Irish National Research Articles

Research

The December 2023 Research Roundup360 looks at: Tissue integration and chondroprotective potential of acetabular labral augmentation with autograft tendon: study of a porcine model; The Irish National Orthopaedic Register under cyberattack: what happened, and what were the consequences?; An overview of machine learning in orthopaedic surgery: an educational paper; Beware of the fungus…; New evidence for COVID-19 in patients undergoing joint replacement surgery.

Determination of Heavy Metals in Municipal Water Network of Tehran, Iran: A Health Risk Assessment with a Focus on Carcinogenicity

Background: Several contaminants such as trace elements can pollute drinking water sources with subsequent toxic effects on humans. These compounds may also accumulate in target organs and result in carcinogenic reactions. Objectives: The concentrations of heavy metals, including arsenic (As), nickel (Ni), zinc (Zn), aluminum (Al), copper (1), cobalt (Co), lead (Pb), cadmium (Cd), iron (Cd), tin (2), antimony (Sb), chromium (3), and mercury (Hg) were aimed to determine in the drinking water of Tehran, Iran and to assess the carcinogenic and non-carcinogenic risk for consumers. Methods: A total of 66 tap water samples were collected from 22 regions of Tehran and their heavy metal contents were measured by inductively coupled plasma mass spectrometry (ICP-MS). The non-carcinogenic and carcinogenic health risks were calculated, using hazard quotient (HQ) and incremental lifetime cancer risk (ILCR), respectively. Results: The findings revealed that the mean concentrations of measured elements were lower than the maximum permissible limits established by Iranian National Standards, United States Environmental Protection Agency (USEPA), and the World Health Organization (WHO). HQ was less than 1 for all metals except Cr and ILCR was higher than 1× 10-4 for Cr and Cd, which may cause human health risk. Conclusions: No carcinogenic effects were posed by heavy metals contamination in the drinking water of Tehran; however, the content of Cr and Cd may cause human health risks because of the high daily intake of tap water throughout the lifetime and the tendency of these metals to accumulate in the human body organs. Therefore, implementing ongoing programs to monitor heavy metals in municipal drinking water and applying appropriate corrective actions to prevent the transfer of these pollutants to drinking water is crucial.

Conscious Irish Fiction and the Repetitiveness of War: Transcultural Memories to Negotiate Peace in “Redemption Falls” and “TransAtlantic”

Drawing on recent scholarship on transcultural memory and its role in peacebuilding, this paper explores the implications of entangling memories that belong to different pasts, places, and cultural groups in Joseph O’Connor’s Redemption Falls (2007) and Colum McCann’s TransAtlantic (2013). Both novels, written by authors interested in the notions of oppression and suppression of stories, are polyphonic texts that disrupt any single linear narrative by interweaving multiple storylines through constant movements across time and space. McCann’s focus shifts from the aftermath of WWI to the 1998 Belfast Agreement, while O’Connor’s novel deals with the American Civil War and Irish nationalism; both recount episodes of the Great Famine, the ensuing emigration, and the history of Abolitionism. Hence, painful memories of the Irish mingle with the mnemonic repertoires of those who suffered the abominations of slavery or internecine conflict in an attempt to give voice to the marginalised and highlight bonds between (apparently unrelated) groups of people. Moreover, this convergence of inherited memories binds the past with the present and the future, as the recollections have echoes of contemporary conflicts and global phenomena involving Ireland, whose role in them is implicitly interrogated. By fusing significant cultural memories across generations and spaces, these novels assert the ‘historical duty’ to remember to promote negotiation and mutual understanding between different cultural groups today. This paper, therefore, will first offer an overview of contemporary Irish fiction, characterised by an original world-facing, rather than nation-focused, outlook. Second, it will undertake the analysis of the selected novels to contribute to the ongoing discussion about the potential of literature to build sound knowledge of diverse human experiences and, as a consequence, promote peace.

Racializing the Irish: the discursive production of race and nation by the young Ireland movement

ABSTRACT This essay will analyse the ways in which definitions of race in nineteenth-century Ireland were not only, nor simply set by British colonizers, but rather were produced and determined by Irish people themselves. This long history of Irish engagement with concepts of race shaped how the Young Ireland movement understood how the Irish nation was (racially) constituted. Additionally, the multi-racial history of the Irish nation inflected Young Ireland's understanding of how history structured the construction of an Irish nationality. This paper then will show how the Young Irelanders understood race and, more particularly, how they recognized themselves as racialized subjects. Their own adoption of a racialized Irishness was important to their vision for Ireland's revolutionary future. Placing race centrally within the writings of Young Ireland, highlighting its essential role in a historical account of Irish nationality, this essay will thereby cast new light on the difficulties inherent in Young Ireland's nationalist project. In particular, it will underscore the anxieties experienced by Young Ireland about the potential impossibility of the nationalist project with reference to its production and experience of racialized but ambiguous subject positions.

Impact of Various Risk Factors on the Positive Fecal Immunochemical Test for Colorectal Cancer in the Iranian Population.

Background: Colorectal cancer (CRC) is the most prevalent cancer with high mortality worldwide. We aimed to evaluate the incidence of CRC based on the positive fecal immunochemical test (FIT) result in the Iranian population. Methods: The present study was conducted on the health assessment data recorded in the SINA (Integrated Health Information System) in 2018 and 2019 from individuals who had participated in the national program, including asymptomatic people aged 50-69 years or had risk factors of CRC such as family or past personal history of CRC as well as symptomatic individuals, for the early detection and prevention of CRC in Mashhad, Iran. Results: The study participants included 140,463 eligible individuals, of whom 8258 (5.88%) and 145 (2.21%) were positive for FIT and diagnosed with colon cancer, respectively. Unfortunately, only 654 people had undergone colonoscopy. Our results indicated that age, fast food intake (≥two units per day), family history of CRC in first or second-degree relatives, some gastrointestinal diseases such as inflammatory bowel disease (IBD) and CRC, as well as bleeding per anus, constipation, abdominal cramp, and losing body weight were associated with increased risk of positive FIT. However, some other factors, including having a hard job, physical activity, and Iranian nationality (compared to non-Iranians), were associated with a low risk of positive FIT screening tests for CRC. Conclusion: A high number of high-risk persons in Mashhad were positive for the FIT test in 2018-2019, and many of them were diagnosed with CRC, according to the colonoscopy results. Therefore, screening is highly recommended as the first step in the early detection of CRC.

Learning from experience: Integrating patient experience survey responses with other key metrics to understand and improve care quality and patient safety

Abstract Issue The Irish National Care Experience Programme (NCEP) collects rich qualitative and quantitative data on patient and service-user experiences of healthcare. These survey data are not routinely triangulated with other quality and safety datasets for patient safety surveillance. Description of the problem The Irish Health Service Executive has commenced development of a quality and patient safety surveillance system called Quality and Safety Signals (QS Signals). This programme seeks to optimise the use of existing data to reduce variability in quality and safety of services, identify risks and signals of concern, as well as learnings from signals of excellence. Patient experience data is a rich source of insight into quality and safety of care but currently, it is not routinely considered alongside other quality and safety measures. Results As a proof of concept, the Quality and Safety Signals programme is collaborating with the National Women and Infants Health Programme (NWIHP) to develop a composite profile of quality and safety for maternity and neonatal services. A Clinical Advisory Group (CAG) has been established with multi-disciplinary clinical representation from Ireland's six Maternity Networks. To reach agreement amongst the CAG on the indicators relevant to the measurement of quality and safety, a series of interviews, workshops and a Delphi Survey are being conducted. The co-design process seeks consensus on the themes and classification structure appropriate for a composite profile of quality and safety. Lessons The implementation of a patient safety surveillance system challenges the Irish health system to reflect on how available data can best be harnessed. Person-centredness is a core domain of healthcare quality. Capturing the person's experience of care through the NCEP surveys is vital to ensuring the development of a comprehensive profile and guiding quality improvements.

8.G. Workshop: Developments in patient experience surveys: how do we maintain relevance and maximise impact?

Abstract Background Patient and service-user experiences of healthcare are a vital component of the monitoring and assessment of the quality and performance of health and social care services and systems, as well as an important predictor of patient outcomes. The National Care Experience Programme (NCEP) is a partnership between the Irish health and social care regulator (Health Information and Quality Authority, HIQA), the national public healthcare provider (Health Service Executive, HSE), and policy makers (Department of Health). The NCEP conducts national care experience surveys with the aim of learning from people's experiences in order to improve the quality of health and social care services in Ireland. The programme includes surveys of acute hospital inpatient, maternity, maternity bereavement, nursing home and end-of-life care. Additional surveys of cancer care and mental health services are currently in development. Objectives Regular review and adaptation of existing surveys, expansion into new areas of care, and development of new methods of data collection, analysis and dissemination of survey findings and stakeholder engagement are required in order to remain agile and responsive to evolving health and social care landscapes and the changing needs of stakeholders, as well as harnessing technological advances and ensuring sustainability. The aim of this workshop is to bring together experts in patient experience from across the health system to stimulate discussion, knowledge sharing and cross-fertilisation of ideas. Presentations will focus on international developments and trends in patient experience, as well as considerations for surveying bereaved parents and families on their experiences of maternity bereavement and end-of-life care. The use of new technologies, including computational text analytics and predictive modelling to facilitate qualitative data analysis and maximise the use of survey findings will be outlined, followed by case studies of how care experience data are used to inform health and social care legislation, policy and practice in Ireland. Experiences from other jurisdictions and potential implications will be discussed with the audience. The workshop will contribute to a better understanding of the value and impact of collecting patient experience feedback and explore how new technologies can be used to generate insights and maximise the use of survey data. Format of the workshop The workshop will include a brief introduction on patient experience and the Irish National Care Experience Programme, followed by five presentations with time for audience contributions and questions after each speaker. The workshop will conclude with a discussion with the audience and presenters. Key messages • Patient experiences are a key component of the monitoring and assessment of the quality and performance of health and social care services and systems. • Regular review and adaptation of surveys and development of new methods are required to remain responsive to evolving health and social care landscapes and ensure sustainability.

Piloting patient-reported outcome measures for evaluation of the Irish Chronic Disease Programme

Abstract Background The Irish National Integrated Care Programme for Chronic Disease (ICPCD) aims to deliver end-to-end, patient-centred care across three clinical programmes; Heart, Respiratory and Diabetes. Patient-reported outcome measures (PROMs) are a means of objectively measuring changes in patients’ subjectively-perceived health status over time in response to services. As such, PROMs facilitate service monitoring and evaluation and are an important tool for the ICPCD to ensure optimal, patient-centred, value-based healthcare delivery. Methods To select the most appropriate PROMs instrument for use across ICPCD, comprehensive literature review was undertaken followed by key stakeholder consultation in winter 2022. Following consideration against a set of pre-determined criteria the EQ-5D-5L, a well-validated, reliable PROMs instrument, was selected as the most appropriate PROMs instrument for use. Study design involved pilot implementation of EQ-5D-5L in one ICPCD ambulatory care hub service followed by mixed methods evaluation of staff experience of the pilot. Results The pilot was conducted from April to June 2023 among a socio-demographically diverse sample of patients attending their first and last episode of care with the ICPCD diabetic patient education service in Galway. Following service attendance there was a significant aggregate improvement in self-reported overall health rating but no significant change in self-reported mobility, self-care, usual activities, pain/discomfort or anxiety/depression. Predominant staff concerns included staff and patient burden and the need for adequate staff resourcing and information technology support. Conclusions In conjunction with key national stakeholders findings from the pilot will be used to support the development of a PROMs implementation plan at scale for adoption across all ICPCD services. Ultimately national implementation will support the ongoing delivery of high quality patient-centred care within ICPCD services. Key messages • PROMs facilitate service evaluation and are an important tool for the Irish National Integrated Care Programme for Chronic Disease (ICPCD) to ensure optimal patient-centred healthcare delivery. • This pilot will support PROMs implementation at scale across ICPCD services and ultimately reinforce the ongoing delivery of high-quality, value-based, integrated healthcare.

How do patient and care experience data inform policy and practice? Insights from the Irish National Care Experience Programme

Abstract Issue Patient experiences are central to the delivery of quality, person-centred care and an important predictor of outcomes. Prior to 2017, there was no unified, national approach to the collection of care experience data in Ireland. Description of the problem The National Care Experience Programme is a partnership between a regulator, policy makers and the Irish public health service, with a suite of surveys of inpatient, maternity, nursing home and end of life care. The surveys aim to learn from people's feedback on health and social care services to identify areas of good experience and areas requiring improvement. Results Findings have informed national policies, including a healthcare communication programme to support staff to develop communication skills with patients and families. Survey data provide a key input to the Irish health quality indicator framework and the Health Systems Performance Assessment Framework, which assess the overall performance of the Irish health system. National Maternity Experience Survey results informed the allocation of funding for post-natal supports and new lactation consultant posts, and supported the implementation of a specialist perinatal mental health services model of care, leading to increased diagnosis and vigilance of mental health issues ante- and postnatally. National Nursing Home Experience Survey findings supported legislative amendments, including provision for the delivery of in-person advocacy awareness campaigns and the strengthening of complaints processes within nursing homes. Lessons In order to maximise the use of survey findings and ensure the voices of people using health and social care services are acted on, routine surveying of care experiences is required to track the impact of policy and practice initiatives. The programme is currently expanding to include people's experiences of cancer care and mental health services, in addition to exploring options for continuous, local care experience surveys.

Social and biological factors associated with unsuccessful TB treatment outcome in Ireland 2011-2021

Abstract Background Tuberculosis (TB) treatment success rates are crucial for TB control programme evaluations. The World Health Organisation sets targets of > 90% but Ireland remains below 70%. We analysed notifications from the Irish National TB Surveillance System from 2011-2021 to explore factors associated with successful treatment outcome in Ireland. Methods We selected potential predictor variables based on clinical relevance and literature review. We examined each predictor's unadjusted association with treatment success using univariable logistic regression. We used backwards elimination to remove predictors that failed to remain significant in multivariable logistic regression. Treatment success was defined as treatment completed or cured, while unsuccessful treatment was defined as treatment failed, treatment interrupted, transferred out and died from any cause. We used Stata for analysis. Results Between 2011-2021, 52% of cases were successfully treated, 10.7% were unsuccessfully treated and treatment outcome was not reported for 37%. Treatment outcome completeness declined significantly between 2019-2021. Univariable analysis showed successfully treated cases had higher odds of being a migrant (OR:1.9; 1.5-2.5), being linked to outbreaks (OR:1.9; 1.2-3.0), being a contact of a case (OR: 1.0-2.5;), having a normal X-ray (OR:1.7;1.1-2.6) and being an outpatient (OR:3.0;2.2-4.2). Significant predictors of unsuccessful treatment in the final model were age >70 years, unemployment, immunesuppression and any anti-TB drug resistance. Conclusions Surveillance data shows that Ireland fails to meet the WHO target of > 90% treatment success with high levels of missing data. Data quality improvement initiatives are needed to reverse the decline in completeness associated with the Covid-19 pandemic period so control programmes can robustly evaluate performance. Additional supports should be considered for patients who are older, unemployed, immunesuppressed or with drug resistant TB. Key messages • Additional patient supports should be considered for patients who are unemployed, age 70 years and older, immunesuppressed or with drug resistant forms of TB. • Ireland fails to meet the WHO TB treatment success target with high levels of missing data. Treatment outcome completeness needs to be improved so control programmes can robustly evaluate performance.

Socioeconomic Disparities in Beliefs about Cancer: Irish National Cancer Awareness Survey

Abstract For most tumour types survival varies according to socioeconomic position (SEP) and stage at diagnosis. The aim of this study was to examine the association between SEP and beliefs about cancer, and the impact of beliefs on symptom awareness and help-seeking. This is important as negative beliefs about cancer may represent a modifiable target in cancer awareness campaigns aimed at adults aged 50+ years. A cross-sectional study of 1,327 adults aged 50+ years was conducted using data from the Irish National Cancer Awareness Survey, 2022. SEP was indexed using educational attainment. Beliefs about cancer were assessed using the Awareness and Beliefs about Cancer measure, symptom awareness using the Cancer Awareness Measure, and help-seeking using the French Cancer Barometer. Latent Clas Analysis (LCA) was used to identify unobserved ‘beliefs about cancer’ subgroups across belief items. Multivariable logistic regression, adjusted for age, sex, smoking status and cancer experience, was then used to identify associations between SEP and belief subgroups, and subsequently between belief subgroups and symptom awareness and anticipated help-seeking. LCA identified two subgroups: n = 1,033 (77.7%) broadly positive and n = 294 (22.3%) broadly negative. Those with primary education or less, and those with secondary education, were more likely to endorse negative beliefs relative to those with tertiary education (aOR 3.20 (95%CI 1.84, 5.53;p<0.001) and aOR 1.88(95%CI 1.32, 2.70;p<0.001) respectively). Compared to the positive beliefs subgroup, the negative subgroup were less aware of persistent cough as a potential cancer symptom (aOR 0.60(95%CI 0.40, 0.88);p=0.01) and less likely to anticipate seeing a doctor first with symptoms (aOR 1.52 (95%CI 1.11, 2.08;p=0.009) ‘other’ vs. ‘doctor’). Negative beliefs about cancer are associated with lower SEP. Negative beliefs about cancer should be targeted in health promotion campaigns seeking to increase awareness and help-seeking behaviour. Key messages • There is a need for interventions to increase symptom awareness and encourage timely help-seeking in those with symptoms suggestive of cancer particularly among socioeconomically disadvantaged groups. • Negative beliefs about cancer should be targeted in health promotion campaigns seeking to increase awareness and help-seeking behaviour.

Seasonal Study of Aflatoxin M1 Contamination in Cow Milk on the Retail Dairy Market in Gorgan, Iran

Milk and milk products are the main nutritional foods for all age groups, especially for infants and children. Milk may be dangerous to consume due to the presence of a harmful substance called Aflatoxin M1 (AFM1). The objective of this study was to assess the levels of AFM1 in milk, particularly those that exceed the standards set by the European Union (50 ng/L), the Food and Drug Administration (500 ng/L), and the Iranian National Standards Organization (100 ng/L). The study included one hundred and eighty samples of raw cow’s milk from various retail dairy markets in Gorgan, with 45 samples collected during each season. The level of Aflatoxin M1 in the samples was measured using the enzyme-linked immunosorbent assay (ELISA) technique. AFM1 was detected in 139 (72.2%) raw cow milk samples with a range of 3.5–357 ng/L. All of the samples collected had Aflatoxin M1 concentration levels that were below the maximum limit of 500 ng/L set by the FDA. However, 41 samples (22.7%) exceeded the EU’s limit of 50 ng/L, and 26 samples (14.4%) exceeded the INSO’s limit of 100 ng/L for Aflatoxin M1 in raw cow’s milk. The lowest and highest AFM1 levels of contamination were detected in the summer and winter seasons, which constituted 32 (71.1%) and 38 (84.4%) samples, respectively. The consumption of raw cow milk can lead to health risks for individuals from various age groups because regulatory limits are not being followed.

Changes in anticoagulation practice in subjects admitted with stroke associated with atrial fibrillation, following introduction of direct oral anticoagulants over 2013-2021.

The adoption of direct oral anticoagulants (DOACs) has changed practice in prevention of stroke in atrial fibrillation (AF). We used Irish data national data on stroke and anticoagulation therapy over 9 years to investigate changes in anticoagulation practice and potential consequences on stroke prevalence and thrombolysis. AF, anticoagulation, thrombolysis, and stroke data from the Irish National Audit of Stroke (INAS) 2013-2021 were reviewed. The proportion of patients with ischemic stroke (IS) and intracerebral hemorrhage (IH) with known AF admitted on anticoagulation was determined. Effects on age distribution in the population and thrombolysis practice were assessed. AF data were available on 34,630 of 35,241 individuals (98.3%) included in INAS; median age was 74 years and 56% were male. AF was found in 10,016 (28.9%, 9059 IS, 957 IH). 6313 had known AF prior to stroke (63.1%). The proportion all total IS due to AF decreased by 15.3% (31.3%-26.5%, chi-square = 24.6, p < 0.0001). The proportion of IH did not change significantly (21.6%-20.2%, chi-square = 1.8, p = 0.18). Over the 9 years, 3875 (38.6%) of the subjects with AF were recorded as receiving anticoagulants at admission. In 2013, 4.4% of AF-associated strokes were admitted on a DOAC and 21.4% on warfarin; by 2021, 44.1% were receiving a DOAC and 6.2% warfarin. There was a strong inverse correlation between the proportion of anticoagulated stroke patients and the total proportion of AF-associated strokes over time (r = -0.82, p = 0.006). In contrast, no correlation was found between increasing DOAC usage and IH (r = 0.14, p = 0.71). Increased anticoagulation usage correlated with a reduction in patients ⩾ 80 years (r = -0.83, p = 0.006) and also correlated with a relative reduction of 30.1% in subjects thrombolysed <4 h from onset (r = -0.89, p = 0.001). DOACs have led to increased use of anticoagulation, but warfarin use fell by two-thirds. There has been a reduction in the proportion of AF-associated IS without a noticeable increase in IH. Increased anticoagulation correlated with reduced numbers of strokes in those >80 years and in the proportion of patients thrombolysed.

Making of Scapegoats: The Complicity of Church, State and Society in Claire Keegan’s Small Things Like These

Claire Keegan’s novel Small Things Like These (2021) brings such notions as purity, impurity and scapegoating into discussion within the context of the convent laundries in Ireland. The novel critiques the reduction of morality and immorality to a sexist category and focuses on the “fallen women” as both victims and saviours of society. It also portrays the harsh socio-economic environment of New Ross, Ireland where capitalism and inequality prevail, and the characters are victims of the capitalist system. Drawing a sketch of the Magdalen Laundries, which served as institutions instrumental in creating ideal women for the Irish nation and protecting the public from the “fallen” women until 1996, Keegan points at the complicity between religious and capitalist influences. She emphasises the relationship between Christianity and capitalism by implying out that capitalism prioritises private ownership, profit and competition, and that Christianity propagates the core tenets of the system. The narrative underscores how capitalism’s pursuit of profit can lead to the exploitation and marginalization of vulnerable groups, perpetuating a system of scapegoating to protect the interests of the rich and the powerful. Hence, the primary objective of this study is to analyse the phenomenon of scapegoating as exemplified, particularly by the girls at the convent who have been marginalized and confined within a convent in Keegan’s literary work, Small Things Like These, drawing upon the theories related to “mimetic desire,” “violence,” and “scapegoating mechanism.” It also aims to show how these girls, ostracised and accused of subverting national ideals, function as a mirror to the truth and reveal the unfeasibility of achieving true communal purification within the intricate interplay of church, state, and society– all of which are manipulated by the forces of capitalism.

Adapting a quality improvement collaborative to a new national context: a co-design and feasibility study to improve dementia care in Ireland

BackgroundAdaptation seeks to increase intervention fit with context, an important influence upon implementation. People with dementia in acute hospitals in Ireland do not routinely receive best care. To improve care in Ireland, we sought to adapt an existing quality improvement collaborative, to support the improvement capabilities of recipients of feedback from the Irish National Audit of Dementia.MethodsThe study followed a staged process to co-design adaptations to reflect contextual differences between the English and the Irish healthcare systems, and to explore feasibility of the adapted Quality Improvement Collaborative in Ireland. We used co-design group meetings involving dementia clinicians from three hospitals, delivered the intervention virtually and interviewed healthcare workers from seven hospitals to adapt and explore the fidelity, affective response and reported appropriateness of the intervention.ResultsThe intervention required adaptation to reflect differences in strategic intention, ways of working and hospital social structures. There was evidence that the adapted intervention generated a positive affective response, was perceived as appropriate and led to fidelity of receipt and response.ConclusionWe describe implications for the adaptation of interventions to increase participants’ quality improvement capabilities and highlight the importance of socio-adaptive work. We propose further work to explore antecedents of senior positional leader engagement, to describe the delivery of intra-participant behaviour change techniques and to adapt the intervention to other clinical domains.

From Research to Practice: Strengthening the Irish National Code of Professional and Ethical Frameworks for Librarianship

ABSTRACTAll over the world, libraries are facing fraught political and economically insecure times; books are being banned, marginalised communities are being protested, and Library and Information Professionals (LIPs) are struggling to narrow the digital divide to support a well‐informed society. This poster explores the connection between the competencies required by two professional library organisations and the reality of Irish library and information professionals in their actual work context. Our initial data collection consisted of a quantitative survey with 897 Irish library‐based participants. The preliminary analysis suggests the need for the strengthening of an Irish national code of professional and ethical framework, which would be of benefit to LIPs and Irish society. These ethics and values statements are the foundational pillars on which knowledge, skills, and professional abilities are built.

The Epidemiology of Hospital-Acquired Urinary Tract Infections in Intensive Care Units in Kermanshah Hospitals (Iran)

Background: Urinary tract infection (UTI) is the highest incidence of hospital-acquired infection (HAI), and hospital-acquired urinary tract infections (HAUTI) are a common problem of critical illness. Objectives: This study aimed to determine the epidemiology of HAUTIs in medical intensive care units (ICUs) and hospitals in Kermanshah, Iran. Methods: This cross-sectional and descriptive/analytical study was conducted in the ICUs of hospitals in Kermanshah from March 2018 to 2019. All the recognized HAUTIs were recorded in the Iranian National Nosocomial Infection Surveillance System. Descriptive and inferential statistics such as t-tests and chi-square were used for data interpretation. Results: A total of 1136 patients were admitted to the two ICUs (61 missed out of 1197 patients). The number of patients with UTI was 51, and the overall HAI rate was 4.5%. The results showed a significant relationship between sex and HAUTI (P = 0.038), so women tended to have more HAUTIs than men (6.3 and 3.6%, respectively). A significant relationship was observed between age, date (different seasons of the year), and HAUTI (P = 0.588, 0.115, respectively). Conclusions: There are few studies on HAUTIs, especially on intensive care unit-acquired infections, and more studies are required to describe the epidemiology and management of these problems. Improving conditions for expanding any strategy to reduce infections associated with HAUTIs in ICUs is recommended.

A registration trend in eyelid skin cancers and associated risk factors in Iran, 2005–2016

BackgroundEyelid skin cancers are the most prevalent ophthalmic malignancies. This study aimed to evaluate the association of the Human Development Index (HDI) and lifestyle risk factors with eyelid skin cancers in Iran.MethodsThis ecological study analyzed the data collected from the Iranian National Population-based Cancer Registry (2005–2016). The data on provincial-level eyelid skin cancer risk factors were obtained from national sources. The association between provincial HDI and lifestyle risk factors with the prevalence of eyelid skin cancers was assessed.ResultsThe mean 12-year age-standardized incidence rate (ASIR) of eyelid skin cancers was 16.22 per 100,000 (9,104 cases). The overall ASIR showed an upward trend with an estimated annual average increase of 0.006 per year. There were positive correlations between the prevalence of overall eyelid skin cancers and provincial HDI, smoking, and obesity (r = 0.32, 0.42, and 0.37, respectively). In multivariate analysis, obesity/overweight remained a positive predictor for high prevalence of total eyelid skin cancers (OR = 1.97, 95%CI = 1.08–3.58, P = 0.026), carcinoma (2.10, 1.15–3.83, P = 0.015), and basal cell carcinoma (1.48, 0.99–2.20, P = 0.054).ConclusionsAn increasing trend in ASIR of eyelid skin cancers was observed in more than a decade in Iran which was positively associated with provincial HDI and prevalence of obesity. The findings of the study highlight the importance of promotional programs for preventing obesity/overweight and appropriate allocation of screening facilities based on the HDI level.

The effectiveness of Allen Carr's method for smoking cessation: A systematic review.

Allen Carr's (AC) method is a pharmacotherapy-free approach to quit smoking that is delivered through seminars, online courses, or in the form of a book. It has gained popularity, but its effectiveness remains controversial due to a lack of scientific evidence. This systematic review aims to provide an updated overview of the current evidence on the effectiveness of the AC method. We conducted a systematic literature review of all epidemiological studies evaluating the effectiveness of the AC method for smoking cessation, published in PubMed/MEDLINE and Embase up to March 2023. Among 34 original studies identified through the literature search, six met the inclusion criteria. These studies were published between 2006 and 2020, with sample sizes ranging from 92 to 620 participants. Of the six studies, two did not have a comparison group while four, including two randomized control led trials (RCT), had a comparison group. The included studies showed cessation rates for people who attended the seminars from 19% to 51%. An observational study found an odds ratio (OR) of abstinence for those attending AC single-session seminars of 6.52 (95% confidence interval, CI: 3.10-13.72) compared with controls with no treatment. One RCT found higher quit rates for AC single-session seminars compared with the online Irish National service (OR=2.26; 95% CI: 1.22-4.21). Another RCT reported no significant difference between AC single-session seminars and a specialist stopsmoking service. One single study on patients with head and neck disorders analyzed the effectiveness of reading the AC book, showing no significant results. The AC seminar may be an effective intervention for smoking cessation. This approach deserves further RCTs with large sample sizes to strengthen the evidence. Scant data are available on the effectiveness of reading the AC book.

Persian orientalism: Raciolinguistic ideologies and the construction of ‘Iranianness’

AbstractThis article excavates the Eurocentric roots of Iranian nationalist discourse, which emerged from the political and intellectual trajectories of the late 19th and early 20th centuries. Premised on the epistemic privilege of the Persian language, a selective remembrance of the past, and forging an internal Other, I contend that this raciolinguistic ideology equated Persianness with Iranianness and naturalised Persian as both a language and a race. I begin by tracing the origin of Iranianness or Irāniyat: a concept coined by Mirza Fath'Ali Akhundzadeh and Mirza Aqa Khan Kermani, two influential figures in late Qajar Iran, whose writings introduced and disseminated the Eurocentric and Orientalist view of the non‐Persian Other. In the second section, I examine how the Berlin Circle, a group of Iranian nationalist intellectuals in the early 20th century, elaborated these ideas into a coherent racial and political ideology that later informed the Pahlavis' state‐building project in 1925. The last section of the article engages with the recent neologism of the ‘Persianate World’, an intellectual enterprise imbued with an Orientalist predisposition that aims to inscribe a trans‐border and transcultural quality to Persian culture far beyond its current boundaries, encompassing Eurasia and Central Asia.