Iranian Red Crescent Medical Journal
Volume:20 Issue: 11, Dec 2018

Context: Emergency department is the first place in the hospital that patients refer to receive services, and patients often experience an emergency referral in their lives. Emergency care and paraclinical services are provided to patients in this department. The current study aimed at evaluating the patients’ satisfaction with emergency department in Iran through a systematic review and meta-analysis. Evidence Acquisition: The databases including Web of Science (WOS), Embase, PubMed, Scopus, Ovid, as well as the Iranian databases such as Irandoc and Magiran in the Persian and English languages were searched from 2000 to 2017. The STROBE (strengthening the reporting of observational studies in epidemiology) checklist was used to assess the quality of the research methodologies. The random model was used to determine the mean value of satisfaction and the results were reported with the confidence interval (CI) of 95%. Also, sensitivity analysis, subgroup and meta-regression were conducted. The Egger test was used to investigate the publication bias in the studies. Based on the random model, the mean of satisfaction with emergency services in Iran was 70.52% (95% CI: 63.81 - 77.23). The results of sensitivity analysis showed no change before and after the analysis of the results. Highest and lowest rates of patient satisfaction were reported in the Eastern (79.17%) and Northern regions (67.15%) of Iran, respectively. The current study findings showed that patients’ satisfaction with emergency services in Iran was high compared with the neighboring countries. Health policymakers should increase patients’ satisfaction through appropriate training, information, and increased human resources

E-learning is a recent approach in education, commonly appreciated for teaching students in most scientific fields, particularly in the industry. However, in medical education, this approach has difficulties that reduce its performance. Through the survey of the present models defining E-learning components, in respect to the patient simulation systems playing an important role in medical education, some deficiencies of these models have been revealed. In order to provide appropriate tools and techniques for implementing patient simulation within the learning management system, this research aimed at identifying the deficiencies of E-learning models and proposing a new model. In this review article, published accredited articles or books were initially searched in order to obtain E-learning components and different types of patient simulation systems. Through a study of E-learning components in selected models, the shortcomings in implementing various kinds of patient simulation systems were determined and the “Parsian” model was subsequently introduced. According to the results of the conducted research, it was found that the group of component tools in E-learning models, which could be classified in 3 different groups, was not adequate for implementing patient simulation. In the “Parsian” model, necessary tools and techniques were introduced in 3 different groups of software, methods, and techniques and medical equipment. All these groups introduced in the “Parsian” model were applicable. In the faculty of medicine, professors need patient simulation systems to provide students with E-learning. However, at the moment, there is not such patient simulation system in the existing LMS s all over the world. The LMSs are usually designed to teach courses that are mostly theoretical (rather than practical). Implementation of an LMS, exclusively applicable with high competence for teaching in all the realms of medical sciences, is provided by the means of “Parsian” tools and techniques

Bipolar disorder (BD) is defined as emotion dysregulation. Since such dysregulation is also present during remission, it may be a risk factor for the development of further affective episodes. Therefore, the current study aimed at examining the impact of group cognitive behavioral therapy (GCBT), in comparison to treatment as usual (TAU), on the cognitive emotion regulation strategies of patients with BD. Patients and Methods: The current single - blind, randomized, controlled trial (RCT) was performed from 2015 to 2017 at the Psychiatric Clinic of Razi Hospital affiliated to Tabriz University of Medical Sciences, Tabriz, Iran. A total of 70 adolescents with early - onset BD were selected by the convenience sampling method based on the diagnostic and statistical manual of mental disorders - fourth edition - text revision (DSM-IV-TR) and allocated into receive either 12 sessions of GCBT (N = 35) or TAU (N = 35). Cognitive emotion regulation strategies were evaluated by cognitive emotion regulation questionnaire (CERQ) at baseline, after the intervention, and at 3 - month follow - up. Efforts were made to follow up all randomized participants even if they withdrew from the assigned treatment prior to completion of GCBT sessions. Compliance with treatment was moderate and the mean number of GCBT sessions that the participants attended was 6.97 (2.81). The 2 groups had significant differences in terms of post - test scores for other - blame (P = 0.001), rumination (P = 0.049), positive refocus (P = 0.008), positive reappraisal (P = 0.005), and putting into perspective (P = 0.001). In the 3 - month follow - up, the 2 groups were significantly different only in other - blame (P = 0.001), positive reappraisal (P = 0.001), and putting into perspective subscales (P = 0.001). Therefore, the effects of the intervention were not effectively sustained after 3 months and there was room for improvement in terms of both outcome and compliance. The GCBT is more effective when the participants are involved in the study and get instructions on emotion regulation. However, since the effects of the intervention were not sustained for most of the subscales after 3 months, booster sessions might improve and prolong the impact of psychotherapies

Spouses can influence their wife’s health during pregnancy. However, dietary intake comprised of high value nutrition in addition to spouses’ participation during pregnancy is an important aspect of female’s health, which has been widely neglected. This study aimed at evaluating the effectiveness of educational programs with spouse’s participation on dietary during pregnancy. In the randomized controlled trial study, 128 nulliparous females attending Najmieh hospital based in Tehran, Iran, were randomly allocated to 2 intervention and 1 control group. In Group A, females received nutritional education with their spouses’ participation, in Group B, females received nutritional education alone, and in Group C, females received routine prenatal care, yet no guidance on dietary intake. Data was collected by completing 2 questionnaires, including demographic characteristics and the semi-quantitative food frequency questionnaire (FFQs). In this trial study, the mean differences of serving/day of vegetables and yogurt from the dairy range was significantly higher in group A compared to B and the control group (1.27 serving/day vegetables - group A compared to 0.81 and 0.41 serving/day vegetables in groups B and C, respectively; P < 0.001, and 0.56 serving/day of yogurt in group A versus 0.33 and 0.32 serving/day of yogurt in groups B and C, respectively, P < 0.024). The mean differences of serving/day of dairy in groups A and B were significantly higher than the control group (1.97 and 1.66 serving/day in groups A and B, respectively versus 0.81 serving/day in the group C, P = 0.003). In addition, the mean differences of serving/day for fat sources in the intervention groups were significantly lower than the control group (2.58 and 1.18 serving/day in groups A and B, respectively versus 0.38 serving/day in the group C, P = 0.035). The findings found improvement in intervention group A with intake of vegetables and yoghurt as dairy sources compared to Group B. In addition, their mean differences of dairy source was higher than Group C, while serving of fat sources was lower in both groups compared to the control group

Transient tachypnea of the newborn (TTN) is one of the important causes of neonatal respiratory distress and hospitalization in the neonatal intensive care unit (NICU). The current study aimed at identifying the risk factors of TTN in a single tertiary care center. The current prospective, case-control study was conducted on 180 newborns allocated in the 2 groups of with TTN (n = 90) as the case group, and without TTN (n = 90) as the control group for 1 year from April to March 2015 in a public hospital of Hamadan, Iran. Newborn and mother’s information was extracted from their medical records. Diagnosis of TTN was based on clinical and radiological findings, after ruling out other respiratory distress causes. Data were analyzed using logistic regression and P < 0.05 was considered the level of significance. The raw data analysis of regression factors associated with TTN showed that the risk of TTN was higher in late preterm infants (odds ratio (OR): 6.15; 95% confidence interval (CI): 3.17 - 11.92, P = 0.001) as well as male newborns (OR: 0.33, 95% CI: 0.17 - 0.62, P = 0.001), and those born by cesarean (OR: 11.22, 95% CI: 5.33 - 23.62, P = 0.001). Moreover, the risk of TTN increased with Apgar score in the first minute (OR: 0.02.95% CI: 0.00 - 0.05, P = 0.001) and decreased with the fifth minute (OR: 0.02; 95% CI: 0.00 - 0.06, P = 0.001). The results of multiple regression analysis showed that the odds of TTN of late preterm newborns was 2.96 times higher than that of term newborns (OR: 2.96, 95% CI: 1.09 - 8.04, P = 0.033). Furthermore, with increase in Apgar score in the first minute, the risk of TTN reduced (OR: 0.02; 95% CI: 0.01 - 0.07, P = 0.001). Prematurity and Apgar score in the first minute were the risk factors for TTN. Consequently, the risk of TTN can be reduced by the prevention of preterm birth and improvement of perinatal care.

The aim of the present study was to determine the prevalence of calcified carotid artery plaques (CCAPs) on digital panoramic radiographs (DPR) and its association with gender, age, as well as 3 risk factors of cerebrovascular attack including hypertension, cardiovascular diseases, and diabetes mellitus.

In this retrospective study, a total of 500 DPRs of subjects 45 years old and older (248 females and 252 males) were evaluated. All the subjects had been referred to the Faculty of Dentistry, Necmettin Erbakan University, Konya, Turkey, during 2014 - 2017 for routine dental examination. Socio-demographic variables as well as medical anamnesis were obtained from the participants and medical records. The radiographs were grouped according to gender, age groups (45 - 60 years old and 61 years old and older), and associated risk factors (diabetes mellitus & amp; hypertension & amp; cardiovascular diseases).

Of 500 DPRs, 243 (48.6%) were noted to have CCAPs. The 243 individuals who had CCAPs consisted of 119 males (49.0% of all males) and 124 females (51.0% of all females). Of the subjects aged 45 - 60 years old, 87 individuals (17.4%) showed carotid artery calcifications on their DPRs while 156 subjects (31.2%) aged 61 years old and older showed carotid calcification. There were significant differences between age groups, hypertension, cardiovascular diseases, and the prevalence of CCAP, which increased (P < 0.01). As the associated risk factor increased, the prevalence of bilateral CCAP also increased (P < 0.01).

The existence of bilateral CCAPs on DPRs has a higher prevalence in the subjects who had at least 2 associated risk factors and older, however, their detection is important to orient the diagnosis and prevention of diseases in asymptomatic high-risk patients

Reduction of pain and anxiety during labor is necessary to prevent some of the maternal and fetal complications, as well as request for cesarean section. There is limited evidence assessing the effects of saffron and dates on intensity of pain and anxiety. The current study aimed at examining the effect of saffron with or without dates on the intensity of pain and anxiety during transitional and active phases of labor in primiparous females. In the current superiority trial, 96 primiparous females admitted to a hospital covered by the iranian social security organization in Tabriz, Iran, at the onset of active phase of labor were recruited using convenience sampling method from 10 January to 21 October 2016. They were randomly divided into three equal groups using block randomization; receiving 80 mL oral syrup of saffron (250 mg) plus date juice (65 g), saffron (250 mg) plus artificial sugar (165 mg sodium saccharin and 420 mg sodium carboxymethyl cellulose), or placebo every two hours for maximum three doses (240 mL). Intensity of pain and anxiety were assessed using 0-10 visual analogue scale every one hour. Compared with the placebo, mean scores of both pain and anxiety were lower in the intervention groups. The differences were statistically significant at the saffron plus date juice group (adjusted mean difference: -0.8 (95% confidence interval (CI): -1.5 to 0.0), P = 0.022 and -1.3 (95% CI: -2.4 to -0.2), P = 0.012, respectively), but were not significant at the saffron plus artificial sugar group (-0.5 (95% CI: -1.2 to 0.2), P = 0.322 and -1.1 (95% CI: -2.2 to 0.0), P = 0.058, respectively). The differences between the two intervention groups were not statistically significant (-0.3 (95% CI: -1.0 to 0.4), P = 0.557 and -0.2 (95% CI: -1.3 to 0.8), P = 0.927, respectively). One woman from saffron plus date juice, three from saffron plus artificial sugar, and four from the placebo groups had emergency cesarean section. The current study results show that the oral syrup of saffron plus date juice could be used to reduce the intensity of pain and anxiety during labor in primiparous females. However, the results are inconclusive for the effects of saffron plus artificial sugar.

Operating room staffs are constantly subjected to a wide range of risks and injuries; therefore, any attempt to increase their safety through education is justified and considered a necessity. The aim of present study was to determine the effect of education based on the health belief model on adherence to standard precautions in operating room staff. This single-arm clinical study was carried out with a single-group, before-after study design. Seventy eligible operating room staff members from a hospital in Islamabad-e-Gharb, a city in Iran, were selected using the census sampling method in 2016-2017. The educational program, based on the constructs of the health belief model and related to taking standard precautions, was completed by operating room staff in three separate 30 to 45-minute sessions. Data collection tools included a demographic questionnaire and six researcher-created questionnaires based on the health belief model constructs and a standard self-efficacy questionnaire. The validity and reliability of all questionnaires were assessed and verified. Data were collected and analyzed before and 4 weeks after the educational program. Both the descriptive and inferential statistics (paired t-test) functions of SPSS version 22 were used to analyze the data. Nearly 85.7% of the operating room staff participants were men, and their mean age was 37.30 ± 6 years. The means and standard deviations of adherence to the standard precautions before and after the education were 35.17 ± 5.65 and 37.71 ± 5.83, respectively. The results of the paired t-test showed that except in case of cues to action, education based on the health belief model brought about significant changes in the constructs of this model, including perceived susceptibility (p = 0.03), perceived severity (p = 0.01), perceived benefits (p = 0.04), perceived barriers (p = 0.01), self-efficacy (p = 0.03), and adherence to standard precautions (p = 0.04). Nursing managers, nurses, and operating room staff can use the findings of this study for education and assessment of adherence to standard precautions

  A cost-effectiveness analysis is used to evaluate and compare the cost versus the benefits of different treatment modalities. The clinical effectiveness of laparoscopic cholecystectomy has been well documented. To our knowledge, there was no published data on the cost-utility of laparoscopic cholecystectomy in Iran. This study aimed to compare the cost-utility of the two surgical methods for removing gallstones: open cholecystectomy and laparoscopic cholecystectomy. Patients and Methods: In this comparative cross-sectional analysis, we investigated the data of patients who had undergone laparoscopic and open cholecystectomy operations in Kashani hospital, Iran, between 2012 and 2014. Using the available samples, two groups of 30 patients were randomly selected. SF-36 was used to assess the quality of life (QoL) of patients 30 to 35 days after operation, and quality-adjusted life years (QALYs) were calculated by multiplying the SF-36 score by healthy years of life. An activity-based costing method was used to determine the costs of the operations. The cost-effectiveness ratio (CER) was calculated by dividing the costs of each method by the gained QALY. To determine the difference between the two surgical methods, we used independent-samples t test. The data of 60 patients, 40 men and 20 women, with the mean age of 54.30 ± 16.44 in the laparoscopic group and 51.77 ± 18.41 in the open cholecystectomy group were analyzed. The mean cost of surgery was lower in the laparoscopy group (2259 ± 895 USD) than in the laparotomy group (2972 ± 907.9 USD) (P = 0.003). The mean SF-36 score was higher in the laparoscopic group (65.98 ± 9.22) than in the open cholecystectomy group (58.03 ± 11.30) (P < 0.004). The cost of gaining QALY was also significantly lower in the laparoscopic group. The mean of the gained QALY index was 1.79 ± 0.29 and 1.14 ± 0.41 for the laparoscopic and open surgeries, respectively (P < 0.001). The incremental CER was 1067 USD for each QALY for the laparoscopic group in comparison to the value of open cholecystectomy. Laparoscopic cholecystectomy was more cost-effective than open cholecystectomy and is therefore preferred and recommended in patients with gallstones

Hepatitis E infection is one of the most common causes of acute hepatitis. It is caused by the RNA virus of the hepatomegaly viridae family, which is transferred through stool in contaminated water. Cases of infection are most prevalent in developing countries. This study was conducted to investigate the seroprevalence of hepatitis E among urban adults. The reason was the current lack of information on the hepatitis E prevalence among the general population in the city of Birjand in eastern Iran. This information is necessary because Southern Khorasan is in close proximity to Afghanistan. In this cross sectional study, 522 participants aged over 17 years were selected from the city of Birjand, eastern Iran, using the random cluster sampling. The participants completed a researcher-made questionnaire that included demographic characteristics, risk factors for infectious diseases such as records of blood transfusions, specific exposures, intravenous drug abuse, recent diagnosis or a history of liver disease, and other medical information. After selection, a blood sample was taken from each participant to a volume of 5 cc. Each blood sample was then measured for the title of IgG antivirus of hepatitis E by the enzyme-linked immunosorbent assay (ELISA) method using the third generation ELISA kit made by Delavara Company. This study included 554 participants. The mean age of the participants was 41.4 ± 14.3 years (age range, 17 - 72 years). From a total of 554 participants, 295 (53.2%) were females and the remainder were males. Results showed that the hepatitis E antibody title was positive in 139 (25.1%) participants and negative in the others. Comparison of the prevalence rates of positive HEV between men and women showed no statistically significant difference although it was significantly higher in married participants than in single ones (P < 0.001). Results also showed that the prevalence was less in participants with a tertiary education compared to those with a lower level education. Along with age, the prevalence of the positive antibody title increased significantly. The prevalence of HEV in participants who were smokers was significantly (P < 0.001) lower than in those who were nonsmokers. In this study, the seroprevalence of contact with HEV in urban adults in the city of Birjand was 25%. The results of this study showed that the prevalence of hepatitis E in the city of Birjand, eastern Iran, was higher than in other places compared with previous studies on communities in Iran. Also, the prevalence of HEV in single and educated people was significantly less than that in married and literate individuals

Quality-of-life therapy (QOLT) is an integrative psychotherapy that was formed by adding positive psychology concepts to cognitive-behavior therapy (CBT). The aim of the current study was to evaluate the efficacy of QOLT on the sexual self-concept of Iranian women. Patients and A double-blind randomized experimental study was done from February 2011 to January 2012. The study subjects were recruited from a mental health nongovernmental organization in Isfahan, Iran. They were assigned randomly to two groups. The first group was under ten sessions of QOLT, and the second, as a control group, was under psycho-sexual education (PSE). General Health Questionnaire-28 (GHQ-28), the Multidimentional Sexual Self-Concept Questionnaire, and the Female Sexual Function Index (FSFI) were completed for participants before and after the intervention. The ANCOVA model was used for analysis. The findings revealed no significant differences between the two groups in mental health (GHQ-28 scores) and female sexual dysfunction, but sexual self-concept changed. Two subscales of sexual self-concept, sexual monitoring (QOLT group = 6.3 ± 2.7 vs PSE group = 4.7 ± 3.1 P < 0.05) and sexual-problem management (QOLT group = 15.4 ± 3.8 vs PSE group=13.7 ± 3.9 P < 0.05), increased significantly during QOLT. QOLT did not impact mental health, but it could change many dimensions of sexual self-concept.

Physicians continually need to update their knowledge to ensure appropriate decision making about patient care. We aimed to identify and compare information sources used by specialists and residents, their reasons for choosing these sources, and the level of their confidence in these sources. We conducted a cross-sectional study among specialists and residents using a validated questionnaire in the five academic hospitals affiliated with Mashhad University of Medical Sciences (in northeast Iran). We compared the specialists with residents in term of gender, age, years since graduation, use of information sources, confidence in use of information sources, and reasons for selecting the information sources. Within each group, we also investigated the effect of work experience and gender on frequently used information sources and users’ confidence in them. The questionnaire was sent to 315 physicians, including 155 specialists and 160 residents. One hundred twenty-six specialists (response rate: 81 %) and 126 residents (response rate: 79%) completed it. The most frequently mentioned sources by all specialists included “English textbooks” (84.9%), “web/internet” (74.6%), “English medical journals” (62.3 %), and “discussions with colleagues” (57%). Among residents, “web/internet” (65.9%), “discussion with colleagues” (61.3%), and “Persian textbooks” (50.4%) were the most frequently used sources of information. In both groups, high confidence was demonstrated in “English textbooks,” “English medical journals,” and “international instructions/guidelines.” Both groups counted reliability, easy accessibility, and being up to date as their primary reasons for the selection of their information sources. There was also a significantly negative correlation between using the internet as an information source and age in specialists (Spearman’s rho=- 0.238, p=0.01), but not in residents. Reliability, easy accessibility, and being up to date should be considered in establishing information sources for physicians.

The current study aimed at changing relaxation behaviors (RB) of patients with chronic low back pain based on educational programs through the Theory of Reasoned Action. The current experimental study was conducted from May to Nov 2016 on patients with chronic low back pain referred to pain clinics in Yazd, Iran. Through random blocking of every two participants, two groups were formed; the intervention (N = 43) group received educational programs based on the theory of reasoned action plus physician visits, and the control group (N = 45) received just physician visits. The mean age of intervention and control groups was 40.14 ± 6.8 and 38.33 ± 5.46 years, respectively. The mean score of RB in the intervention group improved from 4.58 ± 1.73 at baseline to 4.51 ± 1.69 and 3.02 ± 1.64 at three- and six-month follow-up times, while in the control group the changes were from 2.84 ± 1.62 at baseline to 3.49 ± 1.16 and 3.20 ± 1.42 at the same follow-up times; the changes were significant (P = 0.04). The educational programs of the current study could be recommended to change the beliefs of patients with chronic low back pain about the relaxation behaviors

Monitoring of food insecurity is a critical issue for planners and policymakers in the public and private sectors in developing countries. Due to the multifactorial and multidimensional nature of food security and a lack of clarity concerning the causes, specific signs, and consequences of food insecurity, developing a reliable food security index is the major challenge related to monitoring food security. The objective of this study was to identify the most appropriate indicators of food security at the provincial level in Iran through the application of an integrated approach including Delphi (classic Delphi) and analytic hierarchy process (AHP) from March to September 2013. The sample included 43 senior-level managers and experts at the national and provincial levels from different fields of related sciences; they were selected purposively as Delphi and AHP panel members based on the experts’ opinions and snowballing. In the first round of Delphi, out of 103 identified indicators, 38 were selected by the experts; the indicators were ranked in the second round. In the AHP study, 25 experts assigned weights in a pairwise comparison of the 20 indicators that had the highest priority based on the Delphi results. Using AHP matrix calculations, this list of indicators was ranked based on priority. Out of 38 indicators identified in Delphi, 8 were related to the availability dimension, 14 were related to the access dimension, and 16 were related to the utilization dimension. Out of 20 indicators that were ranked in the AHP study, 6 indicators were related to availability, 7 were related to utilization, and 7 were related to access dimensions. However, the indicators related to availability had an overall higher rank compared to indicators related to access or utilization. This study identified and ranked 20 indicators as the most appropriate indicators of food security measurements at the provisional level in Iran

The use of weight-loss dieting has always been overemphasized as the first modality to treat obesity. Success in weight loss is considered a major problem in obese individuals. The processes of behavior change have been used to facilitate intervention promoting change. Only a minority of studies have employed this construct for weight loss. The purpose of this study was to assess the effect of a balanced low-calorie diet with or without nutrition education on the weight loss and processes of change among obese women. Patients and In a randomized clinical trial, 90 apparently healthy obese women age 18 - 50 with body mass index (BMI) of 30 - 40 kg/m2 were recruited from the nutrition clinic in Ardabil, located in the northwest of Iran. Participants were assigned randomly to receive a balanced low-calorie diet with or without nutrition education. Participants completed a processes of change questionnaire at baseline and at three and six months after intervention. A generalized linear model repeated measures analysis of variances was used to assess the time effect as well as the interaction between the time and the group effect. Significant differences were found in the time effect for weight (F = 12.64, df = 2, P < 0.001), BMI (F = 10.90, df = 2, P = 0.001), andcounterconditioning (F = 22.82, df = 2, P < 0.001), and helping relationships (F = 5.47, df = 2, P = 0.006), reinforcement management (F = 3.65, df = 2, P = 0.03), self-liberation (F = 5.05, df = 2, P = 0.008), stimulus control (F = 12.12, df = 2, P < 0.001), and substance abuse subscales (F = 6.72, df = 2, P = 0.002). Significant differences were shown in interaction time and group effect for weight (F = 5.69, df = 2, P = 0.011), BMI (F = 4.91, df = 2, P = 0.018) and counterconditioning (F = 5.11, df = 2, P = 0.008) and stimulus control (F = 5.50, df = 2, P = 0.006) subscales. The findings support the use of nutrition education for more weight loss and improvement in the counter conditioning and stimulus control subscales among obese women attending the nutrition clinic. It seems that nutrition education should be considered important in effective weight-loss interventions

Stroke can be seen as a family matter, and nearly all stroke patients live with their families in their communities. Comprehensive insights into stroke recovery from family caregivers’ point of view are lacking. The aim of the present study is to explore and describe family caregivers’ experiences about the contributing elements of promoting the stroke recovery of older adults in the Iranian context. A qualitative content analysis approach was conducted. From September 2013 to April 2014, 17 family caregivers from multiple physiotherapy clinics in Sari, Iran, participated in this study. Data were generated through in-depth interviews, and the content analysis method was used to determine themes. The results of data analysis were categorized into three main themes: 1) promoting functional recovery; 2) improving psychological health; and 3) strengthening social roles. The general, overarching theme was promoting positive recovery. The family positively figures in the stroke patient’s recovery. Health practitioners must help the stroke families effectively play their critical roles in helping their stroke patients recover

  Obese and overweight females require proper programs for moderating and regulating their weight gain during pregnancy and preventing gestational diabetes. The aim of this study was to determine the effect of a lifestyle-based training package on weight gain and frequency of gestational diabetes in obese and overweight pregnant females. This randomized controlled trial was conducted on 140 obese and overweight pregnant females in Tehran, Iran. The training program administered to the intervention group consisted of a 60- to 90-minute session of group training using lectures, booklets, and text messages. A 2-hour 75 g oral glucose tolerance test (OGTT) was performed to screen for gestational diabetes at 24 to 28 weeks of gestation, and gestational diabetes was diagnosed based on the obtained results. The weight increase was calculated 8 weeks after the intervention compared to the beginning of the study. The test results of fasting blood sugar (FBS) and glucose tolerance test (GTT) showed 15 cases of gestational diabetes in the intervention group and 17 in the controls after the intervention, suggesting no statistically significant differences between the 2 groups (P = 0.687). Moreover, based on analysis of covariance (ANCOVA) and with adjusting the baseline values, the mean weight gain was found to be 3.4 kg in the intervention group and 3.8 kg in the control group, suggesting no statistically significant differences between the 2 groups after the intervention (P = 0.634). Although the frequency of gestational diabetes was found to be higher in the intervention group than in the controls, the difference was insignificant possibly due to use of a small sample size. Further studies are therefore recommended to be conducted using larger sample sizes

Physical activity is a vital element in diabetic patients and training of this behavior is important. Therefore, the present study aims to compare the effect of multimedia and short message service (SMS) based on the health promotion model on the physical activity of patients with Type 2 diabetes. In this clinical trial study, 37 subjects in the SMS group and 40 subjects in the multimedia group were studied. Subjects in the SMS group received training messages based on the health promotion model for 2 weeks, and the subjects of multimedia group received a teaching CD based on the health promotion model. Both groups completed the questionnaires at the beginning of the study, 2 weeks after training and 3 months after the 2nd stage. The participants in the 2 groups were similar in terms of demographic variables. The comparison of the 2 groups showed that there was a significant difference between 2 groups in terms of the perceived self - efficacy (p = 0.032), benefits (p < 0.001), family (p = 0.024), and friend support (p = 0.002), however, the perceived health status (p = 0.271) and barriers (p = 0.085) had no statistically significant difference between 2 groups during the study. Additionally, 3 months after the education, the mean metabolic equivalent of task (MET) increased to 2634.71 ± 502.01 and 2614.03 ± 592.45 in SMS and multimedia groups respectively; there was no significant difference between the 2 groups (P = 0.662). The results of this study showed more usefulness of multimedia rather than SMS education in changing the belief of diabetic patients about the physical activity and also the effectiveness of both educational methods for promoting physical activity of diabetic patients.

Taking care of veterans with Post-Traumatic Stress Disorder (PTSD) is associated with negative impacts on the quality of life and lifestyle of the care givers, especially the spouses. The current study aimed at evaluating the effect of a health promotion lifestyle training program on the spouses of veterans with PTSD in Gorgan city, Iran. Patients and A total of 63 spouses of Iranian veterans with PTSD covered by the Foundation of Martyrs and Veterans Affairs in Gorgan were enrolled into this quasi-experimental study by the target-based sampling method. Subjects were assigned to 2 groups of experimental (n = 30) and control (n = 33). Eight 45- to 60-minute sessions of educational training were held for the experimental group within 8 weeks. Demographic data checklist and the Health Promoting Lifestyle Profile (HPLP) questionnaire were employed to collect data. The mean total scores of health promotion lifestyle and subscales of physical activity, stress management, health care responsibility, and spiritual development significantly increased in the experimental group after the intervention (P < 0.05). The total score of health promotion lifestyle in the experimental group increased from 112.93 ± 20.63 to 122.52 ± 19.36, while the total score of health promotion lifestyle in the control group changed from 112.25 ± 26/09 to 110.27 ± 24.83. However, changes in the subscales of nutrition and interpersonal relationships were insignificant (P > 0.05). According to the results of the current study, educational interventions significantly improved lifestyle and health promotion behaviors in the spouses of veterans with PTSD. Hence, it is recommended to emphasize on training interventions as part of health promotion programs and improvement of lifestyle in care givers

Umbilical cord blood (UCB) gas analysis is recommended in high-risk pregnancies. However, in chronic medical conditions, cord blood acidosis might not indicate acute fetal stress, rather it might be due to fetal adaptation to the chronic stress. Evaluating the association between UCB acidosis with maternal factors and adverse neonatal outcomes in term pregnancies with gestational diabetes mellitus. This prospective cohort evaluated 673 pregnant women who had term pregnancies and were admitted for elective cesarean delivery. A total of 80 women had gestational diabetes. After delivery, a blood sample was obtained from the umbilical artery for arterial blood gas analysis. The neonates were then followed. Term pregnancies with gestational diabetes had significantly higher UCB acidosis rates compared to the healthy controls (26.2% vs. 6%, P < 0.001). In mothers with gestational diabetes, UCB acidosis was independently associated with higher maternal body mass index (P = 0.04) and HbA1C levels (P = 0.01). In the term neonates born to gestational diabetes mothers, after adjustment for gestational age, birth weight and pre-delivery blood glucose, UCB acidosis remained significantly associated with macrosomia (47.6% vs. 23.7%, P = 0.04), neonatal hypoglycemia (76.1% vs. 25.4%, P = 0.002), and moderate-severe jaundice (71.4% vs. 27.1%, p0.01). In our study term, pregnancies with gestational diabetes had a higher rate of UCB acidosis, which was associated with poor maternal glycemic and weight control during the last gestational trimester. UCB acidosis in these pregnancies seems to be independently associated with adverse neonatal outcomes

Food insecurity, as a major public health concern, is a useful indicator of an individual’s health and wellbeing. This study aimed to identify the relationship between the structural social determinants of health and food insecurity among pregnant women. This cross sectional study was conducted on 837 pregnant women, using stratified cluster sampling. The number of samples from each city of Ilam Province was determined, based on the proportion of women at reproductive age in every city. Urban healthcare centers were selected from each city, and eligible samples were recruited at 24 - 28 weeks of gestation, based on the inclusion criteria. Data were collected on women’s demographic and obstetric characteristics, socioeconomic status, and food security status. Data were analyzed using SPSS version 19. The results showed that the mean age of women was 28.73 ± 4.41 years. Overall, 35.1% of samples had food insecurity (mild, moderate, and severe insecurity: 24.9%, 7.5%, and 2.9%, respectively). Food insecurity had a significant relationship with the structural social determinants of health (P < 0.001). The logistic regression analysis revealed that the structural social determinants of health were protective factors against food insecurity, as the probability of household food insecurity was lower in women with college education, employees, and high-income households (OR, 0.118, 0.411, and 0.050, respectively). Food insecurity is a common problem, associated with the social determinants of health. Therefore, establishment of food security requires access to the necessary nutrients for all family members, especially the vulnerable ones.

Inactivity is one of the factors to increase the risk of having cardiovascular diseases. This methodological design study was conducted on the staff of Ilam Medical Science University (Ilam, Iran) in 2016 in order to assess the psychometric properties of the Iranian version of Impact of Sport on the Cardiovascular Diseases Scale based on the Health Belief Model (HBM - ISCS). In this study, first, targeted questions were selected based on the scientific literature review (N = 54) and then, the basic version of the questionnaire, including 14 questions in terms of HBM (Health Belief Model) constructs, went on the validation phase using the opinions of experts. At this stage, content and construct validity and reliability were reviewed and approved. Over all, 433 individuals with a mean age of about 38 years participated in the study. Based on the results, content validity rate (CVR) higher than 0.05 (number of specialists = 20) and content validity index (CVI) higher than the acceptable level of 0.79 were calculated. The primary Exploratory Factor Analysis (in a random spitted sample, N = 187) extracted five factors that jointly accounted for 59.804% of the variance observed. The results of Confirmatory Factor Analysis (in a random spitted sample, N = 246) showed that the questionnaire has desirable construct validity: (X2 = 146.81, df = 67, P < 0.001, CFI = 0.93, IFI = 0.93, RMSEA = 0.074 and SRMR = 0.067). Similarly, the Cronbach’s alpha coefficient was calculated between 0.715 and 0.816, and the Intraclass Correlation Coefficient (ICC) was obtained between 0.455 and 0.623 for the subscales. The results indicated that HBM - ISCS is a valid and reliable tool for measuring the health beliefs about the impact of sport on CVDs prevention.

High sodium intake can increase the symptoms of patients with chronic heart failure. To examine the effect of the education program on the adherence intention to the dietary sodium restriction and sodium intake in patients with chronic heart failure hospitalized in a teaching hospital affiliated with Yazd University of medical sciences, Yazd, Iran from January to July 2016. This controlled randomized clinical trial was conducted on 100 patients suffering from chronic heart failure. Block randomization was used to assign the patients to the intervention and control groups. In addition to routine education, the patients in the intervention group and one of their family members participated in the education program for 6 consecutive weeks. The amount of sodium intake in a 24-hour period was measured. A urine sample was collected for the measurement of the secondary outcome. A questionnaire was used for data collection about the evaluation of the adherence intention to the dietary sodium restriction. There were statistically significant differences between the intervention (2539.40 ± 1130.03) and control (3016.80 ± 790.38) groups in terms of the sodium intake 6 weeks after the intervention (P = 0.0023). Also, statistically significant differences were reported between these groups (2601.84 ± 1128.43 and 3041.95 ± 789.75 in the intervention and control group, respectively, P = 0.036) 12 weeks after the intervention. Six and 12 weeks after the education program, statistically significant differences were found between the groups in terms of the attitude (P < 0.001), subjective norm toward the restricted-sodium diet (P < 0.001), and perceived behavioral control (P < 0.001). The education program promoted the adherence intention to the dietary sodium restriction among patients with chronic heart failure, which subsequently led to the sodium intake reduction

Adherence to screening services is a prerequisite for the success of screening programs. This study aimed at determining factors associated with participants’ compliance with Dual-energy X-ray Absorptiometry (DXA) screening for osteoporosis. In this population-based participatory study, 1000 males and females older than 55 years old were invited to participate in the study. The study took place in the city of Kerman, Iran, where subjects were informed face to face about the risk factors and complications of osteoporosis and asked to complete a questionnaire. The subjects were then invited to visit a densitometry center for a free DXA study. Four rural areas and 4 locations in Kerman were selected based on municipal divisions. A total of 923 individuals completed the questionnaire: 562 (60.9%) were female, nearly two-thirds were from urban areas, and 284 (30.8%) were willing to undergo densitometry. Eight percent had a history of corticosteroid use for more than 3 months. About two-thirds of the participants were walking less than 150 minutes per week. In the logistic regression analysis, urban residents (OR = 1.88), females (OR = 1.52), and those who perceived high risk of osteoporosis (OR = 1.67) were more likely to adhere to DXA screening. On the whole, despite informing people about osteoporosis and offering free services, compliance to densitometry was not remarkable.

Chronic daily headache is a serious disease, causing significant problems such as disability. It is characterized by pain localized to the head (headache) and headaches occurring on 15 or more days per month for more than 3 months (> 180 days per year). Programs for pain and health improvement in patients with painful diseases, such as headache, are not still fully developed. Acceptance and commitment therapy (ACT) is a new psychotherapy, which appears to be effective in the treatment of chronic pain. This study aimed to examine the effectiveness of ACT in cognitive emotion regulation strategies, headache-related disability, and headache intensity in patients with chronic daily headaches. In the current study, a semi-experimental method was applied. The study was conducted at Shahid Beheshti Governmental hospital of Kashan, Iran in 2016. The sample consisted of 40 patients with chronic daily headache, who were selected via convenience sampling. The participants were randomly allocated into medical treatment as usual (MTAU) and ACT groups (20 samples per group) via block randomization. The ACT group received eight 90-minute weekly treatments, based on the ACT protocol. The cognitive emotion regulation questionnaire (CERQ), diary of headache severity, and headache-related disability inventory (HDI) were administered at pretreatment, posttreatment, and three-month follow-up in both groups. In the current study, no significant differences were found between the groups in terms of demographic variables (P > 0.05). In the ACT group, the mean (SD) scores of emotional and functional aspects of headache disability were 26.87 ± 10.11 and 28.50 ± 9.04, respectively before the intervention, which decreased to 17.75 ± 8.32 and 18.12 ± 9.42 after the intervention and 21.37 ± 8.53 and 21.37 ± 9.87 in the follow-up, respectively (P < 0.05). In addition, the mean (SD) score of nonadjustment cognitive emotion regulation strategies was 54.31 ± 10.02 at pretreatment, which significantly reduced to 44.43 ± 7.7 at posttreatment and 49.78 ± 9.1 in the follow-up (P < 0.05). Furthermore, the mean (SD) score of adjustment cognitive emotion regulation strategies was 61.43± 12.02 in the pretest, which significantly increased to 72.06 ± 8.66 in the posttest and 69.62 ± 11.84 in the follow-up (P < 0.05). The mean score of headache intensity decreased from 6.40 ± 1.19 to 5.00 ± 1.09, compared to the pretest (P < 0.05); however, there was no significant difference between the groups in the follow-up (P > 0.05). The results of the present study suggested that ACT is an effective treatment for reducing nonadjustment cognitive emotion regulation strategies, headache-related disability, and headache intensity and improving adjustment emotion regulation strategies in patients with chronic daily headache.

Obsessive-Compulsive Disorder (OCD) disrupts individual and family functioning because of its characteristics. Therefore, the intervention based on patient and family participation can enable the sufferers and their families reach the desired level of functioning. This study was conducted to evaluate the effect of psychoeducational intervention on improvement of symptoms of patients with Obsessive-Compulsive Disorder (OCD) and general family functioning of companions, using the McMaster model dimensions. In this quasi-experimental study, the first population included all the patients who referred to psychiatric clinics in Yazd City, Iran, in 2016 with the diagnosis of obsessive-compulsive disorder. The second population consisted of one member of their family who was selected using purposive sampling method and included 30 patients and 30 members of their family. Of these, 15 patients with their family members were assigned to the control and experimental groups. The patients completed the Yale-Brown questionnaire and the family members completed Family Assessment Device (FAD) questionnaire before and after the intervention. Only the experimental groups received eight intervention sessions. Finally, the experimental and control groups were compared in terms of general functioning and improvement of symptoms. The data were analyzed with SPPS 23.0 using independent t-test and analysis of covariance tests. The difference in the average age and length of marriage in both groups was not significant (P > 0.05). The results of independent t-test showed that there was a significant difference between the two groups in general family functioning (P < 0.05). In addition, analysis of covariance showed that psycho-educational intervention led to significant reduction in obsessive-compulsive disorder in the experimental group (P < 0.05). This study showed that psycho-educational intervention was effective in improving the general family functioning of a companion, and therefore, it was effective in reducing the severity of obsessive-compulsive disorder in patients.

Changes in body composition in advanced ages (i.e., physical, physiological, and social changes) may influence the perception of body image in the elderly population. In some studies, it is stated that negative body image is associated with the consequences of unhealthy physical and mental health status. The purpose of the study is to examine changes in body weight, body satisfaction, and quality of life in the elderly. This descriptive analytical study was performed from July 2015 to April 2016 on individuals aged 45 years and above who lived in Kirikkale, Turkey. The participants were divided into four age groups of 45 - 59 years (group 1), 60 - 69 years (group 2), 70 - 79 years (group 3), and 80 years and above (group 4). Body satisfaction was evaluated using Body-Cathexis Scale (BCS), and the quality of life was evaluated using the Nottingham Health Profile (NHP). the highest body mass index (BMI) was found in the 60 - 69 years age group (29 ± 4.72 kg/cm2), whereas the lowest score was found to be in the individuals pertaining to the 80 years and above age group (26.53 ± 4.53 kg/cm2). BCS total scores were 85.95 ± 22.09 in group 1, 94.78 ± 26.68 in group 2, 103.29 ± 31.41 in group 3, and 107.28.35.84 in group 4. A significant difference was found between the groups in terms of quality of life and body satisfaction (P < 0.05). There was a positive correlation between BCS and NHP in groups 1, 2, and 3 (P < 0.05). However, there was no correlation between BCS and NHP in group 4 (P > 0.05). Evaluations and practices performed for body weight control in middle-aged and older adults are of importance in terms of increasing the quality of life.