Evidence Gap on the Prevalence of Non-conventional Risk Factors for Type 2 Diabetes in Iran

AbstractObjectivesRobust scientific evidence exists about the role of non-conventional risk factors in type 2 diabetes worldwide. The current epidemiological pattern of the disease in Iran suggests a precipitating role for these non-conventional risk factors. This review was performed to examine the research evidence suggesting a higher prevalence of non-conventional type 2 diabetes risk factors in Iran.MethodsMeSH keywords were applied to search several databases, including PUBMED, MEDLINE, AMED, EMBASE, Iran DOC, and the Scientific Information Database without a time limit from inception to September 2011. The quality of the non-interventional and population-based studies on Iranians included in these databases was assessed by the authors and any disagreement was resolved with consensus.ResultsThe literature search yielded 1847 publications, of which 62 were included in this study after eliminating non-relevant and overlapping papers. No study was found that verified a higher prevalence of the non-conventional type 2 diabetes risk factors in the Iranian population.ConclusionThe identified evidence gap about the role of prominent non-conventional risk factors of type 2 diabetes in the Iranian population could be a major caveat in the application of an evidence-based approach to endorse or reject existing hypothesis about these risk factors. Studies on the prevalence of non-conventional biomarkers of type 2 diabetes among Iranians could be a promising area of research

Approaches to Recruiting ‘Hard-To-Reach’ Populations into Re­search: A Review of the Literature

Background: ‘Hard-to-reach ’ is a term used to describe those sub-groups of the population that may be difficult to reach or involve in research or public health programmes. Application of a single term to call these sub-sections of populations implies a homogeneity within distinct groups, which does not necessarily exist. Different sampling techniques were introduced so far to recruit hard-to-reach populations. In this article, we have reviewed a range of ap-proaches that have been used to widen participation in studies. Methods: We performed a Pubmed and Google search for relevant English language articles using the keywords and phrases: (hard-to-reach AND population * OR sampl*), (hidden AN

A Pilot Physical Activity Initiative to Improve Mental Health Status amongst Iranian Institutionalized Older People

Background: Sufficient level of physical activity may promote overall and mental health of old people. This study was carried out to investigate the practicability of a physical activity promotion initiative amongst institutionalized older people in Tabriz, Iran. Methods: Purposive sampling method was used in this semi-experimental study to recruit 31 older people living in a selected residential care in Tabriz. Moderate-intensity aerobic and muscle-strengthening activity was planned for those who had not severe baseline cognitive impairment or were not too frail to undertake the survey. The General Health Questionnaire (GHQ-28) was used to measure mental health status before and after intervention through a face-to-face interview. Descriptive statistics, Wilkcoxon rank-sum, Mann–Whitney U and Chi-Square tests were employed to analyses the data. Results: The applied intervention was significantly improved status of physical health, anxiety and insomnia, social dysfunction and severe depression. Conclusion: Incorporation of physical activity promotion programs into routines of older people residential care homes in Iran is feasible but may need training of physical activity specialists to work with older people based on their physical endurance and limitations

Recess Activity and General Health Status among Iranian Elementary Schools’ Pupils

Background: Regular and daily physical activity during childhood and at school is one of the important part of requirements of normal growth, development and well-being. To achieve physical activity promotion among school child aged population recess as outside of class time efforts is scheduled and allows students to engage in physical and social activities. The purpose of the present study was to assess recess activities as well as status of physical activities among a sample of Iranian students at the pri¬mary schools.Methods: This cross-sectional study was performed in four randomly se¬lected schools from a list of 26 elementary schools in March, 2012 in the city of Shahindej, located in North-west of Iran. Participants were 439 (10–12 years) elementary schools’. Physical activity level by self-reporting, mental health using the parent-completed Child Health Questionnaire, and happiness was assessed using a Persian translated version of the Subjective Happiness Scale. Hierarchical logistic regression analysis was applied in two steps using the enter method to analyze data in the SPSS version 17.Results: Backward logistic regression analysis showed that gender of the parent who answered the study questions, father’s education, educational grade of children, BMI, physical function, physical health, health status of the children and family function were significantly related to the children’s physical activity level.Conclusion: Promoting parents’ awareness and schools’ staff about im¬portance of physical activities especially in recess times must be an impor¬tant part of school and community mental health promotion programs

Reporting of Health Promotion Research: Addressing the Quality Gaps in Iran

Quality of health behavior research determines usefulness of the findings for application.The authors individually scrutinized quality of a representative sample of abstracts (n=315)submitted to the 1st International and 4th National Congress on Health Education and Promotion,held in Tabriz, Iran on 16-19 May, 2011. Among the assessed abstracts, introductionsection had the standard format in 18.1% (CI: 14.2-22.7%), sampling method and samplesize were concurrently explained in 56.3% (CI: 50.3-62.1%), and the data in 40.6% (CI:35.4-46.1%) were insufficient to support the conclusion section. The observed heterogeneityin the quality of Iranian research may reflect gaps in research methodology education.Revision in the current research performance is recommended to ensure a more stringentnational research output

Tobacco Use Prevention by Integrating inside and outside of School Based Programs: a Systematic Review

Background: Experience of tobacco use in early ages will increase probability of addiction to nicotine therefore, efficient tobacco control programs for teenagers are crucial. This study was conducted to recognize elements of successful integrated inside and outside of school based smoking prevention programs. Methods: MeSH terms and related keywords were used to search PubMed, Cochrane, Medline, EMBASE, ERIC, SID databases from inception to 29th October 2013. Trials with random and non-random designs, systematic reviews and cohort studies that assessed or reported application of integrated tobacco control programs were included. Quality of the retrieved publications was checked independently by the authors and any disagreement was resolved by consensus. Result: Among the 745 identified publications, only 15 studies had the inclusion criteria with a considerable methodological heterogeneity. While, precise out-come of integrated out of school/school-based interventions were not percepti-ble but this study’s findings implied that outside of school intervention could strengthen school-based tobacco prevention programs. No study was found to examine school-based interventions integrated with primary health care such as anti-tobacco consultations, high-risk students screening and their referral to special centers. Conclusion: Integration of outside and inside of school-based programs may boost probability of obtaining favorable outcomes and success rate in practice

Factorial Structure and Psychometric Analysis of the Persian Version of Perceived Competence Scale for Diabetes (PCSD-P)

As a basic psychological need, the level of perceived competence could expedite the achievement of diabetes self-management goals. Because of a lack of a specific data collection tool to measure the level of self-competence among Persian-speaking patients with diabetes, this study was conducted for (1) cross-cultural adaptation and (2) psychometric assessment of the Persian version of the Perceived Competence Scale for Diabetes (PCSD-P). Standard translation/back-translation procedure was carried out to prepare a preliminary draft of the PCSD-P. Content and face validities of the early draft were checked by an expert panel including 15 scholars in the field of health education and promotion as well as nursing education with experience of working and research on diabetes. The final drafted questionnaire was completed by 177 randomly selected patients with type 2 diabetes. On the basis of the collected data, the structural validity of the contrived version was appraised using exploratory and confirmatory factor analysis (EFA, CFA). Cronbach’s alpha and intraclass correlation (ICC) coefficients were used to check the scale’s reliability and internal consistency. The estimated measures of content validity index (CVI = 0.95) and content validity ratio (CVR = 0.8) were within the acceptable recommended range. The EFA analysis results demonstrated a single factor solution according to the items’ loadings for the corresponding component. The model fit indices, that is, root mean square error approximation (RMSEA = 0.000), comparative fit index (CFI = 1), Tucker−Lewis index (TLI = 1), incremental fit index (IFI = 1), normed fit index (NFI = 0.999), and relative fit index (RFI = 0.995), confirmed the consistency of the hypothesized one-factor solution. The values of the internal consistency and reliability coefficients were also in the vicinity of an acceptable range (α = 0.892, ICC = 0.886, P = 0.001). The study findings revealed good internal validity and applicability of the PCSD-P to measure the degree of self-competence among Persian-speaking type 2 diabetes patients to manage the chronic disease. Owing to unrepresentativeness of the study sample, future cross-cultural tests of PCSD-P are recommended on diverse and broader Persian-speaking populations

Challenges in Developing Health Promoting Schools’ Project: Application of Global Traits in Local Realm

Background: Despite the importance of student health and school hygiene as an aspect of the infrastructure of community health, few feasibility studies have been conducted on school health programs in developing countries. This study examined possible barriers to and challenges of such programs from the executive perspective in East Azerbaijan Province in Iran. Methods: This qualitative study used the content analysis approach to recognize barriers to and challenges of health promoting school program from the executive perspective. Fourteen experts were selected in the areas of children and adolescents and school health, physical education and school headmasters. Data were collected using semi-structured interviews and analyzed using the content analysis method. Results: Five themes were extracted as major barriers and challenges: 1. Intraand inter-sectorial collaboration; 2. Policy and rule formulation; 3. Infrastructure and capacity; 4. Human resources; 5. Community involvement. Conclusion: The localized version of the current health promoting school program had major faults. If this program is considered to be a healthcare system priority, it should be revised to set effective policies for implementation and to sustain school health programs based on the capacities and objectives of each country

The Status of Observing Patient Rights Charter in Outpatient Clinics of Tabriz University of Medical Sciences: Perspectives of Health Service Clients

Introduction: Patient Rights Charter consists of a series of patients' legal rights that health care providers must observe and carry out but available evidences show that these are not fully practiced in some outpatient centers. This study aimed to investigate the status of observing patient rights from the perspective of clients in outpatient clinics affiliated to Tabriz University of Medical Sciences. Methods: This cross-sectional survey study was conducted on patients admitted to outpatient centers of Tabriz University of Medical Sciences within December 2011 (N=382). These people were chosen through simple random sampling based on Cochran formula. Data collection instrument was a researcher-made questionnaire derived from Iranian Patient rights charter, which its validity and reliability was approved. Data was analyzed using t-test and ANOVA. Results: Mean and standard deviation of total score for observing all essentials of patients’ rights charter in outpatient centers of the university was at a moderate and reasonable level (42.18±15.15) from the viewpoint of patients. The area of “providing health services based on respecting patient’s privacy and observing the essentials of secrecy and confidentiality” enjoying the highest mean score (66.12±24.39), was at a desirable level compared to other areas. The area of “having access to effective complaint management system” showed the lowest mean score (23.85±23.07) from the participants’ perspective proving a poor level. Ninety three (24.17%) of health service receivers believed that almost all areas of Patient Right Charter were observed totally in outpatient centers of the university. This is while 96 people(25.17%) believed that patients’ right chart has never been practiced in outpatient centers of Tabriz University of Medical Sciences. Conclusions: The general satisfaction with observation of patients’ right charter in outpatient centers of Tabriz University of Medical Sciences is at a moderate level and considered to be acceptable. Only in area of “providing health services based on respecting patient’s privacy and observing the essentials of secrecy and confidentiality”, the satisfaction level is higher than norms. Therefore, study of factors affecting patients’ satisfaction is among research priorities for responding about the current satisfaction status and the manner of providing health services