Empowerment in the self-management of hypertension: challenges from the perspective of Iranian elderly patients

Uncontrolled hypertension in the elderly causes various diseases and disability. This study was aimed to explore the challenges in self-management empowerment from the perspective of Iranian elderly patients with hypertension. Using exploratory descriptive approach, on 30 hypertension patients in Bushehr by purposive and convenience sampling method. First, qualitative data were collected through interviews with the elderly , and the quantitative data were then collected using a researcher-made questionnaire in three dimensions of knowledge, attitude and performance. Qualitative data was directed with the content analysis approach, and quantitative data were analyzed with SPSS. In the qualitative phase, coding and summarizing of the data obtained from deep semi-structured interviews with the elderly led to five areas of awareness of changes, autonomy, satisfaction with performance, coping and sense of control. 7 men and 23 women participated in the qualitative phase, in which the average age of participants was 66.17% and 63% were married. Data analysis showed that the mean score of the elderly was equal to 10.17 and 58.26 for the dimensions of knowledge and performance respectively, which were at a weak level; and the mean attitude score was 9.96, which was at a moderate level. Given the challenges in empowering the management of hypertension in elderly, the planned training is recommended to be developed for the elderly and health care staff to achieve the main objective, i.e. the empowerment of the elderly through the self-management of hypertension

Renal Artery Stenosis and Its Predictors in Hypertensive Patients Undergoing Coronary Artery Angiography

Background: Renal artery stenosis (RAS) has been increasingly recognized in the recent years, especially in patients with coronary artery disease (CAD). RAS affects the patients with hypertension (HTN), but the exact prevalence is not known. Objectives: This study was performed to determine the prevalence and to identify the predictors of RAS in hypertensive patients undergoing coronary artery angiography. Patients and Methods: In a cross-sectional study from August 2008 to August 2009, 481 patients with HTN and suspected CAD underwent selective coronary and renal angiography for screening and predicting RAS. RAS was defined as a higher than 50% stenosis in the renal artery lumen. Multivariate analysis of factors associated with the presence of RAS were examined using a logistic regression model. Results: The mean ± standard deviation of age was 59.25 ± 10.81 years and 50.3% were men. According to angiographic data, 425 patients (88.4%) had CAD, while 56 (11.6%) had normal coronary arteries. RAS was seen in 94 (22%) patients with CAD. The multivariate logistic regression analysis identified only age (P < 0.001) and the number of significant coronary lesions (P < 0.001) as independent predictors of RAS. Gender, smoking, congestive heart failure, diabetes mellitus (DM), hyperlipidemia (HLP) and body mass index (BMI) were not independent predictors. Conclusions: This study suggests that in the management of patients with RAS, risk factors should most likely be considered as beneficial. In addition, the clinical and angiographic features are helpful in predicting its presence in elderly patients with CAD

Designing and Psychometric Properties of Elderly Cognitive Empowerment Questionnaire of Individual Changes

Background: Considering the growing elderly population and reducing their physical and mental abilities, and higher frequency of chronic diseases, attention to their empowerment is considered a necessity. So, the aim of this study was to designing and psychometric properties of elderly cognitive empowerment questionnaire of individual changes. Material and Methods: In this methodologic study, 294 elderly aged 60-70 years were studied by using a convenience sampling method in Bushehr city. Waltz 2010 was used to design the questionnaire. According to targeted literature review and available documents about the empowerment of the elderly, the initial version of the questionnaire was designed with 42 items. After confirming the content validity of questionnaire by 10 medical specialists, exploratory factor analysis was performed using the construct validity. Its reliability was determined by calculating Cronbach's alpha coefficient and test re-test. To analyze the data, SPSS version 18 was used. Results: The first version of the questionnaire cognitive empowerment of individual changes were designed with 42 items. In the process of psychometric evaluation no item were removed during the validity of the content. Content validity index and content validity ratio was calculated 0.82 and 0.95 respectively. Based on the exploratory factor analysis, the number of the questionnaire items was reduced to 32 and dimensions of empowerment were classified in the eight factors as physical abilities, self-respect, spirituality, commitment, performance role, positional identification, self-management and self-assessment which can predict with 75.787 %. Internal reliability of the questionnaire dimensions were ranged from 0.62-0.84 and external reliability was 0.96. Conclusion: Due to the appropriate reliability and validity of the questionnaire cognitive empowerment, applying it in training centers, treatment and rehabilitation centers is recommended to evaluate the cognitive empowerment of seniors to verify their requisites and offering qualitative services to them

Comparison of Power Hierarchy, Cohesion and Structure in Families with and Without a Disabled Child From the Perspective of their Mothers, Bushehr 2015

Background: Power hierarchy, cohesion and family structure are the main component of every family. Families with disabled children may be affected with this structure and function. The aim of this study was to comparison of the power hierarchy, cohesion and family structure with disabled and non-disabled children in Bushehr from the perspective of their mothers (2015). Materials & Methods: In this Cross-sectional study, 150 mothers of disabled and non-disabled children in Bushehr city were selected by census and clusters method, respectively. Family structure, cohesion and hierarchy of mothers was assessed by using the Family System Test (FAST). Data were analyzed by using SPSS software (Version 18) and statistical tests carried out such as (Independent t-test, ANOVA and chisquare test. Results: Based on this results, there was no significant difference between the families in terms of power (p=0.22) but the cohesion of families with children with physical disabilities (p=0.0001, 1/90 ± 0.54) and mentally (p=0.0001, 1.56 ± 0.73) is less than the natural family (p=0.0001, 2.26 ± 0.52), Also in terms of structure, there was no significant difference between families with healthy children and physical disability and mentally (p=0.05). Conclusion: Findings showed that the cohesion of families with disabled children are more vulnerable than healthy family. In the first step, awareness of young couples about the outcome of the birth of a disabled child is necessary and inevitable and in second step, providing training and adequate support to families with disabled child

The effect of Empowerment of Grandmother on Depression and Maternal Role Realization in Primiparae with Hospitalized Infant: A Randomized, Controlled, Clinical Trial

Background: Hospitalization of the newborn infant can cause depression crisis and severely undermine the attainment and realization of maternal role in a primipara. The neonate’s maternal grandmother can provide the support needed to help the primipara avoid or overcome the ensuing problems. Aim: This study aimed to investigate the effect of empowerment of grandmothers on depression and maternal role realization in primiparae with hospitalized newborn. Method: In this randomized, controlled, clinical trial, 84 primiparae with their infants admitted to Shahid Rajaei Hospital of Gachsaran, Iran, were assigned to intervention and control groups. A grandmother empowerment intervention was devised by combining the concepts of Mercer’s theory with the stages of Ravanipour’s self-management empowerment model. The control group received the routine care. Depression and maternal role realization in all the primiparae were measured with Beck Depression Inventory and a researcher-made role realization questionnaire before and one month after the intervention. Data was analyzed by independent and paired t-test in SPSS, version 18. Results: The mean ages of the mothers in the intervention and control groups were respectively 27.02±5.3 and 24.0±4.1 years. Before the intervention, there was no significant difference between the depression scores (P>0.38) and role realization scores (P>0.40) of the subjects in the two groups; however, after the intervention, both scores showed significant differences (P<0.05). Implications for Practice: The intervention based on the self-management empowerment model led to significant improvement in depression and maternal role realization of the primiparae with hospitalized infant. This model can serve as a directive in neonatal wards and neonatal intensive care units

The Trend of Hookah Use among Adolescents and Youth: A Qualitative Study

Introduction: Recently, there has been an increasing trend in hookah use. If this trend continues, morbidity and mortality due to smoking will increase dramatically. Thus, the aim of this study was to investigate the causes of the increasing trend in hookah use in adolescents and youth living in Bushehr, Iran. Method: This qualitative study was performed using qualitative content analysis. The research environment consisted of all public areas and the research population was comprised of all children and youth in Bushehr. The 12 participants were selected using purposive sampling. Data was collected using semi-structured interviews. After gaining the consent of the participants, the interviews were tape recorded and transcribed verbatim. Qualitative content analysis was used to analyze the data. Results: Data analysis led to the extraction of the 5 main themes of "the influence of culture, media preparation, sensory appeal, mistaken belief, and difficulty of quitting". Hookah use among family and friends, lack of enforcement of laws prohibiting public consumption, lack of awareness and the mistaken belief that it is less harmful than cigarettes, the pleasant fruity smell and taste, not having any alternative healthy pastimes, and social pressure were the most common reasons for the increasing trend of hookah use in Bushehr. Conclusion: These results suggest the need for authorities to view this issue as an important dilemma, and to plan to reduce hookah use and solve this problem using effective methods to educate and inform people Keywords: Hookah, Teens, Young, Qualitative research, Tobacc

Renal Artery Stenosis and Its Predictors in Hypertensive Patients Undergoing Coronary Artery Angiography

Background: Renal artery stenosis (RAS) has been increasingly recognized in the recent years, especially in patients with coronary artery disease (CAD). RAS affects the patients with hypertension (HTN), but the exact prevalence is not known. Objectives: This study was performed to determine the prevalence and to identify the predictors of RAS in hypertensive patients undergoing coronary artery angiography. Patients and Methods: In a cross-sectional study from August 2008 to August 2009, 481 patients with HTN and suspected CAD underwent selective coronary and renal angiography for screening and predicting RAS. RAS was defined as a higher than 50% stenosis in the renal artery lumen. Multivariate analysis of factors associated with the presence of RAS were examined using a logistic regression model. Results: The mean ± standard deviation of age was 59.25 ± 10.81 years and 50.3% were men. According to angiographic data, 425 patients (88.4%) had CAD, while 56 (11.6%) had normal coronary arteries. RAS was seen in 94 (22%) patients with CAD. The multivariate logistic regression analysis identified only age (P < 0.001) and the number of significant coronary lesions (P < 0.001) as independent predictors of RAS. Gender, smoking, congestive heart failure, diabetes mellitus (DM), hyperlipidemia (HLP) and body mass index (BMI) were not independent predictors. Conclusions: This study suggests that in the management of patients with RAS, risk factors should most likely be considered as beneficial. In addition, the clinical and angiographic features are helpful in predicting its presence in elderly patients with CAD

Bushehr Elderly Health (BEH) Programme, phase I (cardiovascular system)

Purpose: The main objective of the Bushehr Elderly Health Programme, in its first phase, is to investigate the prevalence of cardiovascular risk factors and their association with major adverse cardiovascular events. Participants: Between March 2013 and October 2014, a total of 3000 men and women aged ≥60 years, residing in Bushehr, Iran, participated in this prospective cohort study ( participation rate=90.2%). Findings to date: Baseline data on risk factors, including demographic and socioeconomic status, smoking and medical history, were collected through a modified WHO MONICA questionnaire. Vital signs and anthropometric measures, including systolic and diastolic blood pressure, weight, height, and waist and hip circumference, were also measured. 12-lead electrocardiography and echocardiography were conducted on all participants, and total of 10 cc venous blood was taken, and sera was separated and stored at –80°C for possible future use. Preliminary data analyses showed a noticeably higher prevalence of risk factors among older women compared to that in men. Future plans: Risk factor assessments will be repeated every 5 years, and the participants will be followed during the study to measure the occurrence of major adverse cardiac events. Moreover, the second phase, which includes investigation of bone health and cognition in the elderly, was started in September 2015. Data are available at the Persian Gulf Biomedical Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran, for any collaboratio

Bushehr Elderly Health (BEH) Programme, phase I (cardiovascular system)

Purpose: The main objective of the Bushehr Elderly Health Programme, in its first phase, is to investigate the prevalence of cardiovascular risk factors and their association with major adverse cardiovascular events. Participants: Between March 2013 and October 2014, a total of 3000 men and women aged ≥60 years, residing in Bushehr, Iran, participated in this prospective cohort study ( participation rate=90.2%). Findings to date: Baseline data on risk factors, including demographic and socioeconomic status, smoking and medical history, were collected through a modified WHO MONICA questionnaire. Vital signs and anthropometric measures, including systolic and diastolic blood pressure, weight, height, and waist and hip circumference, were also measured. 12-lead electrocardiography and echocardiography were conducted on all participants, and total of 10 cc venous blood was taken, and sera was separated and stored at –80°C for possible future use. Preliminary data analyses showed a noticeably higher prevalence of risk factors among older women compared to that in men. Future plans: Risk factor assessments will be repeated every 5 years, and the participants will be followed during the study to measure the occurrence of major adverse cardiac events. Moreover, the second phase, which includes investigation of bone health and cognition in the elderly, was started in September 2015. Data are available at the Persian Gulf Biomedical Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran, for any collaboration