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Transition to the role of mothering is one of the most important events in a woman’s life. While childbirth is a biological event, pregnancy and the experiences around it are more influenced by social structure, which is shaped by cultural perceptions and practices. The aim of this study was to explore cultural context during maternal role attainment in neonatal intensive care units (NICUs) in Iran. The study was part of a grounded theory study on how the mothers of preterm neonates go through maternal role attainment. Data collection was carried out by purposeful sampling from 20 participants (15 mothers of preterm neonates and 5 NICU nurses). Data were analysed according to Corbin and Strauss’s (2015) approach. Four categories of childbearing culture emerged: ‘The necessity of childbearing’, ‘Childbearing rituals’, ‘Maternal persistent presence’ and ‘Attitudes and religious beliefs’. The findings showed that the special beliefs and practices in Iranian culture affected all of the participants’ reactions to mothering process. Culture is one of the most important factors affecting the development of motherhood in Iran. In order to provide sensitive and culturally appropriate care, nurses should be aware of the general impact of cultural norms and values on the process of maternal role attainment and strive to meet the cultural needs of all mothers.
Exercise has been found to be important in maintaining neurocognitive health. However, the effect of exercise intensity level remains relatively underexplored. Thus, to test the hypothesis that self-paced high-intensity exercise and cardiorespiratory fitness (peak aerobic capacity; VO2peak) increase grey matter (GM) volume, we examined the effect of a 6-month exercise intervention on frontal lobe GM regions that support the executive functions in older adults.
Ninety-eight cognitively normal participants (age = 69.06 ± 5.2 years; n = 54 female) were randomised into either a self-paced high- or moderate-intensity cycle-based exercise intervention group, or a no-intervention control group. Participants underwent magnetic resonance imaging and fitness assessment pre-intervention, immediately post-intervention, and 12-months post-intervention.
The intervention was found to increase fitness in the exercise groups, as compared with the control group (F = 9.88, p = <0.001). Changes in pre-to-post-intervention fitness were associated with increased volume in the right frontal lobe (β = 0.29, p = 0.036, r = 0.27), right supplementary motor area (β = 0.30, p = 0.031, r = 0.29), and both right (β = 0.32, p = 0.034, r = 0.30) and left gyrus rectus (β = 0.30, p = 0.037, r = 0.29) for intervention, but not control participants. No differences in volume were observed across groups.
At an aggregate level, six months of self-paced high- or moderate-intensity exercise did not increase frontal GM volume. However, experimentally-induced changes in individual cardiorespiratory fitness was positively associated with frontal GM volume in our sample of older adults. These results provide evidence of individual variability in exercise-induced fitness on brain structure.
This study presents a buoyancy-driven stability analysis in a three-dimensional inclined porous medium with a capillary transition zone that is formed between a non-wetting and an underlying wetting phase. In this two-phase, two-component, partially miscible system, a solute from a non-wetting phase diffuses into a porous layer saturated with a wetting-phase fluid, creating a dense diffusive boundary layer beneath an established capillary transition zone. Transient concentration and gravity-driven velocity fields are derived for the wetting phase while the saturation field remains fixed. Linear stability analysis with the quasi-steady-state approximation is employed to determine the onset of solutal convective instability for buoyancy-dominant, in-transition and capillary-dominant systems. The analysis of the problem leads to a differential eigenvalue problem composed of a system of three complex-valued equations that are numerically solved to determine the critical times, critical wavenumbers and neutral stability curves as a function of inclination angle for different Bond numbers. The layer inclination is shown to play an essential role in the stability of the problem, where the gravity-driven flow removes solute concentrations in the diffusive boundary layer. The results indicate that the horizontal porous layer exhibits the fastest onset of instability, and longitudinal rolls are always more unstable than oblique and transverse rolls. The inclination angle has a more substantial impact on stabilizing the diffusive boundary layer in the buoyancy-dominant than in the capillary-dominant systems. Furthermore, for both buoyancy-dominant and capillary-dominant systems, the critical times and wavenumbers vary exponentially with inclination angle ≤ 60° and follow the Stirling model.
This study aimed to investigate the challenges of hospital disaster risk management so that it can take a step to provide strategies and interventions to remove these barriers and improve the hospital disaster risk management (HDRM) through identifying and introducing them to disaster experts.
This is a systematic qualitative review study. Data sources included Persian and international databases, which were searched using the keywords of hospital, disaster, risk management, risk reduction, disaster and challenge, and the combination of them. The search period ranged from January 2010 to January 2020. Data were extracted by 2 independent examiners for qualitative thematic analysis.
A total of 762 articles and documents were recovered. Finally, 12 articles entered the study, including 7 studies from Asia, 2 articles from Europe, 2 articles from the United States, and 1 article about Africa. After thematic analysis, 17 sub-themes were achieved and were classified into 4 subjects of technical-physical barriers, organizational-managerial barriers, financial barriers, and human barriers. All articles have not discussed on all categories.
The results of evaluating the challenges of hospital disaster risk management gained from this study can be beneficial in developing a roadmap to improve the status of HDRM.
The concept of Disaster Risk Management (DRM) has changed throughout history. Identifying changes and related factors can be effective in adopting logical, scientific and evidence-based approaches in the future. Therefore, this study was conducted with the aim of depicting the process of changes in the concept of DRM and creating an original perspective. In this narrative literature review study, we used historical approach. Literature, regardless of the time of publication, was searched using divergent keywords including “disaster, health, emergency, management, risk, disaster medicine, and hazard.” DRM evolution started with the emergence of civil defense during the last century. Although DRM was initially focused on responses, currently, this concept includes disaster risk reduction (DRR) and disaster management. DRR includes prevention and mitigation, and disaster management includes response and recovery measures. DRR considering underlying risk factors such as social factors, and focusing on participation of communities are important steps to be taken.
Previous investigations have mostly studied an individual methyl donor nutrient in relation to psychological disorders and the findings were inconsistent. We investigated the association of methyl donor micronutrients (folate, B6, B12, choline, betaine and methionine) with psychological disorders in Iranian adults. In this cross-sectional study, dietary intakes of 3299 adults were collected using a validated food frequency questionnaire. Methyl donor micronutrient score (MDMS) was calculated based on energy-adjusted deciles of each nutrient. Hospital Anxiety and Depression Scale (HADS) and General Health Questionnaire (GHQ), validated for Iranians, have been applied to assess depression, anxiety and psychological distress. Participants had a mean age of 36·3 ± 7·9 years, of whom 58·5 % were women. After considering potential confounders, adults in the top quartile of MDMS, compared to the bottom one, had decreased odds of anxiety (OR: 0·53, 95 % CI: 0·37, 0·75), depression (OR: 0·75, 95 % CI: 0·58, 0·97) and psychological distress (OR: 0·61, 95 % CI: 0·46, 0·80). Among women, the top quartile of MDMS was protectively associated with anxiety (OR: 0·60, 95 % CI: 0·40, 0·90), depression (OR: 0·68, 95 % CI: 0·50, 0·93) and psychological distress (OR: 0·53, 95 % CI: 0·38, 0·74). Overweight and obese subjects in the highest quartile of MDMS had a 67 %, 35 % and 53 % lower odds of anxiety (95 % CI: 0·20, 0·56), depression (95 % CI: 0·44, 0·94) and psychological distress (95 % CI: 0·31, 0·70), respectively. We found that high consumption of methyl donor micronutrients was related to a reduced odds of psychological disorders, especially in women and overweight or obese individuals.
Eating behaviours have been associated both with being underweight or overweight and poor growth. The Children's Eating Behaviour Questionnaire (CEBQ) is a widely used measure of child eating behaviours. The instrument is, however, mostly validated in high-income countries, with a scarcity of evidence among developing countries such as Ethiopia. The present study aims to assess the cultural adaptability and validity of the CEBQ to be used in Ethiopia. We conducted a school-based cross-sectional study among 542 caregivers of children aged 3–6 years in selected preschools. Tests of factorial validity, convergent validity and reliability were performed. The Confirmatory Factor Analysis model indicated that eight subscales provided the best fit (root-mean-square error of approximation = 0⋅05 (90 % CI 0⋅045, 0⋅055); Comparative Fit Index = 0⋅92 and Tucker–Lewis Index = 0⋅90) after seven items from the original CEBQ were removed. Convergent validity with child's weight status was found for emotional overeating, food fussiness, satiety responsiveness and slowness in eating subscales. Reliability, measured using Cronbach's α, provided values between 0⋅50 and 0⋅79. The eight-factor structure of the CEBQ showed adequate content validity and provided factorial, discriminant and convergent validity among preschool children. Further replication of the study among low-income countries is essential to improve the literature on children's eating behaviours.
To offer regular continuous professional development opportunities covering both clinical and non-clinical skills to trainees and trainers and enhance their experience and skills to increase their wellbeing and resilience.
There are approximately 50,000 doctors undertaking postgraduate training in England. Of these, 10% (5000) are taking approved time out of training at any time. A 2017 HEE survey revealed that doctors returning to work reported numerous concerns. Based on these and with the backdrop of the Bawa-Gaba case HEE's Supported return to Training programme (SuppoRTT) was developed.
We at Sheffield Health and Social Care NHS Foundation Trust devised a unique “Mindful SuppoRTT” initiative and were successful in securing funding from HEE. Part of which was the organisation of a conference aimed at various groups of doctors including those who have previously had time out of training, are currently out of training and those considering time out.
The Sheffield Mindful SuppoRTT Programme not only aimed to provide a structured and systematic process for planning and returning from absence, but also focussed on enhancing performance through promoting the wellbeing of participants and supporting them with important clinical and non-clinical skills.
2-day twice yearly conferences, which covered training on speciality specific as well as non-technical skills were organised. The clinical workshops covered interactive sessions of common and emergency clinical scenarios. A wide range of non-technical skills such as an introduction to mindfulness, tai chi, resilience, team-working and leadership, “Thinking Environment” and meditation were introduced and developed using bespoke training. Feedback was collected at the end of each conference day. The attendees were asked to use a 5-point Likert scale (5 being the highest) to rate their satisfaction with the day and to highlight which sessions they found most and least useful.
The attendee satisfaction rate was high. The first conference had ratings of 56% of attendees scoring 5 (excellent) and the remainder scoring 4 (very good). The second conference achieved even higher satisfaction ratings with 94% of attendees scoring 5 and the remainder scoring 4.
The conference had high attendee satisfaction. The hope is to expand on its success and open it up to delegates from all specialities within HEE South Yorkshire and the Humber. Evaluation of the long-term impact of this programme is also warranted.
This project aimed to further develop a teaching programme for Foundation Doctors attached to a psychiatry rotation. The purpose was threefold – to educate foundation doctors about important psychiatric topics; to encourage them to think about wider impacts of psychiatry; and to inspire them to consider psychiatric training in the longer term.
The Royal College of Psychiatrists’ mission statement includes actively promoting psychiatry as a career and improving knowledge of mental health, including its interactions with people's physical and social backgrounds. Targeting foundation doctors rotating into psychiatry posts is a good opportunity to achieve these objectives, as they will be the cross-speciality doctors of the future, and have specific learning needs given their unique rotations and new medical careers.
On one Wednesday morning per month Foundation Doctors had a specific teaching session for them. The sessions consisted of four 30-minute teaching blocks which, crucially, were given by foundation doctors. They were facilitated by a core psychiatry trainee, and the topics were decided by the doctor teaching each 30-minute block. The foundation doctors were able teach on any topic related to psychiatry that interested them. Feedback forms were developed and provided at the end of each session for the foundation doctors, as well as at the end of each recent foundation rotation, to get feedback on the overall quality of the course delivered.
The programme has now had 6 complete cohorts of foundation doctors. We have built a varied topic bank from past sessions, including the Mental Health Act, dementia, the Mind-Body Problem, psychiatry in video games and sociology of psychiatric illness, amongst other topics. All foundation doctors questioned have agreed or strongly agreed that the sessions were helpful for their psychiatric rotation and general medical training. Particularly praised aspects were the ability to discuss psychiatric topics that weren't normally discussed in an academic environment, being able to take ownership over learning and practicing giving teaching. Vitally, core trainee facilitators also found the sessions inspiring for their training.
The Foundation Teaching Programme has increased doctors’ knowledge of a range of psychiatric topics, the breadth of which and agency in choosing topics has increased engagement with psychiatry, regardless of planned medical training speciality. Areas to explore in the future include potentially opening attendance to medical students and physician associate students, and to other regions of the deanery. Evaluating the long-term impact of this training is also warranted.
Midwakh, which involves smoking an Arabian tobacco blend typically mixed with herbs and spices, has recently become a major health concern due to a spreading popularity among adolescents and young adults in the United Arab Emirates (UAE). It is known to contain a higher nicotine content than cigarettes, potentially increasing the risk of addiction, despite contrary popular belief among young smokers. Yet, little is known about attitudes and decision-making processes involving this emerging smoking behaviour. The aim of this study was to ascertain the knowledge, attitudes and practices of Midwakh use among adult males in the UAE.
A cross sectional study was conducted among male adults in Abu Dhabi, Dubai and Sharjah. A total of 500 participants completed self-administered validated questionnaires, which consisted of 30 questions that targeted the public's understanding, perception and use of Midwakh. Data were analysed using SPSS 23. Percentages and means were calculated for demographic data and Chi-Square was utilised to measure relations between categorical variables. Odds Ratio (OR) was used to estimate how strongly a predictor was associated to an outcome. A p-value less than 0.05 was considered statistically significant.
The prevalence of smoking Midwakh was 34.8% among the study sample. Males between ages 26 to 35 were found to be 4.48 times (95% CI: 1.59–12.66) more likely to be current Midwakh smokers than any other age groups (P = 0.01). Emiratis in the study were 5.92 times (95% CI: 2.83–12.35) more likely to smoke Midwakh than expats. 65% of respondents reported willingness to smoke Midwakh if it was offered to them. Adults with 3-4 close friends who smoke Midwakh were 6.8 times (95% CI: 2.08–22.41) more likely to smoke Midwakh themselves. Knowledge of being unsafe was cited in 62% of the participants as a cause of quitting Midwakh within two years.
Our results demonstrate a significant impact of peer pressure on the decision-making process of Midwakh smoking. The high prevalence among young male residents warrants a multi-agency public health approach to tackle the issue. Culturally sensitive campaigns raising awareness to the harmful effect of Midwakh including its addictiveness appear to be essential. Further research investigating the effects of a targeted Midwakh-smoking cessation approaches is warranted.
This paper examines the effect of a tariff on long-run growth and welfare in a two-country innovation-led growth model. We show that although raising the home country’s tariff reduces the growth and GDP of the foreign country, it will backfire by depressing R&D and growth of the home country. The Nash equilibrium tariffs can be positive, and they are larger when the government expenditure is more beneficial to private production and/or when the productivity of innovation is higher. The presence of positive Nash equilibrium tariffs provides a theoretical explanation for why countries have incentives to implement a tariff policy regardless of its negative effect on growth. Finally, the Nash equilibrium tariffs are higher than the globally optimal tariffs, that is, the levels that maximize the joint welfare of both countries.
COVID-19 pandemic continues to be a global health crisis. The gut microbiome critically affects the immune system, and some respiratory infections are associated with changes in the gut microbiome; here, we evaluated the role of nutritional and lifestyle habits that modulate gut microbiota on COVID-19 outcomes in a longitudinal cohort study that included 200 patients infected with COVID-19. Of these, 122 cases were mild and seventy-eight were moderate, according to WHO classification. After detailed explanation by a consultant in clinical nutrition, participants responded to a written questionnaire on daily sugar, prebiotic intake in food, sleeping hours, exercise duration and antibiotic prescription, during the past 1 year before infection. Daily consumption of prebiotic-containing foods, less sugar, regular exercise, adequate sleep and fewer antibiotic prescriptions led to a milder disease and rapid virus clearance. Additionally, data on these factors were compiled into a single score, the ESSAP score (Exercise, Sugar consumption, Sleeping hours, Antibiotics taken, and Prebiotics consumption; 0–11 points), median ESSAP score was 5 for both mild and moderate cases; however, the range was 4–8 in mild cases, but 1–6 in moderate (P = 0·001, OR: 4·2, 95 % CI 1·9, 9·1); our results showed a negative correlation between regular consumption of yogurt containing probiotics and disease severity (P = 0·007, OR: 1·6, 95 % CI 1·1, 2·1). Mild COVID-19 disease was associated with 10–20 min of daily exercise (P = 0·016), sleeping at least 8 h daily, prescribed antibiotics less than 5 times per year (P = 0·077) and ate plenty of prebiotic-containing food.
The spiritual well-being scale (SWBS) is a widely used clinical scale which should be evaluated for Iranian patients with cancer. The aim of this study is to evaluate the psychometric properties of the Persian version of the SWBS in Iranian patients with cancer.
This cross-sectional, methodological study was conducted among Iranian patients with cancer (n = 400). The participants were recruited using convenience sampling. The content, construct, convergent and discriminant validity, and reliability of the Persian version of the SWBS were evaluated.
A two-factor structure for the scale was indicated with the factors being: connecting with God and meaningless life that explained 54.18% of the total variance of the concept of spiritual well-being. The results demonstrated the model had a good fit. Cronbach's alpha, McDonald's omega, and the inter-item correlation values of the factors indicated good internal consistency of the scale.
Significance of results
These results suggest that the Persian version of the SWBS is a reliable and valid measure to assess the spiritual well-being of patients with cancer through 16 items related to connecting with God and meaningless life.
Heavy rains in March 2019 led to severe floods in large parts of Iran, with severe financial and physical casualties (in the Golestan province, 11 districts were trapped in water). An increase in the EMS missions while serving a big portion of the needed population was a big problem for the health system during the flood; Therefore, a new solution was needed to overcome this problem. Using a farm tractor for transporting the patients and injured people was the first relief experience ever documented in the whole country. In the present report, despite the limitations and challenges, the tractor has been shown to be a proper and effective disaster relief vehicle. This report could help other similar countries face disasters, especially floods.