Context: Sex hormones play a vital role in reproductive health and influence muscle function and metabolism. Exercise affects these hormones by raising testosterone levels and improving metabolic markers. However, the impact of team sports on female sex hormone levels remains understudied. Objectives: This review aims to systematically examine how sports like soccer, volleyball, basketball, and handball influence female sex hormone levels. Evidence Acquisition: This systematic review was conducted without any restrictions on language, publication date, or study type, based on the guidelines for systematic reviews and meta-analyses [preferred reporting items for systematic reviews and meta-analyses (PRISMA)] on Google Scholar, PubMed (MEDLINE), Scopus, Embase, and Web of Science databases on June 22, 2024. The search strategy utilized a combination of keywords and their synonyms from MeSH and Emtree-controlled vocabulary, including "Sex Hormone", "testosterone", "cortisol", "team sport", and "women." Results: Among the 690 articles identified, 11 were selected and used based on the inclusion criteria. Studies have shown that football, netball, volleyball, and handball have varying effects on testosterone and cortisol levels in athletes. Football generally increases both hormone levels, whereas netball often raises cortisol and lowers the testosterone-to-cortisol ratio. Volleyball tends to increase testosterone significantly, though with fluctuating trends, whereas handball mainly raises cortisol without a significant change in testosterone levels. Conclusions: Despite the limitations of the included studies, such as sample size, study design, data collection standards, reporting practices, and potential biases, this systematic review indicated that playing team sports like football, basketball (netball), volleyball, and handball can alter testosterone and cortisol levels in females. However, further research is needed to fully understand these hormonal changes' effects.
Context: Cervical cancer (CC) is a significant global health issue primarily associated with human papillomavirus (HPV) infection. While most HPV infections resolve spontaneously, persistent infections can lead to chronic inflammation and the development of precancerous lesions. High-risk HPV types, particularly HPV-16 and HPV-18, are notably linked to the majority of CC cases, establishing a clear causal relationship between HPV infection and CC through extensive epidemiological studies. Evidence Acquisition: The databases of PubMed, Scopus, Web of Science, and Google Scholar were utilized for the search. Papers without a time limit until 2024 were included, encompassing clinical studies, review articles, systematic reviews, and meta-analyses. The following keywords were systematically employed to identify relevant publications for this comprehensive review: "HPV", "pathogenesis", "immune response", "immune evasion", "cervical cancer", "diagnostic methods", "prevention", and "treatment". Results: The study reveals that while most HPV infections are transient, persistent infections significantly elevate the risk of developing CC over time. Screening methods such as Pap smears and HPV vaccination are crucial for early detection and prevention. The incorporation of sensitive biomarkers for early-stage detection is essential for effective management of CC. Conclusions: Cervical cancer is largely preventable, highlighting the need for increased awareness and access to vaccination and screening programs to reduce incidence and mortality rates globally. Ongoing research into HPV's pathogenicity is vital for developing targeted prevention strategies against CC.
Background: Evidence on the safety and efficacy of phosphate (P) replacement in hypophosphatemic intensive care unit (ICU) patients remains limited. Objectives: To evaluate the efficacy and safety of a 24-hour weight-based intravenous phosphate replacement protocol. Methods: Adult ICU patients with hypophosphatemia received potassium acid phosphate (25 mL) diluted in 500 mL of saline or 5% glucose, administered via infusion pump. Dosing was 0.3 mmol/kg/24 h for mild hypophosphatemia (0.65 - 0.73 mmol/L) and 0.6 mmol/kg/24 h for moderate to severe cases (≤ 0.64 mmol/L). Phosphate levels were measured every 24 hours. Efficacy was defined as normalization of phosphate within 24 hours. Safety outcomes included hypocalcemia, hypotension, hyperphosphatemia, hyperkalemia, and acute kidney injury. Results: Among 134 patients (aged 67.6 ± 14.6 years; 55% female; median APACHE II median 18), 197 hypophosphatemia episodes were treated. Phosphate normalized within 24 hours in 121 episodes (61%). Mild adverse events occurred in 28 patients (21%); no severe complications were reported. Conclusions: This protocol is not a replacement for standard guidelines in symptomatic hypophosphatemia and unstable patients. It proved effective and generally safe in critically ill patients with mild to severe hypophosphatemia, offering a feasible approach in resource-limited ICU settings where oral formulations are unavailable and frequent laboratory monitoring is unfeasible.
Background: Mothers of children with type 1 diabetes often experience significant stress and anger. Spirituality is a promising source of support and an important dimension of self-care. Objectives: To determine the effect of spirituality-based self-care on the stress and anger of mothers of children with type 1 diabetes. Methods: A clinical trial was conducted in 2024 at the Diabetes Center of Imam Reza (AS) Specialized Clinic in Zabol, Iran. Seventy mothers were randomly assigned to experimental (n = 35) and control (n = 35) groups. Data collection tools included a demographic questionnaire, the Parenting Stress Index, and the Spielberger Anger Expression Scale. The experimental group received a spirituality-based self-care training package over six sessions, while the control group received routine care. Stress and anger levels were measured before the intervention and three months afterward. Data were analyzed using chi-Square, or Fisher's Exact test, and independent t-tests via IBM SPSS version 23. Results: There was no significant difference in pre-test stress scores between groups (P = 0.220). Post-intervention stress scores also showed no significant difference (102.25 ± 6.22 vs. 99.25 ± 8.77; P = 0.104). Pre-test anger scores were not significantly different (P = 0.880); however, post-intervention anger scores differed significantly between groups (121.28 ± 5.97 vs. 134.20 ± 7.05; P < 0.001). Conclusions: Spirituality-based self-care interventions can effectively reduce anger in mothers of children with type 1 diabetes. Integrating such training into nursing practice is recommended. However, this intervention alone was insufficient to reduce stress, indicating the need for additional support strategies.
Background: Migraine, a chronic neurological disorder, significantly impacts women's quality of life through psychological distress. Acceptance and commitment therapy (ACT) enhances distress tolerance and cognitive flexibility by promoting acceptance and value-driven action. Compassion-focused therapy (CFT) fosters self-compassion, reducing self-criticism to alleviate distress and support cognitive flexibility. Objectives: The objective of this study was to compare the effectiveness of ACT and CFT in enhancing distress tolerance and cognitive flexibility in women with migraine. Methods: This quasi-experimental study employed a pre-test-post-test design with a 3-month follow-up and a control group. The statistical population included women diagnosed with migraine in Ahvaz, Iran, in 2023. A sample of 108 participants was selected via convenience sampling from patients attending the Labkhande Zendegi Counseling Center and randomly assigned to three groups (ACT, CFT, and waitlist control; n = 36 per group) using computer-generated random numbers. The experimental groups received 8 weekly 90-minute sessions of either ACT or CFT, while the control group remained on a waitlist. Data were collected using the Distress Tolerance Scale (DTS) and Cognitive Flexibility Inventory (CFI) and analyzed using repeated measures analysis of variance with a significance level of 0.05. Results: Both ACT and CFT significantly improved distress tolerance (ACT: From 29.70 ± 4.13 to 50.40 ± 4.72; CFT: From 30.00 ± 3.99 to 49.35 ± 4.25) and cognitive flexibility (ACT: From 46.06 ± 5.28 to 78.12 ± 5.88; CFT: From 46.60 ± 4.92 to 68.00 ± 5.43) compared to the control group (P < 0.001), with effects maintained at follow-up. The ACT showed a significantly greater improvement in cognitive flexibility compared to CFT (mean difference: 10.12, P < 0.001), but no significant difference was observed for distress tolerance (P = 0.325). Conclusions: The findings indicate that both ACT and CFT are effective in improving distress tolerance and cognitive flexibility in women with migraine, with ACT showing a relative advantage in enhancing cognitive flexibility. These results suggest that clinicians can select either approach based on patient needs, potentially improving psychological management of migraine-related distress.
Background: The flipped classroom is a learner-centered teaching strategy that has gained increasing attention in recent years for promoting active and collaborative learning. Evaluating such educational methods is essential, and several frameworks exist for this purpose. Among them, Kirkpatrick’s model was selected in this study due to its applicability to educational settings. Objectives: This study aimed to evaluate the effectiveness of the flipped classroom in a master’s nursing research course by assessing both student learning outcomes and reactions, based on the first two levels of Kirkpatrick’s evaluation model. Methods: This quasi-experimental study with a pretest-posttest control group design was conducted among all first-semester master's-level nursing students, 24 people enrolled in the research course at Birjand University of Medical Sciences. Due to time constraints and the limited target population, census sampling was used, and all eligible students were included. In an initial session, study objectives were explained, informed consent was obtained, and a pre-test was administered. Students were randomly assigned to either the intervention or control group. The intervention group received three flipped classroom sessions (two hours weekly), with pre-session e-learning materials. The control group received traditional lectures. Student reactions and learning outcomes were assessed through a Researcher-designed Questionnaire and pre-post-tests. Data were analyzed using independent t-tests and paired t-tests via SPSS version 24. Results: The satisfaction scores (reaction level) were measured at the end of each session. The results indicated a consistent increase in satisfaction, with the mean total reaction score rising from 48.80 in the first session to 51.10 in the second and 51.20 in the third session. Regarding learning outcomes, the mean post-test score in the intervention group (12.5 ± 1.95) was significantly higher than that of the control group (7.66 ± 3.11; P = 0.001). In addition, within-group analysis showed a significant improvement from pre-test to post-test in both groups, with a greater increase in the intervention group. Conclusions: The flipped classroom method enhanced student satisfaction and learning in the nursing research course, supporting its use as an effective teaching strategy in advanced nursing education.
Background: This prospective registry-based cross-sectional study of 500 percutaneous coronary intervention (PCI) patients assessed lesion morphology, clinical and procedural determinants of coronary bifurcation complexity, and the utility of machine learning (ML) for lesion stratification. Objectives: Characterize bifurcation lesion classes (0: No bifurcation; 1: Simple; 2: Complex), identify key demographic, anatomical, and procedural predictors of complexity, and evaluate interpretable ML models for accurate classification. Methods: We analyzed patient demographics, comorbidities, angiographic features (e.g., side-branch stenosis, bifurcation angle, calcification), and procedural outcomes, selecting ten critical complexity drivers. Four ML approaches — k-nearest neighbors (KNN), support vector machines (SVM), ensemble trees, and probabilistic classifiers — were optimized via hyperparameter tuning and feature-selection methods, with SHapley Additive exPlanations (SHAP) values quantifying feature importance. Results: The SHAP analysis identified side-branch stenosis, heavy calcification, and dual-stent technique as top predictors. Weighted KNN and medium-scale SVM achieved 89 - 92% accuracy, while ensemble models peaked at 97.8% using 10 - 15 features. Complex lesions (class 2) required dual-stent deployment more often (35% vs. 10%) and had lower post-PCI TIMI 3 flow (85% vs. 92%). Wrapper-based feature selection outperformed filter and embedded methods, reaching 96.8% accuracy. Conclusions: Integrating anatomical metrics, patient risk factors, and interpretable ML significantly improves PCI decision-making for bifurcation lesions, outperforming traditional systems and enabling personalized interventional strategies to optimize outcomes and resource allocation.
Background: Spirituality and coping strategies employed by an individual in their life are two significant factors in determining the quality of life (QoL). Objectives: The present research aimed to investigate the correlation between religious attitudes and QoL among medical students at Abadan University of Medical Sciences. Methods: The present research is a cross-sectional, descriptive-analytical study was conducted in 2023 - 2024 with the participation of 462 students from 11 different fields of study at Abadan University of Medical Sciences. Stratified sampling was employed, and the research instruments consisted of a demographic, questionnaire, the quality-of-Life Questionnaire, and the Religious Attitude Scale. Data analysis was performed using descriptive statistics, the independent t-test, and ANOVA and Pearson correlation test with SPSS 21 at a significance level of 0.05. Results: The mean total score of QoL was 90.66 ± 16.02, and the mean score of religious attitudes was 135.86 ± 37.26. There was no statistically significant difference in the mean scores of QoL and religious attitudes among students from different fields of studying order (P = 0.143, P = 0.791). The results revealed a significant correlation between the total scores of QoL and religious attitudes (P < 0.001, r = -0.431). Conclusions: The results of this study showed that religious attitude and QoL are two concepts that are correlated with each other. Given the impact of religious attitudes on QoL and the decline in scores for both variables in higher semesters and older age groups, the need to strengthen the religious dimension among students through developing cultural programs and providing necessary infrastructure in universities seems evident.
Background: Education is effective in improving the quality of life of patients, and needs assessment is an important factor in effective education. Objectives: This study aimed to assess the educational needs of cardiac patients referred to the cardiac rehabilitation (CR) department. Methods: The list of educational topics required by cardiac patients was determined using the fish bowl technique. In the next step, the checklist was completed by patients and healthcare providers based on the five-point Likert scale. Results: The mean score of “The role of a healthy diet in the prevention and management of heart disease” was 3.79 ± 0.37 for patients and 4.65 ± 0.56 for healthcare providers. Conclusions: The results of the study show that educational needs are different from the perspectives of patients and healthcare providers. Therefore, in addition to paying attention to the priorities expressed by patients, it is essential to design and implement necessary interventions to increase patients' perceived sensitivity to other educational topics.
Introduction: Cerebral palsy (CP) is a neuromotor disorder that affects growth, movement, muscle tone, and body posture. Children with this condition face significant limitations in daily life activities and movement ability. These limitations necessitate the need for long-term care. The purpose of this study was to apply Kolcaba's comfort theory in caring for a child with CP. Case Presentation: This case study investigated the application of Kolcaba's comfort theory in the nursing care of a 26-month-old boy with CP admitted to Ali Ibn Abi Talib Hospital in Rafsanjan, southeast Iran. He was admitted due to fever, respiratory distress, and decreased consciousness. His growth indicators were below normal (weight: 7200 g, height: 69 cm), and he had a history of multiple surgeries, including colostomy and developmental dysplasia of the hip repair. He required continuous care due to limited mobility, limb spasms, and developmental delays. In healthcare, comfort is central to patients’ experiences and serves as a primary goal of practice. Enhanced comfort is a positive, affirmative, and desired health outcome. Based on the data, eight nursing diagnoses were made in four experimental fields (physical, psychological, social-cultural, and environmental) and three dimensions of comfort (relief, ease, and transcendence). Nursing care was implemented and evaluated for the child and mother based on Kolcaba's comfort theory. Conclusions: According to the results, nursing care based on Kolcaba's comfort theory is recommended for application in children's departments to increase the level of comfort for the child and the family.
Background: Congenital anomalies (CAs) significantly contribute to neonatal mortality and long-term disabilities. The present study aimed to assess the prevalence of major CAs among live births in Birjand, Iran. Objectives: This study assessed the prevalence of major congenital anomalies among live births in Birjand, Iran. Methods: A cross-sectional analysis was conducted on 45,281 neonates from 2018 to 2022 using census sampling. Each neonate underwent a clinical examination, and data were collected using a researcher-designed checklist. Statistical analysis was performed using SPSS version 22, with significance set at P < 0.05. Results: Out of 65 cases, the most common anomalies were cardiovascular, gastrointestinal, and central nervous system anomalies, with 18, 16, and 15 cases, respectively. No significant association was found between the presence of anomalies and neonatal gender (P = 0.28), maternal nationality (P = 0.35), maternal age (P = 0.39), gestational age (P = 0.08), or birth season (P = 0.09). Conclusions: A significant association was found with maternal residence (P < 0.001), with rural mothers having a higher rate of anomalies (0.38%) compared to urban mothers (0.10%). The prevalence of CAs was 14.3 per 10,000 live births, which is lower than in other regions of Iran.
Background: Mothers caring for children with cancer experience sustained psychological distress and considerable emotional strain, making resilience a crucial determinant of their mental health. Objectives: This study aimed to evaluate and compare the effectiveness of compassion-focused therapy (CFT) and mindfulness-based cognitive therapy (MBCT) in enhancing resilience among mothers of pediatric cancer patients. Methods: A randomized clinical trial was conducted using a pretest–posttest design with a three-month follow-up. Participants were mothers of children receiving cancer treatment at Mofid Hospital in Tehran during 2024 - 2025. Forty-five eligible mothers were purposively recruited and randomly assigned to three groups (n = 15 per group): The CFT intervention, MBCT intervention, and a control group receiving no treatment. Each intervention consisted of eight weekly sessions over two months. Resilience was assessed using the Connor-Davidson Resilience Scale (CD-RISC). Data were analyzed using repeated-measures ANOVA in SPSS version 26. Results: Both CFT and MBCT interventions led to significant improvements in total resilience scores compared to the control group (P < 0.001), with MBCT demonstrating greater efficacy than CFT (P < 0.001). Subscale analyses — including personal competence, trust in instincts and tolerance of negative affect, positive acceptance of change and secure relationships, control, and spiritual influences — showed more pronounced improvements with MBCT in most domains. No significant differences were observed between posttest and follow-up, indicating that the benefits were sustained over time. Conclusions: These findings underscore the value of integrating third-wave psychotherapies into supportive care programs for mothers facing pediatric oncology challenges. Clinicians are encouraged to prioritize MBCT for optimal resilience enhancement, while employing CFT adjunctively to address self-criticism. Such strategies may foster enduring emotional resilience and family stability within this high-risk population.
Introduction: Bronchogenic cysts are congenital cystic lesions that arise due to abnormalities during the embryonic development of the tracheobronchial tree. When located in close proximity to the trachea, they may lead to significant respiratory symptoms. Case Presentation: A 21-year-old female patient presented with persistent cough and intermittent dyspnea. Thoracic imaging revealed a cystic lesion measuring 3.8 × 5.8 × 4.4 cm located in the right paratracheal region. During uniportal video-assisted thoracoscopic surgery (u-VATS), a tracheal rupture occurred while dissecting the lesion. The tracheal injury was successfully repaired with primary suturing without conversion to open surgery, and the cyst was completely excised. Histopathological examination confirmed the diagnosis of a bronchogenic cyst. The patient was discharged uneventfully on the third postoperative day. Conclusions: The u-VATS is a safe and effective approach for the surgical management of bronchogenic cysts, offering advantages not only in diagnosis and treatment but also in the management of intraoperative complications. This case highlights the feasibility and novelty of managing intraoperative tracheal injury using the u-VATS approach, which offers a less invasive yet effective alternative in thoracic surgical emergencies.
Background: Adolescent self-harm is an escalating public health issue, frequently associated with challenges in personality organization and exposure to cyberbullying. Objectives: This study examines the direct and indirect relationships among personality organization, cyber-victimization, and self-harm behaviors in adolescents, emphasizing the mediating role of emotion regulation difficulties. Methods: Utilizing a descriptive correlational design, we employed multi-stage cluster random sampling to recruit 356 adolescents (65.17% female, 34.83% male) from Tehran in 2024. Data were gathered using validated instruments: The Self-harm Behavior Questionnaire, Personality Organization Questionnaire, Difficulties in Emotion Regulation Scale-Short Form, and Cyber-victimization Scale. Structural equation modeling (SEM) was performed using AMOS software to explore variable relationships. Results: The results indicated significant positive associations between personality organization (primitive psychological defenses: 24.76 ± 6.33; identity diffusion: 22.92 ± 5.14; reality testing: 40.46 ± 9.79, cyberbullying (cyber aggression: 15.41 ± 4.10); cyber victimization: 16.96 ± 4.18, and self-harm behaviors: 6.06 ± 1.88 (all P < 0.001). Emotion regulation difficulties (e.g., lack of clarity: 6.77 ± 2.49); non-acceptance: 9.41 ± 2.92 significantly mediated the relationships between personality organization, cyberbullying, and self-harm (P < 0.001). Conclusions: These findings highlight that compromised personality organization and cyber-victimization are strong predictors of self-harm, with emotion regulation difficulties acting as a crucial mediator. Interventions focused on enhancing emotion regulation skills may reduce the risk of self-harm in adolescents, presenting a promising strategy for prevention and support.
Background: Health education centers are highly exposed to a range of medical errors due to the presence of students who are learning. Objectives: This study aimed to assess the frequency of medical errors and their reporting barriers among operating room students at Birjand University of Medical Sciences in 2024. Methods: This descriptive-sectional study was conducted on 71 operating room students who completed their fourth semester at Birjand University of Medical Sciences in 2024. Students were selected by the census method. The questionnaire used included three sections: "Demographic information", "Frequency of medical errors", and "Barriers to reporting medical errors". Data analysis was done using SPSS 26 and descriptive statistics. Results: The frequency of errors among the studied students was evaluated. The most common medical errors were related to retained foreign bodies in the surgical site (3.00 ± 1.014), incorrect counting of surgical sponges (2.96 ± 0.992), and failure to identify the correct patient (2.94 ± 0.954). The most common reasons for not reporting errors were "some nursing errors are not important to report" (3.37 ± 1.174), "forgetting to report errors" (3.31 ± 1.178), and "nursing errors have no specific definition" (3.17 ± 1.207). Conclusions: Error reporting effectively identifies and prevents errors because it helps identify them, especially frequent errors and errors of high importance. Therefore, an effective reporting system in operating rooms and the removal of barriers are necessary
Background: The relatively high prevalence of preterm infants (10%) often necessitates long hospitalizations and stays in intensive care units. In this regard, probiotics have been suggested to reduce associated risks. Objectives: This study aimed to compare the effect of two types of probiotics in Iran with a placebo on reducing morbidity and improving health outcomes in preterm infants. Methods: In this randomized controlled trial (RCT), 98 preterm infants were admitted with a gestational age of ≤ 37 weeks and weighing 1000 - 2000 g. Neonates were randomly divided into two intervention groups and one placebo group. Each neonate received 5 drops of the assigned treatment daily. The studied variables included demographic characteristics of the mother and neonate, feeding start time, time to reach full enteral feeding, the incidence of necrotizing enterocolitis (NEC), jaundice (icterus), duration of hospitalization, and daily weight gain. Results: The mean days for oxygen therapy and phototherapy in the group receiving probiotics were significantly reduced compared to the placebo group. The highest weight gain was observed in the group receiving Pedilact, which was also more remarkable than the Reuteflor group. However, the incidence of jaundice, NEC, and mortality, time to reach full enteral feeding, and mean days of hospitalization in the study groups were not statistically significant (significance level α = 0.05). Conclusions: Results showed that probiotics can be effective in improving health outcomes such as weight gain, enhancing the intestinal function of hospitalized preterm infants, and reducing the required time for oxygen therapy and phototherapy in preterm infants.
Background: Depression, anxiety, and stress are common issues observed among patients undergoing hemodialysis. Objectives: The present study was conducted to determine the effect of foot reflexology massage on stress, anxiety, depression, and serum cortisol levels among hemodialysis patients. Methods: A double-blind randomized controlled trial was conducted on 57 patients undergoing hemodialysis. The patients were randomly assigned to either a control group or an experimental group. The Depression Anxiety Stress Scale (DASS-21) was used to measure stress, anxiety, and depression in the sessions before and after the intervention. Serum cortisol levels were also measured between 7:30 and 8:00 a.m. before and after the intervention. Foot reflexology and simple foot massage were performed three times per week for four weeks, with each session lasting 15 minutes for each foot rotationally in the intervention and control groups, respectively. Results: There was no significant difference between the intervention group and the control group in terms of the mean scores of cortisol, stress, anxiety, or depression before the intervention. However, the differences in the mean scores of stress (P < 0.0001), anxiety (P = 0.01), depression (P < 0.0001), and cortisol (P < 0.0001) in the intervention group significantly decreased compared to those in the control group. Conclusions: This study showed that foot reflexology can reduce cortisol levels, stress, anxiety, and depression among hemodialysis patients.
Background: Postoperative mobilization is a crucial aspect of nursing care, and delays in mobilization can lead to numerous adverse outcomes. Objectives: This study aimed to investigate the effect of the initial mobilization time following laparoscopic cholecystectomy on patient pain and bowel motility. Methods: This cross-sectional and descriptive study was conducted with 94 patients scheduled for elective laparoscopic cholecystectomy at the general surgery clinic of a university hospital between November 2022 and March 2023, who met the research criteria. Data were collected using the personal information form and the Visual Pain Scale. A P-value of < 0.05 was considered statistically significant. Results: A sustainable, moderately significant relationship was found between the initial mobilization time after surgery and the first gas discharge and first defecation status (r = 0.502, P < 0.00; r = 0.503, P < 0.05, respectively). As the mobilization time decreased, the times for first gas discharge and defecation also decreased. Additionally, a moderately significant statistical relationship was observed between the initial mobilization time after surgery and pain levels at the 8th and 24th hours, as well as the number of analgesics used (r = 0.510, P < 0.05; r = 0.502, P < 0.00; r = 0.574, P < 0.05, respectively). As the mobilization time decreased, both the pain level and the amount of analgesics used decreased. Conclusions: The study determined that the initial mobilization time of participants after surgery positively affected bowel motility, reduced pain, and decreased the amount of analgesics used.
