Barriers to adherence to home-based pulmonary rehabilitation among patients with chronic obstructive pulmonary disease in Iran: a descriptive qualitative study.

OBJECTIVES: Chronic obstructive pulmonary disease is a chronic disease with numerous complications. Therefore, its effective management depends on home-based pulmonary rehabilitation. The effectiveness of home-based pulmonary rehabilitation programmes in turn depends on patient adherence to them. The aim of this study was to explore the barriers to adherence to home-based pulmonary rehabilitation among patients with chronic obstructive pulmonary disease. DESIGN: Qualitative descriptive design. SETTING: The lung care wards of Al-Zahra and Khorshid teaching hospitals and the comprehensive lung care clinic of Khorshid hospital, Isfahan, Iran. PARTICIPANTS: Participants patients with chronic obstructive pulmonary disease (n=20), their family caregivers (n=15) and healthcare providers (n=14) recruited via purposive sampling. RESULTS: The five main categories of the barriers to adherence to home-based pulmonary rehabilitation among patients with chronic obstructive pulmonary disease were patient-related barriers, caregivers' caregiving burden, limited support for patients, healthcare providers' limited professional competence and ineffective home-based pulmonary rehabilitation planning. CONCLUSION: Different and complex factors related to patients, families and healthcare providers can affect adherence to home-based pulmonary rehabilitation among patients with chronic obstructive pulmonary disease. Healthcare authorities can use the findings of this study to develop strategies to support patients with chronic obstructive pulmonary disease and their family caregivers and thereby reduce the physical and mental complications of Chronic obstructive pulmonary disease.

Barriers to rational antibiotic prescription in Iran: a descriptive qualitative study.

INTRODUCTION: Rational antibiotic prescription (RAP) refers to the purposeful and appropriate antibiotic prescription with correct dose and course to produce the most possible benefits and less possible side effects. Identification and management of the barriers to RAP can help promote RAP. The aim of the study was to explore the barriers to RAP in Iran. METHODS: This descriptive qualitative study was conducted in 2021 on 46 physicians (including general physicians, specialists, and subspecialists), pharmacologists, microbiologists, and nurses. Participants were purposefully selected from five specialty and subspecialty hospitals in Isfahan, Iran, and the Treatment Administration of Isfahan University of Medical Sciences, Isfahan, Iran. Data were collected via semi-structured interviews and were analyzed via conventional content analysis. RESULTS: The barriers to RAP in Iran came into sixteen subcategories and four main categories, namely physicians' limited professional competence (with six subcategories), poor informational and functional resources (with four subcategories), ineffective supervision of RAP (with three subcategories), and inappropriate context for RAP (with three subcategories). The subcategories of these categories were physicians' limited professional knowledge, physicians' poor attitude towards RAP, physicians' routine-based practice instead of evidence-based practice, physicians' limited accountability, physicians' fear over the legal consequences of not prescribing antibiotics, physicians' financial motives, limited access to quality educational materials, poor in-service training for physicians, lack of culturally appropriate guidelines, inefficiency of the stewardship committee, limited supervision of physicians' performance, ineffective managerial supervision, limited supervision of sampling for antimicrobial susceptibility testing, sociocultural factors contributing to irrational antibiotic prescription, poor adherence of insurance companies to their financial commitments, and financial incentives of pharmaceutical companies for physicians. CONCLUSION: The barriers to RAP are different and complex and include physician-related, resource-related, supervision-related, and contextual factors. Physicians with limited professional competence, limited access to resources, and limited supervision will have problems in RAP. Effective management of the barriers to RAP can promote RAP and minimize irrational antibiotic prescription and its consequences, chiefly antimicrobial resistance.

Prevention of Postpartum Weight Retention during One Year after Childbirth by Prenatal Nutrition Education: A Randomized Controlled Trial.

BACKGROUND: It seems that 14-25% of the women retain at least 5 kg weight from 6 to 12 months after delivery and gestational weight gain is the most important reason of weight retention. Thus, we assessed the effect of prenatal nutrition education program on the retained weights at 8, 26, and 52 weeks after delivery in primiparous women. METHODS: This randomized controlled trial was implemented among 192 primiparous pregnant women in five hospitals, fifteen community health centers, and fifteen private offices. Self-developed questionnaire was used to collect the participants' characteristics. A 72-hr dietary recall was applied to evaluate the food intakes before and after intervention. The pregnancy physical activity questionnaire determined the physical activity score. The participants' weights at 8, 26, and 52 weeks after delivery were measured by a digital beam. RESULTS: The means of postpartum weight decreased in both groups, but nutrition education was significantly effective on reducing postpartum weight in intervention group (ß = -3.112, SE =. 7384, P < 0.001). Also, the women in intervention group had less retained weight compared to control during the follow-up (ß = -3.35, SE = 0.75, p < 0.001). The proportion of pregnant women in intervention group who reached to their pre-gravid weight was more than control during the follow-up (OR = 2.86, 95% CI: 1.62, 5.07). CONCLUSIONS: Nutrition education considering an individualized calorie-appropriate diet for each pregnant woman and based on the national guideline is effective on postpartum weight retention and reaching to pre-gravid weight.

Exploring the barriers to pulmonary rehabilitation for patients with chronic obstructive pulmonary disease: a qualitative study.

BACKGROUND: The complexity of chronic obstructive pulmonary disease (COPD) and its different physical, mental, familial, occupational, and social complications highlight the necessity of pulmonary rehabilitation (PR) for afflicted patients. However, PR for patients with COPD usually faces some barriers. The aim of this study was to explore the barriers to PR for patients with COPD. METHODS: This qualitative descriptive study was conducted in January 2019 to October 2020. Participants were 19 patients with COPD, 11 family caregivers of patients with COPD, and 12 healthcare providers, who all were recruited purposively from two teaching hospitals in Isfahan, Iran. Data were collected through semi-structured interviews and were analyzed through conventional content analysis. RESULTS: The barriers to PR for patients with COPD fell into three main categories, namely barriers related to patients and their families, inefficiency of PR services, and inappropriate organizational context for PR. Each category had four subcategories, namely patients' and families' lack of knowledge, complexity and chronicity of COPD, heavy financial burden of COPD, patients' frustration and discontinuation of PR, lack of patient-centeredness, lack of coordination in PR team, inadequate professional competence of PR staff, lack of a holistic approach to PR, limited access to PR services, inadequate insurance for PR services, ineffective PR planning, and discontinuity of care. CONCLUSION: PR for patients with COPD is a complex process which faces different personal, familial, social, financial, organizational, and governmental barriers. Strategies for managing these barriers are needed in order to improve the effectiveness and the quality of PR services for patients with COPD.

The keys to a good and lasting marriage: Exploration of Iranian couple's experiences.

BACKGROUND AND AIM: Marital satisfaction is a multidimensional phenomenon, which refers to the quality of marital relationship, or the general view of marriage status and reflection of happiness and marital performance. Repetition of certain positive behaviors can make a huge difference in the success of continued married life, and that awareness of such behaviors seems to be critical to recognizing certain warnings. Therefore, this study with qualitative approach conducted to promoting long-term marital satisfaction by exploring couple's experiences. MATERIALS AND METHODS: This study was conducted using descriptive phenomenology method. The participants were 12 person (six couples) with a history of 20-30 years of married life expectancy and a marital satisfaction score of above 65. The data were collected by purposeful sampling and semi-structured interviews, analyzed using Colaizzi method. By categorizing the codes, subcategories, and main categories were extracted. RESULTS: An analysis of the experiences of the participants resulted in emergence of eight subcategories, and three main categories: "Strong Foundation For Living Together," "Mutual Commitment To Protecting Marital Cohesion," and "Striving To Improve Sexual Relations." CONCLUSIONS: A long-term marriage associated with a variety of variables, including a strong foundation for living together, a mutual commitment to protect marital cohesion, and an effort to improve sexuality. And the results showed that the type of relationship will change during the years after marriage in a way that takes on certain meanings and concepts and can be interpreted in physiological, cultural and other specific contexts.

Effect of attachment-based interventions on prenatal attachment: a protocol for systematic review.

BACKGROUND: Parental attachment was defined as: series of inner behaviors that would cause the infant to develop an intimate relation with his/her parents. This emotional relationship is formed long before birth during the pregnancy and has been associated with psychosocial outcomes for women and children. This relationship is known as one of the major components of the child's social and emotional development. Parents' relationship with their fetus could be strengthened using various strategies, but efforts to augment the maternal-fetal relationship have not always been successful. This study aims to conduct a comprehensive systematic review and a meta-analysis survey of the effects of attachment-based interventions on prenatal attachment. METHODS: A comprehensive search of relevant randomized and quasi-randomized controlled trials will be performed in EMBASE (via Scopus), ProQuest, Pubmed, Scopus, Ovid and Web of Science, The Cochrane Central Register of Controlled Trials, SID, MagIran, Irandoc, Barakat Knowledge Network System and Iranian registry of clinical trials website as Iranian databases using English and Persian keywords such as prenatal attachment, relationship, maternal attachment. Only randomized controlled clinical trials conducted between 2000 and 2016 will be included in this review. The study will be selected if their participants were expectant mothers, their partners or both. Our primary outcome will be the effect size of intervention. The quality of experimental studies will be evaluated using CONSORT checklist and Study Quality Guide by Cochrane Consumers and Communication Review Group. Two authors will independently assess the eligibility of the studies. Any disagreements will be resolved through a third reviewer. The risk of bias will be independently determined using the Cochrane Risk of Bias Tool. The quality of the papers will be assessed based on the CONSORT checklist. If possible quantitative data will be pooled in statistical meta-analyzing with random effect model. DISCUSSION: In this review the current state of knowledge on prenatal attachment is examined. Effectiveness of attachment-based interventions during pregnancy is analyzed. Finally, practice and research implications based on analysis of the current status of maternal-fetal attachment are identified. The expected findings will help healthcare providers to develop pregnant women and infants' health when offering prenatal care.

Spiritual experiences of family members to cope with the challenges of childhood disability: A Qualitative study in Iran.

BACKGROUND: If we take the family as a circle, the disabled child is in the center of the circle and weights on all communications in the family. Therefore, in this research, the experiences of all family members are studied. The knowledge about families' experiences helps the caregivers to have a deep recognition of family status and individual and social relations. MATERIALS AND METHODS: This was a phenomenological study. Participants were Iranian families with disabled child and were selected by a goal-oriented sampling. Data collection was done through an unstructured interview. Interviews were transcript based. Data analysis was done by Colaizzi's method. Codes were extracted from the interviews and then the main concepts were formed by organizing the formulated meanings into clusters of themes. RESULTS: Data were being compiled from the 18-h interview tapes and the verbatim transcription of the interviews with the 12 study participants. Then, the researchers formulated the meanings of each significant statement into 65 codes and organized the formulated meanings into following four clusters of themes: 1 - protective structure, 2 - adjustment, 3 - social isolation, 4 - psychological tension. CONCLUSION: The existence of a disabled child may lead to psychological and spiritual distress and vast changes in every aspect of each member of the family.

Maternal-fetal emotional relationship during pregnancy, its related factors and outcomes in Iranian pregnant women: a panel study protocol.

BACKGROUND: Considering the importance of attachment in child's development and mother's health, various related factors and also lack of necessary information in this regard in our country, the research team decides to conduct this study to evaluate maternal-fetal attachment during pregnancy, its changes and post-partum consequences on mother-infant relationship. This process should be studied during pregnancy and also after delivery so that the effect of related factors and the changes in attachment over time could be determined and comprehensible information about the effective underlying conditions on this issue would be gathered. METHODS: The present research is a longitudinal study (panel study). Data gathering would start at the first trimester, continue during second and third trimesters of pregnancy, first visit after delivery, second, fourth and end sixth months later. Pregnant women in the first trimester would be selected and contacted. If they have inclusion criteria, they would be selected as a participant. At first, their demographic-reproductive characteristics, Beck Depression Inventory (BDI), Spielberger State-Trait Anxiety Inventory (SSTAI), The Social Support Appraisal (SSA), Adult Attachment Scale (AAS) and Parental Bonding Instrument (PBI) would be completed; during the second trimester, BDI, SSTAI and Cranley's Maternal-Fetal Attachment Scale (CMFAS) would be completed. In the third trimester, the same questionnaires would be completed. During the first month after birth, Avant's questionnaire of Mother-Infant Attachment Behaviors would be completed. At the second, fourth and sixth months after delivery Muller's Mother -Infant Attachment Scale would also be completed. DISCUSSION: The results of the study will be provided to maternal child health policy-makers in the health system. This information could not be obtained through cross-sectional studies and through one episode of data collection and more studies are needed to provide us a perspective of the mother-infant relation over time. Studying attachment during pregnancy would provide us a chance to learn more about this process.

Reproductive Health Needs Assessment in the View of Iranian Elderly Women and Elderly Men.

Objective: To assess reproductive health needs in men and women as the first and basic step in educational planning. Materials and methods: The study was qualitative. Participants were Postmenopausal women and men over 60 years. Data gathering was done by semi structured interviews. Analysis of the qualitative data was conducted during a multi-step process according to the assessment method of Altschuld et al needs analysis. Results: Two general themes were considered in categorizing codes extracted from interviews: 1) Problems, 2) Demands. Women's reproductive health problems were Problems associated with menopause, Related to family planning, sexual problems, and diseases and cancers. Reproductive health problems in men were in two main subthemes Urinary-reproductive problems and sexual dysfunction. Their main demand was for establishing a health center for geriatric reproductive health. Conclusion: Aging has severe effect on men's and women's reproductive health and elderly peoples need health services to cope with changes, therefore these needs should be considered in medical curriculums.

The Effect of Resistance Exercise on Lipid Profile of Coronary Artery Disease Patients: A Randomized Clinical Trial.

BACKGROUND: Increased level of blood lipids is one of the risk factors for cardiovascular diseases. Considerable research has done to assess the effects of physical exercises on lipid profile, of which aerobic exercises are the main part of evidence. However, in recent years, resistance exercise has been less investigated. Thus, the present study investigates the effect of resistance exercise on lipid profile in coronary artery disease patients. MATERIALS AND METHODS: This study was a randomized clinical trial. Forty eligible participants were selected through selective sampling and were assigned randomly to either intervention or control groups (20 participants in each group). Fasting blood sample was taken for measurement of lipid profile before, after, and after 4 weeks of the end of intervention. The intervention period lasted 8 weeks and included two exercise sessions of 45-60 minutes per week. Resistance exercise was performed by use of light weights in the range of motion of the elbow, shoulder, and knee joints. The number of repetitions was initially 10 and was gradually increased to 15. Then, the weight was increased by 3-5% and the number of sets too. Data were analyzed on significant level of P < 0.05. RESULTS: In both the groups, the mean and mean changes of lipid profile, before, after. and 4 weeks after the end of the intervention were not significantly different (P < 0.05). CONCLUSIONS: The 8-week of resistance exercise did not lead to a significant decrease in the mean lipid profile.

The effect of resistance exercise on mean blood pressure in the patients referring to cardiovascular research centre.

BACKGROUND: One of the most important risk factors for cardiovascular disease is hypertension. 1 billion people in the world and 25-35% of the adult population in Iran suffer from hypertension. Despite the emphasis on medicational treatments, non-medicational treatments and modification of lifestyle, including physical activity and exercise, are important for the control and treatment of hypertension and lead to a reduction in cardiovascular diseases. Among the various types of exercises, resistance exercise has been considered important by the cardiologists. The present study investigates the effect of resistance exercise on mean blood pressure in the cardiovascular patients. MATERIALS AND METHODS: In a randomized clinical trial, 40 patients admitted to the rehabilitation unit of cardiovascular research center were assigned to study and control groups. Demographic data were collected. Their blood pressure values were measured and recorded once 1 day before the beginning of the intervention and another time 1 day after its completion. All study subjects participated in two 45-60 min exercise sessions for eight straight weeks. The control group followed routine rehabilitation unit protocol that was aerobic exercise. The study group subjects performed resistance exercise in addition to routine exercise. The weight was determined in the first session of the intervention. At the beginning, the number of the repetitions in the range of motion was 10, which was increased gradually to 15. After it reached 15 repetitions, the amount of weight was increased by 3-5% and the number of sets increased. RESULTS: One day before the beginning of the intervention, mean systolic blood pressure was 128.21 (15.39) mmHg in the study group and 120.00 (20.51) mmHg in the control group. Mean diastolic blood pressure was 82.50 (9.35) mmHg in the study group and 82.00 (13.11) mmHg in the control group. There were no differences between the groups in terms of mean systolic and diastolic blood pressure (P > 0.05). After the end of the intervention, mean systolic blood pressure values were 116.42 (7.18) mmHg and 112.00 (12.60) mmHg in the study and control groups, respectively. There were no significant differences between the groups (P = 0.24). Mean diastolic blood pressure values were 81.78 (7.99) mmHg in the study group and 78.25 (12.48) mmHg in the control group. There was no significant difference between the groups (P = 0.35). At the end of the intervention, mean systolic blood pressure in the study group decreased significantly (P = 0.02). CONCLUSIONS: In the present study, the effect of resistance exercise on mean systolic blood pressure showed a significant difference, caused by the aerobic exercise.

The opinion of Iranian students about the society's perception on using surrogacy as an infertility treatment in the future community.

BACKGROUND: Surrogacy is one of the challengeable treatments for infertility; therefore, it seems necessary to learn the attitutude of people toward it, especially the opinion of those who are working in infertility treatment. Students studying midwifery, medicine, psychology and law are involved in this process to various degrees. The aim of this study was to investigate the students' opinions about the perception of the society on using surrogacy. MATERIALS AND METHODS: This study was a descriptive cross-sectional survey. The sample of this study included 200 students of the Isfahan University and Isfahan University of Medical Sciences from the following courses: Midwifery, Medicine, Psychology and Law. Since the number of students in different discipline was not equal, we therefore used quota sampling. The data collection instrument was a researcher-made questionnaire. The questionnaire included questions on their knowledge, attitude and surrogacy acceptance in the future in Iran. RESULTS: The students of the medical course were mostly in the category "strongly agree" and "agree" with surrogacy (43 students which constitute 79.6%), then, midwifery students (15 students which constitute 78.9%) and finally, the students of other courses agreed less with this method. According to chi-square test, there was no significant difference between attitudes of students (P=0.08). Individuals mostly assert their acceptance of this method through "increasing tendency to this method in the future" (77.1%). CONCLUSION: Students in this study had a positive attitude toward surrogacy and they accepted it as a norm; despite this, it is essential to make some changes within cultures to improve the situation.

The effects of red clover on quality of life in post-menopausal women.

BACKGROUND: Due to symptoms and its complications, menopause influences the mental, psychological and physical health, social performance and familial relationships. Because of the undesirable side effects of hormone replacement therapy, tendency and desire toward alternative treatments in relieving menopausal symptoms have increased. Among the alternative therapies are herbs and among those, herbs with phytoestrogens are more preferable. Red clover is a rich source of phytoestrogens. The present study investigated the effect of red clover on quality of life in post-menopausal women. MATERIALS AND METHODS: In a randomized, triple-blind, placebo-controlled clinical trial, 72 menopausal women who at least obtained 15 scores in Kupperman Menopausal Index, after two weeks of monitoring, were randomly allocated to receive either placebo or 45 mg of red clover isoflavones for eight weeks. Before the treatment and at the end of the study, menopause-specific quality of life questionnaire (MENQOL) was completed in the two groups. FINDINGS: A total of 55 women completed the study, 28 subjects in red clover and 27 in placebo group. Mean score of total quality of life (p < 0.001 in both groups), mean score of quality of life in vasomotor domain (p < 0.001 in both groups), psycho-social domain (p < 0.001 in red clover and p = 0.02 in placebo group) and physical domain (p < 0.001 red clover and p = 0.01 placebo group) significantly reduced compared to the baseline values. However, the differences between two groups were significant neither for total quality of life nor for its domains. Red clover had no side effects and all the subjects in the red clover group were satisfied with the prescribed administration. CONCLUSIONS: In the present study, the effect of red clover supplementation on menopausal women's quality of life showed no difference with the placebo. Further clinical trials are recommended.