Health literacy and mental health: a national cross-sectional inquiry.

Health literacy and mental health are among the most important issues in the modern health and era of public health. This study aimed to investigate the association between health literacy and mental health status. This was a national cross-sectional study that was conducted in Iran. A sample of literate individuals aged 18-65 was entered into the study using multistage sampling. The data were collected by the Health Literacy Instrument for Adults (HELIA) and the 12-item General Health Questionnaire (GHQ-12). Logistic regression and path analysis were used for data analysis. A total of 20,571 individuals completed the questionnaires. The mean(± SD) age of participants was 34.9(± 11.8) years old, 51% were female, and 38.1% had higher education. The mean(± SD) health literacy score was 68.3(± 15.2), and 29.8% of the respondents reported some mental health problems. Logistic regression analysis showed that limited health literacy was associated with poor mental health status (OR 2.560, 95% CI 2.396-2.735, P = 0.001). The path analysis showed that an increase in health literacy could reduce psychological and social dysfunction (the effect of health literacy on reducing psychological distress is more profound). It is recommended to carry out interventions that strengthen adult's cognitive and communication skills to improve their ability to access and use health information to make healthy choices.

Knowledge, attitude, and practice of Iranian adults toward Persian Medicine: a national survey.

BACKGROUND: Previous researches conducted in both developed and developing countries have demonstrated a rising trend in the utilization of complementary and alternative medicine. The World Health Organization has underscored the importance of studying the prevalence and determinants of such alternative practices. This study delves into the knowledge, attitudes, and practices of Iranian adults towards Persian medicine, a distinct form of complementary and alternative medicine, through a national survey for the first time. METHODS: A total of 2882 Iranian adults (aged ≥ 15 years) were randomly chosen from all regions. Data were gathered through structured door-to-door interviews using a survey questionnaire, wherein cases were selected randomly based on postal codes, and interviewers completed the forms at the participants' residences. RESULTS: Approximately 46% of the subjects exhibited familiarity with Persian Medicine. The study revealed that the primary sources of knowledge about Persian Medicine were family, relatives, and friends, with only 2.9% indicating medical staff as their source of information. Furthermore, the study indicated that 21% of participants expressed a strong interest in using Persian Medicine, while 30.3% did not. When comparing Persian medicine to modern medicine, respondents indicated that Persian medicine is more cost-effective and has fewer side effects, yet modern medicine is more widely used globally; although, the majority responded "I don't know" to other questions. The results also demonstrated that approximately 37% of the participants had a history of Persian Medicine utilization in their lifetime. CONCLUSION: This study revealed that Iranian adults have low reliable knowledge (from medical staff, Persian medicine books and other publications) and limited familiarity with Persian medicine, with about one third of the participants expressing disinterest (attitude) and over half of them having not utilized this form of medicine (practice).

Non-thermal CO2 Laser Therapy (NTCLT): A Novel Photobiomodulative Approach for Immediate Pain Relief of Patchy Oral Mucositis Due to Chemotherapy of Solid Tumors.

Introduction: Chemotherapy-induced oral mucositis (COM) is a prominent complication of chemotherapy (CT). Non-thermal CO2 laser therapy (NTCLT) has been demonstrated as an innovative and safe photobiomodulative approach in some kinds of painful oral lesions. The purpose of this study was to evaluate the palliative effects of one session of NTCLT on COM lesions. Methods: Patients with painful COM (WHO grade:≥2) were included in this before-after clinical trial based on the eligibility criteria. The oral lesions were irradiated with a CO2 laser (power: 1 W, scanning the lesions with the rapid circular motion of the defocused handpiece) through a thick layer (3-4 mm) of a transparent gel containing a high-water content. The severity of pain in the lesions was self-assessed using a 0-to-10 visual analogue scale (VAS) for 7 consecutive days. The evaluating physician visited the patients on the 3rd and 7th days in search of any kind of complications. Results: Seventeen adult patients with 35 patches of OM due to chemotherapy of solid tumors completed the trial. Immediately after NTCLT, the mean for non-contact VAS pain scores of the lesions significantly declined from 4.91±2.356 to 0.29±0.622 (P<0.001) and the mean for contact VAS pain scores from 7.77±1.57 to 1.31±1.18 (P<0.001). The mean VAS pain scores of the lesions showed statistically significant differences between the follow-up periods compared to the baseline (P<0.001). The process was completely pain-free and required no anesthesia. After NTCLT, no kind of thermal adverse effects such as irritation, destruction, aggravation and even erythema were observed. Conclusion: Based on the results of this before-after clinical trial, NTCLT has the potential to be considered as a non-invasive and safe palliative option for the pain management of patchy OM due to chemotherapy of solid tumors.

Measuring health literacy: A systematic review and bibliometric analysis of instruments from 1993 to 2021.

BACKGROUND: It has been about 30 years since the first health literacy instrument was developed. This study aimed to review all existing instruments to summarize the current knowledge on the development of existing measurement instruments and their possible translation and validation in other languages different from the original languages. METHODS: The review was conducted using PubMed, Web of Science, Scopus, and Google Scholar on all published papers on health literacy instrument development and psychometric properties in English biomedical journals from 1993 to the end of 2021. RESULTS: The findings were summarized and synthesized on several headings, including general instruments, condition specific health literacy instruments (disease & content), population- specific instruments, and electronic health. Overall, 4848 citations were retrieved. After removing duplicates (n = 2336) and non-related papers (n = 2175), 361 studies (162 papers introducing an instrument and 199 papers reporting translation and psychometric properties of an original instrument) were selected for the final review. The original instruments included 39 general health literacy instruments, 90 condition specific (disease or content) health literacy instruments, 22 population- specific instruments, and 11 electronic health literacy instruments. Almost all papers reported reliability and validity, and the findings indicated that most existing health literacy instruments benefit from some relatively good psychometric properties. CONCLUSION: This review highlighted that there were more than enough instruments for measuring health literacy. In addition, we found that a number of instruments did not report psychometric properties sufficiently. However, evidence suggest that well developed instruments and those reported adequate measures of validation could be helpful if appropriately selected based on objectives of a given study. Perhaps an authorized institution such as World Health Organization should take responsibility and provide a clear guideline for measuring health literacy as appropriate.

A proposed framework for holding intensive 3Rs workshops in laboratory animal science.

Principles of 3Rs are the backbone of today's animal research. Applying 3Rs in practice requires proper education and training. Although this could be achieved via long-term courses ranging from several weeks to years, in some circumstances a short-term course may be the only viable option. In this paper we define scientific and ethical objectives for running short-term 3Rs workshops. To meet these objectives, we propose a 2-day workshop curriculum and an ethical framework. The curriculum comprises theoretical and practical sessions and covers Replacement, Reduction, and Refinement strategies. The ethical framework defines the responsibilities of lecturers and attendees, and proposes the animals and facilities requirements to run the proposed workshop curriculum. The attendees will be assessed at the end of the workshop and they receive certificates for working under supervision until they are deemed competent at their intended functions. The proposed curriculum and framework are not subscriptive, instead they share the experience gained through running more than 60 laboratory animal 3Rs workshops.

Ethics of research on stem cells and regenerative medicine: ethical guidelines in the Islamic Republic of Iran.

BACKGROUND: Regenerative medicine plays a major role in biomedicine, and given the ever-expanding boundaries of this knowledge, numerous ethical considerations have been raised. MAIN TEXT: Rapid advancement of regenerative medicine science and technology in Iran, emerged the Iranian National Committee for Ethics in Biomedical Research to develop a comprehensive national ethical guideline. Therefore, the present ethical guideline which comprises eleven chapters was developed in 2019 and approved in early 2020. The titles of these chapters were selected based on the ethical considerations of various aspects of the field of regenerative medicine: (1) ethical principles of research on stem cells and regenerative medicine; (2) ethical considerations for research on stem cells (embryonic stem cells, epiblast stem cells, tissue-specific stem cells, stem cells derived from transdifferentiation, induced pluripotent stem cells [iPSCs], germline pluripotent stem cells, germline stem cells, and somatic cell nuclear transfer [SCNT] stem cells); (3) ethical considerations for research on somatic cells in regenerative medicine (adult somatic cells, fetal tissue somatic cells, and somatic cells derived from pregnancy products [other than fetus]); (4) ethical considerations for research on gametes in regenerative medicine; (5) ethical considerations for research related to genetic manipulation (human and animal) in regenerative medicine; (6) ethical considerations for research on tissue engineering in regenerative medicine; (7) ethical considerations for pre-clinical studies in regenerative medicine; (8) ethical considerations for clinical trials in regenerative medicine; (9) ethical considerations for stem cells and regenerative medicine bio-banks; (10) ethical considerations for privacy and confidentiality; and (11) ethical considerations for obtaining informed consent. CONCLUSION: This article discusses the process of developing the present ethical guidelines and its practical points. We hope that it can play an important worldwide role in advancing ethics of research on stem cells and regenerative medicine.

Systematic review and meta-analysis of the effect of iron-fortified flour on iron status of populations worldwide.

OBJECTIVE: Assess the effectiveness of iron-fortified flour on iron status. DESIGN: Systematic review and meta-analysis. SETTING: Argentina, Australia, Azerbaijan, Bangladesh, Brazil, Cameroon, Chile, China, Costa Rica, Côte d'Ivoire, Denmark, India, Iran, Jordan, Kazakhstan, Kenya, Kuwait, Mongolia, Morocco, Norway, South Africa, Sri Lanka, Tajikistan, Thailand, UK, USA, Uzbekistan, Venezuela, Vietnam, and Zambia. PARTICIPANTS: Fifty-two articles (ninety-four trials) were examined. The main target groups were women, children, and infants/toddlers. The effects of different types of iron-fortified flour (wheat, maize, rice, soy, and beans) on iron status were examined. RESULTS: A random effects analysis of before-after studies showed that iron-fortified flour led to significant increases of mean haemoglobin level (3·360 g/l; 95 % CI: 0·980, 5·730) and mean serum ferritin level (4·518 µg/l; 95 % CI: 2·367, 6·669); significant decreases of anaemia (-6·7 %; 95 % CI: -9·8 %, -3·6 %) and iron deficiency (ID) (-10·4 %; 95 % CI: -14·3 %, -6·5 %); but had no significant effect on iron deficiency anaemia (IDA). A random effects analysis of controlled trials indicated that iron-fortified flour led to significant increases of mean haemoglobin level (2·630 g/l; 95 % CI: 1·310, 3·950) and mean ferritin level (8·544 µg/l; 95 % CI: 6·767, 10·320); and significant decreases of anaemia (-8·1 %; 95 % CI: -11·7 %, -4·4 %), ID (-12·0 %; 95 % CI: -18·9 %, -5·1 %), and IDA (-20·9 %; 95 % CI: -38·4 %, -3·4 %). CONCLUSIONS: Flour fortification with iron is an effective public health strategy that improves iron status of populations worldwide.

Adherence to prescribed medications of Iranian traditional medicine in a group of patients with chronic disease.

OBJECTIVE: The extent to which a person's health-related behavior corresponds with medical instructions (adherence) is an important modifier of health system effectiveness. This study was designed to determine the patients' adherence to Iranian traditional medicine in a group of patients with chronic disease. METHODS: Convenience sampling was used to enroll 320 patients with chronic diseases from January 2014 to January 2015 in clinics of traditional medicine affiliated with medical universities in Tehran. Morisky Medication Adherence Scale (MMAS) was used to measure the adherence. After describing the variables and the frequency of adherence, logistic regression analysis was used to determine the influencing factors. FINDINGS: Mean age was 40.8 (standard deviation [SD] =13) years. The mean of the duration of disease was 54.6 (SD = 56.1) months and mean of the duration of referring to the clinics 6.5 (SD = 6.9) months. Total score of MMAS was zero in 33 (10.3%) of patients (high adherence), one or two in 128 (40%) of patients (moderate adherence), and more than two in 159 (49.7%) of patients (low adherence). Forgetfulness, bad taste, not availability, and the high cost of the drugs were the most commonly reported causes of non-adherence. Adherence was associated with age (odds ratio [OR] =1.05, 95% confidence interval [95% CI] 1-1.1), marriage (OR = 10.8, 95% CI 2.05-57.6), number of prescribed drugs (OR = 0.05, 95% CI 0.02-0.14), and duration of disease (OR = 1.01, 95% CI 1-1.02). CONCLUSION: Considering the low adherence in users of medications of Iranian traditional medicine, health care practitioners need to be trained in adherence and the influencing factors and also to use some interventions to increase the adherence.

Towards a Holistic Approach to Healthy Diet: Evidence from Iranian Health Perception Study.

BACKGROUND: The aim of present study was to investigate the relation between the perception of population on healthy diet and lifestyle related behaviors. METHODS: As part of national study on Iranian Health Perception, a cross-sectional study was carried out in Iran, 2010. A multistage sampling approach was applied to include a representative sample of population aged between 18 and 65 in the study. To collect data a designed questionnaire was administered. RESULTS: In all 27,883 individuals (50.4% women, 48.8% men) were included in the study. The mean age of participants was 34.6 years (SD = 12.8) and most were married (61%). The findings indicated that Iranian population often pay attention to healthy diet (39.5%), never smoke (74.9%), sometimes were doing exercise (29.5%), felt happy to some extent (39.5%), often care about themselves (47.1%) and rated their health as good (54.5%). Further analysis of the data showed that increased paying attention to healthy diet was associated with reduced smoking, more exercise, more self-care and happiness, and a better self-rated health status. CONCLUSION: The findings suggest that a healthy diet and other determinants of lifestyle are very integrated into each other. The efforts for changing any components of lifestyle can potentially change all individual related lifestyle behaviors. Indeed, one of effective strategies in fostering healthy diet is fostering other healthy lifestyles. This holistic approach might help decision-makers to design appropriate interventions in order to influence diet behaviors of people.

Knowledge translation for research utilization: design of a knowledge translation model at Tehran University of Medical Sciences.

INTRODUCTION: The present study aimed to generate a model that would provide a conceptual framework for linking disparate components of knowledge translation. A theoretical model of such would enable the organization and evaluation of attempts to analyze current conditions and to design interventions on the transfer and utilization of research knowledge. METHODS: This research, performed in 2006-2007 at the Tehran University of Medical Sciences (TUMS), utilized two distinct methodologies: a narrative review to identify existing knowledge transfer models and frameworks and focus group discussions to determine the views and opinions of researchers and decision makers regarding barriers to knowledge translation within the health system. RESULTS: A knowledge translation cycle is described, with five domains: knowledge creation, knowledge transfer, research utilization, question transfer, and the context of organization. DISCUSSION: The knowledge translation cycle offers a theoretical basis for identifying basic requirements and linking mechanisms in the translation of knowledge for research utilization.

Weight, height, body mass index and risk of breast cancer in postmenopausal women: a case-control study.

BACKGROUND: Many women in Iran have a relatively high body mass index. To investigate whether the condition contributes to excess breast cancer cases, a case-control study was conducted to assess the relationships between anthropometric variables and breast cancer risk in Tehran, Iran. METHODS: All incident cases of breast cancer in the Iranian Centre for Breast Cancer (ICBC) were identified through the case records. Eligible cases were all postmenopausal women with histological confirmed diagnosis of breast cancer during 1996 to year 2000. Controls were randomly selected postmenopausal women attending the ICBC for clinical breast examination during the same period. The body mass index (BMI) was calculated based on weights and heights as measured by the ICBC nursing staff. Both tests for trend and logistic regression analysis were performed to calculate odds ratios and 95% confidence intervals as measures of relative risk. RESULTS: In all, 116 breast cancer cases and 116 controls were studied. There were no significant differences between cases and control with regard to most independent variables studied. However, a significant difference was observed between cases and controls indicating that the mean BMI was higher in cases as compared to controls (P = 0.004). Performing logistic regression analysis while controlling for age, age at menopause, family history of breast cancer and parity, the results showed that women with a BMI in the obese range had a three fold increased risk of breast cancer [odds ratio (OR) = 3.21, 95% confidence interval (CI): 1.15-8.47]. CONCLUSION: The results suggest that obesity in postmenopausal women could increase risk of breast cancer and it merits further investigation in populations such as Iran where it seems that many women are short in height, and have a relatively high body mass index.

Flour fortification with iron: a mid-term evaluation.

OBJECTIVES: Iron-deficiency anaemia is a major nutritional problem in Iran. A programme of flour fortification with iron was launched in 2001. A mid-term evaluation was conducted in 2004 to determine the effectiveness and coverage of this programme. METHODS: To determine the effectiveness of the program, a field trial was conducted in which blood hemoglobin and ferritin levels were measured in a sample population from Bushehr (intervention) and Fars (control) provinces. The target population was women aged 15-49 years. The coverage of the programme was determined using a cross-sectional study that measured iron content in samples of flour and bread from Bushehr province. RESULTS: Five hundred and sixty-seven and 296 women were studied in the intervention and control provinces, respectively. Women in the intervention province had a lower prevalence of low ferritin levels compared with women in the control province (P=0.04). Women from the two provinces did not differ in terms of haemoglobin levels and iron-deficiency anaemia. The coverage of fortified flour and bread was 100% and 99.7%, respectively. CONCLUSIONS: This mid-term evaluation found that the iron fortification programme in Iran has only had a beneficial effect on the prevalence of low ferritin levels. The final evaluation is likely to provide more useful information regarding the effect of this programme on a number of anaemia indicators.

Is the Uniscale an appropriate mother-child scale?

OBJECTIVE: To determine the reliability and acceptability of the Uniscale. METHODS: Two studies were conducted from December 2000 to February 2001 in Iran. In the first study, weights of subjects were obtained using the Uniscale and compared with weights obtained from the currently used scale. The sample comprised pregnant women and children under 5 years old. The main measure was reliability, which was assessed by two indicators: intra-instrument error for each of the two scales, and inter-instrument error. The second study was a descriptive study designed to test providers' perceptions of acceptability of Uniscale measurements. RESULTS: In the first study, a total of 458 subjects participated in the study. Overall, mean values of repeated measurements using each of the scales (intra-instrument error) were not significantly different. There was no significant difference between the weight measurements of the two scales (inter-instrument error) when weighing children, but a significant difference was detected when weighing pregnant women (p < 0.001). In the second study, 54 providers were included. The proportions of providers who recommended use of the Uniscale for children under 2 years, children 2-5 years and pregnant women were 57%, 75% and 80%, respectively. CONCLUSIONS: The Uniscale had the same accuracy as the current scale when weighing children. However, for use with adults, we suggest additional studies be conducted with increased training of providers because we found that measurements were influenced by individual variation in use. It is recommended that new versions of mother-child scales be developed that are more user friendly.

Congenital rubella syndrome in Iran.

BACKGROUND: Congenital rubella syndrome (CRS) can be prevented with appropriate vaccination programs. The prevalence rates of rubella and CRS in Iran are unknown; therefore, the risk of exposure in pregnant women is not clear. The prevalence of CRS in the pre-vaccine period can be estimated by evaluating the proportion of children in the population with sensorineural hearing loss attributable to rubella. METHODS: This was a case-control study to estimate prevalence of CRS in Tehran (Iran) by evaluating the proportion of children with sensorineural hearing loss attributable to rubella. The study used rubella antibody titer as an indicator, and compared the prevalence of rubella antibody between children with and without sensorineural hearing loss. Using these findings, the proportion of cases of sensorineural hearing loss attributable to rubella was estimated. RESULTS: A total of 225 children aged 1 to 4 years were entered into the study (113 cases and 112 controls). There was a significant difference between cases and controls with regard to rubella antibody seropositivity (19.5% vs. 8.9%, respectively, odds ratio = 2.47, 95% CI = 1.04-5.97). The proportion of sensorineural hearing loss cases attributable to rubella was found to be 12%, corresponding to a CRS prevalence of 0.2/1000. CONCLUSION: The prevalence of CRS was approximately 0.2/1000 before rubella vaccination in Iran, Moreover; the results suggest that implementation of appropriate rubella vaccination programs could potentially prevent about 12% of cases of sensorineural hearing loss in Iranian children. This data could potentially be used as baseline data, which in conjunction with an appropriate method, to establish a surveillance system for rubella vaccination in Iran. An appropriate surveillance system is needed, because the introduction of a rubella vaccine without epidemiological data and an adequate monitoring program could result in the shifting of rubella cases to higher ages, and increasing the incidence of CRS.