Background and Objective: Due to the spread of the new coronavirus disease 2019 (COVID-19), the amount of physical activity and exercise in people’s lifestyles was greatly reduced to reduce interpersonal contact to control the infection. The current study aimed to investigate students’ physical fitness levels during the quarantine period of COVID-19, and the study examined its changes after four months of training at home.
Methods: This quasi-experimental study was done on thirty-two students (16 males and 16 females) in Shahrekord University, Iran during 2019-21. Physical fitness (swimming, Sit-ups, jumping rope, and flexibility) was measured and compared three times before the start of the Coronavirus, one year after the beginning of the Coronavirus, and after four months of exercise at home.
Results: COVID-19 leads to a decrease in the level of physical fitness in the post-exam phase compared to the pre-exam phase. Due to the restrictions related to the quarantine period, students’ physical fitness levels showed a significant reduction in the post-corona period compared to the pre-corona period. In addition, four months of training at home showed a significant effect on physical fitness indicators, compared to the time of quarantine, in such a way that the average of physical fitness factors increased significantly (P<0.05). Therefore, growing measures are needed to motivate and support students to maintain a conscious level of physical fitness to avoid any threat to the population’s health, especially in quarantine conditions.
Conclusion: The quarantine period during the outbreak of COVID-19 caused a decrease in the physical fitness of the studied students, and performing four-month exercises at home increased their physical fitness.

Background and Objective: Physical disability caused by multiple sclerosis (MS) increases MS patients' need for support from others. Medication adherence is one of the main success factors in the treatment of chronic diseases, which is influenced by various factors. This study aimed to determine the relationship between perceived social support and medication adherence in patients with MS.
Methods: This descriptive-analytical study was conducted on 110 patients (70 women and 40 men) aged 39±9 years with MS who visited the 2 medical training centers of Isfahan University of Medical Sciences (Kashani and Al-Zahra), Isfahan, Iran during 2021. After sampling by the systematic random method, the data were collected by interviews and using Zimmet's Perceived Social Support Scale (MSPSS) and the Morisky Medication Adherence Scale (MMAS-8).
Results: The mean and standard deviation of the scores of medication adherence and perceived social support were 6.10±1.72 and 62.83±14.97, respectively. According to the Pearson correlation coefficient, perceived social support did not show any significant relationship with medication adherence (r=0.185, P=0.053). Perceived social support showed a statistically significant relationship with income satisfaction (F=4.54, P=0.01), the pattern of clinical course (F=2.95, P=0.03), difficulty in accessing medical care (t=-2.29, P=0.02), and clinical symptoms, including motor (t=-3.72, P=0.001), balance (t=-3.23, P=0.002), and urinary disorders (t=-2.53, P=0.01).
Conclusion: Perceived social support in patients with MS did not cause medication adherence.

Background and Objective: Gerotranscendence, as a component of spiritual health, influences their quality of life and adaptation to chronic diseases by creating meaning in life. It is an important approach to enhancing the dimensions of aging health. This study was conducted to determine the relationship between gerotranscendence and quality of life in the elderly with cancer.
Methods: This descriptive-analytical study was performed on 200 older adults with cancer who were selected from Firouzgar and Rasool Akram medical centers in Tehran, Iran, during 2021. The checklist of demographic characteristics, the Gerotranscendence Scale (GTS), and the quality of life questionnaire (LEIPAD) were used.
Results: Gerotranscendence had a statistically significant relationship with marital status, level of education, employment status, housing status, type of cancer, and type of treatment (P<0.05). Age had a statistically significant negative correlation with the quality of life (r=-0.206). Gerotranscendence also had a statistically significant positive correlation with the dimensions of quality of life (r=0.221, P=0.002), including depression and anxiety (r=0.146, P=0.04), mental performance (r=0.167, P=0.018), social performance (r=0.266, P<0.001), and satisfaction with life (r=0.256, P<0.001).
Conclusion: Increasing gerotranscendence increases the quality of life of the elderly.

Background and Objective: Loneliness is one of the problems experienced by the aging population, and the lack of social communication plays a major role in the emergence of loneliness. This study was conducted to determine the effects of telenursing on the loneliness of the elderly.
Methods: This field trial was conducted on 100 elderly people over 60 years of age who were selected by convenience sampling from the clients of Gonabad (Iran) community health centers during 2017. The elderly participants were randomly assigned to 2 groups of 50 people, intervention and control. Then, the demographic information questionnaire, the Informant Questionnaire for Cognitive Decline in the Elderly, and Dehshiri et al.'s Loneliness Scale were completed. The intervention group received face-to-face training by the researcher for 2 hours. There was no intervention for the control group, and the elderly received routine care from the family health unit. After the face-to-face meeting, phone calls were made by the researcher to the intervention group for 12 weeks. One month after the end of the intervention, the questionnaires were completed again by the two groups and evaluated and compared.
Results: The mean (standard deviation) score of loneliness was 60.82±21.07 and 57.48±18.76 before the intervention in the intervention and control groups, respectively, and this value after the intervention was 35.06±14.20 and 61.40±18.72, respectively, in the intervention and control groups. After the intervention, a statistically significant difference was found in terms of a reduction in the loneliness score of the elderly in the intervention group compared to the control group (P<0.05).
Conclusion: This study showed that telenursing was effective in reducing the loneliness of the elderly.

Background and Objective: Coronavirus disease 2019 (COVID-19) can lead to organ failure by the occurrence of mechanisms such as increased thrombosis and, subsequently, increased lactate dehydrogenase (LDH). This study was conducted to determine LDH serum levels in COVID-19 patients and the factors affecting their mortality.
Methods: This descriptive-analytical study was conducted on 212 patients (57 males and 155 females) with COVID-19 with a mean age of 49.19±10.6 referring to Imam Ali Hospital in Chabahar, Iran during 2021. After obtaining patients’ informed consent and demographic information, the heparinized peripheral blood sample was taken from them. The LHD levels were determined using an autoanalyzer.
Results: Twenty-nine (13.67%) patients died. The mean LDH serum level of 29 deceased patients (708.420±96.25 U/L) was not statistically significant compared to survivors (640.360±96.80 U/L in 183). The comparison between the surviving and deceased groups showed that 25% of the deceased patients were hospitalized in the intensive care unit (ICU), and 90.90% of the survivors were hospitalized in the internal ward (P<0.05). All the deceased and 85.85% of the survivors were 40 years old and above, and this difference was not statistically significant. Furthermore, 24.56% of the deceased were male, 90.32% of the survivors were female (P<0.05), 22.72% of the deceased had a university education, and 88.69% of the survivors had a diploma or under-diploma education (P<0.05), and 71.42% of the deceased patients had thin, and 91.37% of the survivors were overweight (P<0.05).
Conclusion: There was no difference in the LDH serum levels of the COVID-19 survivors and deceased. The age of 40 years and above, lean and morbidly obese body mass indices, male gender, and the need for hospitalization in the ICU were determined as risk factors.

The visual processing disorder is broadly observed among individuals with autism. This study was conducted to develop an integrated rehabilitation program based on vibroacoustics and virtual reality and to assess its effectiveness on the visual processing of autistic children. This experimental case report was conducted using an Aberrant Behavior Checklist (ABC) design on 5 children with autism referred to Zehnara Rehabilitation Clinic in the second half months of 2021. First, the integrated program was implemented for ten 30-minute sessions on 2 subjects randomly selected from among the samples. After determining the program validity, 3 more subjects were entered into the study. The sensory profile questionnaire-2 was used. The questionnaires were filled out at the baseline stage, at the end of each intervention session, and at the one-month follow-up stage. The visual analysis, the percentage of recovery, the percentage of non-overlapping data (PND), and the percentage of overlapping data (POD) were used for data analysis. The implemented intervention was evaluated to be effective for all five subjects so that for Subjects No. 1, 2, 3, 4, and 5, the PND rates were obtained to be 90%, 90%, 70%, 100%, and 90%, respectively. The results of this study demonstrated that the integrated sensory rehabilitation program could be used to improve the visual processing of children with autism.

Background and Objective: Oral and dental health are crucial for nutrition intake, speech, and facial aesthetics. They also significantly influence individuals' physical, social, and psychological activities. This study aimed to determine the relationship between the Dental Caries Index (DMFT) and oral health-related quality of life.
Methods: This descriptive-analytical study was conducted on 61 patients (29 men and 32 women) aged 20-50 years who visited the Gorgan Dental School Clinic, Iran during 2019. The DMFT index, encompassing Decay (D), Missing (M), and Filled (F) teeth, was calculated. Quality of life was assessed using the 36-item DIDL (Dental Impact on Daily Living) questionnaire, which covers five domains: dental appearance and aesthetics, oral comfort, overall oral and dental function, eating limitations, and dental and jaw pain. Scores were categorized into three groups: dissatisfied (below 0), moderately satisfied (0 to 7), and satisfied (above 7).
Results: The mean score for oral health-related quality of life was 5.14±0.229, indicating a relative level of satisfaction. Pearson's correlation coefficient between DMFT and oral health-related quality of life was -0.358, suggesting a significant inverse relationship between DMFT and quality of life (P<0.05). The mean DMFT score ranged from 0 to 28, with a mean of 9.36, and the most frequent scores were 7, 11, and 13, each accounting for 11.5% of the sample. The mean decay (D) score was 3.44, the mean missing (M) score was 1.98, and the mean filled (F) score was 3.93, with ranges of 0-12, 0-19, and 0-13, respectively.
Conclusion: The results of this study indicate an inverse impact of the Dental Caries Index on patients' quality of life. Oral health-related quality of life is a multifaceted construct that affects various aspects such as appearance, oral comfort, and eating limitations, which are critical components of overall quality of life and satisfaction.

Background and Objective: Non-adherence to treatment regimens is a significant factor contributing to the persistence of cardiovascular diseases and their complications. This study aimed to compare the effects of two educational methods, with and without short message service (SMS) reminder, on adherence to treatment regimens among patients with acute coronary syndrome (ACS).
Methods: This clinical trial was conducted on 111 patients with ACS divided into three 37-people groups: A control group (receiving routine education), the first intervention group (receiving education and a booklet), and the second intervention group (receiving education, a booklet, and SMS reminders). The study was conducted in patients at the coronary care units (CCUs) and post-CCUs of the following educational therapeutic centers: Shahid Sayyad Shirazi in Gorgan, the Fifth Azar in Gorgan, Amir Al-Momenin in Kordkuy, and Al-E-Jalil in Aqqala, Iran, during 2019. The research instrument consisted of the Treatment Adherence Perception Questionnaire (TAPQ) in three domains, including dietary regimen, medication regimen, and exercise and activity, which was completed at the time of discharge and two months later.
Results: The mean scores of adherence to treatment dietary in patients with ACS two months after discharge in the three domains of dietary regimen, medication regimen, and exercise and activity were significantly higher in the group receiving education and SMS reminders (105.54±75.8, 16.00±2.71, and 23.67±3.85, respectively) compared to the education group (84.73±5.02, 11.05±1.69, and 17.45±2.48, respectively) (P<0.05). Moreover, the scores in the three investigated domains were significantly higher in both intervention groups compared to the control group (82.68±13.54, 11.40±1.96, and 17.67±5.04, respectively) (P<0.05).
Conclusion: The use of education and a booklet along with SMS reminders to patients with ACS discharged from the hospital increased adherence to treatment. This adherence was higher in the intervention group receiving SMS reminders.

Background and Objective: Fear of childbirth is a common problem during pregnancy. Previous studies have shown that pregnancy outcomes and experiences can significantly vary across various ethnic groups. This study aimed to determine the prevalence of fear of childbirth among pregnant mothers of various ethnicities referring to comprehensive health service centers in Gorgan, Iran.
Methods: This descriptive-analytical study was conducted on 341 pregnant women of Fars, Turkmen, and Sistani/Baluch ethnicities using a random sampling method at comprehensive health service centers in Gorgan during 2023. Data collection instruments consisted of a demographic and pregnancy characteristics form and the Childbirth Fear Questionnaire (CFQ; Zar and Wijma).
Results: The mean fear of childbirth score in pregnant women was determined to be 69.88±20.19 (severe fear). Among all studied groups, mild fear (21 individuals), moderate fear (100 individuals), severe fear (147 individuals), and clinical fear (73 individuals) were identified in 6.2%, 29.3%, 43.1%, and 21.4% of the pregnant women, respectively. The combined prevalence of severe and clinical fear of childbirth among pregnant women of Sistani/Baluch, Turkmen, and Fars ethnicities was determined to be 73%, 73.3%, and 52.2%, respectively, and this difference was statistically significant (P<0.05). A statistically significant relationship was observed among the variables of age, gestational period, and the level of satisfaction with prenatal care received at comprehensive health service centers (P<0.05).
Conclusion: Severe and clinical fear of childbirth is more prevalent among pregnant women of Sistani/Baluch and Turkmen ethnicities compared to the Fars ethnicity.

Stroke survivors often experience various motor complications, and sustained treatment is crucial for their recovery. Game-based telerehabilitation interventions appear to facilitate motor improvement in these patients by ensuring sustained treatment. Therefore, the present study aimed to evaluate game-based telerehabilitation on motor function in stroke patients. This narrative review involved a comprehensive search of the PubMed database up to August 2024, using the keywords "Game," "Games," "Serious games," "Telerehabilitation," and "Stroke," both individually and in combination. Out of 118 articles initially identified, duplicates and articles published before 2018 were excluded. Ultimately, 9 articles meeting the inclusion and exclusion criteria were selected for review. The full text of these English articles was then analyzed and compared in terms of study design and intervention outcomes on improving motor function. Of the 9 studies reviewed, 6 focused on improving upper extremity motor function, 2 on improving lower extremity motor function, and 1 on improving motor function in both upper and lower extremities. All 9 studies reported positive results regarding improving upper and lower extremity motor function through game-based telerehabilitation. However, most studies had small and varied sample sizes, and there was no consensus on the optimal frequency or duration of game use. Furthermore, the technology employed in these games was found to be expensive for less developed countries. Given the positive outcomes of this approach for stroke patients, developing affordable, localized games and integrating them into national rehabilitation programs could significantly benefit both patients and healthcare systems.

Background and Objective: Most Iranian provinces, including Golestan Province, have achieved the 2015 Sustainable Development Goals (SDGs) for childhood mortality. However, evidence suggests that mortality rates in some population groups within these regions remain high and concerning. This study aimed to determine the childhood mortality rate in the city of Aqqala in Golestan Province, Iran.
Methods: This descriptive study was conducted on 416 cases (243 males, 172 females, 1 ambiguous genitalia) of mortalities among children aged 0-18 years residing in rural and urban areas of the city of Aqqala from 2017 to 2022. All registered mortalities were extracted from the electronic health record system at Golestan University of Medical Sciences. Incomplete records or those with imprecisely documented causes of mortality were excluded from the study. The causes of childhood mortality were categorized based on the International Classification of Diseases (10^th Revision, 2016). Age divisions were regarded as 0-28 days, 1-12 months, 1-2 years, 2-6 years, 6-12 years, and 12-18 years for neonates, infants, toddlers, preschoolers, school-aged children, and adolescents, respectively.
Results: The overall mortality rate was determined to be 2.15 deaths per 1000 live births, with rates of 23.1 per 1000 live births for male children and 10.3 per 1000 live births for female children. This rate decreased from 22.7 deaths per 1000 live births in 2017 to 12.3 deaths in 2022. The neonatal mortality rate was determined to be 32.8 per 1000 live births, and the infant mortality rate was 5.5 deaths per 1000 live births. The primary causes of mortality, in order of frequency, included certain conditions originating in the perinatal period (28.2%), congenital malformations and chromosomal abnormalities (17.2%), and transport-related accidents (12%).
Conclusion: Despite a declining trend in the overall mortality rate of children under 18 years in the city of Aqqala in Golestan Province, the neonatal mortality rate in this region is alarmingly higher than the Iranian average, necessitating attention and appropriate measures for further evaluation and intervention.

 

Influenza is an acute viral respiratory disease with diverse clinical manifestations. Despite extensive research, ambiguities remain regarding its prognostic factors. In this cross-sectional retrospective study, conducted during 2021 on 993 samples (546 males 447 females) from patients with suspected acute viral respiratory infections who were hospitalized in hospitals of Golestan Province, we evaluated the clinical and laboratory findings of patients with influenza. The samples were sent to the provincial molecular diagnostics laboratory for real-time polymerase chain reaction (PCR) molecular testing. All samples were also tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Test results, along with demographic, clinical, and laboratory data, were collected using a standardized questionnaire. Of the 993 samples tested for influenza, 174 were reported as positive. All, but one, of these positive cases were influenza A. From 993 tests for SARS-CoV-2, 271 cases were also reported as positive. Additionally, 11 patients had influenza and SARS-CoV-2 co-infection. The mean age of influenza patients hospitalized in the intensive care unit (ICU) was determined to be 55.60±15.11 years, while in other wards, it was 37.51±12.1 years (P<0.05). Regarding gender, the ICU-hospitalized male-to-female ratio was 3 times and 1.35 times in other wards (P<0.05). In ICU-hospitalized patients, the highest percentage of clinical symptoms belonged to fever, cough, chills, and anorexia, and in patients hospitalized in other wards, the highest percentage belonged to fever, followed by cough, chest pain, and chills. There was a statistically significant difference between ICU-hospitalized patients and those hospitalized in other wards for symptoms, such as anorexia, arthralgia, myalgia, sore throat, cough, nausea, headache, and chills (P<0.05). Blood factors, such as white blood cell (WBC) count, neutrophil and lymphocyte percentages, hemoglobin, erythrocyte sedimentation rate (ESR), and platelets, were evaluated, and no statistically significant difference was observed between the two patient groups. Biochemical factors, including blood urea nitrogen (BUN), creatinine, sodium, potassium, liver enzymes, such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), lactate dehydrogenase (LDH), creatine phosphokinase (CPK), and direct and indirect bilirubin, were also examined, and no significant difference was found between the two patient groups. Additionally, other factors, such as oxygen and carbon dioxide saturation percentages, bicarbonate, and blood pH were assessed, and a statistically significant difference was found between the two groups for oxygen and carbon dioxide saturation percentages (P<0.05). Based on the findings of this study, age and gender are effective factors in the severity of influenza. Men and older adults are at particular risk for ICU hospitalization. The high prevalence of influenza A and cases of SARS-CoV-2 co-infection also highlight the importance of accurate diagnosis and appropriate treatment. Given the increased risk of infection and disease severity among the elderly, implementing preventive programs, such as annual influenza and coronavirus disease 2019 (COVID-19) vaccinations, is essential for this group. Additionally, attention to laboratory findings like blood oxygen levels can be effective in the early identification of high-risk patients.

Excessive weight gain during pregnancy is recognized as a global epidemic and is associated with complications, such as gestational diabetes. While a healthy diet and regular physical activity positively influence weight control and overall well-being, in-person consultations can be costly and time-consuming. The use of digital technologies, particularly smartphones, has increased for delivering lifestyle interventions and improving well-being. These technologies provide affordable access to health services for pregnant women, especially those in remote areas. This narrative review was conducted to evaluate the effect of telehealth on weight control and the promotion of a healthy lifestyle among pregnant women. A search was performed in the PubMed, Google Scholar, and Scopus databases. Of the 631 initial articles published during 2020-2024,
15 were selected and evaluated after excluding irrelevant articles, review articles, and those without full texts. The selected articles showed that mobile health (mHealth) could improve indicators, such as weight, body mass index (BMI), maternal and infant health, and lifestyle. However, certain limitations, including access issues, cultural barriers, and fluctuations in service quality, impacted their effectiveness. Based on the findings of these articles, it is suggested that personalized interventions be designed with continuous consultations and daily reminders. Forming virtual groups and providing timely feedback can strengthen the sense of belonging and promote adherence. These strategies are valuable for telehealth clinics and online counseling programs.
 

Background and Objective: Chlamydia, a zoonotic bacterial agent, is a major concern for both human and avian public health. This bacterium belongs to the family Chlamydiaceae, with 11 identified species. The Chlamydia psittaci (C. psittaci) species is shared between animal hosts and humans. Ornamental birds are among the hosts of C. psittaci. This bacterium causes respiratory and gastrointestinal problems in these birds. This study aimed to determine the prevalence of chlamydial infection in ornamental birds in Urmia, Iran.
Methods: This descriptive study was conducted on 60 fecal swabs collected from 60 ornamental birds in Urmia. Giemsa staining and molecular polymerase chain reaction (PCR) testing, using genus-specific primers to amplify a 580-base pair (bp) fragment of the ompA gene, were performed on the samples.
Results: The Chlamydia molecule was detected in 11.7% of budgerigars with gastrointestinal symptoms and in 5.88% of apparently healthy budgerigars. Additionally, the infection was detected in 11.11% of cockatiels, 14.28% of mynahs, 20% of canaries, and 11.11% of finches, but not in other species.
Conclusion: The results of this study demonstrate the presence of the Chlamydia bacterium in ornamental birds in Urmia, which can be considered a source of infection for gastrointestinal diseases.