Structural equation modeling analysis of Iranian womens food consumption: influence of socio-demographic characteristics and the information, motivation, and behavioral skills model / Análise de modelagem de equações estruturais do consumo alimentar de mulheres iranianas: influência das características sociodemográficas e do modelo de Informação, motivação e habilidades comportamentais

ABSTRACT Objective This study aimed at examining whether food consumption varies in accordance with socio-demographic and behavioral factors in the conceptual model, analyzing adult women in Tehran, Iran, for that purpose. Methods This cross-sectional study was conducted with 247 women in childbearing age, who were selected through systematic cluster sampling from five regions in Tehran. Dietary assessment was done through a Food Frequency Questionnaire, and the anthropometric indices were measured. Data on socio-economic status and information-motivation-behavioral skills model were obtained through a questionnaire. Then, subjects were stratified according to the socio-economic status and model components. Statistical analysis was done using analysis of variance and structural equation modeling. Results Consumption of food groups among the participating women differed based on their living region, education, occupation, household expenditure, and model components (p<0.05). Intake of red and processed meat (p<0.05) was at the lowest level in illiterate or low educated women. Those with lower total expenditure had higher consumption of fats and oils (p<0.05). Women with higher perceived social support consumed more milk and dairy products (p<0.05), fats and oils (p<0.05), and less bread and cereals (p<0.05). Model components including information, attitude, social support, self-efficacy, and self-regulation were the most important factors negatively affecting the consumption of unhealthy foods (red and processed meat, fats and oils, sugar, and salty foods). Conclusion Considering the impact of model components on women's eating behaviors, the specific integration strategies delineated for each construct of the model can be utilized to design model-based interventions targeting the promotion of healthy nutritional behavior.

RESUMO Objetivo Este estudo buscou examinar se o consumo de alimentos varia de acordo com fatores sociodemográficos e comportamentais no modelo conceitual entre mulheres adultas em Teerã, Irã. Métodos Este estudo transversal foi conduzido em 247 mulheres em idade reprodutiva, selecionadas por amostragem sistemática por conglomerados de cinco regiões de Teerã. A avaliação da dieta foi realizada por meio de um questionário de frequência alimentar, e os índices antropométricos foram medidos. Os dados sobre o status socioeconômico e o modelo de habilidades de informação-motivação-comportamento foram obtidos através de um questionário. Em seguida, os sujeitos foram estratificados conforme o status socioeconômico e os componentes do modelo. A análise estatística utilizou análise de variância e modelagem de equações estruturais. Resultados O consumo de grupos de alimentos entre as mulheres participantes diferiu de acordo com a região onde vivem, educação, ocupação, gasto familiar e componentes do modelo (p<0,05). A ingestão de carne vermelha e processada (p<0,05) foi mais baixa entre mulheres analfabetas ou com baixa escolaridade. Aquelas com menor gasto total apresentaram maior consumo de gorduras e óleos (p<0,05). Mulheres com maior apoio social percebido consumiram mais leite e derivados (p<0,05), gorduras e óleos (p<0,05) e menos pão e cereais (p<0,05). Os componentes do modelo, incluindo informação, atitude, apoio social, autoeficácia e autorregulação, foram os fatores mais importantes que afetaram negativamente o consumo de alimentos não saudáveis (carne vermelha e processada, gorduras e óleos, açúcar e alimentos salgados). Conclusão Considerando o impacto dos componentes do modelo nos comportamentos alimentares das mulheres, as estratégias de integração específicas delineadas para cada construto do modelo podem ser utilizadas para projetar intervenções baseadas em modelos visando promover um comportamento nutricional saudável.

Determinants of satisfaction with health care system: a population-based study from Iran

Satisfaction with health care system is an important indicator of health care delivery effectiveness. It could contribute to both policy and practice. This study aimed to examine Iranians' satisfaction with health care. This was a nationwide cross sectional study. A random sample of individuals aged between 18 and 65 years were entered into the study. Respondents were asked to rate their overall satisfaction with health care system on a 5-point-likert scale. The record of demographic and socioeconomic data included age, gender, education, marital status, employment, income, and chronic diseases. Logistic regression analysis used to estimate odds ratios to indicate factors contributing to satisfaction with health care system. In all, 27,833 individuals examined in this study. The mean age of respondents was 32.7 [SD=11.8] years old. Overall 20.7% of the respondents were satisfied or very satisfied with the health care delivery system while 36.2% of people indicated low or no satisfaction with health care system. The regression analysis results indicated that income [a proxy measure of access to health care], and information variable were the most significant factors contributing to people's dissatisfaction [OR for lower income=2.17, P<0.0001; OR for people with poor health information=2.01, P<0.001]. The study findings suggest that access to health care and information would lead to improved people's satisfaction with health care system

Quality of life in gynecologic cancer patients.

OBJECTIVE: A descriptive study for evaluating the variables which influence the quality of life was performed in women with gynecologic cancer undergoing various kinds of treatment. METHODS: The study was based on a chart review of 104 women with gynecologic cancer and analyses of their compiled FACT-G (V4); (Functional Assessment of Cancer Therapy-General) questionnaires. Patients were assessed before and 3 months after treatment.The relationship of a number of biomedical variables with quality of life outcomes was tested. RESULTS: The mean age of patients was 50.13 years. The most involved organ was ovary (42.3%).The mean of socio-familial, emotional, functional well-being and overall quality of life 3 months after the treatment were greater than previously. The mean of physical well-being after 3 months of treatment was lower than before that (p<0.05). There were no statistical difference between the mean of overall quality of life before treatment and that 3 months after treatment for variables such as marital status, qualification, job, parity, co-morbidity diseases, organ involved, and stage of cancer (p>0.05). CONCLUSIONS: More studies must utilize quality of life as a primary endpoint. As gynecologic cancers are usually discovered in late stages, strategies for supportive care need to focus on symptom management.

The role of depression in the development of breast cancer: analysis of registry data from a single institute.

Although controversial, the belief that developing breast cancer may be associated with psychological distress is not uncommon. The present study examined the role of psychological variables in the development of breast cancer in women attending a breast clinic for medical examination in Tehran, Iran. During a three-year period (1997-1999) a trained female nurse interviewed all women attending the Iranian Center for Breast Cancer (ICBC) before a confirmed diagnosis was made (N = 3000). Data were collected on demographic variables (age, education and marital status), known risk factors (age at menarche, age at first time full term pregnancy, family history of breast cancer, menopausal status, and oral contraceptive use), psychological variables, including history of psychiatric medications, depression (depressed mood, hopelessness, and loss of interests and pleasures), anxiety (mental and somatic signs) and two single measures of overall health and quality of life. In all, 243 patients were diagnosed as having breast cancer. A total of 486 patients with benign disease were randomly selected from the original cohort as controls. Univariate and multivariate logistic regression analyses were performed to determine the predictive effect of each factor on the risk of breast cancer. There were no significant differences between cases and controls except for age at menarche (P = 0.007) and family history of breast cancer (P<0.001). With regard to psychological variables studied, the results showed that there were significant differences between cases and controls regarding depression (depressed mood P<0.0001, hopelessness P = 0.001, and loss of interest and pleasures P = 0.001), and anxiety (mental signs P = 0.006). Finally, after performing multiple logistic regression analysis in addition to family history and age at menarche, depressed mood and hopelessness showed significant results (odds ratios of 1.90, and 1.63 respectively). The findings of the present study suggest that in addition to the known risk factors, psychological determinants such as depressed mood may play an important role in etiology of breast cancer and deserve further investigation, especially in different populations.

Breast cancer in Iran: a survival analysis.

A prospective study was undertaken to examine survival in Iranian breast cancer patients. One hundred and sixty-seven breast cancer patients diagnosed in 1997 were entered into the study and followed up for five years. The mean age of the patients at diagnosis was 47.2 (SD = 13.5), ranging from 24 to 81 years. A total of 39 patients were lost in the follow-up period, leaving 128 for analysis of data. Of these, 79 were alive and 49 were dead after five years. Most patients (61%) presented with advanced disease. Using life table analysis, the overall relative 5-year survival rate was found to be 62% (SE = 0.04). In addition, after adjustment for age at diagnosis, initial treatment (mastectomy, breast conserving surgery, and neo-adjuvant therapy), and disease stage, using Cox's regression model, it was found that receiving neo-adjuvant therapy as the initial treatment was an independent predictor of poorer survival (Hazard ratio = 4.56, 95% CI 2.20-9.44, P<0.0001). The other variables (older age and late stage disease), although associated with high hazards rates, were not significant. The study findings suggest that overall relative survival rate in Iranian breast cancer patients stands between western and eastern European countries and needs to be improved. It seems that early detection and better management using standard guidelines might contribute considerably to improvement of survival in women experiencing breast cancer.