The effect of educational intervention based on the Progressively Lowered Stress Threshold extended model on the process of caregiving for people with dementia.

BACKGROUND: This study examined the impacts of an educational intervention based on the Progressively Lowered Stress Threshold (PLST) extended model on caregiving for people with dementia (PWD). METHOD: This study was conducted in Isfahan, Iran, from May 2016 to June 2018, with 38 caregivers of PWD as participants assigned to an intervention group. Data were collected using a multi-sectional, researcher-developed questionnaire that recorded the demographic characteristics, and measured the dementia-related knowledge and caregiving practices of the participants. The questionnaire and an educational program were designed in three parts according to the educational needs of caregivers to enhance their practice, skills, and ability to handle challenging behaviours in PWD. The questionnaire's face validity was confirmed by expert review, and its reliability was assessed with Cronbach's alpha coefficient (knowledge section, 0.838; practice section, 0.802). The sampling method used was convenience sampling, and none of the caregivers refused to receive the educational content. Therefore, the evaluation of the program lacks a randomized controlled group. To tailor the intervention program to the participants' needs, the educational content was based on the PLST extended model. RESULTS: The mean scores for knowledge and practice increased following the intervention (P < 0.05). An educational intervention, using the PLST extended care model, thus produced positive impacts in improving the knowledge and practice of caregivers of PWD. CONCLUSION: Educating caregivers with the PLST extended model, with a specific focus on the cultural and religious backgrounds of societies, is recommended.

Exploration of the primary needs of health care services for earthquake victims in the west of Iran.

BACKGROUND: Natural disasters always have significant effects on social infrastructures, living conditions, and health care systems. This study aims to explain the needs of victims in the west of Iran for primary health care services. MATERIALS AND METHODS: This thematic content analysis and qualitative study was done from September 2020 to June 2021 in the west of Iran. Participants were selected using purposive sampling method. The data were extracted through semi-structured interviews with 17 earthquake victims and then examined through thematic content analysis. RESULTS: By analyzing and coding the data, the primary needs of victims post an earthquake in the west of Iran were classified into four main categories) health services, mental health, social health, and health management (and 14 subcategories. CONCLUSION: Regarding the primary needs (health services, mental health, social health, and health management), establishing a headquarters to meet the immediate and special health care needs seems to be required. It was recommended to create institutions for monitoring and supporting the health care needs at the level of the community and even policymaking, as well as guiding earthquake-stricken areas such as the eco-village.

Stress as a challenge in promoting mental health among dementia caregivers.

BACKGROUND: Caregiver stress is harmful to the health of both caregivers and people living with Alzheimer's disease or other dementias. The present study was conducted to assess stress and its predictors of people living with Alzheimer's disease or other dementias' caregivers. METHODS: The present descriptive, analytical, cross-sectional study was conducted in December 2017-June 2018 in Isfahan, Iran. Data were collected by interviewing 99 caregivers had at least 6 months of experience caring for a patient diagnosed with Alzheimer's disease, through questionnaires developed by the researcher. A convenience sample (easy access) of caregivers was recruited from calling the home of formally diagnosed with Alzheimer's patient, that have registered in educational hospitals affiliated to Isfahan University of Medical Sciences and psychiatrists' office both paid caregivers (formal) and unpaid caregivers (family). All caregivers provided informed consent. The type and severity of the relationship between the dependent (stress) and independent variable were assessed using Pearson's and Spearman's correlation coefficients, the independent t-test, and the multivariate regression analysis. RESULTS: The caregivers' mean stress score was 25.4 ± 10.9 (range: 4-54). About 80% of the caregivers were female. Age and stress score was correlated (P = 0.004), the mean stress score was significantly higher in female caregivers (P = 0.04), informal caregivers (P < 0.001), and significantly lower in the caregivers with previous experience of caring for Alzheimer's patients (P = 0.02) or those introduced by service companies (P = 0.005). Variables including the family relationship with the patient (P = 0.01), kind of caregiving (P = 0.03), and previous experience of caring for Alzheimer's patients (P = 0.04) were stronger predictors of the stress score. CONCLUSION: Stress is a challenge in promoting mental health among dementia caregivers. Providing social support with an emphasis on physical, mental, and social health is mandatory, especially for female and family caregivers, to promote stress management, mental health in this group, and enable optimal and purposeful care.

What motivates informal caregivers of people with dementia (PWD): a qualitative study.

BACKGROUND: The burden of caring for People with Dementia (PWD) is heavy; identifying incentives that motivate them in providing care is essential in facilitating and optimizing care. This study aims to explore and describe these motivating factors. METHODS: We conducted this qualitative study between January 2016 and January 2017 in Isfahan, Iran. Data were extracted through in-depth, semi-structured interviews with 19 caregivers of PWD. These data were then examined through thematic content analysis. RESULTS: We identified four categories of psychological motives based on the caregivers' feedback and experience. These include 1) Moral-based motives, 2) Religious, and spiritual motives; 3) Financial motives, and 4) Wicked motives. CONCLUSIONS: Our results revealed several aspects of caregivers' motives. They include moral, religious, and spiritual aspects; sharing housing accommodations, and the likelihood of inheriting a portion of the patient's assets based on unspoken rules and informal arrangements in the family, and wicked and immoral aspects. These findings can inform future efforts in enhancing the experiences of caregivers of PWD, and subsequently, the quality of care these patients receive. It further suggests that family members, members of a religious and spiritual organization, as well as social media, could play important roles in setting the stage.

The effects of mobile text messages on raising knowledge of men with type 2 diabetes, Isfahan, 2015: an educational experimental study.

BACKGROUND: Diabetes is one of the most common metabolic disorders which are rapidly increasing. Distance training is a cost-effective, easy and accessible way in which time and place dimensions of communication are removed. OBJECTIVE: To determine the effects of mobile text messages on raising knowledge of men with type 2 diabetes. METHODS: This educational experiment recruited 76 people selected by convenient sampling from a population of male patients with type 2 diabetes presenting to Sedigheh Tahereh Research Center in Isfahan, Iran, in 2015. They were randomly assigned into intervention and control groups. Data were collected with a questionnaire of demographic characteristics and questions pertaining to the variable of knowledge, through interview. The intervention group received training and follow-up through cell phones and text messages for 12 weeks. Data were analyzed in IBM-SPSS version 20 using Mann-Whitney test, Chi-square, Independent-samples t-test and paired-samples t-test. RESULTS: Findings suggested that patients' knowledge in both groups significantly increased after the training (p<0.001). However, this rise in the intervention group was significantly higher than that of the control group (p<0.001). CONCLUSION: The results indicated that designing and implementing educational programs based on text messages and cell phones can improve knowledge in diabetics.

The predictors of metabolic syndrome based on Walker Health-Promoting lifestyle in Iran 2016.

BACKGROUND: Understanding the metabolic syndrome has been the center of attention in recent years as a major risk factor of many diseases. Given the rising incidence of this disease and as the patient can compete against this disease with choosing healthy lifestyle, in the present study, we investigated the predictors of metabolic syndrome, based on Walker's health-promoting lifestyle in two large cities in Iran, in 2016. METHODS: This cross-sectional study used two-stage cluster sampling to select 1128 patients, among patients who referred to health centers in Isfahan and Yazd. Data were gathered by Walker lifestyle questionnaire that evaluates health-promoting behavior (nutrition, physical activity, health responsibility, spiritual growth, interpersonal relations, and stress management) by self-report that were completed by interviews for illiterate and semi-literate individuals. Data analysis was performed by SPSS statistical software. RESULTS: In this study, 576 women and 454 men participated with mean age of 56.19±12.11years and mean weight of 73.90±14.45kg. RESULTS: showed that the highest mean score for different health-promoting behaviors was related to social responsibility (25.53±5.65) and the lowest was related to nutritional status (15.18±5.79). Regarding the strongest predictor of lifestyle, the results of regression analysis showed that the most direct impact was related to stress management (R2=0.343) and the least direct impact was related to social responsibility (R2=0.243). Among the structures, physical activity with overall effect of R2=0.621 was the strongest predictor of lifestyle based on Walker's pattern. CONCLUSION: Considering the results of this study, the greater emphasis in planning and interventions to reduce the risk of metabolic syndrome should be spotted on physical activity and stress management in patients with the metabolic syndrome.

Sustained-release methylphenidate in methamphetamine dependence treatment: a double-blind and placebo-controlled trial.

BACKGROUND: The objective of this randomized, double-blind, placebo-controlled study was to evaluate the efficacy of sustained-release methylphenidate (MPH-SR) in treatment of methamphetamine dependence. METHODS: Fifty-six individuals who met DSM-IV-TR criteria for methamphetamine dependence participated in this 10-week trial. The participants were randomly allocated into two groups and received 18 to 54 mg/day sustained-released methylphenidate or placebo for 10 weeks. Craving was evaluated by a visual analogue craving scale every week. Urinary screening test for methamphetamine was carried out each week. The Beck Depression Inventory-II (BDI-II) was used to monitor participant depressive symptoms at baseline and bi-weekly during the treatment period. RESULTS: At the end of the trial, the MPH-SR group was less methamphetamine positive compared to the placebo group and the difference was significant (p = 0.03). By the end of the study, MPH-SR group showed significantly less craving scores compared to the placebo group [MD (95% CI) = -10.28(0.88-19.18), t(54) = 2.19, p = 0.03]. There was greater improvement in the depressive symptoms scores in the intervention group compared to the placebo group [MD (95% CI) =2.03(0.31-3.75), t (54) =2.37, p = 0.02]. CONCLUSION: Sustained-released methylphenidate was safe and well tolerated among active methamphetamine users and significantly reduced methamphetamine use, craving and depressive symptoms. TRIAL REGISTRATION: IRCT201202281556N38.