratios in the range of 0.135-0.697).

Conclusions: This study indicates asthma profiles of children/adolescents and the higher prevalence of severe class in the area, explaining the possible effect of air pollution.
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http://dx.doi.org/10.1016/j.ecoenv.2021.112344DOI Listing
August 2021

Effects of Melatonin and/or Magnesium Supplementation on Biomarkers of Inflammation and Oxidative Stress in Women with Polycystic Ovary Syndrome: a Randomized, Double-Blind, Placebo-Controlled Trial.

Biol Trace Elem Res 2021 May 19. Epub 2021 May 19.

Nutrition and Metabolic Disease Research Center, Clinical Science Research Institute, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran.

Magnesium and melatonin are known to exert multiple beneficial effects including anti-inflammatory and antioxidant actions. This study was designed to determine the effects of magnesium and/or melatonin supplementation on metabolic profiles in women with polycystic ovary syndrome (PCOS). This randomized double-blind, placebo-controlled trial was conducted among 84 subjects with PCOS aged 18-40 years old. Patients were randomly assigned based on the random block procedure to take magnesium, melatonin, magnesium plus melatonin, or placebo for 8 weeks. Fasting blood samples were taken at baseline and after the intervention to quantify related variables. After the 8-week intervention, an insignificant marginal difference was seen in waist circumference (WC) between groups (P = 0.085). Magnesium-melatonin co-supplementation resulted in more reductions in hirsutism compared with other groups (P < 0.001). Serum levels of tumor necrosis factor-α (TNF-α) declined significantly in the melatonin and co-supplementation groups compared to baseline (P < 0.05). Also, magnesium plus melatonin was associated with a more increase in total antioxidant capacity (TAC) levels, as compared to the other treatment groups (P = 0.001). Overall, we found a favorable effect of co-supplementation of magnesium and melatonin for 8 weeks in women with PCOS on hirsutism, serum TNF-α, and TAC levels. Furthermore, melatonin independently contributed to decreased serum values of TNF-α.Clinical trial registration number http://www.irct.ir : IRCT20191130045556N1, January 2020.
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http://dx.doi.org/10.1007/s12011-021-02725-yDOI Listing
May 2021

Disparities in the quality of and access to services in children with autism spectrum disorders: a structural equation modeling.

Arch Public Health 2021 Apr 26;79(1):58. Epub 2021 Apr 26.

Hospital Management Research Center, Iran University of Medical Science, Tehran, Iran.

Background: Socioeconomic disparities in health and healthcare are global issues that affect both adults as well as children. Children with exceptional healthcare needs, especially those with developmental impairments, including Autism Spectrum Disorders (ASD), encounter major disparities in access to and quality of health services. However, disparities in the population of children are rarely studied. The main aim of this paper is to study the socioeconomic disparities in children with ASD by examining the association between their Social Determinants of Health (SDH) status and access to and the quality of services.

Methods: This is a cross-sectional study on 202 children with ASD conducted in 2019 in two provinces including Ardabil and East-Azerbaijan, in the North-West of Iran. A structured, valid questionnaire was used to collect data on demographic, SDH status, quality of services, and access to services in a population of children with ASD aged 2-16-year-old. Around 77% participants were male and the mean age of children was 2 years and 6 months. Structural Equation Modeling (SEM) were used to assess the relationship.

Results: Based on the results of this study, the overall mean scores of the quality of services, access to services, and SDH status were 61.23 (30.01), 65.91 (21.89), and 29.50 (22.32) out of 100, respectively. All the associations between the quality and access dimensions and quality (B: 0.464-0.704) and access (B: 0.265-0.726) scales were statistically significant (P < 0.001). By adjusting to covariates, the access was also significantly related to service quality (P = 0.004). Finally, the associations between SDH score with service quality (P = 0.039) and access (P < 0.001) were positively significant.

Conclusions: There are socioeconomic disparities in the quality of and access to services among children with ASD, who use ASD services, in the North-West of Iran. We recommend health/medical centers, where children are diagnosed with ASD, conducting SDH screening and providing families of low-SDH status with specific information about the quality of and access to services for children with ASD. Additionally, medical universities must have a plan to routinely monitor the quality of and access to services provided for the children with low SDH.
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http://dx.doi.org/10.1186/s13690-021-00577-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8074455PMC
April 2021

A novel inflammatory signaling pathway in patients with slow coronary flow: NF-κB/IL-1β/nitric oxide.

Cytokine 2021 Jul 8;143:155511. Epub 2021 Apr 8.

Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Electronic address:

Purpose: The slow coronary flow (SCF) was identified as delayed opacification of epicardial coronary arteries in the absence of stenotic lesion. Metabolic syndrome (MetS), oxidative stress, and inflammation may be possible known insulting factors for the pathogenesis of SCF. This investigation aimed to assess the relationship between some inflammatory markers, oxidative stress parameters and MetS components with SCF phenomenon.

Methods: A total of 35 patients with SCF and 35 subjects with normal coronary flow (NCF) were included in the study. We assessed some inflammatory markers (IL-1β, IL-18, TNF-α, and NF-κB mRNA expression in peripheral blood mononuclear cells (PBMCs)). Moreover, blood samples of the participants were tested for total antioxidant capacity (TAC), glutathione peroxidase (GPX) and nitric oxide (NO) levels using enzyme-linked immunosorbent assay (ELISA). Diagnosis of MetS was based on the National Cholesterol Education Program's Adult Treatment Panel III report (ATPIII) criteria, 2005. Diagnostic criteria for coronary flow rates of all subjects were documented by thrombolysis in myocardial infarction (TIMI) frame count method.

Results: SCF patients had significantly higher prevalence of MetS (46%, p = 0.048).We found that the level of TAC was significantly higher in the NCF group (p = 0.006). Furthermore, the NO concentration was significantly lower in SCF groups (p = 0.001). A significant incremental difference was detected in IL-1β (fold change 2.82 ± 0.31, p < 0.05) and NF-κB (fold change 4.62 ± 0.32, p < 0.05) mRNA expression in the SCF group when compared with its level in the NCF group. Furthermore, according to logistic regression analysis, there were significant associations between IL-1β, NF-κB expression levels and the incidence of SCF (p < 0.05).

Conclusion: Based on the findings of this study, the pathogenesis of the SCF phenomenon may be closely associated with metabolic syndrome and inflammation. The NF-κB/IL-1β/nitric oxide & MetS signaling pathway might be considered as potential therapeutic targets in the management of SCF patients but further researches is required to guarantee these findings.
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http://dx.doi.org/10.1016/j.cyto.2021.155511DOI Listing
July 2021

The association of dietary patterns with dietary inflammatory index, systemic inflammation, and insulin resistance, in apparently healthy individuals with obesity.

Sci Rep 2021 Apr 6;11(1):7515. Epub 2021 Apr 6.

Department of Nutrition and Food Sciences, Maragheh University of Medical Sciences, Margheh, Iran.

Inflammation is considered a key mechanism leading to obesity. Dietary patterns and certain food items influence inflammation. Few studies have investigated the contribution of major dietary patterns to biological measures of inflammation. Therefore, the present study aimed to examine the associations of different dietary patterns with dietary inflammatory index (DII), systemic inflammation, and insulin resistance (IR) in the apparently healthy obese. In this cross-sectional study, 151 abdominally obese subjects were recruited from the Northwest of Iran. Dietary intake, demographic data, anthropometric indices, and physical activity (PA) was assessed. DII scores were calculated based on a validated 168-item food frequency questionnaire (FFQ). Three dietary patterns were identified, using principal component analysis. Basal blood samples were collected to determine biochemical parameters. Linear regression test with adjusted beta estimates was applied for data analysis. Three dietary patterns were extracted as Healthy, Western, and Traditional. Body mass index (BMI) (p < 0.01) and fat mass (p < 0.001) were directly associated with the Western dietary pattern. Conversely, serum lipopolysaccharide-binding protein (LBP) (b = - 0.1, p < 0.04) was negatively associated with Healthy dietary pattern, after controlling for confounders. The Traditional pattern was found to be inversely related to DII (b = - 0.3, p < 0.001). The association was also reveresed between Traditional pattern and IR (Odds Ratio: 0.3 (95% Confidence Interval 0.1-0.9)). The results suggested that the Western dietary pattern was related to higher BMI and fat mass. In addition, the Healthy pattern was associated with decreased levels of LBP. Adherence to the Traditional dietary pattern was inversely related to DII as well as IR.
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http://dx.doi.org/10.1038/s41598-021-86993-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8024341PMC
April 2021

Validity and reliability of the Iranian preterm birth experiences and satisfaction scale: A methodological and cross-sectional study.

Health Promot Perspect 2021 7;11(1):97-108. Epub 2021 Feb 7.

Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, UK.

Women's experience and satisfaction with childbirth care are increasingly being addressed by health care providers, managers, and policymakers. Due to need for a validated special scale for assessing satisfaction of women with preterm birth, we aimed to translate and adapt the first specific tool, Preterm Birth Experiences and Satisfaction Scale (P-BESS), into Persian language and evaluate its psychometric properties. A methodological and cross-sectional study was conducted in two tertiary levels of maternal hospitals in Tabriz. The Iranian version of the scale was developed from the original English version using forward-backward translation. After confirmation of its face and content validity, the scale was completed by 201 women who had given birth prematurely. Exploratory factor analysis revealed three factors (staff professionalism and empathy, confidence in Staff, information and explanations) with eigenvalues greater than 1, explaining a total variance of 55.4%. Confirmatory factory analysis showed that the 17-item, three factor model fitted the data well: the root mean square error of approximation 0.060. There were moderate correlations between the total and sub-scales of Iranian P-BESS and overall satisfaction (r = 0.45 to 0.66), as well as need for improvement (r = -0.46 to -0.61), which confirm convergent validity. Internal consistency and test-retest reliability of the scale and its sub-scales were satisfactory (α = 0.852 to 0.922, intraclass correlation coefficient; 0.83 to 0.92). The Iranian version of P-BESS is a valid and reliable scale which can be used by policy makers, managers, health care providers and researchers.
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http://dx.doi.org/10.34172/hpp.2021.13DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7967130PMC
February 2021

Psychometric Evaluation of Stress in 17,414 Critical Care Unit Nurses: Effects of Age, Gender, and Working Conditions.

Adv Exp Med Biol 2021 ;1286:199-212

Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.

Recent events regarding the COVID-19 pandemic have demonstrated the importance of healthcare workers around the world and the stressful working conditions that are often associated with their profession. The severity of stress can be influenced by a number of factors such as age, seniority gender, family status, and position in the wards. Thus, it is important to monitor signs of stress and other psychiatric symptoms in order to understand the mediating factors and guide appropriate interventions. Here, we describe a cross-sectional study of 17,414 nurses from 31 Iranian cities carried out from 2011 to 2015, using a 22-item tool of work stressors. The tool examined interactive, managerial, and situational domains and the main objective was to identify the main background variables associated with the stress of nurses in critical care settings.
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http://dx.doi.org/10.1007/978-3-030-55035-6_14DOI Listing
March 2021

Corrigendum to "Breast Cancer Survival and Incidence: 10 Years Cancer Registry Data in the Northwest, Iran".

Int J Breast Cancer 2021 20;2021:2604819. Epub 2021 Feb 20.

Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.

[This corrects the article DOI: 10.1155/2020/1963814.].
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http://dx.doi.org/10.1155/2021/2604819DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7920743PMC
February 2021

The eight-item Morisky Medication Adherence Scale: validation of its Persian version in diabetic adults.

Caspian J Intern Med 2021 ;12(1):77-83

Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.

Background: Adherence to treatment is an important factor in the management of diabetic patients. The aim of this study was to examine the psychometric properties of the 8-item Morisky Medication Adherence Scale (MMAS-8) among type 2 diabetes.

Methods: This study carried out in Family Medicine Clinics (FMCs) in Tabriz, North West of Iran from May to September 2018. A total of 320 patients suffering from Type 2 diabetes were included. Content and face validity of the Persian version of MMAS-8 ‎ were quantitatively evaluated. The Cronbach's alpha and intra-class correlation (ICC) were calculated to assess the reliability. Exploratory factor analysis (EFA) was used to assess the construct validity of the questionnaire.

Results: Content and face validity of the Persian version of MMAS-8 were confirmed. Good internal consistency (Cronbach's a = 0.83) and test-retest reliability (ICC= 0.87, P<0.001) were found. According to the results of the EFA, Persian version of MMAS-8 among diabetic patients had two dimensions: stopping to take medication due to the forgetfulness and for reasons other than forgetfulness.

Conclusion: The Persian version of the MMAS-8 is a high valid and reliable questionnaire to screen medication adherence of Persian-speaking patients with diabetes.
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http://dx.doi.org/10.22088/cjim.12.1.77DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7919181PMC
January 2021

Modeling Survival in Patients With Brain Stroke in the Presence of Competing Risks.

J Prev Med Public Health 2021 Jan 7;54(1):55-62. Epub 2020 Dec 7.

Department of Statistics and Epidemiology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran.

Objectives: After heart disease, brain stroke (BS) is the second most common cause of death worldwide, underscoring the importance of understanding preventable and treatable risk factors for the outcomes of BS. This study aimed to model the survival of patients with BS in the presence of competing risks.

Methods: This longitudinal study was conducted on 332 patients with a definitive diagnosis of BS. Demographic characteristics and risk factors were collected by a validated checklist. Patients' mortality status was investigated by telephone follow-up to identify deaths that may be have been caused by stroke or other factors (heart disease, diabetes, high cholesterol, etc.). Data were analyzed by the Lunn-McNeil approach at alpha=0.1.

Results: Older age at diagnosis (59-68 years: adjusted hazard ratio [aHR], 2.19; 90% confidence interval [CI], 1.38 to 3.48; 69-75 years: aHR, 5.04; 90% CI, 3.25 to 7.80; ≥76 years: aHR, 5.30; 90% CI, 3.40 to 8.44), having heart disease (aHR, 1.65; 90% CI, 1.23 to 2.23), oral contraceptive pill use (women only) (aHR, 0.44; 90% CI, 0.24 to 0.78) and ischemic stroke (aHR, 0.52; 90% CI, 0.36 to 0.74) were directly related to death from BS. Older age at diagnosis (59-68 years: aHR, 21.42; 90% CI, 3.52 to 130.39; 75-69 years: aHR, 16.48; 90% CI, 2.75 to 98.69; ≥76 years: aHR, 26.03; 90% CI, 4.06 to 166.93) and rural residence (aHR, 2.30; 90% CI, 1.15 to 4.60) were directly related to death from other causes. Significant risk factors were found for both causes of death.

Conclusions: BS-specific and non-BS-specific mortality had different risk factors. These findings could be utilized to prescribe optimal and specific treatment.
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http://dx.doi.org/10.3961/jpmph.20.463DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7939750PMC
January 2021

Effect of French maritime pine bark extract supplementation on metabolic status and serum vascular cell adhesion molecule-1 levels in patients with type 2 diabetes and microalbuminuria.

Complement Ther Med 2021 May 18;58:102689. Epub 2021 Feb 18.

Department of Endocrine and Metabolism, Sina Medical Research and Training Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.

Objectives: This study investigated the effect of French maritime pine bark extract (PBE) supplementation on metabolic parameters, vascular cell adhesion molecule 1 (VCAM-1), urinary albumin-to-creatinine ratio (UACR), and anthropometric indexes in patients with type 2 diabetes (T2DM) and microalbuminuria.

Design: This randomized, double-blind, placebo-controlled clinical trial was conducted on 46 patients with T2DM and the evidence of microalbuminuria aged 30-65 years.

Setting: Patients were recruited from the endocrinology clinic of Sina hospital (Tabriz, Iran) from March 2018 to April 2019.

Interventions: The subjects were randomly assigned to receive two capsules/day each containing 50mg of PBE or placebo for eight weeks.

Main Outcome Measures: Glycemic parameters, serum VCAM-1 and lipid profile, UACR, and anthropometric indexes were measured for all patients at baseline and the end of the study.

Results: PBE supplementation significantly reduced glycosylated hemoglobin, VCAM-1, total cholesterol, UACR, waist circumference, and waist-to-height ratio compared to the placebo group at the end of the study (all P < 0.05). Changes in fasting blood glucose, insulin, triglyceride, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol were not significant between the two groups (all P > 0.05).

Conclusions: The study findings demonstrated some favorable effects of PBE supplementation on glycemic control, serum VCAM-1 and total cholesterol levels, and microalbuminuria, as well as abdominal obesity in patients with T2DM.
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http://dx.doi.org/10.1016/j.ctim.2021.102689DOI Listing
May 2021

Psychometric properties of the Persian version of delivery fear scale (DFS) in Iran.

BMC Pregnancy Childbirth 2021 Feb 18;21(1):147. Epub 2021 Feb 18.

Road Traffic Injury Research Center, Faculty of Health, Professor of Biostatistics, Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran.

Background: The aim of the present study was to evaluate the psychometric properties of the Persian version of delivery fear scale (DFS) among Iranian women population.

Methods: This is a methodological study that was conducted to evaluate the psychometric properties of DFS. Convenience sampling was used to select 200 pregnant women from the maternity ward of Razi Hospital in Ahvaz, Iran. In the first step, the scale was translated into Persian using backward-forward translation method. Afterwards, the following types of validity were examined: face validity based on impact score, construct validity based on confirmatory factor analysis (CFA), and concurrent validity. The Pearson correlation test was used to determine the correlation of DFS with pregnancy-related anxiety questionnaire (PRAQ), Childbirth Attitude Questionnaire (CAQ), Spielberger's state-trait anxiety inventory (STAI), and the short form of Lowe's childbirth self-efficacy inventory. Reliability of DFS was assessed by determining internal consistency (Cronbach's alpha) and split-half method.

Results: CFA had satisfactory validity considering x⁄df < 5 and the RMSEA < 0.08. /the obtained Cronbach's alpha coefficient was 0.77. The split-half coefficient of the questionnaire was 0.83, indicating an acceptable reliability for the questionnaire. The results showed that DFS had a direct significant correlation with the CAQ (r = 0.72), PRAQ (r = 0.74), STAI-Y1 (r = 0.71) and STAI-Y1 (r = 0.63) and a reverse significant correlation with subscales of the short form of Lowe's childbirth self-efficacy inventory including outcome expectancy (r= -0.75) and self-efficacy expectancy (r= -0.76).

Conclusions: The findings of the present study confirm the validity and reliability of the Persian version of DFS as an instrument for measuring fear of childbirth (FOC) in Iranian women population.
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http://dx.doi.org/10.1186/s12884-021-03634-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7890816PMC
February 2021

Association between Dietary Patterns and Non-alcoholic Fatty Liver Disease: Results from a Case-Control Study.

Arch Iran Med 2021 01 1;24(1):35-42. Epub 2021 Jan 1.

Nutrition Research Center, Department of Clinical Nutrition, School of Nutrition & Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran.

Background: This study aimed to investigate the association between dietary patterns and non-alcoholic fatty liver disease (NAFLD) among Iranian adults.

Methods: This case-control study was conducted on 210 subjects. NAFLD diagnosis was made by ultrasound examination. Anthropometric measures, physical activity, fasting serum levels of glucose, alanine aminotransferase (ALT), aspartate aminotransferase, and lipid profile were assessed. A three-day food diary was used to assess dietary intakes of the subjects. Dietary patterns were determined using factor analysis. To determine the relationship between dietary patterns and NAFLD, multivariable-adjusted odds ratio (OR) obtained from the logistic regression analysis was used.

Results: Two dietary patterns were extracted as follows: vegetables, legumes, fruits, and low-fat dairy products (VLFD) ; and sweet, hydrogenated fat, red and processed meat, and soft drink (SHMS) dietary patterns. By taking all possible confounders into account, the VLFD dietary pattern was found to be significantly related to lower odds of NAFLD, while the SHMS dietary pattern was independently related to higher odds of NAFLD (P < 0.05). Among major food groups, high consumption of processed meat, hydrogenated fats, sweets and desserts, and soft drinks was positively related to NAFLD (P < 0.05), whereas vegetable consumption exhibited a protective role against NAFLD (P = 0.01).

Conclusion: The VLFD dietary pattern was associated with reduced likelihood of having NAFLD, while the SHMS dietary pattern was associated with higher likelihood. Therefore, the VLFD dietary pattern might be useful in the nutritional strategies for NAFLD patients. Further studies with larger sample sizes and prospective design are warranted.
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http://dx.doi.org/10.34172/aim.2021.06DOI Listing
January 2021

Gender difference about death anxiety among older adults: Structural Equation Model.

Psychogeriatrics 2021 May 12;21(3):296-303. Epub 2021 Feb 12.

Clinical Psychiatry Research Centre & Department of Health Education & Promotion, Tabriz University of Medical Sciences, Tabriz, Iran.

Background: Older adults may be more prone to death anxiety than their younger counterparts. This study explores factors affecting death anxiety based on gender differences.

Methods: In this correlational study, 450 older adults referred to the health centres in the city of Bukan, Iran were recruited by using a randomised sampling method. Next, data were collected about the demographic questionnaire, anxiety about ageing, death anxiety, mental well-being, perceived social support, and quality of life questionnaire. The Spearman correlation coefficient was used to determine the correlation between variables, and the predictors of death anxiety were evaluated using quintile regression. Relationship between death anxiety and other variables was evaluated by the Structural Equation Model (SEM). The study was approved by the Tabriz University of Medical Sciences Ethics Committee (Ethics Code: IR.TBZMED.REC.1397.304).

Results: The results showed that death anxiety in men had a significant relationship with the level of literacy (P = 0.047), body self-imaging (P = 0.031), and perceived social activity (P = 0.033). Among women, death anxiety had a significant relationship with physical activity (P = 0.007) and perceived social activity (P = 0.002). Additionally, quintile regression analysis was calculated: among men, anxiety about ageing was related to death anxiety (β = 0.182, P = 0.05), while in women, only perceived social support was associated to death anxiety (β = -0.376, P = 0.05). Finally, according to SEM, a significantly different level of predictability of mental well-being was found for death anxiety among older men and women.

Conclusion: Understanding the gender differences about death anxiety by the healthcare system might be useful in controlling and reducing a variety of concerns among elders who experience high levels of anxiety of death.
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http://dx.doi.org/10.1111/psyg.12663DOI Listing
May 2021

The Persian Translation and validation of the celiac disease quality of life questionnaire (CDQOL).

Health Qual Life Outcomes 2021 Feb 10;19(1):52. Epub 2021 Feb 10.

Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.

Background: Considering the importance of having a celiac disease-specific measure of the quality of life (QOL) in Persian, the present study aimed to translate the celiac disease quality of life questionnaire (CDQOL) into Persian and evaluate its psychometric properties.

Methods: In this cross-sectional study, the Forward-Backward translation method was used. The content validation ratio (CVR) and the content validity index (CVI) were used for content validity assessment. The construct validity was assessed by exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) on 220 celiac patients who were selected randomly from the celiac disease (CD) registry database. The correlations between the result of the Persian version of CDQOL (PCDQOL), self-rated QOL, and short form-36 (SF36) were analyzed using the Pearson correlation test. The internal consistency and test-retest reliability were measured through Cronbach's alpha and intraclass correlation coefficient (ICC).

Results: In the present study, 220 celiac patients with a mean age of 35.54 ± 10.29 years participated. The mean CVI, CVR, and impact score of PCDQOL were 0.98, 0.96, and 4.82 respectively. Using EFA, four factors have extracted that had a good fit in CFA (Chi-square/DF = 1.74, RMSEA: 0.08, and CFI: 0.90, and NFI: 0.90). The results showed that there was a moderate to high correlation between PCDQOL, SF36 (r: 0.587, p = 0.02), and self-rated QOL (r: 0.64, p < 0.001). The questionnaire had high internal consistency (Cronbach alpha: 0.93) and test-retest reliability (ICC: 0.96 [0.86-0.99]).

Conclusion: The PCDQOL questionnaire could be used by physicians and nutritionists to assess HRQOL in celiac patients in Iran.
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http://dx.doi.org/10.1186/s12955-021-01694-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7876810PMC
February 2021

Synbiotic Supplementation Improves Metabolic Factors and Obesity Values in Women with Polycystic Ovary Syndrome Independent of Affecting Apelin Levels: A Randomized Double-Blind Placebo - Controlled Clinical Trial.

Int J Fertil Steril 2021 Jan 19;15(1):51-59. Epub 2021 Jan 19.

Department of Obstetrics and Gynecology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.

Background: This research investigated the symbiotic supplement influences on serum glycemic indices and lipids as well as apelin rates and obesity values in polycystic ovary syndrome (PCOS) patients.

Materials And Methods: A total of 68 obese or overweight patients (20-44 years old) with PCOS were enrolled to conduct a randomized double-blinded placebo-controlled clinical trial. A total of 34 people in the synbiotic group received a synbiotic supplement and 34 people in the placebo group received placebo, daily for 8 weeks. Fasting blood specimens, anthropometric measurements and dietary intake data were gathered three times during the study. The information was analyzed by independent t test, paired t test, analysis of covariance and chi-square test.

Results: Synbiotic supplementation significantly decreased serum fasting glucose (P=0.02), insulin (P=0.001), homeostatic model assessment for insulin resistance (IR, P=0.001), weight (P=0.02), body mass index (BMI, P=0.02), waist circumference (WC, P=0.01), hip circumference (HC, P=0.02), and waist-to-height ratio (WHtR, P=0.02) but significantly increased high-density lipoprotein (HDL) cholesterol (P=0.02) compared to the placebo. At the end of the trial, no significant differences were seen in serum total cholesterol, triglyceride (TG), low-density lipoprotein (LDL) cholesterol, or apelin levels as well as waist-to-hip ratio (WHR) between the two groups.

Conclusion: Synbiotic supplementation improved glycemic indices, lipid profile and obesity values in women with PCOS. These beneficial effects were not related with alterations in serum apelin levels (Registration number: IRCT20100408003664N19).
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http://dx.doi.org/10.22074/ijfs.2021.6186DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7838763PMC
January 2021

Daily consumption effects of probiotic yogurt containing Lactobacillus acidophilus La5 and Bifidobacterium lactis Bb12 on oxidative stress in metabolic syndrome patients.

Clin Nutr ESPEN 2021 02 2;41:136-142. Epub 2021 Jan 2.

Department of Biochemistry and Diet Therapy, Nutrition Research Center, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran. Electronic address:

Background And Aims: Available evidence substantiates a strong association between metabolic syndrome and elevated oxidative stress. This study was aimed to assess the effects of probiotic yogurt containing Lactobacillus acidophilus La5 and Bifidobacterium lactis Bb12 on the oxidative stress biomarkers in patients with metabolic syndrome. Furthermore, the association between uric acid levels and insulin resistance indexes was assessed.

Methods: An 8-week randomized, double-blind, placebo-controlled, parallel study was designed. Forty-four patients, 22 males and 22 females aged 20-65 years, were assigned into two groups. Treatment (n = 22) and control (n = 22) groups consumed 300 g/d of probiotic and regular yogurt, respectively. The serum concentration of uric acid, oxidized Low-Density Lipoprotein (oxLDL), Malondialdehyde (MDA) and Total Antioxidant Capacity (TAC) were measured at the beginning and the end of the trial. This study was recorded at http://www.irct.ir (code: IRCT201608213140N17).

Results: Probiotic yogurt consumption resulted in a significant decrease in the level of serum uric acid and a significant increase in the level of TAC (p < 0.05). A positive significant association between uric acid with insulin concentration and the homeostasis model assessment of insulin resistance (HOMA-IR) and an inverse significant relationship with insulin sensitivity (Quicki) were also found (p < 0.05).

Conclusion: Probiotic yogurt consumption through improvement in insulin sensitivity may exert positive effects on the oxidative stress and uric acid levels. However, further studies are needed to make concise conclusions.
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http://dx.doi.org/10.1016/j.clnesp.2020.12.003DOI Listing
February 2021

Social Capital and Its Predictive Role in Quality of Life among the Elderly Referring to Health Centers in Tabriz, Iran: A Community- Based Study.

J Caring Sci 2020 Dec 1;9(4):212-219. Epub 2020 Dec 1.

Department of Community Health Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran.

Paying attention to the quality of life (QOL) in the elderly life is an important issue, given the criticality of this period. The Objective of the present study is to determine social capital and its predictive role on QOL among elderly people living in Tabriz, East- Azerbaijan province, Iran. The present cross-sectional study was accomplished in 2018 on 522 elderly people referred to the health centers in city of Tabriz. A multi-stage random cluster sampling was implemented. The data were collected, using a demographical questionnaire, Onyx-Bullen social capital, and WHOQOL-BREF QOL questionnaires. Then, they were analyzed by SPSS software version 15 and descriptive (frequency, percentage, mean (SD) and inferential statistics (Pearson, and Multivariate linear regression) were provided. The mean age of the participants was 65.7 years, 58% were women, 85.5% were married, and 37.5% were illiterate. The mean )SD (of social capital score was 71.87 (10.51) (in the range of 36-144) and for QOL, it was 64.64 (10.81) (in the range of 0-100). Social capital had positive and direct relation with QOL. Out of all the variables studied; marital status, education, economic status, health status, the absence of cardiovascular diseases (CVDs), and joint pains had significant relation with QOL. By some modifications in context factors, social capital was considered to be a predictive factor for QOL [β (95%CI): 0.28 to 0.36)]. For the promotion of QOL among the elderly, certain strategies must be implemented by health policy makers to enhance social capital among elderly people.
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http://dx.doi.org/10.34172/jcs.2020.032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7770394PMC
December 2020

Effects of soy intake on circulating levels of TNF-α and interleukin-6: a systematic review and meta-analysis of randomized controlled trials.

Eur J Nutr 2021 Mar 5;60(2):581-601. Epub 2021 Jan 5.

Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.

Purpose: Pro-inflammatory mediators, including serum tumor necrosis factor alpha (TNF-α) and interleukin-6 (IL-6), can be used as biomarkers to indicate or monitor disease. This study was designed to ascertain the effects of soy products on TNF-α and IL-6 levels.

Methods: PubMed, EMBASE, Science Direct, Web of Science, Google Scholar and the Cochrane Central Register of Controlled Trials were searched to November 2019 for RCTs around the effects of soy-based products on TNF-α and IL-6. A random effects model was used to calculate overall effect size.

Results: In total, 29 eligible publications were considered in the present systematic review, of which 25 were included in this meta-analysis. The overall effect of soy products on TNF-α and IL-6 levels failed to reach statistical significance (MD = - 0.07; 95% CI - 0.22-0.09; I 50.9; MD = 0.03; 95% CI - 0.07-0.14; I 42.1, respectively). According to a subgroup analysis, natural soy products led to a reduction in TNF-α concentration compared with processed soy products (MD = - 0.32; 95% CI - 0.45 to - 0.19; I 0.0). Moreover, IL-6 reduction was stronger in participants who were affected by different diseases (MD = - 0.04; 95% CI - 0.07 to - 0.02; I 0.0).

Conclusions: A review of RCTs published to November 2019 found that natural soy products are effective in lowering TNF-α levels. While the beneficial effects on reduction of IL-6 appeared stronger in individuals affected by different diseases, this finding cannot be generalized to all individuals affected by different diseases.
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http://dx.doi.org/10.1007/s00394-020-02458-zDOI Listing
March 2021

An Interventional strategy of physical activity promotion for reduction of menopause symptoms.

Health Promot Perspect 2020 7;10(4):383-392. Epub 2020 Nov 7.

Dean, University of Washington School of Nursing, Seattle, Washington, USA.

Physical activity (PA) programs are inexpensive, non-pharmaceutical and universally accessible options with demonstrated efficacy in reducing menopausal symptoms. The purpose of this study was to determine the effectiveness of a behavioral strategy for initiating and sustaining PA with the hope to reduce or eliminate menopausal symptoms. : Menopausal and perimenopausal women (n=190) were randomly assigned to intervention (n=95) and non-intervention (n=95) groups using a random-numbers table. The intervention group consisted of 18 neighborhood network subgroups, each consisting of five to six women known to one another. They participated in a 12-week regular PA program, augmented by eight interactive group education and discussion sessions. The Menopause Rating Scale (MRS) self-report instrument was used to determine perceived severity of menopausal symptoms. The intervention group showed a significant reduction in the frequency and severity of menopausal symptoms (P < 0.001). Those whose symptoms rated severe/very severe for hot flushes were reduced from 30.1% to 11.8%. Also, participants whose sleep problems and joint discomfort rated severe/very severe declined from 28% to 6.5% and joint discomfort rated severe or very severe was reduced from 52.7% to 4.4%, respectively. Conversely in the nonintervention group, hot flushes, sleep problems and joint problems got significantly worse(P < 0.05). Implementing educational program that increases awareness of PA benefits in combination with existing neighborhood networks that facilitate communication and cooperation may increase PA levels and decrease menopausal symptoms. Such networks offer alow-cost means of improving quality of life (QOL) for perimenopausal and menopausal women.
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http://dx.doi.org/10.34172/hpp.2020.57DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7722991PMC
November 2020

Dietary natural methylxanthines and colorectal cancer: a systematic review and meta-analysis.

Food Funct 2020 Dec 18;11(12):10290-10305. Epub 2020 Nov 18.

Student Research Committee, Faculty of Nutrition and Food Science, Tabriz University of Medical Sciences, Tabriz, Iran.

Some evidence suggests that caffeine, theophylline, and theobromine, as natural methylxanthines (MTXs), possess anti-cancer effects. We systematically reviewed the animal and human studies investigating the effect of (or association between) dietary natural MTXs on (and) colorectal cancer (CRC) and performed a meta-analysis of epidemiological studies. Relevant studies were identified by searching MEDLINE, Embase, Scopus, and Web of Knowledge through September 2020. The overall relative risk (RR) and confidence interval (CI) were determined using a random-effects model. Eight animal and eight epidemiological investigations met our inclusion criteria. Animal studies indicated detrimental effects of high levels of caffeine intake on the initiation and promotion of CRC, while showing beneficial or non-significant effects at lower doses. The meta-analysis of six epidemiological studies found no association between dietary caffeine intake and the risk of CRC (RR = 0.98 (95% CI = 0.88-1.10)). Subgroup analysis revealed a direct association between caffeine intake and risk of CRC only in the studies with a moderate risk of bias and a lack of adjustment for smoking. The results of the only epidemiological study investigating the association between the serum levels of MTXs and the risk of CRC showed an inverse association. In conclusion, some animal studies underlined the beneficial effects of caffeine, at regular doses consumed by humans, on CRC. However, current epidemiological evidence does not support an association between caffeine intake and the risk of CRC.
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http://dx.doi.org/10.1039/d0fo02518fDOI Listing
December 2020

Psychometric properties of satisfaction with the childbirth education class questionnaire for Iranian population.

BMC Pregnancy Childbirth 2020 Nov 5;20(1):669. Epub 2020 Nov 5.

Social determinants of Health Research Center, Tabriz University of Medical sciences, Tabriz, Iran.

Background: Childbirth preparation classes can reduce pregnant women's anxiety and fear for their childbirth. However, to evaluate women's feedback and their satisfaction with these classes, there is a need for a standard instrument that is suitable for Iranian context. This study is aimed to translate and conduct a psychometric analysis of the Satisfaction with the Childbirth Education Class Questionnaire (SCECQ) for Iranian population.

Methods: The questionnaire was translated from English into Persian through the forward-backward translation method. The cluster sampling method was employed to select 205 pregnant women with gestational age of 35-37 weeks from all health complexes of Tabriz, Iran. The face, content, and construct validity of the research instrument were assessed through exploratory and confirmatory factor analyses. Internal consistency and test-retest reliability were measured to evaluate the overall reliability of the questionnaire.

Results: The impact scores of all items were above 1.5. The content validity index (CVI) and content validity ratio (CVR) of the questionnaire were 0.88 and 0.94, respectively. The convergent construct validity of the whole questionnaire and those of its three subscales were confirmed through the exploratory factor analysis (EFA). The factor loadings of no items were below 0.3, and the X/df ratio was smaller than 5. The overall model validity was confirmed by having the Root Mean Square Error of Approximation (RMSEA) smaller than 0.08. Cronbach's alpha and intraclass correlation coefficient (ICC) were 0.93 and 0.96, respectively, indicating the acceptable reliability of the questionnaire.

Conclusion: The Persian version of this questionnaire, entitled SCECQ is a valid and reliable instrument for measuring Iranian women's satisfaction with childbirth education classes.
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http://dx.doi.org/10.1186/s12884-020-03349-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7643332PMC
November 2020

The outcome in patients with brain stroke: A deep learning neural network modeling.

J Res Med Sci 2020 24;25:78. Epub 2020 Aug 24.

Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran.

Background: The artificial intelligence field is obtaining ever-increasing interests for enhancing the accuracy of diagnosis and the quality of patient care. Deep learning neural network (DLNN) approach was considered in patients with brain stroke (BS) to predict and classify the outcome by the risk factors.

Materials And Methods: A total of 332 patients with BS (mean age: 77.4 [standard deviation: 10.4] years, 50.6% - male) from Imam Khomeini Hospital, Ardabil, Iran, during 2008-2018 participated in this prospective study. Data were gathered from the available documents of the BS registry. Furthermore, the diagnosis of BS was considered based on computerized tomography scans and magnetic resonance imaging. The DLNN strategy was applied to predict the effects of the main risk factors on mortality. The quality of the model was measured by diagnostic indices.

Results: The finding of this study for 81 selected models demonstrated that ranges of accuracy, sensitivity, and specificity are 90.5%-99.7%, 83.8%-100%, and 89.8%-99.5%, respectively. Based on the optimal model (tangent hyperbolic activation function with the minimum-maximum hidden units of 10-20, max epochs of 400, momentum of 0.5, and learning rate of 0.1), the most important predictors for BS mortality were time interval after 10 years (accuracy = 92.2%), age category (75.6%), the history of hyperlipoproteinemia (66.9%), and education level (66.9%). The other independent variables are at moderate importance (66.6%) which include sex, employment status, residential place, smoking habits, history of heart disease, cerebrovascular accident type, blood pressure, diabetes, oral contraceptive pill use, and physical activity.

Conclusion: The best means for dropping the BS load is effective BS prevention. DLNN strategy showed a surprising presentation in the prediction of BS mortality based on the main risk factors with an excellent diagnostic accuracy. Moreover, the time interval after 10 years, age, the history of hyperlipoproteinemia, and education level are the most important predictors for BS.
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http://dx.doi.org/10.4103/jrms.JRMS_268_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7554543PMC
August 2020
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