What medical conditions lead to a request for euthanasia? A rapid scoping review.

Background and Aims: Euthanasia is a controversial issue related to the right to die. Although euthanasia is mostly requested by terminally sick individuals, even in societies where it is legal, it is unclear what medical conditions lead to euthanasia requests. In this scoping review, we aimed to compile medical conditions for which euthanasia has been requested or performed around the world. Methods: The review was preferred reporting items for systematic reviews and meta-analysis for scoping reviews (PRISMA-ScR) checklist. Retrieved search results were screened and unrelated documents were excluded. Data on reasons for conducting or requesting euthanasia along with the study type, setting, and publication year were extracted from documents. Human development index and euthanasia legality were also extracted. Major medical fields were used to categorize reported reasons. Group discussions were conducted if needed for this categorization. An electronic search was undertaken in MEDLINE through PubMed for published documents covering the years January 2000 to September 2022. Results: Out of 3323 records, a total of 197 papers were included. The most common medical conditions in euthanasia requests are cancer in a terminal phase (45.4%), Alzheimer's disease and dementia (19.8%), constant unbearable physical or mental suffering (19.8%), treatment-resistant mood disorders (12.2%), and advanced cardiovascular disorders (12.2%). Conclusion: Reasons for euthanasia are mostly linked to chronic or terminal physical conditions. Psychiatric disorders also lead to a substantial proportion of euthanasia requests. This review can help to identify the features shared by conditions that lead to performing or requesting euthanasia.

Clinical learning evaluation questionnaire: a reliable and valid tool for the evaluation of clinical education by educators and students.

BACKGROUND: The clinical learning evaluation questionnaire can be used in the clinical trial period of medical students to measure the effectiveness of the clinical learning environment. The purpose of this study was to collect validity evidence of an adapted questionnaire to measure the transcultural adaptation of a Persian version of CLEQ. METHODS: A total of 200 questionnaires were completed by students who were at the end of their clinical rotation. The study instrument was the latest version of the CLEQ consists of 18 Items in four dimensions. The CLEQ was translated into Persian language through a four-step process of forward and backward translation. Data analysis was performed on two softwares, SPSS, version 22 and Lisrel, version 8.8. RESULTS: The results showed that the 18-question CLEQ could be applied to the Persian translation of the tool. The response process evidence of the Persian questionnaire was established through feedback from 15 students in the sample group. The content validity index (CVI) for the items were between 0.8 and 0.9, and the content validity ratio (CVR) for the entire questionnaire was 0.9. The 4-factor feature of CLEQ was good model fit. The internal consistency analysis indicated that the Cronbach's alpha values for all items of the 18-item questionnaire were equal to 0.87 and for the subscales were 0.68 to 0.79. CONCLUSION: The Persian translation of the 4-factor CLEQ has sufficient validity evidence to measure the transcultural adaptability of clinical education activities by instructors and students. The validity evidence are content, response process and internal structure. We recommend that the English 6-factor and 6-factor versions of CLEQ be tested on medical students at multiple foreign academic institutions to assess their efficiency.

Improving family health climate, effect of role modeling and maternal support in female students.

INTRODUCTION: Girls can use their mother's emotional, informational and behavioral support to perform healthy behaviors due to their constant access to their mothers. This study aimed to evaluate the effect of role modeling and maternal support in the family to improve healthy behaviors and perceived Family Health Climate (FHC) in female students. METHODS: In this educational quasi-experimental study, 261 female students (133 in the intervention group and 128 in the control group) and 223 mothers (109 intervention and 114 control) were selected using the cluster multi-stages sampling method and entered the study. Participants (intervention and control groups) completed the FHC scale at three stages (before intervention, immediately after the intervention, and 2 months after intervention). A training program that comprised 12 sessions for students and six sessions for their mothers using collaborative learning techniques and printed materials was conducted with the experimental group. Also after completing the questionnaire in the follow-up phase, pamphlets and educational videos were given to the control group. Data were analyzed using SPSS20 via a chi-square test, independent t-test, and Repeated Measures ANOVA at a significance level of 0.05. RESULTS: Before the intervention, there was no significant difference between demographic variables and the score of the FHC scale in both groups (p < 0.05). Immediately and 2 months after the intervention, the experimental group (female students and their mothers) showed a significant increase in dimensions of FHC, including FHC-NU (Family Health Climate-Nutrition) and FHC-PA (Family Health Climate-Physical Activity), compared to the control group (p < 0.05). CONCLUSIONS: Educating and informing mothers about the impact of their role modeling on their children, especially girls, can make them more aware of health-oriented behaviors towards their children. Such findings reinforced the importance of focusing on actions to encourage a healthy lifestyle (healthy diet and physical activity) in students with a focus on role modeling and parental support, especially mothers.

Empowering teachers to screen, guide, and refer schoolchildren with behavioral and mental health problems. A pilot study to promote mental health in Iran.

Background: Schools are ideal for promoting the mental health of school-age children, but the teachers' current knowledge is insufficient to play an influential role in mental health services at schools. Fortunately, however, teachers have a high sense of responsibility, interest, and talent to receive knowledge and the ability to participate in this field. This study aimed to examine whether a protocol focused on the role of teachers could identify, guide, and care for school-age children with behavioral and mental health problems. Method: The current research was a "before and after" pilot quasi-experimental study conducted in three elementary, secondary, and high schools. The main intervention consisted of a 5-h workshop based on a ready-to-use booklet for teachers conducted separately in each school. A total of 58 teachers and 872 school-age children were included using a judgmental sampling technique. Results: The pre-and post-workshop mean scores of teachers' knowledge about common mental disorders in school-age children were 6.21 ± 4.58 and 12.50 ± 7.27, respectively. According to the Strengths and Difficulties Questionnaire (SDQ), the teachers made 127 referrals, of whom 102 school-age children had problems. Consultants diagnosed 114 school children who reflected 90% of all teachers' recommendations needing psychological care and counseling. Finally, only 50 diagnosed school-age children were followed up and attended therapy sessions at counseling centers. The sensitivity and specificity of this brief intervention in detecting school-age children with psychological problems were respectively 80.3 and 98.0%. Conclusions: This study's results support teacher empowerment training's effectiveness in identifying and guiding school-age children needing mental health care. Psychological counseling programs in schools in various quantitative and qualitative dimensions, including responding to school-age children's needs and psychological problems, should be adequately evaluated, and appropriate measures should be taken to promote mental health services. Collaboration between health systems and the education department will increase the effectiveness of mental health programs' promotion and drug abuse prevention. These pilot data lead the way to designing scientifically sound follow-up studies that will concretely ascertain the benefit of this program.

Reliability and validity of the Persian version of the ACE tool: assessing medical trainees' competency in evidence-based medicine.

BACKGROUND: Evidence-based medicine (EBM) allows users to integrate evidence into decision-making alongside clinical expertise and patient values. This study aimed to evaluate the reliability and validity of the Persian version of the Assessing Competency in EBM (ACE) tool across knowledge, skills, and attitude. METHODS: This cross-sectional study was performed on medical residents (first-year residents and junior residents) of Shiraz University of Medical Sciences in 2019. The study instrument was the ACE tool which consists of 15 two-choice questions (yes-no) and each of these questions measures one of four steps in evidence-based medicine (1- asking the answerable question, 2- searching the literature, 3- critical appraisal, and 4- applying the evidence to scenario). This tool was translated into Persian according to international standards. To ensure that the original and translated ACE questionnaire can be matched accurately and conceptuality, content validity index (CVI) and content validity ratio (CVR) were determined. Cronbach's alpha was applied to determine the internal consistency for each scale and Confirmatory factor analysis (CFA) was used to survey the factor structure validity. RESULTS: One hundred sixty-three questionnaires were studied, selecting 59 first-year medical residents and 104 s-year medical residents. The results showed that using the Persian translation of the ACE tools, the content validity index (CVI) values were equal to or above 0.8 for all items. The content validity ratio (CVR) value was 0.90 for the total scale. The indicators of the confirmatory factor analysis (CFA) for the ACE tool revealed that this model had an acceptable fit. Cronbach's alpha for the overall score was 0.79. CONCLUSION: The Persian translated version of the ACE tool is a valid and reliable instrument for assessing medical trainees' competency in EBM.

Application of protection motivation theory (PMT) on skin cancer preventive behaviors amongst primary school students in rural areas of Fasa city-Iran.

BACKGROUND: Considering that exposure to sunlight in childhood and adolescence has an important role in skin cancer, so it seems that training protective behaviors in this period is more effective. OBJECTIVES: To survey the application of protection motivation theory (PMT) on skin cancer preventive behaviors among students in rural areas of Fasa city, Iran. METHODS: This study was done in two stages: Phase I of this study, the descriptive-analytic and cross-sectional study was conducted in 2018 to investigate the predictive value of the protection motivation theory on skin cancer preventive behaviors. In the second stage, a quasi-experimental interventional study was conducted on 400 primary school students in 2019. The educational intervention was performed in the experimental group for 8 sessions. Data were collected using a demographic information questionnaire and protection motivation theory before and six months after the intervention. RESULTS: The constructs of protection motivation theory predicted 58.6% of skin cancer preventive behaviors. The results indicated that there was no significant difference between the two groups in terms of knowledge, perceived sensitivity, perceived severity, reward, fear, protection motivation, response efficacy, self-efficacy, response costs, and the skin cancer preventive behaviors in before the intervention (p > 0.05). However, six months after the intervention, the experimental group showed a significant increase in each of the mentioned constructs and skin cancer protective behaviors (p < 0.05). CONCLUSION: This study showed the effectiveness of the intervention based on the PMT constructs in adoption of skin cancer preventive behaviors in 6 months' post intervention in primary school students.

The Validity and Reliability of the Persian Version of the Family Health Climate Scale (FHC-Scale) in Female Students and Their Mothers in Iran 2019.

OBJECTIVES: This study examined the validity and reliability of the Family Health Climate Scale (FHC-Scale) among Iranian families. Second, can it be attributed to other family members by measuring the health climate in one person? METHOD: In total, 261 female students and 196 mothers completed the FHC-Scale. The study instrument was a Persian version of the FHC-Scale prepared through a translation and back-translation process. RESULTS: The results showed that the Persian version of the FHC-Scale is acceptable. Cronbach's alpha coefficient for FHC-PA in female students and their mothers, respectively, was 0.88 and 0.86 for the whole scale. Cronbach's alpha coefficient for FHC-NU in female students and their mothers, respectively, was 0.83 and 0.92 for the whole scale. The CVI values for all the items were equal to or above 0.8, and the CVR value for the total scale was 0.90. CONCLUSION: The Persian version of the FHC-Scale is therefore an effective tool for evaluating the different dimensions of family health climate in the Iranian population.

Effectiveness of theory-based diabetes self-care training interventions; a systematic review.

BACKGROUND: Permanent compliance of self-care behaviors is a challenging issue in managing chronic diseases like diabetes. The evidence supports theory-based intervention in promoting self-care behaviors. However, no systematic review was done to monitor these interventions and compare more effective constructs. This study was conducted to investigate the studies using self-care theories and introducing the most effective theories. METHODS: This is a systematic review study during which some scientific databases including Scopus, Elsevier, Google scholar and PubMed were searched by using some key words like self-care or self-management, diabetes, theory or model. English articles from the start of 2013 up to the end of November 2020 were monitored. RESULTS: 20 articles were selected and studied based on eight theories which they used. These theories were: Social support theory, Health Belief Model, Heath Belief Model and Empowerment Theory, Empowerment Theory, Self-efficacy Theory, precede-proceed model, Self-regulation Theory, behavioral theory and Social Cognitive Theory. CONCLUSION: Four theories appeared to be more effective for the target behavior of present research: Social Support Theory and the combination of Empowerment Theory and Health Belief Model, Social Cognitive Theory and Self Efficacy Theory. Taken together, the findings of this systematic review suggest that interventions that go beyond individual determinants (such as changing knowledge and attitudes) to determinants of upper cognitive, motor, and social levels (such as the development of skills and competencies) they have led to raised self-care outcomes.

Validation of Perceived Wellness Survey (PWS) in a Sample of Iranian Population.

The individual's perception of health, when health is understood to include many dimensions of life, is considered the basis for any improvement in health status. Therefore, the present study aimed to assess the reliability and validity of the Persian version of the Perceived Wellness Scale (PWS) by applying it to employees of the Shiraz University of Medical Sciences. This cross-sectional study was conducted with 180 staff members of the university selected by convenience sampling. The study instrument was a Persian version of the PWS prepared through a translation and back-translation process. The reliability and validity of the instrument were assessed by using confirmatory factor analysis (CFA) and Cronbach's alpha coefficient. A total of 180 employees participated in the study. The mean age of the participants was 32.29 years (SD = 7.39) and 78.1% of the participants were women. The results showed that the Persian version of the PWS is acceptable. Cronbach's alpha coefficient was 0.87 for the whole scale, ranging from 0.68 to 0.85 on different dimensions of the scale. The results of split-half reliability and CFA indicated that the reliability and validity of the PWS are acceptable. The PWS is therefore an effective tool for evaluating the different dimensions of perceived wellness in the Iranian population.