THE EFFECTS OF COGNITIVE BEHAVIORAL INTERVENTIONS ON REMOVING BARRIERS TO TREATMENT ADHERENCE IN HEMODIALYSIS PATIENTS

ABSTRACTObjective: Treatment adherence in chronic patients results in favorable treatment outcomes. Today, one of the main causes of mortality in hemodialysispatients is that of lack of treatment adherence. Identifying barriers to adherence to treatment is the first step to help these patients. The purpose ofthis study is to determine the effects of cognitive behavioral interventions on removing barriers to treatment adherence in hemodialysis patients.Methods: This clinical study was carried out in the hemodialysis wards of Imam Reza Hospital of Larand Vali-e-Asr Hospital of Lamerd. The sampleincluded 70 patients who were randomly assigned into two groups of intervention (n=35 for even days)and control (n=35 for odd days). Theintervention group received a six-step cognitive behavioral treatment. The level of barriers to treatment adherence was assessed using a self-reportquestionnaire in two stages (pre-intervention and post-intervention). Data were analyzed using SPSS via independent t-test.Results: Before the intervention, the two groups were not significantly different in terms of barriers to treatment adherence (p=0.68). However, afterthe treatment regimen, the barriers significantly decreased for the intervention group. There was a significant difference between the two groups interms of barriers to treatment adherence (p<0.001).Conclusion: Given the efficacy of cognitive behavioral intervention, it can be used to identify barriers to adherence and design individualizededucation programs based on barriers to adherence in hemodialysis patients to increase their treatment adherence.Keywords: Cognitive behavioral, Barriers to treatment adherence, Hemodialysis patients

Evaluating Occupational Exposure of Workers for Metallurgy with Alkanol Amines

Liquids being used in metallurgy are a composition of dangerous chemicals including Alkanol amines. Alkanol amines include Mono-, Di- and 3- ethanol amine. Alkanol amines are used as lubricant in metallurgy. Dermal absorption of these chemical substances is so important and some studies are being done about carcinogenesis of these chemical substances. Meanwhile, ethanol amine has been recognized as a factor causing occupational asthma. The present study was done on 29 turnery and rolling workers in Cupper Industrial Complex of Sarcheshmeh in descriptive- sectional manner. Data related to concentration of Alkanol amines in the atmosphere were gathered with the method proposed by NIOSH and data for pulmonary function were extracted from spirometry experiments. Demographic data were obtained from medical files of the workers. Statistical tests were carried out using software SPSS. In this study, workers' Time Weighted Average (TWA) individual exposure to Mono-ethanol amine (MEA) with density scope 0.03- 1.16, exposure to Di-ethanol amine (DEA) with density scope 0.36-1.35 and exposure to TEA with density scope 0.49-1.28 equal 0.54, 0.87 and 0.85 mg/m3 respectively without occupational group separation for each. Also, FVC reduction in studied individuals without occupational group separation was 3.17% (SD= 6.55%). The results indicated that workers' Time Weighted Average exposure to Mono-Di-Tri- ethanol amine was lower than occupational legal limit. In rolling process, exposure to Alkanol amines is lower compared to other processes of metallurgy because of semi- enclosure of this process. Having done Pearson correlation test to determine relation between individuals' work experience and FVC reduction, it was observed that there is no meaningful relation between these two variables

Evaluating Occupational Exposure of Workers for Metallurgy with Alkanol Amines

Liquids being used in metallurgy are a composition of dangerous chemicals including Alkanol amines. Alkanol amines include Mono-, Di- and 3- ethanol amine. Alkanol amines are used as lubricant in metallurgy. Dermal absorption of these chemical substances is so important and some studies are being done about carcinogenesis of these chemical substances. Meanwhile, ethanol amine has been recognized as a factor causing occupational asthma. The present study was done on 29 turnery and rolling workers in Cupper Industrial Complex of Sarcheshmeh in descriptive- sectional manner. Data related to concentration of Alkanol amines in the atmosphere were gathered with the method proposed by NIOSH and data for pulmonary function were extracted from spirometry experiments. Demographic data were obtained from medical files of the workers. Statistical tests were carried out using software SPSS. In this study, workers' Time Weighted Average (TWA) individual exposure to Mono-ethanol amine (MEA) with density scope 0.03- 1.16, exposure to Di-ethanol amine (DEA) with density scope 0.36-1.35 and exposure to TEA with density scope 0.49-1.28 equal 0.54, 0.87 and 0.85 mg/m3 respectively without occupational group separation for each. Also, FVC reduction in studied individuals without occupational group separation was 3.17% (SD= 6.55%). The results indicated that workers' Time Weighted Average exposure to Mono-Di-Tri- ethanol amine was lower than occupational legal limit. In rolling process, exposure to Alkanol amines is lower compared to other processes of metallurgy because of semi- enclosure of this process. Having done Pearson correlation test to determine relation between individuals' work experience and FVC reduction, it was observed that there is no meaningful relation between these two variables

Amniotic Membrane for Pain Control After Cesarean Section

Objectives: Pain is one of the major problems for patients after cesarean section. The aim of this study was to assess the effect of amniotic membrane as cesarean wound dressing on pain after cesarean section. Materials and Methods: This study was conducted on 90 pregnant women who underwent cesarean section in Amir-alMomenin hospital, Gerash, Iran. The participants were divided into 2 groups each of 45. The wound was dressed with amniotic membrane in one group and with simple gauze in the other group. Pain was measured and recorded in the 2 groups by visual analogue scale (VAS). The need for receiving analgesics 24 hours after the cesarean section was also assessed and compared between the 2 groups. Results: The results showed no signifcant difference between the 2 groups regarding the mean pain, 4 and 12 hours after the cesarean section (P=0.308 and P=0.628, respectively). However, a signifcant difference was observed between the 2 groups, in this regard, 24, 36, and 48 hours after the operation (P=0.026, P=0.026, and P=0.004, respectively). Moreover, the patients in the amniotic membrane group needed less analgesics compared to those in the control group 24 hours after cesarean section (P=0.041) Conclusions: Use of amniotic membrane dressing can be effective in reducing pain after cesarean section and can eliminate the patients’ need for analgesics. Hence, it can be used as an effective complementary method along with usual analgesics for pain relief

Estimation of the prevalence of chronic kidney disease: The results of a model based estimation in Kerman, Iran

Background: Chronic kidney disease is asymptomatic until its last stages and though it is increasing globally, we are faced with paucity of a population-based model to assess this disease, particularly in developing countries. Therefore, the aim of this study was to estimate the prevalence and trends of CKD according to a new estimation method. Methods: Using multiplier method, we estimated the numbers of different stages of CKD based on the number of patients with end stage renal failure from 2006 to 2016. The required multipliers were extracted from a simulation of the disease in Kerman following a dynamic model. The 95% uncertainty interval was computed using Monte-Carlo technique with 10,000 iterations. Results: The prevalence of CKDA (GFR<=90mL/min/1.73m2) and CKDB (GFR less than 60mL/min/1.73m2) patients were estimated to be 7.6% (95% uncertainty interval (UI), 5.7-9.1%) and 1.1% (95% UI, 0.8-1.3%), respectively in 2011. The method revealed that the prevalence may rise up to 25.7% (95% UI, 18.2-32.5%) and 3.7% (95% UI, 2.7-4.5%) for CKDA and CKDB, respectively in 2016, indicating approximately 3.3 times increase for both figures. Conclusion: This study predicted an increase in the prevalence of CKD in the future. This may be due to the increasing life expectancy of the population, the increase in the prevalence of non- communicable diseases such as hypertension and diabetes, or patients’ survival due to receiving better support. Therefore, the policymakers should be concerned and well informed about this increase

Competing Risk Analyses of Patients with End-Stage Renal Disease

Introduction: Chronic kidney disease (CKD) is an important health problem that gradually leads to end-stage renal disease (ESRD). In ESRD patients, death due to other diseases or some events, such as renal transplantation (known as competing risks), would change the probability of observing the event of interest. The aim of this study was to estimate the survival of ESRD patients using competing risk analyses. Methods: In this retrospective longitudinal study, 307 ESRD patients who were older than 20 were recruited from the dialysis and kidney transplant Centers in Kerman City, Iran, from2007 to 2011. To assess the impacts of the investigated factors on the outcome, a cause-specific hazard model and competing risk models were fitted. Also, the cumulative incidence (CI) approach and sensitivity analysis were implemented. All of the analyses were performed using Stata software, V.12. Results: The results of competing risk models showed that age and type of dialysis were associated with death (hazard ratio (HR)=1.03, p<0.001 and HR=1.65, p=0.011, respectively). In cause specific hazard model each year increase in age was associated with a 2% increase in the risk of death. Also, the types of dialysis were associated significantly with death (HR=1.93), and the effect of the type of dialysis was estimated as HR=1.51 (p=0.04) when we assumed that all patients who had experienced transplantation survived for the longest survival time. For those for whom receiving the transplantation was considered as death, the HR for the type of dialysis as well as the corresponding p-values were 1.82 and 0.001, respectively. Conclusion: Ignoring the competing risks of death due to ESRD, such as renal transplantation, in estimating the survival of these patients might lead to overestimation of the results

Five years after implementation of urban family physician program in fars province of Iran: Are people's knowledge and practice satisfactory?

Introduction: Urban family physician program (UFPP) was launched in Fars province of Iran in 2012. We aimed to assess the knowledge and practice of people toward this 5-year-old program. Methods: In this population-based study, through a multistage random sampling from 6 cities of Fars province, 1350 people older than 18 years were interviewed. For data collection, a questionnaire consisting of sociodemographic characteristics and items about knowledge and practice toward UFPP was used. Results: The mean age of the interviewees was 42.4 ± 14.2 years; male (674; 49.9%)-to-female (651; 48.2%) ratio was 1.03. Mean score of knowledge was 4.2 ± 1.7 (out of 14), while 961 (71.1%) had < 50% of the desirable knowledge. Mean score of practice was 4.4 ± 1.3 (out of 9), while only 443 (32.8%) had a good performance toward this program. Knowledge and practice did not show a significant correlation (r = 0.06, P = 0.05). Among cities, the highest and the lowest mean of knowledge belonged to Pasargad (5.6 ± 2.1) and Lar (3.0 ± 1.0) (P < 0.001), respectively. Pasargad (4.8 ± 1.4) had also the highest level of practice compared to Farashband (3.8 ± 1.4) which had the lowest score (P < 0.001). Multivariable analysis showed that supplemental insurance coverage (odds ratio [OR] = 2.5, %95 confidence interval [CI]: 1.6–3.9), female gender (OR = 1.9, %95 CI: 1.2–2.9) and higher level of education (OR = 1.7, %95 CI: 1.1–2.5) were the significant determinants of knowledge, while practice in those who were not covered by supplemental insurance was better (OR = 1.6, 95% CI: 1.2-2.5). Conclusions: After 5 years of implementation of UFPP, knowledge and practice of people toward UFPP are not satisfactory. This finding calls for a serious revision in some aspects of UFFP