Experiences of High School Students about the Predictors of Tobacco Use: a Directed Qualitative Content Analysis

Background and Objectives: Tobacco use is one of the most important risk factors that increases the burden of diseases worldwide. Based on the increasing speed of tobacco use, the aim of the present study was to explain the experiences of high school students about the determiners of use and non-use of tobacco (cigarettes and hookah) based on the theory of protection motivation. Materials and Methods: The present study is a qualitative study based on content analysis that has been carried out for five months from 22, November of 2014 to 20, April of 2015 on male high schools in Noshahr. Data were collected in the form of semi-structured interviews from 21 male high school students of whom 7 smoked cigarettes, 7 used hookah and 7 of them did not use any type of tobacco. Data analysis was carried out through the use of directed qualitative content analysis. Results: Data analysis led to the extraction of 99 primary codes that were categorized into 9 predetermined levels of protection motivation theory including perceived sensitivity, perceived intensity, fear, perceived self-efficacy, response expense, efficiency of the perceived answer, external perceived reward, internal perceived reward, protection motivation. The findings of the study showed that the most important predictors for the use of tobacco were the structures of response expense and high perceived rewards and the most important predictors for non-use of tobacco were perceived sensitivity, perceived intensity and high self-efficacy of students. Conclusions: the findings of the present study showed that the pressure from peers, being present in a group using tobacco and the absence of alternative recreational activities are among the most important factors of using tobacco. So, it is suggested that planners of the health department take the comprehensive interventions to improve effective individual and environmental factors of using tobacco so that they could reduce smoking cigarettes and hookah

Environmental Determinants of Cardiovascular Diseases Risk Factors: A Qualitative Directed Content Analysis

Background: Cardiovascular diseases (CVDs) are the number one cause of death in the world. In most analyses of health problems, environment plays a significant and modifiable role in causing the problem either directly or indirectly through behavior. Objectives: This study aims to understand the patients and healthcare providers' experiences about the environmental determinants of CVD risk factors based on the Precede Model. Patients and Methods: This qualitative study conducted over six months in 2012 at Diabetes Units of Health Centers associated with Alborz University of Medical Sciences and Health Services which is located in Karaj, Iran. The data were collected based on individual semistructured interviews with 50 patients and 12 healthcare providers. Data analysis was performed simultaneous with data collection using the content analysis directed method. Results: Lack of behaviors like stress control, healthy eating and physical activity were the roots of the risk factors for CVD. The environmental factor is one of the barriers for conducting these behaviors. The environmental barriers included of structural environment including "availability and accessibility of health resources", "new skills", and "law and policies" which are located in enabling category and social environment including "social support", "motivation to comply" and "consequences of behavior" which are located in reinforcing category. The most barriers to performing health behaviors were often structural. Conclusions: The environmental factors were barriers for doing healthy behaviors. These factors need to be considered to design health promotion interventions. Policymakers should not only focus on patients' education but also should provide specific facilities to enhance economic, social and cultural status

Mutual Viewpoints of Faculty Members and Residents Regarding Clinical and Educational Performance Compliance with Professional Ethics in Qazvin University of Medical Sciences

Introduction: Dualism in the professional identity of medical faculty members and residents and conflict between the role of education and patient care have caused problems at professional performance level. This study was conducted to examine the viewpoints of faculty members and residents regarding clinical and educational performance compliance with professional ethics. Methods: This cross-sectional descriptive study was performed on all residents and clinical faculty members of Qazvin University of Medical Sciences in 2013. Data collection tools were questionnaires retrieved from Iranian-Islamic sources, whose validity and reliability had been verified. The questionnaires consisted of three parts: demographic data, ethical performance in educational and clinical fields. The collected data were analyzed using Chi-square test Kruskal- Wallis and Mann-Whitney tests. Results: Findings showed that in the field of clinical performance, the highest and lowest scores belonged to conscience domain and confession of error domain respectively (90.3% versus 50% for faculty members and 93% versus 62.1% for residents). In the educational field, the most known performance problems of faculty members and residents were lack of attention to learners’ educational problems (65.5%) and the lack of interest to participate in teaching weaker students (68.8%). Conclusion: Results indicated that the state of ethical-professional performance of faculty members and residents were moderate in the clinical and educational fields, which was far from the desirable status. Hence, comprehensive and codified interventions are suggested for improving professional practice of faculty members and residents in educational centers in order to reduce the distance between the quality of education and patient care

The effects of an educational program based on PRECEDE model on depression levels in patients with coronary artery bypass grafting

&nbsp;&nbsp; BACKGROUND: Depression is among the most important barriers to proper treatment of cardiac patients. It causes failure in accepting their conditions, decreases their motivation in following the therapeutic recommendations, and thus negatively affects their functionality and quality of life. The present study aimed to investigate the effects of an educational program based on Predisposing, Reinforcing, Enabling Constructs in Educational Diagnosis and Evaluation (PRECEDE) model on depression level in coronary artery bypass grafting (CABG) surgery patients. &nbsp;&nbsp; METHODS: This was a quasi-experimental study in which 54 post-bypass surgery patients of Isfahan Cardiovascular Research Center were investigated. The patients were randomly divided into two groups of intervention and control. The data was collected using two questionnaires. Primarily, the cardiac depression scale was used to measure the degree of depression followed by PRECEDE model-based educational questionnaire to identify the role of the educational intervention on patients. The PRECEDE model-based intervention composed of 9 educational sessions per week (60-90 minutes each). The patients were followed up for two months post-intervention. &nbsp;&nbsp; RESULTS: Following the educational intervention, mean scores of predisposing, enabling, and reinforcing factors, and self-helping behaviors significantly increased in the intervention group compared to the control group (P &lt; 0.001). In addition, a significant difference in mean scores of depression was observed between the two groups following the educational intervention (P &lt; 0.001). &nbsp;&nbsp; CONCLUSION: The findings of the current study confirmed the practicability and effectiveness of the PRECEDE model-based educational programs on preventing or decreasing depression levels in CABG patients. &nbsp;&nbsp; &nbsp; &nbsp;&nbsp; Keywords: Educational Program, PRECEDE Model, Depression, Coronary Artery Bypass Surgery. &nbsp;</p

Quality of life and Related Factors in Rheumatoid Arthritis Patients

Introduction and purpose: Assessment of quality of life (QOL) in rheumatoid&nbsp;arthritis (RA) patients is of great importance for health researchers, health planners, and clinical specialists. Therefore, we aimed to evaluate QOL and the&nbsp;factors affecting it in patients with RA.Methods: This descriptive-analytical study was performed in 185 RA patients&nbsp;(2014) at Shariati Hospital. The participants were chosen through convenience&nbsp;sampling. The data collection tools included a form on demographic and clinical&nbsp;factors, health status (arthritis impact measurement scale2 [AIMS2]), and SF20&nbsp;QOL questionnaire. Data was analyzed in SPSS 16 using descriptive, univariate,&nbsp;and multivariate regression analysis.Results: The patients had a mean age of 46.97&plusmn;11.47 years, and most of the&nbsp;patients were female (80.5%), 67.6% of whom were housewives. In general,&nbsp;90% of the patients had diploma or lower education. Mean of physical dimension&nbsp;of QOL was lower and social and role dimensions were higher than other&nbsp;dimensions. Univariate analysis regression showed that QOL have significant&nbsp;negative relationship with age, disease duration, disease activity score (DAS) and&nbsp;significant positive relationship with education and health status. In multivariate&nbsp;regression analysis, health status, DAS, and education explained 71.7% of QOL.&nbsp;Conclusion: Our results highlighted the influence of demographic and diseaserelated&nbsp;factors on QOL. Thus, they should be implemented in designing&nbsp;educational programs to increase QOL in RA patients

Effect of PRECEDE educational model on depression and quality of life of patients with coronary artery bypass graft surgery

&nbsp;&nbsp; BACKGROUND: This study was conducted to evaluate the effect of an educational intervention on depression and quality of life (QoL) of patients with coronary artery bypass grafting (CABG) surgery. &nbsp;&nbsp; METHODS: This was a quasi-experimental study on 54 patients after CABG who were randomly divided into the test and control groups. To evaluate depression, Cardiac Depression Scale was used. Then a researcher-made questionnaire of Predisposing, Reinforcing, Enabling Causes in Educational Diagnosis and Evaluation (PROCEED) was used and finally the 36-item Short-Form Health Survey (SF-36) was employed. The intervention was done through 9 educational sessions, once a week, lasting 60-90 minutes based on PRECEDE model and it was followed-up for two months. &nbsp;&nbsp; RESULTS: After the educational intervention, the mean score of predisposing causes, enabling causes, reinforcing causes and self-care behaviors significantly increased in the test group compared to the control group (P &lt; 0.001). There was a significant difference in mean score of depression between the two groups after the educational intervention (P &lt; 0.001). In addition, there was a significant difference after the intervention in physical functioning (P = 0.04), mental problems related to QoL (P &lt; 0.001) and generally, in psychological health (P = 0.04). &nbsp;&nbsp; CONCLUSION: The findings of this study confirmed the efficacy of PRECEDE educational model and its components (predisposing, enabling and reinforcing causes) and behavioral factors of it on improvement of psychological status and depression of the patients which finally increased QoL of patients after CABG. &nbsp;&nbsp; &nbsp; &nbsp;&nbsp; Keywords: Educational Intervention, Depression, Quality of Life, PRECEDE Model.</p

Behavioral determinants of cardiovascular diseases risk factors: A qualitative directed content analysis

BACKGROUND: The PRECEDE model is a useful tool for planers to assess health problems, the behavioral and environmental causes of the problems, and their determinants. This study aims to understand the experiences of patients and health care providers about the behavioral causes of cardiovascular diseases (CVDs) risk factors and their determinants. METHODS: This qualitative study utilized content analysis approach based on the PRECEDE model. The study was conducted for over 6 months in 2012 at the diabetes units of health centers associated with Alborz University of Medical Sciences, which is located in Karaj, Iran. Data were collected using individual semi-structured interviews with 50 patients and 12 health care providers. Data analysis was performed simultaneously with data collection using the content analysis directed method. RESULTS: Stress, unhealthy eating, and physical inactivity were the behaviors, which predict the risk factors for CVD. Most of the patients considered stress as the most important underlying cause of their illness. In this study, 110 of the primary codes were categorized into seven subcategories, including knowledge, attitude, perceived susceptibility, severity, perceived benefits, barriers, and self-efficacy, which were located in the predisposing category of the PRECEDE model. Among these determinants, perceived barriers and self-efficacy for the mentioned behaviors seemed to be of great importance. CONCLUSION: Identifying behavioral determinants will help the planners design future programs and select the most appropriate methods and applications to address these determinants in order to reduce risky behaviors. &nbsp; Keywords: Behavior, Cardiovascular Diseases, Risk Factors, Qualitative Research&nbsp;</div

The burden of metabolic risk factors in North Africa and the Middle East, 1990–2019: findings from the Global Burden of Disease StudyResearch in context

Summary: Background: The objective of this study is to investigate the trends of exposure and burden attributable to the four main metabolic risk factors, including high systolic blood pressure (SBP), high fasting plasma glucose (FPG), high body-mass index (BMI), and high low-density lipoproteins cholesterol (LDL) in North Africa and the Middle East from 1990 to 2019. Methods: The data were retrieved from Global Burden of Disease Study 2019. Summary exposure value (SEV) was used for risk factor exposure. Burden attributable to each risk factor was incorporated in the population attributable fraction to estimate the total attributable deaths and disability-adjusted life-years (DALYs). Findings: While age-standardized death rate (ASDR) attributable to high-LDL and high-SBP decreased by 26.5% (18.6–35.2) and 23.4% (15.9–31.5) over 1990–2019, respectively, high-BMI with 5.1% (−9.0–25.9) and high-FPG with 21.4% (7.0–37.4) change, grew in ASDR. Moreover, age-standardized DALY rate attributed to high-LDL and high-SBP declined by 30.2% (20.9–39.0) and 25.2% (16.8–33.9), respectively. The attributable age-standardized DALY rate of high-BMI with 8.3% (−6.5–28.8) and high-FPG with 27.0% (14.3–40.8) increase, had a growing trend. Age-standardized SEVs of high-FPG, high-BMI, high-SBP, and high-LDL increased by 92.4% (82.8–103.3), 76.0% (58.9–99.3), 10.4% (3.8–18.0), and 5.5% (4.3–7.1), respectively. Interpretation: The burden attributed to high-SBP and high-LDL decreased during the 1990–2019 period in the region, while the attributable burden of high-FPG and high-BMI increased. Alarmingly, exposure to all four risk factors increased in the past three decades. There has been significant heterogeneity among the countries in the region regarding the trends of exposure and attributable burden. Urgent action is required at the individual, community, and national levels in terms of introducing effective strategies for prevention and treatment that account for local and socioeconomic factors. Funding: Bill &amp; Melinda Gates Foundation

Adolescent transport and unintentional injuries: a systematic analysis using the Global Burden of Disease Study 2019

Background Globally, transport and unintentional injuries persist as leading preventable causes of mortality and morbidity for adolescents. We sought to report comprehensive trends in injury-related mortality and morbidity for adolescents aged 10-24 years during the past three decades. Methods Using the Global Burden of Disease, Injuries, and Risk Factors 2019 Study, we analysed mortality and disability-adjusted life-years (DALYs) attributed to transport and unintentional injuries for adolescents in 204 countries. Burden is reported in absolute numbers and age-standardised rates per 100 000 population by sex, age group (10-14, 15-19, and 20-24 years), and sociodemographic index (SDI) with 95% uncertainty intervals (UIs). We report percentage changes in deaths and DALYs between 1990 and 2019. Findings In 2019, 369 061 deaths (of which 214337 [58%] were transport related) and 31.1 million DALYs (of which 16.2 million [52%] were transport related) among adolescents aged 10-24 years were caused by transport and unintentional injuries combined. If compared with other causes, transport and unintentional injuries combined accounted for 25% of deaths and 14% of DALYs in 2019, and showed little improvement from 1990 when such injuries accounted for 26% of adolescent deaths and 17% of adolescent DALYs. Throughout adolescence, transport and unintentional injury fatality rates increased by age group. The unintentional injury burden was higher among males than females for all injury types, except for injuries related to fire, heat, and hot substances, or to adverse effects of medical treatment. From 1990 to 2019, global mortality rates declined by 34.4% (from 17.5 to 11.5 per 100 000) for transport injuries, and by 47.7% (from 15.9 to 8.3 per 100000) for unintentional injuries. However, in low-SDI nations the absolute number of deaths increased (by 80.5% to 42 774 for transport injuries and by 39.4% to 31 961 for unintentional injuries). In the high-SDI quintile in 2010-19, the rate per 100 000 of transport injury DALYs was reduced by 16.7%, from 838 in 2010 to 699 in 2019. This was a substantially slower pace of reduction compared with the 48.5% reduction between 1990 and 2010, from 1626 per 100 000 in 1990 to 838 per 100 000 in 2010. Between 2010 and 2019, the rate of unintentional injury DALYs per 100 000 also remained largely unchanged in high-SDI countries (555 in 2010 vs 554 in 2019; 0.2% reduction). The number and rate of adolescent deaths and DALYs owing to environmental heat and cold exposure increased for the high-SDI quintile during 2010-19. Interpretation As other causes of mortality are addressed, inadequate progress in reducing transport and unintentional injury mortality as a proportion of adolescent deaths becomes apparent. The relative shift in the burden of injury from high-SDI countries to low and low-middle-SDI countries necessitates focused action, including global donor, government, and industry investment in injury prevention. The persisting burden of DALYs related to transport and unintentional injuries indicates a need to prioritise innovative measures for the primary prevention of adolescent injury