Effect of an educational intervention based on self-efficacy theory and health literacy skills on preventive behaviors of urinary tract infection in pregnant women: A quasi-experimental study.

OBJECTIVE: The impact of self-efficacy and health literacy skills on pregnant women's adherence to urinary tract infection (UTI) preventive behaviors is inadequately investigated. Thus, the present study explored whether an educational intervention based on self-efficacy and health literacy skills managed to improve UTI preventive behaviors among pregnant women. METHODS: A quasi-experimental study was conducted from January to July 2021 among pregnant women residing in Mashhad, Iran. To this aim, 110 pregnant women at a gestational age of 12-18 weeks were randomly assigned to a control (n = 55) and an intervention group (n = 55) and completed all questionnaires during the intervention and the 3-month follow-up. The intervention group received the full training program, comprising six 2-hourly training sessions. RESULTS: Most women were from low-income families (69.1%), were housewives (74.5%) with high school education or lower (63.6%). The theory-based intervention had a significant effect (P < 0·05) on UTI preventive behavior outcomes (i.e., clothing habits, nutrition, urination, health, and sexual behaviors) in the intervention group compared with the control group after intervention, and in their variation from baseline to follow-up in all scores. CONCLUSIONS: An educational intervention based on health literacy skills and self-efficacy could be an effective theory-based intervention to improve UTI preventive behaviors and reduce recurrent UTI and complications.

Health Risk Assessment of Exposure to Heavy Metals in Wheat Flour from Iran Markets: Application of Monte Carlo Simulation Approach.

The significance of flour in the Iranian diet underscores the need to ensure its safety from chemical pollutants. This study aimed to evaluate the potential health risks posed by certain heavy metals, such as Fe, Zn, Cu, Al, Co, Hg, Cr, Ni, Pb, and Cd, in wheat flour available in the Iranian market. A total of 248 flour samples were collected from 11 provinces in Iran during the winter of 2021. The health risks associated with heavy metals in children and adults were evaluated using USEPA health risk assessment guidance for superfund part A and Monte Carlo Simulation. The average concentration of Fe, Zn, Cu, Al, Co, Hg, Cr, Ni, Pb, and Cd, was equal to 30.62 ± 59.24, 4.94 ± 13.64, 1.24 ± 3.08, 2.85 ± 4.98, 0.03 ± 0.01, 0.12 ± 0.03, 1.42 ± 1, 0.23 ± 0.05, 1.71 ± 0.65, and 0.02 ± 0.004 mg/kg dry weight, respectively. Analysis of Fe, Cr, Al, Hg and Cr in all flour samples showed that the average concentration of these metals were greater than the standards levels set by the WHO/FAO. The results of the non-carcinogenic risks (HI) showed that the hazard index values (children: 0.969 ± 1.04, adult: 0.837 ± 0.905) of heavy metals through the consumption of flour to both study population were acceptable. The results of the carcinogenic risks (CR) based on Cd, and Pb concentration showed that the CR values from ingestion of flour to the children and adults population were 1.45 × 10-5 ± 5.08 × 10-5 and 1.26 × 10-5 ± 4.40 × 10-5, respectively. The results of Monte Carlo simulation showed that conventional deterministic health risk evaluation could overestimate risk outcomes. Likewise, Cr has 68.8% and 69.1% probability of non-carcinogenic risk to children and adult, respectively, and 80% and 79.8% probability of CR for adults and children respectively for Pb, suggesting that Cr and Pb is a priority control heavy metals. Therefore, it is recommended to continuously monitor the levels of heavy metals in wheat and its derived food products to ensure food safety.

Concentration of heavy metals in pasteurized and sterilized milk and health risk assessment across the globe: A systematic review.

OBJECTIVE: Although milk and dairy products are almost complete food, they can contain toxic heavy elements with potential hazards for consumers. This review aims to provide a comprehensive report on the occurrence, concentration, and health risks of selected heavy metals in pasteurized and sterilized milk recorded worldwide. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) was used to develop this systematic review. Databases included the Web of Knowledge, Scopus, Scientific Information Database, Google Scholar, and PubMed from inception until January 2023. Keywords related to the terms "Heavy metals", "Arsenic" and "Pasteurized and sterilized milk" and "Risk Assessment" were used. The potential health risks to human health from milk daily consumption were estimated using extracted data on heavy metals concentration based on metal estimated daily intake, target hazard quotient, and carcinogenic risk. RESULTS: A total of 48 potentially relevant articles with data on 981 milk samples were included in the systematic review. Atomic Absorption Spectroscopy, atomic absorption spectroscopy, inductively coupled plasma-mass spectrometry, and inductively coupled plasma-optical emission spectrometry were the most common valid methods to measure heavy metals in milk samples. Following the initial evaluation, Cu, Cd, Zn, and Pb were the most contaminants, which exceeded the maximum permissible criteria in 94%, 67%, 62%, and 46% of the milk samples tested. Relying on target hazard quotient and carcinogenic risk results, milk consumers in 33(68.75%) and 7 (14.5%) studies were exposed to moderate to high levels of carcinogenic and non-carcinogenic risk, respectively. The highest level of risk is due to the consumption of pasteurized and sterilized milk detected in Pakistan, Brazil, Egypt, Slovakia, and Turkey. CONCLUSION: The elevated levels of heavy metals in milk samples, especially Pb and Cd is a public health concern; therefore, maximum control and strict regulations must be adopted to decrease heavy metals contaminants in the dairy industry. Further studies are required to develop safe milk processing and handling methods for the decontamination of heavy metals in milk and its products.

Nutrition self-efficacy intervention to improve nutritional status of Iranian older adults.

OBJECTIVES: Older adults are a vulnerable group that is at risk of poor nutritional status, which can lead to disease and increase their healthcare costs. Our study aimed to investigate the impact of a self-efficacy intervention on the nutritional status of older adults. METHODS: A controlled before and after study was conducted on 110 older adults in the Mashhad, Iran, from 2020 to 2022. Participants were randomly allocated to the intervention (n = 55) and control groups (n = 55). Participants in the intervention group received educational training that was based on the self-efficacy theory. The control group received the routine care. Data collection tools included demographic information questionnaire, Mini Nutritional Assessment Questionnaire, and standard self-efficacy questionnaire. The questionnaires were completed at baseline (before intervention), instantly after the intervention, and at 3-months follow-up by participants in both groups. Data were analyzed using SPSS version 25 and the significance level was considered less than 0.05. RESULTS: The Mean of nutritional status in the intervention group, at the baseline, immediately after intervention and 3 months of follow-up were 25.1 ± 2.3, 28.3 ± 5.2 and 27.6 ± 6., respectively. This increase was significant (p < 0.001). Our findings revealed that self-efficacy among participants in the intervention group significantly changed (P < 0.001) across time from baseline through follow-up. There was no significant difference in the mean of self-efficacy and nutritional status in the control group during the study period (P > 0.05). CONCLUSION: This current study provided a basis to examine in the effectiveness of such intervention using a properly powered randomized controlled study. Therefore, it can be concluded that self-efficacy interventions are a promising approach to improving the nutritional behaviors of the older adults. TRIAL REGISTRATION: IRCT20160619028529N9.

Body image perception and physical activity behavior among adult population: Application of trans-theoretical model of behavior change.

BACKGROUND: The human body changes during life, but research on how sociodemographic characteristics and physical activity (PA) related to all aspects of body image are still unclear and there is conflict in the relevant results. This study aims to examine gender-specific body image perception and physical activity in relation to BMI and sociodemographic characteristics among health employees who worked in health and medical care centers. METHODS: The study was a population-based cross-sectional survey of 170 health employees (55 men and 115 women) in Binaloud, Iran. Participants completed a self-administered questionnaire, which consisted of a self-administered Multidimensional Body-Self Image Questionnaire (MBSRQ) and stages of change scales. The full version of Marcus-TTM based on the stages of physical activity changes was used based on 5 items related to regular physical activity behavior and intentions. RESULTS: There were no significant differences between men and women in total body image score, body area satisfaction, and attitude. Disease orientation (p = 0.02) and health orientation (p = 0.05) were the only significant differences between men and women. The number of children, level of education, BMI, and PA had a stronger influence on body image concerns and body dissatisfaction. PA and 7 of the 10 subclasses of MBSRQ (appearance evaluation, fitness evaluation, fitness orientation, health evaluation, health orientation, and illness orientation) showed a significant difference (P<0.05) between participants in the five TTM stages. CONCLUSION: The ideal body image and body satisfaction may differ by the number of children, level of education, gender, BMI, and PA. Evidence from this study supports that participants' stages of change affect their physical activity and body image perception. This result suggests a need for conducting work/home place intervention to promote adults' body image perception and body area satisfaction based on the usage-specific stage under consideration.

Electrochemical biosensor for rapid and sensitive monitoring of sulfadimethoxine based on nanoporous carbon and aptamer system.

In this study, a straightforward electrochemical aptasensor was developed to detect sulfadimethoxine (SDM). It included a glassy carbon electrode decorated by boron nitride quantum dots (BNQDs) and aptamer-functionalized nanoporous carbon (APT/CZ). CZ was first synthesized by calcinating a zeolitic imidazolate framework (ZIF-8). Then, the electroactive dye methylene blue (MB) was entrapped inside its pores. By attaching aptamer to the CZ surface, APT/CZ acted as a bioguard, which prevented the MB release. Therefore, the electrochemical signal of the entrapped MB was high in the absence of SDM. Introducing SDM caused the conformation of aptamers to change, and a large number of MB was released, which was removed by washing. Therefore, the detection strategy was done based on the change in the electrochemical signal intensity of MB. The aptasensor was applied to detect SDM at a concentration range of 10-17 to 10-7 M with a detection limit of 3.6 × 10-18 M.

Application of nanotechnology in air purifiers as a viable approach to protect against Corona virus.

The outbreak of COVID-19 disease, the cause of severe acute respiratory syndrome, is considered a worldwide public health concern. Although studies indicated that the virus could spread through respiratory particles or droplets in close contact, current research have revealed that the virus stays viable in aerosols for several hours. Numerous investigations have highlighted the protective role of air purifiers in the management of COVID-19 transmission, however, there are still some doubts regarding the efficiency and safety of these technologies. According to those observations, using a proper ventilation system can extensively decrease the spread of COVID-19. However, most of those strategies are currently in the experimental stages. This review aimed at summarising the safety and effectiveness of the recent approaches in this field including using nanofibres that prevent the spread of airborne viruses like SARS-CoV-2. Here, the efficacy of controlling COVID-19 by means of combining multiple strategies is comprehensively discussed.

Quality of life and life satisfaction among university students: Exploring, subjective norms, general health, optimism, and attitude as potential mediators.

OBJECTIVE: This study aims to examine the association of quality of life (QOL) with life satisfaction, subjective norms, general health, optimism, and attitude among university students. PARTICIPANTS: Respondents include 632 university students (Mage=21.36, SD = 2.86). METHODS: This cross-sectional study was conducted on university students in Torbat Heydariyeh, Iran. Several statistical models were tested, including hierarchical regression and path analysis, to examine the direct or indirect association between a set of important variables. RESULTS: According to the results of path analysis, constructs of subjective norms, general health, positive attitude, optimism, and life satisfaction were significant predictors of students' QOL. Compared with other constructs, general health status (p < 0.001, R2 = 0.548) and life satisfaction (p < 0.001, R2 = 0.253) showed the strongest association with QOL. CONCLUSIONS: The results indicate that efforts to improve life satisfaction by targeting general health, subjective norms, optimism, and attitudes may provide promising ways to improve QOL.

An educational intervention based on family-centered empowerment model to modify high-risk behaviors of brucellosis via mother education.

The relative contribution of a theory-based intervention to modify high-risk behaviors in training programs is a major priority that remains an open question. Here, we tested whether the family-centered empowerment model used in the educational intervention was effective to modify high-risk behaviors of brucellosis via mother education. A quasi experimental study was conducted on 200 women presenting to healthcare practices in rural areas of Torbat-e Jam, Iran, from April 2020 to February 2021. Four rural areas were randomly assigned to the control and intervention groups. The intervention group received the training program, which included four 2-h sessions and consulting support via social network and messaging service. The control group did not receive any training. SPSS16 was implemented to test multiple statistical analyses. Our finding showed in the intervention group compared with the control group, knowledge, attitude, self-efficacy, self-esteem, and behavior outcomes were significantly changed (P < 0.001) across time during baseline through follow-up. Likewise, there are no differences (P > 0.05) in the change in construct of the family-centered empowerment model and risk behaviors in the control group from baseline to follow-up. Intervention based on a family-centered empowerment model is possible and very acceptable to modify high-risk behaviors of brucellosis by increasing an individual's knowledge, changing attitude, and promoting self-efficacy and self-esteem.Trial registration: Iranian Registry of Clinical Trials (IRCT), IRCT20160619028529N12. Registration date: 24/03/2020.

Attributes of Organizational Health Literacy in Health Care Centers in Iran: A Qualitative Content Analysis Study.

Organizational Health Literacy (OHL) is described as a new concept to remote health organizations to implement practices, policies, and systems that make it easier for patients to use, understand, and navigate health information to take care their own health. In Iran, there is no consensus on the attributes of OHL, and its practical implications and scope have not been evaluated. This manuscript is one of the first attempts to explain the attributes of the OHL in health care centers in Iran. This study is a content analysis survey, which was guided by the attributes of the OHL provided by Brach et al. and 26 semi-structured interviews were conducted with Iranian health professionals and employees of healthcare organizations from June 2020 to January 2021. A data analysis was performed using the MAXQDA 10 software. Across the study, ten sub-themes, 21 subcategories, and 67 codes emerged. The 10 main attributes of OHL were management, integration of health literacy in the organization, workforce, participation, range of HL skills, HL strategies, access, media variety, the role of the organization in crisis, and costs. These attributes may guide the planning of health care centers improvements and have the potential to promote health service reforms and public health policy.

Predictors of physical activity among women in Bojnourd, north east of Iran: Pender's health promotion model.

BACKGROUND: This study examined how socio-demographic characteristics constructs derived from the health promotion model (HPM) influence the level of physical activity (PA) women in Bojnourd, North East of Iran. METHOD: This cross-sectional study has been carried out through multi-stage sampling design on 356 women aged 18-60 years living in Iran. Data was collected through reliable and valid questionnaire survey women who were selected from their homes. RESULTS: Most of participants (53.40%) had a low level of physical activity behaviors with minimal physical activity (PA) scores. Using regression analysis showed that 23.22% of the total variance in PA behaviors was predicted by socio-demographic variables, whilst 40.81% of the variance in PA behaviors was predicted by constructs from the HPM. The results from Path modeling indicated that prior behavior, interpersonal influences, perceived self-efficacy, perceived barriers and commitment to PA, were significant predictors for PA behaviors with 86.93% of total effects on PA, whereas, activity-related affect and situational influences had no significant effect on the PA behaviors. CONCLUSIONS: We found that constructs derived from the HPM are determinants of PA among Iranian women and may be important in developing educational intervention programs to facilitate a physically active lifestyle in this population.

Effect of a theory-based educational intervention for enhancing nutrition and physical activity among Iranian women: a randomised control trial.

OBJECTIVE: The relative contribution of health promotion models (HPM) to improve health-related behaviours in intervention programmes is still limited. Here, we tested whether Pender's HPM operationalised in the educational intervention was effective to modify nutrition and physical activity (PA) behaviours among Iranian women. DESIGN: A randomised controlled field trial evaluating the efficacy of an educational intervention based on Pender's HPM to improve PA and nutrition behaviours from August 2016 to October 2016. R version 3.0.2 and SPSS version 16 were used to conduct multiple statistical analyses. SETTING: Ten public healthcare centres in Bojnourd, Iran were randomly divided into intervention and control groups. The experimental group received the full intervention programme, which included nine 4-h training sessions and consulting support via phone contact and social media group. The control group did not receive any intervention. PARTICIPANTS: Women aged 4-6 years (n 202) were randomised to intervention (n 102) and control conditions (n 100) and completed baseline and 3-month follow-up. RESULTS: In the experimental group, the intervention programme had a significant effect (P < 0·05) on all construct of Pender's HPM and behaviour outcome, and the estimates for prior behaviours, self-efficacy, interpersonal influences, feeling, perceived benefits and barriers, commitment and behaviour outcomes in the intervention group were 0·72 (95 % CI 0·31, 0·98), 0·54 (95 % CI 0·27, 0·71), 0·74 (95 % CI 0·27, 0·91), 0·52 (95 % CI 0·19, 0·75), 0·62 (95 % CI 0·22, 0·91), 0·63 (95 % CI 0·30, 0·86) and 0·56 (95 % CI 0·37, 0·85), respectively. CONCLUSIONS: Educational intervention based on Pender's HPM was feasible and highly acceptable to modify PA and nutrition behaviours in the women population.

The Status of Health Literacy in Students Aged 6 to 18 Old Years: A Systematic Review Study.

BACKGROUND: Adolescents and children are a core target population for health literacy (HL) studies and practice. There is limited knowledge regarding the HL skills and abilities that help young people and children in making health decisions. This study aimed to evaluate the status of HL in ongoing school students. METHODS: Literature searching was performed using nine databases (Web of Science, PubMed, Scopus, Google Scholar, Iranmedex, Magiran, Scientific Information Database) without restriction in time until January 2019, and database searches were supplemented with reference hand searches and gray literature. Cross-sectional and experimental studies with focuses on validated measures of HL in ongoing students were included. RESULTS: This systematic review of identified 17 studies and 199714 samples specifically studied on ongoing school students aged 6-18 years. Students and their mothers have a moderate level of HL in four dimensions of menstrual health, physical activity, breast self-test, and iron deficiency anemia, and most of them have a high level of HL only in terms of nutrition. The relationship of HL with health outcomes, health promotion behaviors, self-efficacy, self-mutilating behaviors, and self-care abilities was statistically significant. HL status is related to parents' education level, socio-economic determinants (culture, family income, and environmental contextual factors), age groups, and media/digital communication channels. CONCLUSION: This review identified seven main determinates that significantly affect HL status in the target group. This systematic review shows most of the ongoing school students had an inadequate level of HL skills. HL strategies have a potential impact on improving students' health behaviors and life quality.

The Health Literacy Status and Its Role in Interventions in Iran: A Systematic and Meta-Analysis.

There are increasing calls for public health policies to realize the visions of a health literate society and health literacy on a global scale. However, there are still more gaps in what researchers recognize and what steps they should take to improve health literacy (HL) skills. This review aimed to measure the HL status of the Iranian population and the effect size of the underlying association between HL and other health outcomes, and to examine the effectiveness of HL interventions on improving the functional dimension of HL, self-efficacy, and health-promoting behaviors. All full text published articles written in English and Persian language were included from inception until January 2019, but the type of study is not limited. A total of 52 potentially relevant articles with data on 36,523 participants were included in this review. In the population with health conditions, the average HL score was 62.51 (95% CI: 59.95-65.08), while in the patient population, the HL score was 64.04 (95% CI: 60.64-67.45). Health literacy was positively and significantly correlated with self-care behaviors 0.42 (95% CI; 0.35-0.49), self-efficacy 0.35 (95% CI; 0.26-0.43), knowledge 0.50 (95% CI; 0.44-0.55), communication skills 0.33 (95% CI; 0.25-0.41), and health promotion behaviors 0.39 (95% CI; 0.35-0.44). The meta-analyses showed that overall, HL interventions significantly improved HL status, self-efficacy, and health promotion behaviors. Results indicate that HL status was in the range of marginal HL level in the Iranian population. Our finding highlights the beneficial impact of HL intervention on health-promoting behaviors and self-efficacy, particularly in low literacy/socioeconomic status people.

Review of Organizational Health Literacy Practice at Health Care Centers: Outcomes, Barriers and Facilitators.

The term organizational health literacy (OHL) is a new concept that emerged to address the challenge of predominantly in patients with limited health literacy (HL). There is no consensus on how OHL can improve HL activities and health outcomes in healthcare organizations. In this study, a systematic review of the literature was conducted to understand the evidence for the effectiveness of OHL and its health outcome, and the facilitators and barriers that influence the implementation of OHL. A literature search was done using six databases, the gray literature method and reference hand searches. Thirteen potentially articles with data on 1254 health organizations were included. Eight self-assessment tools and ten OHL attributes have been identified. Eleven quality-improvement characteristics and 15 key barriers were reviewed. Evidence on the effectiveness of HL tools provides best practices and recommendations to enhance OHL capacities. Results indicated that shifting to a comprehensive OHL would likely be a complex process because HL is not usually integrated into the healthcare organization's vision and strategic planning. Further development of OHL requires radical, simultaneous, and multiple changes. Thus, there is a need for the healthcare system to consider HL as an organizational priority, that is, be responsive.

Health Literacy in Iranian Women: A Systematic Review and Meta-Analysis.

BACKGROUND: Inadequate health literacy (HL) is associated with poorer health outcomes and worse health care. Up to one-half of Iranian women have difficulty in interpreting medical information, and national HL assessment has been limited in Iran. We have undertaken a systematic review of the literature and used a meta-analysis to examine the situation of HL status in Iranian women, and determine the relationship between HL and self-efficacy, and self-care behaviors. METHODS: Six databases (PubMed, Web of Science, Scopus, Google Scholar, Scientific Information Database) and other non-indexed citations were searched using a variety of keywords regarding HL and Iranian women. The bias risk was decreased by the involvement of two independent reviewers assessing study quality and eligibility of included articles. RESULTS: The average HL scores were in the range of marginal or limited (63.08; 95% CI, 59.83-66.32) in the Iranian women. The HL score was significantly higher among pregnant women (67.55; 95% CI, 32.54-82.57) and was lower in women with chronic disease (57.79; CI, 48.34-67.24). There was a significant association between HL and self-efficacy and self-care behaviors. CONCLUSION: The average level of HL in the period of the review was marginal among Iranian women. The relationship of HL with self-efficacy and self-care behaviors was statistically significant but moderate.

Communication skills training for physicians improves health literacy and medical outcomes among patients with hypertension: a randomized controlled trial.

BACKGROUND: Improving the training of physicians about communication skills and patient health literacy (HL) is a major priority that remains an open question. We aimed to examine the effectiveness of communication skills training for physicians on the hypertension outcomes and the health literacy skills, self-efficacy and medication adherence in patients with uncontrolled blood pressure (BP). METHODS: A randomized, controlled trial method was conducted on 240 hypertensive patients and 35 physicians presenting to healthcare clinics in the Mashhad, Iran, from 2013 to 2014. Using stratified blocking with block sizes of 4 and 6, eligible patients with uncontrolled blood pressure were randomly allocated to the intervention and control groups. Physicians in the intervention group received educational training over 3 sessions of Focus -Group Discussion and 2 workshops. The control group received the routine care. The primary outcome was a reduction in systolic and diastolic BP from baseline to 6 months. The secondary outcome was promoting HL skills in hypertensive patients. Data were analyzed using the regression model and bivariate tests. RESULTS: After the physician communication training, there was a significant improvement in physicians-patient communication skills, hypertension outcomes, medication adherence, and self-efficacy among the patients being managed by the physicians receiving training, compared to the control group. CONCLUSION: The educational intervention leads to better BP control; it may have been sufficient training of physicians change to impact counseling, HL and self-efficacy and adherence. The quality of physician-patient communication is an important modifiable element of medical communication that may influences health outcomes in hypertensive Iranian patients. TRIAL REGISTRATION: Iranian Registry of Clinical Trials (IRCT), IRCT20160710028863N24. Registered April 4, 2018 [retrospectively registered].

Organizing framework to investigate associations between diabetes knowledge, health literacy, and self-care behaviors in patients with type 2 diabetes based on the extended parallel process model.

OBJECTIVE: The mechanisms underlying the relations between diabetes self-care behaviors, cognition, and social factors are still equivocal, and it is unclear how diabetes knowledge and health literacy is associated with self-care behaviors. Here, we tested a hypothetical path model linking diabetes self-care behaviors to knowledge, health literacy, and constructs of the extended parallel process model (EPPM) to understand potential predictors that may influence patients' self-care behavior with type 2 diabetes. METHODS: A cross-sectional study was conducted, and 404 patients with type 2 diabetes were recruited from healthcare centers in Khaf, Iran. Diabetes self-care behaviors were indicated by, glucose self-control, foot care, physical activity, medications, smoking, and a healthy diet. The main data collection instruments in this study were the Health Literacy for Iranian Adults questionnaire (HELIA), diabetes knowledge, and self-care behavior based on the EPPM questionnaires. RESULTS: The results from path modeling indicated that perceived susceptibility, efficacy, self-efficacy, knowledge, and health literacy were significant (p < 0.05) predictors for diabetes self-care behaviors and path model accounted for 32% of the total variance. CONCLUSION: Based on the results, key constructs of EPPM, diabetes knowledge, and health-related literacy are empirically supported diabetes self-care behaviors. These factors could apply to health professionals for developing educational intervention programs to facilitate a physically active lifestyle.

The Effectiveness of an Educational Intervention Based on Theories and Models on Diabetes Outcomes: A Systematic Review.

Background & Introduction: Patient's self-management behaviors are essential to control diabetes. Studies have demonstrated that health educational interventions can improve some aspects of glycemic control and clinical outcomes, however, it is unclear which education theories underlying these interventions improve effectiveness. In this review of the literature, we aimed to assess the efficacy of health education and promotion theories, or models, to improve self-care and self- management behaviors among patients with type 2 diabetes (T2D). Methods & Results: Eight scientific databases (Web of Science, PubMed, Scopus, Magiran, Google Scholar, Medlib, ProQuest and Scientific Information Database) were searched to identify a published academic article from 2010 to 2019. We included quasi-experimental, clinical trial and randomized clinical trial studies. A total of 26 studies including data from 3879 patients with T2D met the inclusion criteria. We found that the PRECEDE (7/26, 26.92%) and Health Belief Models (7/26, 26.92%) were the most common models used to assess the efficacy of health education and health promotion models. Conclusion: Overall, health promotion and education theories and models have been used as a useful instrument for improving the self-care behaviors and self-management behaviors among patients with T2D.

Anemia is associated with cognitive impairment in adolescent girls: A cross-sectional survey.

Anemia is associated with impairment in oxygen transport, affecting an individual's physical and mental wellbeing, and work performance. The aim of this study was to examine the prevalence of anemia and its possible association with serum antibody titers to Hsp27 (as an indicator of cellular stress), cognitive function, measures of emotion, and sleep patterns in adolescent girls. A total of 940 adolescent girls were assessed to evaluate neuropsychological function with validated questionnaires. A complete blood count was determined as part of the assessment of hematological parameters. Serum anti-Hsp27 was measured for each subject. Among the total of 940 participants, 99 girls (10.5%) were anemic [hemoglobin <12(g/dL)]. Serum anti-HSP27 was significantly higher in anemic compared to healthy girls (p < 0.05). There was no significant differences in depression, aggression, insomnia, daytime sleepiness and sleep apnea score between two groups. However, the total cognitive abilities score was significantly lower in the anemic girls (76.8 ± 2.1 vs. 85.7 ± 2.5, p = 0.002). Logistic regression analysis showed that anemic girls were 1.73 times more likely than nonanemic girls to have cognitive impairment (95% confidence interval [CI] = 1.07-2.78; P = 0.025). Anemia was associated with elevated levels of anti-HSP27 and supports the hypothesis that cellular stress may be associated with anemia. Anemia was adversely associated with an assessment of cognitive abilities and was an independent risk factor for cognitive impairment in this group.