Clinical Evaluation of a 2-Minute Ultrafast Brain MR Protocol for Evaluation of Acute Pathology in the Emergency and Inpatient Settings

BACKGROUND AND PURPOSE

The use of MR imaging in emergency settings has been limited by availability, long scan times, and sensitivity to motion. This study assessed the diagnostic performance of an ultrafast brain MR imaging protocol for evaluation of acute intracranial pathology in the emergency department and inpatient settings.

MATERIALS AND METHODS

Sixty-six adult patients who underwent brain MR imaging in the emergency department and inpatient settings were included in the study. All patients underwent both the reference and the ultrafast brain MR protocols. Both brain MR imaging protocols consisted of T1-weighted, T2/T2*-weighted, FLAIR, and DWI sequences. The ultrafast MR images were reconstructed by using a machine-learning assisted framework. All images were reviewed by 2 blinded neuroradiologists.

RESULTS

The average acquisition time was 2.1 minutes for the ultrafast brain MR protocol and 10 minutes for the reference brain MR protocol. There was 98.5% agreement on the main clinical diagnosis between the 2 protocols. In head-to-head comparison, the reference protocol was preferred in terms of image noise and geometric distortion (P < .05 for both). The ultrafast ms-EPI protocol was preferred over the reference protocol in terms of reduced motion artifacts (P < .01). Overall diagnostic quality was not significantly different between the 2 protocols (P > .05).

CONCLUSIONS

The ultrafast brain MR imaging protocol provides high accuracy for evaluating acute pathology while only requiring a fraction of the scan time. Although there was greater image noise and geometric distortion on the ultrafast brain MR protocol images, there was significant reduction in motion artifacts with similar overall diagnostic quality between the 2 protocols.

Explaining the personal cognitive factors affecting physical activity and nutritional behaviors in the middle-aged at risk of coronary artery disease: A directed qualitative content analysis

Background and Aims

Coronary artery disease (CAD) is the most common cardiovascular disease worldwide. Nutrition and physical activity are recognized as the major lifestyle-related behaviors to reduce the risk of noncommunicable diseases. It is essential to explain personal cognitive factors to identify potential ways to increase physical activity and improve nutritional behavior. Therefore, the present study aimed to explain the personal cognitive factors affecting physical activity and nutritional behavior in the middle-aged population at risk of a CAD.

Methods

The present qualitative study was conducted with a directed content analysis approach. A purposive sampling was used with maximum variety of sex, age, education, marital status, job, and risk factors of CAD. The data were collected through semistructured interviews with 20 middle-aged participants at the risk of CAD visiting comprehensive health centers in Bandar Abbas city. The interviews continued until data saturation.

Results

The present findings led to the identification of 4 main categories (i.e., self-efficacy, collective efficacy, outcome expectations, knowledge) and 10 subcategories.

Conclusion

It seems that to increase the self-efficacy, attention should be paid to individuals' past experiences, self-efficacy of action and maintenance and successful middle-aged peers. Measures should be taken to improve and strengthen it. Peer support, networking, forming online groups (in social networks), and a comprehensive use of social media can help increase collective efficacy. Expectations of positive and negative outcomes and the public knowledge can also be modified through accurate and appropriate information provided in different campaigns for awareness-raising.

Ultrafast Brain MRI with Deep Learning Reconstruction for Suspected Acute Ischemic Stroke

Background Deep learning (DL)-accelerated MRI can substantially reduce examination times. However, studies prospectively evaluating the diagnostic performance of DL-accelerated MRI reconstructions in acute suspected stroke are lacking. Purpose To investigate the interchangeability of DL-accelerated MRI with conventional MRI in patients with suspected acute ischemic stroke at 1.5 T. Materials and Methods In this prospective study, 211 participants with suspected acute stroke underwent clinically indicated MRI at 1.5 T between June 2022 and March 2023. For each participant, conventional MRI (including T1-weighted, T2-weighted, T2*-weighted, T2 fluid-attenuated inversion-recovery, and diffusion-weighted imaging; 14 minutes 18 seconds) and DL-accelerated MRI (same sequences; 3 minutes 4 seconds) were performed. The primary end point was the interchangeability between conventional and DL-accelerated MRI for acute ischemic infarction detection. Secondary end points were interchangeability regarding the affected vascular territory and clinically relevant secondary findings (eg, microbleeds, neoplasm). Three readers evaluated the overall occurrence of acute ischemic stroke, affected vascular territory, clinically relevant secondary findings, overall image quality, and diagnostic confidence. For acute ischemic lesions, size and signal intensities were assessed. The margin for interchangeability was chosen as 5%. For interrater agreement analysis and interrater reliability analysis, multirater Fleiss κ and the intraclass correlation coefficient, respectively, was determined. Results The study sample consisted of 211 participants (mean age, 65 years ± 16 [SD]); 123 male and 88 female). Acute ischemic stroke was confirmed in 79 participants. Interchangeability was demonstrated for all primary and secondary end points. No individual equivalence indexes (IEIs) exceeded the interchangeability margin of 5% (IEI, -0.002 [90% CI: -0.007, 0.004]). Almost perfect interrater agreement was observed (P > .91). DL-accelerated MRI provided higher overall image quality (P < .001) and diagnostic confidence (P < .001). The signal properties of acute ischemic infarctions were similar in both techniques and demonstrated good to excellent interrater reliability (intraclass correlation coefficient, ≥0.8). Conclusion Despite being four times faster, DL-accelerated brain MRI was interchangeable with conventional MRI for acute ischemic lesion detection. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Haller in this issue.

Etiology, consequences, and solutions of working women's work-life conflict: a qualitative study

INTRODUCTION

Work-life conflict (WLC) is important in organizational behavior research and human resource management. The present research aimed to investigate the underlying causes, consequences, and solutions to WLC in Iranian working women.

MATERIALS AND METHODS

The present qualitative study was conducted through a content analysis method among 19 working married women in Birjand, a city in the east of Iran, from December 2021 to February 2022. To collect the data, semi-structured interviews were held. The average interview time was 45 minutes, and all interviews were recorded upon the participants' consent. Finally, after coding, the information was analyzed with MAXQDA software.

FINDINGS

The causes of conflict included 4 main categories of individual, interpersonal, organizational, and cultural factors, with seven subcategories: the pressure of the mother's role at home, personality traits, lack of individual skills, insufficient support, work characteristics, organizational policies, and the traditional role of women in society. The consequences of conflict included 2 main categories, Decreasing quality of life and work problems with 4 subcategories: physical and mental illnesses, forgetting one's role towards others, limiting social communication, and reducing productivity. Conflict resolution methods included 3 main classes of individual-oriented, other-oriented, and organization-oriented with 8 subclasses: program-oriented, meaning-oriented, emotion-oriented, avoidance, emotional support, instrumental and work support, support work policies, and correct management views.

CONCLUSION

To solve the problem of conflict, different aspects should be considered and help to solve this challenge by influencing each dimension.

Determinants of Adherence to Treatment in Type 2 Diabetic Patients: A Directed Qualitative Content Analysis Based on Pender's Health Promotion Model

Adherence to the treatment of type 2 diabetes (T2D), which includes the use of prescribed drugs, following a healthy diet, and adopting a physically active lifestyle, is important to control the disease and improve the patients' quality of life. The present study aimed to explain the determinants of adherence to treatment in patients with T2D based on Pender's Health Promotion Model (HPM). The present research used a qualitative content analysis and was based on Pender's HPM. The data were collected through in-depth semi-structured interviews with 20 T2D patients using a purposive sampling in Bandar Abbas, southern Iran. Maximum variation was considered in terms of gender, age, history of diabetes, type of drug used, education, and occupation. The data collection continued until data saturation. At the same time, the collected data were analyzed using the directed content analysis. MAXQDA 10 was used to manage codes and facilitate data analysis. The data analysis led to the extraction of 10 categories and 19 subcategories as the determinants of adherence to the treatment of T2D patients. The participants shared their experiences about personal characteristics and their ecological environment, specific cognition and emotions, and the behavioral results and experience as the determinants of adherence to T2D treatment. The categories extracted from this study in the form of HPM constructs provided a framework to explain treatment adherence. This information can help policy makers and planners in designing future programs.

Epidemiological surveillance of respiratory viral infections in SARS-CoV-2-negative samples during COVID-19 pandemic in Iran

BACKGROUND

To improve the patient care, public health surveillance, and infection control, it is crucial to identify the presence and frequency of the common respiratory infections in individuals with COVID-19 symptoms but tested negative for SARS-CoV-2. This study aimed to shed light on this during the COVID-19 pandemic in Iran.

METHODS

In this cross-sectional study, a total of 1,002 patients with acute respiratory infection who had negative SARS-CoV-2 test results and referred to Valfajr Health Center, the National Collaborating Laboratory of Influenza and COVID-19 National Reference Laboratory at Pasteur Institute of Iran were recruited between January 2020 and January 2022. Nasopharyngeal and oropharyngeal swab samples were collected to detect 17 common respiratory viruses via TaqMan one-step real-time multiplex PCR. Demographic and clinical data of the participants were obtained from their electronic medical records.

RESULTS

In total, 218 samples (21.8%) were tested positive for at least one respiratory virus infection. Most of the common investigated respiratory viruses belonged to the years 2020 and 2022. The number of investigated patients in 2021 was few, which highlights the impact of health measures following the COVID-19 pandemic in Iran. Influenza A was the most common virus (5.8%), while adenovirus had the lowest prevalence (0.1%). Although the rate of respiratory virus infection was higher in men (24%) compared to women (19.3%), this difference was not statistically significant (P = 0.069). The prevalence of respiratory viruses had an inverse association with increasing age, with the highest rate (55.6%) observed in the age group below 2 years and the lowest rate (12.7%) in those above 65 years.

CONCLUSION

Our findings underscore the significance of adopting a comprehensive approach to respiratory infections detection and management. These results can be employed for the development of syndromic surveillance systems and implementation of the effective infection control measures. Furthermore, the results contribute to better understanding of the dynamics of respiratory viruses, both during pandemic periods and in non-pandemic contexts.

Increased prevalence of thyroid dysfunction in Tehran - HAMRAH study

BACKGROUND

The aim of the current study is to assess the prevalence of different categories of thyroid dysfunction and their associated risk factors among the modern urban population of Tehran, the capital of Iran.

METHODS

The present investigation is a sub-study of the HAMRAH study, a population-based prospective study designed to assess the prevalence of traditional cardiovascular risk factors and their changes through a 10-year follow-up. 2228 (61% female) adults aged between 30 and 75 years old and with no overt cardiovascular diseases were selected through a multistage cluster randomized sampling. Blood levels of thyroid-stimulating hormone (TSH), thyroxin (T4), and triiodothyronine (T3) were measured with the aim of assessing the prevalence of abnormal thyroid function status among the modern urban Iranian population, and in order to report the total prevalence of participants with clinical hypo- or hyperthyroidism, the number of individuals taking thyroid-related drugs were added to the ones with overt thyroid dysfunction. A subgroup analysis was also performed to determine the associated risk factors of thyroid dysfunction.

RESULTS

The prevalence of thyroid dysfunction among the total population was 7% (95%CI: 5.9 - 8%) and 0.4% (95% CI: 0.1 - 0.6%) for subclinical and overt hypothyroidism, and 1.6% (95% CI: 1 - 2%) and 0.2% (95% CI: 0 - 0.3%) for subclinical and overt hyperthyroidism, respectively. Clinical thyroid dysfunction was detected in 10.3% of the study population (9.4% had clinical hypo- and 0.9% had clinical hyperthyroidism). In the subgroup analysis, thyroid dysfunction was significantly more prevalent among the female participants (P-value = 0.029).

CONCLUSIONS

In the current study, the prevalence of different categories of abnormal thyroid status, and also the rate of clinical hypo- and hyperthyroidism was assessed using the data collected from the first phase of the HAMRAH Study. In this study, we detected a higher prevalence of clinical and subclinical hypothyroidism among the Iranian population compared to the previous studies.

Improving the mental health of working women with work-life conflict: A protocol development for an explanatory mixed method study

BACKGROUND

Today, one problem facing working women is the conflict between work and life, and the resultant stress has a great impact on their mental health. A well-known model for stress management is Lazarus and Folkman's model. The primary goal of the present study is to improve working women's mental health through stress management.

MATERIALS AND METHODS

The present study employs a mixed approach and is conducted in 4 phases. The target population is women working in Birjand University (South Khorasan province/Eastern Iran). The first step is to describe the research population of a cross-sectional study. The measurement instrument used is Carlson's standard work-life conflict measurement questionnaire. The sample size in this step is 319. The second step is to conduct a qualitative study by interviewing working women with work and life conflict. The sampling will continue until data saturation and then the data will be analyzed through a content analysis. The third step will be the development of a questionnaire based on Lazarus and Folkman's model using the information obtained from the qualitative step. This questionnaire will be then validated in the target research population. Moreover, an exploratory factor analysis, a confirmatory factor analysis and a reliability test will be run. The last step is to carry out an educational intervention to measure the effect of the intervention on stress management and general health in working women with work and life conflict. The measurement instruments used in this step are Cohen's Perceived Stress Questionnaire, General Health Questionnaire, and a researcher-made stress management questionnaire.

CONCLUSION

It seems that the educational intervention of stress management with educational content designed based on the needs of the audience, can be effective in controlling and managing the stress caused by women's work-life conflict.

TRIAL REGISTRATION

IRCT (IRCT20210918052508N1) from the Iranian Registry of Clinical Trials in 2021-09-21.

Design, implementation and evaluation of an intervention based on a social cognitive theory of physical activity and nutritional behaviors in middle-aged people at the risk of coronary artery disease in Bandar Abbas: A study protocol

BACKGROUND

Coronary artery disease (CAD) is the most common cardiovascular disease (CVD) and the main cause of mortality in developed and developing countries. Physical activity and nutritional behaviors are modifiable factors in people at the risk of CAD and its risk factors; thus, the present study aimed to design, implement, and evaluate an intervention based on the social cognitive theory for physical activity and nutritional behaviors in the middle-aged population at the risk of CAD residing in Bandar Abbas city.

MATERIALS AND METHODS

The present study will be conducted in three phases: qualitative, cross-sectional, and community-based intervention. The middle-aged population with less than 150 minutes of physical activity a week with at least one other risk factor of CAD (hyperlipidemia, hypertension, diabetes, overweight and obesity, smoking) will be included in the study. In the qualitative phase of study, the participants will be selected with maximum diversity and with the aim of obtaining comprehensive information to clarify the nature and dimensions of the phenomenon in question. The cross-sectional phase aimed to determine the intensity of physical activity and nutritional behaviors. By analyzing the data obtained from the cross-sectional phase, the most important constructs of the social-cognitive theory in physical activity and nutritional behaviors will be determined, and accordingly, an effective intervention will be designed. The third phase of the pre-test-post-test intervention study will include a randomized control group. The interventions will be a combination of face-to-face meetings and the use of educational technologies. Individuals in the control group will not undergo the educational intervention. Those in the intervention group will be evaluated in two phases (before the implementation of the intervention, and 3 months after the intervention).

CONCLUSION

The findings of the present study can be used as a strategic plan to help policy makers to strengthen CVD prevention and management alternatives to include physical activity and nutritional behavior as part of their preventive measures.

Impact of the Social Marketing-Based Intervention on Preconception Healthy Behaviors of Women With Sickle Cell Disease

INTRODUCTION

A suggested method to improve the outcomes of pregnancy with sickle cell disease (SCD) is to engage more women at reproductive age in preconception healthy behavior (PCHB). Social marketing can be a suitable strategy to achieve this goal. We aimed to assess the impact of the social marketing-based intervention on women's engagement in PCHB.

METHODS

A quasi-experimental study was conducted in Bandar Abbas and Minab (the two largest cities of Hormozgan province in Iran with a high prevalence of SCD) from 2021 to 2022. A social marketing-based intervention with the main components (participation in PCHB as a "product," social media and traditional promotional channels as a "promotion," selecting healthcare centers as a "place" for implementing the intervention, and free access to medical experts and speciality as a "price") was designed based on formative research. The sample size was estimated at 140 participants in each intervention and control group. The study's main outcome was the level of engagement in PCHB, which was assessed according to the health belief model (HBM).

RESULTS

We compared the PCHB scores of both groups. Employing healthy behavior was more dominant in the intervention group. Awareness, perceived severity, perceived susceptibility, perceived benefits, and self-efficacy increased in both groups following intervention, while perceived barriers decreased. An analysis of covariance (ANCOVA) was performed to control and moderate the effect of scores in the pretest. As observed between the adjusted averages, awareness, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, self-efficacy, and engagement in the PCHB were significantly different between the control and intervention groups after the intervention. A multivariate linear regression analysis showed that awareness, perceived susceptibility, and self-efficacy were strong predictors of PCHB.

CONCLUSIONS

Social marketing-based intervention successfully increased PCHB among women of reproductive age with SCD.

Prevalence and associated factors of chronic venous disease among the modern Iranian urban population

OBJECTIVES

Chronic venous disease (CVD) of the lower extremities is one of the common venous diseases in different populations, with a wide range of clinical manifestations and undetermined exact prevalence owing to different population characteristics and measurement methods. This study aimed to estimate the prevalence of CVD among the modern Iranian urban population and determine its associated risk factors.

METHODS

The Heart Assessment and Monitoring in Rajaie Hospital study, a longitudinal population-based cohort, aims to investigate the baseline prevalence and the 10-year incidence of cardiovascular diseases and associated risk factors in the adult population aged 30 to 75 years with no overt cardiovascular diseases in Tehran. Two instructed interventional cardiologists performed CVD evaluation using the Clinical-Etiology-Anatomy-Pathophysiology classification. CVD was graded as C1 to C6, and chronic venous insufficiency (CVI) as C3 to C6. A multivariable regression model was used to analyze the association between CVD and prespecified covariates of age, sex, body mass index (≥30 kg/m2), smoking, hypertension, diabetes mellitus, physical activity, dyslipidemia, and delivery method.

RESULTS

CVD prevalence among 1176 participants was 36.5% (95% confidence interval [CI], 33.8-39.3) and was higher in women than men (44.2% vs 23.5%). CVI prevalence was only 0.7% (95% CI, 0.3-1.3). Multivariable analysis showed that advanced age (odds ratio [OR], 1.06; 95% CI, 1.04-1.08), female sex (OR, 2.98; 95% CI, 2.14-4.14), and body mass index of ≥30 (OR, 1.36; 95% CI, 1.03-1.81) were independently associated with CVD. Physical activity (OR, 0.77; 95% CI, 0.58-1.02) was nearly protective, whereas other factors, including traditional cardiovascular risk factors, had no meaningful association with CVD.

CONCLUSIONS

Our findings showed that CVD was prevalent in the modern Iranian urban population. However, considering the very low prevalence of the higher stages of the disease, the benefit of mass screening is debatable, and better risk discriminators should be investigated.

Evaluation of the barriers and facilitators of iron supplementation program among adolescent females

BACKGROUND & AIMS

Iron deficiency anemia is a major health problem in female adolescents; so, the iron supplementation program has been implemented in Iranian female high school students for nearly two decades. This study aimed to assess the barriers and facilitators of the program.

METHODS

This cross-sectional study was conducted by cluster random sampling with a sample size of 399 high school girls from the northern, southern, eastern, western and central regions of Iran. To collect data, we applied valid and reliable researcher-made questionnaires. Data were analyzed by SPSS version 22 software using the chi-squared test.

RESULTS

From the students' point of view, the most important reasons for not taking iron supplements were the bad taste of iron supplements, nausea after consumption, and not prescription of the iron supplement by physicians. Most the students believed that inviting health care professionals and movies or clips had the greatest impact on encouraging students to take supplements. About 45% of students reported that educational programs were not held for them, and only 28% of students received educational content/educational media about iron supplement. Also, 71% of students reported that there are not enough glasses for the consumption of supplement iron. There were significant relationships between iron supplements distributors (deputy assistant: 22.6% vs. 14.1%, P = 0.045), allocated enough time to intake iron supplements (72.0% vs. 37.1%, P < 0.001), implemented the educational program in schools (61.8% vs. 33%, P < 0.001), and the educator person of the program (health teachers: 42.7% vs. 35.7%, P = 0.039) with consumption of iron supplement by the students.

CONCLUSION

To achieve the goals of the program, it is necessary paying attention to various aspects of the program such as providing better quality iron supplements, providing more appropriate environmental conditions, designing more attractive training programs, strengthening general announcement, and employing more experienced executive staff.

CONCLUSION

The role of social support and self-control in tobacco consumption: a cross-sectional study among tobacco consumers and non-consumers

INTRODUCTION

Tobacco use is recognized as one of the most important causes of preventable death due to non-communicable diseases and disability worldwide. The present study was conducted with the aim of comparing social support and self-control between tobacco consumers and non-consumers in Hormozgan Province.

METHODS

The present cross-sectional study was conducted on the adult population above the age of 15 years living in Hormozgan province. A total number of 1,631 subjects were selected using a convenient sampling method. An online questionnaire was used to collect the data, which consisted of three sections: demographic information, Zimet's perceived social support and Tangney's self-control questionnaires. In the present study, Cronbach's alpha coefficients of social support and self-control questionnaires were 0.886 and 0.721, respectively. Data were analyzed using chi-squared test, Mann-Whitney U-test, and logistic regression analysis with SPSS software (v. 25).

RESULTS

Among the participants, 842 (51.6%) reported to be tobacco non-consumers, and 789 (48.4%) reported to be consumers. The mean scores of perceived social support among the consumers and non-consumers were 4.6 ± 1.012 and 4.93 ± 0.518, respectively. The mean scores of self-control among the consumers and non-consumers were 2.74 ± 0.356 and 2.75 ± 0.354, respectively. There was a significant difference among tobacco consumers and non-consumers in gender, age, education level and job status (p < 0.001). The results showed that the mean scores of social support, support received from family and others were significantly higher in non-consumers than in consumers (p < 0.001). There was no statistically significant difference between the mean scores of self-control, self-discipline, and impulse control in consumers and non-consumers (p > 0.05).

CONCLUSION

According to our findings, tobacco consumers received more social support from family and others compared to non-consumers. Considering the important role of perceived support in tobacco consumption, this variable should receive copious attention in developing interventions and trainings, especially family education workshops.

Effect of Photobiomodulation Therapy With an 810-nm Diode Laser on Pain Perception Associated With Dental Injections in Children: A Double-Blind Randomized Controlled Clinical Trial

Introduction: This study investigated the photobiomodulation effect of an 810-nm diode laser in adjunction with topical anesthesia on pain perception during infiltration anesthesia of primary maxillary molars in children. Methods: This double-blind randomized controlled clinical trial was conducted on 64 children (aged 5-9 years) requiring extraction or stainless steel crown for their primary maxillary molars. The patients were randomly allocated into two groups (n=32) of laser and control. In the laser group, the injection site (buccal and palatal mucosa) was irradiated with an 810-nm laser (200 mW, 5.2 J/cm2) after 20% benzocaine topical anesthetic application, while the control group received a placebo laser following topical anesthesia. The pain intensity experienced by children during needle insertion into the buccal and palatal mucosa was determined using a visual analog scale (VAS) and modified behavioral pain scale (MBPS). Results: According to the results of the VAS and MBPS, no significant difference was detected in pain scores between the laser and control groups neither in the buccal nor in the palatal mucosa (P>0.05). Conclusion: Photobiomodulation therapy with an 810-nm laser with the current setting adjunct to topical anesthesia did not promote significant additional effects on the pain intensity.

Deep learning-based left ventricular segmentation demonstrates improved performance on respiratory motion-resolved whole-heart reconstructions

Introduction

Deep learning (DL)-based segmentation has gained popularity for routine cardiac magnetic resonance (CMR) image analysis and in particular, delineation of left ventricular (LV) borders for LV volume determination. Free-breathing, self-navigated, whole-heart CMR exams provide high-resolution, isotropic coverage of the heart for assessment of cardiac anatomy including LV volume. The combination of whole-heart free-breathing CMR and DL-based LV segmentation has the potential to streamline the acquisition and analysis of clinical CMR exams. The purpose of this study was to compare the performance of a DL-based automatic LV segmentation network trained primarily on computed tomography (CT) images in two whole-heart CMR reconstruction methods: (1) an in-line respiratory motion-corrected (Mcorr) reconstruction and (2) an off-line, compressed sensing-based, multi-volume respiratory motion-resolved (Mres) reconstruction. Given that Mres images were shown to have greater image quality in previous studies than Mcorr images, we hypothesized that the LV volumes segmented from Mres images are closer to the manual expert-traced left ventricular endocardial border than the Mcorr images.

Method

This retrospective study used 15 patients who underwent clinically indicated 1.5 T CMR exams with a prototype ECG-gated 3D radial phyllotaxis balanced steady state free precession (bSSFP) sequence. For each reconstruction method, the absolute volume difference (AVD) of the automatically and manually segmented LV volumes was used as the primary quantity to investigate whether 3D DL-based LV segmentation generalized better on Mcorr or Mres 3D whole-heart images. Additionally, we assessed the 3D Dice similarity coefficient between the manual and automatic LV masks of each reconstructed 3D whole-heart image and the sharpness of the LV myocardium-blood pool interface. A two-tail paired Student's t-test (alpha = 0.05) was used to test the significance in this study.

Results & Discussion

The AVD in the respiratory Mres reconstruction was lower than the AVD in the respiratory Mcorr reconstruction: 7.73 ± 6.54 ml vs. 20.0 ± 22.4 ml, respectively (n = 15, p-value = 0.03). The 3D Dice coefficient between the DL-segmented masks and the manually segmented masks was higher for Mres images than for Mcorr images: 0.90 ± 0.02 vs. 0.87 ± 0.03 respectively, with a p-value = 0.02. Sharpness on Mres images was higher than on Mcorr images: 0.15 ± 0.05 vs. 0.12 ± 0.04, respectively, with a p-value of 0.014 (n = 15).

Conclusion

We conclude that the DL-based 3D automatic LV segmentation network trained on CT images and fine-tuned on MR images generalized better on Mres images than on Mcorr images for quantifying LV volumes.

Socio-personal factors affecting adherence to treatment in patients with type 2 diabetes: A systematic review and meta-analysis

PURPOSE

The purpose of study was to identify the socio-personal factors affecting adherence to the treatment of patients with type 2 diabetes.

METHODS

Cross-sectional articles were extracted from databases such as Web of Science, PubMed, Elsevier. A meta-analysis was performed using integrated odds ratios (OR) and 95% confidence interval (CIs) for age, BMI, depression, educational level, gender, employment status, marital status, smoking status. STATA 12.0 was used to estimate pooled RR in definite subgroups. The quality of the studies included was evaluated using the STROBE checklist.

RESULTS

Thirty-one studies out of 7407 extracted articles were finally selected for the meta-analysis. The results showed that younger people had a 17% higher risk than older people, smokers had a 22% higher risk than non-smokers, and the employed had a 15% higher risk of non-adherence to treatment.

CONCLUSION

In conclusion, older age, smoking and employment can lead to non-adherence to T2D treatment. Interventions are suggested to be made besides common health care considering the socio-personal features on type 2 diabetes patients' treatment adherence.

Predicting cervical cancer screening behavior among women in southern Iran: a cross-sectional study with PEN-3 model

INTRODUCTION

Despite the fact that the Pap smear test is a simple, affordable, painless and relatively reliable method to diagnose cervical cancer in women, the majority of women are unaware of the value of this valuable diagnostic method. There are many cultural and social barriers to this diagnostic method. The present study was conducted to predict cervical cancer screening behavior with PEN-3 model among women residents of Bandar Abbas.

METHODS

The present descriptive-analytical study was conducted on 260 women aged 18 years and above who visited the comprehensive health centers of Bandar Abbas. The data were collected online using a demographic information questionnaire and a researcher-made questionnaire based on the PEN-3 model constructs and analyzed using Mann-Whitney U test, Pearson correlation test and logistic regression analysis in SPSS-23.

RESULTS

The participants' age ranged between 18 and 52 years with an average of 30.95 ± 5.47 years. 27.7% of the participants had done their last pap smear test less than 1 year before the study and 26.2% had not done a pap smear test until the time of study. The results showed that the mean scores of knowledge (11.28 ± 2.87), attitude (64.96 ± 4.96), enablers (44.66 ± 5.8), and nurturers (36.02 ± 8.83) in women who had done the cervical cancer screening behavior was more than those who had not done the behavior. Also, the results of logistic regression analysis showed that knowledge, attitude and nurturers were the major predictors of cervical cancer screening behavior.

CONCLUSION

The present findings showed that knowledge, attitude, enablers and nurturers play a major role in women's participation in Pap smear test. These findings should be considered in the development and implementation of educational interventions.

Myocardial Perfusion SPECT Imaging Radiomic Features and Machine Learning Algorithms for Cardiac Contractile Pattern Recognition

A U-shaped contraction pattern was shown to be associated with a better Cardiac resynchronization therapy (CRT) response. The main goal of this study is to automatically recognize left ventricular contractile patterns using machine learning algorithms trained on conventional quantitative features (ConQuaFea) and radiomic features extracted from Gated single-photon emission computed tomography myocardial perfusion imaging (GSPECT MPI). Among 98 patients with standard resting GSPECT MPI included in this study, 29 received CRT therapy and 69 did not (also had CRT inclusion criteria but did not receive treatment yet at the time of data collection, or refused treatment). A total of 69 non-CRT patients were employed for training, and the 29 were employed for testing. The models were built utilizing features from three distinct feature sets (ConQuaFea, radiomics, and ConQuaFea + radiomics (combined)), which were chosen using Recursive feature elimination (RFE) feature selection (FS), and then trained using seven different machine learning (ML) classifiers. In addition, CRT outcome prediction was assessed by different treatment inclusion criteria as the study's final phase. The MLP classifier had the highest performance among ConQuaFea models (AUC, SEN, SPE = 0.80, 0.85, 0.76). RF achieved the best performance in terms of AUC, SEN, and SPE with values of 0.65, 0.62, and 0.68, respectively, among radiomic models. GB and RF approaches achieved the best AUC, SEN, and SPE values of 0.78, 0.92, and 0.63 and 0.74, 0.93, and 0.56, respectively, among the combined models. A promising outcome was obtained when using radiomic and ConQuaFea from GSPECT MPI to detect left ventricular contractile patterns by machine learning.

Reliability and accuracy of intraoral radiography, cone beam CT, and dental MRI for evaluation of peri-implant bone lesions at zirconia implants - an ex vivo feasibility study

OBJECTIVES

To determine the reliability and accuracy of intraoral radiography (IR), cone-beam-computed tomography (CBCT), and dental magnetic resonance imaging (dMRI) in measuring peri‑implant bone defects around single zirconia implants.

METHODS

Twenty-four zirconia implants were inserted in bovine ribs with various peri‑implant defect sizes and morphologies. True defect extent was measured without implant in CBCT. Defects were measured twice in IR, CBCT, and dMRI with the inserted implant by three experienced readers. Reliability was assessed by ICC, accuracy by the Friedman test, and post-hoc-Tukey's test.

RESULTS

A comparable good to excellent intra- and inter-reader reliability was observed for all modalities (intra-/inter-rater-CC range for IR; CBCT; dMRI: 0.81-0.91/0.79;0.87-0.97/0.96;0.87-0.95/0.94). Accuracy was generally high, with mean errors below 1 mm in all directions. However, measuring defect depth in the mesiodistal direction was significantly more accurate in dMRI (0.65 ± 0.38 mm) compared to IR (2.71 ± 1.91 mm), and CBCT (1.98 ± 1.97 mm), p-values ≤ 0.0001 respectively ≤ 0.01.

CONCLUSIONS

Osseous defects around zirconia implants can be reliably measured in IR/CBCT/dMRI in the mesiodistal directions. In addition, CBCT and dMRI allow assessment of the buccolingual directions. dMRI provides a comparable accuracy in all directions, except for the mesiodistal defect depth, where it outperforms IR and CBCT.

Parents' Perception of Fissure Sealant Therapy in 6-12 Year Old Children: Evaluating a theory-driven intervention

BACKGROUND

Dental caries is considered a major global health issue and among the most challenging diseases worldwide. An effective way of preventing dental caries is the fissure sealant (FS) therapy.

OBJECTIVE

To determine the effectiveness of an educational intervention developed based on the health belief model (HBM) for parents' perception of FS therapy for their children.

METHODS

Quasi-experiment among 300 parents of 6-12 year-old children, 150 in the intervention group (IG) and 150 in the control (CG), in the south of Iran recruited via both clustering and convenience sampling. Data were collected using a validated questionnaire collecting demographic information, knowledge and data on HBM constructs and FS behaviour. Eight intervention sessions, 40-60 minutes long, were held for over month. The primary outcome was child's receipt of fissure sealants 3 months after the intervention.

RESULTS

The two groups had similar knowledge and the HBM constructs at baseline. After the intervention, the receipt of FS therapy was 65% and 12% in the IG and CG, respectively (p ⟨ 0.001, Chi Sq.). ANCOVA supported post-test differences between the intervention and control groups when accounting for baseline scores (p⟨0.05).

CONCLUSIONS

The educational HBM-based intervention improved parents' perceptions and their children's receipt of FS therapy. The intervention affected the HBM constructs. Barriers to healthy oral/dental behaviours may be reduced by interventions at multiple layers (beyond the individual level).

Application of Pender's health promotion model for type 2 diabetes treatment adherence: protocol for a mixed methods study in southern Iran

BACKGROUND

Type 2 diabetes (T2D) mellitus treatment as a chronic disease requires adequate adherence to treatment including controlling blood glucose levels and lifestyle management. The aim of this study is to investigate the factors affecting of adherence to T2D treatment from the perspective of patients and design an intervention program based on Pender's health promotion model (HPM) to increase T2D treatment adherence in Bandar Abbas, a city located in the south of Iran.

METHODS

This mixed method study will consist of qualitative stage, questionnaire design and a randomized, open-label, parallel-group interventional study based on HPM in southern Iran. Sampling for qualitative stage will continue until reaching the saturation. In the intervention stage, participants will be 166 T2D patients referring to the Bandar Abbas Diabetes Clinic will be randomized into intervention and control groups (allocation 1:1). After identifying the factors affecting adherence to treatment in T2D patients by qualitative study and literature review, a questionnaire based on HPM will be designed. In the next stage, 10 sessions of intervention for the intervention group will be designed. To evaluate the effect of the intervention, intervention and control groups will be tested for hemoglobin A1c (HbA1c) before and 3 months after the intervention.

DISCUSSION

This designed study is a program for improving treatment adherence in T2D based on the HPM model and contributes to a better understanding of effective factors in adherence to treatment in T2D patients. The results of this project can be used for macro-diabetic planning.

TRIAL REGISTRATION

This study is registered on the Iranian Registry of Clinical Trials (IRCT20211228053558N1: https://www.irct.ir/trial/61741 ) and first release date of 17th March 2022.

Cardiogenic shock following acute MI in a young patient with familial hypercholesterolemia, and severe aortic stenosis: A case report

Background

Familial hypercholesterolemia is a relatively rare disorder with various clinical manifestations including premature coronary artery disease.

Case presentation

A 15-year-old boy presented with acute exacerbation of dyspnea and exertional chest pain with a progressive feature since one month earlier. He had a clustered family history of premature cardiovascular death, hyperlipidemia, and cutaneous lesions in two of his siblings. He presented with acute severe heart failure accompanied with high levels of cardiac troponin and LDL cholesterol. Echocardiography revealed severe LV dysfunction, in concert with valvular and supravalvular Aortic stenosis. He underwent Coronary angiography, which showed involvement of Left main coronary artery and two-vessel disease. The patient was diagnosed with cardiogenic shock secondary to acute non-ST segment elevation myocardial infarction, and phenotype of familial hypercholesterolemia.

Conclusions

Premature malignant atherogenesis in both aortic root and coronary arteries with early presentation of acute myocardial infarction and severe heart failure is an uncommon constellation in early course of the FH, which leads to confined treatment options.

Effectiveness of educational intervention on women’s participation to cervical cancer screening: a quasi-experimental study based on PEN-3 model

Introduction

Cervical cancer is one of the most common cancer types among women in developing countries. Women’s behavior in the early detection of the disease is influenced by sociocultural factors. Thus, the present study aimed to determine the effect of an educational intervention based on PEN-3 model on women’s participation in cervical cancer screening.

Methods

The present quasi-experimental study was conducted with 160 women participants visiting health care centers in Bandar Abbas in 2021. The sampling was as a multi-stage clustering, and the participants were divided into two groups, an intervention and a control (each with 80 participants). The data collection instrument was a researcher-made questionnaire based on the PEN-3 model constructs before and 3 months after an educational intervention (a training course). The intervention involved 30 online sessions of 15–20 minutes for the intervention group while the control group did not receive any training.

Results

After the educational intervention, the mean scores of knowledge, attitude, enablers, nurturers and the Pap smear test behavior in the experimental group increased significantly compared to the control group (P < 0.05). The analysis of covariance results showed that by modulating the effect of pre-test score, there was a statistically significant difference between the intervention and control groups in the post-intervention behavior score.

Conclusion

In the light of the present findings, it can be concluded that interventions based on the PEN-3 model with a focus on knowledge -raising, changing beliefs and identifying sociocultural and environmental factors that affect cervical cancer screening behavior can prevent cervical cancer in women.

A model for explaining adherence to antiretroviral therapy in patients with HIV/AIDS: A grounded theory study

Maintaining a high level of adherence to antiretroviral therapy is a challenge among HIV/AIDS patients. The study aimed to explore the process of adherence to treatment with a grounded theory approach to help physicians and planners develop strategies to increase adherence to treatment. We conducted in-depth interviews and a focus-group discussion. The data were collected from 2016 to 2018. The participants were 39 HIV/AIDS patients treated with antiretroviral, their relatives (three people) and two treatment staff. The study was conducted at the Behavioural Counselling Center of Imam Khomeini Hospital, located in Tehran, the capital of Iran. The data were analysed at the stages of "analysis for concepts," "analysis for context," "bringing process into the analysis" and "integrating." We obtained a conceptual model to explain the relationship between the categories. "Motivation" was identified as the core variable and the "Becoming resilient" explained the adherence process. Several factors including the interfering factors, contextual factors and resilience factors were identified. The interfering and contextual factors, in the absence of the resilience factors, lead to decreased motivation and increased poor adherence to treatment. The role of motivation in long-term adherence should be emphasised. We think strategies such as helping individuals with HIV/AIDS to form support networks, empowering and encouraging them to seek spiritual help will motivate them to maintain a long-term use of antiretroviral medications and, hence, become more resilient.

Quality of life and its related psychological problems during coronavirus pandemic

Background

The prevalence of coronavirus disease 2019 (COVID-19) has endangered the psychological health of individuals. This study aimed to assess the quality of life and its related psychological problems during COVID-19 pandemic.

Methods

In this cross-sectional study, 559 citizens above the age of 16 years, in Isfahan and Bandar Abbas cities in Iran were selected with a convenient sampling method. An online questionnaire was used to collect the data, which consisted of five sections: demographic information, short health anxiety inventory (SHAI), perceived stress scale (PSS), world health organization quality of life questionnaire (WHOQOL-BREF) and Padua inventory. Data were analyzed using statistical tests including t-test, path analysis and structural equation modeling (SEM) using SPSS 24 and Amos 21 statistical software.

Results

A total of 559 subjects with the mean age of 37.34 ± 11.19 years participated in this study. Most of the participants were female (78.5%), married (71.6%) and employed (40.9%). The majority of them also had a bachelor’s degree (42.9%). There were significant negative correlations between perceived helplessness (r = -.597, p = .000), perceived stress (r = -.715, p = .000), risk of disease (r = -.302, p = .000), negative effect of disease (r = -.424, p = .000), health anxiety (r = -.366, p = .000), contamination obsessions (r = -.187, p = .000) and washing compulsions (r = -.193, p = .000) with quality of life. On other hand, significant positive correlation was found between perceived self-efficacy (r = .665, p = .000) and quality of life.

Conclusions

According to our findings, health anxiety, perceived stress and obsessive-compulsive disorder were negatively affected psychological health during COVID-19 which in turn decreased quality of life. Therefore, we suggest considering prevention and treatment of theses psychological problems to diminish the risk of reduced quality of life during COVID-19 global pandemic crisis.

Explaining the Challenges of Coping with Coronavirus Crisis in the Workplaces: A Qualitative Study

Background

Workplaces play a highly important role in controlling or spreading the prevalence of coronavirus disease 2019 (COVID-19). Therefore, the lack of proper implementation of hygienic protocols in these environments might increase the risk of getting infected with the COVID-19 among the employees, following the increase of the COVID-19 at the family and community levels. This qualitative study aims to explain the challenges of coping with the coronavirus crisis in the workplaces.

Methods

The present qualitative study was conducted with a conventional content analysis approach. We used purposeful sampling with maximum diversity in terms of working processes. Data were collected through semi-structured interviews. Interviews were performed to the point of information saturation. MAXQDA software version 10 was used for data management.

Results

Through the content analysis of the interviews with the participants, we identified two main classes and nine sub-classes. The main classes included intra-organizational challenges (job nature, budget allocation problems, individual factors, disorganization, manpower and equipment, lack of commitment, and insufficient support of managers) and extra-organizational challenges (lack of accessibility to valid information, black market, and inter-sectorial coordination problems).

Conclusion

The study findings indicated that organizations and industries face numerous internal and external challenges in coping with the COVID-19 pandemic. Paying attention to the mentioned limitations and attempting to eliminate them, especially by the governmental organizations, employers, and managers, could help in effectively confronting the COVID-19 pandemic.

Personality and occupational correlates of anxiety and depression in nurses: the contribution of role conflict, core self-evaluations, negative affect and bullying

Background

The work environment and the fatiguing nature of nursing are risk factors that cause psychological disorders. This study was conducted with the aim of investigating the relationship between role conflict, core self-evaluations, negative affect, and bullying with anxiety and depression in nurses.

Methods

This cross-sectional study was conducted on the nurses working in hospitals of Bandar Abbas, Iran over 4 months (August 2019–November 2019). Data were collected using the Positive and Negative Affect Schedule scale, Role Conflict Questionnaire, Core Self-Evaluations Scale, Negative Acts Questionnaire-Revised, Beck Depression Inventory-Second Edition (BDI-II) and Beck Anxiety Inventory. Data were analyzed using t-test, one-way analysis of variance, Pearson correlation coefficient and multiple regression analysis using SPSS version 22 software and the significance level was considered 0.05.

Results

The findings revealed that there was a significant positive relationship between role conflict (r = 0.422, p < 0.01), negative affect (r = 0.715, p < 0.01), and bullying (r = 0.443, p < 0.01) with anxiety. Moreover, there was a significant negative relationship between core self-evaluations with anxiety (r = − 0.482, p < 0.01). Also, the findings indicated that there was a significant positive relationship between role conflict (r = 0.382, p < 0.01), negative affect (r = 0.672, p < 0.01), and bullying (r = 0.433, p < 0.01) with depression. There was a significant negative relationship between core self-evaluations and depression (r = − 0.603, p < 0.01). Moreover, regression analysis results revealed that negative affect, role conflict, and core self-evaluations predicted 54.3% of anxiety variance significantly. And lastly, negative affect and core self-evaluations predicted 53.3% of depression variance significantly.

Conclusions

Findings indicated that having high negative affect, low core self-evaluations, high role conflict, and exposure to bullying at work enhances the rate of depression and anxiety in nurses. Hence, it is essential to improve the mental health of nurses and thus the quality of care provided by them through recognizing suitable supportive strategies and interventions.

Increasing cervical cancer screening in Iran: effectiveness of a theory-based educational intervention

Purpose of study

The high mortality rate of cervical cancer in developing countries is mainly related to inefficient screening programs. The aim of the present study was, thus, to determine the effect of an educational intervention based on BASNEF (Belief, Attitudes, Subjective Norms, and Enabling Factors) model on increasing the rate of cervical cancer screening (CCS) in Bandar Deir in the south of Iran.

Methods

A quasi-experimental educational intervention was made with 202 women participants (101 in the intervention group (IG) and 101 in the control group (CG)) in 2019–20. The sampling was convenience in type. The data were collected using a reliable and valid tripartite questionnaire (demographic information, knowledge, BASNEF constructs). A total number of 14 training sessions were held each taking 60 min, at two levels, personal and interpersonal (for family members, health workers and healthcare givers). Finally, there was a three-month follow-up held in December 2021.

Results

After the training, a statistically significant difference was found between the IG and CG in all model constructs (p < 0.001). Before the intervention, in the IG, the personal health score was 4.35 ± 2.52, which was increased to 5.25 ± 0.753 after the training (p < 0.001). However, in the CG, the difference was not statistically significant (p < 0.030). 63.4% of women in the IG and 32.7% in the CG performed the CCS and the between-group difference was statistically significant (p < 0.001). Attitude, enabling factors and behavioral intention were the main predictors of CCS.

Conclusion

The present findings showed though the training intervention based on the BASNEF model had limited resources and was run in a short time, it managed to motivate women to perform the CCS. It could maximally remove barriers at both personal and interpersonal levels and suggest strategies in the light of these barriers to achieve a successful screening program.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12978-022-01489-5.

Cervical cancer is the fourth most prevalent fatal cancer among women on a global scale, and is one of the few cancers that can be prevented through screening. The high mortality rate of cervical cancer in developing countries, including Iran, has been largely attributed to inefficient screening programs. In developing countries cervical cancer screening programs are far from qualified. Yet, theory-based educational interventions can play an important role in promoting CCS behavior. Therefore, the present study was designed to determine the effect of an educational intervention based on the Beliefs, Attitudes, Subjective Norms and Enabling Factors (BASNEF model on increasing CCS in women in the south of Iran. BASNEF model includes beliefs about behavioral outcomes, attitudes toward behavior, subjective norms and enabling factors. The most significant construct in BASNEF model is the behavior change. Beliefs and attitudes are influenced by culture, values, traditions, education, media, and personal experiences. Subjective norms include family, society, social media, and peer pressure. Enabling factors include income, women’s status, time, and skills. This model can be proposed as a new educational method. A quasi-experimental two-group (pretest–posttest) study was conducted in 2019–2020 on 202 women (101 in the intervention group, and 101 in the control group). In the intervention group, 14 training sessions (10 at the personal level and 4 at the interpersonal level) were held between 40 and 60 min’ long. In the control group, 1 training session was held in 6 groups of 15–20. It was 60 min’ long. The follow-up was held three months after the intervention. The results showed that the educational intervention, by affecting the BASNEF constructs, significantly affected women’s CCS behavior. Maximizing barriers at both personal and interpersonal levels and suggesting strategies based on these barriers can help achieve a successful screening program. In particular, we call for the implementation of goal-oriented training programs according to health education and health promotion models to increase the rate of CCS behavior.

Impact of Baseline Estimated Glomerular Filtration Rate Using CKD-EPI Equation on Long-term Prognosis of STEMI Patients: A Matter of Small Increments!

BACKGROUND

Baseline biomarkers including glomerular filtration rate (GFR) guide the management of patients with ST-segment elevation myocardial infarction (STEMI). GFR is a tool for prediction of adverse outcomes in these patients.

OBJECTIVES

We aimed to determine the prognostic utility of estimated GFR using Chronic Kidney Disease Epidemiology Collaboration in a cohort of STEMI patients.

METHODS

A retrospective cohort was designed among 5953 patients with STEMI. Primary endpoint of the study was major adverse cardiovascular events. GFR was classified into 3 categories delineated as C1 (<60 mL/min), C2 (60-90), and C3 (≥ 90).

RESULTS

Mean age of the patients was 60.38 ± 5.54 years and men constituted 78.8% of the study participants. After a median of 22 months, Multivariate Cox-regression demonstrated that hazards of major averse cardiovascular event, all-cause mortality, cardiovascular mortality, and nonfatal myocardial infarction were significantly lower for subjects in C3 as compared with those in C1. Corresponding hazard ratios (HRs) for mentioned outcomes regarding C3 versus C1 were (95% confidence interval) were (HR = 0.852 [0.656-0.975]; P = 0.035), (HR = 0.425 [0.250-0.725]; P = 0.002), (HR = 0.425 [0.242-0.749]; P = 0.003), and (0.885 [0.742-0.949]; P = 0.003), respectively. Normal GFR was also associated with declined in-hospital mortality with HR of C3 versus C1: 0.299 (0.178-0.504; P < 0.0001).

CONCLUSIONS

Baseline GFR via Chronic Kidney Disease Epidemiology Collaboration is associated with long-term cardiovascular outcomes following STEMI.

Determinants of stress coping behaviors in patients with Multiple Sclerosis (MS-DSCB): development and psychometrics of a PRECEDE model-based questionnaire

OBJECTIVE

Stress management delays the onset or exacerbation of symptoms of multiple sclerosis. The present study aimed to develop and psychometrically evaluate a questionnaire to measure the determinants of stress coping behaviors in patients with multiple sclerosis.

METHODS

This was a methodological study that was conducted in two stages: qualitative and quantitative phases. Participants in this study were patients with multiple sclerosis who referred to the MS Association and Charity Foundations for Special Diseases in Isfahan in 2021. Preliminary item pool was developed by qualitative part of the study. The validity of the questionnaire was determined with item impact, content validity ratio (CVR), content validity index (CVI), face validity, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA).

RESULTS

In the first stage, an item pool containing 97 items were generated and after removing duplicate items and merging some of them, a questionnaire containing 51 items was developed. Ten items were removed based on the results of face validity and content validity. The EFA revealed 11 factors containing 41 items that explained 64% of the total variance of test. In CFA, 9 other items were deleted, and the questionnaire was reduced to 32 phrases in general. The results of the CFA determined the 9-factor structure of the questionnaire including awareness, attitude, self-efficacy, access to resources, skills of using resources, social support, important others, behavioral consequences and social comparison. The Cronbach's alpha coefficient of the questionnaire was 0.726.

CONCLUSION

The results showed that the designed questionnaire is a valid and reliable tool for assessing the determinants of stress coping behaviors in patients with multiple sclerosis. Identifying these factors and designing interventions based on them, in order to control or reduce stress in these patients, can help to improve the quality of life in these patients.

Endodontic working length measurements of premolars and molars in high-resolution dental MRI: a clinical pilot study for assessment of reliability and accuracy

OBJECTIVES

To prospectively assess the reliability and accuracy of high-resolution, dental MRI (dMRI) for endodontic working length (WL) measurements of premolars and molars under clinical conditions.

MATERIALS AND METHODS

Three-Tesla dMRI was performed in 9 subjects who also had undergone cone-beam computed tomography (CBCT) (mean age: 47 ± 13.5 years). A total of 34 root canals from 12 molars (4/8, upper/lower jaw; 22 root canals) and 11 premolars (2/9 upper/lower jaw; 12 root canals) were included. CBCT and dMRI datasets were reconstructed to visualize the root canal in one single slice. Subsequently, two radiologists measured the root canal lengths in both modalities twice in blinded fashion. Reliability and accuracy for both modalities were assessed using intraclass correlation coefficients (ICCs) and Bland-Altman analysis, respectively.

RESULTS

Reliability (intra-rater I/II; inter-rater) of dental MRI measurements was excellent and comparable to CBCT for premolars (0.993/0.900; 0.958 vs. 0.993/0.956; 0.951) and for molars (0.978/0.995; 0.986 vs. 0.992/0.996; 0.989). Bland-Altman analysis revealed a mean underestimation/bias (95% confidence interval) of dMRI measurements of 0.8 (- 1.44/3.05) mm for premolars and 0.4 (- 1.55/2.39) mm for molars. In up to 59% of the cases, the accuracy of dMRI for WL measurements was within the underestimation margin of 0 to 2 mm short of the apical foramen AF.

CONCLUSIONS

In vivo demonstration and measurement of WL are feasible using dMRI. The reliability of measurements is high and equivalent to CBCT. Nonetheless, due to lower spatial resolution and longer acquisition time, the accuracy of dMRI is inferior to CBCT, impeding its current use for clinical treatment planning.

CLINICAL RELEVANCE

dMRI is a promising radiation-free imaging technique. Its reliability for endodontic working length measurements is high, but its accuracy is not satisfactory enough yet.

The effect of a theory-based educational program on southern Iranian prisoners' HIV preventive behaviors: a quasi-experimental research

Background

The present research explored the effect of an educational program based on the health belief model (HBM) on prisoners’ HIV preventive behaviors in the south of Iran.

Methods

The present quasi-experimental research was conducted in 2019–20 on 280 prisoners, 140 in the control group (CG) and 140 in the intervention group (IG). The sampling was simple randomized. The data were collected using a questionnaire in two parts, one exploring the demographic information and the other the HBM constructs. The final follow-up was completed 3 months after the educational intervention (8 sessions long) in November 2020.

Results

After the intervention, statistically significant between-group differences were found in the healthy behavior score and all HBM constructs except for the perceived barriers (p < 0.001). Perceived severity and susceptibility were found to be the strongest predictors of HIV preventive behaviors.

Conclusion

The educational intervention showed to positively affect the adoption of preventive behaviors mediated by the HBM constructs. To remove barriers to HIV preventive behaviors or any other healthy behavior, researchers are suggested to develop multi-level interventions (beyond the personal level) to gain better findings.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13763-z.

Pregnancy in the Sickle Cell Disease and Fetomaternal Outcomes in Different Sickle cell Genotypes: A Systematic Review and Meta-Analysis

Background

Pregnancy is a major concern among women with the sickle cell disease (SCD), and it is associated with increased adverse outcomes. The aim of the present meta-analysis is to report the fetomaternal outcomes in different sickle cell genotypes.

Methods

In this systematic review and meta-analysis, a comprehensive search of databases and search engines such as PubMed, Scopus, Web of Science, ProQuest, Cochrane Library, Science Direct and Google Scholar were performed. Any observational studies that had compared at least one outcome such as maternal outcomes, fetal outcomes, and morbidity between two groups of pregnant women with different types of sickle cell genotypes and pregnant women without SCD were evaluated.

Results

A total number of 9,827 pregnant women with SCD were examined. The results showed that pregnancy in SCD increased the risk of adverse outcomes for the mothers (including postpartum hemorrhage, prematurity, pregnancy-induced hypertension, pre-eclampsia, eclampsia, cesarean section, lower segment cesareansection, maternal death), fetus (including live births, low birth weight, intrauterine growth restriction, APGAR score at 5 min <7, stillbirth, neonatal death, perinatal mortality, acute fetal distress, intrauterine fetal death) and morbidity among the SCD(severe anemia, urinary tract infection, blood transfusion, painful crisis, acute chest syndrome, vaso-occlusive crises).

Conclusion

According to the results of this meta-analysis, pregnancy in the SCD is associated with an increased risk of maternal outcomes, fetal outcomes, and morbidity among SCD patients with different genotypes. Pregnancy in sickle cell hemoglobinopathies needs careful multidisciplinary management and cautious caring so as to decrease maternal and fetal morbidity and mortality.

The Pragmatic Role of COVID-19 on the Thrombus Grade of Patients with Contemporary ST-Segment-Elevation Myocardial Infarction

Background

Limited data exist on the clinical outcomes of patients with coronavirus disease 2019 (COVID-19) presenting with ST-segment-elevation myocardial infarction (STEMI).

Methods

This multicenter study, conducted in 6 centers in Iran, aimed to compare baseline clinical and procedural data between a case group, comprising STEMI patients with COVID-19, and a control group, comprising STEMI patients before the COVID-19 pandemic, and to determine in-hospital infarct-related artery thrombus grades and major adverse cardio-cerebrovascular events (MACCEs), defined as a composite of deaths from any cause (cardiovascular and noncardiovascular), nonfatal strokes, and stent thrombosis.

Results

No significant differences were observed between the 2 groups regarding baseline characteristics. Primary percutaneous coronary intervention (PPCI) was performed in 72.9% of the cases and 98.5% of the controls (P=0.043), and primary coronary artery bypass grafting was performed in 6.2% of the cases and 1.4% of the controls (P=0.048). Successful PPCI procedures (final TIMI flow grade III) were significantly fewer in the case group (66.5% vs 93.5%; P=0.001). The baseline thrombus grade before wire crossing was not statistically significantly different between the 2 groups. The summation of thrombus grades IV and V was 75% in the case group and 82% in the control group (P=0.432). The rate of MACCEs was 14.5% and 2.1% in the case and control groups, respectively (P=0.002).

Conclusion

In our study, the thrombus grade had no significant differences between the case and control groups; however, the in-hospital rates of the no-reflow phenomenon, periprocedural MI, mechanical complications, and MACCEs were statistically significantly higher in the case group.

Barriers to quality of life in patients with multiple sclerosis: a qualitative study

BACKGROUND

Multiple sclerosis (MS) is a chronic progressive disease of the central nervous system that affects the patients' quality of life. This research was conducted with the aim of identifying the barriers of quality of life in patients with MS.

METHODS

This qualitative study was conducted through a conventional content analysis approach. We used the purposeful sampling with maximum diversity in terms of gender, age, education, marital status and employment. Data were collected through semi-structured interviews with 18 patients with multiple sclerosis referred to the MS Association of Isfahan. Interviews were conducted to the point of information saturation.

RESULTS

Through the content analysis of the interviews, we identified 2 main categories and 11 sub-categories. The main categories include intrapersonal problems (physical problems, psychological disorders, turbulent future, functional limitations, job loss and pennilessness), and environmental barriers (disease and treatment process, fatigue of caregivers, information deficiency about MS, family tensions, lack of social support and fun and entertainment).

CONCLUSIONS

In order to improve the quality of life in these patients, there is a need for attention and practical measures in the field of identified factors. By removing barriers such as providing educational and counseling services to the patients and their families, adapting the urban structure, providing financial support and adequate insurance coverage, the authorities can take measures to ensure patients' health and improve their quality of life.

Effect of Aspirin on the prevention of pro-thrombotic states in hospitalized COVID-19 patients: Systematic review

INTRODUCTION

Thromboembolic events are one of the important complications in COVID-19 patients, especially in severe cases. Aspirin affects platelet function through irreversibly inhibiting the activity of cyclooxygenase, and it reduces the risk of thrombosis. The current systematic review was aimed to evaluate the effectiveness of aspirin in preventing prothrombotic states in COVID-19 hospitalized patients.

METHODS

The systematic search was done in PubMed/Medline, EMBASE, and Medrxiv up to September 27, 2021. The following keywords were used: "COVID-19", "SARS-CoV-2", "2019 Novel Coronavirus", "Aspirin", and "Acetylsalicylic Acid".

RESULTS

Twelve studies were included. In COVID-19 patients, aspirin can reduce CRP, IL-6 levels, and platelet aggregation by inhibiting thromboxane A2. It can also improve antiviral immunity by hindering the biosynthesis of prostaglandins and lipoxin. Eight out of twelve articles indicated that aspirin provided a beneficial effect in COVID-19. Most studies consider lowered mechanical ventilation needs, ICU admission, illness severity, overt thrombosis, and clinical outcomes in COVID-19 patients receiving aspirin.

CONCLUSIONS

Aspirin as an antiplatelet and anti-inflammatory agent may reduce the mortality rates in hospitalized patients with severe COVID-19. Further observational studies are necessary to determine the effect of aspirin on the prevention of prothrombotic states in hospitalized COVID-19 patients. The study was registered in the Systematic Review Registration: PROSPERO (pending registration ID: 300515).

Application of a dual functional blocking layer for improvement of the responsivity in a self-powered UV photodetector based on TiO2 nanotubes

A layer of graphene quantum dots (GQDs) was applied on the photoanode of a self-powered photoelectrochemical (PEC) UV photodetector based on TiO₂ nanotubes (NTs). The GQDs layer acted as a dual functional layer and improved the photodetector performance by both UV light absorption and blocking the charge carriers recombination at the photoanode/electrolyte interface. The short circuit current density (Jsc) and thereby the responsivity of the PEC UV photodetector was enhanced by 473%. The highest value of the responsivity in this work obtained for the PEC UV photodetector with the dual functional GQDs layer was as much as 42.5 mA W⁻¹. This value is far better than previously reported responsivities of the PEC devices based on TiO₂ NTs as a photoanode. This high responsivity was obtained under the illumination of a very low intensity UV light (365 nm, 2 mW cm⁻²) and 0 V bias. Moreover, the sensitivity of the PEC UV photodetector with the dual functional GQDs layer has been improved by 345%, which is almost 3.5 times higher compared to the sensitivity of its counterpart without the GQDs coating. The devices with the dual functional GQDs layer present a splendid repeatability and stability. The rise time and the decay time of this device were measured to be 0.73 s and 0.88 s under the on/off switching UV LEDs, respectively. The electrochemical impedance spectroscopy (EIS) results prove the role of the GQDs layer as an effective blocking layer on the photoanode, hindering the charge carrier recombination at the photoanode/electrolyte interface. This study shows that application of the dual functional GQDs layer in the PEC UV photodetector based on TiO₂ NTs is an effective approach for improving the responsivity and sensitivity of a self-powered PEC UV PD, which brought us the possibility of detecting low UV index radiation and using the self-powered photodetectors in cutting-edge wearable electronic devices for the aim of health, safety and environmental monitoring.

A layer of graphene quantum dots (GQDs) was applied on the photoanode of a self-powered photoelectrochemical (PEC) UV photodetector based on TiO₂ nanotubes (NTs).

A predictive model of genital warts preventive behaviors among women in the south of Iran: application of health belief model

BACKGROUND

Genital wart (GW) is known as an infectious disease. Besides the infection, it is associated with a higher risk of cervical neoplasia and cancer in the infected population. The present research aimed to explore the predictors of GW preventive behaviors based on the health belief model (HBM).

METHODS

The present analytical and cross-sectional research was conducted in 2019 among 720 women between 15 and 49 years of age in Bandar Abbas in the south of Iran. The sample was selected in a multi-stratified clustering method. The participants responded to a reliable and valid researcher-made questionnaire which explored demographic information, knowledge-related items and the model constructs. A multivariate linear regression analysis was run to determine the predictors of adopting GW preventive behaviors. A path analysis was also run to test the direct and indirect effects of the model constructs on the dependent variable.

RESULTS

The mean and standard deviation of participants' age was 30.43 ± 8.697 years. As Pearson's correlation coefficients showed, knowledge (r = 0.197, p < 0.001), perceived susceptibility (r = 0.434, p < 0.001), severity (r = 0.463, p < 0.001) and self-efficacy (r = 0.434, p < 0.001) were significantly correlated with the adoption of GWs preventive behaviors. Multiple linear regression analysis showed that self-efficacy (B = - 0.010, p < 0.001), perceived susceptibility (B = 0.070, p < 0.001) and severity (B = 0.078, p < 0.001) were the predictors of GW preventive behaviors. Path analysis showed that perceived susceptibility, severity and self-efficacy directly affected healthy behaviors while perceived benefits and barriers indirectly affected the preventive behaviors.

CONCLUSIONS

The present findings help to promote knowledge of the predictors of GW preventive behaviors. HBM can be a useful theoretical framework to evaluate the preventive behavior of the disease and help to reduce the rate of sexually-transmitted infections including GW.

Balloon-Expandable Cheatham-Platinum Stents Versus Self-Expandable Nitinol Stents in Coarctation of Aorta: A Randomized Controlled Trial

OBJECTIVES

This study sought to compare the safety and efficacy of the balloon-expandable stent (BES) and the self-expandable stent (SES) in the endovascular treatment of coarctation of aorta.

BACKGROUND

Coarctoplasty with stents has conferred promising results. Although several nonrandomized studies have approved the safety and efficacy of the BES and the SES, no high-quality evidence exists for this comparison.

METHODS

In the present open-label, parallel-group, blinded endpoint randomized pilot clinical trial, adult patients with de novo native aortic coarctation were randomized into Cheatham-platinum BES and uncovered nitinol SES groups. The primary outcome of the study was a composite of procedural and vascular complications. The secondary outcomes of the study consisted of the incidence of aortic recoarctation, thoracic aortic aneurysm/pseudoaneurysm formation, and residual hypertension at a 12-month follow-up.

RESULTS

Among 105 patients who were screened between January 2017 and December 2019, 92 eligible patients (32 women [34.8%]) with a median age of 30 years (IQR: 20-36 years) were randomized equally into the BES and SES groups. The composite of procedural and vascular complications occurred in 10.9% of the BES group and 2.2% of the SES group (odds ratio: 0.18; 95% CI: 0.02-1.62; P = 0.20). Aortic recoarctation occurred in 5 patients (5.4%), 3 patients (6.5%) in the BES group and 2 patients (4.3%) in the SES group (odds ratio: 0.65; 95% CI: 0.10-4.09; P = 0.64). Only 1 patient (1.1%) was complicated by aortic pseudoaneurysm. Hypertension control was achieved in 50% of the study population, with an equal distribution in the 2 study groups at the 12-month follow-up.

CONCLUSIONS

Both the BES and the SES were safe and effective in the treatment of native coarctation.

Preconception care counselling among women with sickle cell anaemia in the south of Iran: a qualitative study based on social marketing model

Pregnancy in women afflicted with sickle cell anaemia has certain adverse effects. The present research aimed to promote the quality of preconception care counselling programs. To do this, Hormozgan Province recruited 25 diseased women and five key informants. To acquire the necessary information, in-depth semi-structured interviews were undertaken. Graneheim's directions for guided content analysis were followed while analysing the data. The results were reported in four categories based on the social marketing constructs. Provision of sickle cell services and preconception care counselling were suggested. The participants preferred to be interviewed in comprehensive healthcare centres in their neighbourhood. The high cost of the lab and medical services was raised as an issue. Face-to-face communication together with other care services was suggested. Providing consultation services in nearby places as in the neighbourhood, including local comprehensive care centres, face-to-face interventions, and mass media, can effectively promote preconception care counselling participation.IMPACT STATEMENTWhat is already known on this subject? The high rate of maternal mortality in women afflicted with sickle cell disease in the south of Iran has attracted growing attention to preconception care counselling in these women. It seems that the social marketing model, due to its audience-based nature, is effective in the acceptance of participatory behaviour in preconception care counselling. To the best of the present researchers' knowledge, there is no similar research in this respect in Iran.What do the results of this study add? Participants' discourse analysis has led to the recognition of the social marketing constituent elements in participation in Preconception care counselling. In their accounts, the participants drew attention to 'Provision of sickle cell services' and 'Provision of Preconception care counseling for sickle cell disease' in their accounts. The participants also mentioned personal, organisational, and sociocultural barriers to the rate of participation. The optimal place was determined for the consultation, and the means of communication were also decided on for implementing the program.What are the implications of these findings for clinical practice and/or further research? Policy-makers and programmers can use the present findings to guide the design and implementation of interventional programs to promote participation in Preconception care counselling for women who have sickle cell disease.