BackgroundInterdialytic weight gain (IDWG) is a marker of higher pre-dialysis blood pressure, nutrition, and survival in hemodialysis (HD) patients. However, this relationship is incompletely characterized. In this study, we seek to define the association of IDWG/dry weight x100 (IDWG%) on blood pressure (BP), and the nutritional status of an HD population. Material and MethodsThis study was performed on 300 HD patients. The data was collected over four weeks, including total IDWG, IDWG%, and blood pressure. Normalized protein nitrogen appearance (nPNA), and serum albumin were used as markers of nutritional status. Participants were divided into three groups according to the mean of the IDWG% between two sessions of HD (group A < 3%, group B = 3% -3.9%, and group C ≥ 4%); they were then compared on various aspects. Student t-test, analysis of variance (ANOVA), and linear regression analysis were used as statistical tools. ResultsThe mean (± standard deviation (SD)) age was 61.7 ± 14.2 years with 57.7% of the patients being male and 42.3% being female. The mean IDWG% for the whole studied population was 3.72% ± 1.73%. Between these three groups, a higher IDWG% was associated with younger males (p = 0.032), lower dry weight (p = 0.009), and longer duration on HD therapy (p = 0.009). IDWG% was directly associated with lower pre-dialysis serum sodium (p = 0.04), higher pre-dialysis serum creatinine (P = 0.002), and lower body mass index (BMI) (p= 0.003). Between these three groups, interdialytic variations in weight gain were not associated with increased BP. There was no significant difference between the three groups in terms of nPNA and serum albumin. ConclusionsThe most important associations of IDWG% are age, weight, pre-dialysis sodium, serum creatinine, and duration of dialysis (months). There was no association between IDWG% and increased systolic BP. IDWG% had no association with nutritional status.

In the present study, a meta-analysis was carried out to clarify the association between disinfection byproducts (DBPs) in drinking water and human cancer risk worldwide. Kidney, colorectal, esophagus, urinary bladder, brain, breast, leukemia, lung, and rectum cancers were selected to perform this analysis. According to preferred reporting items for systematic review and metaanalysis protocol (PRISMA) guidelines, the relevant studies were identified and selection criteria (inclusion and exclusion criteria) were applied. Next, effective subgroups in these studies (gender, type of drinking water source, and type of DBPs) were analyzed. The quality of the studies was evaluated using the Newcastle-Ottawa Scale. In addition, this overall study included analyses of 16 case-control and 3 cohort studies. The overall odds ratio (OR) with 95% confidence intervals (CI) between DBPs and cancer risk was 1.01 (95% CI, 0.94-1.09). The summary ORs of cancer risk were 1.04 (95% CI, 0.89-1.19) for kidney; 0.98 (95% CI, 0.87-1.09) for colorectal; 1.07 (95% CI, 0.84-1.29) for esophagus; 0.93 (95% CI, 0.80-1.06) for pancreatic; 1.00 (95% CI, 0.83-1.18) for brain; 1.13 (95% CI, 0.99-1.26) for breast; 0.93 (95% CI, 0.72-1.13) for leukemia; and 1.18 (95% CI, 1-1.36) for lung cancers. The results of this meta-analysis suggested that there is not a significant association between DBPs in water and cancer risk. In addition, subgroup analysis shows a positive association with colorectal and kidney cancer risk in men, as well as colon and breast cancers in females. Studies of both genders have shown a significant association between lung and pancreatic cancers. Moreover, this study finds a significant relationship between cancer rate and consumers of city water and bottled water sources. In analyzing different types of DBPs in water, chlorine and trichloromethane show a significant association in increasing cancer risk. K E Y W O R D Scancer risk, DBPs, drinking water, meta-analysis, water treatment

Objectives Sexual self-concept has an influence on the sexual behaviors of women with breast cancer. Supportive programs for these women have demonstrable empirical efficacy; however, their effectiveness has not been examined. The aim of this study was to investigate the effect of a supportive program based on social networks on the sexual self-concept of women with breast cancer. Methods In this randomized controlled single-blind trial, 60 women were assigned to the intervention (n = 30) and control (n = 30) groups using permuted block randomization. Overall, eight 45-min intervention sessions were held (twice a week). The primary outcome was sexual self-concept, and the secondary outcomes were women's sexual quality of life and participants’ satisfaction. The questionnaires were completed by patients before the intervention and immediately and 1 month after the intervention. Results The generalized equation estimation test showed that the positive sexual self-concept score of the intervention group versus the control group had increased by 15.67 points (P < 0.001, effect size = 2.00) 1 month after the intervention. The negative sexual self-concept score had decreased by 2.65 points (P < 0.001, effect size = 0.74), and the situational sexual self-concept score had upturned by 6.82 points (P < 0.001, effect size = 2.08) in the intervention group at the same period. Also, the sexual quality of life score in the intervention group compared to the control group generally increased by 13.82 points (P < 0.001, Effect size = 2.08) 1 month following the intervention. Significance of the results A social networking support program can be a promising approach to improve the sexual self-concept of women with breast cancer. Clinical trials.gov identifier Iranian Clinical Trial Register, IRCT20150608022609N8. Registered on 2 July 2020.

Background Providing quality care is of the fundamental elements of holistic nursing practice, and burnout and moral intelligence of nurses be mentioned as the important factors influencing the quality of nursing care. The present study was conducted to investigate the relationship between moral intelligence, burnout, and the quality of nursing care. Methods This descriptive-correlative study was conducted on 125 nurses working in Sari-based Educational hospitals affiliated to Mazandaran University of Medical Sciences, Iran, between June and August 2020. The sample was selected via random sampling. The data were collected by the Maslach Burnout Inventory, Lennick and Kiel Moral Intelligence Scale, and Quality of Patient Care Scale. The data were analyzed by SPSS-21 and Amos-24. Results A direct and significant relationship was found between the quality of nursing care and moral intelligence ( r = 0.285, p = 0.001). Quality of care had an inverse relationship with subscales of frequency of burnout including emotional exhaustion ( r = −0.369, p < 0.001) and depersonalization ( r = −0.471, p < 0.001) and also, a direct relationship with personal accomplishment ( r = 0.226, p = 0.011). The findings also showed an inverse relationship between quality of care and subscales of the intensity of burnout. Amos software yielded results that demonstrated moral intelligence as a robust mediator between burnout and the quality of care. Conclusion The findings implied the necessity for more attention to moral intelligence as a mediator in order to come up with properly managing the personality traits influencing the nurses’ burnout reduction, which can ultimately lead to improved quality of nursing care.

Introduction: Due to stressful work conditions, nurses are constantly exposed to various emotions and stressors such as anger and moral distress that threaten their mental health. On the other hand, self-esteem is one of the personality traits essential for people's mental health and improving their performance. Objective: The present study investigates the relationship between anger, moral distress, and self-esteem in nurses. Materials and Methods: This analytical correlational study was conducted on nurses working in the hospitals affiliated with the non-profit organization of Mazandaran Social Security Insurance from August to November 2018. Two hundred nurses were selected for this study via stratified random sampling. The study data were collected using the Cooper-Smith self-esteem inventory, Hamric moral distress scale, and state-trait anger expression inventory. The collected data were analyzed using the Mann-Whitney and Kruskal-Wallis tests, and path analysis was used for testing the conceptual model. Results: The mean±SD age of the nurses was 36.24±5.37 years. The mean ±SD anger, self-esteem, and moral distress scores were 113.68 ± 15.04, 26.61 ± 3.49, and 65.66 ± 35.88, respectively. The results of the path analysis model suggested an inverse causal relationship between self-esteem and moral distress (P<0.05). This model also indicated a significant inverse relationship between self-esteem and anger (P=0.01). Conclusion: As the results show, the nurses' self-esteem can mitigate the adverse effects of moral distress and anger. These results show the significant psychological interventions in controlling anger and promoting self-esteem and reducing moral distress among nurses.