Due to the significant advancement of modern societies, higher education, career growth, and economic independence, more young girls are likely to delay childbearing beyond 30 years of age. The trend of delayed childbearing is more pronounced in industrialized countries but is also becoming common in emerging countries. Delayed childbearing has been linked with several adverse maternal-perinatal outcomes, including hypertensive disorders of pregnancy, abnormal placentation, gestational diabetes mellitus, preterm births, low birthweight, perinatal mortality, congenital birth defects, and chromosomal abnormalities. In this review, we have highlighted the trend of delayed childbearing age, the role of education and employment in delayed childbearing age, and its potential impact on adverse maternal-perinatal outcomes in developed and developing countries. 

Background: Breastfeeding self-efficacy (BSE) is a modifiable factor that can enhance breastfeeding rates. Telemedicine constitutes safe and low-cost health services that can be developed for the interaction between professionals and clients. Therefore, this study aimed to review the effectiveness of telemedicine-based intervention on BSE in Iranian women.

Methods: This systematic and meta-analysis review was performed according to PRISMA guidelines. English databases including Web of Science, PubMed, Scopus, and Persian databases including SID, Magiran, and IranMedex was searched until Aug 1, 2023 to identify randomized control trials about telemedicine-based interventions on BSE in Iran. The search strategy was focused on terms and eligibility criteria. Data analysis was done using CMA V.2 software. The risk of bias in the included studies was assessed.

Results: Out of 385 articles, eight articles that met the inclusion criteria were included in the meta-analysis. The overall result demonstrated that telemedicine-based interventions have a positive impact on BSE compared with the control, especially in the long-term intervention (pooled SMD= 1.27; 95% CI= 1.01–1.53, P-value<0/001); heterogeneity (Cochrane’s Q‐value=51.94, P<0/001, I2=76.90%). In addition, twelve weeks of postpartum had more effect on BSE than the others. Also, breastfeeding intervention in the postpartum period was more effective compared with pregnancy. The publication bias among included studies was assessed by funnel plot.

Conclusion: This review could give insight to healthcare providers into the effect of telemedicine on BSE. Therefore, by strengthening BSE through telemedicine interventions, especially for women who do not have the conditions for face-to-face counseling, we can expect positive results.

Background: We used the Predictive Model Bias Risk Assessment tool (PROBAST) tool to systematically evaluate the existing models worldwide, in order to provide a reference for clinical staff to select and optimize DFU recurrence risk prediction models.

Methods: Literature on DFU recurrence risk prediction model construction published in CNKI, China Biomedical Literature Database, Vipu China Knowledge, China Biomedical Literature Database, Vipu Chinese Journal Service Platform, Wanfang Data Knowledge Service Platform, Embase, PubMed, Web of Science, Cochrane Library and other databases were systematically searched. The search period was until January 29, 2024, encompassing all relevant studies published up to that date. Literature screening and data extraction were conducted by two researchers, and the PROBAST was used to evaluate the bias risk and applicability of the included literature.

Results: Finally, 9 literatures were included, 13 prediction models were established, and the area under the AUC or C-index ranged from 0.660 to 0.943. Nine models were validated internally and one model was validated externally. All the models constructed in the included literature are of high-risk bias, and the applicability of the models is reasonable. Common predictors in the prediction model were Wagner scale, glycosylated hemoglobin, and diabetic peripheral neuropathy.

Conclusion: Although most of the existing DFU risk prediction models have good prediction performance, they all have high risk of bias. It is suggested that researchers should update the existing models in the future, and future modeling studies should follow the reporting norms, so as to develop a scientific, effective and convenient risk prediction model that is more conducive to clinical practice.

Background: Older adults are the most hypertensive population compared to other age groups. The purpose of this study was to determine an education model involving the family and the outcomes of the program.

Methods: Studies conducted in 2023. The search terms "Aged or Older Adult or Elderly and Family-centered or Family Nursing and Hypertension or High Blood Pressure" were used to conduct a scoping review in the journals PROQUEST, SCOPUS, MEDLINE, COCHRANE, and PubMed until 2022. The flowchart for the PRISMA Scoping review shows the search and selection procedure. Tools from the Joanna Briggs Institute (JBI) for Randomized Controlled Trials and Quasi-Experimental Studies are used to critically evaluate a few chosen papers.

Results: There were 11 articles found out of 2,355 articles in the search results. To increase perceived threat, self-efficacy, and self-confidence, the family-involved education intervention is implemented in phases. Knowledge, family involvement, blood pressure, cholesterol, uric acid, quality of life, and behavioral changes were among the outcomes that were evaluated.

Conclusion: Education involving families of the elderly with hypertension can affect a decrease in blood pressure, an increase in self-efficacy and good behavioral change, an increase in self-esteem, improved life quality, and family empowerment.Older adults

Background: This systematic review and meta-analysis aimed to evaluate the prevalence and clinical implications of metabolic syndrome in individuals with diabetes mellitus. 
Methods: A comprehensive search was conducted across multiple databases using key terms related to metabolic syndrome and diabetes. Access to subscription-based journals was facilitated through the HINARI program. Study quality was assessed using the adapted Newcastle–Ottawa scale, with a minimum inclusion score of ≥5/10. Statistical analysis included a meta-analysis using the DerSimonian and Laird random-effects model to determine the pooled prevalence, with heterogeneity assessed using Cochran’s Q and I² statistics. Publication bias was evaluated via funnel plot symmetry. Analyses were conducted using Stata/MP 17.0.
Results: The meta-analysis revealed a pooled effect size of 1.98 (95% CI: 1.85, 2.10), with significant heterogeneity (I² = 92.35%). Prevalence ranged from 19.88% to 88.13%, underscoring a substantial burden. Variations in HbA1c, HDL cholesterol, blood pressure, and BMI highlighted the heterogeneity in metabolic syndrome characteristics. Advanced statistical approaches enriched the understanding of metabolic profiles and their interplay with glycemic control and lipid metabolism.
Conclusion: This study underscores the critical interplay between glycemic control and lipid profiles in metabolic syndrome. The findings emphasize the need for tailored, region-specific interventions to address its substantial burden and implications for clinical practice and policy.

Background: Electronic medical records (EMRs) can minimize mistakes, enhance the comprehensiveness, legibility, and overall comprehension of medical records. However, nurses' limited familiarity with advanced technology lowers their confidence in utilizing EMRs. We aimed to collect and synthesize the most credible evidence on nurses' perception of EMRs, along with the barriers and facilitators that influence their acceptance.
Methods: Searching for relevant studies was carried out across three electronic databases, namely PubMed, Scopus and ProQuest in Dec 2023. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was followed in this study report. The selected studies were then analyzed narratively and organized thematically for presentation.
Results: Out of the 4,382 articles identified through comprehensive database searches, only 19 met the criteria for inclusion and reviewed. Through the synthesis of findings, two primary themes emerged, including nurses' perceptions and experiences with EMRs and facilitators & barriers for nurses’ in utilizing EMRs.
Conclusion: Nurses' perspectives are shaped by their computer skills, confidence in their abilities, and training. Despite obstacles such as nurse stress, EMRs present advantages such as enhanced patient care and decreased errors. Augmenting computer competency, delivering training, and guaranteeing support are essential for effective EMRs integration, leading to enhanced healthcare provision and better patient results.

Background: We aimed to investigate the subject matters and the quality of publications detailing the findings of cohort studies within the realm of complementary and alternative medicine (CAM).
Methods: A scoping review was conducted on cohort studies in the CAM field up to the conclusion of 2023. The evaluation of their quality was carried out utilizing the 'Strengthening the Reporting of Observational Studies in Epidemiology' (STROBE) checklist. Moreover, an analysis of their research settings and associated variables, including publication year, type of disease, intervention method, and study field, was conducted.
Results: Overall, 215 articles were identified. The majority of these cohorts, approximately 42.3%, originated from Taiwan, with stroke and cardiovascular diseases emerging as the most prevalent outcomes of interest. The mean STROBE score was 1.38 (SD=0.57) out of 2. The lowest scores were associated with the methods and funding sections. Methodologically, the principal weaknesses were linked to sample size, loss to follow-up, and bias control.
Conclusion: The frequency of cohort studies in CAM was limited, predominantly concentrated in a few countries. Chinese medicine and acupuncture were the main intervention methods, while other CAM interventions received less focus. Furthermore, the quality of these studies was deemed unsatisfactory in most cases.

Background: Breast cancer (BC) is the leading cancer among women globally. Early detection through screening is vital for reducing mortality, complementing advancements in treatment.
Methods: We aimed to overview BC screening practices in Iran over two-decades to inform policymakers for future research directions and prompt timely diagnoses. A scoping review was conducted on BC studies in Iran from 2000 to 2023, following PRISMA guidelines.
Results: We analyzed 129 articles on BC in Iranian women, and finding six main areas.
Conclusion: Iran's health system lacks an organized BC screening initiative, facing challenges like inadequate infrastructure, sociocultural barriers, unintegrated health insurance packages, and limited research on key indicators.

Background: Avian colibacillosis are infections caused by Avian Pathogenic Escherichia coli which causes high morbidity, high mortality, and significant economic losses. Antibiotics such as tetracycline are an important treatment choice for colibacillosis in Iran. However, the irrational use of antibiotics has caused high antibiotic resistance. The aim of this study was to estimate the tetracycline resistance rate among E. coli isolates from broilers in Iran.
Methods: PubMed, Scopus, Web of Science, Google Scholar, Islamic World Science Citation, Scientific Information Database, and MagIran databases were searched from 2013 and 2023. Risk of bias assessment was assessed with Appraisal tool for Cross-Sectional Studies. For meta-analysis, a random effects model with Freeman-Tukey double arcsine transformation was used. Subgroup analysis for the year of publication and sensitivity analysis to assess the influence of individual studies were conducted and a province-level map of point estimates was drawn.
Results: Among 13 included studies, the pooled tetracycline resistance was 85% (95% CI: 76-92%) and I-squared was 94.29%. In subgroup analysis, resistance rate was higher for articles published in 2018-2023 (91%) compared to articles published in 2013-2017 (76%), but heterogeneity between groups was not statistically-significant (P=0.12). sensitivity analysis showed that the omission of individual studies caused no apparent change. The province-level map showed that most of the studies belonged to northern parts of Iran with Ardabil (99.65%) having the highest value.
Conclusion: Resistance against tetracycline in E. coli isolates from broilers in Iran is alarming. The sensible use of tetracycline is advised.

Background: Couple interventions focus on resolving relationship issues and improving partners' intimacy. Several intervention models are used on different occasions to deal with the issues. The present systematic review and meta-analysis investigated the effectiveness of such couple interventions dealing with marital distress.
Methods: Using the PRISMA guidelines for reporting systematic reviews and meta-analyses, a search was carried out to identify published articles in the areas of study. The meta-analysis investigated the effectiveness of couple interventions by comparing the post-intervention assessments of the experimental and control groups.
Results: The systematic review helped to identify twelve empirical studies published within the last ten years in the following databases: ScienceDirect, EBSCO, APA PsycINFO, NCBI, ProQuest, and Google Scholar. Meta-analysis showed a statistically significant overall effect size (Cohen's d = 0.85, 95% CI: 0.56 - 1.14). Cochran's Q showed that there was a substantial difference between the studies. There were signs of publication bias.
Conclusion: The current study revealed an overall large effect size, indicating that different couple interventions had a noticeable impact on distressed couples who received interventions as opposed to couples who did not receive any interventions.

Background: Depression is a common psychological problem among the elderly. It undermines the elderly’s quality of life and imposes a heavy economic burden on society and families. Depression in this group must be addressed, but effective intervention therapies remain absent in existing studies. Strength-based cognitive behavior theory was combined with narrative therapy in this study. Its effect on depression in the elderly was verified through an intervention experiment.
Methods: From April to June 2024, 319 elderly people were recruited from Huoju Community in Changsha, Hunan Province, China to examine the factors influencing depression. A total of 85 of them with depression symptoms were included in a randomized intervention experiment and divided into two groups: 42 in the experiment group and 43 in the control group. The experiment group was intervened with strength-based narrative therapy, whereas the control group was given no targeted intervention.
Results: After the intervention, 1) the total depression score of the experiment group was significantly lower than that of the control group (P=0.001); 2) the mental state score of the control group decreased more significantly than that of the experiment group (P<0.05); and 3) the quality-of-life score of the experiment group was significantly higher than that of the control group at different time points (P<0.05).
Conclusion: Strength-based narrative therapy can effectively alleviate depression symptoms in the elderly, improve their mental state, delay their cognitive decline, and enhance their quality of life. It is an effective option to promote the elderly’s mental health.

Background: This study was conducted to perform deep learning-based body shape cluster analysis using 3D Body Scanner.
Methods: For this study, 54 variables were measured using 3D Body Scanner on 366 adult men and women at Korea National Sport University in 2022. Transformer learning and dimensionality reduction models were used to perform cluster analysis on the measured data. Mann-Whitney test and Kruskal-Wallis test were applied to compare the principal component differences of new scale characteristics, and all statistical significance levels were set at .05.
Results: First, among the two methods for classifying body types, the transformer algorithm had a higher performance in body type classification. Second, in the classification of body type clusters, two clusters, endomorphic body type and ectomorphic body type, were divided into six clusters, two for cluster 1 and four for cluster 2.
Conclusion: The six clusters provide more granular information than previous body type classifications, and we believe that they can be used as basic information for predicting health and disease.

Background: Under the influence of numerous life factors, speech constantly undergoes changes. Parents of children with speech and language disorders have a lower quality of life compared to the parents of children without. The study examined different domains of the quality of life of families with and without speech disorders. 
Methods: A cross-sectional study was conducted in Serbia, in 2024, on a sample of 206 preschool children aged 5- 7 years and their parents/guardians. As a research instrument, in addition to the General Questionnaire on sociodemographic characteristics of children and parents’ respondents/guardians, the Family Quality of Life Survey (FQOL) was used to assess the family's quality of life.
Results: Articulation disorder was detected in 78.2% of children. Difference between the two groups of parents was found in terms of place of residence, work status, education levels, and children’s age. From the five domains of family quality of life, significance was found in the domain of family interaction regarding the support, support related to disability, and family safety. Regarding the physical/material well-being domain, the significance was found for dental care and parenting domains. No differences were found in the domain of emotional well-being.
Conclusion: The importance of the study reflects in the possibility of applying the obtained research results for the creation of educational programs that will encourage positive attitudes of parents and children about speech therapy interventions, which can influence successful rehabilitation of speech disorders and improve family quality of life.

Background: We aimed to enhance the quality of cancer care by reducing the rate of sample rejection and lowering the incidence of sample mislabeling at the Sultan Qaboos Comprehensive Cancer Care and Research Centre in Muscat, Oman.
Methods: We adopted a one-group pretest-posttest quasi-experimental design from the second quarter of 2022 to the first quarter of 2023, assessing key performance indicators related to sample rejection and mislabeling on quarterly basis before and after implementing targeted interventions. The project utilized the FOCUS PDCA framework for systematic implementation and evaluation. Four FOCUS PDCA sessions were conducted involving a multidisciplinary team of ten participants comprising oncologists, nurses, laboratory technicians, quality management experts, and informatics and cyber security department staff. Ethical clearance was obtained from the Institutional Review Board, ensuring adherence to ethical protocols. Interventions included five educational sessions for nurses and physicians, process modifications, and improved communication protocols.
Results: Analysis revealed a significant decrease in the rate of rejected samples, declining from 20.85% during Pre-Intervention to 6.05% in the Post Intervention phase. Similarly, the mislabeling rate exhibited a substantial reduction, decreasing from 1.68% to 0.25% over the same period. Statistical analysis using ANOVA confirmed significant differences between intervention phases for both the rejected samples rate (F-value = 12.3458, P-value = 0.002) and the mislabeling rate (F-value = 57.1875, P-value < 0.001).
Conclusion: These results underscored the effectiveness of the interventions in improving blood sample collection and management processes, thereby enhancing the reliability of study outcomes.

Background: Students making the transition from high school to university find it difficult to maintain good eating routines/lifestyles and mental health, due to time constraints and stress. The goal of the study was to analyse the correlation between previously mentioned topics.
Methods: We included 948 students, aged 18-27, at the Faculty of Medical Sciences in Serbia and the research was conducted in 2020. Chi-square was used for statistical analysis. Modified WHO questionnaire for lifestyle and eating habits was used, as well as standardized questionnaires for anxiety and depression.
Results: Respondents who had more prominent symptoms of depression (moderate or severe) and anxiety had a significantly higher percentage of eating less than three meals a day (47.7%, 35.7%), skipped breakfast (38.6%, 33.5%), consumed alcohol (11.4%, 3.8%), used energy drinks (38.6%, 31.7%), were on some type of diet (36.6%, 30.2%), were not satisfied with their appearance (66.7%, 53%) and not engaging in physical activity (43.2%, 33.1%). Significant predictors for severe depressive and anxiety symptoms were the consumption of alcoholic beverages, energy drinks, satisfaction with personal appearance and physical activity during a day.
Conclusion: The results suggest that some of the eating and lifestyle habits were linked to higher risks of developing depressive or anxiety symptoms.

Background: We examined the association of breakfast habits with hypertension and obesity risk among Korean adults and older adults, focusing on sex-based and age-based differences.
Methods: We collected data from 2,779 adults (1,380 men and 1,399 women, aged 19–64 years) and 623 older adults (289 men and 334 women, aged ≥65 years) from the 2015 Korea National Physical Fitness Project, an extensive survey organized biennially by the Korea Ministry of Culture, Sports and Tourism and the Korea Institute of Sport Science.
Results: For women aged 19 to 64 yr, skipping breakfast was linked to an increased likelihood of developing both high blood pressure and obesity. For men aged 19–64 years, having breakfast irregularly or replacing it with snacks were linked to a reduced likelihood of hypertension, whereas skipping breakfast slightly elevated the risk. For older women aged above 65 years, irregular breakfast consumption or replacing it with snacks was linked to a heightened likelihood of developing hypertension. Nonetheless, there was no notable correlation identified between breakfast habits and obesity in men and older adults. In older men and women, consistent physical exercise proved to be an essential factor in mitigating the chance of hypertension.
Conclusion: These findings emphasize the importance of sex- and age-specific public health strategies, with implications for public health interventions and guidelines that promote regular breakfast consumption and physical activity.

Background: Air pollution has become a serious threat to public health. Epidemiological and clinical evidence in recent years has shown air pollutants are associated with respiratory diseases. We aimed to analyze the impact of environmental factors on influenza incidence by examining the most polluted countries in the world.
Methods: To analyze the relationship between environmental factors and influenza incidence in eighteen countries, we used a system generalized method of moments (GMM) using data from 2010 to 2020.
Results: The results suggest a positive effect of air pollution (PM_2.5 and NO₂) and population density on the incidence of influenza. While government health expenditures and education have a negative effect on influenza in the studied countries.
Conclusion: Our results confirmed the importance of environmental and social factors in the incidence of influenza. Furthermore, our results are interesting and informative for policymakers to design public health policies synchronized with other policies such as education, industrial, and environmental policies, for better management of influenza.

Background: The COVID-19 pandemic has had a significant impact on global suicide attempt rates. This study evaluated the effect of the COVID-19 pandemic on suicide attempts in the Kerman Province, eastern Iran.
Methods: This is a cross-sectional study. Data on suicide attempt cases in Kerman Province was obtained from the database of Mental, Social, and Addiction Health Office of the Deputy for Health of Medical Sciences Universities from 2018 to 2021. An interrupted time-series model was used to assess the changes in suicide attempts before and after the pandemic.
Results: Suicide attempts exhibited a decreasing trend before the pandemic, with a monthly decrease of 0.9% (P<0.001). The immediate effect of the pandemic indicated that, at the beginning of the pandemic, there was a 4.5% increase in suicide attempts (P=0.134). The sustained effect of the pandemic showed that in the months following the onset of the pandemic, the rate of suicide attempts increased by 1.8% compared to before the pandemic (P<0.001). By the end of 2021, the number of suicide attempts per month exceeded the predicted amount based on pre-pandemic data. Factors such as marital status, education, occupation, place of residence, and previous suicide attempts were found to influence suicide attempts during the pandemic.
Conclusion: Given the significant increase in suicide attempts following the onset of the pandemic, it is crucial to prioritize the implementation of prevention and intervention programs during this crisis.

Background: It is critical to precisely assess the presence of cardiovascular (CV) risk in military personnel, in order to avoid potentially CV-events. In Iran limited number of studies have been performed on military personnel and their CV-risk. We aimed to investigate correlation between obesity and cardiovascular disease (CVD) risk factors in military personnel.
Methods: The present cross-sectional analytical study, analyzed the data of 559 military personnel in Tehran, Iran in 2023. The dataset sourced from the registry system. The biochemical analysis of blood samples was performed by a biomedical analysis company. The univariate regression analyses were conducted through separate univariate linear regression within the obesity group.
Results: The mean age of personnel was 36.58 years. Among obese personel, there was an inverse relationship between age and cholesterol β=-0.11. Moreover, hemoglobin β=-0.68 and MCH β=-0.33 were significantly related to high cholesterol, MCH is associated with risk of metabolic syndrome (β=-0.57). Moreover among obese personnel, lower uric acid levels and higher ALT levels are correlated with an increased risk of Diabetes.
Conclusion: The prevalence of obesity in military personnel was the same as in the general population. Diabetes, hyperlipidemia, high blood pressure, obesity, and metabolic syndrome were all linked to CVD risk factors among military personnel. Although the prevalence of metabolic syndrome in military personnel was lower than their peers in other countries, other risk factors of CVD were prevalent among military personnel.

Background: The cause of oligoasthenoteratozoospermia (OAT) is unclear. In this original study, we examined OAT patients' sperm using RNA-sequencing and studied the impact of curcumin on gene expression during sperm cryopreservation and freeze-thawing.
Methods: RNA-seq was performed using the Galaxy Europe server in IKHC (Imam Khomeini Hospital Complex), Tehran, Iran in 2023. Sperm samples were collected from 30 OAT patients and 30 healthy volunteers. Sperm parameters were analyzed, and samples were frozen with 20 μM curcumin at -196 °C for one week. Thawed samples were assessed for sperm parameters, and the expression levels of bax, bak, bcl-2, bclw, casp9, apaf-1, SOD, cat, and GPX4 genes were measured using RT-PCR.
Result: RNA-seq analysis showed increased expression of NANOS1, HSPA6, and ALOXE3 genes, while BHLHE41, Hey1, and PPM1D genes were down-regulated in OAT patients' sperm. Curcumin (20 μM) effectively preserves sperm parameters and motility during cryopreservation in healthy subjects and in OAT patients in particular. Cryopreserved sperm from both OAT patients and healthy individuals exhibited reduced expression of pro-apoptotic genes, increased expression of anti-apoptotic genes, and elevated levels of SOD and GPX4 genes.
Conclusion: Altered expressions of NANOS1, HSPA6, ALOXE3, BHLHE41, Hey1, and PPM1D genes likely contribute to OAT development. Additionally, curcumin protects sperm parameters during cryopreservation for both healthy individuals and OAT patients.

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