Targeting the prefrontal-supplementary motor network in obsessive-compulsive disorder with intensified electrical stimulation in two dosages: a randomized, controlled trial.

Obsessive-compulsive disorder (OCD) is associated with a high disease burden, and treatment options are limited. We used intensified electrical stimulation in two dosages to target a main circuitry associated with the pathophysiology of OCD, left dorsolateral prefrontal cortex (l-DLPFC), and pre-supplementary motor area (pre-SMA) and assessed clinical outcomes, neuropsychological performance, and brain physiology. In a double-blind, randomized controlled trial, thirty-nine patients with OCD were randomly assigned to three groups of sham, 2-mA, or 1-mA transcranial direct current stimulation (tDCS) targeting the l-DLPFC (F3) and pre-SMA (FC2) with anodal and cathodal stimulation respectively. The treatment included 10 sessions of 20-minute stimulation delivered twice per day with 20-min between-session intervals. Outcome measures were reduction in OCD symptoms, anxiety, and depressive states, performance on a neuropsychological test battery (response inhibition, working memory, attention), oscillatory brain activities, and functional connectivity. All outcome measures except EEG were examined at pre-intervention, post-intervention, and 1-month follow-up times. The 2-mA protocol significantly reduced OCD symptoms, anxiety, and depression states and improved quality of life after the intervention up to 1-month follow-up compared to the sham group, while the 1-mA protocol reduced OCD symptoms only in the follow-up and depressive state immediately after and 1-month following the intervention. Both protocols partially improved response inhibition, and the 2-mA protocol reduced attention bias to OCD-related stimuli and improved reaction time in working memory performance. Both protocols increased alpha oscillatory power, and the 2-mA protocol decreased delta power as well. Both protocols increased connectivity in higher frequency bands at frontal-central areas compared to the sham. Modulation of the prefrontal-supplementary motor network with intensified tDCS ameliorates OCD clinical symptoms and results in beneficial cognitive effects. The 2-mA intensified stimulation resulted in larger symptom reduction and improved more converging outcome variables related to therapeutic efficacy. These results support applying the intensified prefrontal-SMA tDCS in larger trials.

Determining psychometric properties of the Persian version of demoralization scale-II in patients with cancer.

BACKGROUND: One of the emotional problems in patients experiencing cancer is demoralization syndrome. Concerning the importance of demoralization in patients with cancer, having a valid and reliable scale for assessing this problem is crucial. A revised version of Demoralization Scale (DS-II) was designed in 2016. It was necessary to determine its validity and reliability in populations with different cultures. This study aimed to determine the psychometric properties of the Persian version of DS-II (PDS-II) in Iranian patients with cancer. METHODS: The study population comprised 170 Iranian patients with cancer in Ardabil, Iran. The inclusion criteria were: age 18 or more, ability to understand and speak Persian, willingness to consent to participate in the study, having healthy cognitive function, and having an awareness of cancer. To determine the psychometric properties of PDS-II, the content, convergent, construct, and discriminant validity, besides internal consistency, were evaluated. RESULTS: Regarding the high correlation of PDS-II with General Anxiety Disorder, Patient Health Questionnaire, Beck Hopelessness Scale, and Hospital Anxiety and Depression Scale, the convergent validity of the PDS-II was confirmed. Confirmatory factor analyses confirmed both the original 2-factor and one-factor models of PDS-II. Internal discriminant validity of the PDS-II was not confirmed because the Average Variance Extracted from two dimensions of PDS-II (AVE = 0.31 and 0.37) was less than the square correlation between these two dimensions (r2 = 0.79). Cronbach α and coefficient was 0.88 for the PDS-II. CONCLUSIONS: PDS-II is a valid and reliable scale for measuring demoralization among Iranian people with cancer. However, the discriminant validity of the PDS-II was not supported.

Frequency of Self-Medication and Knowledge about Out-of-Counter Drugs during the COVID-19 Pandemic in a Group of Iranian Dental Students

Abstract Objective: To study the frequency of self-medication and knowledge about out-of-counter drugs during the COVID-19 pandemic in a group of Iranian dental students. Material and Methods: A descriptive cross-sectional study was conducted among dental undergraduates from September 2021 to November 2021 after receiving ethical clearance from the Kerman Medical University Ethical Committee. A valid and reliable questionnaire, consisting of demographic data and questions about self-medication and knowledge about out-of-counter drugs, was sent to participants via E-mail. Data was analyzed by SPSS 26 software by using a t-test. The P-value was considered at a 0.05% significant level. Results: A total of 88 students participated in the study with a mean age of 21.39±3.71 years. Prevalence of self-medication was found in 53.4%. The most common cause for self-medication was headache. Acetaminophen was the most commonly used medicine for self-medication. Females had more self-medication than males, but there was no significant differences. There was no significant differences between entering year to university and self-medication. Younger students had significantly more self-medication (p=0.007). Knowledge about out-of-counter drugs was moderate. Conclusion: Moderate self-medication as noticed. The out-of-counter drugs were the most used. Although out-of-counter drugs seem relatively safe, their improper use can cause serious side effects. Dental students need to be educated regarding appropriate safe medication and out-of-counter drugs.

The Role of Perceived Burdensomeness, Thwarted Belongingness, and Giving Meaning to Life in Psychosocial Adjustment: The Mediating Role of Self-Care in the Elderly.

Objective: In old age, people suffer from many mental and physical illnesses, which make it important for the elderly to pay attention to adapting to these diseases. So, the aim of this research was to study the role of perceived burdensomeness, thwarted belongingness, and giving meaning to life in psychosocial adjustment, as well as the mediating role of self-care in the elderly. Method : This research was descriptive and correlational, conducted through available sampling of 200 elderly people who lived in the city of Ardabil. After the necessary assessments in terms of mental disorders and inclusion criteria, they were chosen to conduct this investigation in 2020. The Meaning in Life Questionnaire, Psychosocial Adjustment Scale, Self-Care Questionnaire for the Elderly, and Interpersonal Needs scale were used to gather the data. The data were analyzed using SPSS25 and Amos24 software. Results: The findings showed that perceived burdensomeness and thwarted belongingness have a negative and direct effect on elderly self-care [ß = -0.25, P < 0.01] [ß = -0.20, P < 0.05] and psychosocial adjustment [ß = -0.0, P < 0.05] [ß = -0.12, P < 0.05]. Also, giving meaning to life has a positive and direct effect on elderly self-care [ß = 0.32, P = 0.01] and psychosocial adjustment [ß = 0.033, P < 0.01]. The variable of self-care can play a mediating role in the relationship between thwarted belongingness [ß = -0.174, P < 0.05], perceived burdensomeness [ß = -0.140, P < 0.05], and giving meaning to life [ß = 0.223, P < 0.05] with psychosocial adjustment. Moreover, among the exogenous variables, thwarted belongingness and perceived burdensomeness by change in self-care have been able to reduce psychosocial adjustment. Giving meaning through self-care, however, has increased psychosocial adjustment. Conclusion: The findings revealed that thwarted belongingness, perceived burdensomeness, and giving meaning to life are important variables in health and adaptability of the elderly, which draws attention to family-centered interventions and individual therapies.

Providing a health-promotion behaviors model in elderly: Psychological capital, perceived social support, and attitudes toward death with mediating role of cognitive emotion regulation strategies.

Background and Aims: The aim of this study was to present a health-promotion behaviors model in the elderly based on psychological capital, social support, and attitudes toward death mediated with mediating role of emotional cognitive regulation strategies in the elderly in Ardabil. Methods: The research method was correlational which was done by the path analysis method. The statistical population of the study consisted of all elderly people in Ardabil in 2020, from which 250 people were selected by convenient sampling method and were investigated with research tools including Health-Promotion Lifestyle Profile (1998), attitudes toward death profile (1994), Psychological Capitals (2007), social support (1988) and Cognitive Emotion Regulation (2001). Data were analyzed by Amos-24 software and using structural equation modeling. Results: The results showed that psychological capital, social support, and attitude towards death directly affect health-promotion behaviors and also indirectly improve them through cognitive emotion regulation strategies. These results can have a significant impact on promoting health and improving the quality of life of the elderly population. Conclusions: Based on the findings of the present study, it can be claimed that the proposed model for the health of the elderly has an acceptable fitness and this model can be used in developing educational programs and intervention techniques to improve the health of this group of people.

The relationship between personality profile and self-care among patients with type 2 diabetes.

Background: As a chronic disease, diabetes needs special self-care behaviors until the end of life. Personality traits are considered to be effective psychological factors in controlling diabetes and self-care in patients with diabetes. The present study was conducted to determine the relationship between personality profile and self-care among people with type 2 diabetes. Methods: In this descriptive-correlational study conducted in 2021, 160 patients with type 2 diabetes referred to the diabetes clinic of Imam Khomeini Educational and Medical Center in Ardabil were selected by convenience sampling method. The data collection tools included the Diabetes Self-Care Activities questionnaire (SDSCA) and the short form of the Millon Multi-Axis Clinical Test (MCMI-3), which were completed through interviews with patients. Data were analyzed by SPSS software using descriptive statistics (mean, SD, and frequency) and inferential statistics (Pearson correlation coefficient and linear regression). Results: Based on the results, apart from the obsessive personality disorder, which had a positive relationship with self-care behaviors, a significant negative correlation was observed between schizoid, avoidant, depressed, dependent, antisocial, self-harming, borderline, and paranoid personality disorders with self-care behaviors (p < 0.01). Conclusion: The results showed that there is a significant negative relationship between personality profile and self-care status of patients with type 2 diabetes. In other words, a person's personality profile can predict self-care behaviors. Accordingly, personality traits can be considered as one of the influencing factors on self-care in the educational programs of diabetic patients. Holding educational classes to empower patients using psychological interventions and teaching effective solutions can be an effective step toward increasing the level of mental-physical health and self-care of patients with type 2 diabetes.

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 (ß = 0.18, p < 0.01), interpersonal effects (ß = 0.19, p < 0.01), positive emotion (ß = 0.15, p < 0.05) and perceived benefits (ß = 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.

Post-Traumatic Stress Disorder and Its Related Factors in Nurses Caring for COVID-19 Patients.

Background: Post-Traumatic Stress Disorder (PTSD) is a mental disorder that can result from direct or indirect contact with traumatic events. The current study aimed to evaluate PTSD and its related factors in nurses caring for COVID-19 patients. Materials and Methods: This study was a descriptive correlational study. Using convenience sampling methods, 395 nurses were enrolled in the study. The study instruments included demographic information, Impact of Event Scale-Revised (IES-R), and General Health and Job Content Questionnaire (JCQ). Data were analyzed using the Pearson correlation test, t-test, ANOVA, and multiple regression analysis. Results: The mean (SD) age and work experience of the participants were 33.79 (6.74) years and 9.47 (6.47) years, respectively. Most nurses (86.60%) experienced PTSD. Multiple linear regression results showed general health (R 2 = 0.51, p = 0.001), job insecurity (R 2 = 0.51, p = 0.042), decision latitude (R 2 = 0.51, p = 0.037), and high age (R 2 = 0.51, p = 0.049) to be associated with an increase in PTSD, and having high social support (R 2 = 0.51, p = 0.043) was associated with a decrease in PTSD in nurses. Conclusions: Nurses have experienced high levels of PTSD after the fatal outbreak of COVID-19 disease. Stressful conditions associated with an increased likelihood of this disorder should be identified, and coping skills such as decision latitude (control) and social support should be strengthened to prevent the symptoms of this disorder in nurses.

Management Strategies During the COVID-19 Pandemic Crisis: The Experiences of Health Managers from Iran, Ardabil Province.

OBJECTIVE: The coronavirus disease 2019 (COVID-19) outbreak is the most threatening public health challenge in the 21th century, and more than 200 countries are affected. Considering that Iran was one of the first countries influenced by the COVID-19 pandemic, this study aimed to explain the crisis management strategies during the COVID-19 pandemic in Ardabil province. METHODS: This study used a qualitative method using content analysis in which 12 health-care managers or decision-makers involved in the management of the COVID-19 crisis were recruited through purposeful sampling. In-depth, semi-structured interviews were used to collect data, which continued until data saturation. RESULTS: Data analysis led to nine categories, including prior preparation for the COVID-19 crisis; challenges and management of workforce shortages; benefiting from the participation of volunteer staff; challenges and strategies for physical space, supplies, and personal protective equipment (PPE); designation of referral centers for COVID-19; protocolized patient transport; benefiting from donations and charity support; management of information about COVID-19; and learning from the prior stages of crisis. CONCLUSION: This study revealed that, in critical situations, managers use multiple and, to some extent, unique strategies for decision-making and crisis control. Therefore, the health system can use the findings of the current study for proper response to similar crises and training of future managers.

Experiences of Radiology Personnel About the COVID-19 Crisis: A Qualitative Content Analysis.

Background: The COVID-19 pandemic has affected all health care systems. During these critical times, radiology personnel and nurses have been heavily involved in the diagnosis and management of patients with COVID-19. Purpose: This study investigates the experiences of radiology personnel about the COVID-19 crisis. Methods: This qualitative content analysis was conducted on seven radiology personnel. In-depth semistructured interviews were used to collect data. Purposive sampling was carried out to select the participants. Findings: The data analysis led to the emergence of six categories, including psychological-emotional reactions, knowledge-related challenges, humaneness, workplace conditions, hopefulness, and support. Conclusion: Learning from the experiences of radiology personnel and nurses during the COVID-19 crisis can help better manage any subsequent health crises.

Improved Executive Functions and Reduced Craving in Youths with Methamphetamine Addiction: Evidence from Combined Transcranial Direct Current Stimulation with Mindfulness Treatment.

OBJECTIVE: Transcranial direct current stimulation (tDCS) and mindfulness practices have been proposed as a potential approach to improve executive functions (EFs) and reduce craving in persons with substance use disorders. Based on the neural mechanisms of action of each of these interventions, the combination of both non-pharmacological interventions might have additive effects. In the current study, the effects of tDCS combined with mindfulness-based substance abuse treatment (MBSAT) to improve EFs and reduce craving were investigated in early abstinent methamphetamine abuse. METHODS: Eighty (youths aged between 18 and 21) early-abstinent methamphetamine users were randomly assigned to the research groups (tDCS group [n = 20], mindfulness group [n = 20], combined mindfulness-tDCS group [n = 20], and sham group [n = 20]). Active tDCS (1.5 mA,20 min, 12 sessions) or sham tDCS was appliedover the left dorsolateral prefrontal cortex and the MBSAT protocol was used over twelve 50-min sessions. RESULTS: Both in the post-test phase (immediately after the intervention) and follow-up phase (one month after the intervention), performance in most EFs tasks significantly improved in the combination group which received real tDCS ＋ MBSAT, as compared to baseline values and sham stimulation group. Similarly, a significant reduction in craving was observed after intervention inall treatment groups, but not the sham stimulation group. Interestingly, the increase in EFs and the reduction in craving post versus pre tDCS ＋ MBSAT intervention were correlated. CONCLUSION: Findings from the current study provide initial support for the clinical effectiveness of combination tDCS ＋ MBSAT, possibly influencing cognitive/affective processes.

Psychometric Properties of Nursing Delirium Screening Scale in Patients Admitted to Intensive Care Units.

BACKGROUND: Nursing Delirium Screening Scale (Nu-DESC) is a new instrument for determining delirium by nurses. The study aimed to investigate the psychometric properties of Nu-DESC and determined the sensitivity and specificity of it. METHODS: Two evaluators assessed delirium by Nu-DESC in nonintubated patients admitted to intensive care unit (ICU) wards of Ardabil educational and medical centers. For determining psychometric properties of the instrument, the methods of determining content validity, structural validity, criterion validity (the DSM-5 criteria was used as a standard tool), internal consistency, and inter-rater reliability were used. RESULTS: Ninety-six participants were assessed two times using the Nu-DESC. The mean age of the participants was 58.84, and 51 (53.1%) of them were male. Due to the high correlation of the Nu-DESC with the study criterion (DSM-5), the criterion validity of the instrument is confirmed. By using DSM-5 instrument, the cutoff score of 2 shows the best sensitivity and specificity. The kappa and alpha coefficients were obtained as r = 0.96 and α = 0.86, which indicate a good agreement between the evaluators and acceptable consistency. CONCLUSION: Nu-DESC can be used as an efficient and reliable instrument by nurses in the ICU. It was also found that taking medical history can help nurses to better interpret the Nu-DESC score at diagnosing delirium. HOW TO CITE THIS ARTICLE: Amirajam Z, Noran EA, Molaei B, Adiban V, Heidarzadeh M, Darghah MH. Psychometric Properties of Nursing Delirium Screening Scale in Patients Admitted to Intensive Care Units. Indian J Crit Care Med 2021;25(6):680-684.

The Epidemiology of Hospital-Referred Head Injury in Ardabil City.

Background and Purpose. Trauma is the leading cause of death for youth in developing countries. Given the prevalence of head trauma (HT) in society and its complication and burden, the epidemiologic study of head trauma is necessary and is the main aim of this study. Materials and Methods. This retrospective population-based survey describes the epidemiology of head injury in a defined population in Ardabil city. It includes all 204 patients with head injury referred to the University Hospital of Ardabil, Iran, during 2013-2014. Data were collected by a checklist and analyzed by statistical methods in SPSS.19. Significance level p < 0.05 was considered. Results. Of all registered cases, 146 (71.6%) were male and the rest of them were female. Most of HT patients lived in Ardabil city (60.8%). The mean age of patients was 22.6 ± 25.9 and most of victims were young. 24.5% of traumatic patients have injuries in severe to critical level (grade 3-4). The most cause of trauma was accidents (41.7%). Most of injuries occurred in night (55.9%) and in summer season (42.2%). Causes were traffic accident in 41.7%. Conclusion. Results showed that the leading cause of head trauma especially in the warm seasons is accidents and so, designing programs to reduce road accidents can dramatically reduce the rate of trauma in the future in Ardabil province.