Effectiveness of theory-based educational interventions of promoting oral health among elementary school students.

BACKGROUND: The aim of the present study was to determine the effect of oral health education programs on the oral health of primary school students. METHODS: In this randomized controlled trial study, 190 elementary fifth-grade female students were chosen using the multistage cluster sampling method. In this study, the Plaque Index (PI), Simplified Oral Hygiene Index (OHI-S), Community Periodontal Index (CPI), tooth brushing using fluoride toothpaste, dental flossing frequency and factors affecting them were determined according to social cognitive theory (SCT). Interventions were implemented using the play method and with the help of three pamphlets, five posters, a celebration of oral health, and the creation of a Telegram group. Data were analyzed using descriptive statistics indexes, t tests, paired sample t tests, chi-square tests, and Pearson correlation tests. RESULTS: The results showed that 3 months after the intervention, compared to before the intervention, the percentage of participants in the intervention group who brushed their teeth twice or more per day increased by 48.5%, and the percentage of participants who used dental floss at least once per day increased by 64.2%. The rate of gum bleeding decreased by 6.3%. The good OHI-S rate increased by 44.4%. Dental plaque decreased by 38.1%. CONCLUSION: The results demonstrated that a gamification design can be effective and useful in promoting the oral health of students. TRIAL REGISTRATION: registration timing: retrospective, registration date: 18/10/2022, registration number: IRCT20141128020129N2.

The impact of health education interventions on oral health promotion among older people: a systematic review.

BACKGROUND: One of the most common pathologic changes in older people is oral and dental problems. The oral health of older people is a public health concern. Promotion of good oral health for this cohort will have beneficial impacts on the longer-term quality of life. This study aimed to identify the types of health education interventions for the oral health of older people and to determine their effects on the oral and dental health of older people. METHODS: Potential articles were retrieved from four electronic databases (PubMed/Medline, Scopus, Web of Sciences, and Embase) up to 31 September 2022 in English without limit of time. Experimental and quasi-experimental interventional studies investigating the impact of educational interventions on oral and dental health among older people over 60 years old in both sexes were considered. The quality assessment tool was the Effective Public Health Practice Project (EPHPP). RESULTS: In the initial search, 1104 articles were retrieved. Finally, according to the inclusion criteria, 23 studies (seventeen randomized controlled trials (RCT) and six quasi-experimental studies) were reviewed. In this review, educational interventions for older people and their caregivers are classified. Theoretical frameworks were used in only three interventions related to older people. Outcome measures were both self-reported and objective measures. Fifteen of the included studies were of moderate quality. CONCLUSION: This review provides evidence that the use of oral and dental health educational interventions was effective in improving the oral health of older people. Educational interventions were carried out both among older people and among their caregivers. Although a variety of interventions were used in the reviewed studies, more lectures were used in the interventions related to older people. In the interventions related to caregivers, in addition to lectures, practical education was also used. It is recommended to perform higher quality studies for assessing the effectiveness of interventions in this field.

Cultural appropriateness in randomized controlled trials (RCTs) aimed at reducing pesticide exposure among farmers and farmworkers: a systematic review.

OBJECTIVE: The widespread use of pesticides poses serious health hazards to farmers and their families. Some evidence shows that culturally sensitive interventions could be associated with improved outcomes; however, little is known about the effectiveness of cultural adaptations in interventions among farmers and farmworkers. Therefore, the purpose of this study was to summarize strategies used in the cultural adaptation interventions addressing the reduction of pesticide exposure in farmers and farmworkers, as well as assessing the effects of these strategies. METHODS: A comprehensive systematic literature search was conducted on PubMed, Embase, Clarivate Web of Science, Scopus, NIOSHTIC, Agricola, Agris, as well as reference lists to identify randomized controlled trials (RCTs) published in English from January 2000 until March 2022. Data were extracted to examine the characteristics of interventions in terms of the cultural adaptation strategies and their effectiveness by two independent reviewers. RESULTS: Eleven articles from ten trials met the inclusion criteria. The majority of studies were conducted in the USA (n = 7) and were ranked as poor quality (n = 5). Four of the ten studies were rated moderate, and six were rated weak. The socio-cultural and constituent-involving strategies were the most commonly reported across the included studies, followed by linguistic strategy. Six studies (seven articles) were tailored for subgroups or individuals. Overall, 8 of 10 studies reported significant changes in whole and some outcomes in the intervention groups over controls. Seven studies received moderate cultural adaptation scores which may reflect the moderate effectiveness of the interventions. CONCLUSION: Our review underscored the paucity and low quality of existing studies investigating the culturally adapted interventions in reducing farmers' and farmworkers' pesticide exposure. Future high-quality culturally sensitive studies could increase our knowledge regarding the culture's role in reducing pesticide exposure in farmers and farmworkers.

Identification of factors related to behaviors associated with musculoskeletal pain among elementary students.

BACKGROUND: Musculoskeletal pains are among evident health problems in children and adolescents. Backpack carrying behaviors and the sitting postures are among behavioral factors associated with musculoskeletal pain in schoolchildren. Therefore, this study aims to identify the factors related to these important musculoskeletal behaviors, using Health Promotion Models. METHODS: In this cross-sectional study, a questionnaire was created based on PRECEDE Model and Health Belief Model and was administered to 673 Iranian students, whom were selected randomly from elementary schools of Hamadan, Iran, in 2018. RESULTS: The findings of the study revealed that proper sitting postures and backpack carrying were 42 and 33%, respectively. The findings also showed that predisposing factors including perceived susceptibility (p < 0.05, ß = 0.219), perceived severity (p < 0.05, ß = 0.166), perceived barriers (p < 0.05, ß = - 0.191), perceived self-efficacy (p < 0.05, ß = 0.188) and also enabling factors (p < 0.05, ß = 0.329) were significantly related to sitting behaviors. Moreover, backpack carrying behaviors had significant relationships with predisposing factors of perceived susceptibility (p < 0.05, ß = 0.198), perceived barriers (p < 0.05, ß = - 0.258), perceived self-efficacy (p < 0.05, ß = 0.185) and reinforcing factors (p < 0.05, ß = 0.208). CONCLUSIONS: It seems necessary for future preventive programs to take factors of musculoskeletal pains among children and adolescents into account.

Development and Psychometric Testing of the Signed Donor Card (SDC) Scale in an Islamic Society.

The signed donor card is an important method to overcome the shortage of organs for transplantation. A valid and reliable scale is necessary to have with the development of interventions to increase the signed donor card. This study aimed to develop and psychometric testing of the Signed Donor Card (SDC) in an Islamic society. This methodological study was conducted in Hamadan city, Iran in 2018 on 600 employees of offices. A 46-item scale was developed. It was assessed by face, content, and construct validities. Reliability was examined using the calculation of the Cronbach's α and test-retest method. The SPSS software version 22 and Mplus version 7.4 were used for data analysis. Our scale demonstrated acceptable internal consistency (α = 0.58-0.93) and good test-retest reliability (ICC = 0.76). The fitness indices for the confirmatory factor analysis (CFA) indicated that the model fit was good. CFA revealed nine standalone components including attitude, subjective norms, intention, anticipated regret, descriptive norms, perceived control, knowledge, non-cognitive beliefs, and religious beliefs. Convergent validity and discriminant validity were established. This study provided evidence concerning the validity and reliability of SDC scale. It can be used for the development and implementation of effective interventions for increasing signed donor card with the consideration of contextual and cultural situations.

Effect of TQM educational interventions on the management policy standard of health promoting hospitals.

The purpose of this study was to manage total quality management (TQM) to increase the standard of management policy and contribute to achieve the standards for health promotion hospitals (HPHs). This was a quasi-experimental intervention study. A total of 35 managers participated in this study were selected in the census. Based on the TQM components, educational items were provided as lectures, posters and pamphlets. The TQM questionnaire and HPHs checklist used to collect data in three different periods: before the interventions, immediately after the interventions and 3 months after the interventions (follow-up). The data analysis was done by means of SPSS software (version 23). The results showed that the average difference of the components of the qualitative groups (p < 0.001), education (p = 0.004), evaluation and feedback (p < 0.001), customer-orientation (p < 0.001), suggestion system (p = 0.024), leadership commitment (p < 0.001) was significant over the three periods. Excluding the employment status before the educational intervention (p = 0.002), there was no significant relationship between the demographic characteristics and mean score of TQM (p > 0.05). Based on the findings of this study, the educational interventions had a positive effect on quality management and management policy. Therefore, educational interventions should be accompanied by changes in the culture and management policies of the hospital to meet HPH standards.

Predictors of oral health promotion behaviors among elementary school children: Examination of an extended social cognitive theory.

BACKGROUND: Brushing teeth with fluoride-containing toothpaste and flossing are considered as effective solutions for preventing dental caries and periodontal diseases. AIM: The aim of this study was to use the promoted social cognitive theory (SCT) to investigate factors influencing adherence to oral hygiene behaviors by elementary school children. DESIGN: In this cross-sectional study, 988 elementary school children were chosen using the multistage cluster sampling method. Data were collected using the SCT scale, and its validity and reliability were confirmed. Theoretical models were examined using the structural equation modeling. RESULTS: The SCT explained 50% of the variance in brushing with fluoridated toothpaste and 55.6% of the variance in flossing behaviors. The total effect of family environment (ß = .60, P < .05), self-efficacy in overcoming impediments (ß = .50, P < .05), and emotional coping (ß = .40, P < .05) variables in the conceptual model had significantly influenced tooth brushing behavior. The total effect of self-efficacy (ß = .79, P < .05), family environment (ß = .41, P < .05), and situational perception (ß = .35, P < .05) variables of the conceptual model significantly influenced the flossing behavior. CONCLUSIONS: The SCT, self-efficacy, and family environment were strongly associated with brushing and flossing behaviors. Therefore, supportive family environments should be considered as one of the top contributors to successful oral health promotion.

Barriers and facilitators to the implementation of doctor-nurse substitution strategies in primary care: a qualitative evidence synthesis.

BACKGROUND: Having nurses take on tasks that are typically conducted by doctors (doctor-nurse substitution, a form of 'task-shifting') may help to address doctor shortages and reduce doctors' workload and human resource costs. A Cochrane Review of effectiveness studies suggested that nurse-led care probably leads to similar healthcare outcomes as care delivered by doctors. This finding highlights the need to explore the factors that affect the implementation of strategies to substitute doctors with nurses in primary care. In our qualitative evidence synthesis (QES), we focused on studies of nurses taking on tasks that are typically conducted by doctors working in primary care, including substituting doctors with nurses or expanding nurses' roles. OBJECTIVES: (1) To identify factors influencing implementation of interventions to substitute doctors with nurses in primary care. (2) To explore how our synthesis findings related to, and helped to explain, the findings of the Cochrane intervention review of the effectiveness of substituting doctors with nurses. (3) To identify hypotheses for subgroup analyses for future updates of the Cochrane intervention review. SEARCH METHODS: We searched CINAHL and PubMed, contacted experts in the field, scanned the reference lists of relevant studies and conducted forward citation searches for key articles in the Social Science Citation Index and Science Citation Index databases, and 'related article' searches in PubMed. SELECTION CRITERIA: We constructed a maximum variation sample (exploring variables such as country level of development, aspects of care covered and the types of participants) from studies that had collected and analysed qualitative data related to the factors influencing implementation of doctor-nurse substitution and the expansion of nurses' tasks in community or primary care worldwide. We included perspectives of doctors, nurses, patients and their families/carers, policymakers, programme managers, other health workers and any others directly involved in or affected by the substitution. We excluded studies that collected data using qualitative methods but did not analyse the data qualitatively. DATA COLLECTION AND ANALYSIS: We identified factors influencing implementation of doctor-nurse substitution strategies using a framework thematic synthesis approach. Two review authors independently assessed the methodological strengths and limitations of included studies using a modified Critical Appraisal Skills Programme (CASP) tool. We assessed confidence in the evidence for the QES findings using the GRADE-CERQual approach. We integrated our findings with the evidence from the effectiveness review of doctor-nurse substitution using a matrix model. Finally, we identified hypotheses for subgroup analyses for updates of the review of effectiveness. MAIN RESULTS: We included 66 studies (69 papers), 11 from low- or middle-income countries and 55 from high-income countries. These studies found several factors that appeared to influence the implementation of doctor-nurse substitution strategies. The following factors were based on findings that we assessed as moderate or high confidence.Patients in many studies knew little about nurses' roles and the difference between nurse-led and doctor-led care. They also had mixed views about the type of tasks that nurses should deliver. They preferred doctors when the tasks were more 'medical' but accepted nurses for preventive care and follow-ups. Doctors in most studies also preferred that nurses performed only 'non-medical' tasks. Nurses were comfortable with, and believed they were competent to deliver a wide range of tasks, but particularly emphasised tasks that were more health promotive/preventive in nature.Patients in most studies thought that nurses were more easily accessible than doctors. Doctors and nurses also saw nurse-doctor substitution and collaboration as a way of increasing people's access to care, and improving the quality and continuity of care.Nurses thought that close doctor-nurse relationships and doctor's trust in and acceptance of nurses was important for shaping their roles. But nurses working alone sometimes found it difficult to communicate with doctors.Nurses felt they had gained new skills when taking on new tasks. But nurses wanted more and better training. They thought this would increase their skills, job satisfaction and motivation, and would make them more independent.Nurses taking on doctors' tasks saw this as an opportunity to develop personally, to gain more respect and to improve the quality of care they could offer to patients. Better working conditions and financial incentives also motivated nurses to take on new tasks. Doctors valued collaborating with nurses when this reduced their own workload.Doctors and nurses pointed to the importance of having access to resources, such as enough staff, equipment and supplies; good referral systems; experienced leaders; clear roles; and adequate training and supervision. But they often had problems with these issues. They also pointed to the huge number of documents they needed to complete when tasks were moved from doctors to nurses. AUTHORS' CONCLUSIONS: Patients, doctors and nurses may accept the use of nurses to deliver services that are usually delivered by doctors. But this is likely to depend on the type of services. Nurses taking on extra tasks want respect and collaboration from doctors; as well as proper resources; good referral systems; experienced leaders; clear roles; and adequate incentives, training and supervision. However, these needs are not always met.

Neck and shoulder pain among elementary school students: prevalence and its risk factors.

BACKGROUND: Neck and shoulder pain is relatively common among children and teenagers and has a negative impact on their physical and psychological health. This study was carried out to assess the prevalence of neck and shoulder pain among elementary school students, and to investigate the relationship between this pain and its risk factors. METHODS: In this cross-sectional study, 693 elementary school students aged 7 to 12 years from Hamadan city, located in western Iran, were selected through the multistage cluster random sampling method. Data were collected through interviews and questionnaires. For the social and psychological variables, the parent version of the Strengths and Difficulties Questionnaire (SDQ) was used. For assessing each student's posture, an observational checklist, the Rapid Upper Limbs Assessment (RULA), was used. The data was analyzed using the unadjusted (univariate) and adjusted (multivariate) logistic regression. RESULTS: The prevalence of the neck pain was slightly higher than that of shoulder pain. The prevalence reported over a month was 35.8 and 30.9% for neck and shoulder pain, respectively. The logistic regression analyses showed that, very high desk height (odds ratio (OR) =1.96, 95% confidence interval CI: 1.02-3.74), backward seat pan inclination (OR = 2.10, 95% CI: 1.37-3.24), forward seat pan inclination (OR = 3.12, 95% CI:1.46-6.68), difficulty in viewing the board (OR = 2.54, 95% CI: 1.10-5.84), too much homework (OR = 2.59, 95% CI: 1.49-4.51), RULA score at level III (OR = 2.88, 95% CI:1.64-5.05), and RULA score at level IV (OR = 3.12, 95% CI: 1.72-5.63) increased the risk of neck pain independently. On the other hand, sitting on desk and seat (OR = 0.59, 95% CI: 0.39-0.91) and laying position for doing homework (OR = 0.53, 95% CI: 0.34-0.81) reduced the related risk. Very short desk height (OR = 2.41, 95% CI: 1.26-4.61) and too much homework (OR = 1.94, 95% CI: 1.10-3.42) increased the risk of shoulder pain. CONCLUSION: The elementary school students reported a high prevalence of shoulder and neck pain. This study found that improper sitting positions, as well as physical factors such as the school furniture, too much homework, and difficulty in viewing the classroom board, were associated with pain. Proper interventions considering the risk factors assessed in this study, are suggested.

Health promoting hospitals in Iran: A review of the current status, challenges, and future prospects.

Background: Health promoting hospitals (HPHs), in addition to their routine diagnosis and treatment services, concentrate on health enhancement and disease prevention. This study was conducted to systematically review studies conducted in the field of health promoting hospitals (HPH) in Iran to achieve HPH standards. Methods: Electronic search was conducted from October to February 2016 in Persian and English databases. Search was done IranMedex, SID, ISI Web of Knowledge, ScienceDirect, PubMed, and Google Scholar with the following keywords: Health promotion hospital (s), health promoting hospital (s), health promotion hospitals, HPH, and Iran. Based on inclusion and exclusion criteria and the aim of the study, 10 studies were selected to be reviewed. Results: The results showed that HPH standards in studied hospitals were very poor in overall standard and that the standard of management policy had the lowest mean. Studies conducted in the order modeling HPH in Iran showed that factors of patient empowerment and society had the greatest impact and needs assessment had the lowest impact. The results of interventional studies were reviewed in this study and it was found that implementing standards of HPH and educational interventions increase the standard of HPH. Conclusion: The review of the HPH studied indicated that the most important challenge in achieving the standards of health promotion hospitals is Iran's hospital policy, which is more treatment-oriented.

Is an Iranian Health Promoting School status associated with improving school food environment and snacking behaviors in adolescents?

The Iranian Health Promoting Schools (IHPS) program was first piloted and then formally established in Iran in 2011 as a framework to promote healthy environment and behaviors such as proper dietary practice among adolescents. This study examined the role of IHPS in improving the school food environment and snacking behaviors among adolescents. In this cross-sectional study, 1320 eighth grade students from 40 middle schools with IHPS and non-IHPS program were selected using a proportional stratified random sampling method. A modified 55-item qualitative Food Frequency Questionnaire was used to assess the frequency of consumption of healthy and unhealthy snacks in the studied adolescents. Mixed effect negative binomial regression models were used to analyze the data. The association was also adjusted for individual variables, including gender, socio-economic status, pocket money, family structure and nutritional knowledge level. No significant difference was observed between the average of healthy and unhealthy snack items in IHPS and non-IHPS schools (p > 0.05). On the basis of adjusted analysis, being from/in IHPS was not associated with weekly frequency consumption of unhealthy [prevalence rate ratio (PRR) = 0.99; 95% CI: 0.85-1.16] and healthy (PRR = 1.08; 95% CI: 0.96-1.2) snacks among the adolescents. There was no difference regarding school food environment and snacking behaviors in IHPS and non-IHPS schools. This might indicate that there has been a weakness in institutionalizing the comprehensive concepts of the HPS approach in the studied schools. Addressing the proper understanding of HPS approach and the need for development of HPS through matching and adaptability with health promotion actions to reach defined standards, is necessary.

Acute pesticide poisoning and related factors among farmers in rural Western Iran.

Although acute pesticide poisoning (APP) is known to be a major health concern among farmers in developing countries, knowledge of its prevalence and risk factors is limited. The purpose of this study was to investigate the prevalence and a broad range of potential work-related risk factors of APP among Iranian farmers and farm workers. This cross-sectional study was conducted in rural areas of the Twiserkan County in Iran. In this study, there were 474 farmers and farm workers who had used pesticide 1 week before data collection. Participants were selected from 104 villages. Data were gathered using a questionnaire and analyzed using STATA (version 14.2 SE). Binary logistic regression and multinomial logistic regression were employed. The results of this study showed that 286 (60.3%) farmers and farm workers who applied pesticides suffered from work-related APP. Most frequent APP symptoms were runny nose (29.8%) and headache (25.1%). Five risk factors were identified, including annual income ( p < 0.05), number of farming years (odds ratio (OR) = 0.31), number of spraying years (OR = 2.40), place of pesticide storage (OR = 2.69), and type of sprayer ( p < 0.05). The results of this study indicated that APP is prevalent among the studied farmers. Some work-related factors play an important role in APP among Iranian rural farmers. In addition, the magnitude of these risk factors differed significantly by severity of acute and somatic pesticide poisoning.

Association of caries experience and dental plaque with sociodemographic characteristics in elementary school-aged children: a cross-sectional study.

BACKGROUND: Dental caries among Iranian elementary school children aged 6-12 years continue to rise. To estimate treatment needs and guide health initiatives, current epidemiologic data are required. Such data are currently unavailable for dental health. The purpose of this study was to assess caries experience, dental plaque, and associated factors in elementary school-aged children from Iran. METHODS: In this cross-sectional study, 988 elementary school children aged 7-12 years were selected by multistage cluster sampling. Dental caries was studied using the WHO criteria, dental plaque was examined according to O'Leary index. Data on parental education and occupation, living district, dental pain within the past year, and tooth brushing habits under parental supervision were collected through interviews based on questionnaire. The data were analyzed with descriptive statistics and logistic and linear regression. RESULTS: The mean (SD) age of the elementary school children was 9.64 (1.73) years. The highest dmft was seen in elementary school children aged 7-8 years 6.53 (4.37) and the highest DMFT and dental plaque was in 12 year olds recorded as 1.17 (1.77) and 51.97 (25.86), respectively. The proportion of decayed teeth in 7 years old elementary school based on dmft index was 80.36%, moreover, the proportion in 12 years old elementary school was 40.17% based on the DMFT index. Age, gender, and dental pain within the past year were significantly associated with DMFT and dmft. The odds of developing dental caries (DMFT) was 1.70 times higher in girls than in boys (p < 0.001) and 1.72 times higher in the students that reported dental pain frequently than in those who did not (p = 0.005). The chance of developing dental caries (dmft) was 0.47 times lower in girls than boys (p < 0.001). Age was significantly correlated with dental plaque such that Plaque Index increased by 2.44 times per one year increase in age (p < 0.001). CONCLUSION: Results indicated that dental caries experience and plaque formation among elementary school children in Hamadan were high and they were influenced by their sociodemographic factors. The associations found can be used as a helpful guide for planning accurate preventive programs for elementary school children in this region.

An Examination of the Past Behaviour-Intention Relationship in the Case of Brushing Children's Teeth.

PURPOSE: The present study sought to apply the expanded theory of planned behaviour (TPB) to the prediction of mothers' intention to brush their children's teeth and examine the mediating role of the variables of the TPB on the relationship between past behaviour and the intention. MATERIALS AND METHODS: This cross-sectional study was carried out among 211 mothers with children ages 2 to 5 years. Participants completed measures of the TPB (i.e. attitude, subjective norm, perceived control and intention) and past behaviour in relation to brushing. Regression analyses were conducted to explore the predictors of mothers' intention. Mediation was assessed using Preacher and Hayes' INDIRECT.SPSS macro. RESULTS: The TPB explained 25% of the variance in brushing intention, with attitude, subjective norms and perceived behavioural control making significant contributions. Past behaviour explained an additional 3% of the variance in intention. Analysis showed that TPB variables only partially mediate the effect of past behaviour on intention. CONCLUSIONS: Our findings revealed that mothers' intention to brush their children's teeth is under the control of both past behaviour and psychological factors. Accordingly, interventions to improve children's toothbrushing should focus on the motivational (e.g. attitude) as well as the habitual determinants (e.g. environmental cues). However, given the low explanatory power of our model, it may be necessary to incorporate other psychological and environmental variables into an explanation of the mothers' intention to brush their children's teeth.

The rate of antibiotic utilization in Iranian under 5-year-old children with acute respiratory tract illness: A nationwide community-based study.

BACKGROUND: To investigate the prevalence of antibiotic usage in children aged <5 years with acute respiratory tract illness (ARTI) in Iran. MATERIALS AND METHODS: Data were collected from a national health survey conducted in 2010 (Iran's Multiple Indicator Demographic and Health Survey). Participants of this cross-sectional study were selected by multistage stratified cluster-random sampling from 31 provinces of Iran. Parents of children with <5 years of age responded to questions about the occurrence of any cough during the previous 2 weeks, referral to private/governmental/other health care systems, and utilization of any oral/injection form of antibiotics. Data were analyzed using SPSS software18. The chi-square test was used to determine antibiotic consumption in various gender and residency groups and also a place of residence with the referral health care system. RESULTS: Of the 9345 children under 5 years who participated in the study, 1506 cases (16.2%) had ARTI during 2 weeks prior to the interview, in whom 1143 (75.9%) were referred to urban or rural health care centers (43.4 vs. 30.4%; P < 0.001). Antibiotics were utilized by 715 (62.6%) of affected children. Injection formulations were used for 150 (13.1%) patients. The frequency of receiving antibiotics was higher in urban than in rural inhabitants (66.0% vs. 57.7% P < 0.05). CONCLUSION: The prevalence of total and injection antibiotics usage in children <5 years with ARTI is alarmingly high in Iran. Therefore, interventions to reduce antibiotic use are urgently needed.

Determinants of medication adherence among elderly with high blood pressure living in deprived areas.

INTRODUCTION: The current study was conducted to determine the impact of health literacy and factors related to adherence to drug treatment, using the model proposed by the World Health Organization, in older adults with hypertension residing in informal settlements in Hamadan. METHODS: This cross-sectional study was conducted on 405 patients in Hamadan city, located in the western part of Iran. Data were collected using an interviewer-administered questionnaire that included the 5-dimensional model proposed by the World Health Organization, Health Literacy for Iranian Adults, and Morisky Medication Adherence Scale-8. A two-stage sampling procedure was used to select patients from 14 comprehensive health service centers and health bases. The data were analyzed using SPSS v.24. RESULTS: The study found that medication adherence was suboptimal in 63% of the participants. Additionally, 87.5% of patients had inadequate or insufficient health literacy. Factors related to medication adherence included age (odds ratio (OR) = 1.07), annual income (OR = 0.17), duration of hypertension (OR = 7.33), health literacy (OR = 1.03), self-reported health status (P < 0.05), and regular medication use (P < 0.008). CONCLUSION: The results of this study indicate that more than half of the older adults in the study had suboptimal medication adherence and insufficient health literacy. The study also found that various factors, such as socioeconomic status, disease and treatment-related factors, and patient-related factors, influence medication adherence among older adults.

Socio-Cultural Factors Contributing to Being an Organ Donor in Iranian Employees.

AIMS: The purpose of this study was to use a culturally modified Organ Donation Model (ODM) to explore the significant factors and ways in which these factors could influence signing the donor card. METHODS: This cross-sectional study was conducted among 600 employees from 57 offices in Hamadan, Iran, in 2018. Participants were selected randomly and surveyed on being a donor and their perceptions regarding signing the donor card. Structural equation modeling (SEM) was conducted to determine the inter-relationship between the studied variables. RESULTS: Participants' mean age was 39.5 (SD = 7.0). 20% of participants had a signed donor card. Descriptive norms (ß = 0.53, p < 0.001), non-cognitive beliefs (ß=-0.33, p < 0.001), anticipated regret (ß = 0.28, p < 0.001) and subjective norms (ß=-0.17, p < 0.01) had significant direct effects on signing the donor card. CONCLUSION: This study provides socio-culturally informed evidence on individuals' signing donor card. These factors could provide a guide to policymakers to develop the community-based interventions.

Assessment of Met and Unmet Care Needs in Older Adults without Mental Disorders using the Camberwell Assessment of Need for the Elderly: A Systematic Review and Meta-analysis.

BACKGROUND: Physical, psychological, and social changes in the aging lead to new needs in the care of the elderly. The Camberwell Assessment of Need for the Elderly (CANE) evaluates older adults' care needs. This study aimed to assess the types of needs of the elderly using the CANE questionnaire. STUDY DESIGN: A systematic review. METHODS: This systematic review included all cross-sectional studies. International databases, including Web of Sciences, Medline, Scopus, and ProQuest were searched up to June 2021. Such keywords as aged OR ageing OR "older adults" OR "older people" OR "older person" OR elderly, AND need OR "needs assessment" OR "met needs" OR "unmet needs" were used to design the search strategy. A 95% CI was calculated using the exact method, and the meta-analysis of proportion (metaprob) module was used for data analysis. RESULTS: In total, 769 studies were retrieved in this review. At the following stages, 760 articles were excluded upon checking the duplicates; moreover, the titles and abstracts did not meet the eligibility criteria. Finally, nine studies remained. The mean±SD age of 2200 participants was obtained at 78.4±5.9 years. The highest and lowest met needs were related to the physical (45%) and social (21%) dimensions, respectively. Furthermore, the highest unmet needs were observed in the physical and social dimensions (0.07%), and the lowest unmet needs were related to the psychological and environmental dimensions (0.04%). CONCLUSIONS: The CANE is sensitive enough to identify unmet needs in different samples and settings. Therefore, a new care model and appropriate interventions for the elderly can be designed based on the CANE results.