Reliability of muscle stiffness measures in popliteus, medial and lateral gastrocnemius muscles by ultrasound shear wave elastography in participants with knee osteoarthritis accompanied by myofascial trigger points

BACKGROUND

The objective of this investigation is to evaluate the consistency of intra-rater and inter-rater assessments utilizing ultrasound elastography to examine the muscle stiffness of the popliteus and gastrocnemius (medial and lateral heads) in patients with knee osteoarthritis accompanied by myofascial trigger points.

METHODS

Thirty individuals with knee osteoarthritis accompanied by myofascial trigger points were assessed. Two examiners independently measured the muscle stiffness levels of the popliteus and gastrocnemius (medial and lateral heads) three times using ultrasound elastography in the first session. The second session was conducted one week later.

RESULTS

In the initial test session, the mean shear modulus values for the popliteus and gastrocnemius (medial and lateral heads) muscles were measured as follows for tester 1 (12.75, 13.72, 14.13 kPa) and tester 2 (11.66, 12.81, 13.17 kPa). During the retest session, the previously measured variables by tester 1 and tester 2 yielded the following values: (12.61, 13.43, 14.26 kPa) and (11.62, 12.87, 13.30 kPa) respectively." Good to excellent intra-rater reliability (ICC = 0.912-0.986) and inter-rater reliability (ICC = 0.766-0.956) were reported for the shear moduli of the popliteus, medial and lateral gastrocnemius muscles.

CONCLUSIONS

The assessment of muscle stiffness in the popliteus and gastrocnemius (medial and lateral heads) using ultrasound elastography is a reliable method in patients with knee osteoarthritis accompanied by myofascial trigger points.

An application of social marketing for promoting HIV testing in Iran

BACKGROUND

It has been estimated that 60,000 Iranians have been infected with HIV/AIDS and only 36% of them are aware of their status. This study aimed to design, implement and evaluate a social marketing campaign to promote HIV testing in Boyer-Ahmad County, Kohgiluyeh, and Boyer-Ahmad Province, southwest of Iran.

MATERIALS AND METHODS

This study was a quasi-experimental pretest-posttest without a control group, developed based on a social marketing assessment and response tool. To design the intervention formative research was conducted, comprised of four focus group discussion sessions with 42 participants of the target community along with seven in-depth semi-structured personal interviews with health care providers involved in the HIV/AIDS Program. Data analysis was done manually using content analysis and the main content was formulated for the campaign. Afterward, the slogan and messages of the campaign were developed. The campaign's materials including banners, posters, pamphlets, referral forms, and short messages were designed, pretested, and revised. Ultimately, the campaign was conducted for one month in October 2019. To determine the effectiveness of the campaign, the rate of referrals to the Center for Behavioral Health Counseling Services (CBHCS), for three months before and after the campaign, was compared.

RESULTS

Qualitative findings identified that the majority of the interviewees mentioned that the main reasons for the low rate of referrals to get tested for HIV were lack of awareness and information about HIV/AIDS and its diagnosis as well as the free and confidential tests available from the CBHCS. Moreover, the stigma associated with HIV/AIDS was another important reason for low referrals for testing. The rate of referrals for HIV testing in the three months leading up to the campaign was 18, 32, and 23 people, and three months after the campaign was 64, 81, and 44 individuals; respectively. The results of the multivariate analysis demonstrated that the campaign had increased the rates of referrals for HIV testing through its significant influence on females, and individuals with academic degrees.

CONCLUSION

It can be concluded that the social marketing campaign was successful in persuading people to get tested for HIV.

The Iranian National Blood Pressure Measurement Campaign: What Do the Process and Output Evaluation say?

BACKGROUND

The Iranian National Blood Pressure Measurement Campaign (INBPMC) was conducted all over the country to raise awareness in different groups of people regarding the importance of blood pressure and persuading them to manage their blood pressure. The present research aimed at assessing the process and output of this campaign.

METHODS

For process evaluation, 31 universities/faculties were selected. Experts from the Ministry of Health and Medical Education assessed the documentation of the campaign implementation using the designed checklist. The output was assessed by including 8274 people and through a telephone survey using the designed instructions.

RESULTS

The response rate of the telephone interviews was 82.74% (8274 people). It was found that 79% of the selected groups were aware of the INBPMC. Among them, 64% remembered the messages, 99% of the participants who remembered the messages agreed with those messages, and 89% of the participants who agree with the messages went for a measurement of their blood pressure. In the telephone interviews, 30% of the participants stated that they were diagnosed with hypertension, 97% of these participants received the required consultations for subsequent care, and 86% of them went to the health service centers to receive care. The process evaluation of the INBPMC indicated that the universities of medical sciences obtained 97% of the score of the checklist.

CONCLUSION

The INBPMC was successful and accomplished its objectives.

Designing a Social Marketing-Based Intervention to Promote Sun-protective Behaviors among Urban Adolescent Boys: A Study Protocol

Background

Skin cancer is one of the most preventable diseases. The purpose of this study is to describe a social marketing-based intervention design protocol to promote sun-protective behaviors among adolescent boys living in urban areas in Yasuj, south west of Iran.

Methods

This study will be conducted based on six specific steps including a qualitative study, a systematic review, development of appropriate tools, a cross-sectional study, intervention designing, and a feasibility study. The main objective of the qualitative study is to elicit the views and opinions of adolescent boys, their parents, and teachers about sun-protective behaviors. In the second step, factors affecting sun-protective behaviors will be reviewed systematically. Based on the findings of the first and second steps, an appropriate model/theory of behavior change will be selected, and a standardized questionnaire will then be developed. In the fourth step, a cross-sectional survey will be conducted using the developed questionnaire to assess current sun-protective behavior practices.

Results

Findings of the first to fourth stages will provide a comprehensive picture of the issue and the affecting factors. During the fifth step, the structure and the content of the intervention package, as well as educational and promotional materials, will be developed and pre-tested. Finally, in the sixth step, a feasibility study will be conducted.

Conclusion

This study will provide practical information on the achieving of content and construct of a community-based social marketing intervention. This protocol reports on how to achieve audience-oriented insights for designing a tailored intervention aimed at promoting sun-protective behaviors among adolescent boys using social marketing.

Insights for speed management among Iranian drivers: a social marketing formative research study

BACKGROUND

Road traffic crashes are among the leading causes of death and disability in the world, particularly in low and middle-income countries. This study aimed at to conduct a social marketing formative research to inform the development of a campaign to manage driving speed on the intercity roads of Iran.

METHODS

To carry out the social marketing formative research, a qualitative and quantitative study were conducted. Also, a literature review of the speed management strategies was carried out and an analysis of traffic accident data and speeding violations was performed in selected provinces during 2019 and 2020.

RESULTS

Based on the findings of the qualitative study, perceived sense of lack of speed control, poor monitoring system, and law enforcement are the main reasons drivers exceed the speed limit. They mostly suggest using punitive levers and more stringent law enforcement practices for speed management. Literature reviews also confirm that to successfully develop an effective speed management plan a set of measures should be implemented together, including road safety engineering, raising awareness, social marketing strategies, and finally strict law enforcement. The overriding findings of the formative research revealed that to persuade Iranian drivers to respect the speed limit, the messages of the campaign should focus on strict law enforcement in the selected corridors.

CONCLUSIONS

In the minds of the Iranian audience, strict law enforcement is of paramount importance for a speed management strategy to work; hence it should be taken into consideration when tailoring the campaign messages. From the findings of the present study, it can be concluded that to manage speed on intercity routes in Iran, a social marketing campaign is needed to encourage compliance with speed limits.

Effect of Lattice Structure and Composite Precursor on Mechanical Properties of 3D-Printed Bone Scaffolds

This article presents an investigation on designing and fabricating scaffolds with different structures, desired porosity, composition, and surface area to volume ratio (SA:V) for orthopedic applications by using the computer-aided design (CAD) and the stereolithography (SLA) 3D printing technique. Different triply periodic minimal surfaces (TPMS) and functionally graded lattice structures (FGLS) were designed based on various cell geometries. Finite element analysis (FEA), tensile and compression tests were carried out, and the results are presented. Two different resin compositions were used to print the models and compare the effect of resin precursors on the mechanical properties of scaffolds. The first was a biodegradable resin made from soybean oil commercially available on the market (made by Anycubic Co.). The second was a mixture of biodegradable UV-cured resin with 5% W/W of hydroxyapatite (HA) and 5% W/W calcium pyrophosphate (CPP). Bio-Hydroxyapatite and Bio-Calcium Pyrophosphate were obtained from eggshells waste and characterized using XRD and FESEM. The obtained data show that adding resin precursors (HA/CPP) slightly decreases the mechanical strength of printed scaffolds; however, considering their extraordinary effect on bone regeneration, this small effect can be ignored, and HA/CPP can be used as an ideal agent in bioscaffolds.

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

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

Using social marketing to persuade Iranians to donate blood

This study examined effects of a social marketing intervention to encourage people to donate blood in a southwest city of Iran. To design the intervention, the constructs of theory of planned behavior in 170 consistent blood donors were measured. Persuasive messages were developed, and some printed materials were prepared to transfer the message to the target segment. The trend of the percentage of consistent blood donors was measured during the first four months after the intervention. The percentage of consistent blood donors was increased significantly. The findings showed the effectiveness of the social marketing interventions for blood donation.

Development and application of a tool to measure hearing health literacy of young people in the Islamic Republic of Iran

Background

A reliable and valid tool to assess hearing health literacy in Iranian young people is lacking.

Aims

This study aimed to develop a tool to assess the hearing health literacy of young people in the Islamic Republic of Iran and to use the tool to determine the hearing health literacy of a sample of Iranians aged 12-25 years.

Methods

A questionnaire was designed with three skill sections: obtaining health information, evaluating this information and applying it to benefit health. The validity and reliability of the tool were determined. Cluster sampling was used to select 50 urban clusters across the country from which 5000 Iranians aged between 12-25 years old were selected to complete the questionnaire.

Results

The final questionnaire had 22 items with scores ranging from 22 to 44. The Cronbach alpha was 0.65, and content validity ratio and index were 0.92 and 0.82, respectively. Of the 5000 questionnaires completed, 4890 were included in the analysis. The mean (standard deviation (SD)) age of the participants was 17 (SD 3) years and 45.9% were males. The mean score on the tool was 30.81 (SD 3.75), indicating inadequate health literacy (score 22-36). Only 137 (2.8%) participants had adequate health literacy (score 37-44). Statistically significant differences in mean hearing health literacy were seen for sex, age, years of education, occupation, marital status and income (P < 0.05).

Conclusions

Given the low level of hearing health literacy in Iranian young people, programmes to improve the ear and hearing health literacy are urgently needed.

Evaluation of different haematoxylin stain subtypes for the optimal microscopic interpretation of cutaneous malignancy in Mohs frozen section histological procedure

BACKGROUND

The Mohs technique employs mainly H&E-stained frozen sections for surgical margin assessment of cutaneous excisions, utilising microscopic evaluation of the complete, circumferential, peripheral and deep margins. This study aimed to determine which mordant based haematoxylin (Ehrlich's, Cole's, Mayer's, Gill's I, Gill's II, Gill's III, Weigert's, Harris' or Carazzi's) produced the optimal morphological clarity of staining for the identification of cellular and tissue morphology of cutaneous basal cell carcinoma (BCC).

MATERIAL AND METHODS

In total, 100 anonymised patient cases were selected, sectioned and stained with each haematoxylin subtype. The slides were independently evaluated microscopically by two assessors. A combined score was generated to determine the sensitivity (defined as the intensity of haematoxylin staining being too weak or too strong and the colour appearance of the haematoxylin not being blue/black) and specificity (defined as the appearance of background staining with haematoxylin, uneven staining and staining deposits) for each of the nine haematoxylin subtypes. The scoring criteria were based on the UKNEQAS CPT Mohs procedure assessment criteria.

RESULTS

The scores generated for specificity identified Carazzi's haematoxylin as best performing (99.2%) followed by Gill's III (98.4%), Ehrlich's (98.2%) and Harris' (85.0%). The sensitivity score again identified Carazzi's as producing the best result (85.0%) followed by Weigert's (83.4%), Ehrlich's (81.6%) and Gill's III (80.4%).

DISCUSSION

Carazzi's haematoxylin is the most optimal staining dye for the identification of BCC tumour for use as part of the Mohs micrographic surgery procedure.

The role of knowledge, risk perceptions, and cues to action among Iranian women concerning cervical cancer and screening: a qualitative exploration

Background

Iran has a low incidence but higher rate of death from cervical cancer (CC). The country is in the process of implementing an organized screening program including HPV testing and cytology. Studies show high dropout in continued testing among eligible women. This qualitative study aimed to explore women’s awareness regarding CC and CC testing and the role of knowledge, perceived risk, and cues to action in this process.

Method

Through a qualitative study based on the Framework Method, we recruited 81 women aged 25–65 who participated in 15 focus group discussions (FGDs) and two in-depth interviews in Tehran. The interviewees were selected purposefully during January to May 2015 from households belonging to different socioeconomic classes until data saturation. The data were acquired through 11 open-ended questions and 32 related probe questions. All interviews were transcribed and independently analyzed by two researchers (Kappa and agreement testing respectively: 0.77, 97.11%).

Results

The coded texts were categorized under three themes and 13 subthemes. The three thematic areas referred to knowledge, cues to action, and perceived risks regarding CC and screening. The results showed that women had limited and unspecified knowledge about CC and screening, compounded by misconceptions regarding infection and cancer prevention measures. Social and cultural barriers hindered proper communication between health system/providers and clients and within communities on subjects related to CC and screening. The perceived risk of getting CC was low because of overestimating the role of hereditary factors for CC, difficulty in differentiating between cancer and sexually transmitted infections (STI), and the absence of visible symptoms.

Conclusion

The results indicate a strong need to invest more efforts to improve health education and communication in the current national health program to promote awareness of the need to screen for CC through, for example, establishing correct knowledge and risk perceptions among women. In addition, this intervention should address women’s social environment in order to prevent misconceptions being communicated to women.

Supplementary information

Supplementary information accompanies this paper at 10.1186/s12889-020-09701-6.

A Numerical Study of Fluid Flow in the Porous Structure of Biological Scaffolds

Tissue engineering (TE) is one of the promising areas that aims to address the global problem of organ and tissue shortages. The successful development of TE, particularly in bone tissue engineering, consists of the use of modern methods that allow the creation of scaffolds, the physicochemical, mechanical, and structural parameters of which will allow achieving the desired clinical results. The vast possibilities of the rapidly developing technology of three-dimensional (3D) printing, which allows the creation of individual scaffolds with high precision, has led to various developments in bone tissue TE. In this work, for the successful use of three-dimensional printing in TE to ensure the diffusion of nutrients during cell cultivation throughout the entire structure of the scaffold, a model of a rotating scaffold is proposed, and the movement of the diffusion flow of nutrient fluid is calculated based on Darcy’s law, which regulates the flow of fluids through porous media. The conducted studies of the rate of diffusion flow of nutrients based on glucose in the porous structure of scaffolds with a 10% content of calcium hydroxyapatite demonstrated the promise of using a model of a rotating composite scaffold in TE of bone tissue. The results show that at a scaffold rotation speed of 12 rpm, the diffusion flow rate of nutrients in the composite scaffolds porous structure is practically not affected by their geometric shape.

Women's Views About Domestic Violence: A Qualitative Study in Iran

Violence against women is an urgent health priority in Iran. Designing effective programs for preventing and controlling the problem necessitates a thorough understanding of Iranian women and their perspectives regarding domestic violence. This study was aimed at exploring the domestic violence-related views of married women who were referred to health care facilities in Ahvaz, Iran. In this qualitative research, data were collected through four focus group discussions with 30 married women. All the discussions were recorded and transcribed, after which the data were classified separately. The main themes and subthemes were then manually derived from the data and analyzed. The five main themes identified were domestic violence against women in Ahvaz, behavioral influencing factors, nonbehavioral influencing factors, the necessity to empower women to prevent domestic violence, and recommendations for developing special training programs for Ahvazi women. Most of the participants were aware that domestic violence against women is a common occurrence in Iran. They were well aware of the definition of violence and expressed a belief that behavioral factors exert an important effect on the occurrence of the problem. They recommended the development of appropriate training programs that empower women to prevent the problem, the use of mass media to educate citizens about domestic violence, and the involvement of opinion leaders in eliminating the taboo against considering such violence a crime against Iranian women. Considering the views and ideas of women as consumers of educational services is a principle used to develop effective programs for preventing and controlling domestic violence. As indicated by the findings, the participants believe that empowering women must be treated as a priority in the Iranian health care system. However, they recommended differing approaches and methods of empowerment on the basis of their individual views and concerns.

Using Social Marketing to Reduce Salt Intake in Iran

Objectives: WHO has recommended that the average salt intake must be <5 grams per day. However, people consume salt much more in many countries. In this study, we design and implement an intervention based on social marketing model to reduce salt consumption in Yasuj, Iran. Materials and Methods: This study employed a quasi-experimental pretest-posttest with control group design which consisted of a formative research (qualitative-quantitative) and an interventional phase. To collect the qualitative data, six focus group discussions by participating of 66 people were established. The qualitative data were analyzed manually using directed content analysis. In quantitative study, 166 people aged 25-50 years completed a KAP questionnaire, and their average salt intake was determined through measuring sodium in their urine sample. By analyzing the data, marketing mix components were determined for designing an intervention. An educational package (including posters for installing in the kitchen, pamphlets, phone counseling, four educational classes, and brief interventions done by physicians and other health personnel) focused on reducing salt intake and using alternatives was developed. For one month, program was implemented for intervention group. Two months later, KAP survey and measuring the urine sodium were repeated for intervention and control groups. The data was compared for two groups, before and after the intervention by using independent t-test, paired t-tests and repeated measures ANOVA. Results: The qualitative findings showed that most participants agreed that the salt intake was high in Iran. Most of them recommended home-based and family-driven strategies to reduce salt intake, offered using healthier alternatives for salt, and recognized physicians and health care providers in healthcare facilities as the most important to encourage people to reduce salt intake. After the intervention, the mean and standard deviation of KAP were improved significantly in intervention group. The mean salt intake decreased significantly by 3.01 ± 2.38 in the intervention group and repeated measures ANOVA showed significant change over time (P < 0.001) and a significant difference between two groups (P = 0.04)_. Also, the interaction between time and group was significant (P = 0.001). Conclusion: The mean salt intake among the study population was approximately three times more than the level recommended by the WHO. The social marketing-based intervention succeeded in reducing the salt intake of the study subjects by ~3 grams on average.

Semi-automated standardisation of melanin bleaching procedures of heavily pigmented melanocytic lesions for immunohistochemical analysis on an automated platform

Background: The diagnosis of heavily pigmented melanocytic lesions is problematic. This is often compounded by lack of visibility of nuclear detail of tumour cells due to physical masking by melanin pigment. Similarly, there can be colour merging of chromogenic final reaction products with melanin, making an evidence of antigenic localisation problematic. There are a number of melanin bleaching techniques available for immunohistochemical assessments.Material and methods: All methods to date have involved the bleaching of melanin as a manually performed primary step before loading subsequently bleached slides onto automated immunohistochemical platforms. Here we define a semi-automated bleaching procedure that allows full integration on one of the most widely employed automated IHC staining platforms (Roche Ventana BenchMark Ultra). The bleaching protocol was defined on the BenchMark Ultra and involved the assessment of 24 histological cases of heavily pigmented malignant melanoma lesions (13 cutaneous and 11 metastatic) routinely fixed processed and paraffin wax embedded.Results: Completion of the bleaching was assessed on H&E preparations performed following the semi-automated bleaching step and employing the Roche Ventana BenchMark Ultra machine for 60 min at 42°C. Complete immunohistochemical staining was achieved on the automated platform within 5-6 h including the bleaching step. Results were consistent across all tissue evaluated.Discussion: This data provides evidence that the hydrogen peroxide bleaching procedure can be adapted for integration on one of the most widely employed automated IHC staining platforms and as a result, improve the efficiency and reproducibility of the technique.

Prenatal diagnosis in rare bleeding disorders-An unresolved issue?

Intracranial haemorrhage (ICH) is the most dreadful complication, and the main cause of death among patients with rare bleeding disorders (RBD) and prenatal diagnosis (PND) is a preventative lifesaving program. A total of 39 PNDs were reported in the literature through a search on PubMed, EMBASE, SCOPUS and Web of Science databases, most often for congenital factor (F) XIII and FVII deficiencies and rarely in FX, FV deficiencies and afibrinogenemia. The main cause to request a PND is ICH and related morbidity and mortality. Different molecular methods including direct sequencing and linkage analysis as well as polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) for a specific mutation are the most common used methods for PND, while factor assay and combination of molecular and factor assay also were used. In this research, 7 severely affected foetuses were identified during PND including 3 foetuses with FXIII deficiency, 3 with FVII deficiency and 1 with FX deficiency. Out of these 7 cases, intrauterine ICH occurred in 1 case with FXIII deficiency, 1 was electively aborted and 1 case with severe FVII deficiency received intrauterine factor transfusion. Postdelivery ICH was reported for 1 patient with severe FVII deficiency within the first month of life. All other pregnancies were uneventful.

Use of a novel 1-hour protocol for rapid frozen section immunocytochemistry, in a case of squamous cell carcinoma treated with Mohs micrographic surgery

For squamous cell carcinoma (SCC) treated using Mohs micrographic surgery (MMS), interpretation of haematoxylin and eosin-stained frozen sections can be challenging. In these situations, ancillary use of immunostaining is a useful tool for the Mohs surgeon. However, use of immunostaining in MMS laboratories is limited, mainly because current manual immunostaining platforms are subject to operator error, and automated immunostaining, albeit accurate, is too slow for inclusion in MMS. In this report, we describe a novel 1-hour protocol for rapid frozen section immunocytochemistry, using the pancytokeratin markers AE1/AE3. This protocol has been specifically designed to integrate the speed of manual techniques and the accuracy of automated platforms, making it a valuable addition to the MMS laboratory. We propose that in selected or histologically challenging cases, there is a role for the use of this novel protocol, allowing the Mohs surgeon to more confidently declare tumour clearance, thus preventing further unnecessary surgery and preserving healthy tissue.

Promoting physical activity in Iranian women: A qualitative study using social marketing

BACKGROUND AND AIM

In social marketing, at the center of the program is consumer perception. The objective of this study was to explore the viewpoints of Iranian women for tailoring interventions so as to increase physical activity.

METHODS

The social marketing model served as the framework of the study. Qualitative data were collected via six semi-structured focus group discussions (FGDs), in 2014 in Iran. Participants were 51 women, 20 to 60 years old, selected by purposive sampling, with a maximum diversity. Qualitative content analysis of the data was conducted by researchers.

RESULTS

After data analysis and extracting initial codes, they were all categorized in four predefined categories of social marketing model (product, price, place and promotion) and related sub-categories. Most of the participants were inactive. Price was addressed by women as the dominant category of this study. The majority of participants emphasized the benefits of prevention of chronic diseases, fitness, staying young, and improving family relations. Most women preferred to do physical activity in a secure and enclosed female environment. And the majority of participants considered radio, television, face to face training, texting, and advertising billboards as promotional strategies.

CONCLUSION

This study provides a unique insight into consumers' values and motivations that affect consumers' decisions to adopt physical activity, in Iran. It could also help researchers to design and implement intervention programs to increase physical activity.

New embedding and staining systems PrestoCHILL and Presto stainer for application in the advancement of Mohs micrographic surgery

BACKGROUND

Mohs micrographic surgery (MMS) involves evaluation of frozen tissue sections to determine complete circumferential and deep tissue margin clearance of skin tumours. PrestoCHILL and Presto stainer devices are two new innovative tools which bring benefits of automation, speed and efficiency to the preparation of frozen section analysis in MMS. The devices were assessed at Viapath's Tissue Science Mohs laboratory at Guy's Cancer Centre.

MATERIAL AND METHODS

A total of 279 samples from 10 anatomically different facial sites. These included nose (95), lip (24), forehead (47), cheek (25), eyelids (34), temple (9), chin (15), ear (17), scalp (6) and neck (7). These were analysed using both devices simultaneously.

RESULTS

The PrestoCHILL device was measured for accuracy of tissue orientation by determining how many of the cases examined microscopically had complete margin and full epidermis preservation. The precision and reproducibility of the Presto stainer was evaluated by the consistency of achieving ideal standards of staining quality as defined by the department's internal quality control check, on stained sections examined and evaluated microscopically. The mean (standard deviation) score for accuracy for the PrestoCHILL across all tissue facial sites was 93.5 (11)%; the mean (standard deviation) score for precision/reproducibility of the Presto stainer was 96.5 (11)% (both p < 0.05).

CONCLUSION

The devices combined offer an assured accuracy and precision performance, which is reproducible across all facial tissue types examined. The devices represent a key step forward in the introduction of improved automated embedding and staining procedures within MMS.

Application of short message service to control blood cholesterol: a field trial

Background

Despite recommendations, many middle-age adults neglect to check their blood cholesterol levels. Short message service (SMS, also known as texting) has been seldom studied for preventive education. We estimated how SMS can be a cost-effective method in encouraging people to check their blood cholesterol levels.

Methods

In a field trial, 3600 cell phone users (age > 30) were randomly assigned to the intervention (N: 1200) and the control groups (N: 2400). An SMS was sent to the intervention group for five rounds every two weeks, which targeted the cognitive and affective learning and finally advised the blood cholesterol level to be checked, if not checked during the past twelve months. Two weeks after the last round, both groups were asked for the time/level of their latest blood cholesterol, family history of early cardiac death and having a family member with coronary heart disease (CHD), and to report their attitude about whether annual blood sampling is worth the cost and time to prevent CHD. Moreover, the intervention group was asked if they remembered the SMS content. The cost-effectiveness was evaluated by estimating the “number needed to treat” (NNT) and calculating the cost of sending SMS to that number of people.

Results

In the intervention group, 629 individuals (72.0%) recalled the SMS content. The factors associated with cholesterol screening during the past two years were older age, diabetes, family history of coronary disease, higher education, female gender and being non-smoker. In both groups, women were significantly more aware of their blood cholesterol level (68.7% vs. 53.6%). The relative frequency of respondents who believed it was not worth checking their cholesterol annually was significantly lower in the intervention group (P < 0.001). The intervention group was significantly more likely to check its blood cholesterol levels (OR:1.22) after adjustment for age, diabetes, family history of CHD and smoking. The NNT was estimated ≈ 25 for the general population and ≈ 11 for those who received SMS and had a family member with CHD.

Conclusions

We would postulate that SMS could affect people’s adherence to preventive programs. Relatives of patients admitted with a diagnosis of CHD should be prioritized for superior cost-effectiveness and logistical feasibility.

Mothers' views about sexual health education for their adolescent daughters: a qualitative study

Background

Given that mothers play a role in the sexual education of their daughters, it is important to understand their views of sexual health and related programs. This study was aimed at exploring mothers’ perspectives regarding sexual health education for their adolescent daughters in Mahshahr, Iran.

Methods

In this qualitative study, in-depth interviews with ten key informants and five focus group discussions involving 28 mothers with daughters aged 12–18 were conducted. All the discussions were audio-recorded and later transcribed. The data were classified, after which the main themes and sub-themes were manually extracted and analyzed.

Results

The five main themes determined were: the necessity of sexual health education for adolescent girls, the sources of information that mothers use, barriers to sexual health education, the need to empower mothers to provide sexual education to their daughters, and recommendations for developing special training programs for mothers. Most participants believed in limiting sexual health education for adolescent girls; nevertheless, they stated that trained mothers were best equipped to educate their daughters. The major barriers identified by the mothers were their own insufficient knowledge about sexual issues, embarrassment surrounding discussions of this issue with their daughters, fear of the arrogance and curiosity of girls, and a lack of skills for effective communication.

Conclusion

The results showed that empowering mothers to provide sexual health education is important. Tailored educational programs, based on mothers’ views, should be developed and implemented.

Relationships between Self-Efficacy and Pap Smear Screening in Iranian Women

Cervical cancer is the fourth common cancer among women worldwide. Pap smear screening has resulted in deceasing incidence of cervical cancer in developed countries but low uptake of Pap smear screening among women in developing countries is still a public health challenge. The aim of this cross-sectional study was to assess the relationship between self-efficacy and timely uptake of Pap smear among Iranian women. A total of 580 married women referred to primary health care centers covered administratively by Shahid Beheshti University of Medical Sciences in Tehran were administered a questionnaire by trained staff. Data were analyzed with SPSS (version 16) software, using univariate and multivariate logistic regression. The mean age for participants was 33.1±8.8 years. There was a significant association between self-efficacy and Pap smear screening (P<0.01). There was also a positive correlation between duration of marriage and husband's education with Pap smear uptake (P<0.01). In univariate analysis, there was a significant association between Pap smear uptake and level of self-efficacy (OR = 15.3 for intermediate and OR=7.4 for good level), duration of marriage (OR = 5.7 for 5-14 years and OR=10.4 for more than 15), age (OR =2.7 for 27-34 years and OR=7.4 for more than 35 years) and husband education level (OR=2.3 for more than 12 years of education). In multivariate analysis, significant associations persisted between Pap smear uptake and self-efficacy (OR = 23.8; 95% CI: 8.7, 65.5), duration of marriage (OR = 5.9; 95% CI: 2.8, 12.2), age (OR = 3.9; 95% CI: 1.2, 12.9) and husband's education (OR = 2.5; 95% CI: 2.0, 10.3). Efforts are needed to increase women's knowledge about cervical cancer and improve their self-efficacy and perceptions of the Pap smear screening in order to reduce cervical cancer incidence and mortality rates.

A multicentre study of the precision and accuracy of the TruSlice and TruSlice Digital histological dissection devices

BACKGROUND

Five key factors enabling a good surgical grossing technique include a flat uniformly perpendicular specimen cutting face, appropriate immobilisation of the tissue specimen during grossing, good visualisation of the cutting tissue face, sharp cutting knives and the grossing knife action. TruSlice and TruSlice Digital are new innovative tools based on a guillotine configuration. The TruSlice has plastic inserts whilst the TruSlice Digital has an electronic micrometre attached: both features enable these dissection factors to be controlled. The devices were assessed in five hospitals in the UK.

MATERIAL AND METHODS

A total of 267 fixed tissue samples from 23 tissue types were analysed, principally the breast (n = 32) skin (30), rectum (28), colon (27) and cervix (17). Precision and accuracy were evaluated by measuring the defined thickness, and the consistency of achieving the defined thickness of tissue samples taken respectively. Both parameters were expressed as a total percentage of compliance for the cohort of samples accessed.

RESULTS

Overall, the mean (standard deviation) score for precision was 81 (11) % whilst the accuracy score was 82 (11) % (both p < 0.05, chi-squared test), although this varied with type of tissue. Accuracy and precision were strongly correlated (r_p = 0.83, p < 0.001).

CONCLUSION

The TruSlice Digital devices offer an assured precision and accuracy performance which is reproducible across an assortment of tissue types. The use of a micrometre to set tissue slice thickness is innovative and should comply with laboratory accreditation requirements, alleviating concerns of how to tackle issues such as the 'measurement of uncertainty' at the grossing bench.

Application of the PRECEDE model to improve sexual function among women with hysterectomy

OBJECTIVE

To determine the effect of an educational program based on the PRECEDE model to improve sexual function among women with hysterectomy.

METHODS

The present randomized trial, conducted in Iran during 2014, included 48 women with hysterectomy who were selected through convenience sampling and randomly divided into two equal groups. Women in the experimental group received an educational program based on constructs of the PRECEDE model. The control group received only routine interventions. Before the interventions, the women completed two questionnaires: one that measured the PRECEDE model constructs and the Rosen Female Sexual Function Index. The questionnaires were repeated 4 weeks after the intervention and the results were compared within and between groups.

RESULTS

In each group, a significant improvement in sexual function was demonstrated after the intervention (P<0.001). The mean sexual function score increased to a greater extent in the experimental group (difference 16.95±6.33) than in the control group (difference 4.35±1.94; P<0.001).

CONCLUSION

The findings confirm the effectiveness of an educational program based on the PRECEDE model in terms of improving sexual function among women with hysterectomy. Iranian Registry of Clinical Trials: IRCT2014122220401N1.

Pan-cytokeratin markers for rapid frozen section immunocytochemistry from head and facial Mohs cases of basal cell carcinoma: a comparison and evaluation to determine the marker of choice

The application of immunocytochemistry in the field of Mohs micrographic surgery (MMS) is well established. This study evaluates the use of pan-cytokeratins (AE1/AE3, MNF116 and AE1/AE3+PCK26) in the assessment of basal cell carcinoma (BCC) on frozen tissue debulk specimens. Fifty-five cases of BCC, all from head and facial sites, were assessed in the study. In addition to staining all cases for the three cytokeratin antibodies under investigation, sections were also stained with haematoxylin and eosin (H&E) to demonstrate tumour architecture and morphology. All sections for immunocytochemistry were stained on a Roche Ventana BenchMark Ultra automated platform employing a rapid frozen section protocol. Results were assessed based on the intensity of staining of keratinocytes (scale: 0-100%), as well as sensitivity of staining determined by the total percentage of keratinocytes stained within the tissue section. AE1/AE3 demonstrated the most consistent staining both in terms of intensity of staining and sensitivity, with a mean of 99.1% and 99.9%, respectively. AE1/AE3+PCK26 average results indicated scores of 70.6% for intensity and 87.2% for sensitivity, with MNF116 scoring 92.9% for intensity but only 57.3% for sensitivity. The data indicate that AE1/AE3 is the best pan-cytokeratin antibody to use in the assessment of BCC in MMS. The use of cytokeratin immunocytochemistry is justified in morphologically complex cases of BCC, or in cases where dense inflammatory infiltrate surrounding any suspicious cells make identification of small numbers of tumour cells difficult to determine with just an H&E stain. The significant rationale is that cytokeratin staining is a valuable adjunct in the study of tumour cell assessment in cases of MMS for BCC. In addition, the use of anti-AE1/AE3 cytokeratin antibodies provides the most consistent staining results for such cases.

Persuasion to use personal protective equipment in constructing subway stations: application of social marketing

To study the effects of an intervention based on social marketing to persuade workers to use personal protective equipment (PPE) in constructing subway stations in Isfahan, Iran. This was a quasi-experimental study. Two stations were selected as intervention and control groups. Intervention was designed based on results of a formative research. A free package containing a safety helmet with a tailored message affixed to it, mask and gloves and an educational pamphlet was delivered to the intervention group. After 6 weeks, behaviours in the intervention and control stations were measured using an observational checklist. After the intervention, the percentage of workers who used PPE at the intervention station increased significantly. OR for helmet and mask usage was 7.009 and 2.235, respectively, in the intervention group. Social marketing can be used to persuade workers to use PPE in the workplace.

SWI or T2*: which MRI sequence to use in the detection of cerebral microbleeds? The Karolinska Imaging Dementia Study

BACKGROUND AND PURPOSE

Cerebral microbleeds are thought to have potentially important clinical implications in dementia and stroke. However, the use of both T2* and SWI MR imaging sequences for microbleed detection has complicated the cross-comparison of study results. We aimed to determine the impact of microbleed sequences on microbleed detection and associated clinical parameters.

MATERIALS AND METHODS

Patients from our memory clinic (n = 246; 53% female; mean age, 62) prospectively underwent 3T MR imaging, with conventional thick-section T2*, thick-section SWI, and conventional thin-section SWI. Microbleeds were assessed separately on thick-section SWI, thin-section SWI, and T2* by 3 raters, with varying neuroradiologic experience. Clinical and radiologic parameters from the dementia investigation were analyzed in association with the number of microbleeds in negative binomial regression analyses.

RESULTS

Prevalence and number of microbleeds were higher on thick-/thin-section SWI (20/21%) compared with T2*(17%). There was no difference in microbleed prevalence/number between thick- and thin-section SWI. Interrater agreement was excellent for all raters and sequences. Univariate comparisons of clinical parameters between patients with and without microbleeds yielded no difference across sequences. In the regression analysis, only minor differences in clinical associations with the number of microbleeds were noted across sequences.

CONCLUSIONS

Due to the increased detection of microbleeds, we recommend SWI as the sequence of choice in microbleed detection. Microbleeds and their association with clinical parameters are robust to the effects of varying MR imaging sequences, suggesting that comparison of results across studies is possible, despite differing microbleed sequences.

Cerebral microbleeds: different prevalence, topography, and risk factors depending on dementia diagnosis—the Karolinska Imaging Dementia Study

BACKGROUND AND PURPOSE

Cerebral microbleeds are thought to represent cerebral amyloid angiopathy when in lobar regions of the brain and hypertensive arteriopathy when in deep and infratentorial locations. By studying cerebral microbleeds, their topography, and risk factors, we aimed to gain an insight into the vascular and amyloid pathology of dementia diagnoses and increase the understanding of cerebral microbleeds in dementia.

MATERIALS AND METHODS

We analyzed 1504 patients (53% women; mean age, 63 ± 10 years; 10 different dementia diagnoses) in this study. All patients underwent MR imaging as part of the dementia investigation, and all their clinical parameters were recorded.

RESULTS

Among the 1504 patients with dementia, 22% had cerebral microbleeds. Cerebral microbleed topography was predominantly lobar (P = .01) and occipital (P = .007) in Alzheimer disease. Patients with cerebral microbleeds were significantly older (P < .001), were more frequently male (P < .001), had lower cognitive scores (P = .006), and more often had hypertension (P < .001). Risk factors for cerebral microbleeds varied depending on the dementia diagnosis. Odds ratios for having cerebral microbleeds increased with the number of risk factors (hypertension, hyperlipidemia, diabetes, male sex, and age 65 and older) in the whole patient group and increased differently in the separate dementia diagnoses.

CONCLUSIONS

Prevalence, topography, and risk factors of cerebral microbleeds vary depending on the dementia diagnosis and reflect the inherent pathology of different dementia diagnoses. Because cerebral microbleeds are seen as possible predictors of intracerebral hemorrhage, their increasing prevalence with an increasing number of risk factors, as shown in our study, may require taking the number of risk factors into account when deciding on anticoagulant therapy in dementia.

Rapid and accurate species and genomic species identification and exhaustive population diversity assessment of Agrobacterium spp. using recA-based PCR

Agrobacteria are common soil bacteria that interact with plants as commensals, plant growth promoting rhizobacteria or alternatively as pathogens. Indigenous agrobacterial populations are composites, generally with several species and/or genomic species and several strains per species. We thus developed a recA-based PCR approach to accurately identify and specifically detect agrobacteria at various taxonomic levels. Specific primers were designed for all species and/or genomic species of Agrobacterium presently known, including 11 genomic species of the Agrobacterium tumefaciens complex (G1-G9, G13 and G14, among which only G2, G4, G8 and G14 still received a Latin epithet: pusense, radiobacter, fabrum and nepotum, respectively), A. larrymoorei, A. rubi, R. skierniewicense, A. sp. 1650, and A. vitis, and for the close relative Allorhizobium undicola. Specific primers were also designed for superior taxa, Agrobacterium spp. and Rhizobiaceace. Primer specificities were assessed with target and non-target pure culture DNAs as well as with DNAs extracted from composite agrobacterial communities. In addition, we showed that the amplicon cloning-sequencing approach used with Agrobacterium-specific or Rhizobiaceae-specific primers is a way to assess the agrobacterial diversity of an indigenous agrobacterial population. Hence, the agrobacterium-specific primers designed in the present study enabled the first accurate and rapid identification of all species and/or genomic species of Agrobacterium, as well as their direct detection in environmental samples.

Dermatofibrosarcoma protuberans: dealing with slow Mohs procedures employing formalin-fixed, paraffin wax-embedded tissue in a busy diagnostic laboratory

Dermatofibrosarcoma protuberans (DFSP) is a relatively uncommon tumour that arises in the dermis and underlying soft tissue. Surgical removal is the preferred treatment, with relatively wide clearance margins of 3 cm or more. Slow Mohs procedures are often employed successfully to treat patients with such tumours. Slow Mohs procedures offer the benefit of improved cure rates and maximal tissue conservation. However, dealing with such tissue successfully presents the laboratory with a host of technical problems. This report advocates a set protocol to follow for slow Mohs, based on the experience acquired from dealing with 37 cases of DFSP over a 12-year period. The report establishes the benefits of slow Mohs paraffin wax-embedded tissue over frozen sections in terms of improved morphology, tissue preservation and immunocytochemical labelling with anti-CD34.