Assessing the status and recognizing the performance of various nongovernmental organizations in providing health-oriented services as opportunities in promoting community health.

BACKGROUND: nongovernmental organizations (NGOs( are the hidden system of promoting public health and the symbol and mediator of people's participation. The aim of the present research was to assess the status and recognize the performance of various NGOs in providing health-oriented services as opportunities in promoting community health. MATERIALS AND METHODS: The present study was a descriptive-analytical (cross-sectional) study, which was conducted on the position and function of all NGOs in Kerman from February 2014 to the end of January 2015. A researcher-made checklist was used to collect the data, which was designed based on the statutes of NGOs. The information was collected from a total of 150 NGOs. To analyze the data, in addition to descriptive statistical tests (frequency, percentage, mean, and standard deviation), other tests were also used (Chi-square test and Fisher's exact test). Moreover, all data analysis was done using SPSS (ver. 16). RESULTS: There was a significant relationship between the levels of prevention and field of activity and the objectives and methods of implementation of these objectives (P < 0.001). There was a significant relationship between health prevention levels in the target community of the NGO and initial assets (P = 0.02), licensing organization (P < 0.001), management type in terms of the board of trustees or membership availability (P < 0.001), relevance of members' major with organizational goals (P = 0.02), and activeness or inactiveness of the organization (P = 0.007). CONCLUSION: The results showed that there was a relationship between NGO's target population in terms of levels of prevention and the studied factors. The relationship between the services of these organizations and the levels of prevention is a very important and effective role in community health promotion.

Providing and promoting health-oriented services by nongovernmental organizations: A qualitative study.

BACKGROUND: Benefactors of nongovernmental organizations (NGOs) are the hidden public health promotion systems. These benefactors are the symbol and intermediary of people participation, which is one of the main arms of health promotion and reduction of poverty and injustice in the societies. The present study is aimed to identify the benefactors' experiences in NGOs in terms of providing and promoting health-oriented services. MATERIALS AND METHODS: This study was conducted with a qualitative approach. The total number of participants was 32, which consisted of 25 chief executive officers from active and inactive organizations. Active organizations refer to organizations that submitted their 6-month report at the time of the investigation and whose operating license was renewed and in operation and seven officials of the social deputy of governmental organizations related to NGOs. Data collection was performed by using semi-structured interviews and with purposive sampling and then continued until data saturation. Furthermore, the content analysis method was used for data analysis. MAXQDA software version 2007 was used to manage quality data. RESULTS: During the data analysis, the following four subcategories were obtained: "high effort in empathy with fellow human beings," "role of merit in the success of donors," "creating a platform for social attention for the client's spontaneity," and "respect of the client," which were the results of experience and dimensions. The performance of non-governmental organizations is in line with the confrontation and responsibility of non-governmental organizations with a focus on health-oriented services. CONCLUSION: Having benevolent motives, benefactors attempt to provide conditions, in which help seekers have more chance for living through establishing new, sustainable, and future-reassuring conditions.

The effect of the mobile "blood pressure management application" on hypertension self-management enhancement: a randomized controlled trial.

BACKGROUND: Self-management of hypertension is of great significance given its increasing incidence and its associated disabilities. In view of the increased use of mobile health in medicine, the present study evaluated the effect of a self-management application on patient adherence to hypertension treatment. METHODS: This clinical trial was performed on 120 hypertensive patients who were provided with a mobile intervention for 8 weeks and followed up until the 24th week. Data on the primary outcome (adherence to treatment) and secondary outcomes (adherence to the DASH diet, regular monitoring of blood pressure, and physical activity) were collected using a questionnaire and a mobile application, respectively. The inter-group change difference over time was analyzed using repeated measures ANOVA (general linear model). RESULTS: The treatment adherence score increased by an average of 5.9 (95% CI 5.0-6.7) in the intervention group compared to the control group. The scores of "adherence to the low-fat and low-salt diet plans" were 1.7 (95% CI 1.3-2.1) and 1.5 (95% CI 1.2-1.9), respectively. Moreover, moderate physical activity increased to 100.0 min (95% CI 61.7-138.3) per week in the intervention group. CONCLUSION: The treatment and control of blood pressure require a multifaceted approach given its complexity and multifactorial nature. Considering the widespread use of smartphones, mHealth interventions can be effective in self-management and better patient adherence to treatments. Our results showed that this application can be used as a successful tool for hypertension self-management in patients attending public hospitals in developing countries. TRIAL REGISTRATION: Iran Randomized Clinical Trial Center IRCT2015111712211N2 . Registered on 1 January 2016.

Understanding Non-Adherence to Treatment in Hypertension: A Qualitative Study.

BACKGROUND: Hypertension is a major public health issue. With regard to the current trend, it has been estimated that one out of three people will be suffering from hypertension by 2025. This study was designed to provide a better insight into the adherence to treatment and its underlying reasons. METHODS: A directed qualitative content analysis approach was conducted in collaboration with 35 hypertensive patients and 3 cardiologists in the form of in-depth interviews and focused group discussions from October 2015 to February 2016. Sampling was carried out from patients with hypertension using purposeful and heterogeneous method. Some of the PRECEDE model structures were applied as the conceptual framework. RESULTS: The reasons affecting adherence to hypertension treatment were analyzed in three general categories of predisposing, enabling and reinforcing factors based on the model structures. Factors such as "knowledge", "belief and attitude", "mental-personality traits", "culture and lifestyle" were classified as the predisposing factors category. "Access to health service" and "access to facilities in the workplace, home and society" were fit in the enabling factor category. The reinforcing factors category addresses "individuals' internal incentives" and "family and health service providers' support". CONCLUSION: Several reasons account for non-adherence to treatment in hypertensive patients. Diversity of these reasons is an indication that design and implementation of different kinds of interventions are required in order to increase the patients' awareness, empower them and encourage self-efficacy.

Comparing the effectiveness of the BPMAP (Blood Pressure Management Application) and usual care in self-management of primary hypertension and adherence to treatment in patients aged 30-60 years: study protocol for a randomized controlled trial.

BACKGROUND: Hypertension is one of the most important and well-known risk factors for cardiovascular diseases. Unfortunately, in spite of effective treatments, adherence to the regular use of drugs and other nondrug treatments, such as lifestyle improvement, is often poor. This study evaluates the effectiveness of an educational, supportive intervention - in the form of a Blood Pressure Management Application (BPMAP) - on self-management in patients with primary hypertension on controlling the determinant factors of hypertension, and on adherence to treatment. METHODS/DESIGN: A two-arm, parallel-design randomized controlled clinical trial will be conducted on 30 to 60 year-old patients with primary hypertension who are attending the Tehran Heart Center. One hundred and thirty-two (132) patients will be randomly assigned to the intervention and control (usual method) groups. The most important inclusion criteria are, having primary hypertension and being pharmacologically treated for it, and not having developed the complications of hypertension, such as myocardial infarction, cerebral stroke and cardiac insufficiency. The participants should be able to read Persian and be able to use the application. The most important outcomes of the study include adherence to treatment, weight control, and regular monitoring of blood pressure which are assessed in the primary assessment (baseline data questionnaire) and again at the 8th and 24th weeks. The intervention is a mobile application that has capabilities such as reminders and scientific and supportive information. DISCUSSION: This application has been programmed to reduce many of the nonadherence factors of hypertension treatment. Therefore, the findings may contribute to a rise in adherence to treatment. If proven to have an appropriate impact, it may be extended for use in the national hypertension control plan. TRIAL REGISTRATION: This study was registered in the Iran Randomized Clinical Trial Center under the number IRCT2015111712211N2 on 1 January 2016.

Physical Activity Status and Position of Governmental Employees in Changing Stage Based on the Trans-Theoretical Model in Hamadan, Iran.

Physical inactivity is the fourth leading risk factor for death worldwide. Given the key role of employees as valuable human resources and increasing sedentary life style among them, the aim of this study was to evaluate physical activity status and position of governmental employees in changing stage based on the Trans-Theoretical Model (TTM) in Hamadan, Iran, in 2014.This descriptive-analytical study was performed on 1200 government employees selected using proportional stratified random sampling. Data collection was performed using a three-section questionnaire containing demographic characteristics, SQUASH (Short questionnaire to assess health-enhancing physical activity) questionnaire and Marcus et al's five-part algoritm. Data were analyzed by multiple linear and logistic regression, Chi-square, T-test and ANOVA using SPSS-20. The mean age of the participants was 38.12±8.04 years. About a half of the employees were in the preparatory stage of TTM.49.2% and 50.8% of the sample were classified as active and inactive, respectively .Associations between physical activity status and exercise stage of change were found. The associations between exercise stage of change and age, sex, work experience, education and marital status were significant (p<0.05). Work experience and education were strongly predictors of physical activity (PA) status and accounted for 31.2% of variance in PA (adjusted R2=0.312, R2 change=0.01). The results of this study showed that TTM was useful to evaluate and predict physical activity behavior among the Iranian governmental employees and can be utilized by health planners to inform appropriate intervention strategies, specifically in work place.

Lifestyle of the employees working in hamadan public sectors: application of the trans-theoretical model.

BACKGROUND: A healthy lifestyle is a valuable source to reduce the prevalence of health problems, and promoteehealth. OBJECTIVES: The current study aimed to evaluate the lifestyle and obesity status of Hamadan public employees and their status based on the trans-theoretical model (TTM). PATIENTS AND METHODS: This analytical cross-sectional study was performed in 2014 on 1200 public employees in Hamadan city, Iran selected through proportional stratified random sampling. Data collection was performed using a three-section questionnaire including demographic characteristics, The FANTASTIC lifestyle questionnaire, and the five-part algorithm. Data were analyzed by SPSS-20 using linear regression, Chi-square, Fisher exact test, and ANOVA. RESULTS: The mean age of the employees was 38.12 ± 8.04 years. Most of the employees (61.7%) had favorable lifestyle. About half of the employees were at the preparation stage of TTM. Most of the employees were in a poor condition regarding the physical activity and healthy eating habits. In most of the evaluated items, females got higher scores than males. The associations between lifestyle and age, gender, work experience, income satisfaction, and marital status were significant. Moreover, the associations between obesity and work experience, marital status, number of offspring, and gender were significant (P < 0. 05). Significant predicting variables of obesity were age and work experience; they explained 31.2% variance of obesity (adjusted R(2) = 0.312, R(2) change = 0.01). CONCLUSIONS: Planning health education interventions for employees through effective approaches seems necessary.

Effect of the Intervention Based on New Communication Technologies and the Social-Cognitive Theory on the Weight Control of the Employees with Overweight and Obesity.

BACKGROUND: Work settings provide a unique opportunity for health promotion interventions. Considering the issue of obesity in employees, this study was conducted to evaluate the effect of the intervention based on new communication technologies and the social cognitive theory on weight control in the governmental employees of Hamadan City, western Iran in 2014. METHODS: This randomized control trial study was conducted in "telephone- assisted intervention", "web- assisted intervention", and "control" groups comprising 435 employees of Hamadan City with overweight or obesity in 2014 (Ethics Committee Code: 93/D/130/1139). The educational intervention was performed for 6 months under the title of "lifestyle program". Then, the participants were evaluated in terms of weight and changes in the constructs of the social-cognitive theory 6 and 9 months after the intervention. A researcher-made questionnaire based on the Dishman and Dewar questionnaires was used to evaluate the constructs of social-cognitive theory. The data were collected and analyzed using SPSS-20. RESULTS: The lifestyle intervention resulted in a weight loss of 1.92 and 1.08 kg in the telephone-assisted and web-assisted intervention groups, respectively. The intervention in the telephone-assisted group increased the mean scores of the constructs of self-efficacy (P=0.001), environment (P=0.001), outcome expectations (P=0.040), and outcome expectancies (P=0.001) among participants. In the web-assisted intervention group, the mean scores of the constructs of self-efficacy (P=0.001) and outcome expectancies (P=0.020) increased. CONCLUSIONS: Our results showed the effectiveness of the intervention based on new communication technologies and the Social-Cognitive Theory. Future studies with more retention strategies regarding self-efficacy and environment constructs are needed to further explain the application of SCT and technology-based approaches to reduce obese and overweight.

Psycho-social Determinants of Colorectal Cancer Screening in Iran.

BACKGROUND: Colorectal cancer (CRC) is the third most prevalent cancer among Iranians, and threatens them at younger ages. This study was guided by the theoretical concepts of the preventive health model (PHM) to assess the attitudes and beliefs of Iranians towards CRC screening. METHODS: This cross-sectional study was conducted with participation of 200 individuals aged 50 years or older in a Teaching Hospital in Tehran, Iran. Background characteristics (e.g., age, gender, marital status) were assessed and a validated instrument drawn from the PHM was applied to measure cognitive and psychosocial variables (i.e., self-efficacy, intention to screening, perceived susceptibility, cancer worries, response efficacy, and social support). Data were collected via face-to-face interviews and analyzed using the SPSS version 13.00 for Windows. RESULTS: The age of the participants ranged from 50 years to 83 years (mean 60.13). Most respondents were married (62.5%), unemployed (42%), and had secondary or higher education (44.5%). Overall, 11% of respondents reported prior screening. Individuals obtained relatively poor scores on self-efficacy, intention to screening, perceived susceptibility, cancer worries, response efficacy, and social support. CONCLUSIONS: In this study, individuals mostly reported poor attitude in regard to CRC screening. The results of the present study could guide policy makers in designing tailored interventions to increase the participation of individuals in screening programs.

Effectiveness of a theory-based intervention to increase colorectal cancer screening among Iranian health club members: a randomized trial.

Colorectal cancer is the third most commonly diagnosed cancer and the fourth leading cause of death in the world. There are few published studies that have used theory-based interventions designed to increase colorectal cancer screening in community lay health organizations. The present study was guided by the theoretical concepts of the preventive health model. Twelve health clubs of a municipal district in Tehran were randomized to two study groups with equal ratio. The control group received usual services throughout the study while the intervention group also received a theory-based educational program on colorectal cancer screening plus a reminder call. Screening behavior, the main outcome, was assessed 4 months after randomization. A total of 360 members aged 50 and older from 12 health clubs completed a baseline survey. Participants in the intervention group reported increased knowledge of colorectal cancer and screening tests at 4 months follow-up (p's < .001). Moreover, exposure to the theory-based intervention significantly improved self-efficacy, perceived susceptibility, efficacy of screening, social support, and intention to be screened for colorectal cancer, from baseline to 4 months follow-up (p's < .001). The screening rate for colorectal cancer was significantly higher in the intervention group compared to the control group (odds ratio = 15.93, 95% CI = 5.57, 45.53). Our theory-based intervention was found to have a significant effect on colorectal cancer screening use as measured by self-report. The findings could have implications for colorectal cancer screening program development and implementation in primary health care settings and through other community organizations.

Theory-based interventions in physical activity: a systematic review of literature in Iran.

Lack of physical activity is ranked fourth among the causes of human death and chronic diseases. Using models and theories to design, implement, and evaluate the health education and health promotion interventions has many advantages. Using models and theories of physical activity, we decided to systematically study the educational and promotional interventions carried out in Iran from 2003 to 2013.Three information databases were used to systematically select papers using key words including Iranian Magazine Database (MAGIRAN), Iran Medical Library (MEDLIB), and Scientific Information Database (SID). Twenty papers were selected and studied .Having been applied in 9 studies, The Trans Theoretical Model (TTM) was the most widespread model in Iran (PENDER in 3 studies, BASNEF in 2, and the Theory of Planned Behavior in 2 studies). With regards to the educational methods, almost all studies used a combination of methods. The most widely used Integrative educational method was group discussion. Only one integrated study was done. Behavior maintenance was not addressed in 75% of the studies. Almost all studies used self-reporting instruments. The effectiveness of educational methods was assessed in none of the studies. Most of the included studies had several methodological weaknesses, which hinder the validity and applicability of their results. According to the findings, the necessity of need assessment in using models, epidemiology and methodology consultation, addressing maintenance of physical activity, using other theories and models such as social marketing and social-cognitive theory, and other educational methods like empirical and complementary are suggested.

Giant epidermoid inclusion cyst of the clitoris mimicking clitoromegaly.

We describe a rare case of clitoromegaly due to a large clitoral cyst that occurred spontaneously without any declared previous female genital mutilation. The cyst was excised successfully with good cosmetic results.

Exploring self care in Tehran, Iran: A population based study.

BACKGROUND: self care empowers individuals to self manage their minor ailments, chronic conditions, and to exert more control over their lives. Self care includes activities such as influencing prevention, health maintenance, and treatment of illness by individuals, this study was conducted to assess views about self care among the general population living in south of Tehran. MATERIALS AND METHODS: This survey was cross-sectional study by using of two-stage random cluster sampling, 1200 individuals aged 17 years and over was surveyed regarding self care. A structured closed validated questionnaire was used to collect data. Data were finally analyzed by Kruskal-Wallis, Pearson Chi-square, Fisher exact test and linear by linear association. Questionnaire has totally five parts including knowledge, attitude, performance toward self care, views regarding general health and demographic characteristics as well. Furthermore; project number is 4276-62-02-85. RESULTS: The mean age of subjects was 27.9 years (SD = 5.2); 50.2% (n = 603) were female; 54% (n = 643) were married (deleted), (55%, n = 658) reported that they were not knowledgeable about self care and (82%, n = 986) were interested in self care. Only 4% (n = 53) of subjects indicated they drank ≥ 7 glasses of water daily; fewer reported they consumed at least five portions of fruits/vegetables daily (3%, n = 31; and (4%, n = 51) engaged in physical activity more than 3 h weekly. There were statistically significant relationships between knowledge and interest (P < 0.01), knowledge and practice (P < 0.001), and interest and practice regarding self care (P < 0.001). CONCLUSION: The vast majority of subjects approximately two third felt satisfied with their health, most of subjects reported "feeling healthy" despite engaging in unhealthy life styles, it is revealed that more educated people, and likely those with more income, were interested in and knowledgeable regarding self care and were actually active in healthy life styles. In brief; this study suggests that physicians could support self care through their consultations with patients.

Opium consumption and coronary atherosclerosis in diabetic patients: a propensity score-matched study.

There is a traditional belief among Eastern people that opium may have ameliorating effects on cardiovascular risk factors, especially diabetes; thus, it is widely used among diabetic patients. We attempted to investigate the association of opium consumption with coronary artery disease (CAD) in diabetic patients. A cross-sectional study was conducted on diabetic patients undergoing coronary angiography in our center. Out of 1925 diabetic patients included in the study, 228 were opium users, and the remaining 1697 non-opium users were used as a pool of potential comparators. Propensity scores were used to match the 228 opium consumers with 228 matched comparators for age, sex, and smoking status. The Gensini score and extent score were respectively used to assess the angiographic severity and extent of CAD. The mean Gensini score (86.9 ± 62.7 vs. 59.6 ± 43.4, p < 0.0001) and extent score (7.1 ± 2.9 vs. 5.9 ± 2.9, p < 0.0001) were significantly higher in opium user diabetic patients than in non-opium users. After adjustment for potential confounders, a dose-response relationship was observed between dose of opium and the Gensini score ( ß = 0.27, p = 0.04). There were no significant differences between the routes of opium administration (inhalation vs. oral) regarding the severity and extent of CAD. In conclusion, exposure to opium in diabetic patients may be positively associated with the risk of CAD, and with the angiographically determined severity and extent of the disease. Furthermore, dosage of opium consumption may correlate with severity of CAD.

A 20-year incidence trend (1989-2008) and point prevalence (March 20, 2009) of multiple sclerosis in Tehran, Iran: a population-based study.

BACKGROUND: The frequency of multiple sclerosis (MS) is still undetermined in Tehran. We conducted this survey to assess the incidence trend and point prevalence of MS on March 20, 2009, in Tehran province, Iran. METHODS: Data for patients with a definite diagnosis of MS were obtained from the Iranian MS Society (IMSS). The annual incidence rates were calculated based on year of diagnosis. The prevalence and annual incidence rates were standardized using the WHO (2000-2025) population as a standard. RESULTS: We detected 8,026 definite MS cases that had been registered by the IMSS till the prevalence day. The age- and sex-adjusted incidence rates increased significantly from 0.68/100,000 in 1989 to 2.93/100,000 in 2008 with its peak (4.58) in 2005. On March 20, 2009, we identified 7,896 prevalent cases (5,888 females and 2,008 males) yielding an age-adjusted prevalence rate of 50.57/100,000 (females: 77.24 and males: 25.54). The female-to-male ratio was 3.11 (95% confidence interval: 2.95-3.27). The age-specific prevalence showed a peak in the group aged 35-39 years in females and in that of 40-44 years in males with a mean (±SD) age of 35.48 (±9.9) years for females and 36.98 (±10.5) years for males. CONCLUSION: Tehran is a high-risk area for MS disease, and the incidence has dramatically increased over the last 20 years.

Comparison of the exposure rate of wrapped hydroxyapatite (Bio-Eye) versus unwrapped porous polyethylene (Medpor) orbital implants in enucleated patients.

PURPOSE: To compare the exposure rate of wrapped hydroxyapatite versus unwrapped porous polyethylene orbital implants in enucleated patients. METHODS: Medical records of the patients who underwent primary placement of hydroxyapatite (Bio-Eye) or porous polyethylene (Medpor) orbital implants after enucleation between 2002 and 2005 in Farabi Eye Hospital were reviewed, and the occurrence of implant exposure during follow-up visits was recorded. The exclusion criteria were secondary implantation, evisceration, or follow up of less than 1 year unless the exposure had occurred in the year after surgery. In the hydroxyapatite group, the implants were wrapped either in Mersilene mesh (65%) or in donor sclera (35%). Wrapping was not performed for any patient in the porous polyethylene group. RESULTS: A total of 198 cases with hydroxyapatite and 53 cases with porous polyethylene implant were identified. The most common causes of enucleation in both groups were globe trauma and painful blind eye. Rate of exposure was significantly higher [odds ratio (OR) = 7.97, p < 0.001] in patients with porous polyethylene (34.0%) than in those with hydroxyapatite implant (6.1%). This association remained significant after adjustment for potential confounders. Mean time of exposure after surgery was significantly (p < 0.001) longer in patients with porous polyethylene implant. Kaplan-Meier plots depicted a significantly (p < 0.001) higher rate of exposure in patients with porous polyethylene implant during the follow-up time. CONCLUSION: Unwrapped porous polyethylene implants demonstrated a higher rate of exposure, and longer time interval to exposure, compared with wrapped hydroxyapatite implants.

More than half of senior residents in Tehran have never heard about colorectal cancer screening.

BACKGROUND: Colorectal cancer (CRC) is the third most prevalent malignancy in Iran. Although adequate knowledge about CRC and screening tests has a significant effect on screening behavior, there is still no clear information in this regard in Iran. The aim of the study was therefore to identify knowledge toward CRC and obstacles to screening tests among an Iranian population. METHODS: We conducted a preliminary analysis with baseline data drawn from an ongoing randomized community trial among people aged 50 years and over in municipal district 6 in Tehran. A total of 360 members of health houses, who were not being exposed to CRC screening tests, completed the baseline survey and randomized to two study groups. Data were collected via personal interviews by 12 trained interviewers for demographics, knowledge related to CRC, and barriers to screening tests. RESULTS: The mean age was 58.0 (± 7.13) ranging from 50 to 86 years; 69% were female, 52% were unemployed, 65% had completed high school, and 90% had medical insurance. A considerable number of respondents stated that they had never heard about fecal occult blood test (61%) and colonoscopy (51%) as CRC screening tests. In general, participants were more likely to respond the knowledge items inaccurately. Four commonly stated reasons for not being screened were "absence of clinical symptoms" (29%); "doctor did not recommend the test" (26%); "never think of the test" (22%); and "did not think it was needed" (11%). CONCLUSION: Our findings indicated that lack of knowledge about CRC and various barriers to screening tests exist among Iranians. Our results may facilitate the development of effective educational strategies primarily aimed at high-risk people.

Physical activity among a sample of Iranians aged over 60 years: an application of the transtheoretical model.

BACKGROUND: Physical inactivity is one of the leading causes of major chronic disease, which contributes substantially to the global burden of disease, death and disability. This study examined physical activity in a randomly selected sample of elderly people in Tehran, Iran. METHODS: A random sample of 400 elderly people aged 60 years and over was selected through multistage sampling. A multi-sectional questionnaire that contained demographic characteristics, physical activity knowledge, benefits, barriers, self-efficacy, and readiness stage was used. Physical activity was measured by questions retrieved from the Physical Activity Scale for the Elderly. RESULTS: This study showed knowledge, perceived benefits, and self-efficacy could predict physical activity stage of change (P<0.001). Sixty-two percent of participants reported laziness as the most important barrier for not engaging in physical activity. Meeting new people (74%), having fun (71.8%), and contacting friends (67.73%) were the most prevalent reasons for participating in physical activity. CONCLUSION: According to this study, individuals with higher knowledge, perceived benefits and self-efficacy were more likely to engage in physical activity. Furthermore, those who perceived lower barriers towards this behavior were more physically active.

Consumption of fruit and vegetables among elderly people: a cross sectional study from Iran.

BACKGROUND: There is substantial evidence that low consumption of fruit and vegetables (FV) is a major risk factor for many chronic diseases. The aim of this study was to assess FV consumption and the variables that influence it among elderly individuals in Iran aged 60 and over. METHODS: This was a cross-sectional study to investigate FV intake by a randomly-selected sample of members of elderly centers in Tehran, Iran. A multidimensional questionnaire was used to collect data on demographic characteristics, daily consumption of FV, knowledge, self-efficacy, social support, perceived benefits, and barriers against FV. Data were analyzed using t-tests, one way analysis of variance, Pearson correlation, and logistic regression. RESULTS: In total, 400 elderly individuals took part in the study. The mean age of the participants was 64.07 (SD = 4.49) years, and most were female (74.5%). The mean number of FV servings per day was 1.76 (SD = 1.15). Ninety-seven percent of participants (n = 388) did not know the recommended intake was at least five servings of FV per day. Similarly, 88.3% (n = 353) did not know the size of a single serving. The most frequent perceived benefits of and barriers against FV consumption were availability and expense, respectively. Knowledge (OR = 0.59, 95% CI = 0.39-0.88), perceived benefits (OR = 0.92, 95% CI = 0.88-0.96) and barriers (OR = 1.08, 95% CI = 1.04-1.14), self-efficacy (OR = 0.89, 95% CI = 0.83-0.95) and family support (OR = 0.91, 95% CI = 0.83-0.99) were significantly associated with fruit and vegetable consumption. CONCLUSION: The findings of this study indicate that FV intake among elderly individuals in Iran was lower than the recommended minimum of five daily servings and varied greatly with age, marital status, educational attainment, and income level. The results also indicated that low perceived benefits, low self-efficacy, and perceived barriers could lead to lower consumption of FV. It seems that in order to improve FV consumption among elderly individuals in Iran, raising awareness, improving perception of benefits and enhancing self-efficacy regarding FV consumption should receive more attention. Indeed, it is essential to plan health education programs and nutritional interventions for this group of the population.

Effects of folic acid on preschool children's appetite: randomized triple-blind clinical trial.

BACKGROUND: In recent years some Iranian pediatricians have used folic acid empirically as an appetite-enhancing drug in poor-appetite, low-weight children. Many parents have expressed their satisfaction with this treatment but until now no study has been done to confirm or exclude folic acid as an appetite enhancer. METHODS: In order to determine if complementary folic acid has any effect on preschool children's appetite, 61 3-5-year-old children (27 girls and 34 boys) whose weight/age and weight/height ratios were below the 25 centile and whose parents regarded them as having poor appetite were randomly assigned to receive either folic acid (1 mg/day) or placebo for 20 days. The primary outcome measures were any appetite changes during and 1 month after the end of the intervention, measured by means of a questionnaire completed by parents on the 20th and 60th days. Secondary measures were mean weight gain on the 30th and 60th days. RESULTS: Children who received folic supplement had a significantly better appetite on the 20th day than those who received placebo (mean difference of appetite score: 1.7; 95% confidence interval: 0.1-3.4; P = 0.04) and significantly more children receiving folic acid were reported to have increased appetite than the placebo group (P = 0.03). But 40 days after the end of the intervention there was no difference between the two groups. Weight gain did not significantly differ between groups. CONCLUSIONS: Although folic acid appears to improve preschool children's appetite, further study is necessary to determine whether it has any effect on growth as an adjunctive to management protocols of low appetite for undernourished children.