Effect of needles distance of arteriovenous fistula cannulation on hemodialysis adequacy based on KT/V: a randomized controlled trial.

Background: This study aims to assess the effect of needle distance of arteriovenous fistula (AVF) cannulation on haemodialysis adequacy based on KT/V. Materials and methods: This study was a parallel-group, randomized controlled trial. Patients who met the inclusion criteria were divided into two groups with 3 and 6 cm needle distances using block randomization. Data acquisition transpired through a comprehensive checklist encompassing demographic variables such as age and sex, alongside clinical metrics comprising actual weight, dry weight, average dialysis duration, fistula longevity, and KT/V rate. Results: A total of 42 haemodialysis patients were enroled in this investigation, with 21 allocated to the 3 cm needle distance group and another 21 to the 6 cm needle distance group. The mean post-haemodialysis KT/V values for the 3 cm and 6 cm needle distance groups were 1.25 (SD=0.25) and 1.42 (SD=0.24), respectively, demonstrating a statistically significant difference (P<0.001). While there was no significant difference in the average pre-haemodialysis and post-haemodialysis KT/V values within the 3 cm needle distance group (t=1.93, P=0.068), the corresponding values for the 6 cm needle distance group exhibited a notable discrepancy (t=9.66, P<0.001). Conclusion: In general, a needle distance of 6 cm between arteriovenous points yielded superior enhancements in dialysis adequacy compared to a 3 cm needle distance following haemodialysis. Consequently, health administrators and policymakers may consider instituting efficacious interventions to scrutinize the care and therapeutic protocols for haemodialysis patients, involving the development of policies and applications.

Effects of aromatherapy with Matricaria chamomile essential oil on anxiety and hemodynamic indices in patients with acute coronary syndrome, 2021: a randomized controlled trial.

BACKGROUND: Patients with Acute Coronary Syndrome (ACS) experience high levels of anxiety that may cause instability of hemodynamic indices, increased risk of ischemia, myocardial infarction and poor quality of life. Aromatherapy can affect patients' anxiety levels and improve hemodynamic indices. This study aimed to evaluate the efficacy of aromatherapy on anxiety and hemodynamic indices in ACS patients. METHODS: This study was a double-blind, randomized clinical trial conducted on 154 ACS patients. The participants were classified into two equal groups of intervention and placebo through the block randomization method. The data collection tools consisted of demographic information, a shortened 6-item version of the Spielberger questionnaire and a form of hemodynamic indices. For two consecutive nights, the intervention group inhaled 7 drops of the chamomile essential oil (%10) and the placebo group inhaled 7 drops of the sesame oil poured on a sterile cotton ball. The hemodynamic indices were collected half an hour before, one and four hours after the intervention until the next morning. The Spielberger questionnaire was completed once before the intervention and once after the end of the intervention, by the researcher through an interview. The number of heart rate (HR) was counted for a full minute. Also, the blood pressure (BP) of all the samples was measured by the researcher. Data analysis was done using Chi-square, paired t-test, and analysis of variance (ANOVA) in SPSS22. RESULTS: The mean and standard deviation of the age of patients were 58/2 ± 11.6 and 59.7% of them were female. The results of ANOVA showed a significantly lower anxiety score as well as systolic blood pressure (SBP), diastolic blood pressure (DBP) and HR in the intervention group compared to those of the placebo group (P < 0.001). The decrease in anxiety score after the intervention, in the intervention and placebo groups was (5.2 ± 1.9) and (1 ± 1. 18) respectively. In the intervention group, the SBP and DBP after the intervention, was significant (P < 0.05). Also, the HR was significant (P < 0.001) after the intervention. CONCLUSIONS: Aromatherapy could reduce anxiety and improve hemodynamic indices in ACS patients. TRIAL REGISTRATION: IRCT20080825001083N11.

Needle Direction and Distance of Arteriovenous Fistula Cannulation in Hemodialysis Adequacy; a Systematic Review and Meta-Analysis.

Introduction: This systematic review and meta-analysis aimed to summarize the evidence regarding the impact of needle direction and distance of arteriovenous fistula (AVF) cannulation on KT/V (where k is the dialyzer urea clearance, t, the duration of dialysis, and V, the volume of distribution of urea) and access recirculation (AR) as hemodialysis (HD) adequacy criteria. Methods: A comprehensive systematic search was performed on international and domestic electronic databases from the earliest to June 4, 2022 using keywords. Analysis was performed in STATA software v.14. Results: Three randomized control trials (RCTs) and four non-RCT articles were included in the final review. Six studies reported the effects of direction, while four mentioned the effects of distances of AVF cannulation on outcomes of HD adequacy based on KT/V or AR. Results of three non-RCT studies showed that retrograde direction decreased KT/V more than antegrade direction (ES: 0.44, 95% CI: -0.38 to 1.27). Two non-RCT studies showed that antegrade decreased AR compared to the retrograde direction (ES: -0.64, 95%CI: -1.94 to 0.67). However, the results of two RCTs indicated uncertainty about this issue. Two of the four studies suggested that a distance of 5 cm or more in arterial and venous needles had greater adequacy than a distance of less than 5 cm. However, other studies did not confirm this finding. Conclusion: Overall comparison of the results qualitatively and quantitatively indicated uncertainty about the effects of direction and distance of AVF cannulation on HD adequacy outcomes. More studies with high-quality designs, such as RCTs, are required to better understand and adjudicate the effects of needle direction and distance of AVF cannulation on HD adequacy outcomes.

Lower Urinary Tract Symptoms and Related Factors in Iranian Female Nurses.

Background: Lower Urinary Tract Symptom (LUTS) are common among female nurses. High levels of job stress in nurses may be associated with the prevalence of these symptoms. This study aimed to investigate the prevalence of LUTS and factors related to these symptoms in female nurses. Materials and Methods: A cross-sectional study in which 460 nurses and nursing assistants participated was conducted. A questionnaire consisting of socio-demographic data, International Consultation on Incontinence Questionnaire - Female Lower Urinary Tract Symptoms, and Toileting Behavior - Women's Elimination Behavior Scale was used. Data analysis was performed by descriptive and inferential statistical tests at a significant level of p < 0.05. Results: The highest and lowest scores of LUTS were related to the urgency and nocturnal enuresis with a mean (SD) score of 1.85 (1.03) and 0.05 (0.26), respectively. Concerning toileting behaviors, the highest score was for the place preference for voiding with a mean (SD) score of 4.13 (0.66), which correlated with LUTS. Among controllable variables, years of practice, urinary tract infections, use of perineal pads for urinary leakage, lifting heavy objects at work, and medical history were identified as predictors of LUTS (p < 0.05). Conclusions: LUTS was highly prevalent in the female nurses. The results revealed that unhealthy toileting behaviors may contribute to the prevalence of LUTS. Early identification of these symptoms and the development of an educational intervention program to enhance the knowledge of healthy toileting behaviors may prevent the occurrence of urinary symptoms.

Prevalence of Anxiety and Depression in the Iranian General Population during the COVID-19 Pandemic: A Web-Based Cross-Sectional Study.

Objective: This study aimed to determine prevalence of anxiety and depression and associated factors in the general population of Iran during the COVID-19 pandemic. Method : We conducted this web-based cross-sectional study on 5328 individuals in Iran between 17th and 29th of April 2020. Data were collected using the convenience sampling method through an anonymous online questionnaire via social media like WhatsApp and Telegram. The online survey collected data on demographic variables, COVID-19-related variables, and symptoms of anxiety and depression. Anxiety and depression were assessed using the Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9), respectively. Simple and multiple logistic regression analyses were performed to determine independent predictors of anxiety and depression. Results: The mean GAD-7 and PHQ-9 total scores were 7.17 (SD = 5.42) and 7.80 (SD = 6.68), respectively. Prevalence of anxiety, depression, and comorbid anxiety-depression were 30.1%, 33.4%, and 22.1%, respectively. According to the adjusted analysis, anxiety was significantly associated with female gender, being young and middle-aged, being unemployed or a housewife, having chronic diseases, spending considerable time thinking about COVID-19, having family members, friends, and/or relatives infected with COVID-19, and death of family members, relatives or friends due to COVID-19. Same results were also found for depression. Furthermore, depression was associated with being single, being resident in urban area, and having high risk individual in family. Conclusion: Prevalence of anxiety and depression were considerably higher in the general population of Iran during the COVID-19 pandemic. In addition, the findings suggest that more attention needs to be paid to vulnerable groups such as women, young/middle-aged adults, the unemployed, and people with chronic disease.

Effect of Interposed Abdominal Compression on Cardiopulmonary Resuscitation Outcomes; a Randomized Clinical Trial.

Introduction: Standard cardiopulmonary resuscitation (STD-CPR) is successful in only 10-15% of cases in emergency department (ED). This study aimed to determine the effect of interposed abdominal compression (IAC) during resuscitation on outcomes of ED cardiac arrests. Methods: In this randomized clinical trial study, non-trauma patients aged 18-85 years, patients with in-hospital cardiac arrest hospitalized in the ED were randomly assigned into two either STD-CPR or IAC-CPR group on a 1:1 basis and using computer-generated random numbers. Participants in the intervention group, received abdominal compression during the diastole phase of STD-CPR. The rate of return of spontaneous circulation (ROSC), heart rate (HR), respiratory rate (RR), arterial blood gas (ABG) indicators, and survival rate were compared between the two groups. Results: Ninety patients were enrolled (45 in each group). There were no differences between the two groups regarding age (p = 0.76), sex (p = 0.39), employment status (p = 0.62) and Charlson comorbidity scale (p = 0.46). Abdominal compression had a positive effect on heart rate (p < 0.001), mean arterial pressure (p = 0.003), arterial blood oxygen pressure (p = 0.001), and arterial blood carbon dioxide pressure (p = 0.001) as well as a negative effect on arterial blood oxygen saturation (p = 0.029) 30 minutes after resuscitation. Out of the 90 CPR cases, 8 (17.7%) cases in intervention group and 8 (17.7%) cases in control group were successful, among which all of the 8 patients in the intervention group and 5 of the patients in the control group had been discharged from hospital without any complications. Conclusion: The results showed that abdominal compression during CPR can improve resuscitation outcomes in patients with cardiac arrest. Therefore, in order to use this technique, further research is recommended.

Association between climate variables (cold and hot weathers, humidity, atmospheric pressures) with out-of-hospital cardiac arrests in Rasht, Iran.

Climate change is one of the most important concerns for public health that affects communities and is a threat to human health. Few cross-sectional studies investigated the effects of extreme temperature as a risk factor on the cardiovascular system and the Out-of-Hospital Cardiac Arrests (OHCA).The current study aims to investigate the association between climate variables (cold and hot weathers, humidity, atmospheric pressures) with Out-of-Hospital Cardiac Arrests in Rasht, Iran.This is an ecological time-series study, which investigated 392 patients with OHCA that were hospitalized in Dr. Heshmat Medical center of Rasht city in a 3-years period. Data on meteorological variables were obtained from the General Meteorological Department of Guilan Province. Information regarding the number of cardiac arrest admissions was obtained from the sole specialized cardiac hospital of Rasht. Data were analyzed using R software.Hot weather decreases the number of cardiac attacks on the same day (lag 0), while the cold weather (relative risk (RR) = 1.408; confidence interval (CI): 1.014-1.955) increases the number of OHCA cases and unsuccessful cardiopulmonary resuscitation (CPRs). Low humidity (RR = 1.76; CI: 1.006-3.79) is associated with increased unsuccessful CPRs. High atmospheric pressures (RR = 1.166; CI: 1.001 to 1.787) are also associated with an increased number of cardiac arrest admissions. For women, men, and those aged >65 years of old, exposure with severe cold (RR = 1.335; CI: 1.014-1.758) and hot weathers, respectively, increases and decreases the number of cardiac arrest admissions.Cold weather has immediate impacts on the incidence of OHCA cases and unsuccessful CPRs. Decreasing humidity also increases the number of and decreases the success rate of CPRs. Increasing the awareness of patients with cardiovascular diseases (CVDs as well as improving the preparedness of emergency care teams can decrease the impacts of climate variables.

The effects of meteorological variables on ambulance attendance for cardiovascular diseases in Rasht, Iran.

Climate change has a devastating effect on human societies, including their economic, cultural and health conditions. Our objective was to investigate the association between meteorological variables and ambulance attendance in the event of cardiovascular diseases using time-series analyses. We used a time series analysis to investigate the relationship between meteorological variables and ambulance attendance in the event of cardiovascular diseases from 2010 to 2015. To examine the effect of high temperatures on ambulance attendance, we investigated the relative risk of the daily volume of high temperature attendance, the 99th temperature percentile compared to the 75th temperature percentile. Upon examining the effect of cold temperatures on ambulance attendance, or the relative risk of the daily volume of attendance with low temperatures, the 1st temperature percentile compared to the 25th temperature percentile. In 1826 days, from March 21, 2010 to March 19, 2015, there were 7051 emergency calls for cardiovascular diseases. Significant variations were identified in the monthly (P < 0.001) and seasonal (P < 0.001) distributions. The highest seasonal incidence occurred in the winter and lowest was observed in the summer. With regard to association between cold temperature and calls for ambulance attendance in the event of cardiovascular diseases according to lag days, our findings showed a significant increase in lag 7 ((RR, 1.026; 95% CI, 1.003 to 1.050), lag 8 (RR, 1.023; 95% CI, 1.005to 1.041) and lag 9 (RR, 1.019; 95% CI, 1.002 to 1.036) respectively. These results suggest that the demand for an ambulance for cardiovascular diseases was higher in the cold weather and that humidity can increase this demand in the warm seasons.

Effects of Hemodynamic Factors and Oxygenation on the Incidence of Pressure Ulcers in the ICU.

OBJECTIVE: To investigate the roles of hemodynamic factors and oxygenation on the incidence of pressure ulcers in patients in the ICU on mechanical ventilation. METHODS: This prospective analytical cross-sectional study was performed in several ICUs for a period of 8 months in Iran. Researchers checked patients for pressure ulcers on a daily basis. They collected demographic, hemodynamic, and oxygenation data until a pressure ulcer occurred, the patient's artificial airway was removed, the patient died, or the patient was discharged. RESULTS: From August 2017 to February 2018, a total of 2,581 patients were admitted to the study ICUs; of these, 133 patients were eligible for the study. The results indicated that 41.4% (n = 55) of the patients ended up with pressure ulcers. Investigation of the variables using a Cox regression model showed that, among other variables considered in this study, age, mean arterial pressure, and positive end-expiratory pressure in the mechanical ventilator can contribute to the risk of pressure ulcers. CONCLUSIONS: Providers should pay attention to changes in hemodynamic parameters, especially mean arterial pressure; carefully determine the most appropriate positive end-expiratory pressure for patients connected to mechanical ventilation; and take special care of susceptible groups such as older adults and hospitalized patients to decrease the incidence of pressure ulcers.

The Cardiac Risk Factors of Coronary Artery Disease and its relationship with Cardiopulmonary resuscitation: A retrospective study.

BACKGROUND: Cardiovascular diseases are considered as the most prevalent serious disease in developed countries, and act as the number one cause of death among men and women in all ages and from all races. AIM: The present research aims at determining the relationship between risk factors of cardiovascular diseases and consequences of cardiopulmonary resuscitation (CPR). METHODS: The present study is a retrospective analytic-cross sectional research performed on 100 patients in need for CPR (successful and unsuccessful) during March 2017 - June 2017. As research instrument, a pre-designed checklist was used including demographic information, clinical and medical information, and the information related to modifiable and non-modifiable risk factors of cardiovascular diseases. RESULTS: Obtained results indicated that, 57.1% of the successful CPR cases were administered on men, while 55.1% of unsuccessful CPR cases were administered on women. The patients diagnosed with myocardial infarction were in further need for CPR (rate of successful CPR: 66.7%, and rate of unsuccessful CPR: 61.9%). Significant associations were found between CPR duration, post-CPR survival time (survival time after CPR), systolic blood pressure, diastolic blood pressure, triglyceride level, diabetes, fasting blood sugar level, and body mass index, in one hand, and type of CPR, on the other hand (p < 0.05). CONCLUSION: Results of the present research showed that, there is a significant relationship between modifiable risk factors of cardiovascular diseases and consequences of CPR.

Association between apparent temperature and acute coronary syndrome admission in Rasht, Iran.

OBJECTIVE: Our objective was to assess the relations between apparent temperature and incidence of acute coronary syndrome (ACS) in Rasht, Iran. METHODS: We used a time-series analysis to investigate the relationship between apparent temperature and hospital admission from 2005 to 2014. Distributed lag non-linear models were used to estimate the association between ACS hospitalisation and apparent temperature. To examine the high-temperature effect on ACS hospital admission, the relative risk of ACS hospital admission associated with high temperature, the 99th percentile of temperature (34.7°C) compared with the 75th percentile of temperature (26.9°C), was calculated. To assess the cold effect on ACS hospital admission, the relative risk of ACS hospital admission associated with cold temperature, the first percentile of temperature (-0.2°C) compared with the 25th percentile of temperature (8.2°C), was evaluated. RESULTS: The cumulative effect of hot exposure on ACS admissions was statistically significant, with a relative risk of 2.04 (95% CI 1.06 to 4.16). The cumulative effect of cold temperature on ACS admissions was found to be non-significant. The highest risk of ACS admission in women was in 38°C (RR, 2.03, 95% CI 1.04 to 4.18). The effect of hot temperature on ACS admission occurred immediately (lag 0) (RR, 1.09, 95% CI 1.001 to 1.19). CONCLUSIONS: The high apparent temperature is correlated with a higher ACS admission especially on the same day. These findings may have implications for developing intervention strategies to reduce and prevent temperature-related morbidity especially in the elderly.

The Effects of Apparent Temperature on Cardiovascular Mortality Using a Distributed Lag Nonlinear Model Analysis: 2005 to 2014.

The relationship between apparent temperature and cardiovascular disease (CVD) mortality was studied in Rasht, Iran, from 2005 to 2014. The effects of apparent temperature on CVD mortality were investigated using the distributed lag nonlinear model. Data on all types of cardiovascular mortality cases according to the International Classification of Diseases were collected from the only cardiovascular hospital in Rasht, and the meteorological variables were obtained from Rasht Meteorological Center during the period of study. Our findings showed that low temperatures had significant impacts on CVD mortality, and a reverse J-shaped temperature-mortality relationship was found. Moreover, immediate effects of hot temperatures on CVD mortality with the strongest effects on the same day but delayed effects of cold temperature was observed. This study showed that exposure to both hot and cold apparent temperatures was associated with increased cardiovascular mortality in Rasht.

Ambient temperature and cardiovascular mortality: a systematic review and meta-analysis.

INTRODUCTION: Our study aims at identifying and quantifying the relationship between the cold and heat exposure and the risk of cardiovascular mortality through a systematic review and meta-analysis. MATERIAL AND METHODS: A systematic review and meta-analysis were conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Peer-reviewed studies about the temperature and cardiovascular mortality were retrieved in the MEDLINE, Web of Science, and Scopus databases from January 2000 up to the end of 2015. The pooled effect sizes of short-term effect were calculated for the heat exposure and cold exposure separately. Also, we assessed the dose-response relationship of temperature-cardiovascular mortality by a change in units of latitudes, longitude, lag days and annual mean temperature by meta-regression. RESULT: After screening the titles, abstracts and full texts, a total of 26 articles were included in the meta-analysis. The risk of cardiovascular mortality increased by 5% (RR, 1.055; 95% CI [1.050-1.060]) for the cold exposure and 1.3% (RR, 1.013; 95% CI [1.011-1.015]) for the heat exposure. The short-term effects of cold and heat exposure on the risk of cardiovascular mortality in males were 3.8% (RR, 1.038; 95% CI [1.034-1.043]) and 1.1%( RR, 1.011; 95% CI [1.009-1.013]) respectively. Moreover, the effects of cold and heat exposure on risk of cardiovascular mortality in females were 4.1% (RR, 1.041; 95% CI [1.037-1.045]) and 1.4% (RR, 1.014; 95% CI [1.011-1.017]) respectively. In the elderly, it was at an 8.1% increase and a 6% increase in the heat and cold exposure, respectively. The greatest risk of cardiovascular mortality in cold temperature was in the 14 lag days (RR, 1.09; 95% CI [1.07-1.010]) and in hot temperatures in the seven lag days (RR, 1.14; 95% CI [1.09-1.17]). The significant dose-response relationship of latitude and longitude in cold exposure with cardiovascular mortality was found. The results showed that the risk of cardiovascular mortality increased with each degree increased significantly in latitude and longitude in cold exposure (0.2%, 95% CI [0.006-0.035]) and (0.07%, 95% CI [0.0003-0.014]) respectively. The risk of cardiovascular mortality increased with each degree increase in latitude in heat exposure (0.07%, 95% CI [0.0008-0.124]). CONCLUSION: Our findings indicate that the increase and decrease in ambient temperature had a relationship with the cardiovascular mortality. To prevent the temperature- related mortality, persons with cardiovascular disease and the elderly should be targeted. The review has been registered with PROSPERO (registration number CRD42016037673).

Acute triggers of myocardial infarction: A case-crossover study.

BACKGROUND: Acute myocardial infarction (AMI) is one of the most preventable non-communicable diseases in human. Identifying triggers of myocardial infarction (MI) and prevention ways of exposure-induced complications can reduce morbidity and mortality in people at risk. AIM: The aim of this study was to identify the emotional, environmental, physical and chemical dimensions of acute triggers in patients with AMI. METHODS: This case-crossover study was conducted on 269 patients with AMI, hospitalized at two remedial centers in Rasht in 2015. The study samples were selected by convenient sampling method. Data were collected using researcher-made questionnaire through interviews. Hazard and control periods for each trigger and its effects on the development of MI were studied. The collected data were analyzed using descriptive and analytical statistical methods, Cochran test, and generalized estimating equation (GEE) model with logistics function default in SPSS version 21, and p < 0.05 was considered statistically significant. RESULTS: The results showed that quarrel (P = 0.008, OR = 2.01) and hearing the sudden news (P = 0.001, OR = 2.19) were the most common emotional triggers. Respiratory infections (P = 0.0001, OR = 6.78) and exposure to hot or cold weather (P = 0.005, OR = 2.19) were the most frequent environmental triggers. Doing heavy activities (P = 0.005, OR = 1.66) and sexual activities (P = 0.003, OR = 2.36) were among the most common physical triggers. High-fat foods consumption and overeating (P = 0.0001, OR = 3.79) were the most frequent chemical triggers of AMI. CONCLUSION: It seems that given the importance of the triggers in the incidence of AMI, planning is necessary to train vulnerable individuals to reduce exposure to triggers.

Complementary health insurance, out- of- pocket expenditures, and health services utilization: A population- based survey.

Background: Studies have shown that people using complementary health insurances have more access to health services than others. In the present study, we aimed at finding the differences between out- of- pocket payments and health service utilizations in complementary health insurances (CHIs) users and nonusers. Methods: Propensity score matching was used to compare the 2 groups. First, confounder variables were identified, and then propensity score matching was used to compare out- of- pocket expenditures with dental, general physician, hospital inpatient, emergency services, nursing, midwifery, laboratory services, specialists and rehabilitation services utilization. Results: Our results revealed no significant differences between the 2 groups in out- of- pocket health expenditures. Also, the specialist visits, inpatient services at the hospital, and dental services were higher in people who used CHIs compared to nonusers. Conclusion: People did not change their budget share for health care services after using CHIs. The payments were equal for people who were not CHIs users due to the increase in the quantity of the services.

Fertility and Minority: A Study in Two Provinces of Iran Using Matching Estimator Technique.

The main aim of this study was to compare fertility in minor (Sunnah) and major (Shia) religious groups of Iran after matching the two groups by some confounding factors. 12,099 data of population and census survey of Iran in 2011 in two provinces of Guilan and Kurdistan were used in this study. Propensity scoring matching method was used for matching two groups. First confounder variables were found and after that the groups were matched. Principal component analysis was used to make a socioeconomic (SES) variable. At the end, two groups were compared to each other by nearest neighborhood method. Also Poisson regression was used to find the effective factors of fertility. Before using matching method, the results showed that fertility in Kurdistan was higher than Guilan, but after matching, fertility in Guilan was higher. The results of regression model showed that in Guilan, living in urban region, age and level of education had effect on fertility, but in Kurdistan, education, age and SES were effective factors.