Comparison of outcomes between off-pump and on-pump coronary artery bypass graft surgery using collaborative targeted maximum likelihood estimation.

There are some discrepancies about the superiority of the off-pump coronary artery bypass grafting (CABG) surgery over the conventional cardiopulmonary bypass (on-pump). The aim of this study was estimating risk ratio of mortality in the off-pump coronary bypass compared with the on-pump using a causal model known as collaborative targeted maximum likelihood estimation (C-TMLE). The data of the Tehran Heart Cohort study from 2007 to 2020 was used. A collaborative targeted maximum likelihood estimation and targeted maximum likelihood estimation, and propensity score (PS) adjustment methods were used to estimate causal risk ratio adjusting for the minimum sufficient set of confounders, and the results were compared. Among 24,883 participants (73.6% male), 5566 patients died during an average of 8.2 years of follow-up. The risk ratio estimates (95% confidence intervals) by unadjusted log-binomial regression model, PS adjustment, TMLE, and C-TMLE methods were 0.86 (0.78-0.95), 0.88 (0.80-0.97), 0.88 (0.80-0.97), and 0.87(0.85-0.89), respectively. This study provides evidence for a protective effect of off-pump surgery on mortality risk for up to 8 years in diabetic and non-diabetic patients.

A model to explain smokeless tobacco consumption in adults: A grounded theory study.

Introduction: Smokeless tobacco use remains a significant public health concern, necessitating the acquisition of comprehensive and extensive data to effectively address and control its consumption. Understanding the underlying patterns of consumption is crucial for this purpose. Objective: This study aimed to develop a model that explains smokeless tobacco consumption among adults in the southeastern province of Iran, specifically in the city of Chabahar. Methods: A qualitative study was conducted using a grounded theory approach with inductive processes. The participants consisted of 30 adults aged 18-64 years from Chabahar City in southeastern Iran. Purposive sampling was used to select participants, and data collection continued until theoretical saturation was achieved. Data analysis followed Strauss and Corbin's perspective, involving four stages: Analyzing Data for Concepts, Analyzing Data for Context, Bringing Process into the Analysis, and Integrating Categories. Results: The analysis of data yielded three main categories: "starting to use," "continued use," and "cessation attempts," each with their respective subcategories. Additionally, two main categories related to the consequences of smokeless tobacco consumption were identified: "addiction and efforts to overcome addiction," also with their respective subcategories. Conclusion: The Dependency Cycle Model in Consumption provides a comprehensive understanding of the contextual factors, processes, and consequences associated with smokeless tobacco consumption. This model serves as a valuable tool for researchers aiming to develop effective interventions in the field of smokeless tobacco consumption.

The Determinants of Salivary Cotinine Concentration in Smokeless Tobacco Users.

BACKGROUND: Smokeless tobacco products due to their high nicotine content are highly addictive and ultimately lead to an increased risk of oral cavity, laryngeal and oesophagal cancer. AIM: This research was conducted with the aim of assessing the relationship between the salivary cotinine concentration and demographic characteristics and smokeless tobacco use for the first time in tradespeople in Chabahar, Iran. METHODS: This descriptive cross-sectional study was conducted on 150 different tradespeople using smokeless tobacco in Chabahar who were selected through simple random sampling in 2018. In addition to the salivary cotinine measurement, data were collected using a researcher-made questionnaire with demographic and behavioural items. The data obtained were analysed in SPSS-16 using descriptive and inferential statistics. RESULTS: The mean salivary cotinine score was 887.7 ± 180.7 in men and 611.2 ± 139.7 in women, making for a significant intergroup difference (P = 0.043). The mean salivary cotinine score was higher in those who used two or more smokeless tobacco products compared to those who used one type of tobacco, and a significant difference was observed between the type of smokeless tobacco used and the salivary cotinine score in the participants (P = 0.005). CONCLUSION: Based on the results of the regression analysis, the type of smokeless tobacco used was a strong predictor of the concentration of salivary cotinine in the participants. It is, therefore, necessary for the government to adopt appropriate policies and take educational measures to reduce the vending and use of these substances.

An Extended Theory of Planned Behavior (TPB) Used to Predict Smoking Behavior Among a Sample of Iranian Medical Students.

BACKGROUND: Smoking among the youth is an important public health concern. Although several studies have investigated the correlates of smoking behavior, no theory-based study has particularly assessed this problem among medical students. OBJECTIVES: This study aimed to evaluate the efficacy of the extended theory of planned behavior (TPB) to predict smoking behavior among a sample of Iranian medical students. PATIENTS AND METHODS: This is a cross-sectional study carried out in Ahvaz, Iran, 2014. The data were collected through a self-administered questionnaire, which included items on demographics, smoking behavior, and components of the TPB model (attitude, subjective norms, perceived behavior control, and intention), and an added construct on smoking refusal skill. Data were analyzed using descriptive correlation, and linear regression statistics by SPSS, version 16. RESULTS: One hundred and seventy medical students with a mean age of 21.25 (SD = 2.9) years were enrolled in the study. Of them, 24 (13.5%) students were smokers. All components of the TPB model and smoking refusal skill were statistically significant as to intention to smoke (P < 0.001). The TPB constructs with and without smoking refusal skill accounted for 77% (adjusted R2) and 78% of the variance observed for intention to smoke, respectively. The results also revealed the highest weight for perceived behavior control (ß= -0.40). CONCLUSIONS: The findings of this study indicated that all TPB variables are useful tools for prediction of the smoking behaviors among students. Particularly, students' perceived behavioral control and attitudes towards smoking were found to be important determinants of smoking intentions. Thus, the findings could be used for planning effective tobacco control programs targeting University students.

Effect of education on preventive behaviors of breast cancer in female teachers of guidance schools of Zahedan city based on health belief model.

BACKGROUND: Breast cancer is one of the most common cancers in females. Methods of screening are the best among early detection methods. The goal of this study is effect of education on preventive behaviors of breast cancer in female teachers of guidance schools of Zahedan city based on health belief model. MATERIALS AND METHODS: This study was a semi-experimental, a kind of case-control research. This study was carried on 240 female teachers in guidance schools, Zahedan city, in 2011-2012 academic years with multi-stage sampling. Data collection tool was a questionnaire that was used after confirmation of validity and reliability. Data were collected with questionnaire after analysis, educational intervention with lecture, view video, group discussion, question and answer performed. Two month after intervention, secondary evaluation was performed. Collected data with SPSS software and appropriate statistical tests like: Paired t-test, independent t-test, regression analysis, Chi-square were analyzed. RESULTS: Persons mean age in this study was 39.40(±7.4) years. In awareness item and health belief model constructs (awareness, perceived susceptibility, perceived seriousness, perceived benefits, perceived barriers, self-efficiency, behavior) and also practice, paired t-test showed significant difference among before and after education (P > 0.0001). In two groups based on Chi-square in level of education and married status, there were no significant differences. Also, regression analysis outcomes showed that perceived barriers had the most effect on behavior, and this construct could be predictor of preventive behaviors from breast cancer. CONCLUSIONS: The findings of this study could conclude that educational programs designed based on the health belief model have significant impact on improving preventive treatment of breast cancer. Given the fact that Iran has a very high incidence of breast cancer, since Iranian women's awareness level and performance specially research samples according to educational level (associate degree and higher) and employment conditions as model for today girls and future mothers in breast cancer screening before educational intervention was very low. So, due to need, increasing women's awareness in health belief model framework to promote preventive behaviors is recommended.