Background: In patients with advanced cancer, family caregivers are crucial in providing care throughout the illness, particularly towards the end of life. These caregivers often face unique challenges and emotions that may differ significantly from those experienced by other family members following the patient’s death. Objectives: The purpose of this study was to explore the experiences of family caregivers following the loss of a patient with advanced cancer. Methods: A qualitative study was conducted in Iran from June 2023 to January 2024 to explore the experiences of family caregivers after the death of a patient with advanced cancer. Using purposive sampling, face-to-face, in-depth semi-structured interviews were carried out with 14 Iranian family caregivers of cancer patients. The interviews were subjected to conventional content analysis for thematic extraction. To ensure the trustworthiness and rigor of the study, Lincoln and Guba's criteria were applied. Results: Data analysis and abstraction resulted in the formation of three main categories with eight sub-categories. The categories extracted from the caregivers' experiences were: Caregiver's inconsolable mourning, Unforgettable experience of caring for loved ones, and Constant mind involvements. Conclusions: The different experiences of family caregivers after the death of a patient and the more intense emotions they experience indicate that caregivers require additional attention and support following the loss. Consequently, health systems should identify these individuals during the patient care process and provide targeted support after the patient's death.

Background: Diabetes is a prevalent chronic disease and is considered a risk factor for other chronic diseases. Various studies have pointed out the relationship between uric acid and type 2 diabetes. Objectives: This study aimed to investigate the relationship between hyperuricemia and hypertension in diabetic patients undergoing hemodialysis. Methods: The descriptive-analytical cross-sectional study was conducted on dialysis patients referred to the Comprehensive Center for the Treatment of Special Diseases in Birjand in 2022. Data were collected through a checklist, which included information such as age, sex, duration of hemodialysis, duration of diabetes, history of underlying diseases, blood pressure, and serum uric acid level. The data were analyzed using SPSS 26 software and chi-square, Fisher's exact, Mann-Whitney tests with a significance level of 0.05. Results: Hypertension was present in 61 (85.9%) of patients. The average uric acid level was 5.9 ± 1.12, and hyperuricemia was observed in 11 (15.5%) of patients. Although the rate of hyperuricemia was higher in patients with high blood pressure [10 (16.4%) vs. 1 (10%)], no significant relationship between hyperuricemia and high blood pressure was observed (P = 0.605). Additionally, no significant relationship was observed between the average uric acid level and demographic factors (age, sex, duration of dialysis, and average blood sugar) (P > 0.05). Conclusions: According to the present study's results, the rate of hyperuricemia in dialysis patients with high blood pressure is higher than in patients without high blood pressure. However, due to the non-significance of this relationship, there is a need to conduct studies with a larger sample size to truly understand its relationship with high blood pressure in diabetic patients undergoing hemodialysis.

Background: Cerebral palsy (CP) is a neurological motor disability, and children with CP should undergo rehabilitation services to achieve their full potential. Objectives: The purpose of this study was to explore the quality of life (QOL) of children with CP across various domains and to assess the impact of access to rehabilitation services on their QOL. Methods: We conducted a cross-sectional study involving all 126 children aged 4 - 12 with CP and their parents in Saqqez county, Kurdistan province, Iran. The "Physical Rehabilitation Accessibility Assessment Questionnaire" and the "Parental Proxy CP QOL-Child QUESTIONNAIRE" were utilized to measure the main variables. The analysis was divided into two subpopulations: 27 children aged 4 - 6 years and 99 children older than six, using SPSS version 23. After verifying the data's normality with the Kolmogorov-Smirnov test, the Spearman correlation coefficient was employed to identify correlations. Results: The average age of the participants was 8 ± 2.36 years, with 51 (40.5%) being girls. Of the 126 children with CP, 45 (35.7%) had independent mobility function (GMFCS levels I and II). The mean scores for the CP QOL-Child dimension ranged from 35.3 ± 25.1 in the 'access to services' domain to 74.5 ± 16.1 in the 'Emotional well-being and self-esteem' domain. The average accessibility score was 53.8 ± 22.1. Among children older than 6 years, access to rehabilitation services showed a significant correlation with all CP QOL-Child domain scores (P < 0.05), except for 'social well-being and acceptance.' In children aged 4 - 6 years, only the Family Health domain score was significantly correlated with access to rehabilitation services (r = 0.44, P = 0.021). Conclusions: Access to rehabilitation services is a significant predictor of QOL in children older than 6 years. Further experimental research is needed to examine changes in various aspects of QOL in children with CP following improved access to rehabilitation services.

Background: A satisfying and proper sexual relationship that meets the needs of both spouses plays a crucial role in the stability and longevity of the family. Sexual self-concept is one of the factors affecting women's sexual behavior and performance and can be changed throughout life. Objectives: This study aimed to determine the status of sexual self-concept and its socio-demographic predictors of women on the verge of marriage. Methods: This cross-sectional study was conducted on 130 women referring to premarital counseling centers in Tabriz, Iran. The data collection tool was the questionnaire of personal and social characteristics and Snell's Multidimensional Sexual Self-Concept Questionnaire. Pearson's correlation test, one-way analysis of variance, and multivariate linear regression test were used in data analysis with SPSS software version 24. Results: The mean (standard deviation) of the positive sexual self-concept score was 117 (0.20) from the obtainable score of 0 - 176, and the mean (standard deviation) of the negative sexual self-concept score was 16 (0.7) from the obtainable score of 4 - 38. Additionally, the mean (standard deviation) of the sexual self-concept score was 44 (0.9) from the range of the obtainable score of 0 - 72. The results of multivariate analysis with multivariate linear regression test and control of confounding variables showed that the husband’s age, education, and mother's education were the predictors of positive sexual self-concept. Moreover, age, father's education, and duration of previous acquaintance were reported as predictors of negative sexual self-concept, and age was observed as a predictor of situational sexual self-concept. Conclusions: The study's findings indicated that age, education, parents' education, and the duration of acquaintance with the future spouse could predict sexual self-concept in women approaching marriage without sexual abuse. Given that sexual self-concept evolves well before any sexual activity, policymakers can enhance women's sexual self-concept through interventions, such as psychological counseling with a focus on sexual health. This, in turn, can improve their overall well-being, ultimately supporting stable family foundations and successful childbearing in the future.

Background: Reports indicate that probiotics have beneficial effects on both the prevention and treatment of numerous diseases. Objectives: This study aims to explore the overall inclination toward probiotic consumption, its trends, and its association with common gastrointestinal diseases. Methods: We conducted an ecological study utilizing Google Trends (GTs) and Global Concern data. We analyzed search terms related to “probiotic," “Irritable Bowel Syndrome (IBS)," “Peptic," “Constipation," “Diarrhea," and “Stomach Cancer (SC)" across all searches performed on GTs from January 2014 to July 2023. Results: Globally and in Iran, there has been an increasing interest in consuming probiotics over time. This increase is linked to a rise in cases of stomach cancer and irritable bowel syndrome, which, in turn, boosts the propensity to utilize probiotics. Globally, there is a direct correlation between probiotic consumption and IBS (R = +0.69, P = 0.0001), peptic disorders (R = +0.71, P = 0.001), Constipation (R = +0.93, P = 0.001), and diarrhea (R = +0.89, P = 0.001). In Iran, significant direct correlations were found between probiotic consumption and both constipation (R = +0.36, P = 0.001) and diarrhea (R = +0.40, P = 0.001). Among probiotic-containing products, yogurt was preferred over others worldwide and in Iran. Conclusions: The interest in probiotic use is high globally and in Iran. Consequently, there is a need for strategies to educate the public about the areas where the benefits of probiotics are well-supported by evidence and where information is either weak or lacking.

Context: The coronavirus disease 2019 (COVID-19) pandemic adversely affected the operation of health systems and services and dramatically increased the responsibilities of health professionals. Medical and nursing practitioners are an integral part of health care. They shouldered an important role in the fight against the novel coronavirus despite the potential risks. Evidence Acquisition: The present article applied a narrative approach to examine the nature and scope of the medical and nursing professions, especially during a pandemic or epidemic, and to describe the societal impact of the recent public health emergency. This study also analyzed the experience gained from the pandemic and how this could be used to ethically guide health services and clinicians through similar crises in the future. Results: The COVID-19 crisis revealed ethical dilemmas related to the retention of balance between the commitment to duty and the discretion to opt out. Health workers' obligation to treat derives from their professional role and is based on scientific, moral, and legal grounds. A pandemic mandates health staff to work at the limits of their competencies and entails the risk of infection with the pathogen, physical exhaustion, and emotional stress. The tremendous toll on society and health care due to the spread of a pathogen needs to be managed. The responsibility of clinicians to care for the sick is at the core of any successful response to a pandemic. Protective measures, safety training, sustainable working hours, and moral and fiscal compensation are essential prerequisites for the fulfillment of their tasks. Conclusions: Despite the reduced clinical severity associated with new variants, individual and collective fatigue among doctors and nurses continues to exist. The most recent epidemiological indicators show that the COVID-19 pandemic is still progressing but with a decelerating rhythm. In addition, preparation for a potentially catastrophic future pandemic is appropriate. Therefore, there is no time for complacency. All the involved parties need to ensure that health professionals uphold the mission of their profession.

Background: Research indicates that certain demographic groups, including girls, often experience lower-than-average levels of mental well-being. Therefore, it appears that one approach to enhancing mental health is by teaching resilience skills. Objectives: This study aimed to investigate the effects of resilience training on the mental health dimensions of sixth-grade female students in Qaynat city during the academic year 2021 - 2022. Methods: The study employed an experimental design with a control group, conducting pre- and post-tests. The statistical population comprised female sixth-grade students from an elementary school in Qaynat City. Thirty female students exhibiting high scores on measures of depression, anxiety, and stress were selected and randomly divided into two experimental groups, with 15 participants in each group. The experimental group underwent resilience training consisting of 8 sessions. The desired variables were measured using Lovibond and Lovibond's Depression, Anxiety, and Stress Scale (DASS). The data were analyzed using SPSS 25 software through independent samples t-tests and paired t-tests. Results: The findings revealed that the resilience training intervention significantly reduced symptoms of depression (F = 11.542), anxiety (F = 13.67), and stress (F = 6.01) in the experimental group (P = 0.001). Conclusions: The results suggest that participation in a resilience training program can improve students' mental health. Therefore, implementing such intervention programs in the form of workshops and establishing counseling and support groups may be beneficial for enhancing students' mental well-being.

Background: Transformational management (TM) focuses on the characteristics and behaviors required for a manager to empower and motivate team members. Nursing managers and leaders who practice TM mostly demonstrate varying degrees of transformational characteristics. Objectives: This study aimed to explain the characteristics of nursing managers in TM. Methods: In this study, we used the qualitative content analysis method. Twenty-two nursing managers were selected through purposive sampling within April 2022 to September 2023. Semi-structured interviews were used to collect the data. Data analysis followed the technique recommended by Graneheim and Lundman (2020). All interview sessions were recorded, transcribed in a Word file, and subsequently entered and analyzed in MAXQDA (2020). Results: After analyzing the data and extracting 423 open codes, seven subcategories and three final categories emerged regarding the characteristics required for nursing managers in TM. The identified characteristics in this study include the creation of a transformational culture, an ethics-oriented approach, and institutionalization of changes. Conclusions: By identifying and applying the characteristics essential to TM, nursing managers can initiate valuable changes. This, in turn, leads to transformation within their management style, the nursing profession, and the improvement of health services.

Background: The global population is undergoing rapid aging, highlighting the importance of assessing the hope levels of the elderly to develop educational and welfare programs aimed at enhancing their quality of life. This study aimed to assess the state of hope and its associated factors among elderly individuals in Birjand city. Methods: This descriptive-correlational study included 441 elderly aged 60 and above from Birjand City, selected using a systematic stratified sampling method in 2018. Data were collected through interviews conducted by trained interviewers using the standard questionnaire “Schneider's Hope of the Elderly (SHS)." Data were analyzed using SPSS 19 software, and statistical tests, including independent T-Test, ANOVA, and Tukey's post hoc test, were applied at a significance level of α = 0.05. Results: The average age of the participants was 70.1 ± 7.3 years. The mean scores for hope, agentive thinking, and strategic thinking were 27 ± 3.3, 12.9 ± 2.1, and 14.1 ± 2.1, respectively. Men had significantly higher scores in agentive thinking (P < 0.001) and the overall hope score (P < 0.003) compared to women. Illiterate individuals had lower agentive thinking scores than other groups (P < 0.001). Additionally, married individuals had significantly higher scores in agentive thinking, strategic thinking, and overall hope scores compared to other elderly individuals. Conversely, elderly individuals without children had lower scores in these areas compared to other groups (P < 0.05). Conclusions: Based on the study's findings, it is essential to develop and implement educational and welfare interventions aimed at increasing hope among the elderly, particularly targeting women, single individuals, those who are lonely, and those with lower levels of education.