Investigation of factors related to healthy eating behavior based on the developed theory of planned behavior in adolescents

BACKGROUND

Adolescence is a complicated and sensitive period, and proper nutrition in this period of life can influence the quality and quantity of growth and maturity. The aim of the present study is to determine the factors associated with healthy eating behavior based on the developed theory of planned behavior in adolescents.

MATERIALS AND METHODS

This is a descriptive-correlational study in which 400 female students of the first grade of high school in Bandar Anzali participated. Among the junior high schools in this city, two schools were randomly selected and sampling was done using census method. Data collection tool was Healthy Eating Behavior questionnaire based on Theory of Planned Behavior, which includes three sections of demographic information, constructs of Theory of Planned Behavior, including attitude toward behavior, subjective norms, perceived behavioral control, and behavioral intention, and food behavior, and food habits questionnaire. The scale was evaluated and confirmed by content validity ratio, content validity index, and alpha coefficient. P value was considered significant at less than 5%. Data analysis was performed using SPSS software 24, through linear regression and Pearson's correlation.

RESULTS

As shown by linear regression analysis, the developed theory of planned behavior is able to predict 26% of the variance of healthy eating behavior, and this predictive power is related to the constructs of behavioral intention, attitude, and habits.

CONCLUSIONS

In the present study, adding the variable of habits to the theory of planned behavior showed that this variable is very effective in predicting healthy eating behavior in adolescents, just like the constructs of behavioral intention and attitude. Therefore, it is suggested to carry out educational interventions based on the developed theory of planned behavior with the focus of the mentioned structures.

Analyzing the concept of sexual self-care in preschool children: A qualitative study

BACKGROUND

Child sexual abuse is a global concern for families and societies. Therefore, child protection from sexual harassment is of particular importance. The present study aimed to investigate the concept of sexual self-care in children.

MATERIALS AND METHODS

The present research is a qualitative study conducted with a content analysis approach. The study participants include 39 child sex education specialists, parents of children aged 4-7 years, adolescents who were sexually abused in childhood, and those with no experience of sexual abuse in childhood. The participants were selected through purposive sampling method. Different people's interpretations of the concept of sexual self-care in children were explored using semi-structured and face-to-face interviews, which continued until the saturation of concepts. Data were analyzed using the Graneheim and Lundman method. Guba and Lincoln's criteria were used to strengthen the validity and transferability of the data.

RESULTS

Sexual self-care in children was identified from participants' viewpoints in the study. This self-care includes three main components and six subcomponents of (1) knowledge about privacy, risk situation, and trustworthy people, (2) attitude and perception of risk, and (3) behavioral skills in self-protection (i.e., post-injury reaction).

CONCLUSION

Further injuries can be prevented by improving the level of awareness, forming the right attitude, and strengthening children's behavioral skills toward sexual self-care. Such issues, which are representatives of privacy, risk situations, and self-protection ability, can improve children's sexual self-care skills.

Factors associated with health-related quality of life in patients with Crohn's disease in Iran: A prospective observational study

This was a 1-year prospective observational study of the health-related quality of life (HRQoL) of moderate to severe crohn's disease (CD) patients in Iran. Patients' HRQoL were measured using the EQ-5D 3L, EQ-VAS, and IBDQ-9 tools. HRQoL among CD patients were compared using the T-test, Mann-Whitney, Chi-square, and Fisher's exact tests. To discover factors influencing patients' HRQoL, multivariate linear regression and multivariate logistic regression tests were utilized. The study included 222 CD patients, with a mean age of 34.67 and mean disease duration of 7.32 years. The dimensions with the worst reported "relatively or extreme problems" were P/D: 77.5% and A/D: 63.1%. Employment, having "other chronic diseases," and ADA consumption were the most important independent predictors of HRQoL in CD patients, [β = 0.21 (EQ-5D index), β = 19.61 (EQ-VAS), β = 12.26 (IBDQ-9), OR: 0.09 (MO), OR: 0.12 (UA), OR: 0.21 (P/D), OR: 0.22 (A/D)], [β = -0.15 (EQ-5D index), β = -5.84 (IBDQ-9), β = -11.06 (EQ-VAS), OR: 4.20 (MO), OR: 6.50 (UA)], and [OR: 2.29 (A/D)], respectively. Unemployment, presence of "other chronic conditions" had the greatest negative impact on HRQoL of CD patients. There were significant differences in the probability of reporting "relatively or extreme problems" in the SC and A/D dimensions between patients using adalimumab (ADA) and infliximab (IFX).

Exploring the Consequences of Early Marriage: A Conventional Content Analysis

Early marriage is one of the most important social issues for young women and can have many consequences. The present study aimed to explore the consequences of early marriage among Kurdish women in western Iran who were married under the age of 18. This qualitative study was conducted with the approach of conventional content analysis. The data were collected through semi-structured interviews with 30 women selected by purposeful sampling. Data analysis was performed using Graneheim and Lundman's method. A total of 389 codes, 12 subcategories, 4 sub-categories, and 2 main categories were extracted from the data analysis. Negative consequences of early marriage include: 1-physical and psychological problems (high-risk pregnancy and childbirth, physical illnesses, depression, and emotional distress); 2-family problems (dissatisfaction with married life, experience of having lots of responsibility, lack of independence in family life); 3-social problems (risky social behaviors, lack of access to social and health services, social isolation, lack of access to a job, and educational opportunities); and 4-positive consequences, including receiving intra-family support, improving living conditions, and opportunities for progress and empowerment. It is possible to reduce problems and challenges after early marriage by increasing the awareness and knowledge of young women about contraceptives and providing appropriate social and health facilities, and services during pregnancy. Providing the necessary training and psychological counseling for them and their husbands on how to deal with personal problems and marital life will be effective to a great extent.

Activities and challenges of volunteers in confrontation with COVID-19: A qualitative study in Iran

The control and prevention of COVID-19 requires the active and voluntary participation of the people. Because volunteers experience different activities and challenges, the present study aimed to identify the activities and challenges of volunteers in the face of COVID-19. The present study was conducted with a qualitative approach and conventional content analysis method among 35 volunteers in the field of COVID-19 using snowball sampling and semi-structured interviews. Data management was performed using MAXQDA-2018 software and its scrutiny was done by the Graneheim and Lundman analysis method. After analyzing the data, 2 main categories and 15 subcategories were obtained, including 1- Activities (instruction and training; production and distribution of hygiene items; economic aid; psychological and social support for COVID-19 affected people; cooperation with government organizations to implement quarantine; environmental disinfection; cooperation with and support of the medical staff; encouraging and persuading people to participate in voluntary work; attending and cooperating in high-risk centers) and 2- Challenges (fear and worry of getting infected; rejection; being different from other voluntary activities; experience of failure and helplessness; the difficulty of the recruitment and cooperation process; lack of adequate instruction on how to help). Volunteers have played wide and diverse roles in confrontation with COVID-19 and have been able to provide various types of support to government, health and social organizations and the general public in various ways, but due to the special circumstances of the COVID-19 epidemic, they have experienced many challenges at the same time.

Process and outcome evaluation of directly observed treatment short course (DOTs) in Kerman city, Southeast of Iran

BACKGROUND

Understanding tuberculosis (TB) treatment programs' process and the outcome is one of the critical strategies to prevent the disease's occurrence and accelerate achieving sustainable development goals to reduce TB cases. The present study aimed to evaluate directly observed treatment short-course (DOTs) for tuberculosis.

METHODS

The present cross-sectional, descriptive-analytical study extracted information from the tuberculosis surveillance system's recorded data by a researcher-made checklist with questions from patients and health system staff. We analyzed the data by SPSS version 20.

RESULTS

The outcome of patients' treatment was 85.39% improved, and the rest were death and failure of treatment and absence from treatment. The mean and standard deviation of the onset of the first symptom and diagnosis and detection of the disease was 117 and 126 days, respectively. The mean and standard deviation of the interval between diagnosis and treatment was 5.53 and 8.03 days, respectively. Regarding the treatment length, 95.5% of the cases followed the treatment length, and the rest were not observed. The history of hospitalization was 45.3% among patients, and the rest had no history of hospitalization, and the mean and standard deviation of the day of hospitalization were 6.68 ± 9.50 days.

CONCLUSIONS

The existence of an appropriate program for early diagnosis of tuberculosis, observing the length of treatment, training private and public centers to strengthen the care system, and strengthening the DOTs program to control tuberculosis seems to be necessary.

Factors affecting the health literacy status of patients with type 2 diabetes through demographic variables: A cross-sectional study

BACKGROUND

Health literacy (HL) is the ability of a person to acquire the process, understand the necessary health information, and make the health services needed for conscious health decisions. Besides, diabetes is the most common metabolic disorder that affects patients' quantity and quality of life. This study focused on determining the factors that affect the HL status of patients with type 2 diabetes (T2D) through the role of the demographic variables.

MATERIALS AND METHODS

This descriptive-analytical research survey recruited a sample based on 280 patients with T2D at the Diabetes Research Center of Ayatollah Taleghani Hospital in Kermanshah in 2020. This study selected patients with T2D using a simple random sampling technique. The study applied the demographic information questionnaire and the Functional, Communicative, and Critical HL Scale to collect data from patients with T2D. This study used the SPSS version 23 on the received data sets to perform statistical analysis, including t-test, analysis of the variance, and multiple regression, to predict the factors affecting HL among diabetes patients.

RESULTS

The study results showed that the mean age of the participating patients with T2D was 55.80 ± 13.04. The results indicated the mean score and standard deviation of total HL score in patients with T2D 2.70 ± 0.44. The findings specified a statistically significant relationship between HL, gender, education, occupation, income, and place of residence. Results indicated that β-coefficients of the multiple regression analysis and the income variable (β = 0.170), age (β = 0.176), and employment variable (β = 0.157). These are the most predictive of the HL of patients with T2D.

CONCLUSION

The results of this study specified that the HL rate of individuals with diabetes type 2 is average. The potential communicative and critical HL influence is essential for communication and education for diabetes patients in the primary health-care system settings. The findings indicate that communicative and critical HL related to patients' management and functional HL looks passable in this study.

Adalimumab versus Infliximab Treatment Outcome in Ulcerative Colitis: Application of EQ-5D, Visual Analogue Scale, and IBDQ-9 Measures: A Prospective Observational Study

BACKGROUND

Ulcerative colitis (UC) is a chronic global disease, and its incidence and prevalence are increasing worldwide.

OBJECTIVE

Our objective was to compare the secondary outcome of treatment with Infliximab (IFX) and Adalimumab (ADA) in the UC patients.

METHODS

This was a one-year prospective observational study of moderate- to -severe UC patients treated with ADA or IFX. Patients' secondary health outcomes were measured using the EQ-5D 3L, EQ-VAS, and IBDQ-9 tools. T-test, Mann-Whitney, chi-square, and Fisher's exact tests were used to compare health-related quality of life (HRQoL) among UC patients. HRQoL predictor variables were identified by multivariate linear regression and multivariate logistic regression.

RESULTS

A total of 238 UC patients (patients taking IFX: 78, patients taking ADA: 160) with a mean age of 37.66 and a mean disease duration of 9.29 years were enrolled. The EQ-5D index, EQ-VAS, and IBDQ-9 scores of patients taking IFX were 0.65, 55.93 and, 37.42, respectively. Similarly, patients taking ADA were 0.68, 59.27 and, 36.61, respectively. The highest problem reports were in P/D: 86.1% and A/D: 73.5%. The main independent predictors of HRQoL were: education over 12 years (β = 0.054 [EQ-5D index], β = 13.63 [EQ-VAS], OR: 0.28 [MO], OR: 0.07 [SC]), education between 6-12 years (β = 11.23 [EQ-VAS]), and having "other chronic diseases" (β = -0.074 [EQ-5D index], β = -5.29 [IBDQ-9], OR: 2.84 [UA], OR: 3.80 [A/D]).

CONCLUSION

There was no significant difference between the effect of ADA and IFX on secondary health outcomes in patients with moderate-to-severe UC.

Significance of Knowledge in Children on Self-Protection of Sex-ual Abuse: A Systematic Review

Background:

Sexual child abuse is a form of anti-social behavior with the children that cause potential harm to the health, development and dignity of the child. Knowledge of children about these issues can help to protect themselves against sexual abuse. This study aimed to review systematically available documents about the importance of knowledge on self-protection of sexual abuse in children.

Methods:

In this systematic review, “sexual abuse”, “self-protection” and “knowledge” were searched in Scopus, Google Scholar, Ovid, PubMed, and Science Direct as the search words, and after considering the inclusion criteria and excluding irrelevant articles, the relevant articles were included for data extraction. In the included studies, children were educated about sexual abuse, and questionnaires were designed to compare the impact of education and the level of knowledge in children before and after education.

Results:

Overall, 19 articles with overall 6582 children were found that were published from 1987–2020. The main awareness of children was from parents, educators and then the media. Age of the child, education level of family, good relationship between family members, adequate education by school teachers in the form of educational programs and even media play an important role in increasing knowledge of children about sexual abuse. Education to children, on average, led to 77.43% more awareness and as a results self-protection against sexual abuse and rape.

Conclusion:

Insufficient education or lack of knowledge about sexual abuse is a critical issue in children. Therefore, it is necessary to design educational programs to increase their knowledge about sexual abuse and strategies for self-protection in this age group.

Explaining the challenges and adaptation strategies of nurses in caring for patients with COVID-19: a qualitative study in Iran

Background

Nurses, as the primary human resource in the fight against COVID-19, encounter several obstacles and concerns. As a result, the current study used a qualitative method to describe the problems and adaptation techniques of nurses caring for COVID-19 patients.

Methods

The current study used a qualitative conventional content analysis technique with 30 nurses working in COVID-19 wards in Tehran hospitals. Purposive sampling, snowball sampling, and semi-structured interviews were used to get access to participants and gather data. The data was examined using conventional qualitative content analysis and the MAXQDA-18 program. To assess the quality of study findings, Guba and Lincoln’s trustworthiness criteria were fulfilled.

Results

The data analysis revealed two main categories and sixteen subcategories: (1) experiences and challenges (lack of protective equipment, high work pressure, marginalized physical health, problems related to the use of protective equipment, being excluded, a lack of a supportive work environment, problems related to patients, psychological problems, fear, marginalized personal and family life, and the challenge of communicating with patients’ families); and (2) adaptation strategies for work conditions (performing religious-spiritual activities, creating an empathetic atmosphere in the workplace, spiritualizing their work, trying to convince the family and gaining their support, and strengthening their sense of self-worth and responsibility).

Conclusion

Nurses’ working conditions can be improved by providing adequate protective equipment, a suitable work environment, and more social and financial support; paying more attention to nurses’ physical and mental health; and considering appropriate communication mechanisms for nurses to communicate with their families and patients’ families.

Lived Experiences and Challenges of the Families of COVID-19 Victims: A Qualitative Phenomenological Study in Tehran, Iran

Being COVID-19 positive and then dying causes a slew of personal, familial, and social issues for family members. Therefore, the current study was carried out to analyze the lived experiences and issues of COVID-19 victims' families in Tehran, Iran. The phenomenological approach was used in the qualitative analysis of 21 first-degree relatives of COVID-19 victims. From August 22 to October 21, 2020, data was gathered by phone (4 people) and in-person (17 people) using semi-structured interviews. The subjects were chosen through purposeful and snowball sampling. The MAXQDA-2018 program was used to organize the data, and the Colaizzi analytical technique was used to analyze it. Guba and Lincoln's criteria were also used to assess the findings' quality. After analyzing the data, 2 main categories and 14 subcategories were extracted, including (1) challenges in caring for a COVID-19 patient (being rejected, limited access to medical facilities, dissatisfaction with the behavior of medical staff, disruption of family life, the challenge of managing family members' behavior with the patient, and living with doubts and worries (2) challenges after a COVID-19 patient's death (incomplete farewell to the corpse, unbelievability of the death, ambiguity and tension in the burial process, lonely burial, the twinge of conscience, worry about not respecting the deceased, incomplete condolences, and abandonment). The troubles of victims' families can be ameliorated by developing the skills of caring for COVID-19 patients at home, providing medical and psychological services to families before and after the patient's death, appropriately informing the families to guarantee them about dignity and respect and respect of the deceased at the interment, and developing a culture of virtual condolence to provide emotional support to survivors.

Mortality probabilities after revascularization and medical therapy in CAD patients under 60 years old: a meta-analysis study

To estimate death probabilities after coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI), and medical therapy (MT) in patients under 60 years old. We conducted a search systematic on PubMed, Embase, Cochrane Library, and Web of Science up to January 2021. The study included three parts. In the probabilities part (A), Comprehensive Meta-Analysis, and in the comparison parts (B and C), Review Manager was used in conducting meta-analyses. Nine studies consisting of 16,410 people with a mean age of 51.2 ± 6 years were included in the meta-analysis. Over a mean follow-up of 3.7 ± 2 years, overall mortality after CABG, PCI and MT was 3.6% (95% CI 0.021–0.061), 4.3% (95% CI 0.023–0.080) and 9.7% (95% CI 0.036–0.235), respectively. The length of follow-up periods was almost the same and did not differ much (p = 0.19). In Part B (without adjustment of baseline characteristics), 495 (4.0%) of 12,198 patients assigned to CABG died compared with 748 (4.5%) of 16,458 patients assigned to PCI (risk ratio [RR]: 0.77, 95% CI 0.50–1.20; p = 0.25). Seventy-four (3.5%) of 2120 patients assigned to CABG and 68 (4.2%) of 1621 patients assigned to PCI died compared with 103 (9.5%) of 1093 patients assigned to MT in equal follow-up periods (CABG-MT: RR 0.34; 95% CI 0.23–0.51; p < 0.002) (PCI-MT: RR 0.40; 95% CI 0.30–0.53; p = 0.02). In Part C, overall mortality after PCI in PACD patients with STEMI was higher in elderly versus young (RR 2.64; 95% CI 2.11–3.30) and is lower in men versus women (RR 0.61; 95% CI 0.44–0.83). Mortality probabilities obtained are one of the most important factors of effectiveness in the economic evaluation studies; these rates can be used to determine the cost-effectiveness of procedures in CAD patients aged < 60 years.

Long-term outcomes after revascularization and medical therapy in premature coronary artery disease for cost-effectiveness study: A systematic review protocol

BACKGROUND

The long-term outcomes are important concepts for cost-effectiveness analysis in patients with premature coronary artery disease after revascularization (coronary artery bypass grafting [CABG] and percutaneous coronary intervention [PCI]) and medical therapy (MT). The finding of this study will be used to calculate the events probabilities for cost-effectiveness study.

METHODS AND ANALYSIS

This systematic review will use studies in which patients age must be 18-60 years in eligible studies that obtained from PubMed, Web of Science, Scopus, and Embase. We will assess the long-term outcomes after CABG, PCI, and MT by random-effects meta-analysis and effects will be shown by risk ratio. We will ascertain the probabilities of adverse events during certain periods and then outcomes will compare separately based on specific characteristics.

CONCLUSION

This study will provide information related to outcomes of CABG, PCI, and MT in patients with premature coronary artery disease. Doing this systematic review is valuable from clinically and economically aspects such as cost-effectiveness and cost-utility analysis.

Backpack improper use causes musculoskeletal injuries in adolescents: A systematic review

BACKGROUND

This research is one of the very few studies, which seeks a focalized examination to observe the effects of the backpack on the teenager students. Adolescents prefer rucksacks as one of their favorite school bags during their school studies. This study inspects how knapsacks gradually bring changes as injuries in the bodies of school-going adolescents. There are ample studies in the past literature, which evidence the injuries of backpack among adolescents, such as backache, neck pain, and shoulder pain. The principal objective of this study is to determine the effects of backpacks on musculoskeletal injuries among school-going adolescents based on previous studies support in this research field.

MATERIALS AND METHODS

This review study selected observational studies from the past literature indexed in the databases of Scopus, PubMed, ScienceDirect, and CINAHL during 1999-2020. This review focused on the keywords of "Backpack," "Musculoskeletal Injuries," and "Adolescent" from MESH and selected 14 out of 210 articles based on the research objective. According to the Crombie Checklist, inclusion and exclusion criteria, and investigating the quality of the report, this review focused on literature evidence to the field under investigation.

RESULTS

Based on the chosen 14 articles, the findings of the present review indicated two outcomes by considering the impact of the backpack on musculoskeletal injuries and pains among adolescents. The results of the review studies specified that there was a statistically significant positive relationship between the prevalence of musculoskeletal injuries and pain using a backpack among most of the male and female adolescents. The findings also stipulate that injuries and pain intensity among female adolescents were higher than the male students.

CONCLUSION

The results of this review study specified that improper use of the backpack, which exceeded the standard weight, caused chorionic pain and injuries between both genders of adolescents. The generalizability of the results is suitable for this review study.

Determinants of mammography screening in Tehranian women in 2018 based on the health belief model: A cross-sectional study

BACKGROUND

Breast cancer is the most common type of cancer among women. Mammography is the most sensitive and important method for screening and early diagnosis of breast cancer. Considering the importance of using mammography in breast cancer screening, this study was performed to evaluate mammographic determinants.

MATERIALS AND METHODS

In the cross-sectional study, we surveyed 985 women over 40 years in Tehran concerning demographic characteristics: age, socioeconomic status, a problem in the breast, alcohol use, drug use, and health belief model. Logistic regression was used to identify determinant factors associated with mammography performance.

RESULTS

The results of this study showed that 42.1% (95% confidence interval [CI]: 38, 45) participant performed mammography at least once during their lifetime. Age (odds ratio [OR] = 4.252; 95% CI = 2.041-8.857); housing situation (OR = 1.706; 95% CI = 1.178-2.469); having breast problems (OR = 5.224; 95% CI = 3.501-7.795); socioeconomic status (OR = 1.855; 95% CI = 1.035-3.325); family income level (OR = 1.998; 95% CI = 1.028-3.884); alcohol consumption (OR = 2.676; 95% CI = 1.344-5.328); smoking (OR = 2.824; 95% CI = 1.418-5.623); self-efficacy (OR = 1.935; 95% CI = 1.242-3.015); perceived barriers (OR = 2.017; 95% CI = 1.348-3.019); self-care (OR = 4.901; 95% CI = 3.152-7.620); perceived susceptibility (OR = 1.971; 95% CI = 1.271-3.057) and perceived severity (OR = 1.830; 95% CI = 1.170-2.860) were mammography behaviors determinants.

CONCLUSION

The findings indicated that the rate of mammography screening among Tehranian women is low and highlights the need for developing a comprehensive national breast cancer control program, which should be considered as the priority for health-care providers. Furthermore, the identification of these factors can help to design an appropriate educational intervention that focuses on the benefits of mammography screening.

Causes and Grounds of Childbirth Fear and Coping Strategies Used by Kurdish Adolescent Pregnant Women in Iran: A Qualitative Study

BACKGROUND

Fear of childbirth is one of the most common problems among pregnant women that can threaten their and their baby's health. Therefore, the purpose of this study was to explore the causes and grounds of childbirth fear and the strategies used by pregnant adolescent women in Iran to overcome such fears.

METHODS

In this study, which was conducted among primiparous Kurdish women in Iran, conventional qualitative content analysis was used. Data were selected through purposive sampling and semi-structured interviews. Data saturation was reached with 15 participants. The Lincoln and Guba criteria were used to strengthen the research.

RESULTS

After analyzing the data, two main categories were resulted. The first category was fear of childbirth with subcategories of fear of child health, fear of childbirth process, fears about inappropriate medical staff performance, fears about hospital environment, and postpartum fears. The second category was strategies to reduce childbirth fear with subcategories of choosing appropriate medical centers, increasing information on childbirth, avoiding stressful sources, improving self-care, getting prepared for delivery day in advance, and resorting to spirituality.

CONCLUSION

Pregnancy in adult age is better than adolescent age. The women's fear can be reduced by increasing their assurance about child health, providing appropriate training during pregnancy, explaining the whole process of childbirth and making it easier, improving the hospital environment and medical staff specialization, as well as providing appropriate conditions for further care and support after birth.

Experiences and challenges of Prostitute Women in Iran: A phenomenological qualitative study

Background

Prostitutes in Iran are faced with many challenges and problems that pose risks to their health.

Objective

The present study is an attempt to identify and narrate the challenges and experiences of Iranian prostitutes based on a qualitative approach.

Methods

This qualitative study was conducted with a phenomenological approach in (2018) in Tehran, Iran. The data were collected through semi-structured interviews with 22 prostitutes who were selected using a snowball sampling method and analyzed with Colaizzi's method. In order to examine the quality of findings, Guba and Lincoln's measures were used.

Results

Data analysis results were classified into five main categories and 14 subcategories. The main issues are: The experience of violence, Heath risk, social ostracism, objectifying, and lack of social and legal supporting structures.

Conclusion

Prostitutes in Iran experience numerous problems at personal and social levels. By providing social, economic, and legal supports for them such as social services (e.g. educations on how to use contraceptives, how to have safe sexual intercourse, and free counseling services for mental support), we can improve their health and welfare.

The Impact of Educational Intervention Based on Theory of Planned Behavior for Promoting Physical Activity Among Middle-Aged Women Referring to Karaj (Iran) Health Centers

BACKGROUND

Physical activity is the most critical determinant of physical health which reduces the health risks during life. This designed study aims to evaluate the effect of educational intervention based on the theory of planned behavior on promoting physical activity among middle-aged women attending the health centers in Karaj city during 2017-2018.

METHODS

This research was a quasi-experimental controlled trial, and the study incorporated 140 Middle-Aged Women Referring to Karaj Health Centers assigned randomly to a control and intervention group (70 each group). Participants enrolling in the survey were asked to complete the International Physical Activity Questionnaire and also the theory of planned behavior measures at the baseline and the end of the study. The SPSS software were used, to analyze the data. The study applied Nonparametric Wilcoxon and Mann-Whitney tests and ANCOVA to interpret the results.

RESULTS

The results revealed participants' age range between 30 to 50 years with the mean and standard deviation scores 40.07 (8.750) in training and 45.81 (8.513) at the control group. The intervention improved the theory of planned behavior measures and the physical activities of participants. The results showed a significant difference in the attitude score, the perceived behavioral control score, and the level of subjective norms between two training and non-training groups (P < 0.001). The followed-up physical activity score also showed an improvement in the IPAQ score of participants in the training group (p < 0.001).

CONCLUSIONS

The results of this specific study support the effectiveness of the theory of planned behavior for promoting the physical activity of women.

Qualitative study of social determinants of child marriage in Kurdish regions of Iran: Evidence for health promotion interventions

INTRODUCTION

One of the most thought-provoking problems in the world is child marriage that is affected by various factors. Therefore, the purpose of this study is to identify the social determinants of child marriage in Kurdish regions of Iran.

MATERIALS AND METHODS

This qualitative study was conducted using conventional content analysis approach. The participants of the study were 30 Iranian-Kurdish women married under the age of 18 who were selected through purposeful and snowballing sampling. Data collection was conducted through semi-structured interviews and face-to-face interviews and continued until the saturation of concepts was achieved. Graneheim and Lundman method was used to analyze the data, and Guba and Lincoln criteria were used to strengthen the research.

RESULTS

In general, findings include 5 categories and 17 subcategories: 1 - economic factors (financial problems and economic benefits); 2 - sociocultural factors (social customs, cultural beliefs, community encouragement, social learning, gaining prestige, and social support); 3 - individual factors (physical characteristics, personality traits, lack of awareness of the damaging consequences of early marriage, and fear of the future); 4 - family factors (dysfunctional family, weak awareness of parents, and harm prevention); and 5 - structural factors (high demand, limited access to educational services, and the lack of supportive social and legal structures).

CONCLUSION

By raising the level of awareness and attitude of girls and their families about the consequences of early marriage, creating the culture of correcting cultural beliefs and social misconceptions, passing appropriate laws, and the use of local and national media to prevent child marriage, this social harm can be reduced.

A Framework for National Rehabilitation Policy and Strategies in Iran: A Scoping Review of Experiences in Other Countries

Background

The main objective of this study was to review the goals and programs of rehabilitative care in different countries to achieve a framework for a national operational plan for expanding rehabilitation services in Iran.

Methods

In this qualitative study (scoping review), national rehabilitation documents were reviewed in a selected list of countries. We searched several databases including Web of Science, PubMed, Scopus, and Google Scholar and main website such as WHO. Then, the review results were presented to a panel of experts to receive their feedback and opinion for a framework of national rehabilitation policy and strategies in Iran.

Results

In the preliminary phase, 1775 documents were found and 17 documents were selected from Asia, Europe, three islands near Australia, America, and Australia continents. National policies and programs regarding rehabilitation could be categorized in three fields: 1) Removing the barriers to access rehabilitative health services, 2) strengthening and improving rehabilitation, relevant appropriate technologies, Supportive Services, and Community Based Rehabilitation, and 3) Collecting international data on social support and improving the quality of research and services related to rehabilitation.

Conclusion

To achieve a successful national rehabilitation framework in any country, it is required to strengthen information and research database, implement annual monitoring of policymaking, assess the next year rehabilitation needs of society, finding causes of disabilities for effective planning.

Investigation of the quality of life of patients with hypertension in health centers

INTRODUCTION

Hypertension is one of the most critical factors for chronic diseases such as cardiovascular disease, stroke, arrhythmias, heart failure, and renal disease. The aim of this study was to evaluate the quality of life and its related factors in hypertensive patients.

MATERIALS AND METHODS

This study was descriptive research. The sampling method was simple random, i.e., 137 were selected among the ten health centers of the list of the existing patients by simple random sampling. Data were collected using a questionnaire World Health Organization Quality of Life-BREF (Short Form-26). After collecting the questionnaires, the data analysis was carried out using SPSS software and using statistical methods (e.g., number, percentage, mean, standard deviation, and MANOVA tests).

RESULTS

The results showed that the mean score for the physical domain (52.82), the psychological domain (50.26), the social domain (48.33), the environmental domain (46.1), and the total quality of life (49.60). Among the demographic variables, the education level variable (P =0.000), job (P = 0.013), and the duration of hypertension (P = 0.039) were significantly correlated with the quality of life of patients. The "levels of education" variables are significantly correlated with the physical domain (P = 0.000), psychological domain (P = 0.000), social domain (P = 0.000), and environmental domain (P = 0.000) of the quality of life. The "job status" variable is only significantly correlated with the social domain of the quality of life (P = 0.005). The "duration of hypertension" variable is only significantly associated with the physical domain of the quality of life (P = 0.011).

CONCLUSION

The findings of the present study show that demographic variables such as educational level, occupation, and duration of hypertension have a significant relationship with the quality of life domains of hypertensive patients. It is recommended that the principled education of patients is a step toward the improvement of the quality of life of patients.

The effect of educational intervention based on dramatic literature on parents of elementary schoolchildren skills in sex education

BACKGROUND

Today, one of the biggest concerns of parents is protecting their children and properly educating them about sex. The aim of this study was to determine the effect of educational intervention on parental skills in sex education on their children in elementary schools in the northwest of Tehran-Iran in 2019 based on literature.

MATERIALS AND METHODS

This quasi-experimental study was conducted on 125 parents of elementary schoolchildren in the northwestern of Tehran. The data were collected by valid and reliable questionnaire. Before the intervention, two intervention and control groups filled up the pretest questionnaire; the data were collected by valid and reliable questionnaire. Before the intervention, two intervention and control groups filled the pretest questionnaire, and then the parents participated in the educational program based on dramatic literature. Two months later, the same questionnaire was completed by the control and intervention groups. Finally, the data were analyzed by regression and one-way ANOVA test.

RESULTS

The results showed that there was a statistically significant difference between the mean scores of knowledge in the experimental and control groups in the posttest (P < 0.01). There was also a statistically significant difference between the mean scores of attitude in the experimental and control groups at the posttest stage (P < 0.01). There was also a statistically significant difference between the mean scores of performance based on group membership (experimental group and control group) in the posttest phase (P < 0.01).

CONCLUSIONS

The findings of the study showed that educational intervention on parental skills in sex education based on the dramatic literature to their children has significant effect on parental knowledge, attitude, and performance.

Experiences of rural women with damages resulting from an earthquake in Iran: a qualitative study

Background

Women, with more vulnerabilities and less access to resources, are often seen as victims of natural disasters. Therefore, the present study aimed to investigate the experiences of rural women with damages resulting from an earthquake in Iran.

Methods

In this research, a qualitative approach, as well as the conventional content analysis was employed. The study population consisted of rural women residing in the earthquake-stricken areas of Sarpol-e Zahab and Salas-e Babajani counties in Kermanshah Province, Iran. Semi-structured interviews were used for data collection. Moreover, sampling was purposeful, theoretical saturation was achieved by conducting 22 interviews, and the data analysis process was performed according to the steps proposed by Graneheim and Lundman. For the strength and transferability of the research, Lincoln and Guba’s Evaluative Criteria were used.

Results

There were seven categories regarding the experiences of rural women after the earthquakes including neglecting the health needs; tension in the family and marital relations; gender inequality in the provision of assistance; feeling insecure; ignoring the ruling culture of the region; concealing needs for fear of stigmatization, and incoherent mourning as well as two categories regarding their reactions to and interaction with the earthquake consequences including positive and negative interactions.

Conclusions

Paying more attention to the needs of rural women, taking the culture governing the village into account at the time of service delivery, and helping them with positive adaptations are some indispensable measures that should be taken.

The effect of educational intervention on health-promoting lifestyle: Intervention mapping approach

BACKGROUND

The health-promoting lifestyle by empowering individuals will increase control over their health, improve quality of life, and prevent diseases. The purpose of the present study was to determine the effect of the educational intervention based on the intervention mapping approach on health-promoting lifestyle in Iranian college students.

METHODS

This study is a quasi-experimental control study that was conducted in two groups of 65 students of Iran University of Medical Sciences in 2018-2019. The data were collected using the Health-Promoting Lifestyle Standard Profile II questionnaire and a researcher-made questionnaire based on the mapping approach, whose validity and reliability were confirmed. The educational intervention was designed according to the pretest results, including five training sessions and performed for the intervention group. The two groups were evaluated with the same questionnaires 1 month and 3 months later, and the data were analyzed using independent t-test, Spearman, ANCOVA, ANOVA test, and covariance.

RESULTS

Before the intervention, no significant difference was observed between the mean scores of health-promoting behaviors in the two groups, but after the intervention, the mean scores of attitude, subjective norms, enabling factors, and perceived self-efficacy and mean scores of health-promoting lifestyle and its dimensions increased significantly in the intervention group (P < 0.001) compared to the control group.

CONCLUSION

The educational intervention is effective in improving behaviors related to health-promoting lifestyle and its dimensions. Therefore, performing educational interventions are suggested to adopt and adhere to behaviors related to health-promoting lifestyle by utilizing and reinforcing perceived self-efficacy, subjective norms, enabling factors, and attitudinal change.

Economic and non-economic determinants of Iranian pharmaceutical companies' financial performance: an empirical study

BACKGROUND

The pharmaceutical industry in Iran is influenced by various parameters such as internal factors caused by the financial information of each economic unit and external factors including major economic and non-economic variables.

METHODS

This study is aiming to examine the effect of such variables on the stock return of 34 pharmaceutical companies in the Tehran Securities Exchange market using quarterly data from 1995 to 2016. In this research, an autoregressive model was utilized to examine the way that variables affect the stock market index. In such patterns, there is no need for explicit short-term structural relationships and structural knowledge is extracted from causal relationships. Finally, to analyze the results, impulse-response functions, forecast error variance, and historical decomposition were collected.

RESULTS

Results of this research show that positive shock to the variables, namely the currency rate, collection period of quests, and healthcare costs lead to a decrease in the return of pharmaceutical companies. On the other hand, a positive shock to the variables such as GDP, and money volume, leads to an increase in the stock return of pharmaceutical companies.

CONCLUSION

Different factors contribute to the stock return of pharmaceutical companies. Among the variables examined in this study, market currency rate, money volume, pharmaceutical sector inflation, bank interest rate, GDP in the healthcare sector, healthcare costs, and collection period of quests have the most effect on describing changes within the stock return of pharmaceutical companies.

Cost analysis based on performance indicators during Healthcare Reform Plan in selected educational hospitals

INTRODUCTION

Hospitals are the main axis of health-care reforms or national health plans; therefore, accurate recognition of hospital costs based on operational indexes to these plans is necessary. The impact of implementing national health plans on the performance of health systems is ambiguous and misleading; therefore, the aim of this study was to assess the impact of Healthcare Reform Plan (HRP) on the micro level (e.g., educational or university hospitals).

METHODS

This study was a descriptive retrospective study that research variables are checked in 1 year before and mean of 3 years after implementation of HRP by self-administrated checklist in selected public-educational hospitals covered by the medical universities in Tehran. The final analysis of the data was performed using cost-performance ratio and independent t-test for comparing the variables' changes before and after HRP.

RESULTS

Unlike adjusted hospitalization costs, most operational indexes were not significant. The per capita cost adjusted of hospitalization in first and mean of 3 years after HRP increased 49.49% and 16.31%, respectively (P < 0.001), the adjusted cost per day was increased by 24.48% and 21.46% (P < 0.001), and adjusted cost per bed was increased 47.06% and 20.07% compared to before HRP (P < 0.001).

CONCLUSION

Given the lack of alignment in adjusted cost changes in exchange for functional indicators, certainly, it cannot be argued that HRP had a favorable or undesirable effect on the hospitals.

Cost-effectiveness of coronary artery bypass graft and percutaneous coronary intervention compared to medical therapy in patients with coronary artery disease: a systematic review

Coronary artery disease (CAD) has significant social and economic implications. It is necessary to create tools to identify the most cost-effectiveness treatments, which can assist clinicians in their therapeutic decisions so that the maximum possible benefit is reached with the lowest possible cost. Effectiveness must be measured by final treatment goals in which the most effective interventions are those with the lowest costs. This study is aimed to systematically review and compare the studies conducted on the cost-effectiveness of the three coronary artery disease treatment strategies (medical treatment, percutaneous coronary intervention, and coronary artery bypass graft). In this systematic review, the databases NHS Economic Evaluation Database, Embase, MEDLINE, Science Direct, and Scopus were searched for studies on the cost-effectiveness of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) compared to medical therapy (MT) in patients with coronary artery disease between 1 January 2004 to 30 September 2018. The quality appraisal of the included studies was examined using the Consolidated Health Economics Evaluation Reporting Standards (CHEERS) statement. Out of 186 unique retrievals, 8 studies were included. The results showed that the all studies clearly stated the time horizon of the study and included direct medical costs in their analysis. In addition, in most of the studies, quality-adjusted life years (QALY) were the main outcome used for measuring the effectiveness. The studies reported various ranges of the incremental cost-effectiveness ratio (ICER); accordingly, the highest ratio was observed in the USA ($212,800) for PCI v MT and the lowest ratio was observed in Brazil ($4403) for CABG v MT. Although the results of the studies were different in terms of a number of aspects, such as the viewpoint of the study, the study horizons, and the costs of expenditure items, they reached similar results. Based on the result of the present study, it seems that each three treatment strategies for CAD yielded improvements in QALY.

Effect of Health Literacy Education on Self-Care in Pregnant Women: A Randomized Controlled Clinical Trial

BACKGROUND

Prenatal care reduces the risk of adverse pregnancy outcomes. The present study aimed to determine the effect of health literacy education on self-care in pregnant women.

METHODS

The present randomized controlled clinical trial was conducted at two comprehensive health service centers in Pakdasht (Tehran province, Iran) during January-June 2016. Out of the ten comprehensive health service centers in the city, two centers were selected using a simple randomized sampling and randomly assigned to a control group and an intervention group. From each center, 40 pregnant women were recruited into the study. Dedicated questionnaires on self-care and health literacy during pregnancy were developed by the author as data collection tool. The validity and reliability of the questionnaires were confirmed using the test-retest reliability method and by the opinion of ten experts, respectively. The questionnaires were completed before the intervention, and at 1 and 2 months after the intervention. The intervention consisted of four 45-minute educational sessions and group counseling. The data were analyzed using the SPSS software (version 16.0) with the independent t test, Chi-square test, Mann-Whitney test, and repeated measures ANOVA. P<0.05 was considered statistically significant.

RESULTS

There was no significant difference between the groups before the intervention. However, 1 month after the intervention, there was a significant difference (P<0.001) in the mean scores of the total self-care and total health literacy between the control and intervention groups (65±6.23 versus 76.77±4.28 and 30.95±4.63 versus 40±3.54). Similarly, there was a significant difference (P<0.001) between the mean scores 2 months after the intervention.

CONCLUSION

Intervention for the promotion of physical and mental self-care during pregnancy should emphasize on increasing health literacy in computational comprehension, reading comprehension, and behavior. Trial Registration Number: IRCT2017030415650N8.

Effect of Health Literacy Education on Self-Care in Pregnant Women: A Randomized Controlled Clinical Trial

BACKGROUND

Prenatal care reduces the risk of adverse pregnancy outcomes. The present study aimed to determine the effect of health literacy education on self-care in pregnant women.

METHODS

The present randomized controlled clinical trial was conducted at two comprehensive health service centers in Pakdasht (Tehran province, Iran) during January-June 2016. Out of the ten comprehensive health service centers in the city, two centers were selected using a simple randomized sampling and randomly assigned to a control group and an intervention group. From each center, 40 pregnant women were recruited into the study. Dedicated questionnaires on self-care and health literacy during pregnancy were developed by the author as data collection tool. The validity and reliability of the questionnaires were confirmed using the test-retest reliability method and by the opinion of ten experts, respectively. The questionnaires were completed before the intervention, and at 1 and 2 months after the intervention. The intervention consisted of four 45-minute educational sessions and group counseling. The data were analyzed using the SPSS software (version 16.0) with the independent t test, Chi-square test, Mann-Whitney test, and repeated measures ANOVA. P<0.05 was considered statistically significant.

RESULTS

There was no significant difference between the groups before the intervention. However, 1 month after the intervention, there was a significant difference (P<0.001) in the mean scores of the total self-care and total health literacy between the control and intervention groups (65±6.23 versus 76.77±4.28 and 30.95±4.63 versus 40±3.54). Similarly, there was a significant difference (P<0.001) between the mean scores 2 months after the intervention.

CONCLUSION

Intervention for the promotion of physical and mental self-care during pregnancy should emphasize on increasing health literacy in computational comprehension, reading comprehension, and behavior. Trial Registration Number: IRCT2017030415650N8.

Association of self-care status with some relevant factors in middle-aged women in their early menopausal stage

BACKGROUND

Through self-care, people can solve their health-related problems through increasing their awareness and correcting their lifestyles.

OBJECTIVES

To determine the association of self-care status with some relevant factors in Kashanian middle-aged women in their early menopausal stage.

METHODS

This is a cross-sectional study on 351 women in the age range of 45-60 years. Women were selected based on cluster sampling method from the individuals at health-care centers in Kashan, Iran. Researcher-constructed questionnaire on self-care was used. The validity and the reliability of the questionnaire were calculated. The information gathering method was questionnaire completion by the study participants or interview with them. Collected data were analyzed with SPSS 16 software. T-test, ANOVA, Spearman correlation, and linear regression analysis were applied.

RESULTS

The mean (±standard deviation) of the self-care score was 108.14 ± 20.43. Self-care scores were weak in 13.92%, intermediate in 71.02%, and good in 15.06%. Regression analysis showed that the mean of self-care was significantly higher in those with higher educational level of women's (P = 0.045) and their spouses (P = 0.001). Women who were covered by insurance also showed higher self-care; in addition, there was no significant relationship between self-care and participants' job, spouses' jobs, marital status, marital satisfaction, economic satisfaction, number of children, number of households, and type of accommodation (P > 0.05).

CONCLUSION

The results indicate that self-care is inadequate and that the level of education of couples and insurance coverage has a positive effect on the level of self-care in postmenopausal women. To promote self-care in old age, education and empowerment can be considered.

Acceptability of the Urban Family Medicine Project among Physicians: A Cross-Sectional Study of Medical Offices, Iran

INTRODUCTION

It is essential to organize private physicians in urban areas by developing urban family medicine in Iran. Acceptance of this project is currently low among physicians. The present research determined the factors affecting acceptability of the Urban Family Medicine Project among physicians working in the private sector of Mazandaran and Fars provinces in Iran.

METHODS

This descriptive-analytical and cross-sectional study was conducted in Mazandaran and Fars provinces. The target population was all physicians working in private offices in these regions. The sample size was calculated to be 860. The instrument contained 70 items that were modified in accordance with feedback from eight healthcare managers and a pilot sample of 50 physicians. Data was analyzed using the LISREL 8.80.

RESULTS

The response rate was 82.21% and acceptability was almost 50% for all domains. The fit indices of the structural model were the chi-square to degree-of-freedom (2.79), normalized fit index (0.98), non-normalized fit index (0.99), comparative fit index (0.99), and root mean square error of approximation (0.05). Training facilities had no significant direct effect on acceptability; however, workload had a direct negative effect on acceptability. Other factors had direct positive effects on acceptability.

CONCLUSION

Specification of the factors relating to acceptance of the project among private physicians is required to develop the project in urban areas. It is essential to upgrade the payment system, remedy cultural barriers, decrease the workload, improve the scope of practice and working conditions, and improve collaboration between healthcare professionals.

The productivity and its barriers in public hospitals: case study of ran

BACKGROUND

Due to the increasing health care costs, the issue of productivity in hospitals must be taken into great consideration in order to provide, preserve and promote public health services. Thus, increasing the level of productivity must become the main aim of any hospital. Objective of this study is to determine the total factor productivity and its components over the period under the study.

METHODS

In this cross sectional study, total factor productivity changes of hospitals affiliated to Tehran University of Medical Sciences were measured according to Malmquist index over the period 2009-2014. To estimate total productivity changes using Data Envelopment Analysis method, inputoriented and variable return to scale assumptions were applied and Deap2.1 software was used.

RESULTS

The mean value of total productivity changes was 1.013. It means that during the study period the productivity experienced a 1.3% decrease. Technological efficiency changes have the greatest influence on productivity decrease than the other factors. Scale efficiency, managerial efficiency and technical efficiency changes were ranked.

CONCLUSION

Lack of knowledge of hospital personnel on proper application of technology in patient treatment is the main factor leading to productivity decrease resulting from technological changes in the studied hospitals. Therefore, holding courses for personnel in order to teach them the proper use of technology in diagnosis and patient care can be helpful.

Assessing the Awareness of Agents Involved in Issuance of Death Certificates About Death Registration Rules in Iran

INTRODUCTION

In the death registration system, issuance of death certificate, as a binding rule, is considered among the major necessities of preparation of death statistics. In order to prepare death statistics that are adequately valid for subsequent applications, it is necessary to properly encode death certificates and fully follow rules on causes underlying death. This study aimed to assess the awareness and performance of agents involved in issuance of death certificate in the national death records system.

METHODS

It was a descriptive cross-sectional research, which was performed from September 2013 to March 2014 on 96 agents involved in issuance of death certificate Imam Khomeini, Alavi, Fatemi and BuAli education and treatment centers of Ardebil University of Medical Sciences. The population included faculty staff physicians, residents and health information management staffs. The research scale was also a researcher-made questionnaire that questioned the demographic information as well as awareness and performance of participants regarding death certificate coding rules. Research data was analyzed based on descriptive statistics and the chi-square test method in the SPSS software at a confidence level of 95%.

FINDINGS

A total of 34.42% of participants were aware of the general rules on issuance of death certificates while faculty staff higher specialists (41.67%) and clinical coders (38.34%) with five years of experience demonstrated the highest awareness levels. Only 23 participants (24.6%) were trained to issue death certificates. A total of 76 participants (79.3%) announced their need for learning how to complete death certificate forms on a constant basis. The awareness of participants about the general principle was assessed to be low (30.25%). Moreover, their awareness of selection rules and modification rules was low (27.75%) and moderate (45.25%), respectively. The chi-square test revealed a significant relationship between work experience and awareness of participants about coding rules (P=0.001), but no significant relationship was observed between education and awareness of coding rules (P=0.497).

CONCLUSION

The awareness of participants about rules on coding death causes and their performance in this field was so satisfactory. That is to say, the awareness of faculty staff and health information management staffs was unexpectedly low. Seemingly, lack of adequate training is an international issue that causes mistakes in the recording of information on mortality. Hence, a short-term solution is to train faculty staff and residents and also revise the training provided to health information management staffs. As a long-term solution it is possible to provide related courses to general practitioner students.

Proposal for a modernized Iranian notifiable infectious diseases surveillance system: comparison with USA and Australia

This article reports on a comparative study of the national notifiable infectious diseases surveillance systems currently employed in the United States of America, Australia and the Islamic Republic of Iran, with the aim ofdeveloping a modified system specific to the needs of the Iranian health system. Features of the surveillance systems examined in each country included: official data gathering structures; types of data collected; case definition and classification criteria; data collection processes; data analysis methods; disease classification systems; data dissemination and distribution methods; data quality control; and confidentiality procedures and guidelines. After consolidating the data, a model for an Iranian notifiable infectious diseases surveillance system was developed and was tested by the Delphi method in 3 stages.