Lifestyle modification intervention among pregnant women with hypertension based on the self-determination theory using M-Health

BackgroundDigital health technologies have the potential to empower patients and enhance the management of chronic diseases, such as hypertension, which often suffers from low awareness and control rates in developing countries. This study aims to investigate the effectiveness of a lifestyle intervention tailored for hypertensive pregnant women, employing strategies derived from self-determination theory through a mobile health program.MethodsThe study utilized an experimental pre-test/post-test design with a two-month follow-up period. It examined the impact of an educational intervention on pregnant women with hypertension in Kermanshah, Iran, from 2021 to 2023. Sixty pregnant women with hypertensive disorders were recruited from medical centers and randomly assigned to either the intervention group (N = 30) or the control group (N = 30). A mobile app was employed to deliver the educational intervention, addressing lifestyle factors such as nutrition, physical activity, and stress management. The app’s effectiveness was assessed based on multiple criteria, including content quality, data accuracy, decision support, language and cultural sensitivity, user feedback interpretation, and personalized recommendations.ResultsAfter the intervention, repeated measures ANOVA indicated that the intervention resulted in statistically significant improvements in all study variables within the intervention group compared to the control group (p < 0.05), with the exception of blood pressure (p > 0.05). These changes remained significant during the follow-up period, except for relatedness, moderate physical activity, sitting time, and total physical activity (p > 0.05). The intervention significantly enhanced both controlled autonomy (p < 0.001, η2 = 0.21) and autonomous autonomy (p < 0.001, η2 = 0.30), as well as competence (p < 0.001, η2 = 0.27). The effect on relatedness was marginally non-significant (p = 0.053, η2 = 0.053). Improvements in nutrition, physical activity, and perceived stress were significant across between-group, within-group, and interaction effects (p < 0.05). All levels of physical activity showed significant improvements (p < 0.05), except for low physical activity (p > 0.05). There were significant between-group differences in both systolic and diastolic blood pressure (p < 0.05), but no significant within-group or interaction effects were observed.ConclusionThe M-Health intervention led to improvements in lifestyle factors and self-determination constructs, with the exception of relatedness, which may be attributed to the limited features of the app. Although blood pressure did not change significantly, the reduction in systolic pressure could still be clinically meaningful. M-Health interventions grounded in self-determination theory show promise for supporting hypertensive pregnant women

The effect of the social and interpersonal-based intervention on calcium consumption among pregnant women

IntroductionThe present study aimed to evaluate the effect of educational intervention based on Pender’s health promotion model on the calcium intake of pregnant women.MethodsThe pregnant women at three to 5 months were recruited using convenient sampling method and randomly assigned either to the control (n = 37) or intervention (n = 36) groups referred to the health centers in Kermanshah, “Iran,” in 2022, 2023. Participants were randomly assigned to either the intervention group or the control group. The intervention consisted of a series of educational workshops that provided information on the importance of calcium, dietary sources, and practical methods for increasing calcium intake. Participants received personalized dietary plans, and improve knowledge, perceived benefits of action, perceived barriers to action, perceived self-efficacy, activity-related affect, interpersonal influences, situational influences, immediate competing demands and preferences, commitment to plan of action and over 8-week period, and ongoing support through one-month follow-up. The control group received standard prenatal care without additional nutritional education. Pre- and post-intervention assessments measured calcium intake and HPM constructs using validated questionnaires. The food frequency questionnaire was completed before and after the intervention. Data were analyzed in SPSS software version 25.ResultsThere is no significant difference between the intervention and control groups at baseline (p < 0.05). According to the independent sample t-test, all constructs of the Pender’s HPM except for interpersonal influences were significantly improved in the intervention rather than control groups (p > 0.05). The repeated measure ANOVA demonstrated a significant difference in the effect of the intervention on the constructs of the knowledge (F = 9.40; p-value = 0.001), perceived benefits (F = 17.24; p-value = 0.001), perceived barriers (F = 40.80; p-value = 0.001), perceived self-efficacy (F = 10.90; p-value = 0.001), activity-related affect (F = 14.85; p-value = 0.001), interpersonal influences (F = 21.51; p-value = 0.001), commitment to a plan of action (F = 20.20; p-value = 0.001), and immediate competing demands and preferences (F = 9.4; p-value = 0.001) between the intervention and control groups. The ANOVA demonstrated that the calcium consumption significantly increased in the intervention group (p < 0.001).DiscussionA theory-based educational intervention in the health care system can fill the gap in the successful implementation of nutrition education programs

The effect of trans-theoretical model stage-matched intervention on medication adherence in hypertensive patients

IntroductionHypertension is a chronic condition that requires active patient management and awareness of treatment strategies. This study aimed to evaluate the effectiveness of an intervention program grounded in the Transtheoretical Model (TTM) of behavior change for improving treatment adherence among hypertensive patients.Materials and methodsThis study conducted at the Nukan Comprehensive Rural Health Center in Kermanshah, Iran, 120 participants were selected according to specific inclusion criteria. Demographic data and responses to 20 hypertension-related behavior questions were collected via a questionnaire. Participants were categorized into non-adherence (pre-contemplation, contemplation, preparation stages) and adherence categories (action and maintenance stages) based on self-reported medication adherence, with 60 individuals in each group. Each group was then randomly divided into intervention and control subgroups. The educational intervention consisted of four 45 min sessions grounded in TTM constructs regarding to health-related behaviors including Physical activity, salt and oil intake, and fruit and vegetable consumption, and medication adherence. Three months post-intervention, a follow-up questionnaire evaluated the educational impact on treatment adherence. The McNemar test and Chi-square test were utilized to analyze effects across the intervention, control, and pre- and post-intervention groups.ResultsThe participants had a mean age of 58.09 years (SD = 11.85). Three months after the intervention, the non-adherence intervention group showed significant progress in transitioning to the action and maintenance stages across all physical activity behaviors, as well as in salt, oil, fruit and vegetable intake, and medication adherence (P < 0.005). In the adherence intervention group, after the intervention, the number of hypertensive patients who fell into the action and maintenance categories according to all lifestyle variables increased, but the change was not significant. Concerning blood pressure, the intervention group had a significant reduction in mean systolic blood pressure (142.88 ± 20.87 vs. 141.00 ± 18.52; p = 0.015), but the decrease in mean diastolic blood pressure was not significant (88.17 ± 10.30 vs. 87.58 ± 9.70; p = 0.154). No significant changes in systolic or diastolic blood pressure were observed in the control or in intervention groups within the adherence category.ConclusionThis research highlights the potential benefits of applying the TTM to tailor interventions for hypertensive patients with poor treatment adherence, suggesting that such an approach can enhance the efficacy of health education interventions

Divorce from a divorcee woman's perspectives: A qualitative study

Introduction: Divorce is an unexpected change in marital life. This change affects physical and psychological health. Divorce is a complex phenomenon which can be conceptualized from different perspectives. Aim of the present study was to conceptualize divorce from Iranian women's perspectives. Method: A qualitative content analysis approach was employed. Using purposeful sampling, data collected from 26 women with divorce experience. In-depth semi-structured interviews and focus group discussions were used to gather information. Results: The findings suggest two main themes: "concept" and "process of experience". Each theme was divided into sub-themes as general vocabulary, especially lexical (experience), perceived conflict, versusbelief experience, and traumatic. Conclusion: Concept of divorce is driven from social believes. Divorce affects health. In fact, divorce not only is a socio-cultural issue, but also, a social health determinant. Thus, any program in women health promotion needs to consider divorcee women's perspective. We came to conclusion that, several factors make the meaning of divorce. Furthermore, these components are subject to a separated woman's perceived experiences, perceptions, social beliefs, and gender. Keywords: Divorce, Conceptualizing, Women health, women perspective, divorcee women, Qualitative Content analysi

Mapping 123 million neonatal, infant and child deaths between 2000 and 2017

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2—to end preventable child deaths by 2030—we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000–2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations

Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017 : a systematic analysis for the Global Burden of Disease Study 2017

Background: The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk outcome pairs, and new data on risk exposure levels and risk outcome associations. Methods: We used the CRA framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017. This study included 476 risk outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46 749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risks; and (6) changes due to all other factors, approximated as the risk-deleted death and DALY rates, where the risk-deleted rate is the rate that would be observed had we reduced the exposure levels to the TMREL for all risk factors included in GBD 2017. Findings: In 2017,34.1 million (95% uncertainty interval [UI] 33.3-35.0) deaths and 121 billion (144-1.28) DALYs were attributable to GBD risk factors. Globally, 61.0% (59.6-62.4) of deaths and 48.3% (46.3-50.2) of DALYs were attributed to the GBD 2017 risk factors. When ranked by risk-attributable DALYs, high systolic blood pressure (SBP) was the leading risk factor, accounting for 10.4 million (9.39-11.5) deaths and 218 million (198-237) DALYs, followed by smoking (7.10 million [6.83-7.37] deaths and 182 million [173-193] DALYs), high fasting plasma glucose (6.53 million [5.23-8.23] deaths and 171 million [144-201] DALYs), high body-mass index (BMI; 4.72 million [2.99-6.70] deaths and 148 million [98.6-202] DALYs), and short gestation for birthweight (1.43 million [1.36-1.51] deaths and 139 million [131-147] DALYs). In total, risk-attributable DALYs declined by 4.9% (3.3-6.5) between 2007 and 2017. In the absence of demographic changes (ie, population growth and ageing), changes in risk exposure and risk-deleted DALYs would have led to a 23.5% decline in DALYs during that period. Conversely, in the absence of changes in risk exposure and risk-deleted DALYs, demographic changes would have led to an 18.6% increase in DALYs during that period. The ratios of observed risk exposure levels to exposure levels expected based on SDI (O/E ratios) increased globally for unsafe drinking water and household air pollution between 1990 and 2017. This result suggests that development is occurring more rapidly than are changes in the underlying risk structure in a population. Conversely, nearly universal declines in O/E ratios for smoking and alcohol use indicate that, for a given SDI, exposure to these risks is declining. In 2017, the leading Level 4 risk factor for age-standardised DALY rates was high SBP in four super-regions: central Europe, eastern Europe, and central Asia; north Africa and Middle East; south Asia; and southeast Asia, east Asia, and Oceania. The leading risk factor in the high-income super-region was smoking, in Latin America and Caribbean was high BMI, and in sub-Saharan Africa was unsafe sex. O/E ratios for unsafe sex in sub-Saharan Africa were notably high, and those for alcohol use in north Africa and the Middle East were notably low. Interpretation: By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning

Socioeconomic inequalities in prevalence, awareness, treatment and control of hypertension: evidence from the PERSIAN cohort study

Background Elevated blood pressure is associated with cardiovascular disease, stroke and chronic kidney disease. In this study, we examined the socioeconomic inequality and its related factors in prevalence, Awareness, Treatment and Control (ATC) of hypertension (HTN) in Iran. Method The study used data from the recruitment phase of The Prospective Epidemiological Research Studies in IrAN (PERSIAN). A sample of 162,842 adults aged > = 35 years was analyzed. HTN was defined according to the Joint National Committee)JNC-7(. socioeconomic inequality was measured using concentration index (Cn) and curve. Results The mean age of participants was 49.38(SD = +/- 9.14) years and 44.74% of the them were men. The prevalence of HTN in the total population was 22.3%(95% CI: 20.6%; 24.1%), and 18.8%(95% CI: 16.8%; 20.9%) and 25.2%(95% CI: 24.2%; 27.7%) in men and women, respectively. The percentage of awareness treatment and control among individuals with HTN were 77.5%(95% CI: 73.3%; 81.8%), 82.2%(95% CI: 70.2%; 81.6%) and 75.9%(95% CI: 70.2%; 81.6%), respectively. The Cn for prevalence of HTN was -0.084. Two factors, age (58.46%) and wealth (32.40%), contributed most to the socioeconomic inequality in the prevalence of HTN. Conclusion The prevalence of HTN was higher among low-SES individuals, who also showed higher levels of awareness. However, treatment and control of HTN were more concentrated among those who had higher levels of SES, indicating that people at a higher risk of adverse event related to HTN (the low SES individuals) are not benefiting from the advantage of treatment and control of HTN. Such a gap between diagnosis (prevalence) and control (treatment and control) of HTN needs to be addressed by public health policymakers

Global injury morbidity and mortality from 1990 to 2017 : results from the Global Burden of Disease Study 2017

Correction:Background Past research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries. Methods We reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs). Findings In 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty interval: 338 174 876 to 371 610 802) new cases of injury globally, which increased to 520 710 288 (493 430 247 to 547 988 635) new cases in 2017. During this time, age-standardised incidence decreased non-significantly from 6824 (6534 to 7147) to 6763 (6412 to 7118) per 100 000. Between 1990 and 2017, age-standardised DALYs decreased from 4947 (4655 to 5233) per 100 000 to 3267 (3058 to 3505). Interpretation Injuries are an important cause of health loss globally, though mortality has declined between 1990 and 2017. Future research in injury burden should focus on prevention in high-burden populations, improving data collection and ensuring access to medical care.Peer reviewe

Global, regional, and national burden of traumatic brain injury and spinal cord injury, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.

Traumatic brain injury (TBI) and spinal cord injury (SCI) are increasingly recognised as global health priorities in view of the preventability of most injuries and the complex and expensive medical care they necessitate. We aimed to measure the incidence, prevalence, and years of life lived with disability (YLDs) for TBI and SCI from all causes of injury in every country, to describe how these measures have changed between 1990 and 2016, and to estimate the proportion of TBI and SCI cases caused by different types of injury. METHODS: We used results from the Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2016 to measure the global, regional, and national burden of TBI and SCI by age and sex. We measured the incidence and prevalence of all causes of injury requiring medical care in inpatient and outpatient records, literature studies, and survey data. By use of clinical record data, we estimated the proportion of each cause of injury that required medical care that would result in TBI or SCI being considered as the nature of injury. We used literature studies to establish standardised mortality ratios and applied differential equations to convert incidence to prevalence of long-term disability. Finally, we applied GBD disability weights to calculate YLDs. We used a Bayesian meta-regression tool for epidemiological modelling, used cause-specific mortality rates for non-fatal estimation, and adjusted our results for disability experienced with comorbid conditions. We also analysed results on the basis of the Socio-demographic Index, a compound measure of income per capita, education, and fertility. FINDINGS: In 2016, there were 27·08 million (95% uncertainty interval [UI] 24·30-30·30 million) new cases of TBI and 0·93 million (0·78-1·16 million) new cases of SCI, with age-standardised incidence rates of 369 (331-412) per 100 000 population for TBI and 13 (11-16) per 100 000 for SCI. In 2016, the number of prevalent cases of TBI was 55·50 million (53·40-57·62 million) and of SCI was 27·04 million (24·98-30·15 million). From 1990 to 2016, the age-standardised prevalence of TBI increased by 8·4% (95% UI 7·7 to 9·2), whereas that of SCI did not change significantly (-0·2% [-2·1 to 2·7]). Age-standardised incidence rates increased by 3·6% (1·8 to 5·5) for TBI, but did not change significantly for SCI (-3·6% [-7·4 to 4·0]). TBI caused 8·1 million (95% UI 6·0-10·4 million) YLDs and SCI caused 9·5 million (6·7-12·4 million) YLDs in 2016, corresponding to age-standardised rates of 111 (82-141) per 100 000 for TBI and 130 (90-170) per 100 000 for SCI. Falls and road injuries were the leading causes of new cases of TBI and SCI in most regions. INTERPRETATION: TBI and SCI constitute a considerable portion of the global injury burden and are caused primarily by falls and road injuries. The increase in incidence of TBI over time might continue in view of increases in population density, population ageing, and increasing use of motor vehicles, motorcycles, and bicycles. The number of individuals living with SCI is expected to increase in view of population growth, which is concerning because of the specialised care that people with SCI can require. Our study was limited by data sparsity in some regions, and it will be important to invest greater resources in collection of data for TBI and SCI to improve the accuracy of future assessments

Global, regional, and national burden of neurological disorders, 1990–2016 : a systematic analysis for the Global Burden of Disease Study 2016

Background: Neurological disorders are increasingly recognised as major causes of death and disability worldwide. The aim of this analysis from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 is to provide the most comprehensive and up-to-date estimates of the global, regional, and national burden from neurological disorders. Methods: We estimated prevalence, incidence, deaths, and disability-adjusted life-years (DALYs; the sum of years of life lost [YLLs] and years lived with disability [YLDs]) by age and sex for 15 neurological disorder categories (tetanus, meningitis, encephalitis, stroke, brain and other CNS cancers, traumatic brain injury, spinal cord injury, Alzheimer's disease and other dementias, Parkinson's disease, multiple sclerosis, motor neuron diseases, idiopathic epilepsy, migraine, tension-type headache, and a residual category for other less common neurological disorders) in 195 countries from 1990 to 2016. DisMod-MR 2.1, a Bayesian meta-regression tool, was the main method of estimation of prevalence and incidence, and the Cause of Death Ensemble model (CODEm) was used for mortality estimation. We quantified the contribution of 84 risks and combinations of risk to the disease estimates for the 15 neurological disorder categories using the GBD comparative risk assessment approach. Findings: Globally, in 2016, neurological disorders were the leading cause of DALYs (276 million [95% UI 247–308]) and second leading cause of deaths (9·0 million [8·8–9·4]). The absolute number of deaths and DALYs from all neurological disorders combined increased (deaths by 39% [34–44] and DALYs by 15% [9–21]) whereas their age-standardised rates decreased (deaths by 28% [26–30] and DALYs by 27% [24–31]) between 1990 and 2016. The only neurological disorders that had a decrease in rates and absolute numbers of deaths and DALYs were tetanus, meningitis, and encephalitis. The four largest contributors of neurological DALYs were stroke (42·2% [38·6–46·1]), migraine (16·3% [11·7–20·8]), Alzheimer's and other dementias (10·4% [9·0–12·1]), and meningitis (7·9% [6·6–10·4]). For the combined neurological disorders, age-standardised DALY rates were significantly higher in males than in females (male-to-female ratio 1·12 [1·05–1·20]), but migraine, multiple sclerosis, and tension-type headache were more common and caused more burden in females, with male-to-female ratios of less than 0·7. The 84 risks quantified in GBD explain less than 10% of neurological disorder DALY burdens, except stroke, for which 88·8% (86·5–90·9) of DALYs are attributable to risk factors, and to a lesser extent Alzheimer's disease and other dementias (22·3% [11·8–35·1] of DALYs are risk attributable) and idiopathic epilepsy (14·1% [10·8–17·5] of DALYs are risk attributable). Interpretation: Globally, the burden of neurological disorders, as measured by the absolute number of DALYs, continues to increase. As populations are growing and ageing, and the prevalence of major disabling neurological disorders steeply increases with age, governments will face increasing demand for treatment, rehabilitation, and support services for neurological disorders. The scarcity of established modifiable risks for most of the neurological burden demonstrates that new knowledge is required to develop effective prevention and treatment strategies. Funding: Bill & Melinda Gates Foundation