Pathogenesis of Ulcerative Colitis: the role of Claudin-8 in epithelial barrier function and inflammation

Ulcerative colitis is a relapsing and remitting inflammatory bowel disease involving the large bowel. The current hypothesis on the pathogenesis of UC is that an abnormal innate immune response in genetically susceptible individuals, combined with environmental factors, result in excessive activation of the adaptive immune system within lamina propria. The role of abnormal barrier function is widely accepted. Using transcriptomic analysis of punch biopsies of patients with quiescent UC, CLDN8 was identified as grossly downregulated in the intestine. In this thesis, loss of Cldn8, a tight junction (TJ) molecule, was shown to result in reduced susceptibility of mice to DSS-induced colitis. Cldn8 knock out (Cldn98-KO) mice, had smaller increase in intestinal permeability to 3H-mannitol, reduced neutrophils and macrophages in inflammatory cell infiltrate in lamina propria during the early phase of inflammation. The inner layer of mucous is sterile in naïve Cldn8-KO and WT mice, and remains sterile after the animals have been exposed to DSS-water for 12 hours. Transcriptomic analysis between Cldn8-KO and WT mice did not reveal any significant differences between the two groups at different time points. After correction for multiple-testing, no differentially-expressed genes remained. These results suggest that downregulation of CLDN8 in patients with UC is a physiologic response by the intestine to increase local defences against luminal pathogens

Specialist Physicians’ Attitude towards Emergency Medicine; a Semi-Structured Qualitative Study

Introduction: The present study is a survey to assess the pros and cons of emergency medicine (EM) from the viewpoint of the scholars from other medicine disciplines to improve the efficiency of EM in the healthcare system. Methods: This is a semi-structured qualitative study. Face-to-face interviews with various physicians with different specialties were performed to gather information on their viewpoints. Study population was selected mainly based on their history of collaboration with emergency medicine specialists in several educational hospitals in Tehran, Iran. All interviews were recorded and then transcribed to paper. Data were mainly categorized and reported into four themes: 1) general aspects of emergency medicine, goals and policies 2) Management of emergency department 3) Educational aspects 4) therapeutic aspects. Results: 22 specialist physicians with the mean age of 47.3±7.6 years were studied (77.3% male). The average of their work experience as a specialist was 13.6±7.5 years. From the viewpoint of other experts, the establishment of EM and training of EM specialists is accompanied with relative disadvantages and advantages regarding goals and policies, patient management, therapeutic interventions and student education in the emergency department. Initiating resuscitation and maintaining hemodynamic stability and appropriate triage of the patients can add to the benefits of EM by preventing unreasonable hospitalization, and reducing the workload and difficulty of the work of other professionals working in the hospital. Conclusions: Based on the results of the current study, it seems that most Iranian specialist physicians have a positive attitude towards emergency medicine and think that emergency medicine could have beneficial effects for the health system and hospital management system

Psychosocial Distress: A Case Study of a Male African American Veteran with End-Stage Colon Cancer

This in-depth single-case-study explored the emergent trauma of psychosocial distress of an older male African-American veteran after being diagnosed with end-stage colon cancer. Using a qualitative case study methodology, three in-depth interviews were conducted which identified the following five themes: (1) the emotional impact of being diagnosed with cancer, (2) experiencing inescapable loss of control and independence, (3) adjusting to nursing home placement, (4) lacking social support, and (5) navigating complicated services. The findings expand our understanding of the need for identifying and managing psychosocial distress. Implications for behavioral health practitioners are discussed

Utilization and Determinants of Postnatal Care Services in Ethiopia: A Systematic Review and Meta-Analysis

BACKGROUND: Postnatal care use is vital in saving mother and newborn lives which is a continuum of care for maternal, neonatal and child health. This reviewaimed to determine the utilization and determinants of postnatal care use in Ethiopia.METHODS: PubMed, Scopus, Web of Science, and Embase databases were searched on June 25, 2017. The study screening, data extraction and quality assessment were done independently by two reviewers. Effect sizes were pooled using a random-effectsmodel.RESULTS: Nine articles were included in the review. The pooled estimate for utilization of the service was 32% (95% CI: 21%, 43%). The pooled results of determinants of postnatal care use was statistically significant among those mothers who had ability to make decisions (1.89; 1.25, 2.54), had a history of antenatal care utilization (2.55; 1.42, 3.68), received more than two antenatal care visits (1.84; 1.28, 2.40), and received the service from skilled service provider (3.16; 1.62, 4.70). It was also found that mothers who gave birth in health faciliteis (2.13; 1.14, 3.12), had middle monthly income, richer, were from urban areas, and had knowledge of obstetric danger signs were significantly associated with increased odds of postnatal care use.CONCLUSION: Utilization of the services is low in Ethiopia. Antenatal care utilization, skilled service provider, being from urban area and delivery in health facility had a significant effect on postnatal care utilization. More rigorous studies are needed to identify determinant with the causal association to postnatal care utilization. The review was registered on PROSPEROCRD42017060266

A study on factors that drive variation in the levels of social capital among people living with HIV/AIDS in Iran

INTRODUCTION: Social capital is increasingly used in relation to health issues, particularly in sexually transmitted diseases/infections and health behaviors. Experiences indicated that social capital can contribute in changing HIV related risk behaviors and a decline of HIV infection through social groups and networking and make more effective use of HIV/AIDS prevention, care, and treatment services. We aimed to assess social capital in these persons through a quantitative study. METHOD: This cross-sectional study was performed with a convenience sample of 300 people living HIV/AIDS referred to a counseling center of behavioral diseases, in Imam Khomeini Hospital, in Tehran, the capital of Iran, during September 2011 to May 2012. Data collection tools were a demographic questionnaire and World Bank Social Capital Questionnaire (SC-IQ). The analysis of data was performed by the SPSS statistic software version 18. To identify factors influencing social capital in participations, Pearson correlation coefficient, ANOVA, t-test, and a multiple regression were applied. The significant level was considered 0.05 in this study. RESULTS: 165 (55) were male and the rest female. The mean age of participants was 34.3 ± 7.5. The mean score of total social capital was 2.34 ± 0.5 in all participants. The domain of individual trust had the highest mean score (2.53 ± 0.66). The lowest mean score was related to the domain of social trust and associative relations (2.23 ± 0.62). Variables such as ethnicity, age, and middle economic status had a significant impact on the domain of individual trust so that the mean score of this component of social capital was lower among women (0.396) than men. Factors affecting total social capital were ethnicity and middle economic status. CONCLUSION: Finding emphasized on the role of economic status, ethnicity and gender in persons living with HIV/AIDS. Thus recommended that policy makers and program managers consider social groups and networks, especially in women in the design and delivery of intervention strategies to reduce HIV transmission

Socioeconomic status and mortality after acute myocardial infarction: a study from Iran

<p>Abstract</p> <p>Background</p> <p>Studies have shown an inverse relationship between socioeconomic status (SES) and mortality due to coronary heart disease (CHD). Little is known about this association in Iran. This study aimed to investigate whether mortality after myocardial infarction (MI) varies by SES.</p> <p>Methods</p> <p>In a retrospective study, 1283 MI patients who hospitalized in Tehran Heart Center from March 2005 to March 2006 were followed up in March 2008. Demographic, clinical and SES data were collected from case records and by telephone interviews. Multiple logistic regression analysis was performed to estimate the predictive effect of socioeconomic factors on outcome.</p> <p>Results</p> <p>In all 664 patients were studied. Of these, 500 patients were alive and 164 were dead due to MI (64 died at hospital and 100 died at home). The results of regression analysis showed that in addition to treatment (OR = 9.52, 95%CI 4.84-18.7), having diabetes (OR = 1.78, 95% CI 1.12-2.81) or hyperlipidemia (OR = 1.82, 95% CI 1.14-2.90), socioeconomic variables including living area in square per person (lowest level vs. upper level OR = 4.92, 95% CI 2.11-11.4), unemployment (OR = 3.50, 95% CI 1.50-8.13) and education (OR for illiterate patients = 2.51, 95% CI 1.00-6.31) were the most significant contributing factors to increased mortality after MI.</p> <p>Conclusion</p> <p>Although the findings should be interpreted with caution, the study results indicated that socioeconomic variables were significant contributing factors to increased mortality after myocardial infarction. The underlying role of socioeconomic status on increased mortality after MI deserves further investigation.</p

Metamotivation in Medical Students: Explaining Motivation Regulation Strategies in Medical Students

BACKGROUND: Metamotivation is a process that students use to monitor their motivational states to reach their academic goals. To date, few studies have addressed the ways that medical students manage their motivational states. This study aim to identify the motivational strategies of medical students as they use the metamotivational process to monitor and control their motivational states. MATERIALS AND METHODS: This qualitative study uses directed content analysis of the narrative responses of 18 medical students to draft an in-depth and semistructured interview protocol which were conducted through WhatsApp due to social distance restrictions of COVID-19. Data were collected, encoded, and analyzed using deductive content analysis approach descripted by Elo and Kyngäs. RESULTS: Seven main themes were extracted as the motivational strategies of medical students including “regulation of value,” “regulation of situational interest,” “self-consequating,” “environmental structuring,” “efficacy management,” “regulation of relatedness,” and “regulation of situational awareness.” In this study by identifying new strategies, we provide a broader framework of metamotivational strategies in the field of the progression of learners in medical education. CONCLUSION: Medical students use a variety of strategies to regulate their academic motivation. To sustain and improve the motivation of medical students, identifying and strengthening metamotivational strategies is the first step

REACHING CONSENSUS: A SCOPING REVIEW ON SCHOOL-BASED COMPREHENSIVE SEXUALITY EDUCATION PROGRAMS (CSE)

La educación sexual en las escuelas es un tema candente en parte porque está estrechamente entrelazado con las interpretaciones sociales y parentales de lo correcto y lo incorrecto. Este estudio es una revisión de alcance que se realizó en seis pasos: (1) identificación de la pregunta de investigación, (2) identificación de estudios relevantes, (3) selección de estudios, (4) extracción de datos, (5) resumen e informe resultados, y (6) consulta con las partes interesadas. Los currículos se evaluaron mediante la Herramienta de evaluación curricular (SIECUS) y las directrices se evaluaron mediante la evaluación de las directrices para la herramienta de investigación y evaluación (AGREE II). Después de revisar 24 programas extraídos de 50 estudios, la mayoría de los cuales (90%) fueron diseñados y utilizados en países en desarrollo, se respondieron 5 preguntas. Finalmente, se recomendaron con modificaciones las pautas de “Pautas para el componente de educación en salud sexual de la educación integral en salud” y los planes de estudio “FLEHI, WSWM, Tuko Pamoja”. Esta revisión muestra que los programas de CSE no son solo intervenciones rentables, sino también parte de los derechos sexuales de los adolescentes. Al comienzo del programa, puede haber muchas barreras sociales y culturales en los países en desarrollo, pero una vez que se diseña un programa riguroso de base cultural, se pueden lograr resultados exitosos. Por lo tanto, se recomienda encarecidamente diseñar tales programas basados en la cultura iraní.A educação sexual nas escolas é um tema quente em parte porque está intimamente entrelaçada com interpretações sociais e parentais do certo e do errado. Este estudo é uma revisão de escopo que foi conduzida em seis etapas: (1) identificação da questão de pesquisa, (2) identificação de estudos relevantes, (3) seleção de estudos, (4) extração de dados, (5) resumo e relatório da (6) consulta com as partes interessadas. Os currículos foram avaliados pela Ferramenta de Avaliação de Currículo (SIECUS) e as diretrizes foram avaliadas pela avaliação das diretrizes para a ferramenta de pesquisa e avaliação (AGREE II). Após a revisão de 24 programas extraídos de 50 estudos, a maioria dos quais (90%) foram projetados e utilizados em países em desenvolvimento, cinco perguntas foram respondidas. Finalmente, as diretrizes “Diretrizes para o componente de educação em saúde sexual da Educação Integral em Saúde” e os currículos “FLEHI, WSWM, Tuko Pamoja” foram recomendados com modificações. Esta análise mostra que os programas de CSE não são apenas intervenções de baixo custo, mas também fazem parte dos direitos sexuais dos adolescentes. No início do programa, pode haver muitas barreiras sociais e culturais nos países em desenvolvimento, mas uma vez que um programa cultural rigoroso é projetado, resultados bem-sucedidos podem ser alcançados. Portanto, é altamente recomendável projetar esses programas com base na cultura iraniana.Sexuality education in schools is a hot topic in part because it is closely intertwined with social and parental interpretations of right and wrong. This study is a scoping review that was conducted in six steps: (1) identification of the research question, (2) identification of relevant studies, (3) selection of studies, (4) data extraction, (5) summarizing and reporting the results, and (6) consultation with stakeholders. Curricula were assessed by the Curriculum Evaluation Tool (SIECUS) and guidelines were evaluated by the appraisal of guidelines for research &amp; evaluation (AGREE II) tool. After reviewing 24 programs extracted from 50 studies, the majority of which (90%) were designed and utilized in developing countries, 5 questions were answered. Finally, the “Guidelines for the Sexual Health education component of Comprehensive Health Education” guideline, and the “FLEHI, WSWM, Tuko Pamoja” curricula were recommended with modifications. This review shows that CSE programs are not only cost-effective interventions, but also part of adolescents’ sexual rights. At the beginning of the program, there may be many social and cultural barriers in developing&nbsp;&nbsp;countries, but once a rigorous culturally based program is designed successful results can be achieved. Therefore, designing such programs based on the Iranian culture is strongly recommended

Assessing breast cancer risk among Iranian women using the gail model

Background: Breast cancer risk assessment is a helpful method for estimating development of breast cancer at the population level. Materials and Methods: In this cross-sectional study, participants consisted of a group of 3,847 volunteers (mean ± SD age: 463 ± 7.59 years) in a convenience sample of women referred to health centers affiliated to Tehran University of Medical Sciences in Tehran, Iran. The risk of breast cancer was estimated by applying the National Cancer Institute's online version of the Gail Risk Assessment Tool. Results: Some 24.9 of women reported having one first-degree female relative with breast cancer, with 8.05 of them having two or more first-degree relatives with breast cancer. The mean five-year risk of breast cancer for all participants was 1.61±0.73, and 9.36 of them had a five-year risk of breast cancer > 1.66. The mean lifetime risk of breast cancer was 11.7±3.91. Conclusions: The Gail model is useful for assessing probability of breast cancer in Iranian women. Based on the their breast cancer risk, women may decide to accept further screening services