Process evaluation of a community-based program for prevention and control of non-communicable disease in a developing country: The Isfahan Healthy Heart Program, Iran

<p>Abstract</p> <p>Background</p> <p>Cardiovascular diseases are the most common cause of mortality in Iran. A six-year, comprehensive, integrated community-based demonstration study entitled Isfahan Healthy Heart Program (IHHP) conducted in Iran, and it started in 2000. Evaluation and monitoring are integrated parts of this quasi-experimental trial, and consists of process, as well as short and long-term impact evaluations. This paper presents the design of the "process evaluation" for IHHP, and the results pertaining to some interventional strategies that were implemented in workplaces</p> <p>Methods</p> <p>The process evaluation addresses the internal validity of IHHP by ascertaining the degree to which the program was implemented as intended. The IHHP process evaluation is a triangulated study conducted for all interventions at their respective venues. All interventional activities are monitored to determine why and how some are successful and sustainable, to identify mechanisms as well as barriers and facilitators of implementation.</p> <p>Results</p> <p>The results suggest that factory workers and managers are satisfied with the interventions. In the current study, success was mainly shaped by the organizational readiness and timing of the implementation. Integrating most of activities of the project to the existing ongoing activities of public health officers in worksites is suggested to be the most effective means of implementation of the health promoting activities in workplaces.</p> <p>Conclusion</p> <p>The results of our experience may help other developing countries to plan for similar interventions.</p

Opium use and risk of mortality from digestive diseases: A prospective cohort study

Objectives:Opium use, particularly in low doses, is a common practice among adults in northeastern Iran. We aimed to investigate the association between opium use and subsequent mortality from disorders of the digestive tract.Methods:We used data from the Golestan Cohort Study, a prospective cohort study in northeastern Iran, with detailed, validated data on opium use and several other exposures. A total of 50,045 adults were enrolled during a 4-year period (2004-2008) and followed annually until December 2012, with a follow-up success rate of 99. We used Cox proportional hazard regression models to evaluate the association between opium use and outcomes of interest.Results:In all, 8,487 (17) participants reported opium use, with a mean duration of 12.7 years. During the follow-up period 474 deaths from digestive diseases were reported (387 due to gastrointestinal cancers and 87 due to nonmalignant etiologies). Opium use was associated with an increased risk of death from any digestive disease (adjusted hazard ratio (HR)=1.55, 95 confidence interval (CI)=1.24-1.93). The association was dose dependent, with a HR of 2.21 (1.57-3.31) for the highest quintile of cumulative opium use vs. no use (P trend =0.037). The HRs (95 CI) for the associations between opium use and malignant and nonmalignant causes of digestive mortality were 1.38 (1.07-1.76) and 2.60 (1.57-4.31), respectively. Increased risks were seen both for smoking opium and for ingestion of opium.Conclusions:Long-term opium use, even in low doses, is associated with increased risk of death from both malignant and nonmalignant digestive diseases

Effects of dietary L-glutamine supplement on performance, characteristics of the carcase and intestinal morphometry in guinea fowl chickens (Numida meleagris)

This study was conducted to investigate the effects of dietary supplementation of L-glutamine and the synergistic effects between glutamic acid of wheat and glutamine on the performance, carcase characteristics and intestinal morphometry in guinea fowl chickens fed with corn–soybean meal–wheat-based diets. A total of 288 one-day-old guinea fowl chicks (Numida meleagris) were used in a completely randomised design with six treatments, six replicates and 8 male chickens per replicate. The treatments were as follows: (1) corn–soybean meal-based diet (control), (2) corn–soybean meal–wheat-based diet, (3) treatment 1 containing 0.5% L-glutamine, (4) treatment 1 containing 1% L-glutamine, (5) treatment 2 containing 0.5% L-glutamine and (6) treatment 2 containing 1% L-glutamine. The results showed that the body weight gain (BWG) was higher in glutamine-supplemented treatments and the best feed conversion ratio (FCR) was observed in treatment 2 with 0.5% glutamine supplementation (p < .05). The chicks fed by diets containing glutamine supplement showed a higher live weight and percentage of breast, thigh and wings compared to glutamine-free diets, whereas the highest percentage of liver and heart observed in treatment 1 and the highest percentage of gizzard in treatments 1 and 2 (p < .05). The length and the width of villi and crypt depth in all three parts of the small intestine (duodenum, jejunum and ileum) were higher in glutamine-based treatments compared to glutamine-free treatments (p < .05). Also, the addition of wheat to diet had no negative effects on the mentioned parameters; moreover, the 0.5% L-glutamine supplement in wheat–corn–soybean diets improved performance, carcase characteristics and intestinal morphometry

Feeding processed soybean to mid-lactation Holstein cows: ingestive behaviour and rumen fermentation characteristics

The objective of this study was to evaluate the effects of roasted soybean (RSB), extruded soybean (ESB) and their equal blend (RSB + ESB) compared with soybean meal (SBM) on nutrient intake, feed preference, meal and rumination patterns, feeding and chewing behaviour and rumen fermentation characteristics of mid-lactation dairy cows. Eight Holstein dairy cows were used in a replicated 4 × 4 Latin square design with four 28-d periods. Cows received one of the four following experimental diets: (1) 13.88% of diet dry matter (DM) as SBM; (2) 15.22% of diet DM as RSB, (3) 15.55% of diet DM as ESB and (4) 7.69% RSB plus 7.69% ESB (RSB + ESB). Each experimental period consisted of a 21-d diet adaptation period and a 7-d data collection period. Meal patterns, including meal size and inter-meal interval, were not affected by the experimental diets and thereby DM intake was not different among diets. Sorting index was not different across dietary treatments but intake of particles retained on 1.18-mm sieve and on pan increased and decreased in both SBM and ESB as compared with RSB and RSB + ESM, respectively. Total time spent eating and ruminating and rumen volatile fatty acid concentrations were unaffected by dietary treatments. Feeding processed soybean instead of SBM had minimal effects on sorting behaviour and meal patterns and thereby no changes in feed intake occurred. Finally, RSB and ESB and their equal blend had a similar effect on feed intake and chewing behaviour of mid-lactation Holstein cows.Highlights Feeding processed soybean products had the minor effect on feed intake and can be considered as alternative feedstuffs when the price is competitive

Evaluation of the educational environments of undergraduate medicine and pharmacy programmes at the University of Zambia

Background:A Based on the World Health Organization’s reporting, over 1.25 million people die annually in traffic accidents worldwide. Traffic accidents are the ninth main cause of death worldwide, with an average age range of victims of 15 to 29. Broadly speaking, 90% of traffic accidents happen in the lowand middle-income countries that comprise 82% of the global population, and these countries account for half of the world’s vehicles. One of the goals of the National Road Traffic Knowledge Development Trustee is to plan and implement training courses (content design, design and implementation and evaluation) for target groups. To achieve this goal and due to the lack of academic programs on traffic safety in Iran, a single-credit course, “Safety and Traffic,” was developed to be run as a compulsory academic course in all universities across the country. Methods: This course was administered as a national pilot study in four phases and in 17 medical universities across the country. All experts and national authorities in the Ministry of Science and the Ministry of Health and Medical Education were requested to provide feedback. Afterwards, the results and comments were forwarded to the Supreme Council of Cultural Revolution for further investigation. Upon approval of the Council, the course will be implemented in all universities across the country. Results: Results from the pre-test showed that the level of students’ knowledge was low before attending the training courses. Surveys also revealed that the two items of “pedestrian safety” and “first aids in RTCs” were the most useful and applicable subjects. The percentage of wrong answers ranged from 61 to 98%. Conclusion: Considering the importance of traffic accidents and people’s role in traffic-related issues, it seems that it is necessary to provide university courses for traffic safety education