Ardabil University of Medical Sciences
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Identifying Predictors of Self-Managing Behaviors in Diabetic Patients Based on Ecological Approach: A Systematic Review
No full textBackground : Recognizing and preventing the factors that affect the self-management behaviors of diabetes leads to a reduction in the number of patients and an improvement in the quality of care. To be successful in changing or stabilizing healthy behavior, health educators need to be aware of the factors that affect learning, and theories help with this process. The ecological approach focuses on the nature of people's interactions with their physical and socio-cultural environments. The purpose of this study identifying the predictors of self-management behaviors in these patients is with comprehensive approach.
Materials and Methods : This is a systematic review. The Keywords were investigated in the relevant national and international databases including PubMed, Google Scholar, Science Direct, Scopus, and Institute for Scientific Information, Scientific Information Database, Magiran, and Iran Medex to obtain the articles published from 2009 to 2019. Search and article selection strategy was developed based on the Prisma checklist were examined and selected in three steps.
Results : A sum of 28 articles quantitative was selected for the final analysis. In all studies, demographic criteria and individual factors were examined. In 9 studies, in addition to individual factors, interpersonal and social factors have also been studied.
Conclusion : The review showed that the strongest Predictors of Self-Management Behaviors in diabetes Patients Based on Ecologic Approach are “individual” factors and then “interpersonal” factors. “Group and organization” factors and then “Society and Policy Making” factors are the lowest predictions in the management behaviors of diabetic patients, respectively.
Keywords : self-management behaviors, diabete
Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019
No full textBackground
Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease.
Methods
GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk–outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk–outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk–outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden.
Findings
The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10·8 million (95% uncertainty interval [UI] 9·51–12·1) deaths (19·2% [16·9–21·3] of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8·71 million (8·12–9·31) deaths (15·4% [14·6–16·2] of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253–350) DALYs (11·6% [10·3–13·1] of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0–9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10–24 years, alcohol use for those aged 25–49 years, and high systolic blood pressure for those aged 50–74 years and 75 years and older.
Interpretation
Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public.Background
Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease.
Methods
GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk–outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk–outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk–outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden.
Findings
The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10·8 million (95% uncertainty interval [UI] 9·51–12·1) deaths (19·2% [16·9–21·3] of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8·71 million (8·12–9·31) deaths (15·4% [14·6–16·2] of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253–350) DALYs (11·6% [10·3–13·1] of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0–9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10–24 years, alcohol use for those aged 25–49 years, and high systolic blood pressure for those aged 50–74 years and 75 years and older.
Interpretation
Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public
Ocular Complications in Type 1 Diabetes
No full textBackground and objective: Ocular complications are one of the major health problems in diabetic patients, especially in undeveloped and developing countries. Due to the lack of similar studies in Ardabil province (Northwest of Iran), the present study aimed to evaluate the frequency of ocular complications and its effective factors in a sample of patients with type 1 diabetes in Ardabil. Methods and materials: In this one-year cross-sectional study, all type 1 diabetic patients that diagnosed at internal clinic of Imam Khomeini Hospital during 2018 were referred to the ophthalmology clinic of Imam Reza Hospital and were examined for the ocular complications. On arrival at the clinic, the necessary clinical tests and the eye examinations were performed for all the patients and the required information was entered into the pre-designed checklist. Patients' eyes were examined by an ophthalmologist. Results: 66 type 1 diabetic patients with the mean age of 25.6 ± 10.8 years (range 5 to 49 years) were studied with male to female ratio of 54.5% / 45.5%. The most common ocular complications were lens opacity, punctuate epithelial erosions, diabetic retinopathy, staphylococcal blepharitis, and meibomian gland dysfunction with prevalence of 54.5%, 27.2%, 10.6%, 6.1%, and 3% of patients, respectively. Mean HbA1c was higher among patients with diabetic retinopathy compared to patients without retinopathy. The frequency of retinopathy was higher among male patients compared to female patients (13.9% vs. 6.7%), among patients older than 20 years compared to younger patients (14.3% vs. 0%), and among patients with a disease duration of more than 10 years compared to patients with a shorter disease duration (20% vs. 4.9%). Conclusion: The present study showed a variety of ocular complications among a sample of patients with type 1 diabetes in Ardabil, among which the lens opacity, punctate epithelial erosion and retinopathy were the most common. Retinopathy was associated with longer disease duration and higher age. These findings highlight the need for regular screening of ocular complications in patients with type 1 diabetes, especially in cases who are at higher risk, namely patients with higher HbA1c, older than 20 years old and those with a disease duration of more than 10 years
Investigating the factors involved in the occurrence of anal fistula following incision and drainage of superficial perianal abscess
No full textBackground: Perianal abscess is considered a benign anorectal disease that is treated as the gold standard by incision and draining infected soft tissue. However, about 50 % of patients with perianal abscess subsequently develop fistula after I&D abscess. Limited studies have been performed to determine risk factors that have conflicting.
Aim: This study investigates the factors involved in the incidence of anal fistula following incision and drainage of superficial perianal abscess.
Materials & Methods: The present study is a cross-sectional study. The statistical population includes 75 people who underwent I&D, 36 of whom received antibiotics and 39 who did not receive antibiotics. . Basic information was extracted from patients' clinical records and patients were evaluated for fistula development after at least 3 months. Finally, the results were analyzed using appropriate tests in SPSS software.
Results: Out of 75 patients included in the study, 20 were female (26.7%) and 55 were male (73.3%). The mean age was 42.95 ± 15.092. This study showed that there was a significant difference between the group receiving antibiotics and the group without receiving antibiotics in terms of fistula formation. The fistula rate in the group receiving antibiotics was lower than the control group (P = 0.007). Also, this study showed that there was no significant relationship between age, sex and smoking with fistula development.
Conclusion: The results showed that prophylactic antibiotic therapy after incision and drainage of perianal abscess significantly reduced the incidence of postoperative fistula
Reliability and Validity of Place Attachment Scale among Iranian Older Adults
No full textIntroduction: Place attachment is a sense of comfort of people in their neighborhood. Aged people are sensitive to changes in their environment. This study aimed to find the reliability and validity of the Place Attachment Scale (PAS) among Iranian older adults.
Methods: This was a methodological study in which the study population consisted of 550 elderly people living in Tehran. Data were collected through PAS. Data analysis was performed using IBM SPSS statistics v.22 and LISREL v.20 software via Pearson correlation test, independent t-test, Cronbach’s alpha, exploratory and confirmatory factor analysis.
Results: Face validity of the PAS was confirmed by a panel of experts. Internal consistency of PAS was 0.95. Exploratory and confirmatory factor analysis confirmed the construct validity of the PAS (CFI= 1.00, GFI= 0.98, RMSEA= 0.05) . The mean score of the participants' PAS was 23.78 ± 7.58 that was indicative of a moderate level of place attachment.
Conclusion: PAS is a suitable tool for assessing Place Attachment among Iranian older adults
An in vitro comparison of antibacterial efficacy of Iranian green and black tea extracts with chlorhexidine 0.2% on streptococcusmutans
No full textIntroduction: Studies on the effect of medicinal plants such as tea on harmful bacteria of oral cavity have increased day by day to replace current disinfectant mouthwashes if possible, however, there are conflicting results in studies in this field, so this study was conducted to compare the antibacterial effect of green tea extract and Iranian black tea with chlorhexidine 0.2% on Streptococcus mutans.
Materials and Methods: In this in vitro study, the sample consisted of 30 plates of blood agar medium containing Streptococcus mutans (ATCC35668) and each plate consisted of 6 micro wells for green tea and black tea at different concentrations. (25, 50, 75, 100, 200, 300, 400 and 500 mg/ml) and chlorhexidine was 0.2%. The bacteria samples were prepared from the Collection Center of Industrial Microorganisms of Iran and the plates were placed in anaerobic jar containing gazpack A and inculptored for 24 hours at 37°C and after 24 hours the inhibition zone of bacteria with line After laboratory procedures, the size of the halos were measured and recorded, then entered into SPSS software version 24 and analyzed using one-way ANOVA and repeated measure ANOVA at the significant level of 0.05.
Results: The results showed that green tea and black tea at concentrations of 25, 50 and 75 mg/ml have no antimicrobial properties, but by increasing the concentration of green and black tea extract from 100 to 200, 300, 400 and 500 mg/ml, antibacterial activity increases. Also, the antimicrobial activity (halo diameter) of chlorhexidin was 0.2% to the concentration of 200 mg/ml extract higher than black tea and green tea (P0.05).
Conclusion: Green tea extract at concentrations of 300 mg/ml and higher has antibacterial activity against Streptococcus mutans at in vitro situation, but black tea extract has the same antibacterial effect or less than chlorhexidide 0.2%
Evaluating the health promoting schools in Iran: across-sectional study
No full textPurpose: Health-promoting schools have been associated with improvements in the health status of students globally. This study is a secondary analysis study assessing Iranian HPSs. Design/methodology/approach: This was a cross-sectional study on routinely collected data using an external audit 63-item checklist, which was utilized to evaluate 440 HPSs between 2014 and 2017. The mean score for each of the checklists' components was calculated. Nonparametric tests were conducted to investigate the association between the presence of a school caregiver, students' educational level and the school's score. Findings: While the number of five- and four-star schools increased significantly, one- to three-star schools declined. Providing clinical and counseling services had negative growth. Despite the steady growth of the staff's health, this category still had the lowest score among; on the contrary, physical activity had the highest score in 2017. The presence of a full-time school caregiver and middle schools were both significantly correlated with achieving higher scores (p < 0.005). Originality/value: It seems that in addition to developing school facilities to promote physical activities, measures should be taken to promote access to counseling services, considering health issues of students and staff and finally increasing the number of full-time school caregive
Evaluation of Dental Anxiety level and Related Factors in Adults Patients Referred to Ardabil Dental School 2019-2020
No full textIntroduction: Dental anxiety is one of the most important reasons for people to avoid dental treatments and in the long run reduces oral health and quality of life. On the other hand, the occurrence of anxiety in clients and its recurrence in the examination of patients, affects the efficiency of dentists; so, this study was conducted to investigate the prevalence of dental anxiety and its related factors in adult patients of Ardabil Dental University in 2019-2020.
Materials & Methods: In this descriptive cross-sectional study, 200 clients of Ardabil Dental University over 18 were randomly examined in 2019-2020. In order to collect information, the Persian version of dental anxiety questionnaire developed by Statter, Malberg and Hugastraten and an individual factors questionnaire was used; After completing the questionnaires and examination form, the data were entered into SPSS software version 22 and were statistically analyzed using the Human Whitney test, Kruskal-Wallis and Spearman correlation coefficient at a significance level of significance less than 0.05.
Results: Out of 200 patients, dental anxiety of 111 patients (55.5%) was low, 80 patients (40%) was moderate and 9 patients (4.5%) was high. Dental anxiety was higher in women than men (P‹0.05). Also, the rate of dental anxiety in unemployed and housewives was higher and more significant than freelancers and self-employed (P‹0.05). however, the variables of education, age, marriage status, number of family members, income, place of residence, number of visits to the dentist, experience of referring to other dentists, experience of difficult and painful treatment of previous dentists, life satisfaction and patient information about the treatment plan and treatment process had no significant effect on dental anxiety (P‹0.05).
Conclusion: Severe dental anxiety in this study was less estimated than previous studies, and gender and occupation had a significant effect on dental anxiety
Evaluation of the efficacy of topical hydrocortisone in the treatment of rectal Fissure in patients undergoing pharmacological treatment referred to Fatemi Hospital and Kowsar Clinic of Ardabil Medical Sciences in March 2020 to September 2020
No full textBack ground:Anal fissure is a anodermal tearing under dentate line.Pathophysiology of fissure seems to be related with passing of hard stool or prolonged diarrhea.The cycle of pain and ischemia and spasm lead to nonhealing ulcer and acute fissure changes to chronic fissure. Because of high prevalence of this problem and lack of studies for comparison of different local treatments for that and mention of corticosteroid as a part of tretment we dicided to this study for comparison of pain response in this patients to routin treatment with Diltiazem and response to combination of hydrocortisone and Diltiazem.
Aim: Determining the effectiveness of topical hydrocortisone in the treatment of anal fissure in patients undergoing drug treatment in the first 6 months of 2020.
Matherials and Methods:The basis for selecting patients as chronic Fischer was clinical examination by a Specialist surgeonand the existence of characteristics related to chronic fissure. The approach to treatment was that 100 patients were randomly treated with the usual prescription of treatment including diltiazem gel. 2% and in case of constipation were treated with lactulose and psyllium syrup and another 100 people were randomly treated with the usual prescription using the same method as the first group with the use of 1% hydrocortisone ointment three times a day at a rate of 0.4 g It should be noted that the researcher did not know the type of prescription for each patient and the treatment was started randomly by the professor for the patients.
Results:The rate of pain relief from concomitant use of hydrocortisone ointment with diltiazem gel during the first week of treatment was significantly better than the diltiazem treatment group alone. Response to treatment after about 2 weeks of treatment between each two groups were similar and without significant differences. Response to treatment in both treatment groups was not significantly related to age, sex and level of education.
Conclusion:The combination therapy of a topical corticosteroid in this study with hydrocortisone with routine treatment with a calcium channel blocker in this study was diltiazem gel at the beginning of medical treatment for chronic fissures during the first week of treatment leads to a faster response to pain relief. There was no significant difference between the two groups in the long term within 2 weeks of starting treatment
Study of Hepatoprotective effect of aqueous extract of humulus lupulus on CCl4 induced liver damage in rat
No full textBackground: The liver is one of the most important organs in the body and the place of metabolism of most drugs and toxins. Therefore, any damage to the liver can disrupt its function and cause various diseases. On the other hand, due to the increasing use of herbs, in this study, the effects of hepatic protection of aqueous extracts of humulus lupulus on liver damage induced by carbon tetrachloride in rats were investigated.
Aim: Study of Hepatoprotective effect of aqueous extract of humulus lupulus on CCl4 induced liver damage in wistar rat.
Materials and Methods: In this experimental study, 36 male Wistar rats were divided into 6 groups (n=6). Group 1 (normal control) and Group 2 (control CCl4): administered with distilled water orally for 14 days. Groups 3, 4, and 5 were respectively administered with 50, 100, and 200 mg/kg of humulus lupulus extract for 14 days. Group 6: administered with silymarin (as standard drug) 100 mg/kg orally for 14 days. All of groups except group 1 received 1 ml CCl4 (1:1 v/v dissolved in olive oil) on 14th day. Group 1 received only 1 ml/kg of olive on 14th day.
Results: administration with CCl4 alone capable to the increased serum level of ALT, AST, ALP, TAG, and Total Bilirubin but it had no effect on TC,GGT, LDL-C and direct bilirubin. It also caused a decreased serum level of HDL-C, Albumin and Total Protein when compared to control group. Pretreatment with a humulus lupulus extract capable significantly reduced serum levels of ALT, AST, ALP, TG, Total Bilirubin and increased serum levels of HDL-C, Albumin and Total Protein when compared to control group but did not have a significant effect onTC and GGT, direct bilirubin and LDL-C levels. On the other hand, intraperitoneal injection of carbon tetrachloride increased the amount of MDA and decreased the amount of TAC compared to the normal control group. In pathological specimens, carbon tetrachloride injection infects liver walls and also damages hepatocytes, including cell nuclei (dense cell nucleus in the form of a dark, round mass smaller than a true cell), cell vacuolation, and lymph node infiltration. However, pretreatment with some doses of humulus lupulus extract was able to moderate the changes in the evaluated parameters to some extent.
Conclusion: The results of this study showed that humulus lupulus extract can protect the liver against oxidant compounds and free radicals produced by carbon tetrachloride metabolism