Comparison of outcomes between off-pump and on-pump coronary artery bypass graft surgery using collaborative targeted maximum likelihood estimation.

There are some discrepancies about the superiority of the off-pump coronary artery bypass grafting (CABG) surgery over the conventional cardiopulmonary bypass (on-pump). The aim of this study was estimating risk ratio of mortality in the off-pump coronary bypass compared with the on-pump using a causal model known as collaborative targeted maximum likelihood estimation (C-TMLE). The data of the Tehran Heart Cohort study from 2007 to 2020 was used. A collaborative targeted maximum likelihood estimation and targeted maximum likelihood estimation, and propensity score (PS) adjustment methods were used to estimate causal risk ratio adjusting for the minimum sufficient set of confounders, and the results were compared. Among 24,883 participants (73.6% male), 5566 patients died during an average of 8.2 years of follow-up. The risk ratio estimates (95% confidence intervals) by unadjusted log-binomial regression model, PS adjustment, TMLE, and C-TMLE methods were 0.86 (0.78-0.95), 0.88 (0.80-0.97), 0.88 (0.80-0.97), and 0.87(0.85-0.89), respectively. This study provides evidence for a protective effect of off-pump surgery on mortality risk for up to 8 years in diabetic and non-diabetic patients.

A model to explain smokeless tobacco consumption in adults: A grounded theory study.

Introduction: Smokeless tobacco use remains a significant public health concern, necessitating the acquisition of comprehensive and extensive data to effectively address and control its consumption. Understanding the underlying patterns of consumption is crucial for this purpose. Objective: This study aimed to develop a model that explains smokeless tobacco consumption among adults in the southeastern province of Iran, specifically in the city of Chabahar. Methods: A qualitative study was conducted using a grounded theory approach with inductive processes. The participants consisted of 30 adults aged 18-64 years from Chabahar City in southeastern Iran. Purposive sampling was used to select participants, and data collection continued until theoretical saturation was achieved. Data analysis followed Strauss and Corbin's perspective, involving four stages: Analyzing Data for Concepts, Analyzing Data for Context, Bringing Process into the Analysis, and Integrating Categories. Results: The analysis of data yielded three main categories: "starting to use," "continued use," and "cessation attempts," each with their respective subcategories. Additionally, two main categories related to the consequences of smokeless tobacco consumption were identified: "addiction and efforts to overcome addiction," also with their respective subcategories. Conclusion: The Dependency Cycle Model in Consumption provides a comprehensive understanding of the contextual factors, processes, and consequences associated with smokeless tobacco consumption. This model serves as a valuable tool for researchers aiming to develop effective interventions in the field of smokeless tobacco consumption.

Explaining the experiences of health care providers regarding organizational factors affecting health education: a qualitative study.

BACKGROUND: Health education is considered the most important component of primary health care. Paying attention to organizational factors can help to improve the quality of health education. Therefore, the present study was conducted to explain organizational factors affecting health education among health care providers. METHOD: This is a qualitative, descriptive, and phenomenological study that was conducted between 2020 -2022 on 50 health care workers who had been selected by purposeful sampling method in different settings including hospitals, GP office, behavioral disease counseling center, universities, and comprehensive health centers in the south and the center region of Iran. Data were collected by in-depth, semi-structured, and individual interviews, as well as focus group discussion, and continued until data saturation. Data were analyzed by MAXQDA software using qualitative content analysis in three stages: preparation, organization, and reporting. To evaluate the scientific accuracy of the findings in this study, 4 criteria of Lincoln & Guba were used. RESULTS: The results revealed that every practice and policy in a health care organization from assessing needs, setting goals, planning activities, implementations and measurement outcome could affect health education practice and subsequently the health of population; nevertheless, the crucial role of health education practice is being neglected in health organizations. Organizational factors affecting health education were classified into three categories of planning, organizing, and also monitoring and evaluating. The category of planning had three subcategories of infrastructure planning, manpower planning, and design and planning for implementation of health education programs. The categories of organizing had two subcategories of coordination between different units of the Minister of Health and coordination between the health sector and other sectors of society. The categories of monitoring and evaluation had three subcategories of proper feedback, bureaucracy system, reward or reinforcement, failure to define health education as part of the job description, and the impact of electronic health records on the quality of evaluation. CONCLUSION: The results offer expertise and preliminary tools to help with evidence-based health education program planning and evaluation. The Support of managers, like providing manpower in accordance with the target population and infrastructure, can improve health education in the health system. In addition, intra- and inter-sectoral coordination at different levels of the health system to implement tailored programs according to the needs of clients by health education professionals, and the use of health education theories seem necessary. It is also recommended to review the monitoring system with appropriate feedback, define health education as a healthy activity, and develop appropriate criteria for better implementation of health education.

High blood pressure self-care among hypertensive patients in Iran: a theory-driven study.

High blood pressure is becoming a universal epidemic for both developed and developing countries; it is one of the main public health problems all over the world. This research was conducted to assess blood pressure self-care among hypertensive patients in Iran. This cross-sectional analytic study was conducted on 527 patients with hypertension recruited from Zarandieh, Iran in 2018. Data were gathered using questionnaires assessing socio-demographic information, social support, health belief model (HBM) constructs (perceived benefits to healthy behavior, barriers to healthy behavior, perceived disease threat, self-efficacy to engage in healthy behavior, and cues to action), and self-care activities to address blood pressure. A stepwise multiple linear regression analysis was used to determine factors associated with self-care behaviors. Overall, 512 patients (215 men and 297 women) participated in this study. Participants who were married, and more educated engaged in more self-care behaviors. At least one-half of the patients (47.6%) demonstrated a moderate level of self-care behaviors with a mean score of self-care equal to 9.32 ± 3.6 (out of 18). All the elements of HBM and social support were significant predictors of self-care behaviors and self-efficacy was the strongest predictor, followed (in descending order) by perceived barriers, social support, perceived disease threat, and perceived benefits. Health education based on HBM, enhanced with attention to social support, may help patient enact healthier behaviors to reduce blood pressure.

Predicting preventive behaviors against COVID-19: A structural equation modeling approach from Iran.

Background: The purpose of this study was to use the health belief model (HBM) to predict the adoption of preventive behaviors against COVID-19 using the structural equation modeling approach. Methods: As a descriptive-analytical study, this research was conducted on 831 men and women who were under the coverage of comprehensive health service centers in the Lorestan province of Iran in 2021. A questionnaire based on HBM was used to collect data. Data were analyzed by the SPSS software version 22 and AMOS version 21. Results: The mean age of participants was 33.0 ± 8.5, with a range of 15-68 years. The constructs of the HBM explained about 31.7% of the variance in COVID-19-related preventive behaviors. The greatest total effect on preventive behaviors against the COVID-19 disease belonged to the constructs of perceived self-efficacy (0.370), perceived barriers (-0.294), and perceived benefits (0.270), in descending order of impact. Conclusion: Educational interventions can be useful in promoting COVID-19 preventive behaviors by bringing about a correct understanding of self-efficacy, barriers, and benefits.

Oral self-care behavior and its influencing factors in a sample of school children from Central Iran.

BACKGROUND: Oral health is an important part of public health and crucial to health promotion and enhancing the quality of life. This research examined childhood oral self-care behavior and their related factors using extended Theory of Planned Behavior (TPB). METHOD: This cross-sectional study was conducted on 368 sixth-grade elementary school students in Saveh city, Iran, in 2019. The students were selected using a random multi-stage sampling method. The instrument included the socio-demographic questions, TPB constructs, and action and coping plan items. Data were analyzed by SPSS software (Version 21) at alpha level p ≤ 0.05. RESULT: Overall, 24 (6.6%) students have never used toothbrushes, 222 (62.7%) have never used dental floss, and 298 (82.7%) students have never used mouthwash. The stepwise multiple linear regression analysis results indicated that the TPB with action and coping planning constructs had better predictive power than the original model. In the final model, coping planning (ß = .28), intention (ß = .24), action planning (ß = .23), and perceived behavior control (ß = .15) were the most important predictors of oral self-care behavior. CONCLUSION: The results indicated that the oral self-care behavior status in Iranian elementary students was not favorable, and the extended model of the TPB with action and coping plan constructs were significant predictors of self-care behavior. Therefore, these findings emphasize the need for expanding educational interventions based on the extended model of the TPB to improve the oral self-care behavior of students.

The role of correlated factors based on Pender health promotion model in brushing behavior in the 13-16 years old students of Guilan, Iran.

BACKGROUND: Tooth decay is one of the diseases that is closely related to people's behaviors and it can have adverse effects on their performance and their success in the future. Brushing twice a day is the simplest and most effective way to reduce tooth decay. The study aim was to determining the roles of correlational factors based on the Pender's health promotion model in brushing behavior of ninth grade students at urban public schools of Guilan province during the academic year 2019. METHODS: The present study was cross-sectional and had a descriptive-analytical type. We performed the multi-stage random sampling on 761 ninth-grade students (374 girls and 387 boys) at urban public schools of six counties (ten cities) of Guilan province in 2019. The primary tool was a questionnaire on oral health behaviors focusing on brushing behavior. In the present study, which was conducted only on brushing behavior, we revised and changed the initial questionnaire during the sessions of the research team, and then confirmed its validity and reliability. The questionnaire consisted of three parts, demographic characteristics, constructs of health promotion model, and brushing behavior. We analyzed data in SPSS 21 using regression models. RESULTS: 20.1% of students brushed their teeth at least twice a day. Optimal behavior had a statistically significant relationship with parents' education level, and gender. Based on the regression model, the health promotion model constructs described 58% of the variance of the commitment to plan of action. Perceived self-efficacy, situational influences, and perceived barriers of action had significantly stronger relationships with commitment to plan of action respectively. Multiple logistic regression analysis indicated that one-unit increase in scores of commitment to plan of action and self-efficacy increased the chance of desired behavior by 12 and 14% respectively. CONCLUSION: Due to the low rate of brushing behavior in the students and the predictive power of the health promotion model in brushing behavior, we suggest planning and implementation of educational interventions for this group with an emphasis on influencing the commitment to plan of action, self-efficacy, and also the level of knowledge.

Factors affecting pregnancy care and birth weight among pregnant women in Baluchestan, Iran: an application of the social cognitive theory.

This study aimed to determine the effects of self-efficacy, social support, and health literacy on prenatal care and birth weight among pregnant women. This descriptive-analytical study was conducted on 860 primiparous pregnant women who referred to health care centers for prenatal care in Iranshahr, Iran. Participants were selected through a two-stage cluster sampling. The data were collected from November 2016 to the end of January 2017 using a valid and reliable questionnaire. Data were analyzed using descriptive tests, chi-square and hierarchical regression analyses in SPSS 20. The findings indicated that health literacy, self-efficacy, income, social support, and education level explained for 7.5%, 4.6%, 2.6%, 1%, and 0.6% of the variances in caring prenatal care, respectively. Moreover, income, prenatal care, insurance, health literacy, and social support were the most effective on birth weight outcome (OR = 2.21, OR = 2.12, OR = 2, OR = 0.66, OR = 0.17). The results of the current study indicated that a combination of health literacy, self-efficacy, and social support are necessary to improve prenatal care and birth weight for Iranian low-income pregnant women.

The Determinants of Salivary Cotinine Concentration in Smokeless Tobacco Users.

BACKGROUND: Smokeless tobacco products due to their high nicotine content are highly addictive and ultimately lead to an increased risk of oral cavity, laryngeal and oesophagal cancer. AIM: This research was conducted with the aim of assessing the relationship between the salivary cotinine concentration and demographic characteristics and smokeless tobacco use for the first time in tradespeople in Chabahar, Iran. METHODS: This descriptive cross-sectional study was conducted on 150 different tradespeople using smokeless tobacco in Chabahar who were selected through simple random sampling in 2018. In addition to the salivary cotinine measurement, data were collected using a researcher-made questionnaire with demographic and behavioural items. The data obtained were analysed in SPSS-16 using descriptive and inferential statistics. RESULTS: The mean salivary cotinine score was 887.7 ± 180.7 in men and 611.2 ± 139.7 in women, making for a significant intergroup difference (P = 0.043). The mean salivary cotinine score was higher in those who used two or more smokeless tobacco products compared to those who used one type of tobacco, and a significant difference was observed between the type of smokeless tobacco used and the salivary cotinine score in the participants (P = 0.005). CONCLUSION: Based on the results of the regression analysis, the type of smokeless tobacco used was a strong predictor of the concentration of salivary cotinine in the participants. It is, therefore, necessary for the government to adopt appropriate policies and take educational measures to reduce the vending and use of these substances.

The impact of theory-based educational intervention on improving helmet use behavior among workers of cement factory, Iran.

BACKGROUND: The occurrence of occupational accidents is a serious public health issue in industrial workers and may impose life jeopardizing complications. The aim of the study was to assess the effect of a training intervention based on the theory of planned behavior (TPB) on helmet use of workers in cement factories in Khoy and Urmia, Northwest of Iran. MATERIALS AND METHODS: This study was a controlled quasi-experimental investigation (before and after) which was conducted on 170 workers employed in Khoy and Urmia cement factories, Northwest of Iran. Eighty-five eligible subjects from Khoy (as intervention group) and 85 similar samples from Urmia (as control group) were selected and recruited. A valid and reliable four-part questionnaire was used to collect the data including socio demographic information, awareness, the theory constructs, and the behavior. After completing the study questionnaire and needs assessment, a specific educational program was implemented on the intervention group only. The effects of education were compared between the groups before and after intervention. The posttest was applied 1 month after educational intervention. RESULTS: The mean age of workers in the intervention and control groups was 34.32 ± 8.19 and 33.62 ± 6.17 years, respectively. Before education, the mean score of awareness and helmet use behavior of intervention group was 6.15 ± 3.4 and 5.35 ± 2.8, but after education, those changed into 13.61 ± 3.10 and 9.15 ± 1.65, and the differences were significant (p < 0.01). In addition, before education, the mean score of attitude, subjective norm, behavioral control, and behavioral intention of intervention group was 27 ± 5.17, 37.74 ± 6.92, 29.56 ± 6.17, and 17.65 ± 4.90, respectively. After education, the mean score of those changed into 37.26 ± 4.76, 48.34 ± 5.64, 42 ± 8.07, and 24.79 ± 5.33, respectively, and changes were statistically significant (p < 0.01), while no statistically significant differences were observed in awareness, the behavior, and the theory constructs in the control group after the intervention. CONCLUSION AND RECOMMENDATIONS: The TPB-based educational approach had a remarkable effect on helmet use of workers. Applying this theory to improve workers' personal protective behaviors is recommended and emphasized.

The survival rate of patients with beta-thalassemia major and intermedia and its trends in recent years in Iran.

OBJECTIVES: Thalassemia is a common genetic disease in Iran, especially in the north and south of Iran. The present study sought to determine the survival rate of patients with thalassemia in highly endemic regions of Iran and its variation in patients born before and after 1971. METHODS: The present historical cohort study extracted data from the health records of patients with beta-thalassemia major, beta-thalassemia intermedia, and sickle beta-thalassemia who had presented to thalassemia treatment centers in the past years. The collected data were analyzed using the Kaplan-Meier test, the log-rank test, and the chi-square test. RESULTS: Of the total of 5,491 medical records (2,647 men and 2,634 women; mean age, 23.81±11.32 years), 3,936 belonged to patients with beta-thalassemia major, and 999 and 89 to patients with beta-thalassemia intermedia and sickle beta-thalassemia, respectively. In 467 cases, the type of thalassemia was not clear. The cumulative survival rate was calculated as 0.92, 0.83, 0.74, and 0.51 by ages 25, 35, 45, and 55, respectively. The hazard ratio of death was 4.22 (p<0.05) for beta-thalassemia major and 0.77 for beta-thalassemia intermedia (p=0.70). It was calculated as 1.45 for men patients and as 3.82 for single patients. CONCLUSIONS: The present study showed relatively high survival rates in patients with thalassemia. The survival of patients was unfavorable in poorer regions (Zahedan and Iranshahr). Factors including women gender, a higher level of education, being married, and living in metropolises decreased the risk of death at younger ages and improved survival.

Association of health literacy with type 2 diabetes mellitus self-management and clinical outcomes within the primary care setting of Iran.

This study explores the potential association of health literacy with type 2 diabetes mellitus (T2DM) self-management and clinical outcomes in the primary care setting of Iran. A total of 347 T2DM patients, mostly female (52.4%), 50 years old or younger (63.1%), unemployed (53.6%) and rural residents (55.6%) participated in this study. Most of the respondents had type 2 diabetes mellitus (T2DM) for 2-5 years (63.1%) and did not receive any T2DM education (52.2%). Approximately 19.0% were hospitalised due to uncontrolled T2DM. Participants mainly found managing T2DM self-management behaviours difficult. Approximately half of the participants had poor fasting blood sugar (FBS) (47.0%) and haemoglobin A1c (HbA1c) (59.4%) control and were overweight or obese (77.6%). The level of health literacy was poor and most of the participants had difficulties reading hospital materials (66.0%), understanding medical materials (62.5%) and engaging in medical conversations (63.7%). Health literacy could predict 22.5% variance in difficulty of T2DM self-management and 3.8-23.3% variance in T2DM clinical outcomes after controlling for sociodemographic factors. Participants with higher health literacy were more likely to find managing T2DM less challenging and their clinical outcomes were within the normal range. This implies that interventions targeting patient's health literacy can be a promising tool for addressing the burden of T2DM.

Improving prenatal care in pregnant women in Iranshahr, Iran: Applying Health Belief Model.

To determine the effect of an education-based intervention on receiving adequate prenatal care. This randomized, controlled trial was conducted on 90 primiparous pregnant women, referred in Iranshahr, Iran for prenatal care (intervention = 45, control group = 45). The data were collected from February to June 2016 using a questionnaire developed based on the Health Belief Model (HBM). The intervention group received three intervention sessions during the second trimester of pregnancy, and 3 months after intervention, both groups completed a questionnaire. Data were analyzed using independent sample t-tests, chi-squared tests, paired t-test, Pearson and multivariate regression. Unlike the control group, in the intervention group's mean scores for knowledge, variables from the HBM model and frequency of prenatal care significantly differed from pre- to post-intervention (pre-intervention mean = 12.62 ± 2.63, post-intervention mean = 17.71 ± 1.56, (p ˂ 0.05). Self-efficacy was positively correlated with knowledge (r = 0.304, p = 0.02) and adequate prenatal care (r = 0.583, p ˂ 0.001). The constructs of the HBM explained 75% of the variance in frequency of prenatal care in multivariable models. Developing an educational program based on the HBM was effective in the adoptation of prenatal care. Additionally, considering social, economic, and educational follow-up while implementing these programs is recommended.

Prevalence of metabolic syndrome in Middle-East countries: Meta-analysis of cross-sectional studies.

OBJECTIVE: Metabolic syndrome is an important metabolic disorder which impose noticeable burden on health system. We aimed to review and imply the prevalence of it in Middle-East countries. METHODS: present study was a systematic review to present overview about metabolic disorder in Middle East. Electronic literature search of Medline database and Google scholar were done for English-language articles without time filtering, as well as for population-based or national studies of the prevalence of metabolic syndrome. The fallowing search terms were used simultaneously: prevalence of "metabolic syndrome" and "national study", "prevalence of metabolic syndrome in Middle East", "prevalence of metabolic syndrome" and "name of country", "metabolic syndrome &name of country". Additionally, relevant articles in bibliography were searched. Analysis of data was carried out in STATA version 11.0. RESULTS: out of 456 studies in first-step searching (selecting by title) 59 studies were recruited and reviewed. Prevalence of metabolic syndrome fluctuated by country and time of study. This amount was 2.2-44% in Turkish, 16-41% in Saudi-Arabia, 14-63 in Pakistan, 26-33 in Qatar, 9-36 in Kuwait, 22-50 in Emirate, 6-42 in Iran, and up to 23 in Yemen. Pooled estimate was 25%. Attributable risk for cardiovascular disease, coronary heart disease, and stroke was 15.87, 11.7, and 16.23, respectively. CONCLUSION: The prevalence rate of metabolic syndrome is high and it is noticeable cause for stroke, coronary heart disease, and cardiovascular disease.

Effects of Social Support and Self-Efficacy on Maternal Prenatal Cares Among the First-Time Pregnant Women, Iranshahr, Iran.

Objective: Social support and perceived self-efficacy affect health-related behaviors and play an important role on mothers' adaptability with pregnancy. This paper aims to study the impact of educational interventions based on social support and perceived self-efficacy on maternal prenatal care. Materials and methods: The present study is a before after experimental study in which 90 first-time pregnant women were randomly selected and divided into two 45- participants experimental and control groups. Data were collected from 21 January to 20 May 2016. Determining the validity and reliability of the questionnaire, we used the panel of experts and Cronbach's alpha. The data collected from the two groups were compared before and 3 months after intervention and were analyzed by SPSS 18. Results: Unlike the control subjects, there was a significant difference in maternal prenatal cares before and after an educational intervention between the scores of social support and perceived self-efficacy in the experimental group (p < 0.05). Before intervention, the average score of the experimental group was 12.62 ± 2.63 that rose to 17.71 ± 1.56, three months after the educational intervention, which is statistically significant (p < 0.05). There was a direct and positive relation between self-efficacy and maternal prenatal cares (p = 0.000, r = 0.538). Social support and self-efficacy predicted the variance of maternal cares by 69.2%. Conclusion: Developing an educational program based on social support and perceived self-efficacy on maternal prenatal cares is helpful and efficient. The health system, family and society are in charge of making facilities and opportunities to improve social support and perceived self-efficacy in pregnant women, resulting in improved maternal prenatal cares.

The Effect of Stress Management Training through PRECEDE-PROCEED Model on Occupational Stress among Nurses and Midwives at Iran Hospital, Iranshahr.

INTRODUCTION: Occupational stress is a major factor in hindering the performance of nurses and midwives and developing physical and mental complications in them. Given that these two groups are in direct contact with patients more than other medical staff and stress management training can be effective in the reduction of occupational stress among the nurses and midwives. AIM: This study was set out to compare the effect of a PRECEDE-PROCEED based stress management training program on the occupational stress of the nurses and midwives. MATERIALS AND METHODS: This quasi-experimental study was conducted on the aforementioned nurses and midwives. Data collection instruments included the Nursing Stress Scale (NSS). The training program was held in two 4-hour-long sessions for three months from 1st January to 31st March 2013. RESULTS: The results showed a significant increase in the PRECEDE scores of both groups by the end of the program, as compared to the baseline. A significant decrease was also observed in the stress scores of both groups. There was no difference between groups in these regards. CONCLUSION: The PRECEDE-based stress management training is effective in the reduction of occupational stress among the nurses and midwives.

Frequency of Maternal Mortality in Urban and Rural Areas of Iranshahr County (Southeast of Iran) in 2009-2013: A Retrospective Study.

INTRODUCTION: Maternal mortality is one of the threatening factors of human life and the overall status index of women's health in any society. Death of a mother causes irreversible damage to a family and a society. This study aims at examining the causes of maternal mortality in urban and rural areas. AIM: The purpose of this study was to determine the frequney and causes of maternal mortality in urban and rural areas in southeast of Iran in 2009-2013. MATERIALS AND METHODS: This was a retrospective descriptive study and its research population includes the entire pregnant woman who died in Iranshahr County between April 2009 and March 2013. An eight-section questionnaire was used for collecting data. The first section was based on the hospital records of pregnant woman including mother's demographic data and the following sections were completed based on their health records. RESULTS: The frequency of maternal mortality during birth in the study period was 34 (of 4857). The study individuals were between 13 and 40-year-old with the mean age of 30±6.4. Maximum maternal mortality occurred in 2012. Haemorrhage was the most common cause of maternal death (38.2%). CONCLUSION: As haemorrhage was the most common cause of death of pregnant women in this study, it seems necessary to improve care for woman and reduce haemorrhage and its complications during pregnancy period.

Comparison of 2 Methods of Clot Solubility Testing in Detection of Factor XIII Deficiency.

BACKGROUND: Deficiency of factor XIII (FXIII) is a rare bleeding disorder (RBD) affecting approximately 1 person per 2 million worldwide. Its life-threatening diatheses-umbilical cord bleeding, intracranial hemorrhage and central nervous system bleeding-present a significant challenge in both diagnosis and treatment. Confirming FXIII deficiency (FXIIID) is difficult and has been most commonly performed with the clot solubility test. Iran has limited resources and a rate of FXIIID 12-fold higher than the rest of the world, suggesting that in this country optimization of the clot solubility test is crucial. For this reason, we compared clot solubility test methods traditionally used in Iran. METHODS: In this study, we assessed patients suspected to have FXIIID with routine coagulation tests and 2 different methods of clot solubility testing including 5M urea and monochloroacetic acid (MCA) as solubilizing agents, and thrombin and calcium chloride as clotting agents. Finally, we analyzed the data obtained with SPSS software. RESULTS: During the study period, we were referred 83 patients with normal routine coagulation tests, of which 29 patients had abnormal clot solubility test results with 5M urea, and 21 had abnormal results with MCA (P = .03); 19 cases had abnormal results with both methods; 2 patients had abnormal results with MCA but normal results with urea. Ten patients had positive results with urea but normal results with MCA. CONCLUSION: The clot solubility test with 5M urea as solubilizing method and thrombin as clotting agent is more sensitive in the detection of FXIIID, but simultaneous use of the 2 methods can prevent misdiagnosis of a considerable number of patients with FXIIID.

Determinants of adherence to self-care behavior among women with type 2 diabetes: an explanation based on health belief model.

BACKGROUND: Self-care is an essential element in treating a person with diabetes; and managing diabetes is of prime importance. The aim of this study was to investigate the predictors of adherence to self-care behavior among women with Type 2 diabetes. METHODS: This cross-sectional study was conducted on 210 female patients aged 30 to 60. Data collection tool was an anonymous valid and reliable questionnaire designed based on the Health Belief Model (HBM), which acquired information about the followings: Perceived susceptibility, severity, benefits, barriers, self-efficacy and diabetes self-care behavior. Data were analyzed by t-test, chisquare and regression analysis. RESULTS: The multiple regression models revealed 59.9% of the variance of self-care behavior with self-efficacy, perceived barrier, benefit and susceptibility. Additionally, the highest weight for ß (ß=0.87) was found for self-efficacy. Self-care behavior was positively correlated with all HBM variables except for perceived barriers showing a negative correlation. CONCLUSION: The Health Belief Model may be used as a framework to design intervention programs in an attempt to improve adherence to self-care behaviors of women with diabetes. In addition, the results indicated that self-efficacy might play a more crucial role in developing self-care behaviors than t other HBM components. Therefore, if the focus is placed on self-efficacy when developing educational programs, it may increase the likelihood of adherence to self-care behavior.

Impact of Educational Intervention on Patients Behavior with Smear-positive Pulmonary Tuberculosis: A Study Using the Health Belief Model.

INTRODUCTION: Tuberculosis is a single-agent infectious disease, which is the major cause of death around the world. Approximately one third of the world's population is infected with tuberculosis (TB) bacilli and at risk of developing active TB. The purpose of this study was determined the impact of education based on health belief model in promoting behavior of smear-positive pulmonary TB among patients in Chabahar city, Iran. MATERIAL AND METHODS: Of the 80 smear-positive pulmonary TB who referred to health centers in Chabahar voluntarily participated in this interventional study. The data collected using questionnaire based on health belief model. The data were analyzed by using paired t-test, independent t-test, pearson correlation and chi-square test with SPSS 16. RESULTS: The cognitive skills were increased significantly from 6.10 to 6.88 after intervention. All behavioral skills were increased significantly from 2.08 to 2.88 after implementing the intervention. Perceived severity was increased from11.08to12.19 significantly. Percepted benefits were enhanced significantly from 11.48 to 12.23. Mean percepted barrier was decreased significantly from 17.52 to 16.68. CONCLUSION: Findings demonstrated that implementing educational intervention programs can increase the level of knowledge and behavior of patients regarding smear- positive pulmonary TB initiatives.