Depression, Anxiety, and Perceived Social Support among Adults with Beta-Thalassemia Major: Cross-Sectional Study / 가정의학회지

BACKGROUND: Considering the high prevalence of depression and anxiety among thalassemia patients and the role of social support in preventing mental disorders, this study aimed to determine prevalence of depression, anxiety, and perceived social support (PSS) among adults with beta-thalassemia major. METHODS: This cross-sectional study was performed with 389 adults with beta-thalassemia major. Data were collected via a questionnaire consisting of three parts: demographic and medical information, the Persian version of the hospital anxiety and depression scale, and the Persian version of the Multidimensional Scale of Perceived Social Support. Data were analyzed using IBM SPSS ver. 23.0 (IBM Corp., Armonk, NY, USA) through analytical statistics (independent-samples t-test, one-way analysis of variance, Pearson correlation coefficient, and multilevel linear regression), and the results less than 0.05 were considered to be significant. RESULTS: The mean scores of depression, anxiety, and PSS of patients were 7.42±3.17, 7.47±4.35, and 41.8±8.64, respectively. Of 389 patients, 19.8% had depression and 23.7% had an anxiety disorder. Relationships of depression and anxiety with age, the level of education, job, and family income were statistically significant, as were those of PSS with age, thalassemia center, family income, job, and the level of education. PSS from family, friends, and significant others were the significant predictive factors of depression and anxiety among adult patients with beta-thalassemia major. CONCLUSION: Considering the PSS as a factor influencing the reduction in depression and anxiety in thalassemia patients, social support from the social networks (spouse, family members, friends, and healthcare workers) should be integrated with interventions that are designed to improve the mental and physical health of thalassemia patients.

Barriers to pap smear test for the second time in women referring to health care centers in the South of Tehran: a qualitative approach

Background: Cervical cancer is a preventable disease with a regular screening program. Many studies have reported a large number of barriers that women had for the first time, but this study decided to find other barriers for the second time pap smear

Methods: In this qualitative research, data were gathered through in-depth interviews and expressed through conventional content analysis in the form of constant comparison. The participants were 15 women with family profile at 30 health care centers who lived in the south of Tehran and had done Pap smear for one time but didn't do it for the second time

Results: Three main themes emerged from the analysis of the interviews: negative experiences of the first Pap test were as follows: results of the first time test, readiness for performing the test, getting the test itself, and the site of the first Pap test. Personal barriers to getting the second Pap test were: inattention to time, physical barriers to the second Pap test, and inhibitory beliefs. Perceived social barriers to getting the second Pap test with two sub-themes included social supports and abstract norms

Conclusion: This study provided other barriers about Pap smear including lack of the spouse's support, the role of health care providers and physicians in screening program for early diagnosis in women

Associations between a health-promoting lifestyle and quality of life among adults with beta-thalassemia major / 한국역학회지

OBJECTIVES: A health-promoting lifestyle (HPL) is a factor that affects the quality of life (QoL) in patients with beta-thalassemia (β-thalassemia). Due to the lack of studies of this issue, this study aimed to determine the association between HPL and QoL among adults with β-thalassemia. METHODS: This cross-sectional (descriptive-analytic) study was conducted among 389 adult patients with β-thalassemia in Tehran, Iran. The research instrument included a questionnaire consisting of three parts: demographic items, the Short-Form Health Survey and the Health-Promoting Lifestyle Profile. The data were analyzed using SPSS version 23.0. The results were considered significant at the conventional p<0.05 level. RESULTS: The mean age of the participants was 30.2±8.3 years. The mean score of the HPL dimensions was 127.28±21.53, and the mean score of the QoL domains was 61.44±23.38. The highest and the lowest mean scores of the HPL dimensions were found for spiritual growth (23.96±5.74) and physical activity (11.32±3.95), respectively. The QoL scores in all three domains (total, physical component summary score, and mental component summary score) were moderate. Health responsibility, physical activity, spiritual growth, and interpersonal relations were significant predictive factors of QoL in adults with β-thalassemia; these four dimensions explained 37.9% of the variance in QoL. CONCLUSIONS: QoL and HPL were not at acceptable levels among patients with thalassemia. Therefore, educational interventions emphasizing spiritual growth, physical activity, and interpersonal relations are necessary for patients with thalassemia.

Adherence and attrition in a web-based lifestyle intervention for people with metabolic syndrome

The aim of this study was to determine adherence and attrition rates in a lifestyle intervention for people with metabolic syndrome. Adherence and attrition data from a randomized controlled trial were collected. Participants were classified as adherence group if they completed assessments at 3 and 6 months follow-up and as attrition group if they did not. Physical activity and quality of life was measured using the International Physical Activity Questionnaire [IPAQ] and the Short Form Health Survey [SF-36]. Generalized Estimating Equations [GEE] was used to explore predictors of attrition. The mean age of participants [n=160] was 44.1 years. Attrition rate in the intervention and control groups at first follow-up were the same [20%]. However, the control group had significantly higher attrition rate [%33.7] compared to the intervention group [%20] at 6 months follow up. Results showed that low educated participants were more likely to not stay in the study than better educated participants [OR=2.95,CI:1.39-6.33,P=0.05]. According with length of the study, attrition was decreased at six month [OR=0.66,CI:0.52-0.83,P<0.001]. Also, some aspects of health-related quality of life contributed to the attrition rate. Those who had higher scores on general health [OR=0.66,CI:0.54-0.97,P=0.023], social functioning [OR=0.44,CI:0.40-0.76,P=0.032], role emotional [OR=0.74,CI:0.54-0.98,P=0.18], vitality [OR=0.55,CI:0.38-0.90,P=0.015] and mental health [OR=0.63,CI:0.45-0.85,P=0.033] were more likely to stay in the study. It remains a concern that Web-based lifestyle programs may fail to reach those who need it most. Participant in the study generally had better quality of life than those who were lost to follow up

Modifiable lifestyle risk factors and metabolic syndrome: opportunities for a web-based preventive program

Lifestyle is recognized as a key factor as the cause and management of the metabolic syndrome. The aim of this study was to identify individuals at increased cardiovascular diseases risk and determine main features of lifestyle of participants with metabolic syndrome via internet. The study was conducted from Jun 22 to August 22, 2012 in Tehran, Iran. Recruitment was carried out through the study website. Participants with metabolic syndrome who were interested and met the study criteria were invited for free clinic visits and clinical assessments. Baseline measurements were metabolic syndrome risk factors. Physical activity and dietary intake were measured by international physical activity questionnaire [IPAQ- short form] and the frequency food questionnaire [FFQ] respectively. Metabolic syndrome was defined according to Adult Treatment Panel III diagnostic criteria. Mean [SD] age for men and women were 41.9 [10.4] and 48.1 [7.8] yr respectively. Men were well educated and more likely to participate in the study than women. Men with metabolic syndrome had larger waist circumference [105.5] and lower BMI [29.1] than women with metabolic syndrome [P<0.001]. Approximately 73% of the sample was inactive and 3% of participants had health enhancing physical activity. There were significant differences in the intakes of total fat and cholesterol between men and women [P<0.001]. Because of the high prevalence of metabolic syndrome, national lifestyle modification policies must be developed for population. Web-based healthy lifestyle programs may contribute to the reduction of the metabolic syndrome components

Effectiveness of relapse prevention cognitive- behavioral model in opioid - dependent patients participating in the methadone maintenance treatment in Iran

To evaluate the effectiveness of relapse prevention cognitive-behavioral model, based on Marlatt treatment approach, in Opioid-dependent patients participating in the Methadone Maintenance Treatment [MMT] in Iran. The study consisted of 92 individuals treated with methadone in Iranian National Center of Addiction Studies [INCAS]. Participatns were randomized into two groups: educational intervention group [N=46] and control group [N=46]. The intervention was comprised of 10 weekly 90 minute sessions, done during a period of 2.5 months based on the most high risk situations determined using Inventory Drug Taking Situation instruments. Relapse was defined as not showing up for MMT, drug use for at least 5 continuous days, and a positive urinary morphine test. While, only 36.4% of the intervention group relapsed into drug use, 63.6% of the control group relapsed. The result of the logistic regressions showed that the odd ratio of the variable of intervention program for the entire follow up period was 0.43 [P<0.01]. Further, the odd ratio of this variable in one month, three months, and 195 days after the therapy were 0.48 [P<.03], 0.31 [P<.02], and 0.43 [P<.02] respectively that revealed that on average, the probability of relapse among individuals in the intervention group was lower than patients in control group. Relapse prevention model based on Marlatt treatment approach has an effective role in decreasing relapse rate. This model can be introduced as a complementary therapy in patients treated with methadone maintenance

[Relation between empowerment of diabetes control and adoption of self-management behaviors and its related factors among type 2 diabetic patients]

Diabetes mellitus as a chronic disease is associated with complications and stress. Empowerment as a coping index in health issues can be helpful among diabetic patients. In this study, we aimed to determine empowerment and adoption of self-management behaviors and its related factors among type 2 diabetic patients referring to hospitals affiliated to Tehran University of Medical Sciences during 2010. This study was a cross-sectional research conducted during a 9 months period [2010-2011]. A total of 688 samples were selected by random sampling. A questionnaire consisting of three parts including socio-demographic and health related data, diabetes empowerment scale [28 items], and diabetes self- management instrument [35 items] was used. Collected data was analyzed by SPSS software version 18 with using parametric and nonparametric tests. Response rate was 100%. Mean age of participants was 54.41 +/- 8.22 [Mean +/- SD]. Study findings showed that empowerment had significant relation between level of education [p=0.006] and age [p=0.009]. Self- management and some variables such as age [p<0.001], level of education [p<0.001], marital status [p=0.04] and disease duration [p=0.004] had significant relationship. Also, Pearson correlation coefficient showed that empowerment had reverse and linear relation with adoption of self-management behaviors among type 2 diabetic patients. Thus, by increasing empowerment score, adoption of self-management behaviors is increased [r = 0.28, p<0.001]. Regarding to relation between empowerment and adoption of self-management behaviors, focusing on planning empowerment based interventions has been more highlighted. It seems these strategies can be helpful in decreasing complications and mortality.

Factors Influencing Physical Activity Behavior among Iranian Women with Type 2 Diabetes Using the Extended Theory of Reasoned Action

BACKGROUND: Findings of most studies indicate that the only way to control diabetes and prevent its debilitating effects is through the continuous performance of self-care behaviors. Physical activity is a non-pharmacological method of diabetes treatment and because of its positive effects on diabetic patients, it is being increasingly considered by researchers and practitioners. This study aimed at determining factors influencing physical activity among diabetic women in Iran, using the extended theory of reasoned action in Iran. METHODS: A sample of 352 women with type 2 diabetes, referring to a Diabetes Clinic in Khoy, Iran, participated in the study. Appropriate instruments were designed to measure the desired variables (knowledge of diabetes, personal beliefs, subjective norms, perceived self-efficacy, behavioral intention and physical activity behavior). The reliability and validity of the instruments were examined and approved. Statistical analyses of the study were conducted by inferential statistical techniques (independent t-test, correlations and regressions) using the SPSS package. RESULTS: The findings of this investigation indicated that among the constructs of the model, self efficacy was the strongest predictor of intentions among women with type 2 diabetes and both directly and indirectly affected physical activity. In addition to self efficacy, diabetic patients' physical activity also was influenced by other variables of the model and sociodemographic factors. CONCLUSION: Our findings suggest that the high ability of the theory of reasoned action extended by self-efficacy in forecasting and explaining physical activity can be a base for educational intervention. Educational interventions based on the proposed model are necessary for improving diabetics' physical activity behavior and controlling disease.

effect of educational program on increasing cervical cancer screening behavior among women in Hamadan, Iran: applying health belief model

The systematic application of Pap test helps early diagnosis and effective treatment of cervical cancer. This study was conducted to assess the effect of education on health beliefs and practice of women eligible for Pap test using Health Belief Model [HBM]. This quasi-experimental study was conducted in Hamadan City, the west of Iran, in 2010 using before-after design. In this study, 70 women aged 16 to 54 years participated voluntarily who had never done Pap test until the date of the study. The volunteers were divided into several small groups. For each group, 2-hour training session was held twice. The data collection tool was a self-administered multi-choice questionnaire that was developed based on HBM constructs. Health beliefs and practice of the target group were evaluated pre-intervention and four months later. Our findings indicated that education based on HBM was effective and could enhance the participants' knowledge significantly and improve the HBM constructs including perceived susceptibility, severity, benefits, and barriers. The training program enhanced the practice from zero before intervention to 81.4% after that. The results of the present study revealed that increase in knowledge had effect on the HBM constructs. Furthermore, there was a significant relationship between knowledge and both age and educational level. Health education based on HBM can enhance women's knowledge of cervical cancer, change their health beliefs and improve their behaviors regarding screening programs like Pap test

School-based physical activity intervention improves the physical fitness of the adolescent girls and their mothers

To evaluate the effectiveness of a school-based exercise program on the body composition and physical fitness of girls and their mothers. In a semi-experimental study we included 70 subjects [35 high-school girl students as well as their mothers] in 2007. All the students, whose mothers volunteered to take part in the study, were in first to third grades of high school and randomly selected from five high schools in the city. The study was run at Neda high school in Sanandaj-Iran. Eligible subjects participated in an exercise program for 12 weeks, ninety minutes per session, two times per week. The subjects followed the same exercise programme, at the same time in the same place. Measurements included cardiovascular endurance, muscle strength, flexibility, height, weight, body-mass index [BMI], waist and hip circumference. Age mean [standard deviation] for girls and mothers was 15.00[1.60] and 40.00[3.80] respectively. In girls, the intervention had significant effect on weight, BMI, waist and hip circumference [p<0.05]. Physical fitness tests including muscle strength, flexibility and cardiovascular endurance were significantly different between the pre-test and post-test measurements [p<0.05]. In mothers body weight, BMI, waist and hip circumference declined significantly [p<0.05]. Flexibility test was not significantly affected over time, despite an increase in muscle strength and cardiovascular endurance [p<0.05]. The highest correlations were found between the mother's participation index and the girl's participation index [r: 0.48, p< 0.001]. The exercise program was effective in improving physical fitness