Effect of the Theory-driven Educational Intervention on Self-Care Behavior and Glycosylated Hemoglobin Level in Patients with Type 2 Diabetes.

BACKGROUND AND AIMS: The diabetics' lack of knowledge about self-care and incorrect beliefs in this care are the reasons for their admission to hospitals. The present study aimed to examine the impact of education based on the theory of planned behavior (TPB) on intention, self-care behavior, and glycosylated hemoglobin (HbA1c) levels in patients with Type 2 Diabetes. METHODS: The present study was conducted on 60 diabetic patients who were randomly classified into intervention and control groups. In the intervention group, self-care education based on TPB was held, but the control group only received routine care. The data were collected using a fourpart questionnaire including characteristics, items of patients' knowledge, items of TPB constructs, and items of diabetes self-care. Data were analyzed in SPSS software. RESULTS: In intervention group, mean score of self-care behavior and its domains significantly changed from (total: 52.26±14.75, diabetic diet: 22.20±6.05, exercise: 5.17±4.04, blood sugar testing: 5.03 ± 4.15, medication: 5.40±2.28, foot care: 13.47±8.42) into 76.66±8.87, 29.43±5.48, 7.60±2.60, 8.73±2.31, 6.48±1.09, 23.53±3.09, respectively three months after intervention (p<0.01). In this case, these changes were not seen in the control group. The mean level of HbA1c in the intervention group (6.38±0.16) was significantly lower than before the intervention (7.56±1.08) and the control group (8.02±0.25) three months after intervention(p<0.01). CONCLUSION: Education based on the TPB was effective in improving the patients' self-care behavior and HbA1c index. Therefore, we suggest all medical centers to use the TPB as an effective and low-cost educational approach to improve diabetics' self-care behavior and health.

Predictors of Smoking Preventive Behavior Based on Empowerment Components among Male Students of High Schools: A Cross-Sectional Study in Iran.

Background: Smoking among adolescents and young adults is believed to be one of the most important preventable health problems. The etiology of smoking is one of the most pivotal activities in designing prevention programs. The aim of this study was to determine the correlates between components of empowerment in the context of smoking prevention in adolescents. Methods: This cross-sectional descriptive study was carried out on 422 high school male students in spring 2020. The data collection tool of this study was a valid and reliable researcher-made questionnaire containing demographic characteristics, items related to various components of empowerment, and items related to the smoking preventive behavior (SPB). A linear regression model was used, where the "SPB" outcome variable assumed three possible values: sensation seeking, problem-solving skills, self-efficacy, self-esteem, dependence on group, and attitude towards smoking reported in the previous literature were taken as independent variables, and smoking preventive behavior was considered as a dependent variable. Results: The results revealed that 10.42% of the students were active smokers and 40.75% of them had the experience of smoking. The results also showed a positive and significant relationship between problem-solving skills (r = 0.394, P < 0.001), self-efficacy (r = 0.340, P < 0.001), self-esteem (r = 0.310, P < 0.001), and attitude (r = 0.333, P < 0.001) with the SPB. In addition, a negative and significant correlation was observed between group dependence (r = -0.313, P < 0.001) and the SPB. Overall, the components of empowerment were able to explain 26.5% of the variance in the SPB. Among the components, problem-solving skills solely explained 15.5% of variance of the SPB. Conclusion: According to the results of this study, it can be said that most adolescents are at risk of smoking. Explanatory factors for adopting the SPB include improving problem-solving skills, creating a negative attitude towards smoking, increasing self-efficacy to prevent smoking, reducing group dependence, and increasing self-esteem in adolescents. Multilevel interventions and actions by policymakers, educators, and related organizations to prevent adolescent smoking and educate them about adolescent empowerment skills to prevent smoking should be considered.

Comparison of the Agreement and Accuracy Between Paramedic and Hospital Diagnosis.

OBJECTIVE: Making an accurate clinical diagnosis in the field of prehospital is of great challenge in medical services. This study aimed to determine agreement between prehospital and in-hospital diagnoses. METHODS: The diagnostic agreement was determined by a comparison of the discharge diagnosis with the prehospital emergency technicians in a period of 6 months at the emergency medical services in northwest Azerbaijan. The diagnostic agreement of discharge diagnoses was compared with the fist diagnosis by the paramedics. The results were analyzed using the kappa agreement coefficient and the chi-square test. RESULTS: The overall agreement between the diagnosis made by the emergency medical technicians and the hospital's first diagnosis was 67% (95% confidence interval [CI], 61%-77%; k = 0.61; 95% CI, 0.56-0.67), whereas the agreement between the first diagnosis made by the emergency medical technicians and the hospital discharge diagnosis was 58% (95% CI, 49%-65%; k = 0.42; 95% CI, 0.37-0.48).There was a high proportion of diagnostic agreement for pregnancy (100%), poisoning by drugs (88%), essential (primary) hypertension (86%), and ischemic heart diseases (72%). There was a low proportion of diagnostic agreement for weakness (39%), mixed anxiety and depressive disorder (43%), and cerebellar stroke syndrome (59%). CONCLUSION: Our attention in practice and emergency medical courses should be directed to diseases that have a subjective history, such as weakness and anxiety, due to the high proportion of incorrect diagnoses by the prehospital emergency technician. It should be noted that most of the incorrectly diagnosed cases were overestimated with another coronary syndrome.

Determining intention, fast food consumption and their related factors among university students by using a behavior change theory.

BACKGROUND: Today, with the advancement of science, technology and industry, people's lifestyles such as the pattern of people's food, have changed from traditional foods to fast foods. The aim of this survey was to examine and identify factors influencing intent to use fast foods and behavior of fast food intake among students based on the theory of planned behavior (TPB). METHODS: A cross-sectional study was conducted among 229 university students. The study sample was selected and entered to the study using stratified random sampling method. Data were collected using a four-part questionnaire including Participants' characteristics, knowledge, the TPB variables, and fast food consumption behavior. The study data were analyzed in SPSS software (version 16.0) using descriptive statistics (frequencies, Means, and Standard Deviation) and inferential statistics (t-test, Chi-square, correlation coefficient and multiple regressions). RESULTS: The monthly frequency of fast food consumption among students was reported 2.7 times. The TPB explained 35, 23% variance of intent to use fast food and behavior of fast food intake, respectively. Among the TPB variables, knowledge (r = .340, p < 0.001) and subjective norm (r = .318, p < 0.001) were known as important predictors of intention to consume fast foods - In addition, based on regression analyses, intention (r = .215, p < 0.05), perceived behavioral control (r = .205, p < 0.05), and knowledge (r = .127, p < 0.05) were related to fast food consumption, and these relationships were statistically significant. CONCLUSIONS: The current study showed that the TPB is a good theory in predicting intent to use fast food and the actual behavior. It is supposed that health educators use from the present study results in designing appropriate interventions to improve nutritional status of students.

Estimating the prevalence of high-risk behaviors using network scale-up method in medical university students.

BACKGROUND: There is not much information about high-risk behaviors in young groups, especially students. This study was conducted to estimate the prevalence of high-risk behaviors in students of universities of medical sciences in West Azerbaijan Province, Iran, by network scale-up (NSU) method. MATERIALS AND METHODS: This cross-sectional study was performed on 450 students from the universities of medical sciences. A researcher-developed checklist was used to collect the data. We considered number 16 for the social network size of students according to a previous study. Based on the response of individuals to each of the high-risk behaviors (including cigarette smoking, hookah use, opium consumption, alcohol drinking, tramadol/ecstasy taking, and extramarital sex) in their social network, the prevalence of these behaviors was estimated. The required calculations were performed using the NSU method. Furthermore, 95% uncertainty interval (UI) was calculated using the bootstrap method. RESULTS: Totally, 196 (44%) participants were male. The mean age (standard deviation) of the participants was 22 ± 2 years. Results showed that hookah use (20% 95% UI [18.9-21.1]) and opium consumption (0.4% 95% UI [0.24-0.6]) had the highest and lowest frequencies, respectively. Cigarette smoking (17% 95% UI [15.8-18]), alcohol use (8.3% 95% UI [7.5-9.1]), extramarital sex (8.2% 95% UI [7.4-9]), and tramadol/ecstasy taking (4% 95% UI [6.4-4.6]) were the next most common high-risk behaviors, respectively. CONCLUSIONS: Given that hookah use and cigarette smoking are the most common high-risk behaviors in students, especially males, appropriate cultural activities and educational programs should be employed by relevant authorities to reduce these behaviors.

Diabetes is associated with higher mortality and severity in hospitalized patients with COVID-19.

As a novel cause of pneumonia, coronavirus disease 2019 (COVID-19) has rapidly progressed worldwide. Previous studies have indicated COVID-19 patients with diabetes show higher mortality rates and more severe COVID-19 infection with an increased requirement for intensive care and hospital length of stay (LOS) compared to non-diabetic patients. The present study aimed to investigate the association of diabetes and COVID-19 outcome with severity of disease in hospitalized patients. The present case-control study included 268 patients diagnosed with COVID-19 who were hospitalized in Ayatollah Khoyi Hospital, Khoy, Iran. Diabetes was identified based on medical history and/or criteria of published documents. Out of 268 patients (median age of 59 years; 53.4 % male), 127 patients had diabetes (47 %). Diabetic patients had remarkably higher mortality rates (adjusted odds ratio, aOR: 3.36; confidence interval, CI: 1.17-9.66), requirement for invasive mechanical ventilation (IMV) (aOR: 4.59; CI: 1.38-15.25), and LOS (aOR: 1.13; CI: 1.06-1.24) compared to patients without diabetes. Inflammatory biomarkers including C-reactive protein (CRP), lactate dehydrogenase (LDH), and erythrocyte sedimentation rate (ESR) were increased in patients with diabetes compared to non-diabetic patients (P < 0.05 for all the comparisons). In hospitalized patients with COVID-19, diabetes was correlated with increased disease severity and mortality.

Effects of the Continuous Care Model on the Health-Promoting Lifestyle in Breast Cancer Survivors: A Randomized Clinical Trial.

Breast cancer is the most frequently diagnosed cancer and the chief cause of cancer-related death among women worldwide, with the incidence increasing exponentially particularly in low- to middle-income countries. The increase in the incidence of breast cancer is partly accounted for by increases in life expectancy due to improvements in public health, but also related to an increase in risk factors for cancer including smoking, excess body weight, decreased physical activity, and changes in reproductive activity. Health-promoting lifestyle is therefore one of the major topics of importance in studying chronic illnesses and cancer. Health promotion interventions, including the use of care models, have a vast contribution to make in terms of timely diagnosis and improved survival. One such care model, which has been designed to increase self-care, adherence, and performance in chronic patients, is the continuous care model (CCM). This study was conducted with the purpose of determining the influence of the CCM on the health-promoting lifestyle of patients with breast cancer during 2017-2018. In this randomized clinical trial, 60 patients with breast cancer were chosen by convenience sampling followed by random allocation into treatment and control groups. Six sessions of group discussion were held for the treatment group according to the CCM and items in the health-promoting lifestyle questionnaire. Data collection tools included a general health questionnaire, a demographic questionnaire, a family support questionnaire, and the Health Promoting Lifestyle Profile (HPLP), which respondents completed before and after the intervention. P values ≤ .05 were considered significant. When comparing the mean score of health-promoting lifestyle in both the control and treatment groups, before and after the intervention, significant increases in every dimension were observed. The average overall health promotion lifestyle was revealed to be significantly elevated from 123.48 to 147.12. However, in the control group the mean scores had slightly increased or were the same in all the dimensions. In addition, the average overall health promotion lifestyle had increased from 119.89 to 121.32. The observed difference in mean scores was not statistically significant. The CCM increased the score of health-promoting lifestyle of patients with breast cancer. Therefore, this caring model can be considered an alternative to improve healthy lifestyles of patients with cancer.

Psychometric Properties of the Iranian version of Champion's Revised Health Belief Model Scale for Breast Cancer screening.

BACKGROUND: Women's beliefs regarding breast cancer and its screening approaches were considered antecedents of their behavioral changes. Understanding of these beliefs in women requires a valid and reliable instrument. The present study seeks to translate the English version of the Champion's Revised Health Belief Model Scale (CRHBMS) into the Persian language and assess its psychometric properties. MATERIALS AND METHODS: The study was conducted on 334 students at Urmia University of Medical Sciences, Iran, 2016. The 57-item CRHBMS was translated to Persian language, back translated, and tested. To test the face and content validity of the Persian version; item analysis, Content Validity Ratio (CVR), and Content Validity Index (CVI) were applied, respectively. Construct validity of the Persian scale was performed by Exploratory and Confirmatory Factor Analyses (EFA, CFA) using Kaiser-Meyer-Olkin and Bartlett's tests in SPSS 16 and LISREL8.72 software. The reliability of the translated scale was evaluated using Cronbach's alpha and test-retest approaches. RESULTS: In the EFA, eight factors were extracted concerning breast cancer screening, and each item was loaded on its specific factor. These factors were self-efficacy, health motivation, benefits-mammography, benefits-Breast Self-Examination (BSE), barriers-mammography, barriers-BSE, susceptibility, and severity. The final 42-item scale was confirmed by the CFA, and all goodness of fit indices showed a proper fit of the model. Cronbach's alpha coefficient and test-retest correlation of the subscales ranged from 0.72-0.89 and 0.67-0.93, respectively. CONCLUSIONS: The study suggests that the Persian version of CRHBMS is a feasible scale for evaluating women's health beliefs regarding breast cancer and its screening behaviors.

Family Intervention Based on the FOCUS Program Effects on Cancer Coping in Iranian Breast Cancer Patients: a Randomized Control Trial

Background: Breast cancer affects patients' lives. Many breast cancer patients have problems with coping and they need support from their families. Family involvement based on the FOCUS program is designed to support breast cancer survivors within their families. The aim of this study was to investigate the effect of family involvement based on the FOCUS program on coping in breast cancer patients undergoing chemotherapy in academic centers in Urmia in 2016. Methods: In this randomized controlled trial study, sixty breast cancer survivors were randomly assigned into intervention (N=30) and control (N=30) groups. The FOCUS program family-based intervention featured six sessions covering subject areas of family involvement, optimism, cancer coping, uncertainty reduction and symptom management. The instruments used were demographic and cancer coping questionnaires. Data were analyzed with SPSS 20 software. Result: The findings revealed a significant improvement in total cancer coping scores (t= -12/39, p<0.001), in all subscales including individual (t= -11/52, p<0.001), positive focus (t= -7/03, p<0.001), coping (t= -7/28, p<0.001), diversion (t= -11/76, p<0.001), planning (t=-4/91, p<0.001) and in interpersonal (t=-11/14, p<0.001). No significant changes were observed for the control group. Conclusion: The results showed that family involvement based on the FOCUS program increases the ability to cope in breast cancer survivors.

Major dietary patterns in relation to menstrual pain: a nested case control study.

BACKGROUND: Dysmenorrhea is one of the most prevalent gynecological disorders, experienced by approximately two third of young women during menstruation. According to literature, nutrition can play a key role in the prevalence and severity of dysmenorrhea. This study aims to investigate the relation between dietary patterns and the risk of dysmenorrhea among university students. METHODS: A nested case control study was conducted among 293 students of Urmia University of Medical Sciences who were randomly recruited via a proportional cluster sampling method. From 293 students, 46 students with moderate to severe dysmenorrhea and 54 students without dysmenorrhea were assigned to the case and control groups, respectively. The major dietary patterns of students were identified by factor analysis and the association between dietary patterns and risk of dysmenorrhea was investigated using logistic regression analysis in SPSS 20. RESULTS: Three major dietary patterns were found and nominated as "Lacto-vegetarian", "Snacks" and "Mixed food items" patterns. After controlling for family history of dysmenorrhea, subjects in the second and third tertiles of "snacks" pattern had a 4.23 (95% CI = 1.32-13.58, P = 0.01) and 3.41 (95% CI = 1.10-10.50, P = 0.03) times, respectively, higher chance to experience moderate to severe dysmenorrhea in comparison with subjects in the first tertile. There was no significant association between the risk of dysmenorrhea and two other dietary patterns. CONCLUSIONS: The results indicate that adherence to "snacks" pattern is associated with an increased risk of moderate to severe dysmenorrhea during menstruation among young women.

Determinants of Breast Cancer Screening by Mammography in Women Referred to Health Centers of Urmia, Iran

Background: In women, breast cancer accounts for 30 percent of all cancers and it is the second leading cause of mortality. Mammography is considered an effective procedure to detect early breast cancer recommended by World Health Organization. This study was aimed to evaluate breast cancer screening determinants in women referred to health centers of Urmia for mammography in 2017. Materials and Methods: In this descriptive-analytic cross-sectional study, 348 women referred to health centers of Urmia were selected using multistage sampling. Data were collected using a standard questionnaire for mammography screening determinants, with a checklist including demographic characteristics, family, social and economic factors and midwifery background. Analysis was with SPSS software version 20for descriptive and inferential statistic tests, P<0.05 being considered significant. Results: The proportion performing mammography was 12%. Significant relationships were noted with income, menopause status, a history of breast cancer in close relatives, beliefs, inaccessibility, knowledge, cues to action, emotions, self-care, and life priorities (P<0.05). There were no significant links with age at marriage, first age of delivery, number of children, duration of breastfeeding, status of residency, education, marital status, occupation, history of breastfeeding, and previous breast problems (P>0.05). Conclusions: The findings of this study showed that the status of breast cancer screening in participating women was not satisfactory. Therefore, promotion of screening methods by health policy makers in Iran is necessary and given that reliance solely on education is not sufficient, it is essential to pay attention to barriers and eliminate them.

Managerial Self-Efficacy for Chemotherapy-Related Symptoms and Related Risk Factors in Women with Breast Cancer

Background: Breast cancer is one of the most important diseases affecting physical, psychological and social health of women. This study aimed to determine managerial self-efficacy regarding chemotherapy-related symptoms and related risk factors in Iranian patients. Materials and methods: This descriptive-analytical cross-sectional study was conducted on 150 patients with breast cancer referred to medical centers of Urmia in 2016 with a convenience sampling method . The data collection instrument was the symptom-management self-efficacy scale-breast cancer (SMSES-BC) questionnaire whose validity and reliability was evaluated for the first time for Iranians. Data were analyzed using SPSS software version 20. Results: Most of the patients were in the age range of 41-49 years. Lowest scores were in the areas of emotional and interpersonal disorders and the highest scores in the area of managing chemotherapy-related symptoms. The mean score of self-efficacy chemotherapy-related symptoms was 168.0±25.4. There were significant relationships between age, education, economic status, marital status and life status and self-efficacy chemotherapy-related symptoms. In addition, a positive significant correlation for each of the subscales. Conclusion: It should be noted that interventional efforts for improving managerial self-efficacy of symptoms, especially management of interpersonal and emotional disorders in these patients are necessary.

Effects of Energy Conservation Strategies on Cancer Related Fatigue and Health Promotion Lifestyle in Breast CancerSurvivors: a Randomized Control Trial

Purpose: Cancer-related fatigue is frequently experienced by patients during and after therapy. The present study was conducted to assess the impact of energy conservation strategies and health promotion in breast cancer survivors. Methods: A randomized controlled trial was carried out to compare the intervention effect (n=69.0) with controls (n=66.0) based on routine oncology ward care. The intervention was five weekly sessions for groups of 6-8 breast cancer survivors. Data on fatigue and health promotion lifestyle were obtained before and after completion the intervention and then 8 weeks later for analysis of variance (ANOVA) with repeated measures. Results: Our findings showed cancer-related fatigue to be reduced in the intervention group from pre- to post-intervention, and this persisted over the 8-weeks follow-up period (F = 69.8, p<0.001). All subscales of the cancer fatigue scale demonstrated statistically significant effects with partial eta-squared values ranging from 0.15 (the smallest effect in cognitive fatigue) to 0.21 (the largest for affective fatigue). Changes in the health promotion life style indicated a significant promotion from pre- to post-intervention, and this again continued after 8-weeks follow-up (F = 41.6, p < 0.001). All six domains of a health promoting life style featured significantly elevated values, the largest effect being seen in the interpersonal relations subscale (F=57.7, partial η2=0.21, p<0.001) followed by physical activity (F=51.9, partial η2=0.18, p<0.001). Conclusions: The program was effective in decreasing cancer related fatigue and promoting a healthy lifestyle.

Maternal anthropometric measurements and other factors: relation with birth weight of neonates.

The objective of this study was to examine the influence of anthropometric measurements of pregnant women, gestational weight gain, fundal height, and maternal factors, namely age, education, family income, parity along with maternal hemoglobin, on birth weight of neonates. A cross sectional study was performed in Khoy City in north west of Iran. Four hundred and fifty healthy pregnant women in the age between 16-40 years were selected for this study from seven health urban centers and one referral hospital. Findings showed that the mean age, height, fundal height, maternal weight, and gestational weight gain during pregnancy were 26.1 years, 159.1 cm, 32.9 cm, 72.0 kg, 11.8 kg respectively. The mean birth weight of neonates was 3.2 kg and 11% of neonates showed low birth weight. Age, family income, maternal height, weight, gestational weight gain and fundal height were significantly associated with birth weight of neonates. Using binary logistic regression analysis, fundal height, maternal hemoglobin, family income and gestational weight gain of pregnant women could be considered as predictive factors of birth weight of neonates.