The effectiveness of motivational interviewing on the oral health of leukemic children and oral health care knowledge, attitude and practice of their mothers: a hospital-based intervention.

BACKGROUND: Some studies suggest a higher effectiveness of motivational interviewing compared to common oral health instruction in healthy individuals. As regards to higher prevalence of dental diseases like early childhood caries, oral mucositis, and gingivitis are reported for leukemic children, the present study aims to compare the effectiveness of educating mothers through MI with the common instruction (CI) for the oral health of children with leukemia under six years old. METHOD: This quasi-experimental study was designed in Tehran University of Medical Sciences, School of Dentistry and conducted on 61 mothers with leukemic children under age six hospitalized in Mahak Hospital and Rehabilitation Complex which is a Pediatric Cancer Research and Hospital Center, in 2021. Mother and child pairs were allocated to MI or CI (using pamphlets) groups. Data was collected using a questionnaire of mothers' knowledge, attitude, motivation, and practice concerning oral health care in leukemic children. The children underwent clinical examination to assess plaque index before and three months after the intervention. The data were analyzed using SPSS version 25 (IBM, Armonk, NY, USA) by ANCOVA test. RESULTS: The preschoolers mean ages were 4.23 ± 1.41 and 4.32 ± 1.33 (ranged from 2 to 6 years old) in the MI and CI group, respectively. There were 16 girls (53.3%) and 14 boys (46.7%) in the MI group, and 15 girls (48.4%) and 16 boys (51.6%) in the CI group. Significant differences were observed in the amount of plaque index between the MI group and the CI group (0.20 ± 0.04, p-value < 0.001). A significant increase was observed in the mean of changes in scores of knowledge, attitude, motivation, mother's practice concerning child's oral health, mother's practice concerning personal oral health in the MI group (p-value < 0.001). CONCLUSIONS: Considering that instruction using MI showed to be effective in improving oral health adherence in mothers and reducing plaque in children with Leukemia, it may be recommended as a promising method to promote the oral health of such susceptible children in places that they are constantly present for treatment. TRIAL REGISTRATION: The study was registered in the Iranian Registry of Clinical Trials (IRCT) on 11.03.2021 (code: IRCT20131102015238N5).

Psychological Interventions for Irritable Bowel Syndrome: A Meta-Analysis of Iranian Randomized Trials.

BACKGROUND: Irritable bowel syndrome (IBS) is a common health problem, with considerable effects on the individual's quality of life, mental health, work productivity, and financial aspects. Psychological interventions, which are commonly used as adjunct treatments, have received fairly strong empirical support. In Iran, several randomized clinical trials (RCTs) have evaluated the efficacy of these treatments; however, the results of these RCTs have not been synthesized yet. Therefore, in this meta-analysis, we aimed to summarize the results of these trials on the efficacy of psychological interventions in Iranian adults with IBS. METHODS: We searched IranDoc, ElmNet, PubMed, and Scopus for eligible RCTs. The risk of bias was assessed in each trial, according to the Cochrane guidelines, and the random-effect model was used to pool the effect size (EF) across trials. RESULTS: Twenty RCTs met the eligibility criteria and were included in the meta-analysis. Compared to the controls, the standardized mean difference (SMD) for psychological interventions was large regarding the severity of IBS symptoms (-1.21; 95% CI: -1.63 to -0.80), anxiety (-0.97; 95% CI: -1.32 to -0.63), and depression (-0.86; 95% CI: -1.28 to -0.44). There was considerable heterogeneity among the included RCTs regarding all three outcomes, which could not be explained by the available information. On the other hand, the EF of health-related quality of life was 0.64 (95% CI: 0.38 to 0.85), with no significant heterogeneity among RCTs. CONCLUSION: The existing evidence suggests that psychological interventions can be highly effective in improving the severity of IBS symptoms, mental health, and quality of life for Iranian adults with IBS. However, some weaknesses should be considered in the interpretation of the results and future research. The risk of randomization was high or unclear in almost all of the existing trials; there was no single large trial in this area; and there was substantial inconsistency in the EFs, which might be related to methodological or clinical moderators.

Psychological interventions for depression and anxiety: a systematic review and meta-analysis of Iranian chronic pain trials.

Background: Chronic pain is commonly associated with anxiety and depression, making it more challenging to be managed. Psychological interventions are suggested for such complicated issues which are well evident in the United States and Europe. However, generalizing the evidence to Iranian population - as a Middle Eastern society - might be questionable. We aimed to synthesize our evidence on the effectiveness of these interventions among Iranian populations. Methods: This was a systematic review and meta-analysis. Persian and English literature were searched through Iran-doc, Elm-net, and PubMed until March 2019 using the following terms (or its Persian synonyms): chronic pain; persistent pain; chronic fatigue; fibromyalgia; neuropath*; LBP; irritable bowel; CFS; psycho*; cogniti*; acceptance; meaning; mindfulness; relaxation; biopsychosocial; rehabilitation; educat*. Eligible trials were randomized trials that evaluated the effectiveness of psychological interventions on Iranian adults with chronic pain. No setting restriction was considered. Risk of bias for each trial was assessed, and the random-effect model was used to pool summary effect across trials. Results: In all 30 eligible RCTs, the risk of bias for randomization was low except for one study. The pooled standardized mean difference (SMD) for depression and anxiety were 1.33 (95%CI: -1.42 to -0.68) and 1.25 (95% CI: -1.55 to -0.96), respectively. Conclusion: This study suggests that psychological interventions are highly effective in reducing depression and anxiety in Iranian patients with chronic pain, compared to what observed in the U.S. and European studies. However, there are still some methodological issues to be addressed. Future research should focus on high-quality trials with considerations on the methodological issues reported in the present study.

New Model for Couple Therapy for Patients with Chronic Pain and their Caregivers: An Attempt to Improve Quality of Life and Reduce Pain.

BACKGROUND: Several psychological interventions have been implemented to manage chronic pain. In this study, in addition to the patients, his/her spouses have participated in the program. Besides, this innovative therapy integrates several practical approaches into one comprehensive protocol. OBJECTIVE: This study aimed to analyze the effectiveness of couple therapy (patient/caregiver-oriented) on improving the quality of life and reducing pain among patients with chronic pain. METHODS: The present study is a quasi-experimental and clinical trial with a control group with pretest and posttest. The authors conducted this study at LABAFINEJAD Hospital in Tehran on 30 patients with chronic pain and their spouses by having a short form of a questionnaire for quality of life and chronic pain score questionnaire to measure the effectiveness of the treatment. RESULTS: The results indicated that this treatment increased two aspects of quality of life remarkably, social function and strength for continuing the performance; that help boosts interpersonal relationships as well. Regarding the results, although the couple-based treatment could improve all aspects of pain, the two primary subscales, physical health and mental health, both enhanced. Besides, the treatment reduced the intensity of pain. CONCLUSION: Couple-based intervention through increasing social support, improving the quality of sex, decentralizing of pain, and paying attention to the neglected needs of caregivers and patients with chronic pain can improve quality of life and reduce pain in patients.

Cortisol-a Key Factor to the Understanding of the Adjustment to Childhood Cancer.

BACKGROUND: Malignancy and its treatments could cause disturbance in homeostasisof body such as cortisol secretion. The present study has investigated the effects of cortisol level imbalance in behavioral and emotional adjustments. METHODS: Seventy-eight children with Acute Lymphoblastic Leukemia (ALL) have involved in this study. Their salivary cortisol level, which were sensitive to pain and disruptive behaviors, have measured. RESULTS: CORTISOL LEVEL EFFECT IN DIFFERENT PERIODS: within duration of reaction to pain, sensitivity to pain and disruptive behaviors have evaluated. In addition abnormal regulation of cortisol levels have shown a very strong relationship between sensitivity to pain and the disruptive behaviors. Cortisol suppression was responsible for adjustment by the participants to stressful conditions. CONCLUSION: Previous investigations have shown that there is a low reaction to stressor which decreases the vitality as well as impairing a negative memory in low cortisol levels. The findings of the present study demonstrated a nonlinear relation between cortisol level and sensitivity to pain as well as disruptive behaviors. Therefore, regulation of cortisol- up and down- is predisposed to maladjustment.

Emotional regulation and adjustment to childhood cancer: role of the biological, psychological and social regulators on pediatric oncology adjustment.

BACKGROUND: Children with cancer should deal with difficult situations such asundergoing multimodal treatment. Emotion Regulation Mechanisms (ERM) could be more effective for childhood cancer adaptation. The main purpose of this study was examination a number of the biological, psychological and social emotion regulators on adjustment to pediatric oncology. METHOD: In this study, 98 children (39 girls and 59 boys) have participated that diagnosed as Acute Lymphoblastic Leukemia (ALL) cases along with their mothers. The participants were between 8 to 12 years old. Salivary cortisol, cognitive emotion regulation, children's level of inhibition, maternal positivity and Beck Depression Inventory have been applied for evaluation of Emotion Regulation (ER) while Cancer-Specific Stress and Coping, Connor-Davidson Resilience Scale, anxiety-depression scales and vitality test have all used for assessing the Emotional Adjustment (EA). RESULTS: Using the canonical correlation has been showing significant relation between predictors of ER and EA. Cortisol level and mother's depression have played the most important role in above correlation. CONCLUSION: Variation of cortisol level has identified by its various effects on the mother's behavioral system depression, cognitive strategies and emotional inhibition; would determine the rate of coping with cancer, resiliency and vitality.

Sensitivity to Pain in Children With Acute Lymphoblastic Leukemia (ALL).

BACKGROUND: There are many physiological and psychological factors, which affect sensitivity to pain in children afflicted with ALL. The main purpose of this study was to evaluate the relation between salivary cortisol and sensitivity to pain, and also study the role of age and gender. METHODS: Seventy eight children (33 girls and 45 boys, aged 3 to 12 years) with ALL participated in this study. Morning salivary cortisol was measured and Behavior Scales of Sensitivity to Pain for Children (BSSPC) and Pre-Linguistic Behavioral Pain Reactivity Scale (PL-BPRS) were applied. RESULTS: The results showed a high significant correlation between cortisol levels and pain sensitivity. Cortisol suppression was observed in some participants. The roles of gender and age in relation between cortisol levels and sensitivity to pain were assessed by using moderated regression. Gender and age moderated the relation between sensitivity to pain and cortisol level. CONCLUSION: Conditional fear can explain for high sensitivity to pain amongst the participants; chemotherapy drugs might play a role in cortisol suppression and parenthood style perhaps determines sex difference in reaction to pain.