A Report on Drug Resistance Patterns of Mycobacterium tuberculosis Isolates in Northern Iran

BACKGROUND: There are limited data on the Mycobacterium tuberculosis (MTB) drug resistance in regions located at the proximity of the Caspian Sea. We aimed to assess the drug resistance patterns of the MTB isolates to anti-tuberculosis drugs in patients from four northern provinces of Iran between April 2013 and March 2019. METHODS: Drug susceptibility testing (DST) was performed by culturing MTB isolates on the Lowenstein-Jensen medium using the proportion method. RESULTS: Out of 963 MTB isolates, 927 (96.3) were recovered from Iranian cases and 36 (3.7) were from Afghan immigrants. Based on DST, 59 (6.1) showed any drug resistance pattern, while 18 patients (1.9) were multidrug-resistant (MDR) or rifampicin-resistant (RR). Resistance to streptomycin (STR), isoniazid (INZ), rifampicin (RIN), and ethambutol (ETL) was reported in 33 (3.4), 28 (2.9), 18 (1.9), and 12 isolates (1.2), respectively. CONCLUSION: The rate of MDR/RR in four northern provinces of Iran was in line with previous reports from the World Health Organization. Due to proximity to the former Soviet Union, which had a high rate of MDR/RR isolates, the establishment of cross-border tuberculosis (TB) control strategies is recommended to reduce the possibility of MDR-TB transmission. Moreover, DST for all TB cases is recommended as an effective diagnostic tool for optimal monitoring and control of drug resistance in these areas. Future studies with a molecular epidemiology approach will be needed to evaluate the transmission dynamics of MTB in these regions. 2022 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

Evaluation of the Xpert MTB/RIF test accuracy for diagnosis of tuberculosis in areas with a moderate tuberculosis burden

The Xpert MTB/RIF assay (Xpert) is a molecular assay used for direct detection of Mycobacterium tuberculosis (MTB) in clinical specimens. In this study, we aimed to assess the accuracy of the Xpert assay for the diagnosis of tuberculosis (TB) in TB suspected patients from the northern region of Iran. The obtained results were compared with the culture method. The sputum specimens were examined using the Xpert assay, smear microscopy, and solid culture media as a reference diagnostic tool. Among 293 presumptive TB cases, 92 (31.4) were positive according to the culture method. The Xpert method detected 88 (95.7) cases that were positive according to the culture method, compared with 78 (84.8) positive cases according to smear microscopy. The overall sensitivity and specificity of the Xpert method for TB diagnosis were 95.7 and 99, respectively. Also, the sensitivity and specificity for smear microscopy were 84.8 and 97.5, respectively. The Xpert assay showed high overall sensitivity and specificity; thus, it can be effectively used for the early and accurate diagnosis of MTB in TB endemic areas. In addition, the agreement between semi-quantitative results of Xpert and smear microscopy assays could be helpful in evaluating transmission potential in TB patients. © 2020 Scandinavian Societies for Medical Microbiology and Patholog

The relationship between anger with general health in emergency personnel

Context: The emergency staff work in stressful environments and deal with critically ill patients. The occupational nature of their work is such that they are always at risk of being exposed to work violence by patients or patient companions. Aim: The aim of this study was to determine the relationship between anger with general health in emergency personnel. Setting and Design: This was a correlational study that was done in prehospital emergency services and hospital emergency departments in Golestan province, in Iran in 2019. Materials and Methods: The study conducted on 400 of emergency personnel. Samples were selected through multistage sampling. The sampling design included stratified sampling, cluster sampling, and convenience sampling in the first, second, and third stage, respectively. Data were collected using demographic, Spielberger's anger, and general health questionnaires. Statistical Analysis Used: Description of sample under study presented using mean, standard deviation, and frequency. Assessment of associations was performed using Mann- Whitney and correlational analysis at significance level of 0.05. Results: The mean total score of anger of emergency personnel was 121.94 ± 14.66 and for the prehospital and hospital emergency personnel were 123.53 ± 14.08 and 119.38 ± 15.26, respectively (P = 0.002). The mean total score of general health was 12.40 ± 4.22 and for prehospital emergency and emergency personnel were 12.23 ± 4.18 and 12.67 ± 4.29, respectively (P = 0.75). There was a positive and significant correlation between all three dimensions of general health and all three dimensions of anger so that with increasing anger, general health decreased. Conclusion: Emergency personnel were in good general health while their anger score was above average. Furthermore, there was a significant inverse correlation between anger and mental health, so that by increasing the dimensions of anger expression, the general health of prehospital and hospital emergency staff was reduced. © 2021 Journal of Nursing and Midwifery Sciences Published by Wolters Kluwer - Medknow

The factor structure and factorial invariance of short form of smoking temptation for TTM framework in Iranian smoker population: Golestan Province

Purpose TTM pattern has widely been used in smoking cessation interventions. This study was aimed to investigate the compatibility of a hierarchical factor structure of short form questionnaire developed by Velicer et al regarding situational temptation construct among smokers in Golestan province. Methods A cross-sectional study was conducted on 387 smokers that were included using inconvenient sampling method. At first, internal validity and reliability of the short-form questionnaire were examined. At second, invariance of hierarchical structure was tested in sub-groups of ethnicity, residence, education, stage of quit, starting age, and income. Measurement invariance (including five invariances) and structural invariance (including three invariances) were explored in each sub-group. Results Chi-square test for confirmatory factor analysis of hierarchical factor structure was statistically significant for all samples [χ^2 (24)=66.3,p<0.001]; while, other indicators reveled the good compatibility of factor structure (CFI=0.944, TLI=0.915, RMSEA=0.067 ((0.048, 0.087)) and SRMR =0.042). Values of the first order of factor loading were between 0.5 and 0.84. There was strong correlation between first order factors and second order factor such that it was 0.9 for positive and habitual social situations factors and 0.82 for negative effects factor. Cronbach's alpha coefficient for the whole model was also 0.803. Conclusions Given the findings, hierarchical factor structure of short-form inventory about temptation to cigarette smoking was confirmed by three factors that were in line with Velicer et al model. The fitting indices of the model presented that construct validity was observed in all samples and sub-groups, and can be likely used in smoking cessation programs. Funding Golestan University of Medical Sciences, Gorgan, Ira

The examination of relationship between socioeconomic factors and number of tuberculosis using quantile regression model for count data in Iran 2010-2011

Background: Poverty and low socioeconomic status are the most important reasons of increasing the global burden of tuberculosis, not only in developing countries but also in developed countries for particular groups. The purpose of this study was to assess the association between socioeconomic factors and the number of tuberculosis patients using quantile regression for count data. Methods: This cross-sectional study was conducted on 11,320 tuberculosis patients from March 2010 to March 201 in Iran. Data was gathered from the 345 sections of Iran by Ministry of Health and Medical Education and Statistical Center of Iran. The jittering method was applied for smoothing, and then, the quantile regression for count data was fitted. The AIC was used to compare the fitness of quantile regression for count data model and Poisson log-linear model. The R (3.0.1) software and Quantreg and AER packages were used for all analysis and modeling of the data. Results: The results of fitting the quantile regression for count data showed that in all percentiles, the more increase in immigration rate, illiteracy rate, unemployment and urbanization rates, the more tuberculosis morbidity rate was increased. The maximum increase of tuberculosis due to immigration rate, urbanization rate, unemployment rate, and illiteracy rate was in 95th percentile (β=0.315), 85'Th percentile (β=0.162), 75'Th percentile (β=0.114), and 95'Th percentile (β=0.304), respectively. For 50th percentiles and higher percentiles, with increasing the sum of physicians to the number of population, the tuberculosis morbidity rate was decreased, and the maximum decrease was in 95'Th percentile (β=-0.1). For all percentiles, the AIC showed that quantile regression for count data had been a better fit to data. Conclusion: With respect to the relationship between socioeconomic factors and TB rate, health care observers should pay close attention to improving these factors in Iran to reduce the TB mortality and morbidity

Assessing preventive health behaviors from COVID-19: a cross sectional study with health belief model in Golestan Province, Northern of Iran

Background: Coronavirus disease 2019 (COVID-19) is a new viral disease that has caused a pandemic in the world. Due to the lack of vaccines and definitive treatment, preventive behaviors are the only way to overcome the disease. Therefore, the present study aimed to determine the preventive behaviors from the disease based on constructs of the health belief model. Methods: In the present cross-sectional study during March 11�16, 2020, 750 individuals in Golestan Province of Iran were included in the study using the convenience sampling and they completed the questionnaires through cyberspace. Factor scores were calculated using the confirmatory factor analysis. The effects of different factors were separately investigated using the univariate analyses, including students sample t-test, ANOVA, and simple linear regression. Finally, the effective factors were examined by the multiple regression analysis at a significant level of 0.05 and through Mplus 7 and SPSS 16. Results: The participants� mean age was 33.9 ± 9.45 years; and 57.1 of them had associate and bachelor's degrees. Multiple regression indicated that the mean score of preventive behavior from COVID-19 was higher in females than males, and greater in urban dwellers than rural dwellers. Furthermore, one unit increase in the standard deviation of factor scores of self-efficacy and perceived benefits increased the scores of preventive behavior from COVID-19 by 0.22 and 0.17 units respectively. On the contrary, one unit increase in the standard deviation of factor score of perceived barriers and fatalistic beliefs decreased the scores of the preventive behavior from COVID-19 by 0.36 and 0.19 units respectively. Conclusions: Results of the present study indicated that female gender, perceived barriers, perceived self-efficacy, fatalistic beliefs, perceived interests, and living in city had the greatest preventive behaviors from COVID-19 respectively. Preventive interventions were necessary among males and villagers. © 2020, The Author(s)

The Relationship Between Death and Do Not Resuscitation Attitudes Among Intensive Care Nurses

This study aimed to determine the relationship between death and DNR attitudes among ICNs. This descriptive-analytical study was performed on 156 ICNs in 2018. All nurses were enrolled in the study; data collection instruments included Death Attitude Profile-Revised (DAP-R) and the DNR attitude questionnaires. The mean scores of DAP-R and DNR items were 150.89/ ± 23.59 and 91.82 ± 11.41, respectively. There was a significant relationship between death attitude and DNR attitude Famong ICNs. All dimensions of DAP-R significantly predicted attitude toward DNR (P < 0.05). Among those, �neutral acceptance� (1.17 95% CI (0.68--1.65) was the strongest predictor and �death avoidance� was the weakest predictor (0.36 95% CI (0.09--0.62). There was a significant relationship between the ICNs' work experience and attitude toward DNR (p = 0.03). The findings can be used in formulation of the national guideline for DNR order. © The Author(s) 2020

The Relationship Between Death and Do Not Resuscitation Attitudes Among Intensive Care Nurses

This study aimed to determine the relationship between death and DNR attitudes among ICNs. This descriptive-analytical study was performed on 156 ICNs in 2018. All nurses were enrolled in the study; data collection instruments included Death Attitude Profile-Revised (DAP-R) and the DNR attitude questionnaires. The mean scores of DAP-R and DNR items were 150.89/ ± 23.59 and 91.82 ± 11.41, respectively. There was a significant relationship between death attitude and DNR attitude Famong ICNs. All dimensions of DAP-R significantly predicted attitude toward DNR (P < 0.05). Among those, �neutral acceptance� (1.17 95% CI (0.68--1.65) was the strongest predictor and �death avoidance� was the weakest predictor (0.36 95% CI (0.09--0.62). There was a significant relationship between the ICNs' work experience and attitude toward DNR (p = 0.03). The findings can be used in formulation of the national guideline for DNR order. © The Author(s) 2020

Survey of breast self-exam and mammography compliance among female healthcare workers in Aq Qala City, Iran

Background: Breast cancer is the most common cancer among women. The objective of this study was to determine the breast self-examination (BSE) and mammography compliance based on health belief model constructs among female healthcare workers in the city of Aq Qala. Methods: We conducted this cross-sectional study between November 2015 and February 2016 in Aq Qala city, northern Iran. In this regard, we selected 261 female healthcare workers through census. Data were gathered using Rakowski�s stages of change and Champion health belief model scale. We entered the collected data into SPSS 16 and analyzed them via descriptive statistical techniques along with Kruskal-Wallis, Mann-Whitney, chi-square, and Spearman rank correlation coefficient. Results: The results showed that 26.4 of the participants performed regular BSE and 19.3 underwent regular mammogram. Those with regular BSE had significantly more health motivation and self-efficacy (P�0.05). Physicians had more susceptibility and self-efficacy for BSE and less BSE barriers (P�0.05). There was a negative correlation between BSE confidence and barriers (r=-0.376). The results of binary logistic regression revealed that confidence was the only variable influencing BSE (OR=1.77, 95 CI=1.22, 2.572). Conclusion: Almost one-fourth of female healthcare workers of Aq Qala performed regular BSE. Moreover, one-fifth of women over 40 years of age underwent regular mammograms. Participants who performed regular BSE had higher health motivation, BSE self-efficacy, and lower perceived barriers. BSE adherence was more in physicians than in other groups. We recommend increasing confidence to surmount the barriers to perform BSE. © 2020, Shiraz University of Medical Sciences. All rights reserved