Jundishapur Journal of Chronic Disease Care
Volume:13 Issue: 1, Jan 2024

Context: 

A wide range of complications, including chronic respiratory diseases, asthma attacks, cardiovascular diseases (CDs), various cancers (blood, lung, and brain), and even death, can result from air pollution. It is essential to assess the health effects on humans caused by environmental air pollutants and non-communicable diseases (NCDs), including coronavirus disease 2019 (COVID-19). The purpose of this review study was to investigate the synergistic effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and air pollutants on the risk factors for chronic obstructive pulmonary disease (COPD), CDs, and respiratory diseases (RDs).

Evidence Acquisition: 

An extensive literature review was conducted. A total of 1 005 articles were retrieved from sources, including Google Scholar, Springer, PubMed, Web of Science, and Springer databases. In the final stage of the literature review, a significant association between mortality related to COVID-19 and air pollution emissions was identified, contributing to the risk factors associated with CDs and RDs.

The result showed that air pollution can have synergistic effects on the transmission of SARS-CoV-2 viruses and has an increasing effect on the incidence of RDs [such as SARS and Middle East respiratory syndrome (MERS)] and CDs. According to the findings, exposure to toxic air pollutants, whether chronic or acute, can have severe effects, including a decrease in airway ciliary function, damage to the mucous membrane, reduced air sac elasticity, decreased lung capacity, and an increased risk of CDs.

COVID-19 and air pollutants pose a serious threat to human and animal health. Epidemiological studies have shown that in addition to environmental conditions, individual sensitivity plays a key role in the development of conditions such as COPD, CDs, RDs, cancer, and mortality.

 Multiple sclerosis (MS) as an autoimmune condition might lower one’s capacity for work and social interactions, which can lower the quality of life. Therefore, it seems that by determining the factors affecting the quality of life, a step can be taken to improve the quality of life of these patients.

 The goal of this study was to determine the quality of life and its predictors in these patients.

 In this cross-sectional descriptive-analytical study, 200 patients with MS referred to the Guilan MS Association, Guilan, Iran, were included using the convenient sampling method. The study tool with five sections, including demographic information, the quality-of-life questionnaire for patients with MS (Multiple Sclerosis Impact Scale [MSIS-29]), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Perceived Stress Scale-4 (PSS-4), was used to collect the data. The data were analyzed using inferential statistical tests and hierarchical multiple linear regression.

 The mean physical impact and psychological impact scores were 20.2 ± 22.9 and 31.6 ± 26.3, respectively. The MSIS-29 subscales were positively correlated with PSS-4, GAD-7, and PHQ-9 scores (r ranging from 0.538 to 0.867, all P < 0.001). When the PSS-4, GAD-7, and PHQ-9 scores were added to the model, there was a considerable improvement in the model (R2 = 84.7%, ∆R2 = 55.5%, F(20,199) = 49.43, P < 0.001). More specifically, an additional 55.5% of the variance in the psychological impact score was explained by the PSS-4, GAD-7, and PHQ-9 scores.

 In the meantime, various factors, including individual variables (e.g., patient age and marital status), psychological factors (e.g., stress, anxiety, and depression), and disease-related factors (e.g., the duration of the disease), can affect the quality of life of these patients.

 Morality is an important factor affecting the quality of care. To provide high-quality patient care, nurses are facing a number of ethical problems that need moral skills to be solved. Moral sensitivity is the first logical step toward ethical decision-making and judgment.

 This study was conducted to determine the predictive value of moral sensitivity for the quality of care delivered by Iranian nurses.

 This cross-sectional study was undertaken on 250 nurses who were selected by census sampling based on inclusion and exclusion criteria from selected hospitals in Qazvin, Iran, in 2022. The required data were gathered by the Moral Sensitivity Questionnaire (MSQ) and the Quality Patient Care Scale (QUALPAC). Data were analyzed using a multivariate regression model.

 The mean age of the nurses was 32.62 ± 6.95 years old, ranging from 22 to 54 years. The quality of care from the viewpoint of most nurses (n = 198, 78.0%) was desirable. The highest quality of care was related to the physical dimension (69.56 ± 8.48), and the least was related to the psychosocial dimension (89.74 ± 9.47). The highest moral sensitivity was related to the dimensions of relational orientation (15.03 ± 2.93) and respect for the patient's autonomy (7.88 ± 1.73). The results also revealed that moral sensitivity (β = 0.43, P < 0.001), gender (β = 0.30, P < 0.001), and economic status (β = -0.17, P = 0.003) were the most significant predictors of the quality of nursing care.

 Our results highlighted that boosting moral sensitivity among nurses could be effective in improving the quality of nursing care. So, it is recommended to hold periodic training programs to teach ethical principles to nurses to promote their moral sensitivity and, therefore, the quality of patient care.

Due to the recurrent nature of type 1 bipolar disorder, evaluating the disease symptoms and a long-term follow-up of the disease after discharge is very important.

This study evaluated the six-month follow-up of the symptoms of patients with type 1 bipolar disorder after the implementation of the home nursing care program.

This study is part of a clinical trial designed and conducted in two phases. In the first phase, an intervention was conducted to assess the effect of home nursing care on the severity of symptoms of type 1 bipolar patients, and in the second phase, the patients were followed up over 6 months. Data were collected using a demographic questionnaire and young scale and were analyzed by SPSS 24 software with repeated-measures analysis of variance, Mann-Whitney U, and Fisher’s tests at the significance level of < 0.05.

The severity of symptoms was significantly decreased in the experimental group after the intervention. Until the second month of follow-up, almost the same severity scores were reported, but from the third month, an increase was observed in the severity of symptoms (P < 0.001).

A continuous care program for a specific period can maintain the effect of the intervention on reducing the severity of symptoms in type 1 bipolar patients. A home nursing care program is effective in reducing the severity of symptoms until four months after the intervention. This care program should be repeated every four months to maintain the effectiveness of the intervention and reduce the severity of the symptoms of the disease.

One of the psychological stressors for the patients admitted to the coronary care units (CCUs) is being away from family members and lack of visiting time. Also, one of the special needs of families is to visit patients during their hospitalization period. In order to enforce visiting rules in CCUs, it is important to take the needs of all staff, patients, andvisitors into consideration, and a visiting policy should be adopted that ensures the most effective visiting system.

The present study aimed to design a visiting policy based on the challenges of the CCU ward using an interactive approach.

This qualitative research was conducted with a participatory action research (PAR) approach in 2016 at Ganjavian Hospital, Dezful, Iran. Content analysis was performed based on the method proposed by Graneheim and Lundman (2004). Forty stakeholder participants were included in focus groups consisting of 3 to 7 people using a purposeful sampling method.

In order to determine the current situation, after analyzing the extracted codes in the focus groups and according to the similarities and conceptual content, 36 subcategories, 11 categories, and 3 subthemes, including improper physical factors, problems related to human factors, and improper policy quality, were obtained. After determining the current status of the visiting policy and problems, the new policy was developed by the planning group consisting of a representative from each of the focus groups.

In the new visiting policy, efforts have been made to improve the quality of visiting by providing more opportunities for patient-companion and doctor-companion visiting, focusing on ensuring complete and timely information, assigning rooms for doctor-companion and patient-companion visiting, and paying attention to the required equipment. This program can be used by other planners while adjusting its items according to their conditions.

Metabolic and nutritional status influences the condition of patients under mechanical ventilation (MV) and determines if they can be disconnected from the ventilator.

This study was conducted to determine the effect of the planned Entera Meal solution on the duration of weaning patients and the length of intensive care unit (ICU) stay.

In this clinical trial with a pre-test/post-test design, 42 patients admitted to the ICUs of Golestan and Imam Khomeini hospitals of Ahvaz, Iran, who were under MV, were randomly assigned to the two groups of control and intervention. In the intervention group, the Entera Meal solution was used for energy supply. The administration of the solution was started from 50 mL every 3 hours and was scaled up to 30 mL to reach the calculated energy within 48 - 72 hours. For the control group, routine homemade hospital solutions were used. Data were collected by demographic and medical information questionnaires and a checklist for recording outcomes. The data were analyzed using SPSS software version 23.

The results showed that the length of ICU stay was significantly affected after the administration of the planned Entera Meal solution (P = 0.004). Although we observed that the duration of weaning patients from MV was shorter in the intervention group than in the control group, this difference was not statistically significant (5.23 ± 4.77 vs. 7.71 ± 6.14 days, P = 0.15).

The planned Entera Meal solution reduced the length of ICU hospitalization but did not have a statistically significant effect on the duration of patients weaning from the ventilator.

 Gastric cancer has a poor prognosis. Insufficient knowledge of risk factors and poor attitude and practice toward screening have caused patients to notice it in the final stages of the disease.

 The purpose of this study was to determine the knowledge, attitude, and practice levels of a sample of medical sciences students and to explore the predictors of their practice regarding gastric cancer prevention.

 A descriptive cross-sectional study was conducted within 2021 to 2022 with 558 medical sciences students. The census method was used to select the samples. The data were collected with a demographic information questionnaire, a knowledge questionnaire about signs and symptoms, risk factors, management, and prevention of gastric cancer developed by Ghanaei in Iran, and a researcher-made questionnaire of attitude and practice.

 The mean values of the knowledge, attitude, and practice were 19.80 ± 4.92, 69.39 ± 7.57, and 40.68 ± 4.17, respectively. There was a significant positive correlation between the practice with knowledge (r = 0.15, P < 0.001) and attitude (r = 0.21, P < 0.001) and between knowledge and attitude (r = 0.59, P < 0.001). The regression model showed that the levels of the overall attitude (β = 0.167, P < 0.001) and knowledge of prevention (β = 0.102, P = 0.032) were significantly associated with the practice of medical sciences students.

 The results indicated that attitude had the biggest contribution to predicting the practice of students, and their knowledge of prevention was the next predictor of their practice level. Therefore, holding educational programs to increase individuals’ knowledge and create a positive attitude that can, consequently, improve their practice in primary prevention is useful.

Depressive disorders are morecommonin patients with diabetes mellitus (DM) compared to the general population.

Due to heterogeneous evidence on the impact of antidepressants on serum glucose profile, this study was conducted to examine the effects of sertraline and fluoxetine on serum glucose levels in patients with comorbid depression and diabetes.

In this randomized controlled trial, 40 adult patients with DM and depression were randomly allocated into two groups (n = 20 per group). The first group received 50 - 200 mg/day of sertraline, and the second group received 20 - 60 mg/day of fluoxetine. The Beck Depression Inventory (BDI-II) was used to determine depression severity, and body mass index (BMI), blood pressure, serum lipid profile, fasting blood sugar (FBS), 2-hour post-prandial blood glucose, and HbA1c were measured at the baseline and 12 weeks after the intervention.

Body mass index (P = 0.40), systolic blood pressure (P = 0.41), FBS (P = 0.46), 2-hour post-prandial blood glucose (P = 0.53), HbA1c (P = 0.59), serum total cholesterol (P = 0.78), and LDL cholesterol (P = 0.62) insignificantly reduced in both groups after the intervention compared to the baseline; however, the reduction in serum triglyceride level was statistically significant (P = 0.04). Also, the depression severity score was reduced in both groups; however, the difference was not statistically significant (P = 0.27).

In adult patients diagnosed with comorbid depression and type II diabetes mellitus, three months of treatment with sertraline or fluoxetine comparably mitigated depressive symptoms and reduced HbA1c, FBS, and 2-hour post-prandial blood glucose.

Chronic kidney disease (CKD) is defined by a glomerular filtration rate (GFR) or markers of kidney damage persisting for more than 3 months. In Iran, the age-adjusted prevalence of CKD is 14.9%, based on the published literature. It has emerged as a significant health concern associated with morbidity, mortality, and a diminished quality of life.

The present study aimed to assess the survival rate and its predictors in hemodialysis patients.

The data were collected from teaching hospitals affiliated with Abadan University of Medical Sciences between January 2002 and December 2017. The patient survival period was plotted using Kaplan-Meier survival curves. The Cox regression model was employed to analyze the influence of various variables on the desired time.

A total of 389 patients were included in the study. Among them, 79% were married, and 229 (60.1%) were illiterate. The probabilities of 1-, 5-, and 10-year survival of the patients were 0.92, 0.46, and 0.02, respectively. The Cox regression model revealed that the risk of death in hemodialysis patients with hypertension was 1.45 times higher than in those without hypertension. Additionally, factors such as rural residence, older age, using permanent catheters, high serum creatinine, and blood urea nitrogen (BUN) levels increased the adjusted hazard ratio in hemodialysis patients.

After adjusting for confounding factors, this study demonstrated a significant association between advancing age, hypertension, using permanent catheters, and reduced survival rates in patients with end-stage renal disease (ESRD).

Hypertension (HTN) is a global public health problem with an increasing incidence worldwide. The imperative role of self-efficacy and dietary approach to stop hypertension (DASH) in controlling chronic disease has been reported.

We aim to investigate the efficiency of a mobile app for improving self-efficacy in adherence to the DASH diet in HTN patients.

The present randomized controlled trial was conducted on 88 patients with hypertension who were referred to public health care centers between November 2019 and March 2020. The subjects were randomly assigned to receive a video-based mobile app for DASH-related recommendations and usual care. The control group followed their habitual diets, and usual health care was given in a public health care center for twelve weeks. Self-efficacy, systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI), physical activity, and dietary intake were assessed at the trial’s baseline and end. The analysis of covariance (ANCOVA) was used to show the differences between groups and adjust for baseline and covariates.

At the baseline, there were no significant differences between the two groups regarding DBP, SBP, and most of the self-efficacy components. However, we observed significant statistical differences between the groups in the DBP SBP, and all five components of self-efficacy improved significantly at the end of the study. We did not reach a significant statistical difference between study groups in adherence to the DASH diet.

The present study showed that using a mobile app for educating DASH diet and improving self-efficacy leads to better control of HTN and improvement of self-efficacy.

A reciprocal relationship exists between disease and the quality of life experienced by individuals afflicted with chronic illnesses. Thalassemia is one such condition that accompanies individuals throughout their entire lives.

This studyaimedto assess the impact of a family-centeredempowermentmodelutilizing mobile learningonthe quality of life of children aged 6 - 12 years diagnosed with thalassemia.

This study adopted a quasi-experimental design involving 172 patients with medical records at the Shafa Thalassemia Center in Ahvaz, Iran. Participants were selected based on inclusion criteria and subsequently divided into two groups: The intervention group and the control group, each comprising 86 individuals. Data collection tools included the children’s quality of life questionnaire (Pediatric Quality of Life Inventory [Ped-SQL]) and researcher-designed questionnaires to measure parents’ awareness and self-efficacy in the field of thalassemia. The collected data were analyzed using SPSS software (version 21) and the Mann-Whitney U statistical test.

The results demonstrated a significant increase in the level of children’s quality of life following the educational intervention within the intervention group when compared to their pre-education status (P < 0.001). Specifically, 54 (62.7%) of the children who received the intervention exhibited a good level of quality of life after the intervention; however, both before and after the educational intervention, the quality of life of 46 (53.4%) of the children in the control group was reported as poor. Furthermore, the implementation of this model led to a significant increase in parents’ awareness (P < 0.001) and self-efficacy (P = 0.002). These improvements were also notably higher than the control group (P < 0.001).

The findings of this study suggest that family-centered mobile learning programs targeted at parents of children with thalassemia can enhance and enrich the quality of life experienced by these children. This approach should be considered an integral part of the care provided to these patients.

 The prevalence of stress, anxiety, and depression seems to be high in patients with chronic kidney disease (CKD), which may influence their quality of life. Due to limiting some food groups, these patients suffer from a deficiency of some nutrients, which may be related to mood disorders.

 This study aimed to investigate the correlation between nutrient intake, stress, anxiety, and depression in patients with CKD.

 The present cross-sectional study was conducted on 90 patients with CKD. To assess the diet of the patients, the researchers completed three days of the 24-hour food recall. The short self-report Iranian version of the Depression, Anxiety, and Stress Scale 21 (DASS-21) was also used to investigate the participants' mental health.

 Of the 90 patients examined, 64 were men and 26 were women. There was a significant inverse correlation between depression and the dietary intake of polyunsaturated fatty acids (PUFAs) (β = -0.214, P = 0.039) and α-tocopherol (β = -0.225, P = 0.025). A significant inverse correlation was also found between anxiety and the dietary intake of iron (β = -0.319, P = 0.003), copper (β = -0.25, P = 0.031), vitamin B1 (β = -0.314, P = 0.004), vitamin B5 (β = -0.262, P = 0.016), vitamin B6 (β = -0.292, P = 0.007), vitamin B9 (β = -0.241, P = 0.026), fiber (β = -0.224, P = 0.04), and vitamin K (β = -0.26, P = 0.015).

 The dietary intake of nutrients such as PUFAs, α-tocopherol, B vitamins, vitamin K, iron, copper, and fiber might be associated with depression and anxiety. However, further studies with longitudinal designs are needed to reveal cause-effect relationships in this regard.