The impact of using P6 acupressure on the nausea, vomiting, and comfort of myocardial infarction patients: A randomized, single-blind, placebo-controlled clinical trial.

Background: Nausea and vomiting are two common symptoms in myocardial infarction patients. This study aims to determine the impact of p6 acupressure on nausea, vomiting, comfort, and the need for anti-vomiting drugs in myocardial infarction (MI) patients. Methods: This research involved 90 patients with acute heart attacks experiencing persistent nausea despite taking anti-vomiting drugs. They were divided into three groups: acupressure, placebo, and control. The acupressure group wore a wristband with a button, the placebo group had a similar wristband without a button, and the control group received no wristband. Data on nausea severity, comfort, frequency of nausea, vomiting, and retching was collected before and after the intervention at different time points. The study also assessed the use of anti-vomiting drugs within 24 h of the intervention. Results: The patients in the acupressure group, compared to those in the placebo and control groups, experienced significantly lower severity of nausea, frequency of vomiting, nausea, and retching and a substantially higher level of comfort level during the two, four, and 6 h after the start of the intervention (P < 0.05). However, no significant difference between the placebo and control groups was observed (P > 0.05). During the 24 h after the start of the intervention, administration of anti-vomiting drugs to the acupressure group was significantly less than that done in the placebo and control groups (P < 0.05). Conclusions: The results illustrated that p6 acupressure reduces nausea, vomiting, and retching and increases the comfort level in myocardial infarction patients.

Evaluation of Rosuvastatin Therapy on SIRT1 Gene Expression in Patients with Multiple Sclerosis: An Uncontrolled Clinical Trial.

Background: Multiple sclerosis (MS) is a chronic autoimmune disease. Current medications have some limitations such as low efficacy and high side effects. In recent years, statins have been raised as potential therapeutics for MS treatment with minimal complications. In addition, patient monitoring using suitable molecular markers is necessary for treatment response evaluation. Objective: The aim of the present study was the evaluation of SIRT1 gene expression changes following rosuvastatin therapy in patients with MS. Methods: This before-after uncontrolled clinical trial study was performed on 25 patients with MS. Patients were treated with 20 mg rosuvastatin daily for 3 months. The Expanded Disability Status Scale (EDSS) was measured before and after statin therapy. Blood samples were taken from patients 2 times, before and after statin therapy, and centrifuged for white blood cell isolation. Total RNA was extracted using RNX-plus reagent, and complementary DNA was synthesized using Pars Tous cDNA Synthesis Kit. Real-time polymerase chain reaction was done using SYBR blue master mix and gene-specific primers in Roche light cycler. Patients' information was recorded using a checklist. Data analysis was performed using SPSS version 23 and Graph Pad version 9 software and P < 0.05 was considered a significant level. Results: SIRT1 was significantly upregulated in MS patients after statin therapy. Subsequently, EDSS of patients was decreased along with the increase in SIRT1 gene expression, although EDSS changes were not significant (P > 0.05). Pearson correlation test showed no significant relationship between EDSS and SIRT1 gene expression (P > 0.05). No significant relationship was observed between SIRT1 expression or EDSS levels with patients' age, sex, weight, height, and body mass index and administrated drugs (P > 0.05). Conclusions: SIRT1 potentially is a sensitive and reliable biomarker for patients with MS monitoring during statin therapy.

Experiences of persons with multiple sclerosis of a collaborative care programme: A qualitative study.

AIM: This study aimed to explain the experiences of individuals with multiple sclerosis (MS) about the collaborative care programme. DESIGN: This qualitative study was conducted from July 2021 to March 2022. METHODS: We conducted this study with individuals with MS who participated in the collaborative care programme in Hamadan, Iran. A purposive sampling with maximum variety was applied to recruit patients until data saturation. Eventually, 18 patients consented and were interviewed using a semi-structured interview guide. The transcriptions of audio-checked interviews were analysed using a conventional content analysis approach of Graneheim and Lundman by MAXQDA 10, 2010 edition. RESULTS: The study identified three main categories. that emerged from the participants' experiences of collaborative care: the 'Beginning of Communication', which included two subcategories, 'Introduction and Acquaintance with Each Other' and 'Formation of Trust'; 'Mutual Interaction', which included three subcategories, 'Dialogue', 'Mutual Goal Setting' and 'Mutual Agreement of Care Solutions'; and 'Exchange of Targeted Behaviors', which included six categories, Implementation of Strategies for 'Nutritional Behaviors', 'Sleep and Rest', 'Constipation Relief', 'Promotion of Physical Activity and Exercise', 'Fatigue Reduction' and 'Stress Management'. CONCLUSIONS: The findings highlight the statistically significant role of collaborative care in MS management. Utilizing these research findings can update the development of interventions based on collaborative care, which can provide appropriate support to individuals with MS. PATIENT OR PUBLIC CONTRIBUTION: Individuals with multiple sclerosis.

Predictors of COVID-19 related death in elderly patients hospitalized due to COVID-19 infection: a cross-sectional study in the west of Iran.

Aim: Identifying risk factors associated with mortality in elderly patients hospitalized with COVID-19 can be helpful in managing the disease in this age group. Therefore, the aim of this study was to determine the risk factors of death in elderly patients hospitalized with COVID-19 in Hamadan in 2020. Subject and methods: This cross-sectional study was performed on the medical records of 1694 patients aged 60 years and older who were diagnosed with COVID-19 disease between March and August 2020 and were admitted to Shahid Beheshti and Sina Hospitals. A researcher-made checklist included demographic information, clinical information, laboratory results, type of procedures performed for the patient in the hospital, and the number of hospitalization days. Results: The results showed that 30% of the elderly patients died due to COVID-19 complications. The results of adapted logistic regression showed that the variables of gender, age, inpatient ward and laboratory indices of albumin, hemoglobin, ESR, and LDH were the main predictors of COVID-19 related death in elderly patients (p < 0.05). Conclusion: The rate of COVID-19 related death in the hospitalized elderly patients is remarkable. The death rate increased among male patients, age older than 75 years, hospitalization in the ICU, increased ESR and HDR levels, and decreased albumin and hemoglobin.

Effectiveness of Repetitive Transcranial Magnetic Stimulation (rTMS) Add-On Therapy to a Standard Treatment in Individuals with Multiple Sclerosis and Concomitant Symptoms of Depression-Results from a Randomized Clinical Trial and Pilot Study.

BACKGROUND: Compared to the general population, persons with multiple sclerosis (MS) are at increased risk of suffering from major depressive disorder (MDD). Repetitive Transcranial Magnetic Stimulation (rTMS) was used successfully to treat individuals with MDD. Here, we conducted a randomized clinical trial and pilot study, and tested the effectiveness of rTMS adjuvant to a standard pharmacological treatment among persons with MS, compared to a sham condition. MATERIALS AND METHODS: A total of 40 persons with MS (mean age: 32 years; 42.5% females; median EDSS score: 4) and with moderate to severe symptoms of depression were randomly assigned to the rTMS or to the rTMS sham condition, always as adjuvant intervention to the standard treatment with sertraline, a selective serotonin reuptake inhibitor (SSRI). rTMS consisted of 10 sessions each of 37.5 min; the sham condition was identical to the active condition except for the absence of rTMS stimuli. At the beginning and two weeks after the end of the study, participants reported on their fatigue, while experts rated the severity of participants' depressive symptoms (Montgomery-Asberg Depression Rating Scale; MADRS), cognitive performance (Montreal Cognitive Assessment; MoCA), and degree of disability (Expanded Disability Status Scale; EDSS). RESULTS: Data were analyzed per intent-to-treat. Scores for depression, fatigue, and EDSS declined significantly over time (large effect sizes), but more so in the rTMS condition than in the sham condition (large effect sizes for the time by group-interactions). Compared to the sham condition, scores for depression were significantly lower in the rTMS condition. Scores for cognition improved over time in both study conditions (large effect size). CONCLUSION: Compared to a sham condition, adjuvant rTMS to a standard pharmacological treatment ameliorated typical MS-related symptoms (depression; fatigue; EDSS scores). Results from this pilot study suggested that rTMS might be routinely applied in persons with MS displaying symptoms of depression and fatigue.

Identification of gene profiles related to the development of oral cancer using a deep learning technique.

BACKGROUND: Oral cancer (OC) is a debilitating disease that can affect the quality of life of these patients adversely. Oral premalignant lesion patients have a high risk of developing OC. Therefore, identifying robust survival subgroups among them may significantly improve patient therapy and care. This study aimed to identify prognostic biomarkers that predict the time-to-development of OC and survival stratification for patients using state-of-the-art machine learning and deep learning. METHODS: Gene expression profiles (29,096 probes) related to 86 patients from the GSE26549 dataset from the GEO repository were used. An autoencoder deep learning neural network model was used to extract features. We also used a univariate Cox regression model to select significant features obtained from the deep learning method (P < 0.05). High-risk and low-risk groups were then identified using a hierarchical clustering technique based on 100 encoded features (the number of units of the encoding layer, i.e., bottleneck of the network) from autoencoder and selected by Cox proportional hazards model and a supervised random forest (RF) classifier was used to identify gene profiles related to subtypes of OC from the original 29,096 probes. RESULTS: Among 100 encoded features extracted by autoencoder, seventy features were significantly related to time-to-OC-development, based on the univariate Cox model, which was used as the inputs for the clustering of patients. Two survival risk groups were identified (P value of log-rank test = 0.003) and were used as the labels for supervised classification. The overall accuracy of the RF classifier was 0.916 over the test set, yielded 21 top genes (FUT8-DDR2-ATM-CD247-ETS1-ZEB2-COL5A2-GMAP7-CDH1-COL11A2-COL3A1-AHR-COL2A1-CHORDC1-PTP4A3-COL1A2-CCR2-PDGFRB-COL1A1-FERMT2-PIK3CB) associated with time to developing OC, selected among the original 29,096 probes. CONCLUSIONS: Using deep learning, our study identified prominent transcriptional biomarkers in determining high-risk patients for developing oral cancer, which may be prognostic as significant targets for OC therapy. The identified genes may serve as potential targets for oral cancer chemoprevention. Additional validation of these biomarkers in experimental prospective and retrospective studies will launch them in OC clinics.

National trends and projection of chronic kidney disease incidence according to etiology from 1990 to 2030 in Iran: a Bayesian age-period-cohort modeling study.

OBJECTIVES: Chronic kidney disease (CKD) is a major public health problem worldwide. Predicting CKD incidence rates and case numbers at the national and global levels is vital for planning CKD prevention programs. METHODS: Data on CKD incidence rates and case numbers in Iran from 1990 to 2019 were extracted from the Global Burden of Disease online database. The average annual percentage change was computed to determine the temporal trends in CKD age-standardized incidence rates from 1990 to 2019. A Bayesian age-period-cohort model was used to predict the CKD incidence rate and case numbers through 2030. RESULTS: Nationally, CKD cases increased from 97,300 in 1990 to 315,500 in 2019. The age-specific CKD incidence rate increased from 168.52 per 100,000 to 382.98 per 100,000 during the same period. Between 2020 and 2030, the number of CKD cases is projected to rise to 423,300. The age-specific CKD incidence rate is projected to increase to 469.04 in 2030 (95% credible interval, 399.20 to 538.87). In all age groups and etiological categories, the CKD incidence rate is forecasted to increase by 2030. CONCLUSIONS: CKD case numbers and incidence rates are anticipated to increase in Iran through 2030. The high level of CKD incidence in people with diabetes mellitus, hypertension, and glomerulonephritis, as well as in older people, suggests a deficiency of attention to these populations in current prevention plans and highlights their importance in future programs for the national control of CKD.

The effect of applying the nursing process based on the Theory of Goal Attainment on activities of daily living and quality of life in persons with multiple sclerosis during COVID-19 pandemic: a clinical trial.

BACKGROUND: The chronic nature of multiple sclerosis (MS) affects patient's activities of daily living (ADL) and quality of life (QOL). Nursing interventions based on patients' active participation in goal-setting can be beneficial in improving ADL and QOL. AIMS: This study aimed to determine the effect of applying the nursing process based on King's Theory of Goal Attainment (TGA) on ADL and QOL of persons with multiple sclerosis (PwMS) during the COVID-19 pandemic. METHODS: In this clinical trial, 70 patients referred to the MS Society of Hamadan, Iran, were recruited using the convenience sampling method and randomly assigned into 2 groups. A 4-stage TGA was developed and implemented for the intervention group for a month. Data were gathered by ADL, instrumental ADL (IADL), and QOL questionnaires, and Goal of Attainment Scale (GAS) before and 2 months after the intervention. RESULTS: Intervention group achieved a higher number of prioritized goals (p < 0.001) and reported higher QOL (P < 0.001) and instrumental ADL (IADL; P = 0.002) than the control group. CONCLUSIONS: Given the results, TGA could effectively promote mutual goal attainment, QOL, and IADL for PwMS during the COVID-19 pandemic. TRIAL REGISTRATION: ClinicalTriasl.gov Identifier: IRCT20201210049668N1.

An integrative fuzzy Delphi decision-making trial and evaluation laboratory (DEMATEL) study on the risk perception-influencing factors.

Objectives. Risk perception is one of the factors that can guide human behavior in the workplace. The present study aimed to identify the most important factors affecting risk perception. Methods. This cross-sectional study had three phases. In the first, factors affecting risk perception were extracted based on librarian resources and studies. Then, using the fuzzy Delphi method and based on the expert's opinion, the most important factors affecting risk perception were identified. Finally, using the fuzzy decision-making trial and evaluation laboratory (DEMATEL) technique and relying on the opinions of experts, the relationships between these factors were analyzed and their role as cause or effect was determined. Results. Eleven variables were identified as the most important factors influencing risk perception, among which safety knowledge, quality and quantity of safety training, and safety climate had the greatest effect on risk perception with defuzzified scores of 0.826, 0.817 and 0.808, respectively. Seven of the variables had the role of cause and four of them had the role of effect. Experience of accident along with safety climate had the highest interaction with other variables. Conclusion. Precise investigation of risk perception-influencing factors can play an important role in improving risk perception and safe behaviors.

Comprehensive comparison of clinicoradiological, laboratory, and prognostic factors of community-acquired pneumonia in diabetic and nondiabetic hospitalized patients.

Background/aim: Community-acquired pneumonia (CAP) is one of the leading infectious causes of mortality, and diabetes mellitus is a globally prevalent disease. Consequently, the cooccurrence of these two disorders can be common and create challenging medical conditions. Therefore, it was aimed to compare the various aspects of CAP in diabetic and nondiabetic patients, in order to have a comprehensive and comparative picture of the differences. Materials and methods: In this cross-sectional study, CAP patients with and without diabetes were assessed for clinicoradiological signs, laboratory features, disease severity, and pneumonia outcomes. Results: Analyzed herein were 172 CAP patients (77 had diabetes and 95 were nondiabetic). Clinical and radiological signs of pneumonia were mostly similar between the groups, except for purulent sputum, which was more prevalent among the nondiabetic patients. The laboratory results were also mostly similar. However, analysis of the outcomes and prognosis showed different results. The diabetic patients had a longer mean duration of hospital stay (8.52 days vs. 7.93 days, p = 0.015), higher median pneumonia severity based on the CURB-65 criteria (3 vs. 2, p = 0.016), and higher intensive care unit (ICU) admission requirement (22.1% vs. 7.3%, p = 0.004). Moreover, the mortality rate for the diabetic patients was nonsignificantly higher (16.8% vs. 15.7%, p = 0.453). Furthermore, the results of the logistic regression analysis showed that the diabetic patients had significantly higher odds of experiencing more severe forms of pneumonia (adjusted odds ratio (AOR): 5.77, 95% CI: 2.52-13.20), requiring ICU hospitalization (AOR: 3.56, 95% CI: 1.39-9.11), and having a longer hospital stay (AOR: 2.01, 95% CI: 1.09-3.71). In addition, although there was no significant relationship between the severity of pneumonia and the amount of glycated hemoglobin (HbA1c) in the diabetic patients (p = 0.940), the higher level of HbA1c in the nondiabetic patients was significantly correlated with a higher severity of pneumonia (p = 0.002). Conclusion: While diabetic patients with CAP have the same clinicoradiological and laboratory features as nondiabetic patients, the presence of diabetes can significantly worsen the outcomes and prognosis of pneumonia.

Levetiracetam as an Adjunctive Treatment for Mania: A Double-Blind, Randomized, Placebo-Controlled Trial.

BACKGROUND: Levetiracetam is an anticonvulsant with a low side effect profile and favorable properties for individuals with bipolar I disorder during their manic phase. Despite initial promising results until about 2008, it appears that this track of research has not been followed-up. To counter this, we tested the influence of adjuvant levetiracetam on acute mania, compared to placebo. More specifically, we performed a randomized, double-blind, placebo-controlled clinical trial among inpatients with bipolar disorder I during their acute phase of mania. METHODS: A total of 72 inpatients (mean age: 33.98 years; 23.6% females) with diagnosed bipolar disorder I and during their acute manic phase were randomly assigned either to the adjuvant levetiracetam (250 mg to a maximum of 1,500 mg) or to the placebo condition. Standard medication was lithium at therapeutic dosages. At baseline, participants completed a series of self-rating questionnaires covering sociodemographic information and subjective sleep. Subjective sleep was re-assessed 24 days later at the end of the study. Experts rated participants' acute state of mania with the Young Mania Rating Scale at baseline and at day 12 and day 24. Participants' cognitive performance was assessed at baseline and at day 24 at the end of the study. RESULTS: Over time, mania scores significantly decreased (large effect size), but more so in the levetiracetam condition, compared to the placebo condition (medium effect size). Likewise, over time, subjective sleep improved (large effect size), but more so in the levetiracetam condition, compared to the placebo condition (large effect size). Over time, cognitive performance improved (large effect size), irrespective of the study condition. CONCLUSIONS: Compared to placebo, adjuvant levetiracetam to lithium improved symptoms of mania, as rated by experts, and subjective sleep quality. Adjuvant levetiracetam had no further favorable (or detrimental) impact on cognitive performance.

Household Secondary Attack Rate of COVID-19 among Healthcare Workers and Related Factors.

Background: The risk for transmission of COVID-19 to people in close contact with infected people, especially healthcare workers, has not been well estimated. Therefore the present study was conducted to assess the household secondary attack rate (SAR) of COVID-19 among healthcare workers and related factors. Materials and Methods: The present prospective case-ascertained study was conducted on 202 healthcare workers with confirmed COVID-19 in Hamadan, diagnosed from March 1, 2020, to August 20, 2020. For households with close contact with the index case, RT-PCR was performed regardless of symptoms. We defined SAR as the proportion of secondary cases from the total contacts that live in the index case household. SAR was reported as a percentage and 95% confidence interval (CI). Multiple logistic regression was performed to explore the predictors of COVID-19 transmission of index cases to their households. Results: We found 36 secondary cases out of 391 household contacts with laboratory confirmation (RT-PCR), representing a household SAR of 9.2% (95% CI: 6.3, 12.1). Among factors related to the family member, female gender (OR: 2.9, 95% CI: 1.2, 6.9), being the patient's spouse (OR: 2.2, 95% CI: 1.0, 4.6), and living in the apartment (OR: 2.78, 95% CI: 1.24, 6.23), and among factors related to index cases, hospitalization (OR: 5.9, 95% CI: 1.3, 26.9) and caught (OR: 2.4, 95% CI: 1.1, 5.2) were the significant predictors of disease transmission to other family members (P<0.05). Conclusion: The findings of this study suggest that the SAR is remarkable in household contacts of infected healthcare workers. Some characteristics of family members of the index case, including female gender, being the patient's spouse, and living in the apartment, and some characteristics of the index case, including hospitalization and caught, were associated with the increased SAR.

Influence of Lisdexamfetamine Dimesylate on Early Ejaculation-Results from a Double-Blind Randomized Clinical Trial.

BACKGROUND: Among male sexual dysfunctions, erectile dysfunction and early ejaculation have the highest prevalence rates. Here, we tested the influence of lisdexamfetamine dimesylate (Vyas®) on early ejaculation. To this end, we performed a double-blind randomized clinical trial among males with early ejaculation. METHODS: A total of 46 males with early ejaculation (mean age: 35.23 years) and in stable marital relationships with regular weekly penile-vaginal intercourse were randomly assigned either to the lisdexamfetamine dimesylate condition (30 mg) or to the placebo condition. Compounds were taken about six hours before intended penile-vaginal intercourse. At baseline and four weeks later at the end of the study, participants completed a series of self-rating questionnaires covering early ejaculation. Female partners also rated participants' early ejaculation profile. RESULTS: Compared to the placebo condition, dimensions of early ejaculation improved over time in the lisdexamfetamine condition, though improvements were also observed in the placebo condition. CONCLUSIONS: Among male adults in stable marital relationships with regular weekly penile-vaginal intercourse, lisdexamfetamine dimesylate improved dimensions of early ejaculation. Given that improvements were also observed in the placebo condition, psychological factors such as increased attention to early ejaculation and favorable expectations of the compound should be considered.

The effect of self-management intervention program on the lifestyle of postmyocardial infarction patients.

BACKGROUND: Most patients with myocardial infarction (MI) suffer from one or more risk factors such as obesity and overweight, unhealthy diet, lack of physical activity (PA), and high blood pressure. Individual control of these risk factors by lifestyle modification raises the probability of survival in these patients; hence, we used a self-management intervention to assess its effect on the lifestyle of post-MI patients. MATERIALS AND METHODS: This quasi-experimental study was conducted on 92 hospitalized MI patients in Hamadan province in 2016. Convenience sampling method was used for selecting the participants. The patients were selected and assigned to experimental and control groups. The main parameters (diet, blood pressure, waist circumference, and body mass index [BMI]) were measured at the baseline and 8 weeks after discharge. Domestic PA was the only parameter measured 8 weeks after their discharge. A self-management intervention was adopted for the experimental group. The data were analyzed using paired and independent-sample t-tests with SPSS software version 16. RESULTS: The comparison of the scores obtained for diet, blood pressure, waist circumference, and BMI in post-MI patients revealed no statistically significant difference between the two groups at the beginning of the study (P > 0.05). Following the intervention, the experimental group had a significantly higher mean score for diet and domestic PA (walking program from 1st week to 8 weeks), compared to the control group (P < 0.001); however, the intervention had no significant effect on BMI, waist circumference, and systolic and diastolic pressure (P > 0.05). CONCLUSION: The findings indicated that the program had an impact on some risk factors. Therefore, it is recommended to use self-management support in MI patients during the discharge process to improve their lifestyle.

COVID-19 Prevention Behaviors among Health Staff: Data from a Large Survey in the West of Iran.

BACKGROUND: Hospital staffs are at high risk of Novel Coronavirus (2019-nCoV preventive behaviors play a peculiar role in the reduction of the incidence and mortality of this infection. Therefore, the present study aimed to assess the prevention behaviors of COVID-19 among health staff based on the Extended Parallel Model (EPPM) in western Iran. STUDY DESIGN: It was a cross-sectional study. . METHODS: The present study was performed in the west of Iran in April 2020. In total, 1,664 cases were enrolled in this study via multi-stage sampling. The data were collected using a questionnaire, including the demographic characteristics of participants and EPPM constructs. All analyses were conducted in Stata software (version 14) at a 5% significant level. RESULTS: As evidenced by the obtained results,  1,523 (91.53%), 1,226 (73.68%), 1,526 (91.71%), 893 (53.67%), and 862 (51.86%) of health staff wear gloves, use masks, avoid contact with others, maintain a good distance from other people, and wash their hands frequently with water and soap, respectively. In terms of using gloves and avoiding contacts with others, participants with high perceived threat had higher odds of observing health behaviors (OR= 3.14, 95% CI: 2.08, 4.73; P<0.001) and (OR= 3.1, 95% CI: 2.04, 4.69; P<0.001), respectively. In all categories of EPPM, the participants with high efficacy had higher odds of exhibiting health behaviors, compared to those with low efficacy (P<0.001). CONCLUSION: The results of the present study demonstrated that  health workers are expected to be at the highest level of threat and efficiency. Moreover, the findings emphasized the effectiveness of the recommended strategies in the prevention of COVID-19 disease.

Need for recovery scale in the firefighting context: Examination of the Persian culture-adapted version.

BACKGROUND: Work-related fatigue can cause disruption in mental and physical activities of the workers. Considering the importance of recovery from fatigue in emergency services, as seen in firefighting duties, the preparation and validation of the Need For Recovery Scale (NFRS) questionnaire can be useful and effective. OBJECTIVE: This study assessed the reliability and validity of the Persian version of Need For Recovery Scale among industrial firefighters. METHODS: Need for recovery scale contains 11 questions. First, a questionnaire was translated using backward-forward method. Then, for measuring validity of the questionnaire, the opinions of 10 experts in related fields were obtained. Content Validity Index (CVI) and Content Validity Ratio (CVR) were calculated. The reliability was determined through 107 questionnaires completed by the industrial firefighters. RESULTS: The average age of the firefighters in this study was 37.5 years and they had an average of 10 years of work experience. The mean Need For Recovery Index from fatigue was 33.03 for the study population. Of the first 11 questions, 9 questions in the original NFRS showed a satisfactory level of CVR. The Content Validity Index and Cronbach's α were 0.89 and 0.77 respectively. CONCLUSION: Based on the results, the Need For Recovery Scale is a reliable tool for assessing fatigue and revealed an acceptable level of validity and reliability that makes it usable for fatigue assessment in the industrial firefighters.

A Comparison of the Effect of Visual and Auditory Distractions on Physiological Indicators and Pain of Burn Dressing Change Among 6-12-Year-Oldchildren: A Clinical Trial Study.

POURPOSE: This study aimed to compare the effect of audiovisual distraction on physiological indicators and pain of burn dressing change among 6-12 year-old children. DESIGN AND METHODS: The study was a single-blind clinical trial with a three-group that sample size was 120 children aged 6-12 years admitted to the burn ward of Hamadan Besat Hospital. Data collection tools were the Oucher pain scale, a Cheklist form of the physiological Indicators, and apulse oximetry device. The cartoons were shown for visual group and the melodic poems were played for the auditory group 2 min before the dressing until the end of the procedure (at 2-min intervals). Data were analyzed by SPSS-16 software one-way, variance analysis and post-hoc Bonferroni test. RESULTS: Therewere statistically significant differences between visual, auditory and control groups in the mean pain intensity scores at all measurement times, the mean arterial blood oxygen saturation percentage at all measurement times except for the10 min before the dressing and the start of the procedure and the mean heart rate at all measurement times except for 10 min before dressing (p < 0.001). Post-hoc tests showed that the difference in the mean heart rate was related to the difference between the visual and auditory distraction groups during and at the end of the dressing (p < 0.05), the visual and control groups at all measurement times (P < 0.001) and the auditory and control groups at all measurement times (p < 0.05). CONCLUSION: Audiovisual distraction is effective in reducing the fluctuations of physiological indicators and the burn dressing pain intensity in children at all times of measurement, especially during changedressing. PRACTICE IMPLICATIONS: The findings of this study are relevant to clinical practice because they suggest preparing children before and during a burning procedure situation.

Application of Social Network Analysis to Major Petrochemical Accident: Interorganizational Collaboration Perspective.

OBJECTIVE: Crisis management in major accidents requires the collaboration among different organizations. One of the most important problems of crisis management is the lack of coordination between executive organizations. The aim of this study was to examine the structural characters and problems of interorganizational network during crisis in the petrochemical industry and provide solutions to achieve the highest performance in crisis management. METHODS: The organizations involved in crisis management were identified through interviews and questionnaires. Gephi (0.9.1) software was used to examine interorganizational relationships. RESULTS: In this study, the crisis management team consisted of 25 public and private organizations and non-governmental organizations. The highest betweenness centrality was observed in Crisis Management of Provincial Government (CMPG) (142.16) and Fire Department of Petrochemical Complex (FDC) (89.3). The highest closeness centrality was observed in FDC (0.77), CMPG (0.7), Shazand Governorate (0.7), and Crisis Management of University of Medical Sciences (0.7). CONCLUSIONS: Coordination between organizations plays an important role in crisis and emergency management, and social network analysis helps identify strengths and weaknesses of organizations involved in crisis management, overcome those weaknesses, and consequently achieve the best performance in crisis management.

Perceived risk and protective behaviors regarding COVID-19 among Iranian pregnant women.

BACKGROUND: Despite the vulnerability of pregnant women, few studies have been conducted on their perceived risk and protective behaviors during the COVID-19 pandemic. The present cross-sectional study aims to investigate the perceived risk and protective behaviors regarding COVID-19 among pregnant women, in Hamadan, Iran. Using a two-stage cluster sampling method, 225 pregnant women referring to the health centers completed the questionnaires. Data were analyzed using the Kruskal-Wallis and Spearman correlation tests as well as a stepwise linear regression model at 95% confidence level. RESULTS: 93.8% of pregnant women had a high level of knowledge, 97.3% had a high performance in protective behaviors, and 72.9% had a moderate level of risk perception related to COVID-19. The highest mean score of knowledge was observed in women who had a history of influenza in their previous pregnancies (90.97 ± 5.94). The mean score of protective behaviors was significantly higher in women with a high economic level (97.78 ± 5.11), and the highest level of risk perception was observed in nulliparous women (59.97 ± 9.80). Risk perception was an independent predictor of protective behaviors related to COVID-19 (P < 0.05). CONCLUSIONS: Pregnant women had a high level of knowledge, high performance in protective behaviors, and a moderate level of risk perception related to COVID-19. History of influenza in previous pregnancies, high economic level, and nulliparity were associated with higher levels of knowledge, protective behaviors, and risk perception, respectively. Risk perception of pregnant women regarding COVID-19 can predict their protective behaviors.

Dynamic Human Error Assessment in Emergency Using Fuzzy Bayesian CREAM.

BACKGROUND: Human error is one of the major causes of accidents in the petrochemical industry. Under critical situation, human error is affected by complex factors. Managing such a situation is important to prevent losses and injury. This study aimed to develop a dynamic model of human error assessment in emergencies in the petrochemical industry. STUDY DESIGN: A cross-sectional study. METHODS: Fuzzy Bayesian network was used to improve the capabilities of the method for determining the control mode. Fuzzy-AHP-TOPSIS method was also used to prioritize emergency scenarios and human error assessment was applied for the most important emergency condition. RESULTS: Fire in a chemical storage unit was recognized as the most important emergency condition. Common Performance Conditions (CPCs) were determined based on the opinions of a panel of 30 experts and specialists and 7 CPCs were selected for emergencies; then, based on the results of AHP method the relative weights were determined. Finally, membership functions, inputs, and outputs of fuzzy sets, CPC values in 8 emergency response tasks, and the probability of control modes were determined using Bayesian Cognitive Reliability and Error Analysis Method (CREAM) method. CONCLUSION: This method could be applied to overcome the weaknesses of traditional methods, provide a repeatable method for human error assessment, and manage human error in an emergency.