فهرست مطالب maryam peimani

This study presents estimates for type 2 diabetes mellitus (T2DM) burden and attributable risk factors in Iran from 1990–2019, using data from the 2019 Global Burden of Disease study.

This study reports prevalence, incidence, death, disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs) of T2DM in Iran, by sex, age, and province, from 1990 to 2019. We also present the T2DM burden attributable to risk factors. Results are reported in absolute number and age-standardized rates.

Overall, the burden of T2DM had increased greatly since 1990. In 2019, the T2DM incidence and prevalence cases were 291,482 (a 374% increase) and 5,035,012 (a 417% increase) respectively. Moreover, the number of death and DALYs were 14,191 (a 488% increase) and 716,457 (a 417% increase) respectively. DALYs and YLDs in women were consistently higher than men were, whereas women experienced slower increases in YLLs from 1990 to 2019. The age-standardized DALYs rate increased for all Iranian provinces during study period. High body-mass index, ambient particulate matter pollution, and low physical activity remained the three major attributable risk factors in all provinces in 2019.

T2DM constitutes a major health burden in Iran. The remarkable upsurge in the T2DM burden represents an ongoing challenge, given the rapidly aging population in Iran. Thus, integrated and multi-sectoral actions that decrease exposure to risk factors and improve the prevention and early diagnosis are needed.

This study was performed to investigate whether social support and other psychological predictors were associated with physical activity during the prolonged social isolation due to the coronavirus disease 2019 outbreak in Iran.

This cross-sectional study was performed on 494 individuals with type 2 diabetes (T2D) in a diabetes specialty clinic. The questionnaire package comprised five parts, including sociodemographic and clinical characteristics, physical activity level, diabetes-specific social support, feelings of isolation, and diabetes-related distress. Clinical and hemoglobin A1c data were obtained from electronic medical records. Descriptive statistics, Pearson’s chi-square test, and multivariable logistic regressions were conducted to analyze the data.

Approximately 71% of the participants participated in low/insufficient levels of physical activity. The participants who received support from family/friends (odds ratio [OR] = 1.77; 95% confidence interval [CI]: 1.47 - 2.74), diabetes care team (OR = 1.42; 95% CI: 1.15 - 1.77), and neighbors (OR = 1.53; 95% CI: 1.20 - 2.08) were more likely to have sufficient physical activity than those who did not receive these supports. There was also an association between physical activity behavior with feelings of isolation and diabetes distress.

This study points to the importance of social support as an amplifier mechanism for the maintenance of physical activity behavior in individuals with T2D during critical times.

The study aim was to reports detailed characteristics of nutrition research in field of diabetes, and recognize knowledge gap in nutrition science in diabetes in Iran.
Online databases of PubMed, Web of Science and Scopus as well as national databases including SID, IranMedex, and Magiran were searched up to 2015 to identify eligible articles. Finally, 378 articles were included.
Final articles were categorized based on WHO and Australian classifications, study design and subject area. The most number of studies (80%) was related in strategies and interventions of health-related outcome group the WHO classification. The most percentage of publications in Australian classification system was allocated to clinical researches (78%) and the least studies were health service studies (0.08%). The most common designs used in the obtained documents (41%) were Randomized Clinical Trials (RCT) and about 17% of publications were animal studies. Cohort studies were the least studies among the obtained documents. The most common subject was type 2 Diabetes Mellitus and its complications followed by DM management (64%, n=241). The least numbers of publications were dedicated to GDM (Gestational Diabetes Mellitus). There was a large ascent in studies during 2010-2011 and 2012-2013.
Available evidence provides very good support for the role of nutrition diets in the prevention and management of all types of diabetes. This systematic review indicates trend of nutrition researches in diabetes was noticeable flourished, while the important subjects in diabetes studies are forgotten or unimportance.

Despite the benefits of diabetes patient education, it is imperative to analyze the status of researches in this field and identify research gaps and priorities if our limited health resources are to be used wisely and effectively. This study is a part of Iran Diabetes Research Roadmap study to find the knowledge gap in the field of diabetes patient education in Iran.
All publications of Iranian authors about diabetes patient education in national (SID, IranMedex, and Magiran) and international journals (PubMed, Web of Science and Scopus) up to 2015 were reviewed. Overall, 306 studies were categorized by subject category, methodology, WHO classification and NHMRC criteria.
Most numbers of samples in the subject category were about the effect of self-care training (28%) and then model-based educational interventions (13%). Moreover, trend in publication rate of papers related to the patient education topic is relatively increasing with time, despite some difficulties points. Half of the papers were cross-sectional and 46% of them were interventional studies.
Although trend of papers subjects was relatively scattered, most of patient education studies in Iran were about assessing the positive effects of self-care education similar to other countries. However, quality assessment for all studies should be carried out in future research.

This study aimed to provide comprehensive analysis of research output in the field of diabetes and exercise in Iran.
Search process of the present study was a part of search strategy of Iran Diabetes Research Roadmap (IDRR) study. All publications of Iranian authors about diabetes and exercise in national (SID, IranMedex, and Magiran) and international journals (PubMed, Web of Science and Scopus) up to 2015 were reviewed. After screening and adjusting for duplicates, 180 studies were remained and categorized by subject category, methodology, WHO classification and NHMRC criteria.
Among 180obtained articles, in term of subject area mostnumber of documents was about the type of sports (55%) followed by social aspect of exercise and physiologic effects. Aerobic exercise (52.5%) was the most common exercises studied. Moreover, overall trend of publications was relatively increasing during the study period. More than half of the papers were randomized clinical trial (RCT) (51.11%).
Although trend of papers subjects was relatively scattered, most of exercise studies in Iran were about the type of sports with more focus on aerobic exercises in patients with type 2 diabetes. Future research in this field should be directed more toward cohorts and systematic reviews that provide high level of evidence. However, quality assessment for all studies should be carried out in future research.

Diabetes has become a daunting health and medical challenge as well as a hefty economic burden for societies over the past decades. This study was designed to shed light on the overall trend of research across Iran regarding mental health status of diabetic patients.
Search process of the present study is part of search strategy of Iran Diabetes Research Roadmap (IDRR) study. We performed a thorough search about Iran diabetes research output in national (Iranmedex, Magiran, and SID) and international (Pubmed, ISI and Scopus) databases up to 2015. After removing duplicates, 426documents were remained and categorized by subject category, methodology, WHO classification and NHMRC criteria.
Most of obtained studies were concerned with quality of life, treatment, intervention, and behavioral disorders. Based on WHO categories, most studies revolved around epidemiology, causes and determinants of health-related outcomes. Methodological classification showed cross-sectional as the favored method of research. In the Australian classification system, most studies were clinical studies. The year 2010 and 2011 had the greatest spike during the study period.
Overall trend in publication rate of papers related to the mental health is relatively growing. However, the lack of priority setting is obvious and there is a pressing need for more in-depth evaluations, prioritization of study type and interventional studies based on the needs of patients suffering from diabetes.

Most adult patients with diabetes have at least one comorbid chronic condition and approximately 40% have three or more. The purpose of this study was to investigate detailed characteristics of studies examining comorbidities of diabetes in Iran and to identify knowledge gaps in this field.
All documents published by Iranian authors in national and international journals until 2015 were evaluated. A wide search was performed in PubMed, Web of Science, SCOPUS as well as SID, IranMedex and Magiran databases using proper keywords. The obtained documents were categorized into eleven subgroups of complications, comorbidities, management, psychiatry, nutrition, prevention, physical activity, genetics, basic sciences, education and gestational diabetes mellitus (GDM). Documents were categorized based on WHO and Australian National Health and Medical Research Council (NHMRC) classification, the study methodology and topic.
Overall, 311 documents were obtained. The trend of publications was ascending since 2000. About 70% of studies were about epidemiology and causes of comorbid disease and more than 90% of studies were clinical research. The design of the most studies was cross-sectional followed by case-control and randomized clinical trial. The most common subject of documents was related to endocrine (28.61%) followed by gastrointestinal (18.32%) and cardiovascular disease (14.14%).
Epidemiological studies are the most common type of studies about diabetes comorbidity in Iran and cross-sectional design is the most frequent methodology used while there are few cohorts. There is no study about physiopathology and shared etiology and pathogenesis of these comorbidities and diabetes.

The objective of the current study is to assess the effectiveness of Mobile Short Message Service (SMS) intervention on education of basic self-care skills in patients with type 2 diabetes. Moreover, we aimed to determine whether delivering individually-tailored educational messages can be more effective than general educational messages.
A total of 150 patients with diabetes type 2 were randomized into three groups: tailored SMS group, non-tailored SMS group, and the control group. Biochemical parameters including HbA1c, FBS, lipid profile were evaluated for the three groups at baseline and after 12 weeks. Moreover, self-care Inventory (SCI), Diabetes Management Self-Efficacy Scale (DMSES) and Diabetes Self -Care Barriers assessment scale for Older Adults (DSCB-OA) were completed. In the tailored SMS group, each person received 75% of their messages based on the top two barriers to adherence that they had experienced and reported in their scale. In the non-tailored SMS group, random messages were sent to every patient.
After12 weeks, although HgA1c levels did not significantly change, significant decline was observed in FBS and mean BMI in both intervention groups. Mean SCI-R scores significantly increased and mean DSCB and DMSES scores significantly decreased in both tailored and non-tailored SMS groups. In the control group, mean SCI-R scores decreased and mean DSCB and DMSES scores significantly increased (P Sending short text messages as a method of education in conjunction with conventional diabetes treatment can improve glycemic control and positively influence other aspects of diabetes self-care. According to our findings, sending SMS regularly in particular times appears to be as effective as sending individually tailored messages.

One of the factors affecting the process of teaching – learning are students´ learning styles. The aim of this study was to determine the learning styles of undergraduate nursing students at universities across the country. This cross sectional study of nursing students studying in academic year 1389-90 was conducted in 25 provinces of Iran. The questionnaire included demographic information and 12 questions related to learning styles (Kolb), respectively. Totally 1925 undergraduate nursing students completing the questionnaire participated in the study. Data were analyzed by using descriptive statistics and chi-square test. In this study, most nurses belonging to the age group 18-23 years (89/7%). Most students were female (64/8%) and unmarried (87%). The majority of students (%43/1) had accommodative learning styles and learning styles of others were Divergent (%36/5), Convergent (%11/3) and Assimilative (%9/1). nursing students have different learning styles and teachers should consider it and make use of different teaching methods. In this regard, experimental studies recommended assessing different teaching methods on nursing students learning.

Development of evidence-based clinical guidelines to raising standards of medical care in diabetes is a core element of coping with the global diabetes epidemic. The purpose of this study was to develop a systematic clinical diabetes guideline from the latest scientific evidences and also to localize its recommendations according to regional and cultural needs of our society. Searches were conducted using NICE, SIGN, WDPCP, IDF, JDC, ADA, AACE, ICSI, CDA, AMDA, IDC, NyDoH guidelines which were examined and criticized and scored using Agree method. Guidelines which got higher score in some important areas of Agree scale including: rigor of development, clarity and comprehensiveness of the recommendations and applicability, especially in the climatic conditions of our country were selected. The existing recommendations were extracted by committee members and supporting evidences of each recommendation were determined based on the sources listed in the clinical guideline. Recommendations grading were classified from grade A to D based on the quality of their supporting evidences (BEL1-5). This guideline covered all areas related to diabetes including screening and diagnosis, lifestyle modification and patient education, management, complications and hypoglycemia. Regarding capacities of this guideline and lack of comprehensive and updated guidelines in our country and region, it is suggested that designing a pilot study to implement this Learner-centered guideline and finding its weaknesses can lead to patient care improvement and also propel us towards our goal to design a comprehensive guideline in compliance with regional and national needs in Middle East.

Today، the internet has been emerged as a potentially effective medium for information exchange and in recent years، the use of web-based training programs has been steadily considered in the prevention and management of chronic diseases such as diabetes. This technology provides an opportunity to make health care more accessible for a large number of people and reduce costs. This review provides a descriptive discussion of web-based behavioural interventions for the management of type 2 diabetes mellitus. Systematic literature searches were performed using Medline، Embase، Psycinfo، Web of Science and Cochrane library to retrieve articles written in english and published between 2000 and 2012 which fulfilled all inclusion criteria. The search keywords were “diabetes” AND “intervention” AND (“internet OR web”). Only randomised controlled trials and quasi experimental studies were included in this review. A total of 15 studies were reviewed. Goal-setting، personalised coaching، interactive feedback and online peer support groups were some of the successful approaches which were applied in e-interventions to manage type 2 diabetes mellitus. Strong theoretical background، use of other technologies and longer duration of intervention were proven to be successful strategies as well. The web-based interventions have demonstrated some level of favourable outcomes، provided they are further enhanced with proper e-research strategies.

In recent decades، there have been numerous attempts to define precisely what is meant by small group teaching. Many writers argue that small group teaching method is among the most difficult and highly skilled of teaching techniques، in which in addition to the primary objective of teaching students to think، the tutor must have a number of subsidiary objectives if the small group is to function. In other words، the interpersonal and interactive nature of small groups makes them a challenging and appropriate vehicle for engaging students in their own learning. However، not only do tutors have to learn how to teach using small group methods but students also have to learn how to work in small groups. On the other hand، nowadays it is not only that there are more students participating in higher education than before; it is also the case that students are coming from more diverse backgrounds، so inclusion and internationalization are matters to concern ourselves with، and there is a need for providing a more diversified curriculum، that they are responsible not only for what is taught but also، in part، for how students learn. These entire changes mean that the small group is now seen as a means of fostering student engagement، cooperative and collaborative learning. Planning for effective small group teaching is as important as planning any other teaching activity. This point sometimes goes unrecognized because learning in small groups can at first glance appear unstructured. Some lecturers are put off by the seemingly informal، loose or open-ended nature of small group learning، or they fear this informality will be a recipe for chaos، whereas behind the facade of the informal group lies a backdrop in which all the learners are playing within a known set of rules which are spoken or unspoken. In this paper، after the introduction of the context and features of small groups، the necessity of planning for this teaching method is mentioned. Moreover، stages of group development and management as well as the teaching - learning nature in small groups are described. Next، the teacher and learner skills needed for teaching and learning in small groups and other qualifications required to teach in a small group، such as instructional space group، and the use of small groups in clinical and medical education are offered.

By the late 1960s, there seems to be a growing number of articles in medical journals on the subject of the distress that many terminally ill patients declared they had gone through due to repeated resuscitations that only prolonged their suffering. This demonstrates that standard protocols of resuscitating any patient who is undergoing a cardiopulmonary arrest may bring about new problems. A review of studies shows that dealing with patients who are in the last days or hours of their life has been a major challenge for healthcare professionals, and making decisions on therapeutic approach is one of the most fundamental skills for healthcare staff. The scientific, ethical, religious and legal dilemmas in this field make decision-making difficult in some cases.In this paper, we reviewed articles published during the past 30 years, through which the views of health care providers including physicians and nurses on the issue of do not resuscitate (DNR) orders in different societies had been studied. The Islamic perspectives have also been discussed in brief. Moreover, DNR guidelines prepared by various countries such as America, Britain and Saudi Arabia have been assessed. For searching the related studies, we used authentic electronic databases and many reliable websites. Some articles were obtained through hand searching of the references of searched articles.The results showed that despite substantial studies, caring teams are still facing the challenge of DNR in different societies. In Iran, considering the religious values and beliefs, the matter needs more deliberation to help the caring teams to deal with the clinical issues. The religious and cultural background call for a national guideline to be adopted based on Iranian-Islamic culture. Education and awareness rising of different groups including patients, general public, healthcare staff, and health policy makers is crucial in all countries all over the world, and particularly in Iran.

Children with Type 1 diabetes were present one of the greatest challenges in the worldwide. Health-care providers must be sufficiently aware of diabetes so that such children make utmost benefit of their educational opportunities. The aim of the present study was to compare the effect of three educational methods in raising the level of knowledge of school health-care providers. Therefore the best method would be applied for this purpose.

In this interventional study 132 samples were randomly chosen from the list of school health care providers of Tehran and divided to the three groups (educated by posters, booklets, and group education). A questionnaire was completed for all the three groups before and after the education. Questionnaire consisted of two parts: -demographic information and 16 questions about diabetes information. Scores were analyzed by descriptive and inferential methods (T-test, ANOVA).

The level of knowledge of school health-care providers was weak in 23.5% of the case, average in 59.8% of cases, and good in 16.7% of cases. The level of knowledge in the groups educated by booklets and group education increased meaningfully, while no obvious increase was observed in the group trained via posters.

From the three aforementioned training methods, group education and education by booklets have the most effect on raising the level of knowledge of health-care providers.

Neuropathy is one of the most common and dangerous complications of diabetes. Diabetic neuropathy account as the most common cause of mortality among patients. Many studies suggest that neuropathy have a negative effect on quality of life. Although there is limited evidences about relationship between diabetic neuropathy and quality of life in Iran, so this study was conducted to investigate this interaction among a group of patients. As a descriptive-analytical study, 304 diabetic patients with neuropathy was selected via convenience sampling method. The data were collected through interview and physical examination. The tool of data collection was the information sheet of medical records and questionnaire that consisted of three parts, demographic and disease characteristics, list of neuropathic complications of diabetes and questions about dimensions of quality of life. The reliability evaluated via test-retest method and validity assessed via content validity method. the results revealed that tingling (96.1%) and pain (92.1%) in the case of sensory neuropathy were the most common complains. Sexual dysfunction (72.4%) and gastrointestinal problems (70.4%) account the most common symptoms in view of autonomic neuropathy. The results revealed that quality of life among all patients was fairly desirable and there was a significant relationship between neuropathy and quality of life (P<0.001). According to the findings of this study, there is a significant relation between neuropathy and quality of life in diabetic patients. Our results suggest that nurses and educational supervisors should pay attention to promote different dimensions of quality of Life in diabetic patients with neuropathy.

Children with Type 1 diabetes were present one of the greatest challenges in the worldwide. Health-care providers must be sufficiently aware of diabetes so that such children make utmost benefit of their educational opportunities. The aim of the present study was to compare the effect of three educational methods in raising the level of knowledge of school health-care providers. Therefore the best method would be applied for this purpose.
In this interventional study 132 samples were randomly chosen from the list of school health care providers of Tehran and divided to the three groups (educated by posters, booklets, and group education). A questionnaire was completed for all the three groups before and after the education. Questionnaire consisted of two parts: -demographic information and 16 questions about diabetes information. Scores were analyzed by descriptive and inferential methods (T-test, ANOVA).
The level of knowledge of school health-care providers was weak in 23.5% of the case, average in 59.8% of cases, and good in 16.7% of cases. The level of knowledge in the groups educated by booklets and group education increased meaningfully, while no obvious increase was observed in the group trained via posters.
From the three aforementioned training methods, group education and education by booklets have the most effect on raising the level of knowledge of health-care providers.

Neuropathy is one of the most common and dangerous complications of diabetes. Diabetic neuropathy account as the most common cause of mortality among patients. Many studies suggest that neuropathy have a negative effect on quality of life. Although there is limited evidences about relationship between diabetic neuropathy and quality of life in Iran, so this study was conducted to investigate this interaction among a group of patients.
As a descriptive-analytical study, 304 diabetic patients with neuropathy was selected via convenience sampling method. The data were collected through interview and physical examination. The tool of data collection was the information sheet of medical records and questionnaire that consisted of three parts, demographic and disease characteristics, list of neuropathic complications of diabetes and questions about dimensions of quality of life. The reliability evaluated via test-retest method and validity assessed via content validity method.
the results revealed that tingling (96.1%) and pain (92.1%) in the case of sensory neuropathy were the most common complains. Sexual dysfunction (72.4%) and gastrointestinal problems (70.4%) account the most common symptoms in view of autonomic neuropathy. The results revealed that quality of life among all patients was fairly desirable and there was a significant relationship between neuropathy and quality of life (P According to the findings of this study, there is a significant relation between neuropathy and quality of life in diabetic patients. Our results suggest that nurses and educational supervisors should pay attention to promote different dimensions of quality of Life in diabetic patients with neuropathy.