Experiences of stress appraisal in hemodialysis patients: A theory-guided qualitative content analysis.

Chronic renal failure and prolonged hospitalization for the treatment of renal disease incur immense stress and anxiety in patients. Considering the increased prevalence of renal failure, the present study aimed to explain the experiences of stress assessment in hemodialysis (HD) patients based on the transactional model of Lazarus and Folkman. The data collection method was semi-structured interview with 22 patients from dialysis centers in Tehran. Sampling was purposive and continued until data saturation. Data were analyzed using the directed content analysis method. Data analyzed to the extraction of 80 codes that were classified into two predetermined categories of appraisal structures in the transactional stress model, including primary and secondary appraisal, and also seven subcategories (perceived susceptibility, perceived severity, motivational relevance, casual focus, perceived control over outcoms, perceived control over emotions, and self-efficacy). During this study, 15 sub-subcategories were obtained for the stress appraisal in HD patients. The results showed that the subcategories of perceived susceptibility, perceived severity, and casual focus were the most effective factors in the stress appraisal in HD patients. According to the results, an arrangement should be made so that HD patients can evaluate the stressful conditions properly. patients need help to improve their evaluation in subcategories of motivational relevance, perceived control over outcomes, perceived control over emotion, and self-efficacy. In this regard, one of the best models that can be used to identify the appraisals in HD patients and design appropriate interventions for them is the transactional model.

What Are the Hemodialysis Patients' Style in Coping with Stress? A Directed Content Analysis.

BACKGROUND: Nowadays, the prevalence of chronic diseases, such as chronic renal failure, is rising. These patients need hemodialysis to continue their treatment, which is a stressful process. This research was conducted with the purpose of explaining coping styles in hemodialysis patients regarding stress factors based on the Lazarus and Folkman's transactional model. METHODS: This qualitative study was conducted as a content analysis. The data collection method was semi-structured interview with 22 patients from dialysis centers in Tehran. The data were collected from October to January 2017. Sampling was purposive and continued until data saturation. Data were analyzed using the directed content analysis method. The process of data analysis proposed by Hsieh and Shannon's was followed. RESULTS: 106 codes and 24 sub subcategories were obtained through this research and classified into 8 sub-categories of transactional stress model including: problem management, emotional regulation, social support, dispositional coping styles, positive reappraisal, revised goals, spiritual beliefs and positive events; and 3 categories of coping structures that included coping efforts, meaning-based coping and moderators. CONCLUSION: Dialysis patients are making efforts to cope with their stress in order to reduce their stress; in some cases, these efforts lead to reduction in stress, and in some cases, due to using unsound coping style, they are ineffective or even harmful. Therefore, the necessity of planning and proper interventions is felt by health care providers to control stress in dialysis patients.

Predicting and analyzing the trend of traffic accidents deaths in Iran in 2014 and 2015.

BACKGROUND: Predicting the trend in traffic accidents deaths and its analysis can be a useful tool for planning and policy-making, conducting interventions appropriate with death trend, and taking the necessary actions required for controlling and preventing future occurrences. OBJECTIVE: Predicting and analyzing the trend of traffic accidents deaths in Iran in 2014 and 2015. SETTINGS AND DESIGN: It was a cross-sectional study. MATERIALS AND METHODS: All the information related to fatal traffic accidents available in the database of Iran Legal Medicine Organization from 2004 to the end of 2013 were used to determine the change points (multi-variable time series analysis). Using autoregressive integrated moving average (ARIMA) model, traffic accidents death rates were predicted for 2014 and 2015, and a comparison was made between this rate and the predicted value in order to determine the efficiency of the model. RESULTS: From the results, the actual death rate in 2014 was almost similar to that recorded for this year, while in 2015 there was a decrease compared with the previous year (2014) for all the months. A maximum value of 41% was also predicted for the months of January and February, 2015. CONCLUSION: From the prediction and analysis of the death trends, proper application and continuous use of the intervention conducted in the previous years for road safety improvement, motor vehicle safety improvement, particularly training and culture-fostering interventions, as well as approval and execution of deterrent regulations for changing the organizational behaviors, can significantly decrease the loss caused by traffic accidents.

Estimating Completeness of Cancer Registration in Iran with Capture-Recapture Methods.

Completeness is an important indicator of data quality in cancer registry programs. This study aimed to estimate the completeness of registered cases in a population based cancer registry program implemented in five provinces of Iran. Capture-recapture methods were used to esti-mate the number of cases that may have been missed and to estimate rates of completeness for different categories of age, year, and sex. The data used for this study were obtained from three sources: 1) National Pathology Database; 2) National Hospital Discharge Database; and 3) National Death Registry Database. The three sources were linked and duplicates were identified based on first name, last name, father's names, and date of birth, ICD code, and case's residency address using Microsoft Excel. Removing duplicates, the three sources reported a total of 35,643 cases from March 2008 to March 2011. Running many different multivariate models of capture-recapture and controlling for source dependencies revealed an overall under-reporting of 49% in all five registries combined. The estimated completeness differed based on age, sex, and year. The overall completeness was higher for males than females (71.2% for males and 59.9% for females). Younger age had lower rates of completeness compared to older age (38.1% for <40 years, 55.4% for 40-60 years, and 76.7 for>60 years). The results of this study indicated a moderate to severe (depending on the age, sex and year) degree of completeness in the population based cancer registration of Iran.

Effect of enteral feeding with ginger extract in acute respiratory distress syndrome.

PURPOSE: The purpose of this study is to evaluate the effects of an enteral diet enriched with ginger extract on inflammatory factors, respiratory profile, and outcome of patients with acute respiratory distress syndrome (ARDS). MATERIALS AND METHODS: Thirty-two patients with ARDS were randomized to receive a high-protein enteral diet enriched with ginger or placebo. Serum levels of interleukin (IL) 1, IL-6, tumor necrosis factor α, and leukotriene B4; red blood cell glutathione; oxygenation; and static compliance were measured on days 0, 5, and 10. RESULTS: Patients fed enteral diet enriched with ginger had significantly lower serum levels of IL-1, IL-6, and tumor necrosis factor α and higher level of RBC glutathione on days 5 and 10 compared with control group (P < .05). Significant improvement in oxygenation was observed on day 5 (P = .02) and 10 (P = .003) in ginger group compared with control group. Static compliance was increased on day 5 (P = .01) in ginger group compared with control group. A significant difference was found in duration of mechanical ventilation (P = .02) and length of intensive care unit stay (P = .04) in favor of ginger group. We did not find any difference in barotraumas, organ failure, and mortality between the study groups. CONCLUSIONS: An enteral diet supplemented with ginger in patients with ARDS may be beneficial for gas exchange and could decrease duration of mechanical ventilation and length of stay in intensive care unit.

Association between risk of breast cancer and fertility factors--a latent variable approach.

BACKGROUND: Breast cancer is the most common malignant tumor in females. Many studies have been carried out in order to assess the reproductive risk factors. Particular attention has focused on information regarding fertility, including breastfeeding, age at first birth and number of live births. These factors are highly correlated with each other. The objective of this study was to employ latent variables to reduce the confounding effect of this correlation with a logistic regression analysis. METHODS: The investigation drew upon results from a dataset belonged to a hospital based case-control study covering 303 breast cancer patients and 303 hospital controls. Data were collected through interview and reproductive variables included age at first full-term pregnancy and live birth, number of pregnancies and live births, and total length of breast feeding. Latent variables were generated using factor analysis and principal components analysis. RESULTS: The study revealed that for both latent variable approaches the odds ratios of two latent variables significantly indicated a protective impact of number of pregnancy and live birth and breastfeeding and a prognostic relation with age at first pregnancy or live birth. CONCLUSION: The findings suggest that breastfeeding and decreasing age at first live birth have protective influences on breast cancer risk. Also using statistical model with latent variables in the presence of collinear data leads to reliable results.

Nutritional knowledge and attitudes in athletes with physical disabilities.

CONTEXT: Little is known about sport nutritional problems and requirements of athletes with physical disabilities. OBJECTIVE: To compare the nutritional knowledge and attitudes of Iranian athletes with physical disabilities (APDs) after nutrition education. Because proper nutrition is important for both performance and injury healing, learning about the nutritional areas in which APDs are deficient may assist professionals in educating them. DESIGN: Nested case-control study. SETTING: Sport camp. PATIENTS OR OTHER PARTICIPANTS: Seventy-two APDs (42 APDs in the intervention group and 30 age-matched and sex-matched control APDs) and 10 coaches completed the study. INTERVENTION(S): The APDs in the intervention group and their coaches were given nutrition education, which included a booklet with a simplified food guide pyramid, simple concepts about nutrition and weight loss, and four 3-hour courses. The APDs in the control group and their coaches were not given nutrition education. MAIN OUTCOME MEASURE(S): Subjects completed 2 nutritional questionnaires with both quantitative and qualitative components. Nutritional questionnaires were administered at 2 consecutive camps, 30 days apart, before and after nutrition education. Our questionnaires included a demographics section; 88 Likert scale and true-false questions; and 18 open-ended questions, 13 of which were specifically designed for APDs. Each APD completed two 3-day food records. RESULTS: The APDs in the intervention group scored significantly higher after nutrition education and higher than the control group on the knowledge subscales and interest in nutrition. Although the nutrition knowledge score in this study was moderate, several specific areas of deficient nutritional knowledge were identified that are critical for the health of APDs. Our model of nutrition education was more effective than the usual instructions presented irregularly by coaches. CONCLUSIONS: Our findings suggest that Iranian APDs lack nutritional knowledge in areas critical to preventing nutrition-related health problems, especially components related to nutrition for athletes with disabilities.