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Development and Psychometric Properties of a Tool Related to the Adoption of Desirable Behaviors in the Consumption of Sugar-sweetened Beverages in Children Based on the Social Cognitive Theory
No full textBackground: Consumption of sugar-sweetened beverages is associated with chronic diseases such as diabetes and cardiovascular disorders and other severe negative health consequences and is one of the challenging issues in the field of nutrition in today's societies. This study was conducted with the aim of designing a psychometric questionnaire in relation to the consumption behavior of sugar-sweetened drinks in children. Methods: In this cross-sectional research, 607 students were selected and included in the study by multi-stage cluster sampling from the first-year secondary schools covered by the Urmia Department of Education. Waltz's method was used to design the questionnaire, and based on a targeted review of the literature and questionnaires related to nutrition behavior, an initial questionnaire with 51 items was designed. After confirming the face and content validity of the questionnaire by 15 members of the expert panel, construct validity steps were performed using exploratory factor analysis. Finally, the internal reliability of the questionnaire was determined by calculating Cronbach's alpha. Results: The first version of the questionnaire was designed with 51 items and all the items were retained in the psychometric process during content validity. The content validity index and ratio were calculated to be higher than 0.79 and 0.6, respectively. Based on the exploratory factor analysis, the number of items in the questionnaire remained at 51, and the dimensions of the questionnaire were categorized into 6 factors: perceived barriers, self-efficacy, self-regulation, social support, preventive behaviors, and reinforcing behaviors, with a predictive power of 56,261 and in repeating the exploratory factor analysis for items with a different nature from other factors, 3 separate factors were identified: the physical health dimension of outcome expectations, negative outcome expectations, and positive outcome expectations with a predictive power of 54.667. The internal reliability of the questionnaire items was accepted and confirmed with Cronbach's alpha coefficient above 0.70. Conclusion: The final questionnaire with 51 items has the ability to be used by various researchers due to the strength of the factorial structure and suitable psychometric properties. © 2025 The Author(s). Published by Bentham Open
Global, regional, and national burden of upper respiratory infections and otitis media, 1990–2021: a systematic analysis from the Global Burden of Disease Study 2021
No full textBackground: Upper respiratory infections (URIs) are the leading cause of acute disease incidence worldwide and contribute to a substantial health-care burden. Although acute otitis media is a common complication of URIs, the combined global burden of URIs and otitis media has not been studied comprehensively. We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 to explore the fatal and non-fatal burden of the two diseases across all age groups, including a granular analysis of children younger than 5 years, in 204 countries and territories from 1990 to 2021. Methods: Mortality due to URIs and otitis media was estimated with use of vital registration and sample-based vital registration data, which are used as inputs to the Cause of Death Ensemble model to separately model URIs and otitis media mortality by age and sex. Morbidity was modelled with a Bayesian meta-regression tool using data from published studies identified via systematic reviews, population-based survey data, and cause-specific URI and otitis media mortality estimates. Additionally, we assessed and compared the burden of otitis media as it relates to URIs and examined the collective burden and contributing risk factors of both diseases. Findings: The global number of new episodes of URIs was 12·8 billion (95 uncertainty interval 11·4 to 14·5) for all ages across males and females in 2021. The global all-age incidence rate of URIs decreased by 10·1 (–12·0 to –8·1) from 1990 to 2019. From 2019 to 2021, the global all-age incidence rate fell by 0·5 (–0·8 to –0·1). Globally, the incidence rate of URIs was 162 484·8 per 100 000 population (144 834·0 to 183 289·4) in 2021, a decrease of 10·5 (–12·4 to –8·4) from 1990, when the incidence rate was 181 552·5 per 100 000 population (160 827·4 to 206 214·7). The highest incidence rates of URIs were seen in children younger than 2 years in 2021, and the largest number of episodes was in children aged 5–9 years. The number of new episodes of otitis media globally for all ages was 391 million (292 to 525) in 2021. The global incidence rate of otitis media was 4958·9 per 100 000 (3705·4 to 6658·6) in 2021, a decrease of 16·3 (–18·1 to –14·0) from 1990, when the incidence rate was 5925·5 per 100 000 (4371·8 to 8097·9). The incidence rate of otitis media in 2021 was highest in children younger than 2 years, and the largest number of episodes was in children aged 2–4 years. The mortality rate of URIs in 2021 was 0·2 per 100 000 (0·1 to 0·5), a decrease of 64·2 (–84·6 to –43·4) from 1990, when the mortality rate was 0·7 per 100 000 (0·2 to 1·1). In both 1990 and 2021, the mortality rate of otitis media was less than 0·1 per 100 000. Together, the combined burden accounted for by URIs and otitis media in 2021 was 6·86 million (4·24 to 10·4) years lived with disability and 8·16 million (4·99 to 12·0) disability-adjusted life-years (DALYs) for all ages across males and females. Globally, the all-age DALY rate of URIs and otitis media combined in 2021 was 103 per 100 000 (63 to 152). Infants aged 1–5 months had the highest combined DALY rate in 2021 (647 per 100 000 189 to 1412), followed by early neonates (aged 0–6 days; 582 per 100 000 176 to 1297) and late neonates (aged 7–24 days; 482 per 100 000 161 to 1052). Interpretation: The findings of this study highlight the widespread burden posed by URIs and otitis media across all age groups and both sexes. There is a continued need for surveillance, prevention, and management to better understand and reduce the burden associated with URIs and otitis media, and research is needed to assess their impacts on individuals, communities, economies, and health-care systems worldwide. Funding: Bill & Melinda Gates Foundation. © 2025 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens
Exploring the feasibility of augmented reality game-supported flipped classrooms in reading comprehension of English for Medical Purposes
No full textThis quasi-experimental study explored the feasibility of the augmented reality game-supported flipped classrooms for English for Medical Purposes reading among 464 students from the Isfahan University of Medical Sciences in two phases. In the quantitative phase, the participants watched the pre-recorded lectures on English for Medical Purposes reading and took part in the assessment. Then, they gathered in small teams to practice reading through the Commercial-Off-The-Shelf or self-made augmented reality games under the surveillance of the teachers. In the qualitative phase, focus-group interviews were conducted to debrief students’ perceptions of English for Medical Purposes reading in the augmented reality game-supported flipped classrooms. Repeated measures ANCOVA and ANCOVA were used to analyze the quantitative data. The qualitative data were analyzed through thematic analysis. The finding showed that learning English for Medical Purposes in the self-made-augmented reality game-supported flipped classrooms resulted in better reading in academia and the field than learning in the Commercial-Off-The-Shelf augmented reality game-supported flipped classrooms. In these classrooms, students who practiced reading in the heterogeneous small teams made more significant progress; they outperformed those in the small homogeneous teams. The participants highlighted their positive perceptions of hands-on learning for streamlining the self-made augmented reality games in flipped classrooms. The results are discussed in detail. © 2023 Informa UK Limited, trading as Taylor & Francis Group
From Enzyme to Vaccine: Preliminary Insights into the Immunogenic Epitopes in Adenylate Kinase 8 (ADK8) of Echinococcus granulosus
No full textBackground: Globally, developing livestock countries are affected by Cystic Echinococcosis (CE), a neglected zoonosis. Thus, vaccination would help to prevent this neglected zoonosis. Objective: This study aimed to predict the primary biochemical characteristics of E. granulosus Adenylate Kinase 8 (ADK8) and its potential B- and T-cell-binding epitopes as a candidate for vaccination. Methods: Prediction were conducted on multiple web servers to identify immunogenic epitopes as well as biochemical, antigenic, structural, and subcellular properties. Results: The extracellular 38.78 KDa protein possessed no allergenic fragments, while it showed hydrophilicity (GRAVY: -0.239), wide thermotolerance (aliphatic: 98.02), and 36 post-translational modification sites. The secondary structure mostly included helices and random coils, and the best-generated 3D model by the Robetta server had a confidence score of 0.79. Three servers identified common B-cell epitopes and evaluated them for solubility, allergenicity, and antigenic properties. Furthermore, following the screening, MHC-associated epitopes for humans and mice were predicted in the E. granulosus ADK8. Conclusion: These results provide a basis for future research into the development of a proper vaccine against CE. Additional empirical studies using the protein and/or its epitopes alone or in combination with additional antigens are demanded. © 2024 Bentham Science Publishers
Relationship between Moral Sensitivity and Moral Reasoning with Moral Courage in Nursing Students
No full textBackground:Nursing students required to be prepared to face ethical problems in their future workplace. Solving moral dilemmas requires the implementation of moral decisions, which necessitates significant moral courage. Moral sensitivity and moral reasoning can play a key role in the emergence of morally courageous behavior. The aim of this study was to investigate the relationship between moral sensitivity and moral reasoning with moral courage in nursing students. Materials and Methods:This was a cross-sectional study. The participants consisted of 296 nursing students of Isfahan University of Medical Sciences, Iran, in 2021, which selected through the census method. Data were collected using the Persian versions of the Moral Sensitivity and Sekerka's Moral Courage questionnaires and Nursing Dilemma Test. Data were analyzed by SPSS software (v. 25.0) using descriptive and analytical statistical methods (t-test, ANOVA, Pearson correlation, and regression analysis). Results:A total of 296 nursing students participated in this study. The results showed no significant correlation between moral sensitivity and moral courage (r = 0.04, p = 0.41); however, a significant positive correlation was observed between moral reasoning and moral courage (r = 0.19, p < 0.05). The results of multiple regression analysis showed that moral reasoning was the only predictor of moral courage in nursing students (p < 0.05). Conclusions:oral reasoning ability played a more significant role in developing moral courage than moral sensitivity. Tracking the sensitivity, reasoning, and moral courage status during education can reveal valuable information on the process of moral practice formation in nurses
Association between periodontitis and Alzheimer's disease: A narrative review
No full textPeriodontitis is a chronic inflammatory disease that progressively damages the supporting structures of teeth, resulting in gum bleeding, inflammation, gum recession, and eventual tooth loss. Key factors, including poor oral hygiene, plaque accumulation, smoking, inadequate nutrition, and genetic predisposition, drive its development. Recent evidence underscores the potential role of periodontitis as a contributing factor to systemic diseases, including Alzheimer's disease (AD). AD is a neurodegenerative disorder marked by memory loss, cognitive decline, and brain inflammation. Emerging clinical and experimental studies indicate that these two conditions share overlapping risk factors and may be interconnected. One notable finding is the detection of specific periodontal pathogens, such as Porphyromonas gingivalis (P. gingivalis), in the brains of individuals with AD. This suggests a possible link between chronic oral infections and neurodegeneration. These pathogens are believed to exacerbate neuroinflammatory processes by activating microglia and promoting systemic inflammation, which is central to AD pathogenesis. Further research is needed to clarify the biological mechanisms underlying this association. Targeted interventions that address periodontitis, such as anti-inflammatory therapies or treatments targeting specific pathogens like P. gingivalis, could potentially mitigate its impact on the onset and progression of AD, offering a novel avenue for prevention and management strategies
Effect of Different Treatments on Retinal Thickness Changes in Patients With Multiple Sclerosis: A Review
No full textBackgroundMultiple sclerosis (MS) is an autoimmune disorder affecting the central nervous system, with varying clinical manifestations such as optic neuritis, sensory disturbances, and brainstem syndromes. Disease progression is monitored through methods like MRI scans, disability scales, and optical coherence tomography (OCT), which can detect retinal thinning, even in the absence of optic neuritis. MS progression involves neurodegeneration, particularly trans-synaptic degeneration, which extends beyond the initial injury site. This review focuses on the impact of different MS treatments on retinal thickness as assessed by OCT.ResultsInjectable drugs, such as interferon beta and glatiramer acetate (GA), have a relatively modest impact on retinal atrophy. Oral medications like Fingolimod, Teriflunomide, and Dimethyl fumarate also have different impacts on retinal thickness. Fingolimod has been shown to protect against retinal thinning but may lead to macular edema. DMF-treated patients had less ganglion cell-inner plexiform layer thinning than GA-treated patients but more thinning compared to natalizumab-treated patients and healthy controls. Teriflunomide's impact on retinal layers remains unexplored in human studies. Monoclonal antibodies, including Alemtuzumab, Rituximab, Ocrelizumab, and Natalizumab, had protective effects on retinal layer atrophy. Alemtuzumab-treated patients showed significantly less atrophy compared to interferon- and GA-treated patients. Rituximab initially increased atrophy rates in the first months but subsequently demonstrated potential neuroprotective effects. Ocrelizumab slowed the rate of inner nuclear layer thinning in progressive forms of the disease. Natalizumab is considered the most effective in reducing retinal layer atrophy, particularly the peripapillary retinal nerve fiber layer.ConclusionsIt's important to note that the effectiveness of these treatments may vary depending on MS subtype and individual factors. Future research should explore the long-term effects of these treatments on retinal layers and their correlations with overall disease progression and disability in MS patients
Investigation the Effect of Reactive and Proactive Exercises on Balance Performance and Balance Confidence in Stroke Patients: A Randomized Clinical Trial
No full textBackground: Stroke is the leading cause of disability in adults. The most prevalent disorder following a stroke is a balanced is order, and the primary goal of rehabilitation treatment in these patients is to improve balance. Objectives: This study aims to compare the effects of various balance therapy exercises on balance performance and balance confidence in individuals with stroke. Methods: In this double-blind clinical trial, 30 individuals with stroke were randomly assigned to one of three groups:Control, reactive, and proactive. Of these, 27 patients completed the study. Participants underwent 12 treatment sessions overfour weeks. The control group received conventional exercises, the reactive group received conventional exercises plus reactiveexercises, and the proactive group received conventional exercises plus proactive exercises. Balance performance was evaluatedusing the Mini-BESTest and the activities-specific balance confidence (ABC) questionnaire at three stages: Before treatment, aftertreatment, and during a two-month follow-up period. Data analysis was conducted using SPSS version 20. Results: Intra-group analysis indicated significant improvements in balance (F = 64.694; P 0.05). Conclusions: Balance performance and balance confidence improved significantly in all three treatment groups. However, the differences between the groups were not statistically significant. This study concludes that exercise therapy is an integral component of rehabilitation treatment for stroke patients
Herpes zoster ophthalmicus with acute retrobulbar optic neuritis and abducens nerve palsy: a case report
No full textHerpes zoster Ophthalmicus (HZO) affecting the ophthalmic division (V1) of the trigeminal nerve. HZO may cause extraocular muscle palsies, with the third nerve being the most commonly affected and the fourth nerve the least. The combined involvement of the optic nerve and isolated paralysis of the eye muscle is very rare, with only limited case reports documenting this complication of ocular herpes zoster. This case report also describes a case of optic nerve involvement with 6th nerve palsy, which was treated with corticosteroid and valacyclovir
High dose botox injection for treatment of high grade vesicoureteral reflux in a complicated pediatric case: A case report
No full textVesicoureteral reflux (VUR) is a medical condition affecting the bladder and kidneys. Management depends on bladder capacity and compliance. This study found that high-dose BoNT-A is effective in managing high-grade VUR in pediatric patients. In our case, a 3-year-old male with sacral agenesis and neurogenic bladder, experienced a decrease in creatinine levels and improved vesicoureteral reflux after 20 units/kg of BoNT-A were injected into the detrusor and about 100 units were injected into the external sphincter at 3, 9, and 6 o'clock positions