Cesarean section (CS) rates have been increasing globally. Iran has one of the highest CS rates in the world (47.9%). This review was conducted to assess the prevalence of and reasons for women’s, family members’, and health professionals’ preferences for CS in Iran. In this mixed-methods systematic review, we searched MEDLINE/PubMed, Embase, CINAHL, POPLINE, PsycINFO, Global Health Library, Google scholar; as well as Iranian scientific databases including SID, and Magiran from 1 January 1990 to 8th October 2019. Primary quantitative, qualitative, and mixed-methods studies that had been conducted in Iran with Persian or English languages were included. Meta-analysis of quantitative studies was conducted by extracting data from 65 cross-sectional, longitudinal, and baseline measurements of interventional studies. For meta-synthesis, we used 26 qualitative studies with designs such as ethnography, phenomenology, case studies, and grounded theory. The Review Manager Version 5.3 and the Comprehensive Meta-Analysis (CMA) software were used for meta-analysis and meta-regression analysis. Results showed that 5.46% of nulliparous women (95% CI 5.38–5.50%; χ2 = 1117.39; df = 28 [p < 0.00001]; I2 = 97%) preferred a CS mode of delivery. Results of subgroup analysis based on the time of pregnancy showed that proportions of preference for CS reported by women were 5.94% (95% CI 5.86–5.99%) in early and middle pregnancy, and 3.81% (95% CI 3.74–3.83%), in late pregnancy. The heterogeneity was high in this review. Most women were pregnant, regardless of their parity; the risk level of participants were unknown, and some Persian publications were appraised as low in quality. A combined inductive and deductive approach was used to synthesis the qualitative data, and CERQual was used to assess confidence in the findings. Meta-synthesis generated 10 emerging themes and three final themes: ‘Women’s factors’, ‘Health professional factors’, andex ‘Health organization, facility, or system factors’. Despite low preference for CS among women, CS rates are still so high. This implies the role of factors beyond the individual will. We identified a multiple individual, health facility, and health system factors which affected the preference for CS in Iran. Numerous attempts were made in recent years to design, test and implement interventions to decrease unnecessary CS in Iran, such as mother-friendly hospitals, standard protocols for labor and birth, preparation classes for women, midwives, and gynaecologists, and workshops for specialists and midwives through the “health sector evolution policy”. Although these programs were effective, high rates of CS persist and more efforts are needed to optimize the use of CS.

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Prevalence of and reasons for women’s, family members’, and health professionals’ preferences for cesarean section in Iran: a mixed-methods systematic review

Background:Specialist palliative care services have a key role in a whole system response to COVID-19, a disease caused by the SARS-CoV-2 virus. There is a need to understand service response to sh...

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'Necessity is the mother of invention': Specialist palliative care service innovation and practice change in response to COVID-19. Results from a multinational survey (CovPall).

Pesticides are important chemicals or biological agents that deter or kill pests. The use of pesticides has continued to increase as it is still considered the most effective method to reduce pests and increase crop growth. However, pesticides have other consequences, including potential toxicity to humans and wildlife. Pesticides have been associated with increased risk of cardiovascular disease, cancer, and birth defects. Labels on pesticides also suggest limiting exposure to these hazardous chemicals. Based on experimental evidence, various types of pesticides all seem to have a common effect, the induction of oxidative stress in different cell types and animal models. Pesticide-induced oxidative stress is caused by both reactive oxygen species (ROS) and reactive nitrogen species (RNS), which are associated with several diseases including cancer, inflammation, and cardiovascular and neurodegenerative diseases. ROS and RNS can activate at least five independent signaling pathways including mitochondrial-induced apoptosis. Limited in vitro studies also suggest that exogenous antioxidants can reduce or prevent the deleterious effects of pesticides.

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A Common Feature of Pesticides: Oxidative Stress—The Role of Oxidative Stress in Pesticide-Induced Toxicity

Background According to the World Health Organization, two billion people will attain the age of 60 years or more by 2050. Ageing is a major risk factor for a number of neurodegenerative disorders, which currently possess challenge to the global health status, carrying economic and social consequences. Therefore, attention has been dedicated towards the development of neuroprotective agents derived from natural sources. Honeybee products, such as honey, bee pollen, bee bread, propolis, royal jelly, beeswax, and bee venom have been used for therapeutic purposes since ancient times in Egypt, Greece, and China. Despite the emergence of modern medicine, bee products remain clinically relevant owing to their potential as anti-inflammatory, anti-oxidant, and neuroprotective agents. Scope and approach This review demonstrates the potential of bee products against neurological disorders in the light of the current literature. Key findings and conclusions Bee products and individual isolated components have enormous therapeutic potential for multiple neurological disorders. The different studies show overall neuroprotective and nerve-tonic characteristics of bee products, mainly due to their anti-oxidant, anti-inflammatory and anti-apoptotic features. However, some limitations such as allergic reactions and the cytotoxic effect of some bee products warrant a special care in its development as drug leads in future studies.

Honeybee products: An updated review of neurological actions

Statin treatment reduces cardiovascular risk. However, individuals with well-controlled low-density lipoprotein (LDL) levels may remain at increased risk owing to persistent high triglycerides and low high-density lipoprotein cholesterol. Because resveratrol promotes glucose metabolism and mitigates cardiovascular disorders, we explored its mechanism of protective action on high-fat-induced endothelial dysfunction. Human umbilical venous endothelial cells were treated with oxidized LDL (ox-LDL) in vitro. Endothelial function, cell survival, proliferation, migration, and oxidative stress were analyzed through western blots, quantitative polymerase chain reaction, ELISA, and immunofluorescence. ox-LDL induced endothelial cell apoptosis, proliferation arrest, and mobilization inhibition, all of which resveratrol reduced. ox-LDL suppressed the activities of mitochondrial respiration complex I and III and reduced levels of intracellular antioxidative enzymes, resulting in reactive oxygen species overproduction and mitochondrial dysfunction. Resveratrol treatment upregulated Bnip3-related mitophagy and prevented ox-LDL-mediated mitochondrial respiration complexes inactivation, sustaining mitochondrial membrane potential and favoring endothelial cell survival. We found that resveratrol enhanced Bnip3 transcription through hypoxia-inducible factor 1 (HIF1) and 5' AMP-activated protein kinase (AMPK). Inhibition of AMPK and HIF1 abolished resveratrol-mediated protection of mitochondrial redox balance and endothelial viability. Together, these data demonstrate resveratrol reduces hyperlipemia-related endothelial damage by preserving mitochondrial homeostasis.

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Resveratrol Improves Bnip3-Related Mitophagy and Attenuates High-Fat-Induced Endothelial Dysfunction.

Background: Despite the emergence and development of evidence-based practice (EBP) in recent years, its adoption continues to be limited. This study used Rogers's diffusion of innovation theory to identify the factors that advance EBP adoption, determine the process by which such adoption occurs, and develop an EBP adoption model. Methods: This descriptive correlational study with model testing design conducted in 2015.Data were collected from 482 individuals (322 nurses and 160 nursing students) applying a demographic information questionnaire, a standard scale for the perception EBP attributes, an EBP scale, and an individual innovation inventory. The relationships between variables we reexamined by path analysis. Results: The results showed that EBP adoption had a significant positive relationship with individual innovation (r = 0.578, P < 0.001), knowledge (r = 0.657, P < 0.001), attitude (r = 0.623,P < 0.001), and age (r = 0.357, P < 0.001). The findings of path analysis indicated that the goodness of fit indices such as goodness of fit index (GFI) = 0.999, comparative fit index (CFI)= 0.999, root mean square error of approximation (RMSEA) = 0.036 were in the ideal ranges.Knowledge (total effect=0.309, P < 0.001), attitude (total effect = 0.372, P = 0.002), and work experience (total effect=0.321, P = 0.003) had the highest coefficient in the model. Conclusion: The results suggested that EBP adoption was influenced by various factors, such as individual innovation, attitude, knowledge, and the perception of EBP attributes. Among these factors, attitude had the greatest effect on EBP adoption. The findings can serve as a guide for the identification of factors that effectively influence EBP adoption. They can also be used as bases for the design of training programs intended to enhance the adoption of EBP.

https://hpp.tbzmed.ac.ir/PDF/hpp-8-25.pdf

Evaluating the adoption of evidence-based practice using Rogers's diffusion of innovation theory: a model testing study.

Oxidative stress is strongly associated with development of diabetes mellitus. F. vulgaris, contains antioxidant ingredients. This study was designed in order to evaluate the effect of F. vulgaris on the damaged liver in diabetic rats. In this study, hydroalcoholic extract of F. vulgaris was prepared. Sixty four male rats were divided into 8 groups (n = 8), including saline (normal control), streptozotocin (STZ) (diabetic control) (60 mg/kg), F. vulgaris (50, 100, 150 mg/kg), and STZ plus F. vulgaris (50, 100, 150 mg/kg) were administered through oral gavage on treated group once a day for 28 consecutive days. Serum nitrite oxide (NO) level, Ferric reducing/antioxidant power (FRAP), Malondialdehyde (MDA), liver weight, aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), diameter of hepatocytes and central hepatic vein have been examined. Statistical analysis was performed using one-way analysis of variance and the post hoc test. The outcomes showed that administrating streptozotocin enhanced liver MDA, nitrite oxide, the mean diameter of central hepatic vein and hepatocyte, liver enzymes significantly and reduced liver weight compared to saline group (P < 0.05). Though, administrating F. vulgaris and F. vulgaris plus STZ enhanced liver weight and tissue FRAP level significantly and reduced liver enzymes, NO levels, liver MDA, the mean diameter of hepatocyte and central hepatic vein in entire doses were equal to STZ group (P < 0.05). It seems that, were equal F. vulgaris might recover liver injuries in diabetic rats.

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Effect of Falcaria vulgaris on oxidative damage of liver in diabetic rats.

Normal delivery is a natural and physiological process with numerous benefits for mother and baby. Giving birth by Caesarean Section (CS) should be limited to the cases in which normal delivery is not possible. The purpose of the study was to determine the attitudes of pregnant women towards Normal Delivery and factors driving the use of Caesarian Section in Kermanshah, Iran. This analytical-descriptive study was conducted on 410 pregnant women referred to the PHC centers in Kermanshah in western Iran. They had been selected through a multi-stage sampling method, including clustering, randomized, and proportional sampling, from among all eligible women. Data was collected using a questionnaire standardized by previous studies. The level of 0.05 was considered significance association, whenever applied. The mean and standard deviation for participant age was 27.65 ± 5.37 years. The median score for participant attitude was 60.7 ± 9.5 (range from 22 to 85). Generally, 21.5% had a negative attitude toward normal delivery and preferred CS. Participant attitude was negatively correlated with a pregnant woman’s age, lower age, and a more positive attitude towards vaginal childbirth. The attitude of women with a history of normal delivery was 63 ± 9 and for those with a history of CS was 56.7 ± 9.3, significantly different. Most women had a positive attitude towards normal delivery, particularly those who had experienced normal delivery in their previous childbirth. Although only a quarter of the participants had a negative attitude toward normal delivery, this figure still was of utmost significance, therefore educational interventions, specifically encouraging women with history of normal delivery to consult their peers, are recommended.

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Attitude of pregnant women towards Normal delivery and factors driving use of caesarian section in Iran (2016)

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Attitudes Toward Caring of the Elderly From the Perspective of Nursing and Midwifery Students in Kermanshah Province in 2015

Objective: Malathion is the most organophosphates which capable to produce free radicals and induce disturbance on some of male reproductive parameter. Resveratrol is an herbal polyphenol and it has been beneficial antioxidant effects during short-term administration. This study was designed to evaluate the effects of Resveratrol against damage induced by Malathion to the reproductive parameter of male rats. Materials and methods: In this experimental study, 48 male rats were randomly assigned to 8 groups: normal control (saline) and Malathion control (250 mg/kg) groups; Resveratrol groups (2, 8, 20 mg/kg) and Malathion + Resveratrol (2, 8, 20 mg/kg). Treatments were administered intraperitoneally and gavage daily for 65 days. The sperm parameters, testis malondialdehyde (MDA), total antioxidant capacity (TAC), testosterone level and germinal layer height were evaluated and statistically analyzed. Results: The results displayed that the values of all parameters except MDA level (which increased) reduced significantly in the Malathion control group compared to the normal control group (p 0.05). Conclusion: Resveratrol attenuates toxic effect of Malathion on some of male reproductive parameters.

Mohammad Mehdi Mohammadi

Papers

Evaluating the adoption of evidence-based practice using Rogers's diffusion of innovation theory: a model testing study.

Effect of Falcaria vulgaris on oxidative damage of liver in diabetic rats.

Attitude of pregnant women towards Normal delivery and factors driving use of caesarian section in Iran (2016)

Attitudes Toward Caring of the Elderly From the Perspective of Nursing and Midwifery Students in Kermanshah Province in 2015

Resveratrol Attenuates Malathion Induced Damage in Some Reproductive Parameters by Decreasing Oxidative Stress and Lipid Peroxidation in Male Rats.