The effect of a web-based lifestyle intervention on nutritional status and physical activity on prevention of COVID-19: a randomized controlled trial in women's empowerment

Background

Healthy dietary intake and physical activity affect the immune systems. The present study aimed to investigate the effects of a web-based lifestyle intervention on nutritional status, physical activity, and prevention of COVID-19.

Methods

Three hundred-three women (30-60 years old), who did not have COVID-19 in the City of Ardabil, participated in this study. Participants were randomized into an intervention (n = 152) or control group (n = 151). The intervention group received eight online educational sessions focusing on a healthy diet and physical activity via the website. There was no educational session for the control group during the intervention, but they were placed on the waiting list to receive the intervention and given access to the website and educational content after the follow-up. Outcomes were nutritional status, physical activity, immunoglobulin G (IgG), and immunoglobulin M (Ig M) antibody titers against the virus. They were evaluated at the baseline, after 4 and 12 weeks.

Results

Significant improvements in weight (P < 0.001), BMI (P < 0.001), total energy (P = 0.006), carbohydrate (P = 0.001), protein (P = 0.001), and fat (P < 0.001) were found for the intervention group compared to the control group during the study. MET-min/week for moderate physical activity increased during the time for the intervention and control groups (P < 0.001 and P = 0.007, respectively). MET-min/week for walking activity rose in the post-intervention and follow-up compared to that in the baseline in the groups (P < 0.001 for both groups). Total physical activity was increased during the study (P < 0.001) for both groups. The mean of serum IgG and IgM titers against the virus were increased during the study in both groups in time effect (P < 0.001). There was a significant time x group interaction for carbohydrate and fat intakes (P = 0.005 and P = 0.004, respectively).

Conclusion

The web-based lifestyle intervention may improve nutritional status and physical activity, and have the potential to reduce the risk of contracting a COVID-19 infection.

Phase III Study of Hypofractionated, Dose Escalation Radiotherapy vs. Conventional Pelvic Radiation Therapy followed by High Dose Rate Brachytherapy Boost for High Risk Adenocarcinoma of the Prostate (PCS VI): Acute Toxicity Results

PURPOSE/OBJECTIVE(S)

The low α\β ratio of 1.2-2 for prostate cancer (PCa) suggests high radiation-fraction sensitivity and predicts a therapeutic advantage of lager fraction size. We have recently shown (PCS5) that high risk prostate cancer patients can safely and effectively be treated with moderate hypofractionated radiation therapy (HF-RT). To date there has been no phase-III randomized clinical-trial comparing moderately HF-RT with EBRT and HDR boost (HDRB). We are reporting the acute safety of EBRT+HDRB compared to moderate HF-RT in this phase III Canadian trial.

MATERIALS/METHODS

From January 2015-June 2022, 308 high-risk localized PCa patients were randomized to receive either HF-RT or EBRT+HDRB. All patients received neo-adjuvant, concurrent, and long-term adjuvant androgen deprivation therapy (ADT). EBRT+HDRB consisted of 46 Gy in 2 Gy per fraction to the pelvis and a 15 Gy in one fraction HDR boost within 3 weeks of EBRT. HF-RT include concomitant dose escalation of 68 Gy in 2.72 Gy per fraction to the prostate, and 45 Gy in 1.8 Gy per fraction to the pelvic lymph-nodes.

RESULTS

Of the 308 patients, 148 received HF-RT and 144 EBRT+ HDRB. The remainder either withdrew from the study or were treated with standard (2 Gy per fraction) fractionation for technical reasons. In both intention to treat and as treated analysis, using log-Rank, there were more grade 1 or worse (G1+) acute GI and GU events and more G2+ acute GI events in the HF-RT than EBRT+HDRB. As treated analysis the acute G1+ and G2+ GI events were 92 vs 77 (60.1% vs. 53.5%; p < 0.017) and 21 vs 10 (13.7% vs. 6.9%; p = 0.052), respectively for HF-RT and EBRT + HDRB. Similarly, the G1+ acute GU events were 123 vs. 101 (80.4% vs.70.1%; p < 0.001) respectively for HF-RT and EBRT+HDRB. There were only four G3 GI and one G3 GU acute toxicities in both arms. No grade 4 toxicities were reported.

CONCLUSION

This is the first study of EBRT+HDRB compared to moderate HF dose escalated RT in high-risk prostate cancer patients treated with long-term ADT and pelvic RT. Our results demonstrate that both treatment approaches are well-tolerated and that EBRT+HDRB carries less G2+ GI and G1+ GU acute toxicities.

Examining the efficacy of intravenous ibuprofen and meperidine for preventing post-operative shivering after laparoscopic cholecystectomy with general anesthesia

Postoperative shivering is a common complication that can lead to increased postoperative complications. This study aimed to compare the effectiveness of intravenous ibuprofen and meperidine in preventing shivering following laparoscopic cholecystectomy. A total of 120 patients, aged 20-70 and classified as ASA I-II, were enrolled in this triple-blind clinical trial. The participants were randomly assigned to one of three groups: ibuprofen (800mg IV), meperidine (30 mg), or placebo (normal saline 2 ml), administered 30 minutes before the end of surgery. The occurrence of postoperative shivering was assessed and recorded at regular intervals (0, 5, 10, 15, 30, and 60 minutes after surgery). Additionally, postoperative pain levels were measured using a visual analog scale (VAS), sedation levels were evaluated using the Ramsay Sedation Scale (RSS), and the incidence of postoperative nausea and vomiting was documented. The prevalence and severity of postoperative shivering were not statistically significant between groups. The VAS was significantly lower in the meperidine group than the ibuprofen group throughout the study (p <0.001). The VAS was significantly lower in the ibuprofen group than the placebo group at 0 and 15 minutes after surgery. Although the incidence of nausea was slightly higher in the meperidine group, the difference was not statistically significant (p=0.75). Sedation scores were consistently lower in the ibuprofen group and higher in the meperidine group compared to the other groups (p<0.0001) The meperidine group had a significantly higher sedation score indicative of deep sleepiness (score of 4) than the other groups. Intravenous ibuprofen demonstrated comparable efficacy to meperidine in controlling shivering. Additionally, the incidence of nausea, vomiting, and sleepiness was lower in the intravenous ibuprofen group, suggesting it is a potential alternative to meperidine.

Exploring nursing students' perceptions from nursing role function (SP-NRF) during the COVID-19 pandemic in Ardabil Province: a cross sectional study from Iran

BACKGROUND

Perception of nursing roles among nursing students significantly influences their active engagement in nursing processes and care delivery. However, there is evidence to suggest that students' interest in and perceptions from the nursing profession at the undergraduate level are often insufficient.

OBJECTIVE

This study aimed to assess nursing students' perceptions of nursing role function and identify areas that require improvement.

METHODS

A cross-sectional study was conducted in 2021 among nursing students in the third- and fourth-years from three faculties in the Ardabil Province. The participants were selected through census sampling. The data were collected through interviews with the Standardized Professional Nursing Role Function (SP-NRF) questionnaire. Statistical analysis was performed using the SPSS-18 software at a significance level of less than 0.05.

RESULTS

A total of 320 nursing students participated in this study. The mean score for nursing role perception was 223.1 ± 20.3 out of 255. The results indicated significant gender differences in the mean scores of perception of the nursing role function, particularly in the supportive, professional-moral care, and professional-educational dimensions. Women scored significantly higher than men did (P < .05). Additionally, students who obtained a mean score of 19 to 20 (A) had significantly higher total scores in perception of the nursing role function than other students. Furthermore, a positive correlation was observed between students' interest in nursing and their perceived ability with nursing role perception (r = .282, P < .01) and all its dimensions.

CONCLUSION

Overall, nursing students demonstrated a favorable perception of nursing role function. However, their perception of mental and spiritual care was relatively weak. These findings highlight the need to review nursing education programs and incorporate the spiritual care dimension to enhance students' understanding of and preparation for their role as nurses.

Potential of macronutrients and probiotics to boost immunity in patients with SARS-COV-2: a narrative review

Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-COV-2) may cause inflammation and increased cytokine secretion. Dietary factors may play an important role in enhancing the immune responses against infectious diseases such as SARS-COV-2. This narrative review aims to determine the effectiveness of macronutrients and probiotics to improve immunity in SARS-COV-2 patients. Dietary proteins may boost pulmonary function in SARS-COV-2 patients through inhibitory effects on the Angiotensin-converting enzyme (ACE) and reduce Angiotensin (ANG-II). Moreover, omega-3 fatty acids may improve oxygenation, acidosis, and renal function. Dietary fiber may also produce anti-inflammatory effects by reducing the level of high-sensitivity C-Reactive Protein (hs-CRP), Interleukin (IL-6), and Tumor necrosis factor (TNF-α). In addition, some evidence indicates that probiotics significantly improve oxygen saturation which may enhance survival rate. In conclusion, the consumption of a healthy diet including adequate macronutrients and probiotic intake may decrease inflammation and oxidative stress. Following this dietary practice is likely to strengthen the immune system and have beneficial effects against SARS-COV-2.

Action status and willingness to change health-promoting behaviors during the COVID-19 pandemic among elementary school children: a study based on Prochaska's stages of behavior change theory (TTM)

BACKGROUND & AIM

COVID-19 pandemic has significant effects on lifestyle and health-promoting behaviors and adolescence is a very critical period due to the importance of identity formation and individual behaviors. Therefore, the aim of this study was to determine the status of health- promoting behaviors in the sixth grade male students attending elementary schools in Ardabil city based on Prochaska 's stages of behavior change (TTM).

MATERIALS & METHODS

This analytical cross-sectional study was conducted on the 619 sixth grade male students attending elementary schools during 2021. The data were collected using two instruments (a researcher-made questionnaire and Health Promoting Lifestyle Profile-II (HPLP-II) questionnaire). The data were analyzed using SPSS version 22 and one-way analysis of variance.

RESULTS

The majority of students in physical activity and healthy eating behaviors were in the pre-contemplation stage, 29.6% (183 people) and 33.1% (205 people), respectively. All dimensions of health-promoting behaviors were observed to have a significant relationship with the stages of Prochaska's theory behavior change in students, their decision-making balance and self-efficacy scores (P < 0.001).

CONCLUSION

The health of students is under serious threat due to the poor state of health-promoting behaviors and the weak desire to change behavior. By planning in educating the students, significant changes can be made in changing their behavior and improving their health.

The Relationship between Professional Identity, Performance and Attitude to Medical Errors Self-reporting among Medical Students

INTRODUCTION

Medical errors are a serious problem in providing medical care and ensuring the health of society, and discovering the causes of errors to minimize the possibility of their occurrence is one of the main challenges in the field of treating patients. This study aimed to determine the relationship between professional identity, performance and attitude to self-reported medical errors among medical interns of Ardabil University of Medical Sciences.

METHODS

This cross-sectional analytical study was conducted on 187 medical interns with census method in five Ardabil educational hospitals in the second semester of 2020-2021. Data collection tool was a questionnaire consisting of 3 parts (demographic, self-reported attitude towards medical errors and professional identity). The validity of the questionnaire was evaluated using Content validity index (CVI) and Content validity ratio (CVR). The reliability of the attitude section was 0.78 and 0.86 for professional identity section. Data analyses were performed using the IBM SPSS Statistics, version 21 by descriptive statistics, such as mean and standard deviation and independent T-test, chi-square and one-way ANOVA. P-values <0.05 were considered statistically significant.

RESULTS

The mean scores of students' attitudes towards self-report and professional identity were 55.6±8.8 and 60.4±9.8. Less than 50% of the students declared the possibility of reporting their medical errors. There were no significant differences in the mean scores of self-reported attitude, medical error and professional identity according to grade point average, type of faculty and students' gender (P>0.05).

CONCLUSION

The attitude and performance of students regarding the self-disclosure of medical errors was not satisfactory, and it seems that the analysis of the educational programs in the education of medical errors and the legal and ethical aspects of errors needs serious attention.

Self-care behavior prevention of COVID-19 in the general population based on Pender Health Promotion Model: A cross-sectional study

Background and Aims

Coronavirus with its sudden and widespread outbreak has obviously imposed devastating consequences in various aspects of human life. The purpose of this study was to determine the predictive value of Pender's Health Promotion Model (HPM) structures in self‐care preventive behavior against coronavirus disease 2019 (COVID‐19) among the general population of Ardabil, Iran.

Methods

The present retrospective descriptive‐correlational study was conducted on citizens of Ardabil aged 18 years and over in 2021. After dividing the city of Ardabil into four parts, 50 people from each area of the city and a total of 200 people were selected through the available sampling method through social media. Data collection tools included a demographic profile, perceived self‐efficacy scale, perceived emotional questionnaire, perceived social support questionnaire, perceived benefits and barriers questionnaire, researcher‐made COVID‐19 self‐care questionnaire, and commitment to action questionnaire based on Pender's HPM structures in an online manner. Data were analyzed by Amos 22 software and using structural equation modeling.

Results

According to the results, direct path analysis to COVID‐19 self‐care behavior indicated that the variables of perceived self‐efficacy (β = 0.18, p < 0.01), interpersonal effects (β = 0.19, p < 0.01), positive emotion (β = 0.15, p < 0.05) and perceived benefits (β = 0.20, p < 0.01) are able to significantly predict self‐care behaviors. Moreover, the bootstrapping test results in the indirect path analysis demonstrated that the variables of perceived self‐efficacy (95% confidence interval [CI], 0.012, 0.066), perceived social support (95% CI, 0.002, 0.026), and perceived barriers (95% CI, −0.019, −0.002) and benefits (95% CI, 0.001, 0. 015) through the mediator variable of commitment to action are able to significantly predict COVID‐19 self‐care behavior.

Conclusions

Based on the findings of the present study, it can be claimed that the proposed model of COVID‐19 self‐care behavior has an acceptable fitness in the general population. This model can be used in developing educational programs and intervention techniques to modify people's attitudes and behaviors.

Masking Ability of Bleach Shade Composite Resins in Different Thicknesses

Introduction

In recent years, the use of bleach shade composite resins has increased due to the high esthetic demands. The aim of the present study was to investigate the masking ability and translucency of several bleach shade composite resins.

Materials and Methods

In this in vitro study, 180 discs from 9 bleach shade composite resins of 5 brands (G-aenial Anterior, Gradia Direct, Charisma Diamond, Estelite Sigma Quick, and Renamel Microfill) in thicknesses of 0.5, 1, 1.5, and 2 mm were prepared. The color parameters of the specimens were measured in a CIE l ∗ a ∗ b ∗ system using a spectrophotometer. Masking ability and translucency parameters were calculated, and the influence of thickness, shade, and composite resin brand on these variables was analyzed using the Kruskal-Wallis and Mann-Whitney U tests.

Results

Both masking ability and translucency differed significantly among groups (p < 0.001), but only MA was different between different brands (p < 0.001). Higher thicknesses showed lower translucency in all pairwise comparisons (p < 0.001). 0.5 mm-thick specimens had lower masking ability than 1.5 mm- (p=0.016) and 2 mm- (p=0.035) thick ones. However, masking ability of other thickness pairs did not show a significant difference (p > 0.05). G-aenial Anterior and Renamel Microfill had the highest and lowest masking ability. Bleach white shades had lower masking ability and higher translucency than extrawhite bleach shades.

Conclusion

Translucency and masking ability of bleach shade composite resins differed in different thicknesses, composite resin brands, and shade groups.

Assessing the Preparedness of Hospitals in Ardabil Province During COVID-19 Pandemic

Background: Hospitals, as the most important medical institutions, must be adequately prepared before accidents to cope with emergencies and provide rapid response to disasters. This study aimed to determine the preparedness of hospitals in Ardabil Province during the COVID-19 pandemic. Materials and Methods: The present study is a cross-sectional study, and the study population included all hospitals in Ardabil Province, Iran (17 hospitals in total). The data collection tool was a standard checklist of 92 questions for COVID-19 Crisis Preparedness issued by the Iran Ministry of Health and Medical Education. The obtained data were analyzed using descriptive and inferential statistics (the Pearson correlation analysis) in SPSS software v. 22. Results: The mean relative score of preparation for the COVID-19 pandemic was 80.27% among the hospitals in the province. In the studied hospitals, the relative scores of preparedness were as follows: leadership and coordination, 92.64%, resource management, 94.36%; information management, 79.90%; communications, 77.94%; human resources, 77.69%; surge-capacity, 86.55%; rapid identification, 57.18%; diagnosis, 71.32%; isolation and patient management, 81.09%; and infection prevention and control, 84.05%. Conclusion: The level of hospital preparedness in most dimensions (9 out of 10 dimensions) was good, and only in the area of ​​rapid identification was at a moderate level. However, further evaluation is needed at different stages of an epidemic.

Risk perception and adherence to preventive behaviours related to the COVID-19 pandemic: a community-based study applying the health belief model

BACKGROUND

Coronavirus disease 2019 (COVID-19), now a global pandemic, is a new, highly contagious, and preventable disease that has caused many deaths across the world. Correct understanding of the risks and following health instructions are among the most important self-care parameters.

AIMS

To assess people's perception of the risks and their adherence to recommended preventive behaviours regarding COVID-19 infection.

METHOD

This descriptive-analytical study was conducted with 1861 people residing in Ardabil province in 2020. The data were collected electronically and included four elements: demographic details; health belief model (HBM) constructs (perceived sensitivity, perceived severity and perceived benefits); beliefs about the effectiveness of disease prevention strategies; and complying with health behaviours. The data was analysed using SPSS-21 software.

RESULTS

Significant differences were found in the mean scores for beliefs about the effectiveness of preventative measures, the constructs of the health belief model, and compliance with preventive behaviours relating to the participants' gender, age, marital status and level of education. Beliefs and intention to stay at home, collectively predicted 54.7% of the variance in preventive behaviours.

CONCLUSIONS

Although a majority of participants had positive attitudes towards the effectiveness of preventive measures and adhered to them, some people who were not adherent with these healthy behaviours could be key participants in the next wave of the disease.

Managing Back to School Anxiety During a COVID-19 Outbreak

ABSTRACT

The outbreak of the coronavirus is becoming an international crisis these days, overshadowing everything. The outbreak of this disease in different countries, including Iran, has caused a lot of concern. In addition to the dangers it poses to human health, the spread of the virus has become a major challenge and a stressful test, putting additional pressure on these countries. Every step in the coming school year offers an opportunity for an ongoing two-way conversation with your child. Listen carefully to what they say and be careful not to burden them with your fears. Giving voice to concerns means sharing them so no one is holding their worries alone, and remember, kids' development is fluid and many kids can make up for lost time, academically and socially. Humans are resilient. Therefore, if schools do not open - or close their doors - it is important to be hopeful and positive about the future, despite everything that is currently being missed or delayed, whether academic or social.

COVID-19 Has Made the Elderly Lonelier

Loneliness is a major risk factor for the elderly and can double their problems. When COVID-19 started, things became more difficult for the elderly. The news that the elderly are at a higher risk for severe COVID-19 than others made the elderly lonelier. This is a library type study that was conducted over 2 months using valid scientific sources and books. Based on the findings of this study, we believe that focusing on education and reminding people of the necessary dos and don'ts of illness, modifying their diet, emphasizing masking, and even familiarizing the elderly with social media and virtual activities will prevent them from suffering loneliness.

Investigating the relationship between occupation and SARS-CoV2

BACKGROUND

Coronaviruses are a large family of viruses that have symptoms ranging from simple symptoms of colds to severe respiratory syndromes. In December 2019, cases of unknown pneumonia first appeared in Wuhan, China.

OBJECTIVE

The purpose of this study was to investigate the relationship between occupation and COVID-19 in the Ardabil Imam Khomeini hospital.

METHODS

This research was conducted as a cross-sectional and descriptive study. The questionnaires used in this study included demographic information to obtain the required information such as age, sex, clinical symptoms, underlying disease, type of drug used, smoking, occupation, hours of work, number of daily clients, use of mask or shield, type of working hours, weight and height and body mass index, number family, place of residence, role in the family, presence of an infected person in the family, communication with the suspect, observance or non-observance of health protocols. Our sample size consisted of 774 subjects, all patients at the Ardabil Imam Khomeini Hospital. The subjects were selected randomly.

RESULTS

The results of this study showed that the mean age of patients was 56.70 years, with a standard deviation of 18.20 years. Three hundred and sixty participants (46.5%) were female, and 414 (53.5%) were male. In terms of occupation distribution, 317 patients (41%) were housewives. In addition, 57 people (7.4%) were farmers or ranchers.

CONCLUSION

In general, it can be concluded that due to severity of infection and threat posed by Coronavirus and the risk of infections between different occupations like the taxi driver and medical staff, it is very important to find out what jobs are in the big threat.

Exploring nurses' perception of taking care of patients with coronavirus disease (COVID-19): A qualitative study

Aim

Healthcare staff, especially nurses, who are in the frontline of caring of patients with COVID-19 have valuable experiences about taking care of these patients. Therefore, the aim of this study was exploring nurses' perception of taking care of patients with COVID-19.

Design

This qualitative study was performed using the conventional content analysis method.

Methods

13 nurses who were taking care of patients with COVID-19 were selected using purposeful sampling in the Lorestan University of Medical Sciences. The data were collected through telephone interviews and analysed based on the Lundman and Graneheim's approach.

Results

Qualitative analysis of the data revealed 3 sub-categories, 8 categories and 3 main categories including care erosion, nursing professional growth and necessities.

Relevance to clinical practice

Improve the work situation of the nurses during care of COVID-19 patients, which can directly or indirectly improve the quality of care of these patients.

Exploring nurses' perception about the care needs of patients with COVID-19: a qualitative study

BACKGROUND

COVID-19 is a new disease affecting and killing a large number of people across the world every day. One way to improve health care for these patients is to recognize their needs. Nurses, as a large population of health care staff, can be rich sources of information and experience on patients' care needs. Therefore, the aim of this study was to explore nurses' perception about the care needs of patients with COVID-19.

METHODS

The present qualitative research was performed using the conventional content analysis approach in Iran from March to May 2020. The participants of this study included the nurses caring for patients with COVID-19, recruited by the purpose sampling method. The data was collected through 20 telephone interviews and analyzed based on the method proposed by Lundman and Graneheim.

RESULTS

Qualitative data analysis revealed six main categories including need for psychological consulting, need for quality improvement of services, need for upgrading of information, need for improving of social support, need for spiritual care and need for social welfare.

CONCLUSION

The data showed that patients with COVID-19 were psychologically, physically, socially, economically, and spiritually affected by the disease. Therefore, they should be comprehensively supported by health care staff and other supportive systems.

Exploring nurses' experiences of psychological distress during care of patients with COVID-19: a qualitative study

BACKGROUND

COVID-19 infection is a new disease that infects a large number of people, killing a ratio of whom every day in the world. Healthcare staff, especially nurses, experience a great deal of psychological distress during care of COVID-19 patients. Detecting factors that disturb nurses' mental health during care of these patients can help to reduce their psychological distress. Therefore, this study aimed to explore nurses' experiences of psychological distress during care of patients with COVID-19.

METHODS

The present qualitative research was performed using the conventional content analysis method in Iran from March to May 2020. Participants in this study included the nurses caring for patients with COVID-19, and they were selected based on the purposeful sampling method. The data was collected through 20 phone call interviews and analyzed based on the method proposed by Lundman and Graneheim.

RESULTS

Qualitative data analysis revealed 11 categories including death anxiety, anxiety due to the nature of the disease, anxiety caused by corpse burial, fear of infecting the family, distress about time wasting, emotional distress of delivering bad news, fear of being contaminated, the emergence of obsessive thoughts, the bad feeling of wearing personal protective equipment, conflict between fear and conscience, and the public ignorance of preventive measures.

CONCLUSION

The data showed that the nurses experienced a variety of psychological distress during care of patients with COVID-19. Through proper planning by authorities, it is possible to manage the risk factors of mental health distress in nurses and improve their mental health status.

Hospital nurses’ perception of evidence-based practice: A descriptive-analytical study

Background & Aim: Evidence-based practice refers to the use of the best research evidence, personal knowledge and clinical expertise, and patients’ values and preferences for the provision of healthcare services. This study aimed to evaluate hospital nurses’ perception of evidence-based practice. Materials & Methods: This descriptive-analytical study was conducted in 2015 on 374 nurses randomly recruited from five teaching hospitals in Ardabil and Khalkhal, Iran. Data were collected using the Evidence-Based Practice Questionnaire and analyzed through the SPSS software (v.13.0). Results: The total mean scores of nurses’ perception of evidence-based practice and its practice, attitude, and knowledge/skills domains were 107.40±18.76, 4.66±1.34, 3.63±1.48, and 4.63±1.03, respectively. The mean scores of these domains had significant correlations with each other (P<0.05). Conclusion: Nurses’ perception of evidence-based practice is at moderate level and hence, they have moderate readiness for evidence-based practice. Coherent policies, educational strategies, and environmental improvements are needed to improve nurses’ perception of evidence-based practice.

Randomised Phase II Feasibility Trial of Image-guided External Beam Radiotherapy With or Without High Dose Rate Brachytherapy Boost in Men with Intermediate-risk Prostate Cancer (CCTG PR15/ NCT01982786)

AIMS

We conducted a multicentre feasibility study to assess the ability to randomise patients between image-guided radiotherapy (IGRT) and IGRT + high dose rate (HDR) brachytherapy boost and to adhere to appropriate radiation quality assurance standards.

MATERIALS AND METHODS

The primary end point was to determine the ability to randomise 60 patients over an 18 month period. Arm 1 (IGRT) patients received 78 Gy in 39 fractions or 60 Gy in 20 fractions (physician's preference), whereas arm 2 (IGRT + HDR) received 37.5 Gy in 15 fractions with HDR boost of 15 Gy. The secondary end points included >grade 3 acute genitourinary and gastrointestinal toxicity, using Common Terminology Criteria for Adverse Events version 4.0 at 3 months, validation of a prospectively defined radiation oncology quality assurance to assess treatment compliance. All analyses were descriptive; no formal comparisons between treatment arms were carried out.

RESULTS

Between April 2014 and September 2015, 57 National Comprehensive Cancer Network (NCCN)-defined intermediate-risk prostate cancer patients were randomised between IGRT alone (arm 1; n = 29) and IGRT plus HDR brachytherapy boost (arm 2; n = 28). Overall, 93% received the treatment as randomised. There were four patients (one on IGRT arm 1 and three patients on the IGRT + HDR arm 2) who were treated differently from randomisation assignment. For the 29 patients receiving IGRT (arm 1), there were 14 cases reported with minor deviations and three with major deviations. For patients on IGRT + HDR (arm 2), there were 18 cases reported with minor deviations and two with major deviations. At 3 months in the IGRT group (arm 1), one patient reported grade 3 diarrhoea, whereas in the IGRT + HDR group (arm 2), two patients reported grade 3 haematuria. No other gastrointestinal and genitourinary toxicities were reported.

CONCLUSION

The pilot study showed the feasibility of randomisation between treatment with IGRT alone versus IGRT + HDR boost. Treatment compliance was good, including adherence to quality assurance standards.

Characterization of Pepper leafroll chlorosis virus, a New Polerovirus Causing Yellowing Disease of Bell Pepper in Saudi Arabia

During the growing seasons of 2014 through 2016, a total of 336 leaf samples from bell pepper (showing leafroll and interveinal yellowing) and arable weeds were collected from Riyadh region, Saudi Arabia. The use of a polerovirus generic reverse transcription (RT)-PCR assay confirmed their presence in the bell pepper samples. Sequencing of the generic amplicon revealed high similarity (87.6 to 98.1% in nt) with four poleroviruses; Tobacco vein distorting virus, Pepper vein yellows virus, Pepper yellows virus, and Pepper yellow leaf curl virus. To further characterize one of these isolates (105D), a larger part of the genome (∼1,300 nt) spanning approximately from the 3' end of ORF2 to the middle of ORF3, was amplified and sequenced. Blasting the resulting sequence revealed the low amino acid and nucleotide identity percentages in the coat protein and movement protein partial genes with viruses deposited in GenBank. Next-generation sequence was used to acquire a larger part of the genome, which resulted in the reconstruction of isolate 105D's partial genome (5,496 nt). Sequence similarity analysis revealed the presence of a divergent polerovirus isolate belonging to a new species that was tentatively named Pepper leafroll chlorosis virus (PeLRCV). Using a specific RT-PCR assay for this isolate confirmed the presence of this new viral species in the symptomatic peppers. Aphid transmission experiments showed that PeLRCV is vectored by Aphis gossypii and that it can infect at least five out of the 15 different plants species tested. Based on our findings, PeLRCV is a new member of genus Polerovirus in the family Luteoviridae.

Explaining the role of organizational culture on succession-planning at the Ministry of Health and Medical Education: A qualitative study

Background

Developing and guiding new knowledge are futile unless the organizational culture can also be transformed. Future leaders cannot emerge out of an organizational environment that is not conducive to the accumulation of experiences.

Objective

The aim of this study was to explore the role of organizational culture in creating a succession-planning system at the Ministry of Health and Medical Education in 2014.

Methods

The present qualitative framework analysis held interviews with 23 director generals, administrative directors and deputies from the headquarters of the Iranian Ministry of Health and Medical Education in 2014 who were selected through snowball sampling. The data obtained were analyzed in MAXQDA-10. Codes were extracted using inductive techniques.

Results

The cultural factors affecting succession-planning at the Ministry of Health and Medical Education were identified and classified under three main areas, including the cultural factors related to the directors with four themes (Directors’ job security, Constructive competition, Transparency and trust development, Creating opportunities), to the personnel with four themes (Organizational identity and loyalty, Trust in the organization, Talent and merit, Peer envy) and to the system with two themes (Values and beliefs, Politicization).

Conclusion

Findings of the study show that establishment and institutionalization of the succession planning to the Ministry of Health and Medical Education is deeply affected by the components of organizational culture. Accordingly, unprofessional organization culture can deprive the organization of numerous advantages in multiple-succession planning.

Correlation of serum intercellular adhesion molecule 1 and vascular endothelial growth factor with tumor grading and staging in breast cancer patients

BACKGROUND

Breast cancer is the most common cancer among women. There are several prognostic factors for this disease. The aim of this article is to explore the correlation of serum level of vascular endothelial growth factor (VEGF) and intercellular adhesion molecule 1 (ICAM1) with tumor, node, metastasis staging and grading of breast cancer.

MATERIALS AND METHODS

Serum samples of 51 patients with breast cancer were assessed with enzyme-linked immunosorbent assay for the level of VEGF and ICAM1 preoperatively. After the operation, histopathologic specimens stained with hematoxylin and eosin were evaluated for tumor size, histopathologic subtype, grade, lymph node, vascular and lymphatic involvement. Then, the correlation of tumor stage and grade and serum level of markers was analyzed.

RESULTS

There was no significant correlation between serum level of markers with vascular invasions, lymph node involvement, and menstruation. There was a weak correlation between tumor size and serum level of ICAM1 with Pearson score correlation, but there was no significant correlation with VEGF. There was no significant correlation between tumor grading and staging with the level of markers. There was a significant correlation between the level of VEGF and ICAM1 and histologic type of tumors in invasive through in situ tumors.

CONCLUSION

Levels of VEGF and ICAM1 can be used as a predictor of tumor invasion and also for target therapy.

Customers' satisfaction about prehospital emergency medical services in Lorestan, Iran

Introduction

Patient’s satisfaction with health care in ambulance services is an important quality indicator and a helpful tool for managers of prehospital emergency services. This study aimed to measure patient satisfaction with health provided by prehospital emergency medical services (EMS) in Lorestan, Iran.

Methods

This cross-sectional study was conducted on patients (n=450) transferred by EMS to hospitals of Lorestan University of Medical Sciences in a two-year period (2013–2014). Data collection was performed by patient questionnaire, which is a standard LKFR tool. Validity and reliability of the instrument was confirmed by scientific method. Collected data were analyzed by SPSS Version 19. Descriptive and inferential statistics such as Chi-square, paired-samples t-test, independent-samples t-test, ANOVA, Pearson’s product-moment correlation coefficient, and Fisher’s exact test were used.

Results

One hundred ninety-two (42.8%) and 257 (57.2%) patients were female and male, respectively (mean: 41 years, r: 37–83). Patient satisfaction of the dispatcher was good, and satisfaction level in regards to the technicians’ performance, physical situation, and facilities inside the ambulance was moderate. The Wilcoxon test did not show any significant difference between pain severity before and after arriving EMS in the cardiac and respiratory patients (p=0.691), but severity of pain in orthopedic patients after arriving EMS was decreased (p=0.001). Cardiac and respiratory patients had low satisfaction of EMS, and the Chi-square test was significant (p=0.001). Orthopedic patients had the most satisfaction of EMS.

Conclusion

Generally, patients’ satisfaction of EMS was low. Satisfaction with pain relief in orthopedic patients was better than pain relief in cardiac and respiratory patients. It is recommended to take necessary actions to improve the level of patient satisfaction of EMS.

Breast and cervical cancer-screening uptake among females in Ardabil, northwest Iran: a community-based study

PURPOSE

Breast and cervical cancers are the most commonly diagnosed type of cancer and cause of cancer-related deaths in Iranian females. In contrast to previous studies, this study was carried out with a large sample size for assessment of breast self-examination (BSE)-, clinical breast examination (CBE)-, mammography-, and Pap smear-uptake rates and determination of associations among these screening behaviors with sociodemographic and cognitive variables in Azeri females.

MATERIALS AND METHODS

This was a cross-sectional, community-based study that was carried out among 1,134 females 20-60 years old during March-June 2016. Data-collection variables included sociodemographic questions, screening behaviors for breast and cervical cancer, self-efficacy, beliefs, and barriers to breast and cervical cancer screening. Collected data were analyzed by SPSS version 13 using χ2, Mann-Whitney U, and logistic regression tests.

RESULTS

Among the 1,134 participants, 53.9%, 9.8%, and 28.1% had done BSE, CBE, and Pap smear tests, respectively, and among the 625 females aged >40 years, 187 (29.9%) had done the mammography test. Moreover, 416 (36.7%), 103 (16.5%), and 64 (5.6%) females had done BSE, mammography, and CBE regularly, respectively. Beliefs, barriers, income, health insurance, number of children, and age were all important factors for BSE and regular BSE and mammography. Females who had high belief scores were more likely to undertake mammography (odds ratio [OR]: 1.2, 95% confidence interval [CI]: 1.03-1.5), regular mammography (OR: 4.2, 95% CI: 1.9-9.3), regular CBE (OR: 1.25, 95% CI: 1.2-1.3), and Pap smears (OR: 1.2, 95% CI: 1.1-1.4). Also, females who had high self-efficacy scores were more likely to perform regular BSE (OR: 1.8, 95% CI: 1.4-2.5) and mammography (OR: 2.5, 95% CI: 1.4-4.6) than females with lower self-efficacy scores.

CONCLUSION

The frequency of breast and cervical cancer screening was low in our study. The findings of this study indicated that beliefs, self-efficacy, and barriers were important predictive factors of cancer-screening behavior among the females studied.

The Effect of Theory Based Nutritional Education on Fat Intake, Weight and Blood Lipids

INTRODUCTION

Though Nutrition plays a key role in the control of hypertension, it is often forgotten in Iranian patients' diet. In fact, dietary behavior can be regarded as unsatisfactory among Iranian patients. This study was aimed to assess the effectiveness of theory based educational intervention on fat intake, weight, and blood lipids among rural hypertensive patients.

METHODS

This quasi experimental study was conducted on 138 hypertensive patients who had referred to Ardabil rural health centers during 2014. The nutritional education based on DASH and Health Promotion Model (HPM) was treated for six sessions. The pre-test and post-test had intervals of two and six months. Data were analyzed using SPSS-18 and Chi-square, independent-samples t-test, paired-samples t-test and repeated measure ANOVA.

RESULTS

After treating intervention, weight, dietary fat, LDL_C and Total cholesterol, systolic and diastolic blood pressures decreased significantly in the intervention group compared with the control group (p < 0.001). In contrast, HDL_C increased significantly in the intervention group.

CONCLUSION

Educational intervention, provided based on Pender's health promotion model, affecting fat intake, blood lipids, and blood pressure, led to their decrease.

Skin cancer preventive behaviors among rural farmers: An intervention based on protection motivation theory

Background: Skin cancer is a serious public health problem in the world. Its prevalence in many countries has been increased in recent years. This study aimed to assess the effects of a theory-based educational intervention to promote skin cancer preventive behaviors (SCPBs) among rural farmers in Chalderan County, Iran. Methods: This was a quasi-randomized controlled field trial study conducted on 238 rural farmers. The data were collected by a questionnaire containing the constructs of the Protection Motivation Theory (PMT) as well as the items of SCPBs. The differences between the groups before and 3 months after the intervention were determined by independent t-test, paired t-test, and chi-square applying SPSS software. Results: Before the intervention, no significant difference was found in the scores of the PMT constructs between the two groups (p>0.05). However, significant differences were found between the scores of all the variables, as well as SCPBs, in the two groups after the intervention (p<0.05). Conclusion: The PMT was found to be an appropriate framework for designing educational interventions aiming at promoting SCPBs among rural farmers. It was concluded that designing an educational program with a focus on promoting perceived susceptibility increased the level of performing SCPBs among the rural farmers.

Can theoretical intervention improve hand hygiene behavior among nurses?

Background

Hand washing is the best strategy to prevent known nosocomial infections but the nurses’ hand hygiene is estimated to be poor in Iran.

Objective

This study aimed to determine the effectiveness of BASNEF (Behavior, Attitude, Subjective Norms, and Enabling Factors) model on hand hygiene adherence education.

Methods

This controlled quasi-experimental study was conducted on 70 hemodialysis unit nurses (35 case and 35 control) in the health and educational centers of the University of Medical Sciences of Urmia, Iran. To collect the data, a six-part validated and reliable questionnaire was used. The data were analyzed using SPSS version18, using Wilcoxon, Mann–Whitney, chi-square, and Fisher’s exact tests. The significance level was considered P<0.05.

Results

The mean age was 38.4±8.1 years for the intervention group and 40.2±8.0 years for the control group. There was no significant difference between the two groups for any demographic variables. Also, before the intervention, there was no significant difference between the two groups for any components of the BASNEF model. Post-intervention, the attitude, subjective norms, enabling factors, and intention improved significantly in the intervention group (P<0.001), but hand hygiene behavior did not show any significant change in the intervention group (P=0.16).

Conclusion

Despite the improving attitudes and intention, the intervention had no significant effect on hand hygiene behavior among the studied nurses.

Associations between Self-medication, Health Literacy, and Self-perceived Health Status: A Community-Based Study

BACKGROUND

Although the frequency of self-medication has been well-documented in the public health literature, but no study has examined the relationship between health literacy and self-medication yet. This study was aimed to investigating the relationship between health literacy and self-medication in a community-based study.

METHODS

This cross-sectional study was conducted on 924 adults to survey association between health literacy and self-medication among peoples in Ardabil city in 2014 who were selected using a multi-stage random sampling method. Health literacy was measured by the test of functional health literacy in adults and general health status was measured by the 12-item General Health Questionnaire, and self-reported self-medication (overall, sedative, antibiotic and herbal) in last 3 months was assessed. All statistical analysis was performed using the SPSS version 18 and a P < 0.05 was considered significant.

RESULTS

The mean age and weight of respondents were 37 years and 74.7 kg, respectively. The prevalence of self-medication was 61.6%, and the percentage of self-administering antibiotics, sedative, and herbal medicines were 40%, 54.4%, and 59.1% in the last 3 months, respectively. Significant relationship was found between of total health literacy and general health status with self-medication. The prevalence of self-medication among participants with poor and very poor self-rated physical and mental health was significantly higher than other participants (P < 0.001).

CONCLUSIONS

Self-medication had a significant relationship with health literacy and health status. Therefore, the design and implementation of training programs are necessary to increase the perception on the risk of self-medication.

Is there still an immunity gap in high-level national immunization coverage, Iran?

As there is a significant number of Iranian immigrant and illegal refugees living in marginal areas of large cities that might induce immunization gap in these areas.  The aim of this study was to provide reliable information on vaccination status of these people. A cross sectional study was conducted on children 24-47 month old who lived in the suburb areas of five large cities of Iran in 2013. Proportional cluster sampling method was used in each city and standard questionnaire of the World Health Organization applied for the purpose of data collection. The survey counts immunizations based on immunization card plus the history of vaccination according to the mother's memory. All gathered data were analyzed using SPSS software (version 16). Overall, 4502 children (49.2% female) aged 24-47 month participated in this survey among which 88.1% were Iranian and 11.9% were Afghan or other nationalities. Totally, 4479 (99.4%, CI 95%: 99.2%-99.6%) of the children had a vaccination card while 828 (18.5%, CI 95%; 15.8%-21.1%) could not present it to the interviewers. 96.8% of children were fully immunized, 3.2% were partially immunized and 0.1% were not immunized. There was no significant difference in terms of vaccine coverage among males and females. The prevalence of partially immunization in non-Iranian children was six fold of Iranian children (11.9% vs. 2%). Immunization program is implemented appropriately with high coverage rates in suburb areas of the country. However, there is still an immunity gap in non-Iranian immigrants, which should be a health system considered as a high-risk group by the health system.

The relationship between blood pressure and the structures of Pender's health promotion model in rural hypertensive patients

INTRODUCTION AND OBJECTIVE

Perception is the most important predictor of behavior and there is a strong relation and correlation between behavior and believes. Thus, to improve self-care behaviors of patients, it is required to fully understand their perceptions about behavior. This paper aimed to assess the prediction power of health promotion model of systolic blood pressure (SBP) as the result of self-care behavior in rural hypertensive.

METHODS

This cross-sectional study has been carried out through random multistage sampling on 671 rural patients under the coverage of health center of Ardebil city in 2013. Data were collected through reliable and valid questionnaire based on the health promotion model in eight sectors. For data analysis, Pearson correlation statistical tests, multivariate linear regression, ANOVA and independent t-test were used and for confirmatory factor analysis, SPSS 18 and AMOS 18 (SPSS Inc., Chicago, IL, USA) were used.

RESULTS

The results showed significant negative correlation between self-efficacy, perceived benefits, situational influences, affects related to behavior and commitment to action structures with SBP and showed a positive significant correlation between perceived barriers and SBP. Furthermore, age and body mass had direct significant relation with SBP. The age of patients showed inverse significant correlation with self-efficacy, perceived benefits, affects related to behavior, interpersonal influences and commitment and showed a direct significant correlation with perceived barriers, means that by increase of age, the perceived barriers also increased. The structures of health promotion model have in overall the prediction power of 71.4% of SBP changes.

CONCLUSION

The diet perceptions of patients, the same as health promotion model, has good predictive power of SBP, especially the structures of perceived benefits and self-efficacy have inverse meaningful relation with systole blood pressure and predicted a higher percentage of this variable.

Sodium intake prediction with health promotion model constructs in rural hypertensive patients

BACKGROUND

Hypertension is the most common cause of cardiovascular disease, and the growing epidemic is a serious warning to pay more attention to this disease. The aims of this study were to examine the relationships between the health promotion model (HPM) constructs and sodium intake, and to determine the predictive power of the HPM constructs as the possible mediators of sodium intake in rural Iranian hypertensive patients.

MATERIALS AND METHODS

This cross-sectional study was conducted on 671 hypertensive patients in Ardabil, Iran in 2013. The data were obtained during a 25-40 min face-to-face conversation by validated and reliable instruments. The nutritional data were assessed with Nutritionist version 4 (N4) software. Descriptive statistics, Spearman's correlations were calculated using SPSS Statistics version 18.0. Structural equation modeling was conducted using AMOS version 18.

RESULTS

Sodium intake was negatively correlated with perceived benefits (r = -0.707; P < 0.01), perceived self-efficacy (r = -0.719; P < 0.01), situational influences (r = -0.590; P < 0.01), interpersonal influences (r = -0.637; P < 0.01), commitment to action (r = -0.605; P < 0.01), affects related behavior (r = -0.499; P < 0.01), and positively associated with the perceived barriers score (r = 0.563; P < 0.01). The structural equation modeling showed that the model explained 63.0% of the variation in sodium intake.

CONCLUSIONS

HPM constructs were significantly associated with sodium intake and dietary perceptions based on HPM constructs can predict acceptable rate of the variation of sodium intake. Therefore, we suggest using this model constructs to improve the effectiveness of nutritional interventions.

Determinants of Patient's Adherence to Hypertension Medications: Application of Health Belief Model Among Rural Patients

Background:

Hypertension is a major health problem in developing and developed countries, and its increasing epidemy is a serious warning to take more attention to this silent disease.

Aim:

This study was aimed to determine the factors of adherence to hypertension medication based on health belief model (HBM).

Subjects and Methods:

A cross-sectional study was conducted in a rural area of the Ardabil city in 2013. This study was carried out using a pre-structured and validated questionnaire. The questionnaire included information on demographic characteristics, lifestyle habits, HBM constructs and adherence to hypertension medication (Morisky 4-Item Self-Report Measure of Medication-taking Behavior [Morisky Medication Adherence Scale]). Data were analyzed with the use of SPSS version 18. P < 0.05 was considered as statistically significant.

Results:

A total of 671 hypertensive patients participated in the study (169 were males and 502 were females). The prevalence of adherence was 24% (161/671)% in the study population. Respondents with regular physical activity and nonsmokers were more adherent to hypertension medication when compared to respondents with sedentary lifestyle and smoking (P < 0.01). Based on HBM constructs, the respondents who perceived high susceptibility, severity, benefit had better adherence compared to moderate and low susceptibility, severity, and benefit.

Conclusion:

The prevalence of adherence to hypertension management was low in study population, this due to inadequate perceived susceptibility, perceived, severity, perceived benefit and poor lifestyle factors. Improving adherence in hypertension patients need to recognize the value and importance of patient perceptions medications.

First Report of Tomato spotted wilt virus in Lettuce Crops in Saudi Arabia

A survey for viruses in open field lettuce crops was carried out in March 2014 in the Al-Uyaynah area, central region of Saudi Arabia. In one plot, more than 50% of the lettuce plants (Lactuca sativa; hybrid: Romaine), with the majority of the affected plants in the edges of the plot, were showing virus-like symptoms such as necrotic lesions, necrosis of the lamina of the younger leaves, and leaf curling, indicating a possible infection by a Tospovirus, possibly Tomato spotted wilt virus (TSWV). Most of them were dead when the field was visited again 3 weeks later. Samples from 10 symptomatic and two asymptomatic plants were collected. Five of the samples from symptomatic and two from asymptomatic plants were mechanically inoculated onto Nicotiana benthamiana and N. glutinosa (three indicator plants of each species were used for each sample) using 0.1 M phosphate buffer (pH 7) containing 0.01M Na₂SO₃ mM. All the symptomatic lettuce samples were also tested serologically using polyclonal antisera (3) against TSWV, CMV, and by using monoclonal antibodies against potyviruses. Moreover, total RNA was extracted (1) and detection of TSWV was also attempted with reverse transcription (RT)-PCR using species specific primers (4) for a 276-bp fragment of the L RNA segment. In both serological and molecular methods, positive and negative controls were included. All the mechanically inoculated plants with tissue from the symptomatic lettuce plants of N. benthamiana showed chlorotic local lesions followed by systemic top necrosis 2 to 3 weeks post inoculation. Similarly, all inoculated N. glutinosa plants showed necrotic local lesions followed by systemic chlorosis. However, all the indicator plants mechanically inoculated with tissue from asymptomatic lettuce plants gave no reaction. All the symptomatic lettuce samples reacted positively, while asymptomatic samples reacted negatively in ELISA tests with TSWV antiserum and the presence of the virus was further confirmed by RT-PCR by using specific primers (method A) (4). PCR products of two randomly selected positive samples were directly sequenced and BLAST analysis of the obtained sequences (Accession Nos. KJ701035 and KJ701036) revealed 99% nucleotide and 100% amino acid identity with the deposit sequence in NCBI from South Korea (KC261947). Regarding mechanical inoculation, 10 days post-inoculation, both indicator plants showed typical symptoms of TSWV infection, such as necrotic local lesions, systemic necrotic patterns, and leaf deformation. None of the symptomatic plants was found to be infected with either CMV or potyvirus. To our knowledge, this is the first report of TSWV naturally infecting lettuce in Saudi Arabia; therefore, insect vector and weed management are necessary measures to control the virus spread to other crops such as tomato and pepper (2). References: (1) E. Chatzinasiou et al. J. Virol. Meth. 169:305, 2010. (2) E. K. Chatzivassiliou. Plant Dis. 92:1012, 2008. (3) E. K. Chatzivassiliou et al. Phytoparasitica 28:257, 2000. (4) R. A. Mumford et al. J. Virol. Meth. 46:303, 1994.

Psychometric testing of an instrument designed to measure nutritional perceptions of hypertensive patients

INTRODUCTION

Measurement tools designed to ensure the achievements of studies' objectives must be evaluated. Based on the health promotion model (HPM), the present study was conducted to assess the validity and reliability of the designed questionnaire of hypertensive patients' nutritional perceptions.

METHODOLOGY

In a cross-sectional study, the mentioned questionnaire was assessed based on opinions of 11 experienced faculty members and 671 hypertensive patients in rural areas in the year 2013. To evaluate the reliability, internal consistency (Cronbach's alpha) was calculated. Concerning the validity of the questionnaire, its content and construct validity were examined. Data analysis was performed using Statistical Package for the Social Sciences version 18 (SPSS Inc., Chicago, IL, USA).

RESULTS

Spearman-Brown and Cronbach's alpha coefficients results were acceptable in all constructs indicating a satisfactory reliability of the questionnaire. Questionnaire's questions were highly correlated with the total score signifying the internal consistency of the questions; therefore, all questions had a similar effect on the total score and the removal of each did no increase the alpha significantly (all questions had acceptable reliability). Factor analyses showed that all questions had acceptable factor loading and suitable validity. Moreover, the entire constructs of the questionnaire were approved by experts with high validity coefficient of 0.9.

CONCLUSION

The designed questionnaire for assessment of the HPM constructs regarding hypertensive patients' nutritional issues had appropriate psychometric characteristics. Reliability and validity of the questionnaire were also satisfactory and its overall structure was approved.

Earliness per se QTLs and their interaction with the photoperiod insensitive allele Ppd-D1a in the Cutler × AC Barrie spring wheat population

Earliness per se regulates flowering time independent of environmental signals and helps to fine tune the time of flowering and maturity. In this study, we aimed to map earliness per se quantitative trait loci (QTLs) affecting days to flowering and maturity in a population developed by crossing two spring wheat cultivars, Cutler and AC Barrie. The population of 177 recombinant inbred lines (RILs) was genotyped for a total of 488 SSR and DArT polymorphic markers on all 21 chromosomes. Three QTLs of earliness per se affecting days to flowering and maturity were mapped on chromosomes 1B (QEps.dms-1B1 and QEps.dms-1B2) and 5B (QEps.dms-5B1), in individual environments and when all the environments were combined. A QTL affecting flowering time (QFlt.dms-4A1) was identified on chromosome 4A. Two grain yield QTLs were mapped on chromosome 5B, while one QTL was mapped on chromosome 1D. The population segregated for the photoperiod insensitive gene, Ppd-D1a, and it induced earlier flowering by 0.69 days and maturity by 1.28 days. The photoperiod insensitive allele Ppd-D1a interacted in an additive fashion with QTLs for flowering and maturity times. The earliness per se QTL QFlt.dms-5B.1 inducing earlier flowering could help to elongate grain filling duration for higher grain yield. Hence, chromosome 5B possesses promising genomic regions that may be introgressed for higher grain yield with earlier maturity through marker-assisted selection in bread wheat.

Microbial contamination of pumice used in dental laboratories

Dental appliances as well as sending and receiving prosthesis from laboratories are potential sources of cross-contamination for technicians, dentists, patients and can transmit different infectious agents as well. This study was conducted to determine the types of the microorganisms in pumice powder and pumice slurry used in dental laboratory in order to evaluate necessary disinfection control procedure in the dental settings. Twenty-four active dental laboratories of Khorram Abad participated in our study. Samples were randomly collected from prosthesis polishing containers in sterilized condition and were immediately sent to microbiology laboratory. Specimens were cultured on selective bacterial and fungal media in order to determine the microorganisms. Both oral and non-oral bacteria were recovered from pumice samples as follows: Staphylococcus aureus (15.4%), Streptococcus viridance (10.8%), Bacillus cereus (18.7%), Pseudomonas aeruginosa (12.8%), Diphtheriods (7.3%), Enterobacter cloace (4.3%), Escherichia coli (13.1%), Klebsiella pneumonia (5.4%), and Acinetobacter spp. (12.2%). The isolated fungi included Candida albicans (36.7%), other yeasts (17.3%), Fusarium spp. (13.8%), Aspergilus spp. (22.4%) and Penicillium spp. (9.8%). This study showed that polishing pumices in the form of powder or slurry were contaminated with different oral and non-oral bacteria and also fungi. Therefore, the chance of cross-contamination still severely exists, and measures should be conducted to prevent the contamination of predisposed people such as technicians, dentists and patients.