Adoption of IWGDF guidance on prevention and management of foot problems in diabetes for local use in Iran by ADAPTE methodology: a step toward best practice.

Purpose: Adoption of international working group on the diabetic foot (IWGDF) guidance on prevention and management of foot problems in patients with diabetes was the study aim. Methods: The ADAPTE process consisted of three main phases of set-up, adoption, and finalization with overall 24 steps was used. In set- up phase, organizing committee by a multidisciplinary approach was established. In adoption phase, comprehensive search in databases and guideline resources was done. According to the inclusion criteria, the 2015IWGDF guidance was selected for adoption process. Quality, currency, content and consistency of the guidance were assessed. Also, consensus on different level of agreement for each recommendation were reported. On finalization phase, the adopted version was reviewed by the guidance developer and the final guidance for local use in Iran was disseminated. Results: The 2015 IWGDF guidance with 77 recommendations was adopted after screening of 1760 documents retrieved from Jan. 2006 to Nov. 2016. An organizing committee was established according to a multidisciplinary approach including 73 members with endocrinology, orthopedic & vascular surgery, dermatology, infectious diseases, physical medicine and rehabilitation specialties, general practitioners and nurses. This guidance obtained a good quality in all six domains of AGREE II instrument (Score ≥ 80%), good currency, content, and consistency. Also, during the third round of Delphi, the consensus on the agreement level of each recommendation were greater than 80% and 77 recommendations of the original guidance were kept in the adopted version. Conclusion: The 2015 IWGDF guidance with 77 recommendations adopted for local use in different health care settings of Iran. Supplementary Information: The online version contains supplementary material available at 10.1007/s40200-022-01121-0.

Studying the relationship between cognitive impairment and frailty phenotype: a cross-sectional analysis of the Bushehr Elderly Health (BEH) program.

BACKGROUND: Some pathophysiological effects of physical frailty and cognitive impairment might be similar; therefore, finding the associations in epidemiologic studies could guide clinicians and researchers to recognize effective strategies for each type of frailty such as frailty phenotype and frailty index, which in turn will result in a preventive approach. The study aimed to reveal which components of frailty phenotype are more associated with cognitive impairment. The findings of this study may help other researchers clarify the related pathways. METHODS: This is a cross-sectional analysis of the results of the second phase of Bushehr Elderly Health Program; a community-based elderly prospective cohort study conducted in 2015-2016. The participants were selected through a multistage stratified cluster random sampling method. Frailty was assessed based on the Fried frailty phenotype criteria. Cognitive impairment was assessed by the Mini-Mental State Examination (MMSE), the Mini-Cog, and the Category Fluency Test (CFT). Multiple logistic regression models were applied to determine the association between frailty and cognitive impairment. Depression trait was assessed using the Patient Health Questionnaire-9 (PHQ-9). Activities of daily living were assessed using the Barthel Index and Instrumental Activities of Daily Living (IADLs) using Lawton's IADL. RESULTS: The studyp conducted among people ≥ 60 years old (N = 2336) with women consisting 51.44% of the sample group. The mean age of the participants was 69.26 years old. The prevalence of pre-frailty and frailty were 42.59% and 7.66%, respectively. In the fully adjusted model, the odds ratio of the association between pre-frailty and frailty with cognitive impairment was 1.239, 95% CI: 1.011 - 1.519 and 1.765, 95% CI: 1.071 - 2.908, respectively (adjusted for age, sex, education, body mass index, smoking, diabetes mellitus, PHQ- 9, Barthel Index, and IADLs). In the fully adjusted multiple logistic regression models, all of the components of Fried frailty phenotype were significantly related to cognitive impairment except weight loss. CONCLUSION: Cognitive impairment may be associated with frailty phenotype. Moreover, low strength and function of muscles had a stronger association with cognitive impairment. It seems that a consideration of cognitive impairment assessment in older people along with frailty and vice versa in clinical settings is reasonable.

Diabetic foot self-care practice in women with diabetes in Iran.

BACKGROUND AND AIMS: The present study was conducted to determine the situation of foot self-care practice among Iranian women with diabetes. METHODS: In this cross-sectional study, 475 women completed the Diabetic Foot Self-Care Questionnaire (DFSQ) along with other questions. The overall and three components scores including personal care, podiatric care, and foot wearing, were calculated and their relationship with other factors was analyzed. RESULTS: The average total DFSQ score was 60.38 ± 9.9, and 16.98 ± 7, 5.95 ± 2.11, and 12.26 ± 3.95 for personal care, podiatric care, and footwear respectively. Education level, self-reported health status, and life satisfaction had a significant relationship with footwear score, and smoking and life satisfaction were related to personal care and podiatric care respectively. In Pearson regression, DM self-care was correlated with all three components and total DFSQ score. Also, depression and SCS (Social Capital Status) correlated with DFSQ scores except with personal self-care and footwear respectively. Body Mass Index (BMI) and Quality of Life (QoL) were significantly correlated with footwear and podiatric care scores. CONCLUSION: In this study, the DFSQ result was almost acceptable, however, it highlights the importance of suitable interventions to establish better self-care practice among Iranian diabetic women.

Prevalence of osteoporosis among the elderly population of Iran.

In a large population-based study of Iran, the age-standardized prevalence of osteoporosis was 24.6% in men and 62.7% in women aged ≥ 60 years. Osteoporosis was negatively associated with body mass index in both sexes, and with diabetes in men and hypertriglyceridemia in women. PURPOSE: Population aging has made osteoporosis and osteoporotic fractures an important health problem, especially in developing countries. This study aimed to explore the prevalence of osteoporosis and associated factors among the elderly population of the south-west of Iran. METHODS: Baseline data of the second stage of the Bushehr Elderly Health program was used. Spinal, total hip, or femoral neck osteoporosis was described as a BMD that lies 2.5 standard deviations or more, below the average values of a young healthy adult in the lumbar spine, total hip, or femoral neck, respectively. Osteoporosis at either site was defined as total osteoporosis. Age-standardized prevalence of osteoporosis was estimated. We used the modified Poisson regression with a robust variance estimator to identify the factors related to osteoporosis, adjusting for potential confounders. RESULTS: Overall, 2425 individuals (1166 men) aged over 60 years were included. In all, total osteoporosis was detected in 1006 (41.5%) of the participants. Using the reference value derived from Caucasian women aged 20-29 years, the age-standardized prevalence of total osteoporosis was 24.6 (95% CI: 21.9-27.3) in men, and 62.7 (95% CI: 60.0-65.4) in women. In men, osteoporosis was positively associated with age, smoking, history of fracture, and history of renal/liver diseases and negatively associated with body mass index (BMI) and diabetes. BMI, hypertriglyceridemia, and education were negatively correlated with osteoporosis in women, while years after menopause and history of fracture increased the likelihood of osteoporosis, significantly. CONCLUSION: Results support the high prevalence of osteoporosis and osteopenia in the elderly population. Considering the importance of severe complications, especially fractures, comprehensive interventions should be expanded.

Prospect of Stem Cell Therapy and Regenerative Medicine in Osteoporosis.

The field of cell therapy and regenerative medicine can hold the promise of restoring normal tissues structure and function. Additionally, the main targets of stem cell-based therapies are chronic diseases and lifelong disabilities without definite cures such as osteoporosis. Osteoporosis as one of the important causes of morbidity in older men and post-menopausal women is characterized by reduced bone quantity or skeletal tissue atrophy that leads to an increased risk of osteoporotic fractures. The common therapeutic methods for osteoporosis only can prevent the loss of bone mass and recover the bone partially. Nevertheless, stem cell-based therapy is considered as a new approach to regenerate the bone tissue. Herein, mesenchymal stem cells as pivotal candidates for regenerative medicine purposes especially bone regeneration are the most common type of cells with anti-inflammatory, immune-privileged potential, and less ethical concerns than other types of stem cells which are investigated in osteoporosis. Based on several findings, the mesenchymal stem cells effectiveness near to a great extent depends on their secretory function. Indeed, they can be involved in the establishment of normal bone remodeling via initiation of specific molecular signaling pathways. Accordingly, the aim herein was to review the effects of stem cell-based therapies in osteoporosis.

Do-Not-Resuscitate in Iranian Muslim Families: A Conventional Content Analysis.

Families of patients who are dying have a key role in decisions regarding do-not-resuscitate orders. The objective of this study was to explore the aspects and characteristics of this decision by the families of Muslim patients with cancer. This study is a conventional content analysis. Eighteen families who met the inclusion criteria participated in this study and were selected by purposive sampling. Data collection was done by a semistructured interview (each interview was 60-110 minutes). The data analysis was performed using content analysis. The data analysis introduced 4 main categories and 8 subcategories: (a) feeling duality ("sacrifice against selfishness," and "logic against emotion"), (b) religious beliefs ("guilt" and "miracle"), (c) stigmatized ("purgatory talk" and "family rejection") and (d) decision-making mediators ("religious clergymen" and "the application of the deceased"). Maybe, since the effect of religion in Iran is more significant than other elements such as ethnicity and law, it is possible to receive help from clergymen. It seems necessary for Iran's Ministry of Health and Medical Education to plan clinical guidelines in this context.

Barriers to postpartum screening for type 2 diabetes: a qualitative study of women with previous gestational diabetes.

INTRODUCTION: Risk of developing type 2 diabetes is increased in women with previous gestational diabetes mellitus (GDM). Postpartum glycemic screening is recommended in women with recent GDM. But this screening rate is low and the reasons are unclear. The aim of this study was to explore the experiences of Iranian women with recent GDM on barriers of postpartum screening for diabetes. METHODS: This qualitative study was conducted in Tehran, Iran in 2016. Semi-structured interview was used for data collection. 22 women with recent GDM were interviewed. These women gave birth in Tehran hospitals at a minimum of 6 months before interview. The missed screening defined as not attending to laboratory for Fasting Blood Sugar and/or Oral Glucose Tolerance Test, 6 week to 6 month after their child birthing. The data was analyzed by content analysis method. RESULTS: Themes and sub-themes that illustrated the barriers to postpartum diabetes screening were: inadequate education (about developing diabetes in the future, implementation of the screening, and glucometer validity in diagnosis of diabetes), perceiving the screening as difficult (feeling comfortable with the glucometer, poor laboratory conditions, issues related to the baby/babies, and financial problems), improper attitudes toward the screening (unwilling to get diagnosed, not giving priority to oneself, having false beliefs) and procrastination (gap to intention and action, self-deception and self-regulation failure). CONCLUSION: Women with recent GDM reported several barriers for postpartum diabetes screening. This study help to develop the evidence-based interventions for improving this screening rate.

Application of Canonical Correlation Analysis for Detecting Risk Factors Leading to Recurrence of Breast Cancer.

BACKGROUND: Advances in treatment options of breast cancer and development of cancer research centers have necessitated the collection of many variables about breast cancer patients. Detection of important variables as predictors and outcomes among them, without applying an appropriate statistical method is a very challenging task. Because of recurrent nature of breast cancer occurring in different time intervals, there are usually more than one variable in the outcome set. For the prevention of this problem that causes multicollinearity, a statistical method named canonical correlation analysis (CCA) is a good solution. OBJECTIVES: The purpose of this study was to analyze the data related to breast cancer recurrence of Iranian females using the CCA method to determine important risk factors. PATIENTS AND METHODS: In this cross-sectional study, data of 584 female patients (mean age of 45.9 years) referred to Breast Cancer Research Center (Tehran, Iran) were analyzed anonymously. SPSS and NORM softwares (2.03) were used for data transformation, running and interpretation of CCA and replacing missing values, respectively. Data were obtained from Breast Cancer Research Center, Tehran, Iran. RESULTS: Analysis showed seven important predictors resulting in breast cancer recurrence in different time periods. Family history and loco-regional recurrence more than 5 years after diagnosis were the most important variables among predictors and outcomes sets, respectively. CONCLUSIONS: Canonical correlation analysis can be used as a useful tool for management and preparing of medical data for discovering of knowledge hidden in them.

Bushehr Elderly Health (BEH) Programme, phase I (cardiovascular system).

PURPOSE: The main objective of the Bushehr Elderly Health Programme, in its first phase, is to investigate the prevalence of cardiovascular risk factors and their association with major adverse cardiovascular events. PARTICIPANTS: Between March 2013 and October 2014, a total of 3000 men and women aged ≥ 60 years, residing in Bushehr, Iran, participated in this prospective cohort study (participation rate=90.2%). FINDINGS TO DATE: Baseline data on risk factors, including demographic and socioeconomic status, smoking and medical history, were collected through a modified WHO MONICA questionnaire. Vital signs and anthropometric measures, including systolic and diastolic blood pressure, weight, height, and waist and hip circumference, were also measured. 12-lead electrocardiography and echocardiography were conducted on all participants, and total of 10 cc venous blood was taken, and sera was separated and stored at -80 °C for possible future use. Preliminary data analyses showed a noticeably higher prevalence of risk factors among older women compared to that in men. FUTURE PLANS: Risk factor assessments will be repeated every 5 years, and the participants will be followed during the study to measure the occurrence of major adverse cardiac events. Moreover, the second phase, which includes investigation of bone health and cognition in the elderly, was started in September 2015. Data are available at the Persian Gulf Biomedical Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran, for any collaboration.

Survey of Sleep Status and its Related Factors among Hospitalized Patients with Heart Failure.

BACKGROUND: Sleep disorders among heart failure (HF) patients negatively influence the quality of life. Awareness of sleep disturbances, as one of the disturbing factors of the quality of life among HF patients, and its related factors would help health care staff to provide more comprehensive care. Hence, this study was conducted to determine the quality of sleep and its related factors in hospitalized patients with HF. METHODS: This cross-sectional survey study was conducted on 240 patients with HF hospitalized in one of the health centers of Guilan University of Medical Sciences between July and December 2013. Samples were selected by convenience sampling. The Pittsburgh Sleep Quality Index and a researcher-designed questionnaire on sleep disturbing factors were the instruments of this study. The correlation and relationship between sleep quality and variables related to personal, environmental, and disease factors were assessed. RESULTS: The majority of the samples (91.2%) had a poor sleep quality. A significant positive correlation was found between sleep quality and age (r = 0.322; p value < 0.001), body mass index (r = 0.212; p value < 0.001), number of comorbidities (r = 0.205; p value = 0.001), number of hospitalizations (r = 0.202; p value < 0.001), number of drugs consumed (r = 0.178; p value = 0.003), and length of stay in hospital (r = 0.149; p value = 0.011). Also, significant differences were seen between sleep quality and sex (p value = 0.014), smoking (p value = 0.038), educational level (p value = 0. 047), and hospital noise (p value = 0. 004). CONCLUSION: Age, sex, educational level, smoking, and obesity were the most significant factors affecting the sleep quality in our HF patients.

The Hurt of Judgment in Excessive Weight Women: A Hermeneutic Study.

Excess weight is one of the increasing problems of the present society and one of the threatening health conditions around the world. Despite many efforts for prevention and treatment or even surgery, the process of excess weight is not decreased in the world. While most of the studies conducted on excess weight concentrated on the issues why people get excess weight or how the prevention and treatment of excess weight must be performed, there is lake of knowledge about what excessive weight people really experience in their daily life. Understanding the lived experience of excess weight in women is linked with their health and society's health while it indirectly develops the nursing knowledge to improve the quality and access to holistic health care in excessive weight women. The aim of study was to describe with a deeper understanding, the lived experience of excess weight in women. Using a hermeneutic phenomenological approach and a van-manen analysis methods, in depth semi- structured interviews were conducted with twelve women who had lived experience of excess weight. The hurt of Judgment was the main theme that emerged in the process of data analysis. This theme was derived from three sub-themes including social judgment, being different and being seen. These findings can prove helpful in promoting the nursing knowledge concerning a holistic approach in communicating to excessive weight people.

Evaluation of factors impacting cosmetic outcome of breast conservative surgery--a study in Iran.

BACKGROUND: Breast conservative surgery (BCS) followed by radiotherapy is the standard approach in management of stage I-II breast cancer. Several factors can affect cosmetic outcomes. The aim of this study was to evaluate the cosmetic results of BCS and influencing factors in the Iranian Breast Cancer Research Center. MATERIALS AND METHODS: Patients who had undergone BCS were included. Photographs were taken of both breasts of the patients in three aspects and were evaluated by three specialists. The cosmetic scores were calculated based on a standard questionnaire. The data were analyzed using univariate and multivariate regression for relationships between cosmetic scores and clinical data. RESULTS: A total number of 103 patients were included in the study. Mean age and BMI of the patients were 46.8±8.9 and 28.1±3.9, respectively. Breast cup sizes C and D accounted for 74.7% of the study group. The mean cosmetic score obtained from three referees was 5.72+2.06, consisting of 35.9% excellent-good, 35% moderate, and 29.1% unsatisfactory results. Patient BMI, volume of the resected tissue and breast cup size (D) showed significant correlation with the cosmetic score. On multivariate regression analysis, cosmetic score and BMI (p=0.022,) as well as breast cup size (p=0.040), remained significant. CONCLUSIONS: Immediate or delayed symmetrization of the breasts is suggested during breast conservative surgery, meanwhile performing oncoplastic techniques to improve the results significantly. Also it is suggested to discuss anticipation of less satisfactory results with patients having higher BMI and large breast cup size.

Taxane-based regimens as a risk factor for chemotherapy-induced amenorrhea.

OBJECTIVE: The objective of our study was to show the impact of different chemotherapy regimens on the incidence of amenorrhea (chemotherapy-induced amenorrhea [CIA]) in premenopausal women of various ages with breast cancer. METHODS: This is a follow-up study of 226 premenopausal women with breast cancer who had received one of three chemotherapy regimens: conventional (cyclophosphamide/methotrexate/5-fluorouracil), anthracycline based, and anthracycline-taxane based. They were evaluated for the incidence of CIA in the follow-up clinic of the Iranian Center for Breast Cancer. A statistical analysis using SPSS software was performed, and logistic regression and Cox regression model were used to determine the risk factors for CIA. RESULTS: Of the 226 women with a median age of 40 years (range, 26-56 y) who participated in this study, 154 (68.1%) developed CIA. In 101 (65.6%) of these women, CIA was established. CIA was present in 52.5% of the women who had been treated with conventional regimens (cyclophosphamide/methotrexate/5-fluorouracil), 66.7% of the women who had been treated with anthracycline, and 78.7% of the women who had been treated with anthracycline-taxane. Therefore, the frequency of CIA was significantly higher in the taxane-based chemotherapy group than in the other groups (P = 0.015). Although a slightly higher incidence of CIA in women with hormone-insensitive tumors (estrogen receptor negative and progesterone receptor negative) versus hormone-sensitive tumors (estrogen receptor positive and progesterone receptor positive) who had been treated with combination regimens was observed, no statistically significant difference was found (P = 0.629). Of all of the risk factors that were evaluated in the study, anthracycline-taxane-based regimens (odds ratio, 4.059; 95% CI, 1.6-9.8) and age older than 40 years (odds ratio, 3.5; 95% CI, 1.9-6.6) were the most important factors in the development of CIA. CONCLUSIONS: The type of chemotherapy and the age of the woman at the onset of breast cancer are the most important risk factors in CIA. Taxane-based regimens induced more CIA than did other regimens.

Delayed presentation in breast cancer: a study in Iranian women.

BACKGROUND: A cross sectional study was conducted in Tehran Iran to examine the extent of patient delay and associated factors in the presentation of breast cancer. METHODS: A group of newly diagnosed breast cancer patients were interviewed and were asked about the period from first onset of symptoms to first medical consultation to indicate patient delay. This was studied in relation to patients' age, educational level, marital status, family history of breast cancer, history of benign breast disease, number of children and the nature of the first symptom seen. RESULTS: In all, 190 breast cancer patients were interviewed. Of these, 75% presented to physician within 3 months. Forty-two patients (25%) delayed more than 3 months. In multivariate regression analysis it was found that there was a risk for longer delay in widowed or divorced women (OR 3.7, 95% CI 1.5-9.7), women with a positive family history of breast cancer (OR 2.8, 95% CI 1.1-7.7), and less educated patients (illiterate: OR 5.2, 95% CI 1.5-17.7; primary schooling: OR 4.6, 95% CI 1.4-14.7). Significant associations also were found between delay presentation and the late stage disease (P = 0.01) and bigger tumor size (P = 0.004). CONCLUSION: The findings suggest that one in four women with breast cancer present late and this has significant effect on their disease prognosis. To reduce patient delay health education programs regarding breast cancer should be implemented and target women who are at higher risk of delay.