Identifying and validating the educational needs to develop a Celiac Self-Care System.

BACKGROUND: Celiac disease is a major public health problem in many countries, including Iran. Considering the disease's exponential spread throughout the world and its risk factors, identifying the educational priorities and minimum data required to control and treat the disease is of great significance. METHODS: The present study was conducted in two phases in 2022. In the first phase, a questionnaire was developed based on the information obtained from a review of the literature. Later, the questionnaire was administered to 12 pundits in the fields of nutrition (n = 5), internal medicine (n = 4), and gastroenterology (n = 3). As a result, the necessary and important educational content was determined for developing the Celiac Self-Care System. RESULTS: According to the experts' viewpoints, the educational needs of patients were classified into nine categories of demographic information, clinical information, long-term complications, comorbidity, tests, medications, dietary recommendations, general recommendations, technical capabilities as well as 105 subcategories. CONCLUSIONS: Due to the increased prevalence of Celiac disease and the lack of an established minimum set of data, determining the required educational information is of great importance at the national level. Such information could be useful in implementing educational health programs to raise the public level of awareness. In the field of education, such contents can be employed in planning new technology based on mobile phones (mobile health), preparing registries, and producing widely used content.

The nutritional content required to design an educational application for infertile women.

BACKGROUND: Infertility has been considered as a critical health problem for couples and society. Given the worldwide exponential rise of infertility, mobile phone-based applications are drastic ways to deliver nutrition educational content to women with infertility. The present study aimed to prepare the required educational content for designing a mobile phone-based nutrition educational application for women with infertility. METHODS: Educational contents were initially determined based on the literature review and library studies. As a result, a researcher-made questionnaire was designed containing 28 items in six dimensions. To ensure about the questionnaire's validity, a panel of experts (15 nutritionists and 5 infertility specialists) was asked to review the items, make revisions (if necessary), and confirm the final contents. The questionnaire reliability was also corroborated using the KR-20 coefficient (0.89). RESULTS: While the amount of consumed calories per meal and between meals were not significantly effective on fertility, factors such as main definitions, disease and treatment instructions, personal activities and habits, and menstruation were deemed necessary by the respondents. Participants also suggested adding sections entailing introductions to different types of diets, users' suggestions and opinions, and of the address and contact information of senior nutrition centers to the questionnaire. CONCLUSIONS: Followed by obtaining the required valid and reliable contents, a mobile phone- based nutrition education application can be designed to improve the patients' knowledge and facilitate their treatment process.

Women's Preference for Cervical Cancer Screening Methods in Iran: A Contingent Valuation Survey.

Background: Cervical cancer is the fifth most deadly cancer in women in Iran. The present study aimed to investigate the monetary value of cervical cancer screening benefits from a social perspective. Methods: A cross-sectional study was conducted among 480 women aged 30 to 59 years in Mazandaran province, Iran, from 2020-21. The willingness to pay (WTP) for screening tests- Pap smear and simultaneous tests- was investigated using a researcher-made questionnaire based on the contingent valuation method (CVM) in 2 separate sample groups. The first group received basic information regarding cervical cancer (Scenario 1), while the second received complementary information in addition to basic knowledge (Scenario 2). Multivariate regression was applied to examine factors affecting WTP and the difference between the mean WTP in 2 scenarios was analyzed by a t-test. Results: The mean WTP of Pap smear and simultaneous tests was estimated at US$135.08 and US$160.19, respectively. There were significant and negative relationships between age and household size with the WTP of the Pap smear test. The number of people with income, household expenses, a chronic illness, and suggested base price indicated significant and positive effects on WTP of the Pap smear test. The number of people with income and household expenses showed significant and positive relationships with the WTP of simultaneous tests. There was no significant difference between the mean WTP of each group and the demand for screening tests was not elastic. Conclusion: The mean WTP of screening tests is notable when compared to their cost, demonstrating the need of concentrating on screening programs.

Development of an online cancer data collection and processing tool for population-based cancer registries in a low-resource setting: The CanDCap experience from Golestan, Iran.

BACKGROUND: Golestan Population-based Cancer Registry (GPCR) with more than 15-years experiences developed an in-house online software called Cancer Data Collection and Processing (CanDCap) to improve its data collection operations from the conventional offline method to new online method. We aimed to report the methods and framework that GPCR applied to design and implementation of the CanDCap. METHODS: CanDCap was designed based on International Agency for Research on Cancer (IARC) protocols and standards and according to the GPCR workflow. CanDCap has two parts including a web-based online part for data collection and a windows-based part for data processing consisting of quality control and deduplication of repeated records. Questionnaire for User Interface Satisfaction (QUIS) was used in order to assess user interaction satisfaction. RESULTS: CanDCap was implemented in 2018 and could improve the quality of the GPCR data during its first three years of activity (2018-2020), during which about 9,000 records were registered. The coverage for optional items including national ID, father name, address and telephone number were improved from 23 %, 32 %, 83 % and 82 % in conventional offline method (2015-2017) to 83 %, 81 %, 87 %, and 90 % after using the CanDCap (2018-2020), respectively. The timeliness was also improved from 4 years to 2 years. Overall, user interaction satisfaction was acceptable (7.8 out of 9). CONCLUSION: CanDCap could resulted in improvement in data quality and timeliness of the GPCR as a cancer registry unit with limited resources. It has the potential to be considered as a model for population-based cancer registries in lower-resource settings.

Systematic review of women's knowledge, attitude, and practice towards breast cancer.

The present study aims to systematically review the women's knowledge, attitude, and practice (KAP) of breast cancer (BC) screening methods to get enough information for policymakers to orient the screening strategies. All English KAP studies on BC screening methods in five databases up to January 2021 were included. The quality of the final articles was assessed using the STROBE checklist. The qualitative synthesis was performed. Out of 5574 retrieved articles, 28 were included. About 64% of the articles were of high quality. Overall, there were poor knowledge, negative attitude, and low practice between women. The educational programs and cultural plans can encourage regular screening. Women's excessive optimism to their BC risk should be eliminated by focusing on the risk of the disease, more.

Design and evaluation of a mobile-based nutrition education application for infertile women in Iran.

BACKGROUND: The prevalence of infertility in Iran is higher than the world average. Furthermorte, education and nutrition are among the effective factors in improving the quality of life of women with infertility. According to the significant role of smartphones in people's lives as well as health education, the present study aimed to design and evaluate a mobile-based nutrition education application for infertile women. METHODS: This quantitative research was conducted in two stages. Initially, the educational contents were determined based on a review of the literature. Later, the obtained contents were given to 10 nutritionists and five infertility specialists to determine the necessity of each item. In the next stage, the application prototype was designed based on the results of the first stage and distributed among 220 infertile women. After two months, the Questionnaire of User Interface Satisfaction was administrated to assess the usability of the developed application. The results were analyzed via SPSS software version 20. RESULTS: According to the nutritionists and infertility specialists, the contents determined for the nutrition educational application were categorized under three general sections of user's demographic data, educational contents, required capabilities. The users' mean score of the application usability was calculated as 7.44 out of 9 indicating a good level of satisfaction. CONCLUSIONS: Nutrition education of women with infertility problems can play a significant role in improving their awareness and treatment outcomes. Due to the increasing use of smartphones, designing a mobile-based nutrition educational application can be of great benefit for women with infertility according to the cultural conditions and characteristics of each community.

Population or family history based BRCA gene tests of breast cancer? A systematic review of economic evaluations.

BACKGROUND: Nearly 56% of at-risk carriers are not identified and missed as a result of the current family-history (FH) screening for genetic testing. The present study aims to review the economic evaluation studies on BRCA genetic testing strategies for screening and early detection of breast cancer. METHODS: This systematic literature review is conducted within the Cochrane Library, PubMed, Scopus, Web of Science, ProQuest, and EMBASE databases. In this paper, the relevant published economic evaluation studies are identified by following the standard Cochrane Collaboration methods and adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement reporting some recommendations for articles up to March 2020. Thereafter, the inclusion and exclusion criteria are applied to screen the articles. Disagreements are resolved through a consensus meeting. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist is used in the evaluation of quality. Finally, a narrative synthesis is performed. To compare the different levels of incremental cost-effectiveness ratio (ICER), the net present value is calculated based on a discount rate of 3% in 2019. RESULTS: Among 788 initially retrieved citations, 12 studies were included. More than 60% of the studies were originated from high-income countries and were published after 2016. It is noteworthy that most of the studies evaluated the payer perspective. Moreover, the robustness of the results were analyzed through one-way and probabilistic sensitivity analyses in nearly 66% of these studies. Nearly, 25% of the studies are focused and defined population-based and family history BRCA tests as comparators; afterwards, the cost-effectiveness of the former was confirmed. The highest and lowest absolute values for the ICERs were $65,661 and $9 per quality adjusted life years, respectively. All studies met over 70% of the CHEERs criteria checklist, which was considered as 93% of high quality on average as well. CONCLUSIONS: The genetic BRCA tests for the general population as well as unselected breast cancer patients were cost-effective in high and upper-middle income countries and those with prevalence of gene mutation while population-based genetic tests for low-middle income countries are depended on the price of the tests.

Willingness to pay for and acceptance of cervical cancer prevention methods: A systematic review and meta-analysis.

Background: The Willingness to pay (WTP) for and acceptance of cervical cancer prevention (CCP) methods have an important role in the control of this type of cancer. Therefore, the aim of this study was to estimate the WTP and acceptance of CCP methods with the contingent valuation method (CVM). Methods: In this systematic review and meta-analysis study, the required information was collected by searching relevant keywords in PubMed, Scopus, Embase, Web of Knowledge, and their Persian equivalent in the Scientific Information Database (SID) and Elmnet databases during January 1, 2000 to June 30, 2020. All studies that reported the WTP and CCP methods with the CVM in English or Persian were included. The reporting quality of studies was assessed by strengthening the Reporting of Observational Studies in Epidemiology (STROBE). Comprehensive meta-analysis (CMA: 2) software was used to conduct the meta-analysis. The content analysis method was used for qualitative data analysis. Results: Finally, 28 articles (with 49610 people) were included in the study. Most of the participants were women (35.7%). The HPV vaccine was the most common method of prevention (75%). The overall acceptance rate was 64% and the overall positive WTP rate was 66%. The average WTP was US$30.44, which accounts for about 0.84% of GDP per capita. The most significant effective factors included income, age, education, high-risk sexual behaviors, and awareness of cervical cancer, belief in the risk of cervical cancer, and belief about the effectiveness of prevention methods. The cost was the most important reason for the unwillingness to pay and accept. Conclusion: Results show that the WTP and acceptance rate of CCP methods are relatively high. It is recommended to reduce the cost of prevention methods, especially the HPV vaccine, and to increase awareness and improve the attitude of people. Also, it is recommended to consider other methods of estimation of WTP and other cancers in future studies.

A Clinical Decision Support System for Assessing the Risk of Cardiovascular Diseases in Diabetic Hemodialysis Patients.

BACKGROUND: One of the greatest challenges in the field of medicine is the increasing burden of chronic diseases, such as diabetes. Diabetes may cause several complications, such as kidney failure which is followed by hemodialysis and an increasing risk of cardiovascular diseases. OBJECTIVE: The purpose of this research was to develop a clinical decision support system for assessing the risk of cardiovascular diseases in diabetic patients undergoing hemodialysis by using a fuzzy logic approach. METHODS: This study was conducted in 2018. Initially, the views of physicians on the importance of assessment parameters were determined by using a questionnaire. The face and content validity of the questionnaire was approved by the experts in the field of medicine. The reliability of the questionnaire was calculated by using the test-retest method (r = 0.89). This system was designed and implemented by using MATLAB software. Then, it was evaluated by using the medical records of diabetic patients undergoing hemodialysis (n=208). RESULTS: According to the physicians' point of view, the most important parameters for assessing the risk of cardiovascular diseases were glomerular filtration, duration of diabetes, age, blood pressure, type of diabetes, body mass index, smoking, and C reactive protein. The system was designed and the evaluation results showed that the values of sensitivity, accuracy, and validity were 85%, 92% and 90%, respectively. The K-value was 0.62. CONCLUSION: The results of the system were largely similar to the patients' records and showed that the designed system can be used to help physicians to assess the risk of cardiovascular diseases and to improve the quality of care services for diabetic patients undergoing hemodialysis. By predicting the risk of the disease and classifying patients in different risk groups, it is possible to provide them with better care plans.

Design a Fuzzy Rule-based Expert System to Aid Earlier Diagnosis of Gastric Cancer.

INTRODUCTION: Screening and health check-up programs are most important sanitary priorities, that should be undertaken to control dangerous diseases such as gastric cancer that affected by different factors. More than 50% of gastric cancer diagnoses are made during the advanced stage. Currently, there is no systematic approach for early diagnosis of gastric cancer. OBJECTIVE: to develop a fuzzy expert system that can identify gastric cancer risk levels in individuals. METHODS: This system was implemented in MATLAB software, Mamdani inference technique applied to simulate reasoning of experts in the field, a total of 67 fuzzy rules extracted as a rule-base based on medical expert's opinion. RESULTS: 50 case scenarios were used to evaluate the system, the information of case reports is given to the system to find risk level of each case report then obtained results were compared with expert's diagnosis. Results revealed that sensitivity was 92.1% and the specificity was 83.1%. CONCLUSIONS: The results show that is possible to develop a system that can identify High risk individuals for gastric cancer. The system can lead to earlier diagnosis, this may facilitate early treatment and reduce gastric cancer mortality rate.