Determination of the association between body image with sexual function and marital adjustment in fertile and infertile Women by path analysis modeling

Abstract Background & Objective: Infertility has several adverse effects on body, psychological and social aspects of women. Otherwise, body image could be a predictor of different behaviors including sexual behavior. Thus, in the present study we aimed to assess the association between body image with sexual function and marital adjustment in fertile and infertile women. Materials & Methods: One-hundred and thirty fertile and 130 infertile women were enrolled in this study. Statistical analysis was performed by using AMOS 18 with structural equation modeling. Results: In fertile women, the strongest path coefficient was related with the effect of body image on general health, while in infertile women, the strongest path coefficient was associated with the effect of body image on sexual function. In both occupying and non-occupying women the strongest path coefficient was related with the effect of body image on general health. In those infertile women who had the supports of their partners, the strongest path coefficient was associated with the effect of body image on sexual function, and in those infertile women who had not the supports of their partners the strongest path coefficient belonged to the effect of sexual function on marital adjustment. Conclusion: Based on our results, it seems that using structural equation modeling in evaluating and recognition of direct, indirect and total effects of the similar model is absolutely necessary and can be a good alternative method instead of regression

DNA Methylation and Histone Acetylation Patterns in Cultured Bovine Adipose Tissue-Derived Stem Cells (BADSCs)

Objective: Many studies have focused on the epigenetic characteristics of donor cells to improve somatic cell nuclear transfer (SCNT). We hypothesized that the epigenetic status and chromatin structure of undifferentiated bovine adipose tissue-derived stem cells (BADSCs) would not remain constant during different passages. The objective of this study was to determine the mRNA expression patterns of DNA methyltransferases (DNMT1, DNMT3a, DNMT3b) and histone deacetyltransferses (HDAC1, HDAC2, HDAC3) in BADSCs. In addition, we compared the measured levels of octamer binding protein-4 expression (OCT4) and acetylation of H3K9 (H3K9ac) in BADSCs cultures and different passages in vitro. Materials and Methods: In this experimental study, subcutaneous fat was obtained from adult cows immediately post-mortem. Relative level of DNMTs and HDACs was examined using quantitative real time polymerase chain reaction (q-PCR), and the level of OCT4 and H3K9ac was analyzed by flow cytometry at passages 3 (P3), 5 (P5) and 7 (P7). Results: The OCT4 protein level was similar at P3 and P5 but a significant decrease in its level was seen at P7. The highest and lowest levels of H3K9ac were observed at P5 and P7, respectively. At P5, the expression of HDACs and DNMTs was significantly decreased. In contrast, a remarkable increase in the expression of DNMTs was observed at P7. Conclusion: Our data demonstrated that the epigenetic status of BADSCs was variable during culture. The P5 cells showed the highest level of stemness and multipotency and the lowest level of chromatin compaction. Therefore, we suggest that P5 cells may be more efficient for SCNT compared with other passages

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Creation of Illness Meaning: A Central Concept of Spiritual Health

Viktor Frankl, a neurologist and the founder of logo-therapy (1969) stated that “will to meaning” is the basic essence of the universe (1). Logo-therapy means therapy through meaning, which is based on the premise that man has a will-to-meaning; the meaning thus lies in suffering(2). One of the most important human functions is discovering meaning in life, which is also considered as a sign of spiritual health(3). Defining illness by the patient is one of the most primary and significant implications for the formation of spiritual health(4). This study aimed to compare the Theory of Spiritual Well-being in nursing based on studies conducted in other countries with the theory of spiritual health according to Islamic teachings. Spiritual health theory is the theory of spiritual health in nursing. The main component of this holistic theory is to find the meaning of spirituality in the experience of illness. This theory can be taken into account in the care of patients in later stages, long-term chronic illnesses, and any kind of illness or injury that would challenge the person to find the purpose of life and the meaning of illness. In this theory, the patient is a person with the ability of finding the meaning of illness, which ultimately leads to their spiritual health (5). Conceptualization of spiritual health in Iran according to Islamic teachings has shown that spiritual health is a dynamic process oriented to the Creator’s proximity where the patient creates the meaning of his/her illness through wise, prudent, and sincere communication with oneself, the Creator, and others. On this continuum of excellence, different levels and qualities of romantic orientation by the Creator, religious rationality, task orientation, and hereafter prospectiveness can be observed in patients, causing psychological balance during illness and attribution of characteristics to the Creator(6). Differences between the theories mentioned above are as follows: 1. In the theory of spiritual health, the patient acquires spiritual meaning of illness, while in the conceptualization of spiritual health according to Islamic teachings, the patient creates meaning of illness. This difference is rooted in the exogenous and endogenous nature of spirituality. According to religious teachings, endogenous spiritual health focuses on the creation of meaning, while being autonomous and self-standing, background-oriented and valued, spontaneous and dynamic, progressive and constructive. However, exogenous spirituality focuses on the acquisition of meaning, mental spirituality, external and artificial products, while being dependent and attached, whim-oriented and acquired, worldly and instrumental, other-motivated and static, declining and dying (7). 2. In the conceptualization of spiritual health based on Islamic teachings, the patient thinks about himself, explores his moods and thoughts, reviews his past behavior, thinks about his values ​​and beliefs, and tries to figure out whether his past behavior, moods, and thoughts have been coordinated with his value and belief systems (6, 7). 3. In the Theory of Spiritual Well-being, social support is addressed as a contributing factor for the formation of spiritual well-being. It seems that while connection with others is considered as a two-way communication in the conceptualization of spiritual health model based on, a one-way communication link has been reported between the patient and others (6). 4. Another difference in the mentioned conceptualization models is that while spiritual health conceptual model is based on Islamic teachings, the spiritual well-being conceptual model does not take components such as hereafter prospectiveness, task orientation, and mental balance into account (6). In general, it could be concluded that since the search for meaning and spiritual health are context-driven concepts, and significant differences have been observed in their conceptualization based on various cultures, it is recommended that the healthcare system pay especial attention to this crucial issue in order to effectively perform interventions and cares to promote spiritual health of patients

Systematic strategy in nursing curriculum in American, Canadian, Australian nursing and proposed way for applying it in Iranian nursing curriculum: A comparative study

ABSTRACT Introduction: Recently, a systematic strategy has used for improving quality of nursing curriculum that traditional curriculum is not suitable for it. The aim of the present study is to identify how the systematic strategy have applied in the nursing curriculum in the US, Canada and Australia and proposed methods for applying it in Iranian nursing curriculum. Methods: This comparative study was done according to Beredy’s model: Description, interpretation, juxtaposition, and comparison. The analysis was done on the curriculum of nursing colleges in the above mentioned countries. The samples were totally 10 colleges of 3 countries: USA, Australia, and Canada selected by purposive sampling. An inclusion criterion was applied to the systematic strategy in B.A. of nursing curriculum. Data collection instrument was five stages for applying systematic strategy based on the checklist. Nursing curriculum in these countries was retrieved through their publications, books, the Internet, their web sites and electronic communication. The internal validity and external validity of the documents were reviewed. Data analysis was performed according to Bredey's model. Result: This strategy is helpful for selecting students, effective teaching and learning process and outcomes Conclusion: Considering the systematic strategy in the nursing curriculum can promote Iranian nursing curriculum. &nbsp

Exploring the practice of Iranian adolescent females during menstruation and related beliefs: a qualitative study

Abstract Background Menstruation is a natural occurrence that women experience during their reproductive years and may encounter many years throughout their lifespan. Many adolescent females lack accurate knowledge about menstruation, so they may face issues from receiving incorrect information from unreliable sources. Our study aimed to investigate the practices and beliefs surrounding menstruation among Iranian adolescent females. Methods This qualitative study was conducted using conventional content analysis. A purposeful sampling method was used to select 18 adolescent females from secondary and high schools located in the three regions of Neyshabur City-Iran. Data were collected through in-depth, semi-structured interviews. Results Three main themes were extracted, consisting of lifestyle and related beliefs, lake of support, and awareness and information. Conclusions misconceptions and wrong behaviors during menstruation indicate that the lake of knowledge an traditional factors influence adolescent girls’ health. The study provides the basis for intervention planning in this regard and different levels (individual, intrapersonal, health systems, and community)

Relationship between Coping and Spiritual Health in Renal Transplant Recipients

Patients with end-stage renal disease (ESRD) encounter various challenges following kidney transplantation, which should be managed appropriately. These problems can be partly controlled by considering spirituality as one of the care components. Regarding this, the aim of this study was to investigate the relationship between coping and spiritual health in the renal transplant recipients. This descriptive correlational study was conducted on 169 patients referring to the Organ Transplantation Center at Montasserieh Hospital in Mashhad, Iran. The study population was selected through convenience sampling method. The data were collected using demographic characteristics form, Renal Transplant Coping Scale by Valizadeh et al. (2015), and Spiritual Health Questionnaire developed by Khorashadizadeh et al. (2015). The mean scores of coping and spiritual health were 321.2±15.3 and 123.3±6.2, respectively, which were desirable. There was a significant linear relationship between coping and spiritual health mean scores (P˂0.001, r=0.37). Based on the findings, the reinforcement of spiritual beliefs in patients could be a strategy to promote their coping level

The Sources of Stress in Renal Transplant Patients

Introduction Renal transplant is the best treatment of choice for patients with end-stage renal disease (1). Annually, about 17000 patients receive deceased or living donor transplants, which help them promote health and self-efficacy (1-2). However, despite advances in transplant technology, patients face a number of post-operative challenges, which might lead to stress in patients, including uncertainty about future health, costs and finances, side effects of medicinal treatment and medical follow-up; these factors might lead to low quality of life (3). Previous studies demonstrated differences in transplant-related stressors. According to study by Veroux (2010), these stressors are perceived physical appearance, issues related to sexuality, anxiety, and even feeling guilt (4). Gill (2012) stated that concern over transplant outcome is another stressor for patients even years after transplantation (5).  Another study suggested that uncertainty about future and concern over the impact of transplant on physical and physiological health are the main stressors among patients. These stresses continue several years after transplant and lead to fear of graft rejection and hopelessness (6). Several studies were conducted on the effects of stress on renal transplant outcome (5-10) based on which it is necessary for nursing staff to consider stress-generating factors to provide appropriate care for renal transplant patients and as a result, promote nursing clinical performance (7). Culture and politics of care can affect type of stress; however, there is a scarcity of reports on this issue regarding renal transplant in Iran.Therefore, this study was conducted to evaluate the source of stress in renal transplant patients.       1. Evidence Based Care Research Center, Instructor of Nursing, Department of Operating Room, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran 2. Professor of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran 3. Chronic Disease Care Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran 4. Assistant Professor of Nursing, North Khorasan of Medical Sciences, Bojnord, Iran 5. BS Nursing, Center of Organ Transplant, Montaserieh Hospital. Mashhad University of Medical Sciences, Mashhad, Iran   *Corresponding author, Email: [email protected] Methods This descriptive study was conducted on 236 patients in the Montaserieh organ transplant hospital in Mashhad, Iran, during December 2014-May 2015. The participants were chosen through convenience sampling. The sample size was calculated according to  rate of  transplant rejection that  was 44% (9). The inclusion criteria were aged>18 years, not being hospitalized for transplant rejection, and two-month interval since renal transplant. The data collection instrument was Transplant-Related Stressors Scale. The 17-item scale was developed by Frazier et al (1995). Before initiating the study, the scale was translated into Persian based on forward-backward method(11). Items of this scale are categorized into five subscales assessing future health, finances, side-effects of medicinal treatment and physical limitations, interpersonal relations, and following the medical regimen. Patients are were asked to determine each item stressful on a scale ranging from 1 (not stressful) to 5 (extremely stressful); therefore, the scoring range is 17- 68 (8). Validity and reliability of the scale were established by Weng (2008) and Achille (2004) with CVI=0.9 and Cronbach’s alpha=0.86 (3, 12). For the Persian version of the instrument, as estimated by expert panel, S-CVI score and Cronbach’s alpha were 0.89 and 0.89, respectively. The obtained data were exported into SPSS, version 15; the data were analyzed using descriptive and inferential statistics (analysis of variance and independent t-test). To ensure confidentiality, participants’ names were removed from the questionnaire and the questionnaires were coded by numbers.   Results The majority of the subjects (65%) were male, aged between 18 and 60 years old (mean: 37±11.38 years), married (71.6%), and had basic education. Mean duration of being on renal transplant list was 38±44.71 months. Most subjects (56.8%) had undergone transplant less than two years before. The most common stressor was fear of graft rejection and the least common stressor was getting medical questions answered (table 1). The mean stress score in the male patients was 39.99±0.65 and in female was 38.40±9.98. This study used independent t-test to determine the effect of demographic variables on stress level. There were no significant differences between stress score and duration of being on the transplant waiting list (F=0.104, P=0.9) and duration of dialysis (F=0.694, P=0.5). However, there was a significant difference between stress score and age ((F=4.48, P=0.01) and marital statue (t=2.876, P=0.004) The highest stress scores were in ages less than 33 years old and the lowest stress scores were in ages more than 50 years.   Table1: Mean and standard deviation of the stressors in renal transplant patients   Standard deviation Mean Items 0.92 3.37 Fear of graft rejection 1.00 3.01 Financial pressure 1.04 2.68 Uncertainly about future health 1.25 2.60 Travelling for check-up 1.05 2.43 Physical limitation 0.98 2.39 Medicinal side effects 1.01 2.38 Lack of social support 1.10 2.32 Dietary restriction 1.01 2.30 Handling insurance 1.15 2.24 Dependency on medical personnel 1.06 2.17 Weight gain 0/94 2.06 Change in  appearance 0.99 2.05 Being a burden to others 1.06 1.96 Susceptibility to other illnesses 1.06 1.82 Change in  relationship with spouse 0.87 1.60 Getting medical questions answered     Discussion The present study was conducted to determine the most common stressors in patients undergoing renal transplant. It was found that the main stressors in these patients were fear of graft rejection, financial issues, and uncertainly about future health. This result was not in agreement with study Frey (1990). He stated that the main stressor was fear of hospital readmission (7). The reason for this discrepancy might be the fact that Frey assessed stress during the first six weeks after transplant. Due to patients’ unstable condition, particularly in the first few days after transplant, they were readmitted to hospital for creatinine level and renal function examinations; thus, this stressor will be ruled out after some time.  In line with our study, several other studies demonstrated that fear of graft rejection is one of the most important stressors (3, 5, 8, 13-14). Graft rejection threatens transplant patients’ health and it implies undergoing dialysis and tolerating painful needles again. Renal transplant patients experience multiple stresses during dialysis such as awaiting organ transplant, financial pressure, and difficult process prior to receiving transplant. According to the present study, a stress-generating factor related to liver transplant was financial pressure. Consistent with this result, Frazier (1995) showed that an important stressor in  patients was financial pressure due to giving repeated tests, visits, follow-up issues(8). Despite consensus on financial pressure, the cost of insurance was not one of the stressors in some studies such as Chen (2010). He stated that financial issues were not a significant concern in Taiwan. The Taiwanese have national health insurance; therefore, patients are only responsible for a small portion of the costs (6). However, since financial problems are one of the important stressors in countries like Iran, where transplant patients are directly responsible for treatment costs and health insurance is responsible for only a small portion of the costs. In this study, uncertainty about future health was the third highly frequent stressor among the patients. McCormick (2002), quite consistent with our results, stated that uncertainty about future health was a major stressor in transplant patients, which can hinder recovery after renal transplant. Although, patients have learned some coping strategies for the post-transplant period, they are concerned about future health, returning to dialysis (15). In the present study, fear of graft rejection was not the main stressor, the reason for which might be the religious and spiritual beliefs of Muslim patients. Muslims deem Allah as an omnipotent and all-knowing being, which results in accepting their fate with satisfaction. According to the results, there was no significant difference between stress score and the length of post-transplant time; thus, passage of time after transplant cannot affect severity of stress. Chen (2010) proposed that one year after transplant, the patients experienced lower level of stress; however, disregarding post-transplant time, stress continued to some extent (16). Kong (1999) demonstrated that renal transplant patients may experience stress of moderate intensity long after transplant (17).  It is possibly reason that the problem related post time transplant is continuing, the stress factor related to transplant is continuing(18).   Implications for Practice Disregarding the outcome of renal transplant, patients experience stress during post-transplant period. There are differences in type and severity of stress-generating factors depending on culture, health care system, insurance support, and religion. These stressors can deteriorate patients’ physical, psychological, social, and spiritual condition; therefore, identifying and managing these stressors is important. Determination of transplant patients’ perception of stressors can help nurses promote patient outcome. Nursing staff are recommended to employ evidence-based practice to identify vulnerable patients and provide appropriate care for patients.   Acknowledgments This article is part of a PhD dissertation and research project approved and supported by Ahvaz University of Medical Sciences (grant code: 1392.335). The authors would like to thank the Research Board of Ahvaz University of Medical Sciences, as well as the authorities, staff, and transplant patients of Montaserieh Hospital. Conflict of interest The authors declare that there is no conflict of interest

Oral versus written feedback delivery to nursing students in clinical education: A randomized controlled trial

Background: Feedback delivery is deemed as a key element during a students' clinical education. It keeps students on track to meet their goal and increase students' motivation and confidence. Objective: The aim of this study was to compare the quality of feedback delivery in oral versus written feedback delivery to nursing students in clinical education. Methods: A randomized controlled trial was conducted between February and August 2012 in the city of Bojnurd in Iran. Using purposive sampling, last semester’s nursing students (n=44) had been randomly assigned to oral and written feedback delivery groups. Three Instructors received orientation and training on methods of feedback delivery before study initiation. Then, they gave necessary oral and written feedback to the students. Clinical settings of the study included coronary care, surgical, and neonatal units of hospitals. Data collection tools were quality of feedback delivery, students' satisfaction questionnaire and students' reactions checklist. Data were analyzed using SPSS version 11.5 with chi-square test and the t-test. Results: Most of the students (52%, n=23) were male. There were no significant differences between the scores of quality of oral and written feedback delivery (p>0.05). The study did not show a difference of satisfaction level between the oral and written feedback groups. The relationship between students' reactions and feedback type at the confidence level of 90% was significant, so that students who received oral feedback showed more severe reactions as compared to the written feedback group. Conclusion: According to the results, the type of feedback is not an important factor in clinical education quality and satisfaction level. They may achieve a better outcome by focusing on the other aspects of quality of feedback delivery rather than feedback type. Trial registration: The trial was registered at the Iranian Registration Center for Clinical Trials with the Irct id: (IRCT: 201111128076N1). Funding: North Khorasan University of Medical Sciences (permission no. 89/p/209)