Background: In the Middle East, including Iran, breast cancer is the most frequent malignancy among women. Without treatment, a malignant breast tumor advances in stage, diminishing a woman's chances of survival. In this study we aimed to gain insight into the causes of delay in seeking treatment in patients with breast cancer. Methods: The participants in this qualitative, content analysis study were 10 women in whom a diagnosis of breast cancer in the stages of II b, III or IIV had been made. They were selected from patients of a major oncology clinic in Kerman, Iran. Data were collected by means of semi-structured interviews that lasted between 20 to 30 minutes. Sampling was discontinued when data saturation was achieved. Content analysis was conducted by classifying the data into themes and sub-themes. Results: The results of our study revealed several factors that interfered with patients' professional consultation seeking and prompt treatment. These factors included; lack of knowledge, fear of being diagnosed with cancer, not seeing oneself at risk, mental preoccupation and wrong diagnosis by physicians. Conclusions: This study suggests that women and even physicians need further information about breast cancer symptoms. Women need encouragement to seek medical advice when they encounter suspicious symptoms. Additionally, women may benefit from awareness of the pros of early detection and reassurance about the improvements in the success of breast cancer treatment.

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the prevalence of non-communicable diseases is increasing worldwide. Multimorbidity and long-term medical conditions is common among these patients. this study aimed to investigate the patterns of non-communicable disease multimorbidity and their risk factors at the individual and aggregated level. Data was inquired from the nationwide survey performed in 2011, according to the WHO stepwise approach on NCD risk factors. A latent class analysis on multimorbidity components (11 chronic diseases) was performed and the association of some individual and aggregated risk factors (urbanization) with the latent subclasses was accessed using multilevel multinomial logistic regression. Latent class analysis revealed four distinct subclasses of multimorbidity among the iranian population (10069 participants). Musculoskeletal diseases and asthma classes were seen in both genders. In males, the odds of membership in the diabetes class was 41% less by increasing physical activity; but with increased BMI, the odds of membership in the diabetes class was 1.90 times higher. Tobacco smoking increased the odds of membership in the musculoskeletal diseases class, 1.37 and 2.30 times for males and females, respectively. Increased BMI and low education increased the chances of females' membership in all subclasses of multimorbidity. At the province level, with increase in urbanization, the odds of membership in the diabetes class was 1.28 times higher among males (P = 0.027). Increased age, higher BMI, tobacco smoking and low education are the most important risk factors associated with ncD multimorbidity among iranians. interventions and policies should be implemented to control these risk factors.The World Health Organization (WHO) global status report on non-communicable diseases (NCDs) in 2014 reported that NCDs are globally the leading cause of death 1 . In 2016, NCDs killed 287000 people in Iran and the number of NCD related deaths and disability-adjusted life years (DALYs) have increased during the past decades. In just 2016, 6.5 million years of life loss (YLLs), and 8.2 million years of disability (YLDs) were attributed to NCDs in Iran 2 . According to 2017 reports, in the past 20 years, NCD mortality has risen by 14.5%, in Iran; and an adult Iranian's probability of dying prematurely (between 30 and 70 years) from one of the four main NCDs was 17% 3 .A systematic review in WHO Eastern Mediterranean countries in 2013 showed that the high mortality of NCDs is partially related to their multimorbidity 4 . More than half of the adults with NCDs have multimorbidity or multiple concurrent morbid conditions, and not one single chronic disease 5 .The prevalence of multimorbidity is increasing worldwide 6 . NCD multimorbidity affects more young people in low-and middle-income countries. The mean prevalence of multimorbidity was 7.8% in 28 developing open Scientific RepoRtS | (2020) 10:3034 | https://doi.org/10.1038/s41598-020-59668-y www.nature.com/scientificreports www.nature.com/scientificreports/ countries in 2015 7 . NCD multimor...

Living in areas with high air pollution may have adverse effects on human health. There are few studies about the association between breathing polluted air and adverse pregnancy outcomes in the Middle East. The aim of this study was to determine the relationship between air pollution and spontaneous abortion, premature birth, and stillbirth in Ahvaz. A time-series study was conducted. Data about spontaneous abortion, premature deliveries, and stillbirth was collected from Ahvaz Imam Khomeini Hospital. Air pollution data including NO, CO, NO, PM, SO, O, and climate data were, respectively, collected from the Environmental Protection Agency and the Khuzestan Province Meteorology Office from March 2008 until March 2015. The relationship between air pollutants with the number of abortions, premature births, and stillbirths was found using a quasi-Poisson distributed lag model, adjusted by trend, seasonality, temperature, relative humidity, weekdays, and holidays. The average daily dust in Ahvaz on 7.2% days of the year was higher than 500 μg/m (very dangerous). Findings from this study indicate a significant association between each 10-unit increase in SO and spontaneous abortion in lag 0 and 9 days. There was a significant relation between each 10-unit increase in NO and CO, and premature birth in lag 0. Also, we found a significant association between each 10-unit increase in CO and premature delivery in lag 1; PM and premature delivery in lags 10, 11, and 12; and NO and premature delivery in lags 3, 4, 10, 11, 12, and 13 (p value < 0.05). Contact with polluted air during pregnancy may increase adverse pregnancy outcomes and stillbirth. Pregnant women should avoid polluted air.

Background: This study was designed to investigate job satisfaction and its relation to perceived job stress among hospital nurses in Babol County, Iran.Methods: This cross-sectional study was conducted on 406 female nurses in 6 Babol hospitals. Respondents completed the Minnesota Satisfaction Questionnaire (MSQ), the health and safety executive (HSE) indicator tool and a demographic questionnaire. Descriptive, analytical and structural equation modeling (SEM) analyses were carried out applying SPSS v. 22 and AMOS v. 22.Results: The Normed Fit Index (NFI), Non-normed Fit Index (NNFI), Incremental Fit Index (IFI)and Comparative Fit Index (CFI) were greater than 0.9. Also, goodness of fit index (GFI=0.99)and adjusted goodness of fit index (AGFI) were greater than 0.8, and root mean square error of approximation (RMSEA) were 0.04, The model was found to be with an appropriate fit. The R-squared was 0.42 for job satisfaction, and all its dimensions were related to job stress. The dimensions of job stress explained 42% of changes in the variance of job satisfaction. There was a significant relationship between the dimensions of job stress such as demand (β =0.173,CI =0.095 - 0.365, P≤0.001), control (β =0.135, CI =0.062 - 0.404, P =0.008), relationships(β =-0.208, CI =-0.637– -0.209; P≤0.001) and changes (β =0.247, CI =0.360 - 1.026, P≤0.001)with job satisfaction.Conclusion: One of the important interventions to increase job satisfaction among nurses maybe improvement in the workplace. Reducing the level of workload in order to improve job demand and minimizing role conflict through reducing conflicting demands are recommended.