Impacts of chronic illness on families: Experiences of Iranian family of patients with Multiple Sclerosis: A Qualitative Study

Family members are often the primary healthcare providers and support for patients with a chronic disease such as Multiple Sclerosis (MS). Families endure and encounter long term difficulties when caring for a person suffering from MS. This study was conducted to explain the family experiences with multiple sclerosis and their problem and concerns.In a qualitative research, based on conventional content analysis, 18 family caregivers of patients with MS were selected by using purposive sampling method. Data were collected through semi-structured and in-depth interviews conducted at the Multiple Sclerosis Society and hospitals of Tabriz in Iran from May to December of 2015. Data were analyzed according to qualitative content analysis by using the MAXQDA.10 software. Interviews identified three main categories regarding family caregiver experiences with MS: 1) disease onset crisis, 2) disease burden, and 3) living in the shadow of death. The results showed that family caregivers of MS patients face numerous problems and they are at risk for depression and a lower quality of life due to disease burden. Also the results revealed the main concerns of families are financial problems and fear of paralysis and patient be crippled. Healthcare providers can use these results to better support and care for patients and their family members in order to improve their quality of life and reduce disease complications

Prevalence of low back pain and its related factors among pre-hospital emergency personnel in Iran

Objective: Low back pain is one of the most important job injuries among emergency medical personnel. This study was carried out to investigate the prevalence of low back pain as well as its physical, mental and managerial predisposing factors among emergency medical personnel in Iran. Methods: In this analytical cross-sectional study we recruited 298 pre-hospital emergency medical personnel based on census sampling. Data were gathered using Nordic and a research-made questionnaire related to physical, mental and managerial back pain factors. Data were analyzed using SPSS version 20. Descriptive and analytical tests including chi-square test were used appropriately. P value less than 0.05 was considered as the level of significance. Results: Findings showed that 46.3% of pre- hospital emergency technicians had a history of low back pain with different intensities. We observed a significant relationship between age, work experience, occupational-physical factors with low back pain (P > 0.001). However, there was no significant relationship between occupational-managerial factors and mental-occupational factors with low back pain (P > 0.05). Conclusion: Results show that the prevalence of back pain among emergency medical personnel is high. Identifying the factors associated with back pain can help the managers as well as the personnel to control the problem of back pain and increase employees’ productivity

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 cancer incidence, mortality, years of life lost, years lived with disability, and disability-Adjusted life-years for 29 cancer groups, 1990 to 2017 : A systematic analysis for the global burden of disease study

Importance: Cancer and other noncommunicable diseases (NCDs) are now widely recognized as a threat to global development. The latest United Nations high-level meeting on NCDs reaffirmed this observation and also highlighted the slow progress in meeting the 2011 Political Declaration on the Prevention and Control of Noncommunicable Diseases and the third Sustainable Development Goal. Lack of situational analyses, priority setting, and budgeting have been identified as major obstacles in achieving these goals. All of these have in common that they require information on the local cancer epidemiology. The Global Burden of Disease (GBD) study is uniquely poised to provide these crucial data. Objective: To describe cancer burden for 29 cancer groups in 195 countries from 1990 through 2017 to provide data needed for cancer control planning. Evidence Review: We used the GBD study estimation methods to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-Adjusted life-years (DALYs). Results are presented at the national level as well as by Socio-demographic Index (SDI), a composite indicator of income, educational attainment, and total fertility rate. We also analyzed the influence of the epidemiological vs the demographic transition on cancer incidence. Findings: In 2017, there were 24.5 million incident cancer cases worldwide (16.8 million without nonmelanoma skin cancer [NMSC]) and 9.6 million cancer deaths. The majority of cancer DALYs came from years of life lost (97%), and only 3% came from years lived with disability. The odds of developing cancer were the lowest in the low SDI quintile (1 in 7) and the highest in the high SDI quintile (1 in 2) for both sexes. In 2017, the most common incident cancers in men were NMSC (4.3 million incident cases); tracheal, bronchus, and lung (TBL) cancer (1.5 million incident cases); and prostate cancer (1.3 million incident cases). The most common causes of cancer deaths and DALYs for men were TBL cancer (1.3 million deaths and 28.4 million DALYs), liver cancer (572000 deaths and 15.2 million DALYs), and stomach cancer (542000 deaths and 12.2 million DALYs). For women in 2017, the most common incident cancers were NMSC (3.3 million incident cases), breast cancer (1.9 million incident cases), and colorectal cancer (819000 incident cases). The leading causes of cancer deaths and DALYs for women were breast cancer (601000 deaths and 17.4 million DALYs), TBL cancer (596000 deaths and 12.6 million DALYs), and colorectal cancer (414000 deaths and 8.3 million DALYs). Conclusions and Relevance: The national epidemiological profiles of cancer burden in the GBD study show large heterogeneities, which are a reflection of different exposures to risk factors, economic settings, lifestyles, and access to care and screening. The GBD study can be used by policy makers and other stakeholders to develop and improve national and local cancer control in order to achieve the global targets and improve equity in cancer care. © 2019 American Medical Association. All rights reserved.Peer reviewe

Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017

A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of <5% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8–38.5) million) in 2000 to 6.0% (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic

Erratum: 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

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

Work Related Burden of Stress among Emergency Medical Service Personnel

Introduction: The staff of pre-hospital emergency medical service experience many stresses daily in the frontline of emergency responses. Critical conditions and trying to save patients’ lives make operation difficult for emergency medical technicians. The burden of stress in this job group is related with critical incidents, and functional and emotional problems that are the result of the rate of exposure and the intensity of the stressor. Methods: In this descriptive-correlation study, 320 technicians working in pre-hospital emergency bases participated. To gather data, stress burden evaluation questionnaire, which was the result of rate of exposure to stressors, was used. Data were analyzed using SPSS statistical software and descriptive and inferential statistics. Results: In the present study, the most important causes of burden of stress were reported to be environmental occupational factors and patient-related factors. Mean and standard deviation of stress burden was 8.70 ± 3.61. Working with trauma patients, unrealistic expectations of the patient or their relatives, and driving in critical conditions and resuscitation of patients inflicted the highest burden of stress upon the staff. In this study, the mean score of stressor intensity was higher than the mean score of exposure to stressors and a significant correlation was seen between the rate of stress burden with number of operations, educational degree, emergency bases, and status of employment. Conclusion: Proper identification of stressors in terms of prevalence and intensity, leads to better understanding of these factors in pre-hospital emergency and can be of great help in prevention and control of stress burden among emergency medical service staff

بار استرس مرتبط با عملیات اورژانس در تکنسین های فوریت های پزشکی

Introduction: The staff of pre-hospital emergency medical service experience many stresses daily in the frontline of emergency responses. Critical conditions and trying to save patients’ lives make operation difficult for emergency medical technicians. The burden of stress in this job group is related with critical incidents, and functional and emotional problems that are the result of the rate of exposure and the intensity of the stressor. Methods: In this descriptive-correlation study, 320 technicians working in pre-hospital emergency bases participated. To gather data, stress burden evaluation questionnaire, which was the result of rate of exposure to stressors, was used. Data were analyzed using SPSS statistical software and descriptive and inferential statistics. Results: In the present study, the most important causes of burden of stress were reported to be environmental occupational factors and patient-related factors. Mean and standard deviation of stress burden was 8.70 ± 3.61. Working with trauma patients, unrealistic expectations of the patient or their relatives, and driving in critical conditions and resuscitation of patients inflicted the highest burden of stress upon the staff. In this study, the mean score of stressor intensity was higher than the mean score of exposure to stressors and a significant correlation was seen between the rate of stress burden with number of operations, educational degree, emergency bases, and status of employment. Conclusion: Proper identification of stressors in terms of prevalence and intensity, leads to better understanding of these factors in pre-hospital emergency and can be of great help in prevention and control of stress burden among emergency medical service staff. مقدمه: پرسنل اورژانس پیش بیمارستانی روزانه در خط مقدم پاسخ اورژانس استرس های فراوانی را تجربه می کنند. شرایط بحرانی و تلاش برای نجات بیماران،عملیات را بر تکنسین های فوریت پزشکی دشوار می نماید. بار استرس در این گروه شغلی مرتبط با حوادث بحرانی، مشکلات عملکردی و عاطفی است که حاصل میزان مواجهه در شدت تنش زا بودن عامل استرس زا است. بنابراین این مطالعه با هدف بررسی بار استرس مرتبط با عملیات اورژانس در بین تکنسین های فوریت پزشکی ایران انجام گرفت. روش کار: در این مطالعه توصیفی- همبستگی 320 تکنسین شاغل در پایگاه های اورژانس پیش بیمارستانی شرکت نمودند. برای جمع آوری داده ها از پرسشنامه ی بررسی بار استرس که حاصل میزان شدت در میزان مواجهه عوامل استرس زا بود استفاده شد. داده ها با استفاده از نرم افزار آماری SPSS و آمار توصیفی و استنباطی مورد تجزیه و تحلیل قرار گرفت. يافته ها: در این مطالعه مهمترین عامل بار استرس عوامل محیطی شغلی و عوامل مربوط به بیمار گزارش شدند. میانگین و انحراف معیار بار استرس 61/3±70/8 بود. کار با بیماران ترومایی، توقعات بیش از حد بیمار و همرا هان آن و رانندگی در شرایط بحرانی و احیاء بیماران، بیشترین بار استرس را بر پرسنل داشتند. در این مطالعه نمره میانگین شدت عوامل استرس زا بالاتر از نمره میانگین میزان مواجهه با عوامل استرس زا بود و بین میزان  بار استرس با تعداد ماموریت، مدرک تحصیلی، پایگاه های اورژانس و وضعیت استخدام ارتباط معنی داری دیده شد. نتيجه گيری: شناسایی خوب عوامل استرس زا از نظر شیوع و شدت، باعث گسترش آگاهی و فهم بهتر از این عوامل در اورژانس پیش بیمارستانی خواهد بود و کمک شایانی در پیشگیری و کنترل بار استرس در پرسنل اورژانس پیش بیمارستانی خواهد کر

The Effect of Two Educational Methods on Knowledge and Adherence to Treatment in Hemodialysis Patients: Clinical Trial

Introduction: Patients with chronic renal disease (CRD) deal with many potential problems with hemodialysis for all their life. Regarding the importance of preventing dialysis adverse effects, which are in close connection with lack of knowledge and report on how to train the patients? This study aims at comparing the impact of two methods of face to face training and training pamphlet on complying and informing of hemodialysis treatments. Methods: This clinical trial study was conducted on 58 hemodialysis patients who visited Shahid Rahnemun Teaching hospital, Yazd, Iran, and had required conditions of the research. Data were collected through a questionnaire including personal-social information, several questions to assess the level of compliance and to inform the treatment method. The quantitative analysis of this study used the Statistical Package for Social Sciences SPSS version 13 and descriptive (frequency, mean, standard deviation) and inferential (Chi-square, paired t-test, ANOVA, ANCOVA) statistics were employed. Results: The mean scores for informing both groups (face to face and training pamphlet) were significantly increased. The mean score for adherence to treatments was also significant.Conclusion: In this research, face to face training was found to be more effective than training pamphlet. It seemed to have more strong effect on increasing the level of information and adherence to treatment. To train these people, face to face training should be, thus, preferred

بررسی آگاهی و عملکرد پرستاران به آیین اخلاق پرستاری ایران در بیمارستان‌های آموزشی تبریز

Therapeutic considerations noted. In this regard, any disruption in the observance of nursing ethics can affect the most scientific and best nursing care. Today, in the world of nursing, this is reflected in the definition and compilation of codes of professional ethics, which is based on attention to human and ethical issues in establishing communication between nurse and patient in providing care. Ethical codes should be understood by nurses and used in every aspect of nursing practice, so this study was conducted to investigate the knowledge and practice of nurses to the Iranian ethics of nursing ethics in Tabriz teaching hospitals. Method: This descriptive study was performed in 2012 with the participation of 345 nurses working in the internal medicine-surgical wards of Tabriz teaching hospitals and by easy sampling. Data were collected using a researcher-made questionnaire based on Iranian nursing ethics and reliability by Cronbach's alpha method and face and content validity, then with SPSS software version 13 and descriptive and inferential statistics, independent t-test and ANOVA and Pearson correlation coefficient. , Was analyzed at the significance level of p &lt;0.05. Results: The highest percentage of nurses were women, married and had a bachelor's degree in nursing. / 40%) stated that the ritual of nursing ethics has been provided to them in a written form. 86.4% of nurses were aware of the practice of nursing ethics. 91.9% of nurses followed the ritual of nursing ethics. There was a statistically significant relationship between nurses' performance on nursing ethics and variables such as work department and sources of information in the field of ethical guidelines such as participation in conferences, in-service training and regulations. There was a statistically significant relationship between knowledge of nursing ethics and variables such as shift work, job satisfaction and history of complaints from nurses by patients. Conclusion: The knowledge and ethical practice of the studied nurses showed that the Iranian nursing community is ready to follow the path of becoming a professional as energetically and energetically as possible by applying the Iranian nursing ethics and knowledge of professional ethics codes and ethical concepts affecting clinical practice.ملاحظات درمانی توجه کرد. در این راستا هرگونه خلل در رعایت اخلاق پرستاری می‌تواند علمی‌ترین و بهترین مراقبت‌های پرستاری را تحت تأثیر قرار دهد. امروزه، در پرستاری دنیا این امر با تعریف و تدوین کدهای اخلاق حرفه‌ای نمود یافته است که اساس آن توجه به مقولات انسانی واخلاقی در برقراری ارتباط بین پرستار و بیمار در ارائه مراقبت است. کدهای اخلاقی باید توسط پرستاران درک و در هر بعد از عملکرد پرستاری استفاده شود، لذا این مطالعه با هدف بررسی آگاهی و عملکرد پرستاران به آیین ­اخلاق­ پرستاری ایران­ در ­بیمارستان­های آموزشی تبریز ­انجام ­شد. روش: این مطالعه توصیفی در سال 1391 با مشارکت 345 پرستار شاغل در بخش‌های داخلی ـ جراحی بیمارستان‌های آموزشی تبریز و با نمونه‌گیری آسان انجام شد. داده‌ها با استفاده از پرسشنامه محقق ساخته‌ای بر اساس آیین اخلاق پرستاری ایران گردآوری و پایایی به روش آلفای کرونباخ و روایی صوری و محتوایی انجام شد، سپس با نرم‌افزار آماری SPSS نسخه 13 و آمار توصیفی و استنباطی و آزمون‌های t مستقل و ANOVA و ضریب همبستگی پیرسون، در سطح معنی‌داری 05/0 p&lt; تجزیه و تحلیل شد. یافته‌ها: بیشترین درصد پرستاران، زن، متأهل و دارای مدرک کارشناسی پرستاری بودند که (1/79 درصد) آنان واحد آموزشی اخلاق پرستاری را در دانشگاه و (6/53 درصد) دوره‌های بازآموزی اخلاق حرفه‌ای را در طول خدمت گذرانده بودند و (5/40 درصد) بیان کردند آیین اخلاق پرستاری به صورت مدون در اختیار آن‌ها قرار گرفته است. 4/86 درصد پرستاران به آيين اخلاق پرستاري آگاهي داشتند. 9/91 درصد پرستاران به آيين اخلاق پرستاري عمل کردند. بین عملکرد پرستاران به آیین اخلاق پرستاری و متغیرهایی مانند بخش کاری و منابع کسب اطلاع در زمینه راهنماهای اخلاقی از جمله شرکت در همایش‌ها، آموزش ضمن خدمت و آیین‌نامه­ها رابطه آماری معنی‌داری مشاهده شد. بین آگاهی از آیین اخلاق پرستاری و متغیرهایی مانند شیفت کاری، رضایت از حرفه و سابقه شکایت از پرستاران توسط بیماران رابطه آماری معنی‌داری وجود داشت. نتیجه‌گیری: آگاهی و عملکرد اخلاقی پرستاران مورد مطالعه نشان داد، در حال حاضر جامعه پرستاری ایران آمادگی دارد با بکارگیری آیین اخلاق پرستاری ایران و آگاهی از کدهای اخلاق حرفه‌ای و مفاهیم اخلاقی مؤثر بر عملکرد بالینی، مسیر حرفه‌ای‌شدن خود را هرچه پویاتر و پرانرژی‌تر بپیماید.&nbsp