Background: Students may smoke cigarettes to alleviate stress and psychological pressure. Low self-efficacy and limited health literacy may increase their propensity for smoking. Objectives: This study aimed to evaluate the effectiveness of health belief model-based education in improving health literacy, self-efficacy, and attitudes toward smoking. Methods: This quasi-experimental study was conducted in 2025 among students at the University of Social Welfare and Rehabilitation Sciences. Using simple random sampling, 60 students were selected and randomly assigned to the control and intervention groups. A pre-test was administered, and participants completed questionnaires on health literacy, self-efficacy, and attitudes toward smoking. The health belief model intervention protocol was then delivered to the intervention group in eight 1.5-hour sessions, followed by a post-test. For ethical reasons, informed consent was obtained. Data were analyzed using SPSS version 21. The chi-square test was used for demographic variables; means and standard deviations were used for descriptive analysis of the study variables before and after the intervention; and one-way MANCOVA was used for inferential analysis. Results: In the pre-test, the mean ± SD values for attitudes toward smoking were 47.72 ± 6.76 and 46.03 ± 6.93, those for health literacy were 52.15 ± 9.41 and 50.73 ± 7.12, and those for self-efficacy were 31.38 ± 3.79 and 29.73 ± 2.15 in the control and intervention groups, respectively. In the post-test, the mean ± SD values for attitudes toward smoking were 45.91 ± 7.20 and 22.53 ± 5.84, those for health literacy were 51.92 ± 8.08 and 63.16 ± 8.31, and those for self-efficacy were 29.15 ± 4.86 and 55.53 ± 3.92 in the control and intervention groups, respectively. Education based on the health belief model reduced the mean positive attitude toward smoking (P = 0.016), increased the mean self-efficacy score (P = 0.018), and increased the mean health literacy score (P = 0.029) in the intervention group compared with the control group. Conclusions: Education based on the health belief model may lead to changes in attitudes toward smoking, health literacy, and self-efficacy. Therefore, it may be recommended as an educational program for selected students.
Background: The occurrence of extreme behaviors and their detrimental impacts, particularly Internet addiction (IA) among students, have drawn the attention of researchers in contrast to the positive uses of the internet. Objectives: The purpose of this study was to evaluate the correlation between medical students' salivary cortisol levels, anxiety levels, and IA. Methods: One hundred and ten (110) medical interns from Golestan University of Medical Sciences in Gorgan, Iran, participated in this descriptive, analytical, cross-sectional study. A checklist was used to obtain demographic data. Internet addiction was assessed using the Young Internet Addiction Test (IAT), while anxiety levels were assessed using the Hamilton Anxiety Rating Scale (HAM-A). Additionally, a saliva sample was taken early in the morning to examine the correlation between IA and salivary cortisol levels. Results: The subjects' average age was 24.69 ± 1.18 years. The participants' salivary cortisol levels were 5.57 ± 3.20 µg/dL. There was a significant difference in the IAT score for IA between the male and female groups (50.42 ± 24.11 vs. 41.09 ± 22.36, respectively, P = 0.008). The following pupils were categorized as having mild, moderate, and severe IA: 54 (49.1%), 34 (30.9%), and 22 (20%). The male and female groups did not differ substantially in their anxiety Hamilton test scores (29.22 ± 10.95 vs. 28.05 ± 12.02, respectively, P = 0.682). A statistically significant difference was observed in the anxiety scores for mild, moderate, and severe IA categories (P = 0.035). Conclusions: Nearly 20% of medical students suffer from severe IA. The study's conclusions demonstrated a significant correlation between higher levels of anxiety disorders and the intensity of IA.
Background: In hospital settings, equitable care requires that patients with similar clinical needs receive comparable services. However, “recommended patients” (those introduced through personal or political connections) often experience expedited access and preferential treatment, creating disparities in service delivery. Objectives: This qualitative study aimed to explore how the presence of recommended patients influences (1) the provision of services to other patients, (2) clinical treatment processes, and (3) professional interactions among healthcare staff in Iranian teaching hospitals. Methods: Using a purposive sampling strategy, we recruited 14 participants (physicians, nurses, and hospital administrators) with at least five years of direct, continuous experience in hospital service provision. Data were collected through semi-structured interviews, transcribed verbatim, and analyzed via inductive content analysis. Results: A total of 4 categories and 12 subcategories were extracted in this study. The first category was “The Referring Authority and Strategies of Influence” with four subcategories. The others were “Recommended Patient Reaction”, which had 2 subcategories, “Reaction and Effect on Treatment Process and Health Care Provider”, which had 4 subcategories, and “Reactions of Other Patients,” which had 2 subcategories. Conclusions: This study illustrates that, despite their limited numbers, recommended patients are perceived to substantially affect hospital dynamics. They shape service quality for non‑recommended patients, increase staff workload, and alter the professional atmosphere. The findings highlight the need for systemic interventions to promote equity and transparency in Iranian hospital settings.
Background: Patients with inflammatory bowel disease (IBD) experience a disproportionately high burden of low bone mineral density (BMD) and osteoporosis compared with the general population. Chronic inflammation, nutritional deficiencies, corticosteroid exposure, and changes in body composition all contribute to impaired bone health. Objectives: We aimed to investigate the bone metabolism in cases with anti-tumor necrosis factor-alpha (anti-TNF-α) agents which are widely used to control moderate-to-severe IBD. We examinedd the association between anti-TNF-α therapy and BMD in a cohort of IBD patients receiving care at a tertiary center. Methods: This cross-sectional study enrolled 58 patients with ulcerative colitis or Crohn’s disease were enrolled (29 receiving anti-TNF-α and 29 receiving azathioprine-based therapy). Clinical history, medication exposure, cumulative corticosteroid dose, nutritional supplementation, vitamin D levels, disease activity, and lifestyle factors were recorded. Dual-energy X-ray absorptiometry (DEXA) was used to measure lumbar and femoral BMD. Multivariable logistic regression was performed to identify independent predictors of osteoporosis. Resultss: Overall, 43.1% of participants met criteria for osteoporosis based on Z-scores, with markedly higher prevalence among anti-TNF-α users (65.5% vs. 20.7%, P = 0.01). After adjusting for confounders, anti-TNF-α therapy (OR 3.50; 95% CI 1.20 - 10.20), lower BMD (OR 2.00; 95% CI 1.10 - 3.60), higher cumulative corticosteroid exposure (OR 1.50; 95% CI 1.10 - 2.00), and lower BMI (OR 1.20; 95% CI 1.05 - 1.40) were independently associated with osteoporosis. Conclusions: These findings demonstrate a significant association between anti-TNF-α therapy and lower bone mineral density in patients with inflammatory bowel disease. Given the cross-sectional design, causal relationships cannot be established, and residual confounding by disease severity and treatment indication remains likely. Larger prospective and longitudinal studies are required to clarify the temporal and mechanistic relationships between anti-TNF-α therapy and bone metabolism.
Background: Quality of life is a key indicator of general well-being connected to social, emotional, physical, and environmental factors. Objectives: To evaluate the health-related quality of life among nurses employed by Palestinian hospitals. Methods: A cross-sectional study was conducted between January and March 2024. Data were collected from nurses at Palestinian hospitals across the northern, central, and southern regions of Palestine. Data on sociodemographic, professional, and health-related factors were collected, and quality of life was assessed using the Short Form-12 (SF-12) scale, which measures both physical and mental health components. The required sample size was 374 nurses; however, due to an 80% response rate, 301 nurses were included using a convenience sampling method. Statistical analyses included descriptive statistics, independent t-tests, and one-way analysis of variance (ANOVA) to examine group differences. Results: The mean physical health score was 43.0 ± 10.4, indicating below-average physical well-being, while the mean mental health score was 50.2 ± 17.1, near the population norm. Both physical and mental health components were significantly associated with socioeconomic and occupational variables (income and workplace), age, and intention to leave the hospital (all P ≤ 0.042). Gender was only important in the case of mental health (P = 0.049), and marital status did not show any significant relationship with physical health (P = 0.088) but was significant with mental health (P = 0.033). Conclusions: The study highlights suboptimal health-related quality of life among Palestinian nurses, with greater challenges in physical health compared to mental health. Findings emphasize the role of socioeconomic status, workplace environment, and career stability in shaping quality of life. Interventions targeting workplace conditions, fair compensation, and supportive policies are crucial to improve nurses’ well-being and reduce turnover intentions.
Context: Management of pediatric intussusception typically involves nonsurgical or surgical approaches. Although colonoscopy may offer therapeutic advantages, its precise role in pediatric intussusception remains uncertain. This systematic review aimed to evaluate the efficacy and safety of colonoscopy in the management of pediatric intussusception. Evidence Acquisition: A comprehensive literature search was performed in MEDLINE (via PubMed), EMBASE (via Ovid), Scopus, Web of Science, Google Scholar, ScienceDirect, the Cochrane Library, and the Trip Database, from inception to August 30, 2025. Two independent reviewers screened and selected studies involving pediatric patients (< 18 years) with intestinal intussusception who underwent colonoscopy. The search strategy included keywords and MeSH terms such as intussusception, colonoscopy, treatment, management, child, and infant. Results: A total of 121 infants and children with intestinal intussusception who underwent colonoscopy were evaluated. The overall success rate of colonoscopic reduction was 88.4% (range across studies, 66.7%–100%). Recurrence within 24 hours occurred in 11 patients (9.1%; range, 6.2%–26.7%). No colonoscopy-related complications were reported. Discussion: Colonoscopy is a safe and highly effective treatment option for pediatric intussusception, particularly in children who do not respond to reduction with saline enema.
Background: Numerous studies have examined the effectiveness of reality therapy and dialectical behavior therapy (DBT). However, direct comparisons of these approaches regarding their impact on fasting blood sugar (FBS), two-hour postprandial blood glucose (2hpp), and hemoglobin A1c (HbA1C) in women with type 2 diabetes are lacking. Objectives: The present study aimed to compare the effectiveness of reality therapy and DBT on FBS, 2hpp, and HbA1C in women with type 2 diabetes. Methods: This semi-experimental study utilized a pre-test, post-test, and two-month follow-up design with a control group. The statistical population consisted of all women with type 2 diabetes attending a specialized diabetes clinic in Shiraz in 2024. A total of 45 participants (15 in the reality therapy group, 15 in the DBT group, and 15 in the control group) were selected after applying inclusion and exclusion criteria and were randomly assigned to the three groups. The first experimental group received DBT based on Linehan's protocol (2015), and the second group received reality therapy based on E. Wubbolding's perspective (2013), both in 12 sessions of 90 minutes each. The control group received no intervention. Data were analyzed using descriptive statistics [mean ± standard deviation (SD)] and analysis of variance (ANOVA). Results: The mean ± SD FBS values in the DBT group at pre-test, post-test, and follow-up were 140.06 ± 15.72, 117.06 ± 14.39, and 120.93 ± 18.07, respectively. In the reality therapy group, these values were 134.26 ± 23.23, 116.33 ± 23.66, and 119.93 ± 21.53, respectively. For the 2hpp variable, the DBT group had values of 155.52 ± 23.28, 131.00 ± 21.25, and 131.13 ± 18.41; the reality therapy group had 145.26 ± 22.18, 112.40 ± 23.38, and 114.80 ± 23.71. For HbA1C, the DBT group reported 7.0 ± 0.55, 6.23 ± 0.61, and 6.34 ± 0.69, while the reality therapy group had 6.9 ± 0.76, 6.42 ± 0.70, and 6.35 ± 0.73. Both intervention methods significantly reduced FBS, 2hpp, and HbA1C at post-test and follow-up (P < 0.001). A significant difference was observed between the experimental groups and the control group (P < 0.001). However, the difference between the DBT and reality therapy groups was not significant at either post-test or follow-up (P > 0.05). Conclusions: Both reality therapy and DBT are effective interventions for reducing blood sugar levels in women with type 2 diabetes.
Background: Sleep is a key element in adolescent health and affects glycemic control in diabetic patients. Electronic device use and family support are contributing factors to sleep characteristics and glycemic management in type 1 diabetes (T1D) patients. Objectives: This study assessed the interaction between electronic device use, family support, sleep quality, and glycemic control in T1D adolescents. Methods: This cross-sectional study was conducted on T1D adolescents who attended the diabetes clinic at Besat Hospital, Hamadan, Iran, from February 2021 to February 2022. Valid Persian versions of the Pittsburgh Sleep Quality Index (PSQI) and Perceived Social Support from Family (PSS-Fa) Questionnaires were employed to measure sleep quality and family support. We used a self-report questionnaire to assess the time spent on TV, video games, and the Internet. Patients’ characteristics, including hemoglobin A1C (HbA1c) levels, were obtained during the follow-up sessions. Statistical analysis was performed using SPSS 21. Kruskal-Wallis and Dunn’s tests were applied to compare different sleep disorder groups in terms of quantitative variables. Spearman’s correlation test examined the association of PSS-Fa scores and quantitative variables. Results: We recruited 171 patients with a mean age of 12.48 ± 1.75 years. Nine patients (5.3%) had no/mild sleep disorder, 75 (43.9%) had moderate sleep disorder, and 87 (50.9%) had severe sleep disorder. HbA1c was not associated with sleep disorders (P-value = 0.476). Among electronic devices, only watching TV was associated with sleep disorders (P-value = 0.023). Perceived Social Support from Family scores were lower in adolescents with severe sleep disorders than no/mild (P-value = 0.026) and moderate (P-value = 0.029) sleep disorder groups. PSS-Fa scores correlated with the number of annual visits (P-value = 0.033; ρ = 0.164), the time since diabetes diagnosis (P-value = 0.003; ρ = -0.229), and the HbA1c level (P-value < 0.001; ρ = -0.271). Conclusions: A supportive family can contribute not only to better sleep outcomes but also to more desirable glycemic management in T1D adolescents. Digital devices might deteriorate sleep quality, but the pattern of this effect needs further investigation.
Background: Neonatal nurses may experience anxiety and depression, which can contribute to increased turnover rates. Although some studies have reported correlations among perceived organizational support (POS), anxiety, and depression, empirical evidence remains limited. Objectives: This study aimed to examine the relationship between POS, anxiety, and depression in neonatal nurses. Methods: In this cross-sectional study, data were collected from 306 neonatal nurses using a consecutive sampling technique in Tehran, Iran. Data were collected using online scales, including POS and the Hospital Anxiety and Depression Scales (HADSs) from December 2020 to January 2021. For data analysis, the t-test, Pearson correlation coefficients, analysis of variance (ANOVA), and multiple linear regressions were performed using Statistical Package for Social Sciences (SPSS) version 16. Results: The neonatal nurses' POS score was below 50% of the maximum possible score. More than half of the nurses reported mild to severe anxiety and depression [52.9% (n = 162); 58.2% (n = 178)]. A moderate inverse correlation was observed between anxiety and POS (R = -0.359, P < 0.001), and a slight inverse correlation was found between depression and POS (R = -0.303, P < 0.001). Analysis showed that POS was significantly correlated with age (R = 0.137; P = 0.017) and employment status (F = 5.044; P = 0.007) among neonatal nurses. Regression analysis indicated that anxiety was the only statistically significant predictor of POS (β = -0.274, P < 0.001; R² = 0.157). Conclusions: Healthcare managers play a crucial role in reducing depression, especially anxiety, by increasing POS interventions, thus leading to more effective neonatal care. Moreover, improving leadership styles and training nurses on coping methods in the face of global pandemics are highly recommended. Therefore, managers and policy-makers in this sector should adopt measures to optimize POS initiatives.
Background: As Thailand transitions into a super-aged society, promoting health care behaviors among older adults is essential to reduce the chronic disease burden and healthcare costs. Understanding the determinants of these behaviors is crucial for developing targeted interventions. Objectives: This study aimed to examine health care behaviors among older adults in Samut Songkhram Province, Thailand, and identify associated factors using the PRECEDE-PROCEED model. Methods: A cross-sectional study was conducted between February and April 2025 among 420 community-dwelling adults aged ≥ 60 years, selected through multi-stage random sampling. Potential sources of bias were minimized through randomization, standardized questionnaires, and researcher training. Descriptive statistics summarized the data, while chi-square tests, Pearson’s, and Spearman’s correlations examined associations at P < 0.05. Results: Overall, 71.7% of participants reported high health care behavior (Mean = 2.61 ± 0.27). High predisposing (75.5%), enabling (71.0%), and reinforcing (63.1%) factors were observed. Significant associations were found with education (P = 0.024), marital status (P = 0.039), and income sufficiency (P = 0.026). Access to health information, literacy, and community participation were the key associated factors. Conclusions: Older adults’ health care behaviors are shaped by personal, social, and environmental factors. Enhancing health literacy, improving resource access, and strengthening community engagement—particularly via senior clubs—are essential for promoting healthy aging in Thailand’s aging population.
Background: Intrauterine fetal death (IUFD) is a significant obstetric complication with profound medical, psychological, and social consequences. Despite advances in prenatal care, IUFD remains a pressing concern, particularly in developing regions where healthcare disparities persist. Understanding the prevalence and associated risk factors is crucial for developing preventive strategies and improving maternal-fetal outcomes. Objectives: The present study aimed to determine the prevalence of IUFD and examine its associated maternal, fetal, and obstetric factors among pregnant women admitted to the Maternity Ward of Ali Ibn Abi Talib Hospital in Zahedan, Iran, from 2015 to 2018. Methods: A cross-sectional study was conducted by reviewing 23,220 delivery records over a three-year period. Cases of IUFD were identified based on the clinical definition of fetal demise occurring after 20 weeks of gestation or with a fetal weight of at least 500 grams (500 g). A total of 500 IUFD cases were included in the final analysis. Data on maternal demographics, medical history, prenatal care, fetal complications, and placental abnormalities were collected and analyzed using IBM SPSS Statistics Version 22.0. Results: The overall prevalence of IUFD was 2.2% (500 cases out of 23,220 deliveries). The IUFD was significantly more frequent in vaginal deliveries compared to cesarean sections (P < 0.001). The majority of cases occurred in women aged 20 - 34 years (71.6%), with lower education levels associated with higher IUFD incidence (P < 0.001). Gestational age was a critical factor, with most IUFDs occurring between 27 - 34 weeks (38.0%) (P = 0.001). A history of stillbirth (P < 0.001), inadequate prenatal care (P < 0.001), and maternal comorbidities such as hypertension (28.6%) and diabetes (19.0%) were significantly associated with IUFD. Notably, umbilical cord abnormalities were present in 99.0% of cases, making them the leading contributory factor. Conclusions: The IUFD remains a significant concern, with maternal health conditions, prenatal care quality, and umbilical cord complications playing pivotal roles. Strengthening prenatal surveillance, early identification of high-risk pregnancies, and addressing modifiable maternal risk factors could substantially reduce IUFD rates. This study was limited by its retrospective design and reliance on hospital records, which may have led to incomplete documentation of key variables such as the timing and precise causes of IUFD. Inconsistent recording of pathological findings further restricted detailed etiologic analysis. Future prospective studies with standardized data collection and comprehensive pathological evaluation are recommended to better elucidate IUFD risk factors and mechanisms.
Background: As a global health issue, the need for sophisticated prediction models to support early diabetes mellitus diagnosis and treatment is growing. Deep learning (DL) models lack interpretability despite their accuracy; traditional machine learning (ML) models occasionally overlook the complex interaction among genetic, lifestyle, and biological components. Objectives: This work presents a hybrid DL framework combining deep neural networks (DNNs) and Extreme Gradient Boosting (XGBoost) to enhance explainability and predictive performance in early diabetes detection. Methods: This study retrospectively examined 1,284 anonymized patient records collected from two hospitals in Sirjan (March 2023 - 2025), comprising both diabetic and non-diabetic individuals. Glucose level, hemoglobin A1c (HbA1c), insulin resistance, Body Mass Index (BMI), blood pressure, and cholesterol were identified as the most significant predictors using recursive feature elimination (RFE). All analyses were conducted in Python 3.10 using TensorFlow 2.12 and XGBoost 2.0, executed on an NVIDIA RTX 4090 GPU environment. The F1-score, accuracy, precision, recall, positive predictive value (PPV), and negative predictive value (NPV) were applied to evaluate the hybrid model compared to logistic regression (LR), random forest (RF), support vector machine (SVM), standalone XGBoost, and DNN. Results: With an accuracy of 94%, the hybrid model (DNN+XGBoost) outperformed standalone models like XGBoost (89%) and DNN (91%) as well as LR (78%), SVM (82%), and others (P = 0.006). Precision and recall were attained at 93% and 95%, respectively. The most significant predictors identified by SHapley Additive exPlanations (SHAP) analysis were glucose (0.35) and HbA1c (0.30), validating the model's clarity and clinical usefulness. Conclusions: The proposed hybrid AI model balances high accuracy and interpretability, suggesting its potential utility for AI-assisted diabetes prediction in future clinical settings pending external validation. This model builds trust among clinicians by applying SHAP-based explainability.
Background: The transition toward Hospital 5.0 represents a major shift in healthcare, integrating advanced digital technologies with human-centered, sustainable, and resilient approaches. Despite increasing global attention to this emerging concept, a practical framework for assessing hospital readiness for such transformation remains limited. Objectives: The present study aimed to identify and prioritize key indicators influencing hospital readiness for the transition to Hospital 5.0 and to design a practical model that can guide both policymakers and hospital managers. Methods: A mixed-methods design was employed. First, a systematic review following PRISMA guidelines was conducted to identify readiness and maturity indicators from Industry 4.0 and 5.0 contexts. Based on expert input, a conceptual framework for Hospital 5.0 readiness was then developed. Finally, decision-making techniques under uncertainty [grey best-worst method (GBWM)] were applied to prioritize the main and sub-dimensions of the model. Results: The final readiness model includes four main dimensions and twenty-six sub-dimensions. The most influential dimension was technological readiness (49%), followed by human-centric organizational development (23%), resilience (16%), and sustainability (13%). Experts emphasized that while technology is the key driver, the long-term success of Hospital 5.0 depends on the development of human skills, organizational culture, and staff engagement. The designed model allows hospital managers to assess each sub-dimension separately, helping them identify operational strengths and weaknesses more effectively. It also provides a roadmap for improvement planning and resource allocation based on priority areas. Conclusions: The model designed in this study offers a comprehensive and applicable tool for assessing readiness and guiding the transition toward Hospital 5.0. Although technological investment is essential, true transformation requires balanced attention to human, resilient, and sustainable aspects. The findings can assist health authorities in shaping national strategies and help hospitals apply the model as a self-assessment and strategic planning framework for future development.
Background: Understanding psychological states related to sleep disorders often requires the use of conceptual or cognitive metaphors. Objectives: This study aims to perform a cognitive-metaphorical analysis of sleep disorders. Methods: This qualitative study employed cognitive analysis and was conducted in 2024. The study population included all patients with sleep disorders in Tehran. Given the qualitative nature of this research, and following the principle of theoretical saturation, we conducted semi-structured interviews with up to 12 patients who visited sleep clinics at Erfan and Golestan hospitals. The Praglajaz group utilized the metaphorical method to identify metaphorical expressions. Results: Through an analysis of the patients' expressions, we identified 183 metaphorical phrases. The findings revealed seven key metaphorical expressions: Feeling like a car without energy, being in an invisible place, drowning in a deep ocean, experiencing theft at night, falling into an endless abyss, feeling deprived of something, and feeling trapped in suffocating layers. Conclusions: This study highlights the importance of conceptual metaphors in expressing, identifying, and understanding the psychological states associated with sleep disorders. By identifying various metaphors related to sleep disorders, we can explore different avenues for treatment.
Context: Intimate partner violence (IPV) remains a significant public health issue. In India, IPV is a major problem resulting in various physical, mental, emotional, social, economic, and familial issues. Objectives: This study aimed to estimate the prevalence rate of IPV across all Indian states during 2005, 2015, and 2020. Additionally, the study assessed sociodemographic factors, including the economic empowerment of IPV victims aged 15 to 49 years. Evidence Acquisition: This quantitative study utilized secondary data from the national family health surveys (NFHS) conducted during 2005 - 2006 (NFHS-3), 2015 - 2016 (NFHS-4), and 2019 - 2021 (NFHS-5). Data were collected using a pretested questionnaire with face-to-face interviews across India. Exposure to emotional, physical, and sexual violence was considered under IPV. Factors such as age, residential area, education status, religion, economic status, current working status, and employment seasonality were considered. NFHS-3 included 124,385 women, NFHS-4 included 351,625 women, and NFHS-5 included 63,851 women. Bivariate and binary logistic regression analyses were implemented with P < 0.05. Results: The prevalence of violence varied across Indian states, with Karnataka showing consistently increasing rates, while Tripura experienced consistently decreasing rates of all three types of violence. In 2021, the prevalence of emotional violence was 12.5%, physical violence 27%, and sexual violence 5.5% in India. A decreasing trend was observed, as in 2005, emotional violence was 14%, physical violence 31%, and sexual violence 8%. In 2021, 9%, 18%, and 5% of women under 19 experienced emotional, physical, and sexual violence, respectively, while 14%, 29%, and 6% of women aged 45 - 49 experienced the same (P < 0.001). Education plays a crucial role, as women with no education exhibit higher rates of violence. Compared to higher-educated women, those with no education in India during 2021 were more likely to experience emotional (OR = 1.93, 95% confidence interval [CI]: 1.61 - 2.31), physical (OR = 2.29, 95% CI: 1.99 - 2.63), and sexual violence (OR = 1.75, 95% CI: 1.34 - 2.28), while during 2005, it was emotional (OR = 2.62, 95% CI: 2.16 - 3.18), physical (OR = 3.74, 95% CI: 3.20 - 4.37), and sexual violence (OR = 2.32, 95% CI: 1.75 - 3.08) with P < 0.001. Additionally, religion and economic status are influential factors, with significant variations observed over the years. The study reveals that education, religion, economic status, and employment status significantly influence the likelihood of experiencing emotional, physical, or sexual violence. Conclusions: The study underscores the need for a multidimensional approach to address IPV in India, considering cultural, political, legal, and economic factors. The findings call for increased community awareness, especially within the medical system, to promote early detection and intervention in cases of IPV.
Background: There are many reports about incomplete ligation of veins and inadvertent injury to the spermatic artery and lymphatic vessels during varicocelectomy, regardless of the surgical approach or advanced devices utilized. Objectives: Given that varicocelectomy risks arterial injury and vascular spasm, which compromise surgical success, this study aims to evaluate papaverine and hydrodissection as a means to enhance vessel exposure and ultimately improve sperm parameters. Methods: A randomized clinical trial was performed from April to July 2023 at Shahid Beheshti Specialty Hospital and Ofogh Clinic in Hamadan, Iran. Using convenience sampling, 114 patients eligible for varicocelectomy were recruited and randomized into three groups (A, B, and C) through a block randomization method with an equal allocation ratio (1:1:1). Group A underwent varicocelectomy only, Group B was administered papaverine, and Group C received papaverine combined with hydrodissection. The primary outcomes — sperm parameters and arterial preservation — were evaluated three months after surgery, whereas the secondary outcomes, namely operating time and surgical difficulty, were also assessed. Statistical analysis was performed using SPSS version 16, applying ANOVA, chi-square, Fisher’s exact test, and linear regression. Results: Three months after surgery, the mean score of motile sperm in the hydrodissection plus papaverine group was significantly higher compared to the other groups [69.34 (60.00) vs 62.70 (5.39) and 54.77 (14.48), P < 0.001]. Also, the three groups showed significant differences in the mean count of sperm. The highest count of sperm was observed in the papaverine plus hydrodissection group. This difference was statistically significant [65.96 (56.20) vs 39.25 (30.52) and 26.83 (21.65), P = 0.0001]. No significant difference was observed between the groups (P = 0.07) regarding sperm morphology. The mean arterial pressure in the papaverine plus hydrodissection group was superior to the other groups [0.59 (0.04) vs 0.46 (0.14) and 0.50 (0.02), P < 0.001). Conclusions: Papaverine plus hydrodissection provides benefits for semen parameters and preservation of the artery; this method is superior to the standard varicocelectomy procedure and allows for easier differentiation of vessels from each other.
