Effects of Educational Intervention Pertaining to Knowledge, Beliefs, Barriers and Practices on Breast Cancer Screening Behaviors Among Teachers in Selangor, Malaysia

Breast cancer (BC) is the leading cause of cancer death among Malaysian women. Early detection of breast cancer can play an important role in reducing cancer morbidity and mortality. However participation of women in breast cancer screening (BCS) is low in Malaysia. Studies have shown greater risk of breast cancer among women teachers compared to other occupations. The objective of this randomised controlled trial study was to develop and evaluate the effect of an educational intervention to improve knowledge, beliefs, barriers and practices on breast cancer screening among female secondary school teachers in Selangor, Malaysia. A multi-stage random sampling was used for selection of secondary schools in Selangor (4 control schools and 4 intervention schools). All female teachers in the selected schools were invited to participate in the study with informed consent form. Baseline data were collected from 237 (52%) teachers on socio-demographic background, knowledge, beliefs and practices on breast cancer screening. A translated, reliable and valid tool adapted from Champion’s Health Belief Model was used to determine women’s perceptions on BC and BCS. An educational intervention of four months duration comprised a one day seminar supported by an educational model, presentations, brochures, telephone follow-up motivation sessions, and practical demonstration on breast self examination (BSE) and clinical breast examination (CBE) techniques. The control group received all of the informational material after the completion of the study. To evaluate the effect of the intervention data were collected at baseline, immediately, one month and four months after intervention for both groups. Descriptive and multivariate statistics were used for analysing the data using SPSS version 14. The mean age of participants was 37.8 years (SD=7.2) and majority of them were Malay (84%), married (88%) with tertiary education (90%). After intervention, there was a significant increase in the mean score of knowledge (20.7-28.3, p<0.001), beliefs (215.2-225.1, p<0.001) and proportion of BSE (53.4%-87%, p<0.001), CBE (23.3%-37%, p<0.01) and mammography practices (3.4%-10.3% p<0.01,) over the four months follow up in the intervention group. Lack of knowledge (45%- 15%, p<0.001), being busy (37%-28%, p<0.01) and not interested (7%-2%, p<0.01) were the most common barriers to BCS before intervention but these decreased significantly after intervention. Grounded Health Belief Model (HBM) constructs significantly increased for perceived susceptibility, seriousness, confidence and benefits of mammography and decreased in barriers for BSE and mammography was observed in the intervention group but HBM did not predict the BCS behaviours. The logistic regression model showed that change in knowledge score was the predictor of the uptake of BCS practices. The change in knowledge score on risk factors of BC (OR=1.663), screening methods (OR=1.145) and symptoms of BC (OR=1.729) were predictors of BSE, CBE and mammography utilization, respectively. With the exception of a significant change in BSE practice (58.7%-77.9%, p<0.001) the control group showed no significant improvement in all other aspects. These results provide evidence for the effectiveness an educational intervention using a multi-component approaches in promoting breast cancer screening knowledge, beliefs and practices within an educated group as tteachers represent a large portion of educated women in Malaysia. This study suggests that women’s knowledge on BCS can improve breast cancer screening behaviors. In addition availability and affordability of screening services and their cost need to be addressed for promoting breast cancer screening behaviors in Malaysian women

Factors associated with breast self-examination among Malaysian women teachers

The purpose of this study was to examine factors related to breast self-examination (BSE) among teachers in Selangor, Malaysia. A cross-sectional study was conducted among 425 female teachers in 20 randomly selected secondary schools. A self-administered questionnaire based on the health belief model was randomly selected secondary schools. A self-administered questionnaire based on the health belief model was used, including sociodemographic background and knowledge, beliefs and practices about breast cancer and BSE. Only 19% of the women performed BSE on a regular basis. Higher knowledge about breast cancer, greater confidence in performing BSE and regular visits to a physician were significant predictors for practising BSE. To promote BSE practice among Malaysian women, tailored health education and health promotion programmes should be developed based on a specific understanding of women's health beliefs

Predictors of adherence to clinical breast examination and mammography screening among Malaysian women.

Breast cancer is the most common cancer among Malaysian women and early detection can play an important role in reducing cancer morbidity and mortality. The aim of this cross-sectional study was to determine the rates and factors related to clinical breast examination (CBE) and mammography among 425 female teachers in Selangor, Malaysia. A self-administered questionnaire that included questions on socio-demography, cancer-related knowledge practice and an adapted version of Champion's revised Health Belief Model Scale was employed. The mean age of participants was 37.2±7.16 years. Only 25% of the women ever had a CBE. Of women over the age 40 (n=138), 13.6% reported having had a mammography. The results showed higher susceptibility to breast cancer, higher benefits of doing CBE and regular visits with a physician to be significant predictors for undergoing CBE (p<0.05). In addition, higher a perceived susceptibility to breast cancer and regular undergoing CBE were significant predictors for having a mammography. The findings clearly suggest a need for improving women's awareness on breast cancer screening, its importance and recommended guidelines

Association of menopausal sexual dysfunction with demographic and obstetric factors in postmenopausal women in Hamadan, Iran

Background: Sexual dysfunction is a common menopausal problem that may be affected by demographic factors. The present study aimed to determine demographic and obstetric factors affecting sexual dysfunction in menopause.Methods: The present cross-sectional descriptive-analytical study was conducted on 315 postmenopausal women in Hamadan. The research instruments included demographic questionnaire, and female sexual function index (FSFI). Univariate and multivariate linear regressions were used to investigate the association of different factors and sexual function at a significance level of less than 0.05.Results: The participants' mean age was 54.15±4.24 years. Their mean sexual function score was 18.92±4.25 indicating poor sexual function. The multivariate analysis indicated that increasing the number of spouse marriage, sexual function score decreased by 2.45 (p=0.006). Furthermore, the sexual function score in those, who were not satisfied with their marriage, was 5.58 points lower than those who were satisfied with their marriage status (p <0.001).Conclusions: Given the relationship between number of spouse marriage and marital satisfaction with sexual function in postmenopausal women, it is necessary to design and implement training sessions for them.

The mediating role of anxiety to perform social skills between parental attachment and adolescents' self-efficacy

The present study examined the mediating role of adolescent’s anxiety to perform social skills on the relationships between perceived parental attachment and self-efficacy among 374 Iranian adolescents aged 17 to 19 years old. Survey results showed that parental attachment was significantly related to an adolescent’s self-efficacy (p<0.05). Moreover, the results revealed that adolescents with low self-efficacy experienced higher anxiety to perform social skills (p<0.05). Anxiety to perform social skills mediated the relationship between parental attachment and adolescents’ self-efficacy (p<0.05). The findings highlighted the mediating role of anxiety to perform social skills on the relationship between parental attachment and adolescent’s self-efficacy

THE EFFECT OF COUNSELING ON KNOWLEDGE, ATTITUDE AND PRACTICE OF PUBERTY HEALTH AMONG ADOLESCENT GIRLS LIVING IN WELFARE BOARDING CENTERS

The purpose of this study was to improve level of knowledge, attitude and practice of puberty health among adolescent girls living in welfare boarding centers, Hamadan, Iran. This research was applied in terms of its nature and purpose. This quasi-experimental interventional study recruited all eligible 12-19-year-old girls residents (n=30) of the boarding centers affiliated to the Welfare Organization, Hamadan city, Iran. The data collection tool was questionnaires that three times (before, immediately and one month after Intervention) were used. Data using descriptive and inferential statistical methods using SPSS-20 software was analyzed. P-value was considered significant if it was less than 0.05. The results showed that knowledge, attitude and practice in immediately and a month after the intervention at over time compared to before the intervention significantly increased (P<0.001).The present study concluded that adolescents lacked appropriate knowledge, attitude and practices about puberty in the pre-program phase. After implementation of the program considerable improvements were noticed in adolescent girls' knowledge, attitude and practice. Therefore the educational program was successful in attaining its aims of positively changing the knowledge, attitude and practice of puberty health. Development of Teaching program for health care providers who take care of adolescent girls at girls living in welfare boarding centers about issues related to puberty and reproductive health. Keywords: Counseling, puberty health, Adolescent girl

Knowledge and behavior regarding breast cancer screening among female teachers in Selangor, Malaysia.

A cross-sectional study was carried out to determine the knowledge and practices of 425 female secondary school teachers from 20 selected secondary schools in Selangor, Malaysia on breast cancer screening (BCS). A self-administered, structured questionnaire was used for data collection. This study showed moderate to low knowledge on breast cancer (BC) and BCS among teachers. Only 19%, 25% and 13.6% eligible women performed breast self-examination (BSE), clinical breast examination (CBE) and mammography respectively, on a regular basis. Level of breast cancer knowledge was significantly associated with BSE (p=0.000). Having heard/ read about BCS, and regular visit with a physician were associated with BCS behaviors (P0.05 and age, family history of breast cancer, marital status or having health insurance). Efforts are needed to increase knowledge and remove misconceptions about breast cancer and screening practices among Malaysian women

Evaluation of the Effect of Sodium Stearoyl-2-lactylate Emulsifier, Xylanase Enzyme, and Alcoholic Sugar Sorbitol on the Quality of Wheat Bran Bread

Introduction Bran-enriched bread is a source of dietary fibers and other nutritional compounds; However, wheat bran also contains phytic acid, asparagine, a high ratio of insoluble to soluble fiber, insoluble arabinoxylans, and glutathione that cause nutritional and technological problems in the product. Therefore, to produce bran-enriched bread, it is necessary to use pre-processed wheat bran. Despite the modifications made in wheat bran to improve its nutritional and functional properties, wheat bran-rich cereal products have a dark color, rough texture, and small loaf volume. To improve the quality of bran-enriched bread, common additives in the bakery industry such as enzymes, alcoholic sugars, emulsifiers can be used. Xylanase is one of the important classes of hemicellulase enzymes that delays the aggregation of amylose chains, and consequently, bread staling. Moreover, the xylanase enzyme increases the loaf volume by converting water-insoluble arabinoxylans into soluble ones. SSL emulsifier can interact with gliadin protein and prevent its participation in crosslinking bonds, which softens the bread crumbs. Polyols can reduce water activity and improve the softness of bread. Sorbitol is commonly used in starch-based foods to improve their quality by modifying starch gelatinization and retrogradation. So far, no article has been presented on the simultaneous effect of enzyme, alcoholic sugar, and emulsifier improvers on bread enriched with processed wheat bran. In addition, the amount and composition of improvers used in combination with each other can cause various effects on different properties of bread. This study aims to improve the technological, physicochemical, and finally stalling of optimal bread enriched with 15% of pre-processed wheat bran while benefiting from the nutritional properties of wheat bran. Materials and Methods In this study, the effect of sodium stearoyl-2-lactylate emulsifier (0-0.8%), xylanase enzyme (0-0.05%), and sorbitol sugar alcohol (0-6%) as improving agents on The physicochemical and technological parameters of bread enriched with 15% pre-processed wheat bran were investigated based on the response surface method in the form of a rotatable central composite design. After that, design-expert software determined the optimum percentage of improvers to achieve the minimum amount of firmness and cohesiveness of bread and the maximum amount of specific volume, moisture of bread crumbs, lightness of bread crust, and solidity of bread pore structure. Finally, optimal and control samples were compared using the Differential Scanning Calorimetry and Scanning Electron Microscopic experiments.  Results and Discussion The experiments showed the bread's firmness under the influence of SSL emulsifier and sorbitol alcoholic sugar and chewiness, by adding SSL emulsifier and xylanase enzyme decreased significantly. All three improvers caused a significant increase in the specific volume of bread. The pore characteristics of bread crumbs, such as solidity and circularity, were significantly improved by adding an SSL emulsifier, and roundness was considerably enhanced by adding sorbitol alcohol. The brightness of bread crust was also increased significantly by the SSL emulsifier and xylanase enzyme. In addition, the Xylanase enzyme improved the moisture content of bread by substantially increasing the moisture content of bread crumbs, and alcoholic sugar and SSL emulsifier with a significant reduction in crust moisture. Moreover, the chewiness of bread on the first day after baking, specific volume, moisture of bread crust on the third day after baking, and the solidity of bread crumbs were significantly improved due to the interaction of SSL emulsifier and sorbitol alcohol. Also, the interaction of the xylanase enzyme and SSL emulsifier improved the specific volume, moisture of the bread crumbs on the first day after baking, the lightness of the bread crust,  the pore area fraction, and the circularity of the bread crumbs. Finally, the optimal formula was obtained, including 0.563% of SSL emulsifier, 0.040% of xylanase enzyme, and 2.356% of alcoholic sugar sorbitol. The results showed a significant decrease in enthalpy and an increase in the initial gelatinization temperature in the optimal sample compared to the control ones. Also, a weaker gluten network, more swelling, and amounts of starch granules in the microstructure of sample bread were observed. Conclusion In conclusion, SSL emulsifier by interaction with amylose and amylopectin in starch granules, sorbitol alcohol via interacting with water molecules surrounding starch chains or by bonding between starch chains in amorous regions, and xylanase enzyme through reducing rate of crystallization can reduce the gelatinization of starch granules, enthalpy, and finally the retrogradation process of amylopectin and stalling rate of bread with their synergic effects. In this research, we formulate the wheat bran-enriched bread that not only benefits from the nutritional features of wheat bran but also preserves the quality characteristics of bread

The mediating effect of self-efficacy on the relationships between learning organization and career advancement among academic employees in Hamadan, Iran

The aim of this study was to determine relationship between career advancement and learning organization through mediating effect of self-efficacy among academic employees in two public universities in Hamadan, Iran. A survey using a self-administered structured questionnaire was done among 307 randomly selected academics. The results show that learning organization and self-efficacy were significantly related to academic career advancement (P<0.05). The findings show self-efficacy has partially mediated the relationship between career advancement with learning organization (P<0.05). Therefore, universities may strength their academic self- efficacy to increase career advancement