Resilience, Pain Self-efficacy and Health-related Quality of Life in Greek Hemodialysis Patients: A Cross-sectional Study

International Journal of Preventive Medicine (Int J Prev Med)2008-780216220250315Resilience, Pain Self-efficacy and Health-related Quality of Life in Greek Hemodialysis Patients: A Cross-sectional Study18ENDepartment of Obstetrics, University of Western Macedonia, Ptolemaida1 Department of Nursing, International Hellenic University, ThessalonikiDepartment of Obstetrics, University of Western Macedonia, Ptolemaida2 Department of Nursing, University of Ioannina20250315Background: Regardless of the recent advances in Chronic Kidney Disease stage 5 (CKD-5) management people on dialysis face significant changes in their quality of life. The present study aimed to examine the relationship between psychological resilience and quality of life in patients undergoing in-center hemodialysis. Methods: An initial sample of 150 adult patients on hemodialysis for more than 6 months was selected from hospitals in a Southern European country. The study used the Connor-Davidson Resilience Scale (CD-RISC), the Pain Self-Efficacy Questionnaire (PSEQ), and the Kidney Disease Quality of Life (KDQOL-36) questionnaires to assess levels of psychological resilience, pain self-efficacy and quality of life. Results: The results indicated that higher levels of psychological resilience were associated with higher levels of pain self-efficacy, which in turn led to better quality of life. Conclusions: The findings suggest that psychological resilience and pain self-efficacy play important roles in the health-related quality of life of people on hemodialysis, regardless of demographic factors such as age and gender. These have implications for practice in CKD-5 management and highlight the importance of addressing psychological factors in dialysis care.<span class="ej-journal-name" style="box-sizing: inherit; font-style: italic; font-weight: 500; color: #3b3030; font-family: 'Fira Sans', sans-serif; font-size: 14px; font-variant-ligatures: normal; font-variant-caps: normal; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; background-color: #ffffff; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial;">International Journal of Preventive Medicine <span id="ej-journal-date-volume-issue-pg" style="box-sizing: inherit; color: #3b3030; font-family: 'Fira Sans', sans-serif; font-size: 14px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; background-color: #ffffff; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial;"><a style="box-sizing: border-box; color: #005b92; text-decoration: none; background-color: transparent; cursor: pointer; outline: 0px;" href="https://journals.lww.com/ijom/pages/currenttoc.aspx">16():9, February 2025.</a><span style="box-sizing: inherit; color: #3b3030; font-family: 'Fira Sans', sans-serif; font-size: 14px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; background-color: #ffffff; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial;"> | <span class="ej-journal-doi" style="box-sizing: inherit; font-style: italic; font-weight: 500; color: #3b3030; font-family: 'Fira Sans', sans-serif; font-size: 14px; font-variant-ligatures: normal; font-variant-caps: normal; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; background-color: #ffffff; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial;">DOI: <span style="color: #3b3030; font-family: 'Fira Sans', sans-serif; font-size: 14px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; background-color: #ffffff; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; display: inline !important; float: none;">10.4103/ijpvm.ijpvm_108_24<span style="color: #3b3030; font-family: 'Fira Sans', sans-serif; font-size: 14px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; background-color: #ffffff; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; display: inline !important; float: none;">Corresponding Author: Mr. Michail Tsanasidis <span style="color: #3b3030; font-family: 'Fira Sans', sans-serif; font-size: 14px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; background-color: #ffffff; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; display: inline !important; float: none;">E‑mail: michailtsanasidis@gmail.com<span style="color: #3b3030; font-family: 'Fira Sans', sans-serif; font-size: 14px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; background-color: #ffffff; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; display: inline !important; float: none;"> You can also search for this author in: PubMed <a title="google scholar" href="https://scholar.google.com/scholar?hl=en&as_sdt=0%2C5&q=Michail+Tsanasidis&btnG=">Google scholar</a>http://ijpm.mui.ac.ir/index.php/ijpm/article/view/2978http://ijpm.mui.ac.ir/index.php/ijpm/article/download/2978/717718819

International Journal of Preventive Medicine (Int J Prev Med)2008-780216220250315Relation Between Smoking and Disability Progression in Iranian Multiple Sclerosis Patients: A Case‑Control Study912ENDepartment of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan Neuroscience Research Center, IsfahanDepartment of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan Neuroscience Research Center, IsfahanDepartment of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan Neuroscience Research Center, Isfahan1 Department of Biostatistics and Epidemiology, Isfahan University of Medical Sciences, Isfahan,Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan Neuroscience Research Center, Isfahan2 Farabi Psychiatry and Ophthalmology Center, Isfahan University of Medical Sciences, Isfahan20250315Background: To compare characteristics of patients with multiple sclerosis (MS) between cigarette smokers and non‑smokers. Methods: A case‑control study was performed on patients registered in the Kashani MS center from April 2019 to April 2020 in Isfahan, Iran. In total, 136 smoker patients and 220 non‑smokers participated in the study and completed the questionnaire. Results: The frequency of male gender in the smoker group was significantly higher than in the non‑smokers (64.7% vs. 15%, P < 0.001). The mean age at MS onset was 31.5 ± 9.60 years among cigarette smokers and 29.7 ± 9.47 years among non‑smokers (P = 0.794). Furthermore, 80% of cigarette smokers and 64% of non‑smokers had at least one relapse per year (ARR ≥1, P < 0.001). The Expanded Disability Status Scale (EDSS) of more than 4.5 was significantly higher in smokers (26.5% vs. 18%, P = 0.023). There was a relation between an EDSS of more than 4.5 and an interval between smoking initiation and disease onset (P = 0.004). Long duration of smoking was associated with a higher disability scale (16.4 ± 9.5 vs. 9.8 ± 7.3, P = 0.008). Men smoked for a longer period of time before developing MS than women (9.24 ± 10.07 vs. 4.47 ± 7.61, P = 0.002). The average daily cigarette consumption was 7.74 ± 6.65 in women and 10.84 ± 9.44 in men (P = 0.024). Duration of smoking before the onset of the disease was 4.47 ± 7.61 years in women and 9.24 ± 10.07 in men (P = 0.002). Conclusions: Our data suggest that there is a possible relationship between disability score and the duration of smoking before the onset of MS. It also revealed that the duration of smoking can affect the progression of the disease. Further studies are suggested to confirm these findings.<span class="ej-journal-name" style="box-sizing: inherit; font-style: italic; font-weight: 500; color: #3b3030; font-family: 'Fira Sans', sans-serif; font-size: 14px; font-variant-ligatures: normal; font-variant-caps: normal; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; background-color: #ffffff; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial;">International Journal of Preventive Medicine <span id="ej-journal-date-volume-issue-pg" style="box-sizing: inherit; color: #3b3030; font-family: 'Fira Sans', sans-serif; font-size: 14px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; background-color: #ffffff; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial;"><a style="box-sizing: border-box; color: #005b92; text-decoration: none; background-color: transparent; cursor: pointer; outline: 0px;" href="https://journals.lww.com/ijom/pages/currenttoc.aspx">16():12, February 2025.</a><span style="box-sizing: inherit; color: #3b3030; font-family: 'Fira Sans', sans-serif; font-size: 14px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; background-color: #ffffff; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial;"> | <span class="ej-journal-doi" style="box-sizing: inherit; font-style: italic; font-weight: 500; color: #3b3030; font-family: 'Fira Sans', sans-serif; font-size: 14px; font-variant-ligatures: normal; font-variant-caps: normal; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; background-color: #ffffff; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial;">DOI: <span style="color: #3b3030; font-family: 'Fira Sans', sans-serif; font-size: 14px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; background-color: #ffffff; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; display: inline !important; float: none;">10.4103/ijpvm.ijpvm_336_23Corresponding Author: Prof. Fereshteh AshtariE‑mail: f_ashtari@med.mui.ac.irYou can also search for this author in: <a title="PubMed" href="https://pubmed.ncbi.nlm.nih.gov/?term=%28Fereshteh+Ashtari%5BAuthor%5D%29+AND+%28isfahan+University+of+Medical+sciences%5BAffiliation%5D%29&sort=">PubMed</a> <a title="google scholar" href="https://scholar.google.com/citations?user=BoZq8KkAAAAJ&hl=en&oi=ao">Google Scholar</a>http://ijpm.mui.ac.ir/index.php/ijpm/article/view/2981http://ijpm.mui.ac.ir/index.php/ijpm/article/download/2981/717718822

International Journal of Preventive Medicine (Int J Prev Med)2008-780216220250315The Heart Tissue Molecular Response to Resistance Training in Comparison to Irisin Injection: A Focus on VEGF Gene/Protein Expression and Correlations with Serum Irisin Levels1320ENDepartment of Exercise Physiology, Faculty of Sport Science, University of Isfahan, IsfahanDepartment of Exercise Physiology, Faculty of Sport Science, University of Isfahan, IsfahanDepartment of Exercise Physiology, Faculty of Sport Science, University of Isfahan, Isfahan1 Department of Anatomical Sciences, School of Medicine, Isfahan University of Medical Sciences, Isfahan1 Department of Anatomical Sciences, School of Medicine, Isfahan University of Medical Sciences, Isfahan2 Department of Genetics and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan20250315Background: Angiogenesis is crucial in the recovery and maintenance of heart function. Irisin may mediate the cardiac health‑promoting impact of exercise training. The aim of this study was to comparatively assess VEGF gene/protein expression in the heart tissue and correlations with serum irisin levels following resistance training, in comparison to exogenous irisin injection. Methods: Twenty‑one NMRI mice were randomly assigned to the three group (n = 7 for each group): control, resistance exercise, and irisin. Exercised mice, for 8 weeks, three sessions per week and four sets of five repeats for each session were considered and mice climbed up a 1‑m‑height ladder with a slope of 80 degrees with a weight equal to 30% of mouse’s body weight fastened to their tails and gradually increased up twofold of body weight. The Irisin group received 100 µg/kg/week irisin for 8 weeks, intraperitoneally. The cardiac expression of the VEGF gene, by real‑time PCR, the level of VEGF protein, by IHC (immunohistochemistry) and western blot analysis, and serum irisin concentration, by ELISA, were evaluated. Results: The expression of the VEGF gene and protein, as well as serum Irisin levels, increased in all experimental mice compared to the control group (P < 0.05). Pearson’s correlation coefficient data indicated a positive correlation between the analyzed parameters in each group (P < 0.05 and r > 0). Conclusions: There appears to be an interaction between resistance exercise and cardiac angiogenesis factors, mediated by irisin. So, irisin could be considered in cardiovascular health interventions, aiming to target specific molecules or pathways.<span class="ej-journal-name" style="box-sizing: inherit; font-style: italic; font-weight: 500; color: #3b3030; font-family: 'Fira Sans', sans-serif; font-size: 14px; font-variant-ligatures: normal; font-variant-caps: normal; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; background-color: #ffffff; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial;">International Journal of Preventive Medicine <span id="ej-journal-date-volume-issue-pg" style="box-sizing: inherit; color: #3b3030; font-family: 'Fira Sans', sans-serif; font-size: 14px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; background-color: #ffffff; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial;"><a style="box-sizing: border-box; color: #005b92; text-decoration: none; background-color: transparent; cursor: pointer; outline: 0px;" href="https://journals.lww.com/ijom/pages/currenttoc.aspx">16():13, February 2025.</a><span style="box-sizing: inherit; color: #3b3030; font-family: 'Fira Sans', sans-serif; font-size: 14px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; background-color: #ffffff; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial;"> | <span class="ej-journal-doi" style="box-sizing: inherit; font-style: italic; font-weight: 500; color: #3b3030; font-family: 'Fira Sans', sans-serif; font-size: 14px; font-variant-ligatures: normal; font-variant-caps: normal; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; background-color: #ffffff; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial;">DOI: <span style="color: #3b3030; font-family: 'Fira Sans', sans-serif; font-size: 14px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; background-color: #ffffff; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; display: inline !important; float: none;">10.4103/ijpvm.ijpvm_79_24Corresponding Author: Dr. Fahimeh Esfarjani E‑mail: f.esfarjani@spr.ui.ac.ir You can also search for this author in: <a title="PubMed" href="https://pubmed.ncbi.nlm.nih.gov/?term=%28Fahimeh+Esfarjani%5BAuthor%5D%29+AND+%28+University+of+isfahan%5BAffiliation%5D%29">PubMed</a> <a title="google scholar" href="https://scholar.google.com/citations?user=SW0wWzMAAAAJ&hl=en&oi=ao">Google Scholar</a>http://ijpm.mui.ac.ir/index.php/ijpm/article/view/2982http://ijpm.mui.ac.ir/index.php/ijpm/article/download/2982/717718823

International Journal of Preventive Medicine (Int J Prev Med)2008-780216220250315Prevalence of Stroke in People with Multiple Sclerosis2122ENDepartment of Neurosurgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan1 School of Medicine, Isfahan University of Medical Sciences, Isfahan, 2 Network of Immunity in Infection, Malignancy, and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Isfahan1 School of Medicine, Isfahan University of Medical Sciences, Isfahan1 School of Medicine, Isfahan University of Medical Sciences, Isfahan, 2 Network of Immunity in Infection, Malignancy, and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Isfahan20250315Dear Editor, Multiple sclerosis (MS) is a chronic condition affecting the central nervous system (CNS). MS is associated with various comorbidities, including cardiovascular diseases, neurological disturbances, stroke, hypertension, and metabolic disorders.[1] stroke characterized by malperfusion of CNS tissue, is among the significant comorbidities observed in MS patients.[2,3] We undertook a study aimed at determining the prevalence of stroke among pwMS in Isfahan, Iran.<span class="ej-journal-name" style="box-sizing: inherit; font-style: italic; font-weight: 500; color: #3b3030; font-family: 'Fira Sans', sans-serif; font-size: 14px; font-variant-ligatures: normal; font-variant-caps: normal; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; background-color: #ffffff; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial;">International Journal of Preventive Medicine <span id="ej-journal-date-volume-issue-pg" style="box-sizing: inherit; color: #3b3030; font-family: 'Fira Sans', sans-serif; font-size: 14px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; background-color: #ffffff; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial;"><a style="box-sizing: border-box; color: #005b92; text-decoration: none; background-color: transparent; cursor: pointer; outline: 0px;" href="https://journals.lww.com/ijom/pages/currenttoc.aspx">16():10, February 2025.</a><span style="box-sizing: inherit; color: #3b3030; font-family: 'Fira Sans', sans-serif; font-size: 14px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; background-color: #ffffff; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial;"> | <span class="ej-journal-doi" style="box-sizing: inherit; font-style: italic; font-weight: 500; color: #3b3030; font-family: 'Fira Sans', sans-serif; font-size: 14px; font-variant-ligatures: normal; font-variant-caps: normal; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; background-color: #ffffff; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial;">DOI: <span style="color: #3b3030; font-family: 'Fira Sans', sans-serif; font-size: 14px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; background-color: #ffffff; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; display: inline !important; float: none;">10.4103/ijpvm.ijpvm_153_24Corresponding Author: Dr. Hasan Kaveyee E‑mail: kaveyeehasan@gmail.com You can also search for this author in: <a title="PubMed" href="https://pubmed.ncbi.nlm.nih.gov/?term=%28Hasan+Kaveyee%5BAuthor%5D%29+AND+%28Isfahan+University+of+Medical+Sciences%5BAffiliation%5D%29">PubMed</a> <a title="google scholar" href="https://scholar.google.com/scholar?hl=en&as_sdt=0%2C5&q=Hasan+Kaveyee&btnG=">Google Scholar</a>http://ijpm.mui.ac.ir/index.php/ijpm/article/view/2979http://ijpm.mui.ac.ir/index.php/ijpm/article/download/2979/717718820

International Journal of Preventive Medicine (Int J Prev Med)2008-780216220250315MusQan Initiative: Challenges and Opportunities2324ENDepartment of Community Health Nursing, Teerthanker Mahaveer University, College of Nursing Moradabad, Uttar Pradesh, India20250315Dear Editor,I am writing to highlight the essential MusQan Quality Improvement program in healthcare. This initiative systematically monitors, assesses, and enhances care for children from birth to 12 years, aiming to reduce preventable newborn and child morbidity and mortality. <span class="ej-journal-name" style="box-sizing: inherit; font-style: italic; font-weight: 500; color: #3b3030; font-family: 'Fira Sans', sans-serif; font-size: 14px; font-variant-ligatures: normal; font-variant-caps: normal; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; background-color: #ffffff; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial;">International Journal of Preventive Medicine <span id="ej-journal-date-volume-issue-pg" style="box-sizing: inherit; color: #3b3030; font-family: 'Fira Sans', sans-serif; font-size: 14px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; background-color: #ffffff; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial;"><a style="box-sizing: border-box; color: #005b92; text-decoration: none; background-color: transparent; cursor: pointer; outline: 0px;" href="https://journals.lww.com/ijom/pages/currenttoc.aspx">16():11, February 2025.</a><span style="box-sizing: inherit; color: #3b3030; font-family: 'Fira Sans', sans-serif; font-size: 14px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; background-color: #ffffff; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial;"> | <span class="ej-journal-doi" style="box-sizing: inherit; font-style: italic; font-weight: 500; color: #3b3030; font-family: 'Fira Sans', sans-serif; font-size: 14px; font-variant-ligatures: normal; font-variant-caps: normal; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; background-color: #ffffff; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial;">DOI: <span style="color: #3b3030; font-family: 'Fira Sans', sans-serif; font-size: 14px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; background-color: #ffffff; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; display: inline !important; float: none;">10.4103/ijpvm.ijpvm_194_24Corresponding Author: Dr. Ram K. Garg E‑mail: ram.nursing@tmu.ac.in You can also search for this author in: <a title="PubMed" href="https://pubmed.ncbi.nlm.nih.gov/?term=%28Ram+K.+Garg%5BAuthor%5D%29+AND+%28Teerthanker+Mahaveer+University%5BAffiliation%5D%29&sort=">PubMed</a> <a title="google scholar" href="https://scholar.google.com/citations?user=qbgT9BgAAAAJ&hl=en&oi=ao">Google Scholar</a>http://ijpm.mui.ac.ir/index.php/ijpm/article/view/2980http://ijpm.mui.ac.ir/index.php/ijpm/article/download/2980/717718821