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An evaluation of treatment response and remission definitions in adult obsessive-compulsive disorder: A systematic review and individual-patient data meta-analysis
No full textIntroduction: Expert consensus operationalized treatment response and remission in obsessive-compulsive disorder (OCD) as a Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) reduction ≥35% and score ≤12 with ≤2 on Clinical Global Impressions Improvement (CGI-I) and Severity (CGI-S) scales, respectively. However, there has been scant empirical evidence supporting these definitions. Methods: We conducted a systematic review and an individual participant data meta-analysis of randomized-controlled trials (RCTs) in adults with OCD to determine optimal Y-BOCS thresholds for response and remission. We estimated pooled sensitivity/specificity for each percent reduction threshold (response) or posttreatment score (remission) to determine response and remission defined by a CGI-I and CGI-S ≤ 2, respectively. Results: Individual participant data from 25 of 94 eligible RCTs (1235 participants) were included. The optimal threshold for response was ≥30% Y-BOCS reduction and for remission was ≤15 posttreatment Y-BOCS. However, differences in sensitivity and specificity between the optimal and nearby thresholds for response and remission were small with some uncertainty demonstrated by the confidence ellipses. Conclusion: While the empirically derived Y-BOCS thresholds in our meta-analysis differ from expert consensus, given the predominance of data from more recent trials of OCD, which involved more refractory participants and novel treatment modalities as opposed to first-line therapies, we recommend the continued use of the consensus definitions
A model for improving the learning environment in high-stress and emotion-bound clinical settings
No full textIntroduction: In clinical settings, it is necessary to create a clinical learning environment that provides the ground for the learners to acquire competencies especially in high-stress and emotion-bound clinical settings. Methods: In the present study, a model for improving the learning environment in high-stress and emotion-bound clinical settings was designed by conducting a multi-method study in the form of three sub-studies. Results: This model was designed with 3 pivotal concepts; organizing learning opportunities around safe care, fair participation in learning opportunities and creating a positive emotional climate and 6 peripheral concepts; designing physical space and appropriate equipment for education and care, preparing learners to attend the clinical setting, preparing learners to participate in learning opportunities, balancing the learner role and the care provided by the learners, the presence of a competent educator and providing education to all learners, and acquiring the ability to manage emotions by learners, faculty and staff. Conclusions: The implementation of the model obtained from this study provides the basis for solving the challenges of clinical learning environments, especially in high-stress and emotion-bound clinical settings, and improves clinical education and the realization of educational and care outcomes
Factors affecting nurses retention during the COVID‐19 pandemic: a systematic review
No full textBackground: The global nursing shortage was a well-known issue before the Covid-19 pandemic, but the Covid-19 pandemic has exacerbated the current nursing workforce shortage and reduced nursing retention. This systematic review aimed to explore factors affecting retention of nurses. Methods: The PubMed, Web of Science, Scopus and Proquest databases were searched for relevant primary studies published on nurses retention during Covid-19 pandemic. Finally, Google Scholar was searched for retrieving more related documents that may not be indexed in other searched databases. Inclusion criteria were research articles and gray literature related to nursing retention in Covid-19 pandemic, articles published in English, access to the full-texts, and without time limitation. Both qualitative and quantitative studies focusing on factors affecting the nurses retention were included. The Joanna Briggs Institute checklists were used for assessing quality of quantitative and qualitative studies. Qualitative and thematic content analysis methods based on Braun and Clark’s model were used to analyze the data. Results: Eighteen studies were identified through a systematic search of the literature. The results showed that seven factors include personal, interpersonal, organizational, social media, educational, emotional, and protective factors are the factors affect the nurses retention. Conclusion: The findings of this study showed that retention of nurse is complex and multi-factorial issue that factors from micro to macro-level affect it. Managers and health policy-makers based on the results obtained from this study can plan appropriate measures to increase the retention of nurses
Proinflammatory factors inhibition and fish oil treatment: A promising therapy for neonatal seizures
No full textBrain injury is one of the most important causes of infant mortality and chronic neurological disabilities. Hypoxia is an acute brain injury which led to various cognitive, behavioral, and memory disorders throughout life. Previous studies reported neuroprotective possibilities for fish oil (FO) in brain-injured situations. In this study, we evaluated the effect of the FO diet during the lactation period on seizure activity, behavioral performance, histomorphometry, and inflammatory changes in the brains of hypoxia rats. Male Wistar rats were randomly divided in to 4 groups: Sham (intact rats), hypoxia, FO and FO+hypoxia groups. Hypoxia was induced by keeping neonate rats at PND12 in a hypoxic chamber (7 % oxygen and 93 % nitrogen intensity) for 15 minutes. In the FO groups, rats received oral FO (1 ml/day) for 12 days during the lactation period. Seizure activity was assessed by measuring the number of tonic-clonic seizures and seizure thresholds. Novel object recognition tests (NORT), rotarod, and open field tests were used to measure behavioral performances. A Histological study was performed to evaluate histomorphometric changes in the hippocampus and cerebellum. The gene expression of tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) was measured using RT-PCR. Findings showed that the number of tonic-clonic seizures, atrophy, and cell death in the hippocampus and cerebellum, the gene expression of TNF-α and IL-1β in the hippocampus, and behavioral disorders were significantly increased in the hypoxia rats compared to the sham group. Administration of FO in the hypoxia groups significantly decreased the gene expression of TNF-α and IL-1β, the number of tonic-clonic seizures, and neuronal cell death in the hippocampus and cerebellum compared to the hypoxia groups. Furthermore, it can improve behavioral tasks and cognitions
The effects of an 8-week dynamic neuromuscular stabilization exercise on pain, functional disability, and quality of life in individuals with non-specific chronic low back pain: a randomized clinical trial with a two-month follow-up study
No full textBackground: Low back pain (LBP) is a common disorder and is considered one of the leading causes of disability worldwide, resulting in adverse health, social, and economic outcomes. This study aimed to investigate the effects and durability of 8-week Dynamic Neuromuscular Stabilization (DNS) exercises on pain, functional disability, and quality of life in individuals aged 30 to 50 years with non-specific chronic low back pain (NSCLBP). Methods: This research employed a pre- and post-test design with a follow-up period, in which 29 participants (16 in the control group and 13 in the exercise group) remained until the end of the study. Pain intensity, functional disability, and quality of life were assessed using the visual analog scale (VAS), the Oswestry Disability Index, and the SF-36 questionnaire, respectively, before intervention, immediately after, and two months post-intervention. The control group continued their routine daily activities, while the exercise group performed DNS exercises three times a week for 8 weeks. The data was analyzed using a mixed-design ANOVA (P ≤ 0.05). Results: The results showed improvements in pain (F (2,24) = 5.31, P = 0.01, η2 = 0.31), functional disability (F (2,24) = 4.17, P = 0.03, η2 = 0.26), and quality of life (F (2,24) = 4.70, P = 0.02, η2 = 0.28) in the exercise group at the Post-test compared to the Pre-test. However, the durability of the exercise effects at the follow-up assessment was not sustainable compared to the Post-test and Pre-test (P > 0.05). Conclusion: An 8-week period of DNS exercises can improve pain, functional disability, and quality of life in individuals with NSCLBP. However, a 2-month period of detraining can reduce the positive outcomes of these exercises. Trial registration: The researchers retrospectively registered this trial on 21/04/2024, with the identifier IRCT20240107060646N1 in the Iranian Registry of Clinical Trials (IRCT) at the following address: https://irct.behdasht.gov.ir
Does dietary intake of vitamin A and beta-carotene increase the risk of hypertension?
No full textBackground Hypertension (HTN) is a major global public health issue influenced by genetics and lifestyle factors such as diet and psychological stress. Previous research suggests a potential link between HTN and dietary vitamin A intake. This study aims to explore the association between HTN and the intake of various forms of vitamin A. Methods This cross-sectional study was conducted on 1239 patients with HTN and 2945 normotensive individuals aged 35-70 years in Sabzevar, Iran. Dietary vitamin A intake was assessed using the Nutritionist IV software and a food frequency questionnaire. Result A positive association was found between HTN with total vitamin A intake [odds ratio (OR): 1.03, 95% confidence interval (CI): 1.01-1.05, P=0.04] and β-carotene intake (OR: 1.03, 95% CI: 1.02-1.05, P=0.03) after adjusting for age and sex. These associations remained statistically significant after adjusting for physical activity and BMI. The association between HTN and β-carotene intake remained significant after additional adjustment for calorie intake. No significant association was observed between dietary retinol intake and HTN. Conclusion Increased dietary intake of vitamin A and β-carotene may be associated with a higher risk of HTN. Further longitudinal studies are needed to confirm these findings and elucidate the underlying mechanisms
Effects of the Slow-release Curcumin-loaded Selenium Nanoparticles on Experimental Peritonitis
No full textBackground: New pharmaceutical forms of natural compounds such as curcumin can be an effective intervention to control peritonitis and abdominal adhesion. Objectives: This study investigates the effects of slow-release curcumin-loaded selenium nanoparticles ([email protected]) on some inflammatory biomarkers in experimental peritonitis. Methods: After synthesizing selenium nanoparticles (S.N) and ([email protected]), experimental peritonitis was surgically induced in 80 adult male rats. The control group received no treatment, whereas the other groups received single intraperitoneal doses of 0.25 mg/kg S.N, 50 mg/kg curcumin, and 0.25+50 mg/kg ([email protected]). Blood malondialdehyde (MDA), nitric oxide (NO), interleukin 6 (IL-6), and tumor necrosis factor-alpha (TNFα) were measured on days 3, 7 and 14, and also intra-abdominal adhesion assessment was done. Results: On day 3, NO levels in all treatment groups significantly decreased (P>0.05), while the lowest level was seen on day 14 in the S.N group (P<0.05). MDA was significantly lower in the S.N and [email protected] groups than in the control on days 3, 7 and 14 (P<0.05). TNF-α levels in S.N and [email protected] groups were significantly lower than in the control group on day 3 (P≤0.05). Meanwhile, the S.N group had the lowest level on day 14. IL-6 significantly decreased on days 3 and 7 in the [email protected] and curcumin groups compared to the control group (P<0.05). Conclusion: [email protected] group possesses significant anti-inflammatory efficacy by reducing MDA, NO, IL-6 and TNF-α, decreasing peritonitis and intra-abdominal adhesion
Hair and urinary 2-hydroxynaphthalene levels in the people living in a region with frequent oil pipeline incidents in Iran: Health risk assessment
No full textOil spills from pipeline accidents can have long-lasting health effects on residents of polluted regions. Assessing the potential health risk of these accidents is crucial for effective environmental health management. This study analyzed the concentration of 2-OHNAP in urine and hair as biomarkers of PAHs exposure among the people living in a region with frequent oil pipeline incident in Iran. Fifty pairs of hair and urine samples were collected from residents along with demographic information and dietary habits via a questionnaire. The concentration of 2-OHNAP was analyzed using high performance liquid chromatography coupled with fluorescence detector (HPLC-FLD). 2-OHNAP was detected in 100% of urine and 88% of hair samples. The mean concentration of 2-OHNAP in urine was 16.65 ± 21.98 μg/g creatinine and in hair was 8.16±7.62 ng/g dry weight (dw). However, there was no significant correlations between the levels of 2-OHNAP in urine and hair. The mean values of HQ and CR were below 1 and 10−6, respectively. Moreover, some simulated health risk indices were near the threshold levels, and the carcinogenic risk above 70% of the simulated CRs was above 10−6 as well. Therefore, the health risk attributed to the exposure to the parent compound of 2-OHNAP in the study area is currently acceptable, but it is not negligible and may be worsened in the future. This study provides a valuable scientific information for regional decision makers and stakeholders about human health programs and identification of environmental health priorities
Pharmacological Activities and Molecular Mechanisms of Sinapic Acid in Neurological Disorders
No full textSinapic acid (SA) is a phenylpropanoid derivative found in various natural sources that exhibits remarkable versatile properties, including antioxidant, anti-inflammatory, and metal-chelating capabilities, establishing itself as a promising candidate for the prevention and treatment of conditions affecting the central nervous system, such as Alzheimer’s disease (AD), Parkinson’s disease (PD), ischemic stroke, and other neurological disorders. These effects also include neuroprotection in epilepsy models, as evidenced by a reduction in seizure-like behavior, cell death in specific hippocampal regions, and lowered neuroinflammatory markers. In AD, SA treatment enhances memory, reverses cognitive deficits, and attenuates astrocyte activation. SA also has positive effects on cognition by improving memory and lowering oxidative stress. This is shown by lower levels of oxidative stress markers, higher levels of antioxidant enzyme activity, and better memory retention. Additionally, in ischemic stroke and PD models, SA provides microglial protection and exerts anti-inflammatory effects. This review emphasizes SA’s multifaceted neuroprotective properties and its potential role in the prevention and treatment of various brain disorders. Despite the need for further research to fully understand its mechanisms of action and clinical applicability, SA stands out as a valuable bioactive compound in the ongoing quest to combat neurodegenerative diseases and enhance the quality of life for affected individuals
Investigation of the Distribution of Ganglion Cells in the Appendix According to Location: A Cohort Study
No full textBackground: Hirschsprung's disease (HD) is a congenital absence of ganglion cells. Due to the lack of consensus about the possibility of relying on the histology of the appendix to diagnose HD, appendectomy and sampling of the appendix are still performed in many centers in Iran and the world to diagnose it. This study aimed to evaluate the possibility of partial appendectomy and prevent total appendectomy to diagnose HD and determine the prevalence of aganglionosis in each part. Methods: The present study was a prospective cohort study. The study population consisted of patients under 16 years of age in need of appendectomy who were referred to Isfahan teaching hospitals from March 2022 to March 2023. The inclusion criteria were age below 16 years and undergoing appendectomy with the diagnosis of appendicitis based on the Alvarado criteria, and the exclusion criteria were perforated or gangrene appendix and appendix neoplasia. The research variables included age and gender (as background variables) and the number of ganglion cells in each hpf (as dependent variable). Findings: The average age of the examined patients was 8.84 ± 3.33 years. 58 of the patients were male. The total number of ganglion cells seen in the entire slide containing the samples was the highest in the middle and the lowest in the distal slides, which were significantly different (P = 0.038). Conclusion: The middle part of the appendix has the highest number of ganglion cells and is the best part fo biopsy for the HD diagnosis. © 2024 Isfahan University of Medical Sciences(IUMS). All rights reserved