Explaining the challenges of Iranian caregivers in provision of home health care to spinal cord injury patients: a qualitative study.

BACKGROUND: The incidence of spinal cord injury (SCI) is increasing across the globe. The caregivers of patients with spinal cord injuries experience many problems during providing care to these patients. Identifying the problems experienced by caregivers can facilitate the process of care provision to these patients. So, the aim of this study was to explore the challenges of caregivers in provision of home health care to SCI patients. METHODS: This study was conducted by qualitative description approach in Iran from Apr 2021 to Dec 2022. The participants included the caregivers of SCI patients recruited by purposive sampling. The data were collected by face-to-face interviews and analyzed using the method proposed by Lundman and Graneheim. RESULTS: Two themes emerged from the data analysis, including burnout (with the categories of physical challenge and psychological challenges) and coping strategies (with the categories of social support and professional support). CONCLUSION: Resolving the obstacles and problems faced by home caregivers can improve the circumstances of care provision so that they can be relieved of their own physical and psychological conundrums and deliver suitable home care to SCI patients. TRIAL REGISTRATION NUMBER: Not applicable.

Exploring caregivers' perceptions of community-based service requirements of patients with spinal cord injury: a qualitative study.

BACKGROUND: The incidence of spinal cord injury is increasing worldwide. Patients with spinal cord injury and their families face many difficulties during the disease course. Caregivers are more involved with these patients than anyone else, so recognizing patients' care requirements based on caregivers' opinions can facilitate care provision to these people. The purpose of this study was to explore caregivers' perceptions of the community-based services requirements of patients with spinal cord injury. METHODS: This qualitative research was conducted in Iran from Apr 2021 to Dec 2022 using the conventional content analysis method. The participants in the study included family caregivers and providers of home care services to patients with spinal cord injury, who were selected by purposeful sampling. Data were collected by conducting 14 face-to-face interviews and analyzed based on the method proposed by Lundman and Graneheim. RESULTS: Data analysis led to the extraction of 815 primary codes, which were organized into two themes: community reintegration (with two categories, including the need to provide a suitable social platform and lifelong care) and palliative care (with two categories, including family conference and survival management). CONCLUSION: Social facilities and infrastructure should be modified in a way that patients with spinal cord injury can appropriately benefit from community-based care services and an independent satisfactory life. Palliative care should be continuously provided from the time of lesion development until the patient's death.

Explaining health care providers' perceptions about the integration of palliative care with primary health care; a qualitative study.

BACKGROUND: Easy access to palliative care is one of the basic needs of cancer patients, and this can be achieved by providing such services at the community level. One approach to provide community-based palliative care is to integrate it with primary health care (PHC). Considering the antiquity and extension of the PHC system in Iran and the importance of being aware of stakeholders' views in order to integrate a palliative care provision model into a country's health care system, we aimed to explain health care providers' perception of the integration of palliative care with PHC. METHODS: The present qualitative research was conducted using the conventional content analysis method in Iran from October 2016 to July 2020. The participants of the study included the stakeholders involved in providing palliative care to cancer patients, as well as PHC system experts. The participants were selected purposefully using the snowball sampling method. Data were collected through holding 21 semi-structured interviews and one focused group session and analyzed based on the method proposed by Lundman and Graneheim. RESULTS: Qualitative data analysis revealed three main categories and ten subcategories. The main categories included the health system's structure as an opportunity (with the subcategories of employing the network system for providing health services, establishment of a referral system, and establishment of the family physician program and manpower diversity), requirements (with the subcategories of the position of home care centers and their relationship with PHC, opioid use management, equipment management, financial support, and legal issues), and outcomes (with the subcategories of facilitated access to services and good death). CONCLUSION: Iran's health system possesses adequate infrastructure for providing palliative care to cancer patients within the context of PHC. Beside available opportunities, there are also problems that need to be resolved so that families can meet their patients' care needs and provide them with an easy death by having access to home-based palliative care.

Comparison of the effectiveness of home visits and telephone follow-up on the self-efficacy of patients having un-dergone coronary artery bypass graft surgery (CABG) and the burden of their family caregivers: A randomized con-trolled trial.

OBJECTIVES: This study aimed to compare home visits and telephone follow-up effectiveness on patients' self-efficacy undergoing Coro-nary Artery Bypass Graft Surgery -CABG- and caregivers' burden. METHODS: In this randomized clinical trial, 114 patients undergoing CABG were assigned to the three groups of home visits, telephone follow-up, and control based on the stratified block randomization. The self-management program of the home visit group included four face-to-face 60-minute training sessions once a week, and for the telephone follow-up group, four 30-minute telephone counseling sessions twice each week for a month. The control group received routine care. Data were collected using the cardiac rehabilitation self-efficacy questionnaire and the caregiver burden scale before and after the interven-tion. RESULTS: Before the study, there were no statistically significant differences between the three groups in terms of the means of self-efficacy and caregiver burden scores. However, there was a statistically significant difference between the home visit and control groups (p<0.001) and between the telephone follow-up and control groups (p<0.001) after the intervention, with in-creased self-efficacy and reduced caregiver burden reported. In contrast, there was no significant difference between the home visit and telephone follow-up groups regarding self-efficacy and caregiver burden scores. CONCLUSIONS: Both methods of self-management education have similar effectiveness in increasing self-efficacy and reducing the care-giver burden after discharge for patients who have undergone CABG.

The Effect of Vitamin D Supplementation on Treatment-Induced Pain in Cancer Patients: A Systematic Review.

OBJECTIVES: Despite the widespread use of complementary and alternative medicine by patients and physicians alike, there is no accurate evidence regarding the effects of vitamin D supplementation on treatment-induced pain in cancer patients. Thus, the aim of this systematic review of randomized controlled trials (RCTs) was to evaluate the impact of vitamin D administration on therapy-related pain in subjects diagnosed with malignant disorders. REVIEW ANALYSIS METHODS: We searched the Web of Science, Scopus, PubMed/Medline, Embase, and Google Scholar databases up to October 2020 to identify published RCTs that investigated the use of vitamin D in the management of treatment-induced pain in individuals with cancer. RESULTS: Nine RCTs were detected. The median duration of the intervention was of 24 weeks (range 12-52 weeks) and dose of vitamin D employed was 2000-50000 IU of vitamin D3 weekly orally each day. Six RCTs reported a significant reduction in pain, whereas three did not detect a notable decrease of this variable. Of the six studies that reported an alleviation of pain, an RCT which recruited 60 participants and lasted for 24 weeks consisted of supplementation with high doses of vitamin D2 weekly for 8 weeks in women receiving anastrozole as adjuvant therapy, then supplementation with vitamin D2 monthly for 4 months, effectively alleviated the aromatase inhibitor-associated musculoskeletal syndrome (AIMSS). The results of the same RCT also suggested a beneficial effect of vitamin D on musculoskeletal pain. CONCLUSIONS: Our results suggest that the supplementation with high doses of vitamin D in cancer patients with low serum levels of vitamin D, can be effective in reducing treatment-related pain.

Comparison of the effectiveness of home visits and telephone follow-up on the self-efficacy of patients having undergone coronary artery bypass graft surgery (CABG) and the burden of their family caregivers: A randomized controlled trial / Comparación de la efectividad de las visitas domiciliarias y el seguimiento telefónico sobre la autoeficacia de los pacientes sometidos a cirugía de derivación arterial coronaria con injerto y la carga para sus cuidadores familiares: Un ensayo controlado aleatorio / Comparação da efetividade das visitas domiciliares e o seguimento telefónico sobre a autoeficácia dos pacientes submetidos a cirurgia de derivação arterial coronária com enxerto e a carga para seus cuidadores familiares: Um ensaio controlado aleatório

Objective. This study aimed to compare home visits and telephone follow-up effectiveness on patients' self-efficacy undergoing Coronary Artery Bypass Graft Surgery -CABG- and caregivers' burden. Methods. In this randomized clinical trial, 114 patients undergoing CABG were assigned to the three groups of home visits, telephone follow-up, and control based on the stratified block randomization. The self-management program of the home visit group included four face-to-face 60-minute training sessions once a week, and for the telephone follow-up group, four 30-minute telephone counseling sessions twice each week for a month. The control group received routine care. Data were collected using the cardiac rehabilitation self-efficacy questionnaire and the caregiver burden scale before and after the intervention. Results. Before the study, there were no statistically significant differences between the three groups in terms of the means of self-efficacy and caregiver burden scores. However, there was a statistically significant difference between the home visit and control groups (p<0.001) and between the telephone follow-up and control groups (p<0.001) after the intervention, with increased self-efficacy and reduced caregiver burden reported. In contrast, there was no significant difference between the home visit and telephone follow-up groups regarding self-efficacy and caregiver burden scores. Conclusion. Both methods of self-management education have similar effectiveness in increasing self-efficacy and reducing the caregiver burden after discharge for patients who have undergone CABG.

Objetivo. Comparar la eficacia de las visitas domiciliarias y del seguimiento telefónico sobre la autoeficacia de los pacientes sometidos a cirugía de derivación arterial coronaria con injerto (CABG en inglés) y la carga de sus cuidadores. Métodos. En este ensayo clínico aleatorio, 114 pacientes sometidos a CABG se asignaron a uno de los tres grupos de investigación: visitas domiciliarias, seguimiento telefónico y control sobre la base de la aleatorización en bloque estratificada. El programa de educación en autoeficacia en el grupo de visitas domiciliarias incluía cuatro sesiones presenciales de formación de 60 minutos una vez a la semana, y para el grupo de seguimiento telefónico, cuatro sesiones de asesoramiento telefónico de 30 minutos dos veces por semana por un mes. El grupo de control recibió atención rutinaria. Los datos se recogieron mediante el cuestionario de autoeficacia de la rehabilitación cardíaca y la escala de carga del cuidador antes y después de la intervención. Resultados. Antes del estudio, no hubo diferencias entre los tres grupos en cuanto a las medias de las puntuaciones de las escalas de autoeficacia y carga del cuidador. Sin embargo, se encontró una diferencia estadísticamente significativa entre los grupos de visitas domiciliarias y de control (p<0.001) y entre los grupos de seguimiento telefónico y de control (p<0.001) después de la intervención, con un aumento de la autoeficacia y una reducción de la carga del cuidador. Es de anotar que no hubo diferencias significativas entre los grupos de visita domiciliaria y de seguimiento telefónico en cuanto a las puntuaciones de autoeficacia y de carga del cuidador. Conclusión. Ambos métodos de educación en este estudio tuvieron una efectividad similar en el aumento de la autoeficacia y la reducción de la carga de los cuidadores tras el alta de los pacientes sometidos a CABG.

Objetivo. Comparar a eficácia das visitas domiciliares e do seguimento telefónico sobre a autoeficácia dos pacientes submetidos a cirurgia de derivação arterial coronária com enxerto (CABG em inglês) e a carga dos seus cuidadores. Métodos. Neste ensaio clínico aleatório, 114 pacientes submetidos a CABG foram designados a um dos três grupos de investigação: visitas domiciliares, seguimento telefónico e controle sobre a base aleatorizada em blocos estratificada. O programa de educação em autoeficácia no grupo de visitas domiciliares incluía quatro sessões de formação presenciais de 60 minutos uma vez por semana, e para o grupo de seguimento telefónico, quatro sessões de assessoramento telefónico de 30 minutos duas vezes por semana durante um mês. O grupo de controle recebeu atenção rotineira. Os dados se recolheram mediante o questionário de autoeficácia da reabilitação cardíaca e a escala de carga do cuidador antes e depois da intervenção. Resultados. Antes do estudo, não houve diferenças entre os três grupos enquanto às médias das pontuações das escalas de autoeficácia e carga do cuidador. Porém, se encontrou uma diferença estatisticamente significativa entre os grupos de visitas domiciliares e de controle (p<0.001) e entre os grupos de seguimento telefónico e de controle (p<0.001) depois da intervenção, com um aumento da autoeficácia e uma redução da carga do cuidador. É importante anotar que não houve diferenças significativas entre os grupos de visita domiciliar e de seguimento telefónico enquanto às pontuações de autoeficácia e de carga do cuidador. Conclusão. Ambos os métodos de educação neste estudo tiveram uma efetividade similar no aumento da autoeficácia e a redução da carga dos cuidadores após a alta dos pacientes submetidos a CABG.

Exploring COVID-19 patients' experiences of psychological distress during the disease course: a qualitative study.

BACKGROUND: The Coronavirus Disease 2019 (COVID-19) is an emerging disease with many unknown clinical and therapeutic dimensions. Patients with COVID-19 experience a variety of psychological problems during the disease. Understanding patients' mental condition and their distress during the disease is the first step to help these patients. So, the aim of this study was to explain COVID-19 patients' experiences of psychological distress during the disease course. METHODS: The present qualitative research was conducted in Iran from April 2020 to April 2021 using the conventional content analysis method. The participants included patients with COVID-19, selected by the purposeful sampling method. Data was collected through 34 telephone and in-person interviews and analyzed based on the method proposed by Lundman and Graneheim. RESULTS: Qualitative data analysis led to the emergence of sources of psychological distress as the main theme as well as seven categories and seven sub-categories. The categories were the disease's nature (the subcategories of disease's unknown dimensions, and disease severity), the anxiety caused by preventive behaviors (the subcategories of quarantine, worry about transmitting the infection to others and obsessive thoughts related to disinfection measures), the inefficient management by the health system (the subcategories of poor health care condition and lack of spiritual care), death anxiety, stigma, anxiety after recovery, and sleep pattern disturbance. CONCLUSION: Patients with COVID-19 experience great psychological distress during the acute phase of the disease or even long after recovery. It is suggested that psychological and spiritual counseling, as a key element of treatment and support for these patients, is provided to patients in the acute phase of the disease, as well as after recovery. National and local media should boost awareness about the disease as a dangerous yet preventable and curable infectious disease. People should follow health instructions and leave their seeing the disease as a taboo. TRIAL REGISTRATION NUMBER: Not applicable.

Risk perception and adherence to preventive behaviours related to the COVID-19 pandemic: a community-based study applying the health belief model.

BACKGROUND: Coronavirus disease 2019 (COVID-19), now a global pandemic, is a new, highly contagious, and preventable disease that has caused many deaths across the world. Correct understanding of the risks and following health instructions are among the most important self-care parameters. AIMS: To assess people's perception of the risks and their adherence to recommended preventive behaviours regarding COVID-19 infection. METHOD: This descriptive-analytical study was conducted with 1861 people residing in Ardabil province in 2020. The data were collected electronically and included four elements: demographic details; health belief model (HBM) constructs (perceived sensitivity, perceived severity and perceived benefits); beliefs about the effectiveness of disease prevention strategies; and complying with health behaviours. The data was analysed using SPSS-21 software. RESULTS: Significant differences were found in the mean scores for beliefs about the effectiveness of preventative measures, the constructs of the health belief model, and compliance with preventive behaviours relating to the participants' gender, age, marital status and level of education. Beliefs and intention to stay at home, collectively predicted 54.7% of the variance in preventive behaviours. CONCLUSIONS: Although a majority of participants had positive attitudes towards the effectiveness of preventive measures and adhered to them, some people who were not adherent with these healthy behaviours could be key participants in the next wave of the disease.

Developing an integrated model of community-based palliative care into the primary health care (PHC) for terminally ill cancer patients in Iran.

BACKGROUND: Patients with cancer commonly experience pain and suffering at the end of life days. Community-based palliative care can improve the quality of life of terminally-ill cancer patients and provide them with a merciful death. The purpose of this study was to develop an integrated model of community-based palliative care into PHC for terminally ill cancer patients. METHOD: This study is a health system research (HSR) that was conducted in three phases from October 2016 to July 2020. In the first phase, dimensions of community-based palliative care were explored in patients with cancer using qualitative methods and conventional content analysis. In the second phase, a scoping review was carried out to complete the collected data from the qualitative phase of the study. Based on the collected data in the first and second phases of the study, a preliminary draft of community-based palliative care was developed for patients with cancer based on the framework of the World Health Organization. Finally, the developed model was validated using the Delphi technique in the third phase of the study. RESULTS: Data analysis indicated that providing community-based care to patients with cancer is influenced by the context of care. According to the developed model, patients are identified as terminally ill, and then are referred to the local comprehensive health center in a reverse manner. After patients' referral, they can receive appropriate healthcare until death by the home care team in relation to the comprehensive health center based on the framework of primary healthcare. CONCLUSIONS: This model was developed based on the current Iranian healthcare structure and the needs of terminally ill cancer patients. According to the model, healthcare is provided in a reverse manner from the subspecialty centers to patients' homes in order to provide easy access to palliative care. It is suggested to use this model as a pilot at the regional level.

Exploring nurses' perception of taking care of patients with coronavirus disease (COVID-19): A qualitative study.

Aim: Healthcare staff, especially nurses, who are in the frontline of caring of patients with COVID-19 have valuable experiences about taking care of these patients. Therefore, the aim of this study was exploring nurses' perception of taking care of patients with COVID-19. Design: This qualitative study was performed using the conventional content analysis method. Methods: 13 nurses who were taking care of patients with COVID-19 were selected using purposeful sampling in the Lorestan University of Medical Sciences. The data were collected through telephone interviews and analysed based on the Lundman and Graneheim's approach. Results: Qualitative analysis of the data revealed 3 sub-categories, 8 categories and 3 main categories including care erosion, nursing professional growth and necessities. Relevance to clinical practice: Improve the work situation of the nurses during care of COVID-19 patients, which can directly or indirectly improve the quality of care of these patients.

Exploring nurses' perception about the care needs of patients with COVID-19: a qualitative study.

BACKGROUND: COVID-19 is a new disease affecting and killing a large number of people across the world every day. One way to improve health care for these patients is to recognize their needs. Nurses, as a large population of health care staff, can be rich sources of information and experience on patients' care needs. Therefore, the aim of this study was to explore nurses' perception about the care needs of patients with COVID-19. METHODS: The present qualitative research was performed using the conventional content analysis approach in Iran from March to May 2020. The participants of this study included the nurses caring for patients with COVID-19, recruited by the purpose sampling method. The data was collected through 20 telephone interviews and analyzed based on the method proposed by Lundman and Graneheim. RESULTS: Qualitative data analysis revealed six main categories including need for psychological consulting, need for quality improvement of services, need for upgrading of information, need for improving of social support, need for spiritual care and need for social welfare. CONCLUSION: The data showed that patients with COVID-19 were psychologically, physically, socially, economically, and spiritually affected by the disease. Therefore, they should be comprehensively supported by health care staff and other supportive systems.

Exploring nurses' experiences of psychological distress during care of patients with COVID-19: a qualitative study.

BACKGROUND: COVID-19 infection is a new disease that infects a large number of people, killing a ratio of whom every day in the world. Healthcare staff, especially nurses, experience a great deal of psychological distress during care of COVID-19 patients. Detecting factors that disturb nurses' mental health during care of these patients can help to reduce their psychological distress. Therefore, this study aimed to explore nurses' experiences of psychological distress during care of patients with COVID-19. METHODS: The present qualitative research was performed using the conventional content analysis method in Iran from March to May 2020. Participants in this study included the nurses caring for patients with COVID-19, and they were selected based on the purposeful sampling method. The data was collected through 20 phone call interviews and analyzed based on the method proposed by Lundman and Graneheim. RESULTS: Qualitative data analysis revealed 11 categories including death anxiety, anxiety due to the nature of the disease, anxiety caused by corpse burial, fear of infecting the family, distress about time wasting, emotional distress of delivering bad news, fear of being contaminated, the emergence of obsessive thoughts, the bad feeling of wearing personal protective equipment, conflict between fear and conscience, and the public ignorance of preventive measures. CONCLUSION: The data showed that the nurses experienced a variety of psychological distress during care of patients with COVID-19. Through proper planning by authorities, it is possible to manage the risk factors of mental health distress in nurses and improve their mental health status.

Designing a Process Model of Home Care Service Delivery in Iran: A Mixed Methods Study.

BACKGROUND: Considering the position of home health care in the current world, the objective of this study was to design an applied model of providing home care services in Iran. METHODS: The mixed methods approach was employed in three stages in Iran from Feb 2015 to Sep 2016. During the first phase, the qualitative method of content analysis was used. Data were collected by conducting 26 individual interviews and holding one focus group session involving 7 people. Data analysis was based on Graneheim and Lundman's approach to content analysis. In the second phase of the study, a literature review was carried out and at the end of this stage, a preliminary model was designed. The model was standardized in the third phase using the Delphi method with 23 participants in two rounds. RESULTS: In the first and second stages of the study, various categories emerged including patient referral, agreement, determination of the needed level of care, care plans designing, provision of comprehensive services, documentation, service monitoring, inter-professional cooperation, issuance of death certificates at home, ethical considerations, and the evaluation of services. Then, in the Delphi phase, 20 (95.2%) of the experts confirmed the structure and content of the model and its applicability. CONCLUSION: The designed model can be helpful in organizing the provision of integrated and comprehensive health services to clients at home, which can be effective in improving the clients' health and enhancing their self-care and autonomy.

Exploring health care providers' perceptions about home-based palliative care in terminally ill cancer patients.

BACKGROUND: According to the World Health Organization, palliative care is one of the main components of healthcare. As the incidence of cancer is increasing in the world, home-based palliative care can be beneficial for many patients. This study was designed to explore health care providers' perceptions about home-based palliative care in terminally ill cancer patients. METHODS: This qualitative study was carried out using the conventional content analysis from October 2016 to September 2018 in Iran. Participants were home care providers who were selected using purposive sampling. The data were collected through 18 individual interviews, and a focus group meeting. Data were analyzed based on the method proposed by Lundman and Graneheim. RESULTS: from the data analysis, 511 initial codes were extracted, which were categorized into the two main categories of challenges and opportunities for home-based palliative care and 10 subcategories. The subcategories of challenges included deficiencies in inter-sectoral and inter-professional cooperation, lack of infrastructures for end-of-life care, challenges related to the management of death, challenges of transferring patients to home, providing non-academic palliative care, lack of political commitment of the government and Spiritual vacuum. The category of opportunities included subcategories of cost-effectiveness, moving towards socializing health, and structure of the health system. CONCLUSIONS: Home-based palliative care requires government and health system support. Structural and process modification in the healthcare can provide conditions in which terminally ill cancer patients receive appropriate care in home and experience death with dignity through support of family, friends and healthcare.

Exploration of the administrative aspects of the delivery of home health care services: a qualitative study.

BACKGROUND: Because of the variety of services and resources offered in the delivery of home health care, its management is a challenging and difficult task. OBJECTIVES: The purpose of this study was to explore the administrative aspects of the delivery of home health care services. METHODS: This qualitative study was conducted based on the traditional content analysis approach in 2015 in Iran. The participants were selected using the purposeful sampling method and data were collected through in-depth semi-structured personal interviews and from discussions in a focus group. The collected data were analyzed using the Lundman and Graneheim method. RESULTS: 23 individuals participated in individual interviews, and the collected data were categorized into the two main themes of policymaking and infrastructures, each of which consisted of some subcategories. CONCLUSION: Health policymakers could utilize the results of this study as baseline information in making decisions about the delivery of home health care services, taking into account the contextual dimensions of home care services, leading to improvements in home health care services.

Exploring the Position of Community-Based Nursing in Iran: A Qualitative Study.

BACKGROUND: Community-based nursing focuses on providing health services to families and communities in the second and third levels of prevention and this can improve the individuals, families and communities' quality of life, and reduce the healthcare costs. The aim of this study was to explore the status of community-based nursing in Iran. METHODS: This qualitative study was conducted from March to November 2015, in Tehran, Iran, using the content analysis approach. The study setting consisted of Iran and Tehran Faculties of Nursing and Midwifery, Tehran, Iran. The purposive sampling method was used. Twenty faculty members and Master's and PhD students were interviewed by using the face-to-face semi-structured interview method. Moreover, two focus groups were conducted for complementing and enriching the study data. The data were analyzed using the Graneheim and Lundman's approach to content analysis. The trustworthiness of the study findings was maintained by employing the Lincoln and Guba's criteria of credibility, dependability, and confirmability. RESULTS: In total, 580 codes were generated and categorized into three main categories of conventional services, the necessity for creating infrastructures, and multidimensional outcomes of community-based nursing. CONCLUSION: Introducing community-based nursing into nursing education curricula and creating ample job opportunities for community-based nurses seem clearly essential.

Customers' satisfaction about prehospital emergency medical services in Lorestan, Iran.

INTRODUCTION: Patient's satisfaction with health care in ambulance services is an important quality indicator and a helpful tool for managers of prehospital emergency services. This study aimed to measure patient satisfaction with health provided by prehospital emergency medical services (EMS) in Lorestan, Iran. METHODS: This cross-sectional study was conducted on patients (n=450) transferred by EMS to hospitals of Lorestan University of Medical Sciences in a two-year period (2013-2014). Data collection was performed by patient questionnaire, which is a standard LKFR tool. Validity and reliability of the instrument was confirmed by scientific method. Collected data were analyzed by SPSS Version 19. Descriptive and inferential statistics such as Chi-square, paired-samples t-test, independent-samples t-test, ANOVA, Pearson's product-moment correlation coefficient, and Fisher's exact test were used. RESULTS: One hundred ninety-two (42.8%) and 257 (57.2%) patients were female and male, respectively (mean: 41 years, r: 37-83). Patient satisfaction of the dispatcher was good, and satisfaction level in regards to the technicians' performance, physical situation, and facilities inside the ambulance was moderate. The Wilcoxon test did not show any significant difference between pain severity before and after arriving EMS in the cardiac and respiratory patients (p=0.691), but severity of pain in orthopedic patients after arriving EMS was decreased (p=0.001). Cardiac and respiratory patients had low satisfaction of EMS, and the Chi-square test was significant (p=0.001). Orthopedic patients had the most satisfaction of EMS. CONCLUSION: Generally, patients' satisfaction of EMS was low. Satisfaction with pain relief in orthopedic patients was better than pain relief in cardiac and respiratory patients. It is recommended to take necessary actions to improve the level of patient satisfaction of EMS.

Breast and cervical cancer-screening uptake among females in Ardabil, northwest Iran: a community-based study.

PURPOSE: Breast and cervical cancers are the most commonly diagnosed type of cancer and cause of cancer-related deaths in Iranian females. In contrast to previous studies, this study was carried out with a large sample size for assessment of breast self-examination (BSE)-, clinical breast examination (CBE)-, mammography-, and Pap smear-uptake rates and determination of associations among these screening behaviors with sociodemographic and cognitive variables in Azeri females. MATERIALS AND METHODS: This was a cross-sectional, community-based study that was carried out among 1,134 females 20-60 years old during March-June 2016. Data-collection variables included sociodemographic questions, screening behaviors for breast and cervical cancer, self-efficacy, beliefs, and barriers to breast and cervical cancer screening. Collected data were analyzed by SPSS version 13 using χ2, Mann-Whitney U, and logistic regression tests. RESULTS: Among the 1,134 participants, 53.9%, 9.8%, and 28.1% had done BSE, CBE, and Pap smear tests, respectively, and among the 625 females aged >40 years, 187 (29.9%) had done the mammography test. Moreover, 416 (36.7%), 103 (16.5%), and 64 (5.6%) females had done BSE, mammography, and CBE regularly, respectively. Beliefs, barriers, income, health insurance, number of children, and age were all important factors for BSE and regular BSE and mammography. Females who had high belief scores were more likely to undertake mammography (odds ratio [OR]: 1.2, 95% confidence interval [CI]: 1.03-1.5), regular mammography (OR: 4.2, 95% CI: 1.9-9.3), regular CBE (OR: 1.25, 95% CI: 1.2-1.3), and Pap smears (OR: 1.2, 95% CI: 1.1-1.4). Also, females who had high self-efficacy scores were more likely to perform regular BSE (OR: 1.8, 95% CI: 1.4-2.5) and mammography (OR: 2.5, 95% CI: 1.4-4.6) than females with lower self-efficacy scores. CONCLUSION: The frequency of breast and cervical cancer screening was low in our study. The findings of this study indicated that beliefs, self-efficacy, and barriers were important predictive factors of cancer-screening behavior among the females studied.

The Comparison of Dietary Behaviors among Rural Controlled and Uncontrolled Hypertensive Patients.

Nutrition is a dominant peripheral factor in increasing blood pressure; however, little information is available about the nutritional status of hypertensive patients in Iran. This study aimed to compare nutritional behaviors of the rural controlled and uncontrolled hypertensive patients and to determine the predictive power of nutritional behaviors from blood pressure. This cross-sectional study was conducted on 671 rural hypertensive patients, using multistage random sampling method in Ardabil city in 2013. Data were collected by a 3-day food record questionnaire. Nutritional data were extracted by Nutritionist 4 software and analyzed by the SPSS 18 software using Pearson correlation, multiple linear regression, ANOVA, and independent t-test. A significant difference was observed in the means of fat intake, cholesterol, saturated fat, sodium, energy, calcium, vitamin C, fiber, and nutritional knowledge between controlled and uncontrolled groups. In the controlled group, sodium, saturated fats, vitamin C, calcium, and energy intake explained 30.6% of the variations in blood pressure and, in the uncontrolled group, sodium, carbohydrate, fiber intake, and nutritional knowledge explained 83% of the variations in blood pressure. There was a significant difference in the nutritional behavior between the two groups and changes in blood pressure could be explained significantly by nutritional behaviors.