Background: Given the nature of critical care settings, nurses working in intensive care units (ICUs) experience high levels of stress, anxiety, depression, and moral distress. Objectives: This study investigated the mediating role of self-compassion in the relationship between moral distress and mental health symptoms among ICU nurses. Methods: In this cross-sectional descriptive-analytical study using structural equation modeling (SEM), 220 ICU nurses from hospitals affiliated with Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran, were selected through stratified random sampling with proportional allocation and were studied between April and September 2025. Data were collected during on-site visits using a demographic form and validated self-report questionnaires: the Short Form of the Self-Compassion Scale (SCS-SF), the Moral Distress Scale-Revised (MDS-R), and the 21-item Depression, Anxiety, and Stress Scale (DASS-21). Data were analyzed using SPSS version 24 and LISREL version 8.8. Results: Among ICU nurses, scores for depression (7.60 ± 7.84), anxiety (8.11 ± 6.66), and stress (13.42 ± 7.03) were within the normal-to-mild range. Moral distress was substantial (90.14 ± 61.32), whereas self-compassion was moderate (37.26 ± 7.46). Mental health symptoms were positively correlated with moral distress and negatively correlated with self-compassion (r = -0.456 to 0.604; all P < 0.001). Self-compassion significantly mediated the association between moral distress and anxiety (standardized indirect effect = 0.18; 95% CI, 0.12 to 0.24); however, its mediating role was not statistically significant for depression (95% CI, -0.05 to 0.10) or stress (95% CI, -0.04 to 0.13). Conclusions: Moral distress is positively associated with mental health symptoms among ICU nurses. Self-compassion significantly mediates the association between moral distress and anxiety, but not the associations between moral distress and depression or stress. These findings support targeted self-compassion interventions for anxiety, along with organizational strategies. Longitudinal studies are needed to confirm directionality.
Context: Chronic diseases such as diabetes, cardiovascular conditions, cancers, and respiratory illnesses remain leading causes of global mortality, especially among high-risk groups including the elderly, patients with underlying conditions, and socially disadvantaged populations. Early screening and tailored management strategies are essential to reduce disease burden and improve outcomes. Methods: This systematic review and meta-analysis was conducted in line with PRISMA 2020 guidelines and registered in PROSPERO (CRD42025234789). Comprehensive searches were performed across seven databases (PubMed, Scopus, Web of Science, Embase, Cochrane Library, Google Scholar, and medRxiv) up to October 25, 2025. Of 18 eligible studies, 10 contributed complete data for meta-analysis. Statistical analyses were performed using the DerSimonian and Laird random-effects model in R (version 4.3.1). Pooled sensitivity, specificity, AUC, diagnostic odds ratio (DOR), and likelihood ratios (LR+ and LR-) were calculated. Subgroup analyses were conducted by biomarker type, platform, sample type, and disease stage. Study quality and risk of bias were assessed using QUADAS-2, the recommended tool for diagnostic accuracy studies. Results: A total of 18 studies met inclusion criteria, of which 10 contributed complete data for meta-analysis. The pooled sensitivity was 0.86 (95% CI: 0.82 - 0.89; n = 10 studies, 9,840 participants), specificity was 0.88 (95% CI: 0.84 - 0.91; n = 10 studies, 9,840 participants), and AUC was 0.90 (95% CI: 0.87 - 0.93; n = 9 studies, 8,950 participants). DOR and likelihood ratios confirmed strong diagnostic performance. Subgroup analyses showed that miRNA biomarkers outperformed lncRNA and circRNA, while electrochemical platforms demonstrated higher accuracy compared to optical and nanotechnology-based systems. Serum samples and early-stage screening yielded higher diagnostic validity. Moderate heterogeneity was observed (I² = 47 - 59%). Publication bias was detected for specificity but had limited impact after adjustment. Conclusions: Emerging screening technologies — particularly RNA biomarkers and artificial intelligence algorithms — demonstrate high diagnostic accuracy for chronic diseases in high-risk populations. These findings support the integration of advanced screening tools into health programs, resource allocation, and evidence-based policymaking.
Background: Breast cancer profoundly affects patients' psychological health. Research suggests that spiritual practices and social support networks can play a crucial role in mitigating the challenges associated with chronic diseases. Objectives: This study examined the relationships between daily spiritual experiences, perceived social support, and psychological distress (specifically stress, anxiety, and depression) in breast cancer patients receiving treatment at the chemotherapy clinic of Khatam Al-Anbiya Hospital in Zahedan during 2024 - 2025. Methods: In this cross-sectional correlational study, 100 eligible breast cancer patients were selected using convenience sampling from a chemotherapy clinic. Participants completed four instruments: The Depression, Anxiety, and Stress Scale (DASS-21), the Daily Spiritual Experiences Scale (DSES), the Multidimensional Scale of Perceived Social Support (MSPSS), and a demographic form. Data were analyzed using SPSS Statistics (version 24). Descriptive statistics summarized the sample. Spearman’s rank-order correlation coefficients (rₛ) were computed to assess relationships between key variables, with statistical significance set at P < 0.05. Results: Analysis revealed mean scores of 46.24 ± 4.72 for spiritual experiences, 36.14 ± 11.21 for social support, and 42.26 ± 8.38 for psychological distress. A strong negative correlation emerged between social support and psychological distress (rₛ = -0.65, P < 0.001), indicating that higher perceived social support was associated with lower distress. However, no statistically significant relationship was found between daily spiritual experiences and psychological distress (rₛ = 0.09, P = 0.390). Analysis revealed average scores of 46.24 ± 4.72 for spiritual experiences, 36.14 ± 11.21 for social support, and 42.26 ± 8.38 for psychological distress. A significant negative correlation emerged between social support and stress levels, indicating that reduced social support corresponded with increased stress (P = 0.00). However, no statistically significant relationship was found between spiritual experiences and stress levels (P = 0.39). Conclusions: The development and enhancement of social support networks for breast cancer patients represent a valuable approach for distress reduction, potentially facilitating improved adaptation and coping throughout the treatment process.
Background: Sleep problems are among the most common disorders in children with autism, and music therapy has been proposed as a complementary intervention to improve sleep in this population. Objective: Therefore, this study aimed to determine the effect of music therapy on sleep quality in children aged 4 - 12 years referred to autism centers in Lahore, Pakistan. Methods: This quasi-experimental study was conducted on 80 children aged 4 - 12 years with autism who were referred to autism centers in Lahore, Pakistan, in 2026. Samples were selected using a convenience sampling method and randomly assigned to the intervention and control groups through lottery-based allocation. In the intervention group, three pieces of music were played each night for 20 consecutive nights, 30 minutes before bedtime. Data were collected in both groups before and after the intervention using the Children’s Sleep Habits Questionnaire developed by Owens and Spirito (2000). Data analysis was performed using descriptive and inferential statistics with SPSS software version 26. Results: Sleep quality in the intervention group significantly improved in the post-test after the intervention (P < 0.05). However, no significant change in sleep quality was observed in the control group (P > 0.05). Conclusion: Music therapy is an effective, non-pharmacological method for improving sleep quality in children with autism spectrum disorder and may help enhance their sleep and mental health by increasing relaxation and reducing anxiety.
Background: Prior to implementing behavioral strategies, it is crucial to recognize the key obstacles that interfere with consistent engagement in physical activity by individuals diagnosed with coronary artery disease. In Iran, there is no reliable and valid clinical tool for assessing barriers that prevent physical activity in coronary artery disease patients. Objectives: The objective of the current study was to adapt and validate the Physical Activity Barriers Questionnaire for assessing perceived challenges to routine physical activity among coronary artery disease patients, thereby guiding upcoming interventions and tailoring effective clinical follow-up strategies for secondary prevention. Methods: A cross-sectional design with a psychometric approach was employed for this research. All individuals diagnosed with coronary artery disease in Ahvaz city constituted the study's statistical population. They were chosen through convenience sampling in 1403 and completed the Persian adaptation of the Physical Activity Barriers Questionnaire, the Social Support Perception Questionnaire, the DASS-21 scale, and the Cardiac Self-efficacy Questionnaire. The construct validity of the Physical Activity Barriers Questionnaire was established through confirmatory factor analysis as well as convergent and divergent validity testing. The reliability evaluation of the questionnaire included Cronbach’s alpha coefficient. Data analyses were performed using SPSS 27 and Lisrel 10. Results: The study included 242 participants (51.2% female, mean age of 56.451 ± 2.77, range=23-86). Although females reported higher physical activity barriers scores, gender differences were non-significant (P < 0.05). The results supported the unidimensional model of the Barriers to Physical Activity Questionnaire. The BAPAC scale showed internal consistency, as indicated by a Cronbach’s alpha of 0.71 for all participants. To assess convergent validity of the BAPAC, this instrument was evaluated by examining the correlation with the Stress, Anxiety, and Depression Questionnaire, and the divergent validity of the BAPAC was evaluated by examining the correlation with the Cardiac Self-efficacy Scale and the Multidimensional Perception of Social Support Scale, confirming both convergent and divergent validity. Conclusions: Results confirmed that the BAPAC questionnaire adheres to a single-factor structure. Regarding construct validity and reliability, the BAPAC questionnaire has the necessary psychometric properties to correctly assess barriers to regular physical activity in patients with coronary artery disease. The Persian version of the BAPAC questionnaire can be used in research and clinical fields related to obstacles to physical activity in patients with coronary artery disease. Physicians and specialists should pay attention to barriers to physical activity as an important factor to improve the physical activity of their clients and can use this tool for therapeutic purposes.
Introduction: Ischemic heart disease (IHD) management increasingly burdens family caregivers. While many educational programs focus on clinical knowledge, there is a gap in interventions that address caregivers’ internal psychological resources. This study aimed to determine the effectiveness of a social cognitive theory-based empowerment program on reducing caregiver burden and enhancing spiritual care and social support in IHD patient caregivers. Materials and Methods: In this quasi-experimental study, 80 family caregivers of IHD patients were assigned to intervention or control groups. The intervention group received a 5-session social cognitive theory (SCT)-based program, while the control group received usual care. Data on caregiver burden, spiritual care, and social support were collected at three time points using validated questionnaires. Primary analysis was conducted using analysis of covariance (ANCOVA), with effect sizes (Cohen’s d) and 95% confidence intervals reported. We hypothesized that the intervention group would show significantly greater improvements. Findings: The results indicated that the mean age of the participants was 50.5 ± 11.0 years, of whom 72.5% were female and 27.5% were male. The empowerment program led to significant improvements across all key outcomes. Compared to the control group, the intervention group experienced a large reduction in caregiver burden (Cohen’s d = 1.85) and significant increases in spiritual care (d = 1.52) and social support (d = 1.25) (all P < 0.001). Conclusion: This study provides promising evidence that an SCT-based empowerment intervention is an effective solution for reducing caregiver burden and improving caregivers’ mental and spiritual health in the short term. The sustained effects at one-month follow-up suggest its potential value. These findings warrant confirmation in larger, multicenter trials with longer follow-up periods before broad implementation.
Context: Population ageing and multimorbidity have increased the demand for sustainable, community-based chronic care models. Conventional models remain heavily dependent on the professional workforce and family caregiving, while many older adults experience loneliness, functional vulnerability, and unmet supportive care needs. Time banking, a reciprocal exchange system in which service hours are converted into time credits, has emerged as a social innovation that may complement formal chronic care by mobilizing community assets and recognizing non-market care work. Evidence Acquisition: This structured narrative review synthesizes evidence on time banking for active and mutual support ageing, with an emphasis on mechanisms, digital transformation, and policy pathways for sustainable community-based chronic care. A targeted narrative search was conducted across PubMed, Scopus, Web of Science, Google Scholar, ScienceDirect, SpringerLink, Frontiers, Oxford Academic, and PLOS ONE, supplemented by uploaded full-text sources, reference-list screening, and recent web searches. The final search update was completed on 14 May 2026. Search terms included time banking, time bank, time credit, older adults, active ageing, long-term care, chronic care, community care, digital platform, and policy. The search identified 210 records and sources, of which 36 were retained for synthesis. Evidence was coded using a mixed deductive–inductive thematic approach. Results: Evidence suggests that time banking may indirectly support chronic care through reciprocity, recognition, empowerment, trust, belonging, and community resource mobilization. Direct evidence on time banking indicates increased volunteering and indirect quality-of-life benefits mediated by volunteering-related self-efficacy. Indirect evidence from volunteering, social support, and community participation suggests potential psychosocial relevance for chronic care; however, chronic disease-specific outcomes remain insufficiently tested. Conclusions: Time banking should not be conceptualized as a substitute for professional chronic care. Rather, it is best understood as a complementary, community-based supportive-care infrastructure that may address the social, functional, and relational dimensions of chronic illness in later life. Integrated time-banking models in primary care, nursing, and long-term care require prospective evaluation.
Background: The use of electronic tools, particularly mobile phones, has become an important approach to self-care education. Their easy accessibility, time and cost savings, and the ability to use them anywhere and at any time have contributed to their increasing acceptance among menopausal women. Objectives: This study aimed to explore Ahvazi women’s perspectives on using mobile phone applications for self-care during menopause and to emphasize the importance of digital health tools in supporting women’s health needs during this stage of life. Methods: This descriptive cross-sectional study examined the perspectives of 103 menopausal women attending selected health centers in Ahvaz on enhancing self-care through mobile applications during menopause. Data were collected using a researcher-made questionnaire. After the sample size was reached (n = 103), the data were entered and analyzed using SPSS software, version 23. Results: The mean age of the participants was 53.6 years (range, 44 - 64 years), and the mean age of their spouses was 57.8 years (range, 44 - 75 years). Most participants were housewives (85; 83.5%) and had a diploma-level education (39; 37.9%). Most participants reported that mobile health (mHealth) was easy to use (83; 80.6%), that they trusted virtual platforms for medical inquiries (87; 84.5%), that they were willing to use mHealth in the future (91; 87.4%), and that they would recommend it to others (93; 90.3%) (P < 0.001). These findings indicate positive attitudes toward mHealth adoption among the participants. Conclusions: Ahvazi women demonstrated a positive attitude and strong willingness to use mobile applications for self-care during menopause. These findings underscore the need to design and implement simple, reliable, and needs-based mobile applications to effectively improve quality of life and self-care during this important stage of women’s lives.
Background: Chronic pain is a multidimensional phenomenon with sensory, emotional, cognitive, and social consequences. Due to the nature of their long-term injuries and disabilities, veterans are exposed to high levels of pain and its psychological, social, and cultural challenges. Objectives: This study aimed to examine the multidimensional aspects of chronic pain among war veterans residing in Abadan and to assess the relationships between pain dimensions, psychosocial factors, and coping strategies. Methods: The current descriptive-analytical study was conducted on 192 veterans covered by the Martyrs and Veterans Affairs Foundation in Abadan, Iran. Subjects were selected using a convenience sampling method. Data were collected through a demographic questionnaire, the Short-Form McGill Pain Questionnaire (SF-MPQ), the West Haven-Yale Multidimensional Pain Inventory (WHYMPI), and the Coping Strategies Questionnaire (CSQ). The data were then analyzed using SPSS software version 26 with descriptive statistics, Pearson’s correlation, and multiple regression (α = 0.05). Results: The mean total pain score on the SF-MPQ indicated a relatively high level of pain among veterans (105.3 ± 23.4). The WHYMPI revealed that pain severity and interference with daily life were the most affected domains. Pain substantially reduced social and outdoor activities. Among coping strategies, diverting attention and praying/hoping were most frequently used, whereas catastrophizing was strongly associated with higher pain scores (R = 0.50, P < 0.001). Correlation and regression analyses identified pain severity, interference with daily life, and affective distress as the strongest association of overall pain experience. Conclusions: Based on the findings of this study, the prevalence of pain among veterans not only severely influences the psychological and functional aspects of their lives, but also impacts their interaction with the social environment and their choice of coping strategies. These findings highlight the importance of comprehensive, multidisciplinary interventions that integrate medical, psychological, and social support to enhance veterans’ quality of life. However, the cross-sectional design and convenience sampling from a single city may limit the generalizability and causal interpretation of the results. Future longitudinal, multi-center, and mixed-method studies are recommended.
: Khuzestan Province faces significant air quality challenges, ranking among Iran's most polluted regions. This stems from a combination of unique climatic conditions, industrial and agricultural emissions, and the persistent influx of fine dust from both domestic and international sources. As a result, air quality in the province's urban centers is frequently unhealthy for sensitive groups and often for the general population. These conditions have contributed to a marked increase in respiratory ailments, such as asthma. A critical policy gap exists: Decision-makers currently lack robust, systematic, population-level data to understand the full scope of this public health crisis, identify high-risk groups, and evaluate the effectiveness of interventions. Establishing a population-based asthma registry is essential to fill this information void. Such a system would provide healthcare authorities with the evidence base needed to identify underlying risk factors, track disease-related complications, and assess the impact of various therapeutic and preventive measures. Beyond advancing medical research, the data generated would be instrumental in supporting evidence-based decision-making and targeted policy development within the healthcare system. Specifically, insights from this registry would provide critical evidence to inform national health priorities and strategic resource allocation, guiding investments in prevention, specialized care, and infrastructure for respiratory health across Iran. This policy brief outlines the key challenges and proposes strategic actions for the successful implementation of an integrated asthma registry.
Background: Migraine is a highly disabling disorder, particularly in children. However, studies focusing on the prophylaxis of primary headaches in pediatric populations remain rare. Objectives: The present study aimed to compare the efficacy of pyridoxine (vitamin B6) and propranolol in the prophylaxis of pediatric migraine. Methods: In this prospective, randomized, double-blind clinical trial, 62 children aged 7 - 17 years with migraine were randomly assigned to receive either propranolol (10 mg three times daily, n = 31) or pyridoxine (40 mg once daily, n = 31). Randomization was performed using a computer-generated sequence, and both patients and outcome assessors were blinded. Primary outcomes included headache frequency, headache duration, and pediatric migraine disability assessment (Ped-MIDAS) scores, assessed at baseline and after three months. Secondary outcomes included subgroup analyses by age and sex, and the occurrence of adverse events. Analysis of covariance (ANCOVA) was used to adjust for baseline values, age, and sex. Results: The study included 62 participants (31 per group) with a mean age of 9.8 ± 2.47 years in total. Gender distribution was similar between groups, with 59.7% males and 40.3% females. In primary outcomes, headache duration and Ped-MIDAS scores significantly improved in both treatment groups (headache duration: Pyridoxine 6.10 ± 0.91 to 3.00 ± 1.55 hours, propranolol 6.03 ± 0.95 to 3.03 ± 1.44 hours; Ped-MIDAS: Pyridoxine 33.26 ± 5.83 to 20.58 ± 8.94, propranolol 33.03 ± 6.11 to 20.35 ± 8.89; P < 0.0001 for all). No significant differences were observed between the two groups for any primary outcomes (P > 0.05), indicating comparable efficacy. Secondary outcomes, including subgroup analyses by age and sex, also showed no significant differences between groups. Conclusions: Both vitamin B6 and propranolol demonstrated a significant positive influence in reducing pediatric migraine symptoms.
Context: Self-management of type 1 diabetes in children and adolescents is critical for achieving optimal health outcomes. Identifying facilitators and barriers can guide the development of effective interventions. Objectives: This systematic review synthesizes interventional studies to examine key factors influencing self-management and their impact on outcomes. Methods: Following preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 guidelines, PubMed, Scopus, and Web of Science were searched up to August 10, 2025. Eligible studies included randomized controlled trials (RCTs) and quasi-experimental designs. Study quality was assessed using the risk of bias 2 (RoB 2) tool for randomized trials and risk of bias in non-randomized studies (non-RCTs) of interventions (ROBINS-I) for non-randomized studies. Results: Thirty-four studies comprising 4,584 participants aged 3 - 19 years were included. Of these, 65% were rated as low risk of bias and 35% as moderate risk. Interventions mainly involved self-management education (55%), family-centered programs (41%), digital technologies (35%), motivational strategies (32%), and psychological support (29%). Key facilitators included family involvement (47%), structured and repeated education (41%), healthcare team engagement (35%), motivational strategies (32%), and technological tools (30%). Barriers included fear of hypoglycemia (FOH, 29%), emotional stress (25%), lack of peer support (21%), limited access to educational resources (18%), cultural or language challenges (15%), and insufficient school-based education (12%). Interventions generally improved hemoglobin A1c (HbA1c), self-care behaviors, knowledge, self-efficacy, and quality of life. Conclusions: This review underscores the multidimensional nature of self-management in pediatric type 1 diabetes. Effective programs should address both individual and contextual barriers while leveraging facilitators such as family support and technology. Given the generally low-to-moderate risk of bias, findings are robust but highlight the need for culturally tailored and longitudinal research.
Background: Cancer is a major global health burden that affects patients’ physical, emotional, and social well-being. As the disease advances, many patients require palliative care to manage symptoms, reduce suffering, and improve quality of life. Understanding the experiences of cancer patients receiving palliative care is essential for strengthening patient-centered care, enhancing communication, and addressing unmet needs. Objectives: This study was conducted to explore and explain the experiences of cancer patients receiving palliative care. Methods: This qualitative study, using a content analysis approach, was conducted at Shohadaye Tajrish Hospital in Tehran in 2024. The participants included 12 cancer patients selected through purposive sampling with maximum variation. Data were collected through in-depth and semi-structured interviews. Data analysis was performed using the Lundman and Graneheim (2004) content analysis approach. Results: The mean age of the patients (6 males and 6 females) was 47.6 years. Data analysis resulted in three main themes: Existential dimensions (existential distress and fear of death, search for meaning and purpose in the face of illness, spiritual suffering and the need for inner peace), cultural dimensions (cultural beliefs about death and dying, family-centered values and collective decision-making, barriers and facilitators shaped by sociocultural norms), emotional dimensions (emotional struggles and coping with loss, family dynamics and the role of caregivers, emotional support and empathy from healthcare providers). Conclusions: The findings highlight that cancer patients receiving palliative care experience a complex interplay of existential, cultural, and emotional needs. These dimensions shape how patients cope with their illness, find meaning, and engage with care services.
Background: Multiple sclerosis (MS) is a leading cause of non-traumatic neurological disability in young adults, and headaches often intensify the day-to-day burden by worsening headache-related quality of life (QoL). Evidence for low-cost, nurse-delivered behavioral options such as progressive muscle relaxation (PMR) in MS headache care remains limited. We evaluated whether a brief PMR program is associated with lower headache impact on QoL measured by the Headache Impact Test (HIT-6). Methods: In a controlled quasi-experimental, parallel-group, pretest–posttest study (Zahedan, Iran; 2023), adults with neurologist-confirmed MS and recurrent headaches were allocated to PMR (n = 30) or usual care (n = 30). PMR included three nurse-led group sessions (20 - 30 minutes on three consecutive days) plus structured daily home practice for six weeks with weekly telephone support. HIT-6 (range 36 - 78; higher = worse) was collected at baseline and 3 months. Baseline comparability used t-tests/χ². The primary endpoint (3-month HIT-6) was analyzed via ANCOVA adjusting for baseline HIT-6 and MS duration (α = 0.05). Results: Sixty participants completed follow-up (PMR n = 30; Control n = 30). Groups were similar in age and sex; MS duration was longer in PMR. Baseline HIT-6 did not differ. At 3 months, the PMR group showed lower HIT-6 than controls in adjusted analysis: Adjusted Mean Difference (PMR-Control) = -5.64 (95% CI -9.58 to -1.69; p = 0.006; partial η² = 0.128). The adjusted between-group difference in HIT-6 (-5.64 points) exceeded the 3-point MCID, supporting clinical interpretability. Conclusions: A brief, nurse-delivered PMR program with structured home practice was associated with a clinically interpretable reduction in headache impact (HIT-6) at 3 months versus usual care. Given its low cost, safety, and feasibility, PMR appears to be a pragmatic adjunct to multidisciplinary MS services. Larger, multicenter randomized trials with longer follow-up and objective adherence tracking are warranted.
Background: Approximately 10% of patients with diabetes present with neuropathic complications at the time of diagnosis. Evaluating activities of daily living (ADLs) is an important indicator of overall functional performance. In individuals with diabetic neuropathy, ADL levels often decline due to neurological impairment. Objectives: The present study aimed to examine the relationship between ADLs and biochemical markers in newly diagnosed patients with type 2 diabetes mellitus (T2DM). Methods: This prospective observational study included 100 patients with T2DM selected using simple random sampling. Serum levels of total cholesterol, triglycerides, and glycated hemoglobin (HbA1c) were measured at baseline and six months after treatment initiation. Data were collected using a two-part questionnaire assessing demographic characteristics, biochemical parameters, and the standardized Barthel Index for ADLs. Statistical analysis was performed using SPSS v25 with a significance level of P < 0.05. Statistical modeling was based on correlation analysis between biochemical factors and ADL scores. Results: The mean age of participants was 58.5 ± 8 years. Among them 42% were male, and 62% reported a family history of diabetes. During the study, the mean blood biochemical factors decreased; HbA1c decreased from 8.10 to 7.73, triglyceride from 187.12 to 142.03, and cholesterol from 182.09 to 150.70. The amount of ADLs increased from 18.30 to 18.46 six months after diagnosis and treatment of the participants. A significant correlation was found between HbA1c level and ADL score (P < 0.001), whereas correlations between ADL score and cholesterol or triglyceride levels were not significant (P = 0.186 and P = 0.206, respectively). Conclusions: Improved glycemic control, as reflected by lower HbA1c levels, is associated with better functional performance in patients with T2DM. Maintaining optimal HbA1c may help reduce neuropathic complications and enhance ADLs in this population.
Background: Prehypertension, a transitional stage towards hypertension, has been recognized as an independent risk factor for cardiovascular diseases. Objectives: This study aimed to examine the role of the health belief model (HBM) in predicting preventive behaviors among individuals with prehypertension. Methods: This descriptive-analytical study included 200 prehypertensive participants aged 34 to 85 years, selected via multi-stage cluster sampling in Sirjan, Iran in 2023. Data were collected using a validated HBM Questionnaire and standard blood pressure measurements. Average blood pressure values were 128 ± 3 mmHg systolic and 84.5 ± 2.8 mmHg diastolic. Advanced statistical techniques, including multiple regression and structural equation modeling (SEM), and machine learning (ML) models such as random forest, support vector machine (SVM), gradient boosting, and neural networks, were combined to analyze the data, with a significance level of 0.05. Results: Self-efficacy (β = -0.25, P < 0.001) and perceived severity (β = 0.32, P < 0.001) were the strongest predictors of blood pressure control behaviors. Gender differences in knowledge (P = 0.027) and self-efficacy (P = 0.021) were observed, with women showing higher levels than men. Supervised ML models showed high predictive accuracy for blood pressure control behaviors, with the gradient boosting model performing best [area under the curve (AUC) = 0.895, P < 0.001]. Health belief model components such as perceived benefits and barriers did not significantly impact behaviors. Conclusions: The results suggest that psychological and behavioral factors, particularly self-efficacy and perceived severity, should be integrated into prehypertension intervention programs. Tailored interventions focusing on enhancing self-efficacy and addressing perceived severity, particularly among men, can optimize blood pressure control outcomes.
Context: Total knee arthroplasty (TKA) surgeries are among the most significant orthopedic procedures. The high sensitivity of these surgeries makes surgical site infections (SSIs) a critical concern worldwide. Objectives: This study aims to determine the prevalence of SSIs following TKA procedures. Evidence Acquisition: This systematic review and meta-analysis were conducted up to November 2024. Searches were performed in PubMed, Scopus, and Embase to identify relevant studies. The Joanna Briggs Institute Critical Appraisal Checklist was applied for quality assessment. A total of 375 articles were identified through database and hand searches, with 44 articles included in the statistical analysis. The results from the forest plot studies indicated heterogeneity among the studies. Results: The study found a low prevalence of SSIs in TKA surgeries, with a rate of 1.59% (95% CI: 1.44 - 1.73). Controlling the occurrence of SSIs is crucial due to the significance of these conditions, particularly in high-risk procedures like TKA. Conclusions: Given the importance of SSIs, hospital managers should design training courses for patients and healthcare workers to improve awareness of risk factors and preventive measures. Efforts should be made to control the factors that contribute to SSIs as much as possible.
Background: Sleep is essential for regeneration and physiological restoration. Sleep deprivation can increase the risk of infection, cause endocrine imbalances, reduce glucose tolerance, and heighten sympathetic activity. Additionally, poor sleep quality affects the patient’s sense of safety and overall quality of stay in the intensive care unit (ICU). Objectives: The present study aimed to evaluate the psychometric properties of the Arabic for Morocco version of the Freedman Sleep Questionnaire (AM-FSQ) in critically ill ICU patients in Morocco. Methods: This psychometric evaluation included an expert review for content validity, an internal consistency assessment using Cronbach’s alpha (α = 0.816), and an exploratory factor analysis for construct validity. Test-retest reliability was assessed using an intraclass correlation coefficient (ICC) of 0.85 or greater. The study was conducted in Moroccan ICUs between May 15, 2024, and December 10, 2024, with patients completing the AM-FSQ during their ICU stay. Results: The AM-FSQ demonstrated strong content validity, with expert ratings exceeding 3 on a 4-point Likert scale. The internal consistency was high (Cronbach’s alpha = 0.816), and test-retest reliability was excellent (ICC > 0.85). Exploratory factor analysis revealed four distinct factors, supporting the construct validity of the questionnaire. Conclusions: The AM-FSQ exhibits robust psychometric properties, characterized by good content validity, high internal consistency, and excellent test-retest reliability. It is a reliable and valid tool for assessing sleep quality and environmental factors that affect sleep in critically ill patients in Moroccan ICUs.
Background: Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by joint inflammation and progressive disability. Identifying factors contributing to disease severity is crucial for improving treatment outcomes and enhancing the quality of life in these patients. Objectives: This study aimed to determine the predictors of disease severity in patients with RA in Sirjan in 2023, using the Health Belief Model (HBM) as a framework. Methods: This cross-sectional descriptive study was conducted on 100 patients diagnosed with RA at the Seyed Ebrahim Hosseini Specialty Clinic in Sirjan, Iran, between June and November 2023. Patients meeting the inclusion criteria were selected through convenience sampling. Data were collected using a demographic information questionnaire, the Disease Activity Score 28 (DAS28), and the HBM Questionnaire. To minimize bias, data collectors were trained uniformly, and standard measurement tools were employed. The data were analyzed using descriptive statistics and inferential methods, including Pearson correlation and regression analysis. Results: The patients' mean age was 55.09 ± 12.45 years, and the mean disease duration was 4.06 ± 1.30 years. The majority of patients were female, married, and had completed secondary education. Regression analysis results indicated that none of the HBM and demographic variables were significant predictors of DAS28 in patients with RA (P > 0.05). However, a statistically significant correlation was found between the duration of the disease and its severity (R = 0.21, P = 0.041; 95% CI: 0.008 to 0.412), with longer disease duration associated with increased severity. Conclusions: Based on this study's findings, there is an emphasis on the importance of continuous monitoring and managing the disease to prevent the worsening of symptoms and deterioration of the patient's condition. Further research is recommended to more definitively determine the effectiveness of the HBM in patients with RA.
Context: Integrating palliative care (PC) into oncology is essential for improving the quality of life (QoL) of patients with cancer. This review aims to provide a comprehensive and critical analysis of the current nursing perspective on cancer-related symptom management in PC, while identifying gaps and opportunities for improving PC services in Iran. Evidence Acquisition: This study was designed as a state-of-the-art (SotA) review methodology to provide a comprehensive and analytical up-to-date synthesis of the current state of knowledge on PC in oncology nursing. A literature search was conducted across international and national databases, including Scopus, PubMed, Google Scholar, Web of Science, SID, Magiran, and Islamic World Science and Technology Monitoring and Citation Institute (ISC), covering studies published from 2014 to 2025. The focus was on articles addressing nurses’ roles, care strategies, and challenges in symptom management within PC settings. Results: Oncology nurses in Iran play a key role in managing cancer-related symptoms across physical, psychological, social, and spiritual domains. However, their ability to deliver comprehensive care is hindered by limited specialized training, unclear national policies, nursing shortage, and cultural barriers. Most Iranian studies focus on single symptoms rather than symptom clusters, and the use of digital tools such as telemedicine remains minimal. Conclusions: Oncology nurses in Iran play a critical role in symptom management, but face barriers such as limited training in PC, workforce shortages, cultural sensitivities, and policy gaps. Increasing training, developing national frameworks, and utilizing telemedicine can improve the quality and access to PC.
