The Sexual Function, Desire, and Satisfaction of Couples during the Outbreak of COVID-19 in Qazvin

Background

The COVID-19 pandemic has significantly affected the lives of the community. The resulting social constraints and the physical and psychological consequences are also expected to affect sexual health. The present study aims to determine the status of sexual function, desire, and satisfaction of couples during the outbreak of COVID-19.

Materials and Methods

This is a descriptive online cross-sectional study on 400 married individuals living in Qazvin, Iran, from October 15 to November 12, 2020. The multi-stage random cluster method is used for sampling. The following questionnaires have been used for data collection: Female Sexual Function Index (FSFI), Rosen male sexual function, Larson's sexual satisfaction, and Hurlbert Index of Sexual Desire (HISD). The questionnaires were sent to participants through online messengers. The obtained data were analyzed by SPSS software (v25).

Results

The findings show that only 19.20% of study participants had sex three or more times a week. Most of the participating women (56.90%) had sexual dysfunction, while most men (64.30%) had proper sexual function. Also, the majority of participants had moderate sexual desire (46%) and high sexual satisfaction. The primary predictors of sexual dysfunction in men and women during the outbreak of COVID-19 were "employment in health centers" (B = -9.34, p = 0.007) and "spouse working in health centers" (B = -6.16, p = 0.007), respectively.

Conclusions

The psychological burdens of the COVID-19 pandemic and resulting measures, such as prevention protocols, affect couples' sexual relations. Therefore, interventions are necessary to improve the quality and health of the sexual life of couples.

Trends of in-Hospital and ICU Mortality in COVID-19 Patients Over the Fourth and Fifth COVID-19 Surges in Iran: A Retrospective Cohort Study from Iran

Objective

The current study aimed to investigate the temporal trend of in-hospital and intensive care unit (ICU) mortality of coronavirus disease 2019 (COVID-19) patients over 6 months in the spring and summer of 2021 in Iran.

Design

We performed an observational retrospective cohort study.

Setting

Qazvin Province- Iran during 6 month from April to September 2021.

Participants

All 14355 patients who were hospitalized with confirmed COVID-19 in hospitals of Qazvin Province.

Intervention

No intervention.

Main outcome measures

The trends of overall in-hospital mortality and ICU mortality were the main outcome of interest. We obtained crude and adjusted in-hospital and ICU mortality rates for each month of admission and over surge and lull periods of the disease.

Results

The overall in-hospital mortality, early mortality and ICU mortality were 8.8%, 3.2% and 67.6%, respectively. The trend for overall mortality was almost plateau ranging from 6.5% in July to 10.7% in April. The lowest ICU mortality was 60.0% observed in April, whereas it reached a peak in August (ICU mortality = 75.7%). Admission on surge days of COVID-19 was associated with an increased risk of overall mortality (Odds ratio = 1.3, 95% confidence interval = 1.1, 1.5). The comparison of surge and lull status showed that the odds of ICU mortality in the surge of COVID-19 was 1.7 higher than in the lull period (P-value < 0.001).

Conclusions

We found that the risk of both overall in-hospital and ICU mortality increased over the surge period and fourth and fifth waves of severe acute respiratory syndrome coronavirus 2 infection in Iran. The lack of hospital resources and particularly ICU capacities to respond to the crisis during the surge period is assumed to be the main culprit.

Predicting COVID-19 Cases Among Nurses Using Artificial Neural Network Approach

We designed a forecasting model to determine which frontline health workers are most likely to be infected by COVID-19 among 220 nurses. We used multivariate regression analysis and different classification algorithms to assess the effect of several covariates, including exposure to COVID-19 patients, access to personal protective equipment, proper use of personal protective equipment, adherence to hand hygiene principles, stressfulness, and training on the risk of a nurse being infected. Access to personal protective equipment and training were associated with a 0.19- and 1.66-point lower score in being infected by COVID-19. Exposure to COVID-19 cases and being stressed of COVID-19 infection were associated with a 0.016- and 9.3-point higher probability of being infected by COVID-19. Furthermore, an artificial neural network with 75.8% (95% confidence interval, 72.1-78.9) validation accuracy and 76.6% (95% confidence interval, 73.1-78.6) overall accuracy could classify normal and infected nurses. The neural network can help managers and policymakers determine which frontline health workers are most likely to be infected by COVID-19.

Psychological Impact of the COVID-19 on Hospitalized Patients: A Qualitative Study

BACKGROUND

As the 2019 coronavirus spreads rapidly around the world, it has caused widespread fear and anxiety in various populations. This study aimed to explore the psychological effects of COVID-19 on patients with this disease.

MATERIALS AND METHODS

A qualitative study was conducted with a phenomenological approach. A purposive sample of 11 patients with COVID-19 was recruited. Data were collected from the beginning of March to the beginning of June 2020 using semi-structured interviews and they were analyzed according to Van Manen's method. Interviews were audiotaped, transcribed verbatim, and analyzed using thematic analysis.

RESULTS

Initially, 315 codes were extracted. During data analysis and comparisons, the codes were reduced to 108. Ultimately, 10 categories, 38 subcategories, and 3 themes emerged. The theme of "behavioral responses" including 5 categories (Remorse, Fear and despair, Death anxiety, Growth, Support), "disease-caused helplessness" including two categories (Failure, Denial), and "decline of social networks" including three categories (Rejection, Stigma, Feeling guilty).

CONCLUSIONS

After understanding the findings of this research, nurses working in the wards of patients with COVID-19 can better consider the importance of assessing and analyzing the psychological challenges and experiences of these patients during the course of illness and quarantine. Findings also enhance the identification and organization of training needs during such a pandemic and the design of nursing programs to meet them.

Machine learning-based COVID-19 diagnosis by demographic characteristics and clinical data

INTRODUCTION

To facilitate rapid and effective diagnosis of COVID-19, effective screening can alleviate the challenges facing healthcare systems. We aimed to develop a machine learning-based prediction of COVID-19 diagnosis and design a graphical user interface (GUI) to diagnose COVID-19 cases by recording their symptoms and demographic features.

METHODS

We implemented different classification models including support vector machine (SVM), Decision tree (DT), Naïve Bayes (NB) and K-nearest neighbor (KNN) to predict the result of COVID-19 test for individuals. We trained these models by data of 16973 individuals (90% of all individuals included in data gathering) and tested by 1885 individuals (10% of all individuals). Maximum relevance minimum redundancy (MRMR) algorithms used to score features for prediction of result of COVID-19 test. A user-friendly GUI was designed to predict COVID-19 test results in individuals.

RESULTS

Study results revealed that coughing had the highest positive correlation with the positive results of COVID-19 test followed by the duration of having COVID-19 signs and symptoms, exposure to infected individuals, age, muscle pain, recent infection by COVID-19 virus, fever, respiratory distress, loss of smell or taste, nausea, anorexia, headache, vertigo, CT symptoms in lung scans, diabetes and hypertension. The values of accuracy, precision, recall, F1-score, specificity and area under receiver operating curve (AUROC) of different classification models computed in different setting of features scored by MRMR algorithm. Finally, our designed GUI by receiving each of the 42 features and symptoms from the users and through selecting one of the SVM, KNN, Naïve Bayes and decision tree models, predict the result of COVID-19 test. The accuracy, AUROC and F1-score of SVM model as the best model for diagnosis of COVID-19 test were 0.7048 (95% CI: 0.6998, 0.7094), 0.7045 (95% CI: 0.7003, 0.7104) and 0.7157 (95% CI: 0.7043, 0.7194), respectively.

CONCLUSION

In this study we implemented a machine learning approach to facilitate early clinical decision making during COVID-19 outbreak and provide a predictive model of COVID-19 diagnosis capable of categorizing populations in to infected and non-infected individuals the same as an efficient screening tool.

A COVID-19 forecasting system for hospital needs using ANFIS and LSTM models: A graphical user interface unit

Background

Centers for Disease Control and Prevention data showed that about 40% of coronavirus disease 2019 (COVID-19) patients had been suffering from at least one underlying medical condition were hospitalized; in which nearly 33% of them needed to be admitted to the intensive care unit (ICU) to receive specialized medical services. Our study aimed to find a proper machine learning algorithm that can predict confirmed COVID-19 hospital admissions with high accuracy.

Methods

We obtained data on daily COVID-19 cases in regular medical inpatient units, emergency department, and ICU in the time window between 21 July 2020 and 21 November 2021. Data for the first 183 days (training data set) were used for long short-term memory (LSTM) network, adaptive neuro-fuzzy inference system (ANFIS), support vector regression (SVR) and decision tree model training, whilst the remaining data for the last 60 days (test data set) were used for model validation. To predict the number of ICU and non-ICU patients, we used these models. Finally, a user-friendly graphical user interface unit was designed to load any time series data (here the trend of population of COVID-19 patients) and train LSTM, ANFIS, SVR or tree models for the prediction of COVID-19 cases for one week ahead.

Results

All models predicted the dynamics of COVID-19 cases in ICU and non- wards. The values of root-mean-square error and R2 as model assessment metrics showed that ANFIS model had better predictive power among all models.

Conclusion

Artificial intelligence-based forecasting models such as ANFIS system or deep learning approach based on LSTM or regression models including SVR or tree regression play a key role in forecasting the required number of beds or other types of medical facilities during the coronavirus pandemic. Thus, the designed graphical user interface of the present study can be used for optimum management of resources by health care systems amid COVID-19 pandemic.

Comparison of elevated cardiac troponin I with SAPS-II and APACHE-II score in predicting outcome of severe intoxications

Background and Aims:

To date, different methods have been invented to risk-stratify critically ill patients, however, there is a paucity of information regarding assessing the severity of poisonings. This study was designed to determine the comparative efficacy of Simplified Acute Physiology Score-II (SAPS-II) and Acute Physiology and Chronic Health Evaluation-II (APACHE-II)score with cardiac troponin I (cTnI) in predicting severe intoxication outcomes.

Methods:

This was a prospective study conducted on patients who fulfilled defined severe intoxication criteria necessitating intensive care unit (ICU) admission over a period of 6 months. SAPS-II and APACHE-II scores were calculated and cTnI concentrations were measured. These indicators were compared to determine which has the better ability to prognosticate mortality and complications.

Results:

A total of 55 cases (median age, 35 [24-49] years) were enroled. Eight patients (14.5%) died. Mean SAPS-II, median APACHE-II score and median cTnI concentrations were 32.05 ± 11.24, 13 [10-17] and 0.008 [0.002-0.300] ng/ml, respectively, which were significantly different between the survivors and non-survivors. Receiver operating characteristics curve results of SAPS-II, APACHE-II score and cTnI concentrations in predicting mortality were 0.945, 0.932 and 0.763 and in predicting complications were 0.779, 0.739 and 0.727, respectively. High cTnI concentration (>0.37 ng/ml) correlated with soft clinical outcomes, including length of ventilatory support, length of ICU stay and length of hospital stay (LOS) (r: 0.928, 0.881 and 0.735 respectively; all P < 0.001).

Conclusion:

SAPS-II scores were superior in predicting death and complications, while cTnI correlated more closely with soft clinical outcomes, such as the length of ventilator support, length of ICU stay or LOS.

Challenges in the clinical education environment during the outbreak of COVID-19: Development and psychometric testing

BACKGROUND

COVID-19 pandemic poses unique physical and emotional challenges in providing clinical education. Failure to identify the challenges and problems that students face in the clinical learning environment hinders their effective learning and growth. Consequently, the progress of their skills is affected. The aim of this study was to develop a challenge in the clinical education environment of medical students during the outbreak of COVID-19 questionnaire and to test its psychometric properties.

MATERIALS AND METHODS

This study is part of a larger study that was conducted using a combined consecutive method in Qazvin. In the first stage, a phenomenological study was performed with van Manen's method by interviewing 12 students at Qazvin University. To extract the items of the tool in the second stage, the concept was defined. Ultimately, the psychometric properties of the questionnaire were evaluated with face validity, content validity (quantitative and qualitative), construct validity (exploratory factor analysis), internal consistency (Cronbach's alpha), and test-retest reliability (intraclass correlation coefficient).

RESULTS

The initial tool had 70 questions. After validation, 53 items remained in the final questionnaire. Four extracted dimensions were as follows: "Inadequate professional competency," "Inefficient clinical planning" and "outcomes of learning-teaching activities," and "the challenges related to the stigma of medical staff." Cronbach's alpha for the whole questionnaire was 0.98 (range: 0.87-0.98). The test-retest (intraclass correlation coefficient) reliability was 0.98 (P < 0.001).

CONCLUSIONS

According to the obtained results, if the items of "Inadequate professional competency," "Inefficient clinical planning" and "outcomes of learning-teaching activities," and "the challenges related to the stigma of medical staff," the challenges of students' clinical education can be reduced during the COVID-19 outbreak.

Prognosis of patients with tracheal intubation in the emergency department

Background

Intubation of critically ill patients is one of the increasing emergency procedures. We designed this study to determine age and sex-related mortality rates after emergency intubation.

Methods

This retrospective study collected and analyzed non-trauma intubated patients in a referral hospital from the years 2017-2019 and before the appearance of COVID-19. Patients who were intubated outside of emergency by EMS technicians were excluded. We recorded data of intubated patients, like sex, age, length of being intubated and final diagnosis. P values of less than 0.05 were significant.

Results

Data of 520 non-trauma intubated patients were collected and analyzed. More than 64% of the patients were over 65 years old and had a higher mortality rate (86.7%; P < 0.001) than younger patients. The overall in-hospital mortality rate was 80%. More than three quarters of the decedents died within a week of intubation (P < 0.001). There was no significant relationship between sex and mortality rate (P = 0.535).

Conclusion

Our data showed that with increased age there was a decrease in the chance of being extubated.

Agreement between Prehospital and Final Diagnosis in Patients with Acute Allergic Reactions: A Cross-Sectional Study

Introduction: Acute allergic reactions are usually first encountered in the prehospital setting and account for about 0.3% to 0.8% of prehospital runs in different countries. Right, and rapid recognition and treatment are necessary to decrease mortality and morbidity, especially in severe critical cases. This study evaluates the accuracy of prehospital care providers’ diagnosis in patients with acute allergic reactions in comparison with final (discharge) diagnosis as the gold standard. Methods: Patients who were transported to 2 urban referral hospitals between 2008 and 2014 under the dispatch code of “acute allergic reaction” were included in the study, retrospectively. Demographic data, etiology of an allergic reaction, clinical presentations, vital signs stability, and need for epinephrine injection were evaluated. The prehospital care providers’ diagnosis (documented on-call report) was compared with the final diagnosis (documented on discharge summary form). Results: A total of 300 patients were included in the study. In 55 (18.3%) cases the prehospital care providers’ and final diagnoses were different. Diagnoses were similar in 245 (81.6%) patients. Kappa coefficient was calculated as 0.621which shows a moderate-to-substantial agreement between prehospital and final diagnoses. Fifteen patients (5%) were discharged from the hospital with a diagnosis of anaphylaxis and only 4 cases (26.6%) were diagnosed in the prehospital setting. Conclusion: Although the overall agreement between prehospital and final diagnosis of acute allergic reactions calculated in this study was good, the accuracy of diagnosing the anaphylaxis (as the most critical allergic reaction with a potential fatality) was less than optimal.

Neuropsychological and Psychosocial Consequences of the COVID-19 Pandemic

The coronavirus disease designated as COVID-19 reached the level of a pandemic, affecting countries all across the world. Widespread outbreaks of COVID-19 are associated with psychological distress and symptoms of mental disorders. This article is a narrative review of the existing scientific literature on mental health of the society and interventions relevant to the COVID-19 pandemic. A search in the existing databases using the respective keywords has been carried out. It focuses on the consequences of the pandemic with respect to people’s mental health in different clusters of society, including children, health care workers and their relatives, and pregnant women and their families. The unpredictability of the virus pandemic and its high transmission rate is an emergency of psychological problems and certain neuropsychological symptoms, such as fear and abnormal high anxiety, with respect to the spread of the disease, depression, avoidant behaviors, sleep disturbance, irritability, post-traumatic stress disorder (PTSD), pathological anger, and suicide cases.

Factors related to students' satisfaction with holding e-learning during the Covid-19 pandemic based on the dimensions of e-learning

Background

E-learners' satisfaction has a significant impact on the success of the e-learning process and leads to improving the quality of the e-learning system. Many factors affect e-learning satisfaction. This study aimed to determine the factors related to students' satisfaction with e-learning during the Covid-19 pandemic based on the dimensions of e-learning.

Methods

The present study was a cross-sectional study, which was conducted in 2020 among students studying in different fields of Qazvin University of Medical Sciences using stratified random sampling. To collect data three parts of questionnaires were used included the demographic information, the measuring the effectiveness of e-learning, and measuring the level of satisfaction with holding e-learning during the Covid-19 period. Data were entered into spss23 and analyzed by descriptive method, chi-square, and t-test.

Results

The results showed that the mean (standard deviation) score of satisfaction with e-learning in the students was 20.75 (2.13) and 59 % of them had undesirable satisfaction. There was a significant relationship between satisfaction with e-learning and variables of gender and history of attending online classes before Covid-19. Regarding the four aspects of e-learning, there was a statistically significant difference between the two groups of students with desirable satisfaction and undesirable satisfaction. The results revealed that the mean scores of dimensions of teaching and learning; feedback and evaluation; flexibility and appropriateness; and workload among students with desirable satisfaction were higher than students with undesirable satisfaction.

Conclusion

Considering the results, efforts should be made to improve the quality of e-learning and the factors affecting it, because due to the prevalence of Covid-19, distance education may be held for a long time. Lack of attention to these cases can reduce the quality of education and students' level of knowledge.

The effect of yoga on the delivery and neonatal outcomes in nulliparous pregnant women in Iran: a clinical trial study

BACKGROUND

Yoga can reduce the risk of preterm delivery, cesarean section (CS), and fetal death. The aim of the present study was to investigate the effects of Yoga on pregnancy, delivery, and neonatal outcomes.

METHODS

This was a clinical trial study and using the random sampling without replacement 70 pregnant women entered Hatha Yoga and control groups according to the color of the ball they took from a bag containing two balls (blue or red). The data collection tool was a questionnaire pregnancy, delivery, and neonatal outcomes. The intervention in this study included pregnancy Hatha Yoga exercises that first session of pregnancy Yoga started from the 26th week and samples attended the last session in the 37th week. They exercised Yoga twice a week (each session lasting 75 min) in a Yoga specialized sports club. The control group received the routine prenatal care that all pregnant women receive.

RESULTS

The results showed that yoga reduced the induction of labor, the episiotomy rupture, duration of labor, also had a significant effect on normal birth weight and delivery at the appropriate gestational age. There were significant differences between the first and second Apgar scores of the infants.

CONCLUSION

The results of the present study showed that Yoga can improve the outcomes of pregnancy and childbirth. They can be used as part of the care protocol along with childbirth preparation classes to reduce the complications of pregnancy and childbirth.

TRIAL REGISTRATION

IRCT20180623040197N2 (2019-02-11).

The Alteration of Clinical and Laboratory Signs and Symptoms of COVID-19 in Re-infection: A Case Report

Background: Patients can be carriers of the virus for a long time or become re-infected or re-infected following the use of immunosuppressive drugs. Clinical manifestations in patients are very diverse and can range from asymptomatic to severe illness with death. Patients may also present with manifestations such as coagulation disorders, cardiac dysfunction and arrhythmias, acute coronary syndrome, kidney injury, liver injury, Refer to diabetic hyperglycemia and ketoacidosis. This is an essential point in the prevention of Coronavirus Disease 19 (COVID-19). Case Presentation: We reported a case in which the Polymerase Chain Reaction (PCR) test was positive after re-negative after 5 months. Moreover, the patient presented different and more severe symptoms than the previous infection, as the genetic difference between the strains increased over time. Conclusion: As a result, immunization may become more complicated, and different clinical pictures occur; thus, this condition can challenge vaccine immunization.

The Effect of Peers Support on Fear of Hypoglycemia in Iranian Patients with Type 1 Diabetes: A Clinical Trial Study

Background

Fear of hypoglycemia is a medical emergency which leads to disrupt individuals' normal lives. Peers support is a hopeful approach to improve diabetes self-care behaviors. This study was conducted to assess the effect of peers support on the fear of hypoglycemia in patients with type 1 diabetes.

Materials and Methods

This randomized clinical trial study was performed among 60 patients with type 1 diabetes in Qazvin city from September 2019 to October 2020. Patients were assigned to control and intervention groups using a random method. The data collection tools included demographic characteristics and a standard questionnaire for Hypoglycemia Fear Survey (HFS). Patients in the intervention group were trained by skilled peers for 2 months, but those of the control group only received routine hospital training. The data were analyzed by SPSS version 16 and paired and independent t-test.

Results

The scores of the fear of hypoglycemia in diabetic patients in the two groups had no significant statistical difference before intervention (t₅₃ = 0.93, p = 0.94). But after the intervention, the independent t-test showed that there was a significant difference between the scores of the fear of hypoglycemia in both groups (t₅₃ = -2.13, p = 0.03).

Conclusions

Considering the results of the current study, peer support for diabetic patients is an effective way to reduce the fear of hypoglycemia. Therefore, it is recommended using this training method to train diabetic patients.

Delayed post-traumatic Tension Hydropneumocephalus; a Case Report of Conservative Treatment

Pneumocephalus refers to the presence of air in the cranial cavity. Trauma is the most common cause of acquired pneumocephalus. Tension pneumocephalus occurs when intracranial accumulation of air causes high pressure on the brain as compared to extracranial pressure. Tension pneumocephalus is usually acute, and causes neurological symptoms, and its delayed form rarely occurs. A 12-year-old girl presented with a headache, lethargy, mild fever, and nausea from two days before admission to emergency department of Shahid Rajaei Hospital, Qazvin, Iran. The patient had a history of head trauma in a driving accident six weeks before and had undergone brain computed tomography (CT) scan in another centre, which had revealed no sign of pneumocephalus. The patient had been treated for one week and had been discharged in good general condition.

Considering her reduced consciousness, the patient underwent brain CT scan again in our centre. CT scan revealed tension hydropneumocephalus. The patient was transferred to the intensive care unit (ICU) for treatment. Considering the trend of her recovery, the patient was a candidate for conservative non-surgical therapy based on the in-charge neurosurgery specialist’s decision. The patient reported no complications during the six-month follow-up. Delayed tension pneumocephalus is among neurosurgery emergencies usually treated with early surgical intervention and dura defect restoration, but this patient received non-surgical treatment without any serious problem during the six-month follow-up.

Corrigendum to "Depression, anxiety, and stress mediate the associations between internet gaming disorder, insomnia, and quality of life during the COVID-19 outbreak" [Addict. Behav. Rep. 12 (2020) 100307]

[This corrects the article DOI: 10.1016/j.abrep.2020.100307.].

Factors Predicting Death Depression of Emergency Medical Technicians in Iran

Background: Psychological problems such as death depression can have adverse effects on Emergency Medical Technicians (EMTs) including reduced quality of medical services, job dissatisfaction, feelings of incompetence, depression, and reduced job values. Objective: This study aims to determine the factors predicting death depression of EMTs in Iran. Methods: In this descriptive cross-sectional study conducted in 2019, participants were 125 eligible EMTs in hospitals affiliated to Qazvin University of Medical Sciences in Qazvin, Iran. Templer’s Death Depression Scale (DDS) and a demographic form were used to collect data. The collected data were analyzed using descriptive and inferential statistics. Findings: The mean±SD DDS score was reported 4.73±2.93. Most of subjects (n=79, 63.2%) had low death depression. According to the results of linear regression analysis, “number of resuscitation attempts in the last 3 months”, “organizational position” and “history of depression” were the predictors of death depression (P<0.05). In total, the regression model predicts 9% of the variance in death depression. Conclusion: Death depression of EMTs in Iran is low. Due to the importance of mental health in medical staff in providing quality clinical services, it is recommended that further studies should be conducted in this area using a larger sample size

Depression, anxiety, and stress mediate the associations between internet gaming disorder, insomnia, and quality of life during the COVID-19 outbreak

BACKGROUND

For many individuals, the COVID-19 outbreak has increased their psychological distress, changed their behaviors, and impacted their health. With more time spent indoors, many individuals have engaged in increased videogame playing. However, the associations between such behaviors during the COVID-19 outbreak period is unclear.

OBJECTIVE

The present study examined the mediating role of psychological distress (depression, anxiety, and stress) in the association between internet gaming disorder (IGD) and two health outcomes (insomnia quality of life) among adolescents during this COVID-19 pandemic.

METHODS

A cross-sectional study comprising adolescents (N = 1512) aged 13-18 years (mean age = 15.51 years) was utilized to assess measures on insomnia, depression, anxiety, and stress, IGD, and quality of life during the COVID-19 pandemic.

RESULTS

There were small to large significant relationships between the variables. Psychological distress (i.e., depression, anxiety, and stress) served as a strong mediator in the association between IGD and insomnia and quality of life. IGD directly influenced insomnia and quality of life among the participants.

CONCLUSIONS

IGD is associated with different psychosocial outcomes comprising multiple pathways. Parents need to pay special attention to how much time and how frequently their children play videogames. Parents may need to assist their children in coping with psychological distress during the ongoing COVID-19 pandemic period.

Mediated roles of generalized trust and perceived social support in the effects of problematic social media use on mental health: A cross-sectional study

BACKGROUND

Current literature lacks evidence concerning how problematic social media use associates with mental health. To address the gap, the present study used mediation models to examine whether generalized trust and perceived social support (PSS) are potential mediators in the relationship between problematic social media use and mental health.

METHODS

The sample comprised Iranian adults (n = 1073; 614 females). The participants completed a number of scales to assess problematic social media use (Bergen Social Media Addiction Scale), generalized trust (Generalized Trust Scale), PSS (Multidimensional Scale of Perceived Social Support, happiness (Oxford Happiness Questionnaire Short Form), depression and anxiety (Hospital Anxiety and Depression Scale), and mental quality of life (Short Form-12).

RESULTS

Problematic social media use had negative effects on happiness and mental quality of life via the mediators of generalized trust (bootstrapping SE = 0.017; effect = -0.041; 95% CI = -0.079, -0.012) and PSS (bootstrapping SE = 0.023; effect = -0.163; 95% CI = -0.211, -0.119). Problematic social media use had positive effects on anxiety and depression via the mediators of generalized trust (bootstrapping SE = 0.022; effect = 0.064; 95% CI = 0.026, 0.113) and PSS (bootstrapping SE = 0.024; effect = 0.052; 95% CI = 0.009, 0.102).

CONCLUSIONS

Problematic social media use, generalized trust and PSS are important factors for an individual's mental health. Health-care providers may want to assist individuals regardless of having mental health problems in reducing their problematic social media use and improving their generalized trust and social support.

The effects of musical stimulation on the level of consciousness among patients with head trauma hospitalized in intensive care units: A randomized control trial

BACKGROUND

Improvement in the level of consciousness (LOC) is considered as an indicator of recovery among patients with head trauma (HT). musical stimulation is a simple noninvasive intervention with potential positive effects on LOC. This study evaluated the effects of musical stimulation on LOC among patients with HT hospitalized in intensive care unit.

METHODS

This clinical trial was conducted in 2018-2019. Fifty-four patients with HT were purposively and consecutively recruited from two trauma intensive care units in Qazvin, Iran, and randomly allocated to a control (n = 27) and an intervention (n = 27) group. Participants in the intervention group received fifteen-minute musical stimulation once daily for seven consecutive days using an MP3 player and a headphone for their counterparts, the headphones were silent for 15 min without receiving any musical stimulation once daily for seven consecutive days. A demographic questionnaire, the Glasgow Coma Scale, and the Richmond Agitation-Sedation Scale were used for data collection. LOC was daily assessed before and after each musical stimulation session. The SPSS program (v. 23.0) was used for data analysis at a significance level of less than 0.05.

FINDINGS

There were significant between-group differences respecting the posttest mean score of LOC in the third, fourth, fifth, sixth, and seventh days of the study intervention (P < 0.05)., the posttest mean score of LOC in the intervention group significantly increased in the intervention group (P < 0.0001), while it did not significantly change in the control group (P > 0.05).

CONCLUSION

musical stimulation is effective in significantly improving LOC among hospitalized patients with HT. Therefore, it can be used as a non-expensive noninvasive intervention to improve treatment outcomes among these patients.

The Role of Pre-hospital and Hospital Emergency Staff in Time Management of Acute Myocardial Infarction

According to the latest guidelines, in ST-segment elevation myocardial infarction (STEMI) cases, the best intervention to restore blood flow in the occluded coronary arteries is angioplasty at a time less than 90 minutes. Delay in timely implementation of reperfusion is one of the key problems in the management of STEMI. In this review study, the aim is to investigate the role of pre-hospital and hospital emergency staff in time management of STEMI. For this purpose, the articles published 1999-2019 with available full texts in ProQuest, SID, Science Direct, Google Scholar and Scopus databases were searched using the keywords: Pre-hospital Emergency, Hospital Emergency, Primary Angioplasty, Time Management, Ischemia, and Acute Myocardial Infarction. A total of 59 articles in Persian and English (from 10 different countries) covering both qualitative and quantitative studies were initially yielded. Those which were not a review paper and their full texts were unavailable were excluded from the review. Faster reperfusion reduces the cardiac necrosis area, resulting in reduced morbidity and mortality. Early ECG recording by the pre-hospital emergency team followed by the activation of the code STEMI by the emergency team can increase the speed of diagnosis, decision making, and transfer of the STEMI patient to receive the best treatment.

Association between health literacy and adopting preventive behaviors of breast cancer in Iran

BACKGROUND

Health literacy plays an important role in adopting preventive behaviors. Considering the relatively high prevalence of breast cancer in women, this study aimed to assess the association between health literacy and adopting the preventive behavior of breast cancer in Iran.

METHODS

This was a descriptive, cross-sectional study, in which 375 female students at Imam Khomeini International University in Qazvin in the academic year of 2018-2019 were selected through a stratified random sampling method. Demographic and background questionnaire, the standard questionnaire of Health Literacy for Iranian Adults in addition to another questionnaire for measuring breast cancer preventive behaviors, were used for collecting data. Data were analyzed using SPSS 22 using descriptive statistics and logistic regression.

RESULTS

The mean of the breast cancer preventive behaviors and health literacy were 8.92 ± 1.82 out of 16 and 70.80 ± 12.49 out of 100. Regression results showed that there was a statistically significant association between the adoption of breast cancer preventive behaviors and physical activity (P < 0.001) and health literacy (P < 0.018). Accordingly, the chance for adopting the preventive behaviors in good level among students with rare and without physical activity was 0.105 and 0.100 times, respectively, more than students who had been doing physical activity on a daily basis. Moreover, the same chance among students with adequate and very adequate health literacy was 1.802 and 2.169 times more than students with inadequate health literacy.

CONCLUSION

The results indicated that students with lower levels of health literacy and less physical activity had shown less tendency to adopt preventive behaviors of breast cancer. Therefore, special attention should be paid to health literacy (HL), particularly physical activity, application of health information, and assessment in students when designing educational programs to prevent breast cancer.

A Case Report of Kartagener Syndrome

Primary Ciliary Dyskinesia (PCD) and Kartagener Syndrome (KS) are rare genetic disorders. PCD occurs in patients with recurrent sino-pulmonary infection, dextrocardia, chronic vasomotor rhinitis, and bronchiectasis. This study reports a rare case of KS for having further awareness of this disease. According to this study, this disease should be considered in patients with recurrent respiratory infections, because early diagnosis and timely treatment of these patients can lead to reduced irreversible complications and increased life expectancy.

Improving Door-to-Balloon Time for Patients With Acute ST-Elevation Myocardial Infarction: A Controlled Clinical Trial

According to the latest guidelines, the best intervention to restore blood flow through occluded coronary arteries is angioplasty at a time less than 90 minutes. Thereby, the present study was conducted to determine the impact of implementing ST-elevation myocardial infarction (STEMI) code on door-to-balloon time in patients with ST-segment elevation myocardial infarction. This clinical trial was conducted in 2019 at Booali Sina heart center hospital in Qazvin, Iran, in 2019. Fifty-eight patients with STEMI were purposively and consecutively enrolled in the study. Patients were then divided into control and intervention groups, based on their referral period. In both groups, patients were observed since their Arrived by emergency medical services to emergency department until inflating the balloon in the occluded coronary artery, and the intended times were recorded by the researchers. For Participants in the intervention group the "STEMI code" was designed and activated by an emergency physician once there is a patient experiencing a chest pain and early confirmed as a myocardial infarction. The SPSS program (v. 16) was used for data analysis at a significance level of less than 0.05. The difference in the door-to-balloon mean time in both control (113.5 ± 43.6 minutes) and intervention (79.3 ± 27.4 minutes) groups, was statistically significant (P = 0.001). Regarding other parameters, the reduction in the mean between Cath lab time (26.2 ± 18.2 minutes) and balloon time (15.5 ± 7.8 minutes) was also statistically significant (P = 0.008). In this study, implementation of the "STEMI code" could greatly prevent parallel work and squandering time while treating patients with acute myocardial infarction. As the door-to-balloon time gets shorter, the bed occupancy rate in the emergency department had reduced which in turn allowed more patients to be admitted.

Delayed Pneumomediastinum and Subcutaneous Emphysema in Covid-19 Patients: A Case Report

Coronavirus Disease 2019 (COVID-19) is a severe respiratory disease initiated on December 2019. Genome sequence analysis shows that the pathogen is a complex beta-coronavirus RNA, known as Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). Spontaneous Pneumomediastinum and pneumothorax are rare clinical and radiological conditions associated with COVID-19. This study is case report of pneumomediastinum and subcutaneous emphysema in two patients with COVID-19, while investigating the clinical and paraclinical symptoms and the treatment process of two cases. Finding factors related to the severity of COVID-19 for improving the final outcome in patients is very important.

Investigating the Mechanism of Action of SARS-CoV-2 Virus for Drug Designing: A Review

Coronavirus Disease 2019 (COVID-19) is a viral pneumonia emerged in December 2019 in Wuhan, China. Its cause is a new virus from the coronavirus family scientifically named Coronavirus Acute Respiratory Syndrome 2 (SARS-CoV-2). In this review study, articles published in English until March 23, 2020 on new coronavirus infection were reviewed. These articles are obtained by searching in PubMed, Scopus and Google scholar databases using keywords "SARS-CoV-2", "COVID-19" and "Coronavirus". The latest COVID-19 statistics and information were extracted from the websites of World Health Organization and the Centers for Disease Control and Prevention. we investigated the effect of different compounds on the key macromolecules in promoting SARS-COV-2 infection using computational methods and bioinformatics analysis that can be considered as the best targets for designing inhibitory drugs. The most important macromolecules were Angiotensin Converting Enzyme 2 (ACE2) and Transmembrane Protease Serine 2 (TMPRSS2) receptors of the host cell surface and the structural and non-structural proteins of the virus. The most important structural protein was Spike, playing an important role in binding the virus to the ACE2 receptor of the host cell and the entery of the virus genome into it, while the key non-structural proteins were 3-Chymotrypsin-like protease (3CLpro), RNA-dependent RNA polymerase (RdRp), Papain-like cysteine proteinase (PLpro), and non-structural protein 13 (nsp13) helicase which are involved in viral genome replication and the virus’ release from the host cell.

Critical Care Nurses’ Attitudes Towards Organ Donation and its Relationship With Empathy

Background: Critical care nurses play an important role in the organ donation process, and their attitudes towards it and willingness to register as an organ donor are related to various factors, including empathy. Objective: This study aims to compare the attitudes of nurses in Intensive Care Unit (ICU), Emergency Department (ED), and Dialysis Unit (DU) towards organ donation and its relationship with empathy. Methods: This descriptive study with cross-sectional design that was conducted in 2019 in hospitals affiliated to Qazvin University of Medical Sciences in Qazvin, Iran on 222 nurses from the three critical care units who were selected by stratified random sampling method. Data collection tools were Chakradhar’s Organ Donation Questionnaire (ODQ) and Davis’s Interpersonal Reactivity Index (IRI), completed by nurses were completed. Data were analyzed by descriptive and analytical tests. Findings: The mean ODQ score was higher in DU and ICU nurses than in ED nurses (P=0.23), where the nurses of ICU-General had the highest score (51±6.07) and the nurses of ED-Trauma had the lowest score. The highest and lowest IRI scores were related to DU and ICU-General nurses, respectively. The total IRI score (r=0.13, P=0.04) and its dimensions of perspective taking ( r=0.152, P=0.02) and fantasy (r=0.14, P=0.03) had a positive correlation with the nurses’ attitudes. Conclusion: Critical care nurses have greater than the average score in ODQ. There is a significant relationship between empathy and their attitudes towards organ donation. Their empathy with patients has a significant effect on increasing their attitudes towards accepting organ donation. Therefore, it is necessary to implement educational interventions for changing the critical care nurses’ attitudes in order to increase their empathy.

Outcomes of Trauma and Their Relationship With Pre-hospital Time Intervals in Patients Admitted to a Hospital in Qazvin, Iran

Background: Due to the importance of investigating the causes of trauma and functional indicators of pre-hospital emergency care. Objective: This study aims to evaluate the outcomes of trauma and their relationship with pre-hospital time intervals in patients admitted to Shahid Rajaei Hospital in Qazvin, Iran. Methods: In this descriptive study conducted in 2018, the medical records of 700 patients transported to Shahid Rajaei Hospital in Qazvin by Emergency Medical Services (EMS) ambulances were examined which were selected from 3200 cases using a systematic sampling method. We used a two-part questionnaire surveying demographic/clinical information of patients and their clinical outcomes. Findings: Mean age of patients was 33.8 years and 62% were male. Median of on-scene time, transport time, and total prehospital time were 7, 29.3 and 37 minutes, respectively. In overall, 72.4% of transferred patients were discharged from the emergency department, 19.7% admitted to other wards, and 4.4% discharged voluntarily. Conclusion: Time intervals of EMS in Qazvin city are suitable, and their provided pre-hospital services have acceptable quality.

The Accuracy of Diagnosis and Treatment Made by Pre-hospital Emergency Medical Technicians in Patients Admitted to Hospitals in Qazvin, Iran

Background: Correct diagnosis and appropriate treatment measures of pre-hospital Emergency Medical Technicians (EMTs) are very important in improving the quality of patient care and reducing mortality and costs. Objective: This study aims to investigate the accuracy of diagnosis and treatment made by pre-hospital EMTs in patients admitted to hospitals in Qazvin, Iran. Methods: In this descriptive study conducted in 2018, the medical records of 600 patients who were transferred to Bu-Ali Sina and Velayat hospitals in Qazvin by ambulance during March-June 2018 were examined. Diagnosis and treatment measures were extracted from the emergency sheet. Education, work experience, and amount of in-service training of pre-hospital EMTs were also collected. Data were analyzed in SPSS V. 23 software using ANOVA, Chi-square test, and t-test. Findings: Out of 600 cases, 71.7% of the initial diagnoses made by EMTs were correct, 8.5% were incorrect, and 19.8% were without initial diagnosis. Regarding the treatment measures, 65.8% were correct and 3.5% were incorrect. Conclusion: Prompt help and correct diagnostic and treatment measures of pre-hospital EMTs can significantly reduce mortality and potential injuries.

Prevalence and main determinants of early post-traumatic thromboembolism in patients requiring ICU admission

BACKGROUND

Post-traumatic thromboembolism (PE) is now a common challenging particularly in critically ill patients referred to emergency wards. We aimed to identify main factors associated with PE within 72 h of admission after trauma among patients referred to emergency ward.

METHODS

In this retrospective study, the database records of 240 patients, with the primary diagnosis of trauma requiring ICU admission and with a final diagnosis of pulmonary embolism, were reviewed. The patients were categorized as the subjects with early pulmonary embolism (≤3 days) and those with late pulmonary embolism (>3 days).

RESULTS

According to our analysis, 48.5% of the patients suffered PE faced this event within 72 h of trauma events. The patients in early PE group were older than those who suffered late PE. The prevalence rate of long bone fractures in lower extremities was significantly higher in those with early PE compared with the other patients. The group with early PE had more severe injury when compared to those with later PE. The severe and very severe injuries were indicated in 49.5 and 15.4% in early PE group, and 14.0 and 6.9% in late PE group, respectively. Using the multivariable logistic regression model, older age, presence of long bone fractures, and more severe injury could predict occurrence of early PE in trauma patients referred to emergency ward.

CONCLUSION

Occurring early PE is predicted in majority of traumatic patients requiring ICU admission especially in older ones, patients with long bone fractures and those with more severe injury.