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A theory-based intervention to promote medication adherence in patients with rheumatoid arthritis: A randomized controlled trial
Get PDFIntroduction/objectives: Adherence to prescribed medication regimens is fundamental to the improvement and maintenance of the health of patients with rheumatoid arthritis. It is therefore important that interventions are developed to address this important health behavior issue. The aim of the present study was to design and evaluate a theory-based intervention to improve the medication adherence (primary outcome) among rheumatoid arthritis patients. Methods: The study adopted a pre-registered randomized controlled trial design. Rheumatoid arthritis patients were recruited from two University teaching hospitals in Qazvin, Iran from June 2018 to May 2019 and randomly assigned to either an intervention group (n = 100) or a treatment-as-usual group (n = 100). The intervention group received a theory-based intervention designed based on the theoretical underpinnings of the health action process approach (HAPA). More specifically, action planning (making detailed plans to follow medication regimen), coping planning (constructing plans to overcome potential obstacles that may arise in medication adherence), and self-monitoring (using a calendar to record medication adherence) of the HAPA has been used for the treatment. The treatment-as-usual group received standard care. Results: Data analysis was conducted based on the principle of intention to treat. Using a linear mixed-effects model (adjusted for age, sex, medication prescribed, and body mass index), the results showed improved medication adherence scores in the intervention group (loss to follow-up = 16) compared to the treatment-as-usual group (loss to follow-up = 12) at the 3-month (coefficient = 3.9; SE = 0.8) and 6-month (coefficient = 4.5; SE = 0.8) follow-up. Intervention effects on medication adherence scores were found to be mediated by some of the theory-based HAPA variables that guided the study. Conclusion: The results of the present study support the use of a theory-based intervention for improving medication adherence among rheumatoid arthritis patients, a group at-risk of not adhering to medication regimens. Trial registration (in Iranian Registry of Clinical Trials): irct.ir, IRCT20180108038271N1Key Points• Theoretical underpinnings of the health action process approach are useful to improve medication adherence for RA patients. © 2020, The Author(s)
Analysis of the early mother-child relationship in schizophrenic patients
Get PDFBackground and Aim: The mother as the first caregiver plays a significant role in the formation of the child’s behavior, growth, and communication. The present study aimed to analyze the early mother-child relationship in schizophrenic patients. Materials and Methods: This qualitative study employed a descriptive phenomenological approach. The participants were male patients with schizophrenia who were hospitalized in Qazvin Bahman Psychiatric Hospital from March to September 2020 with an age range of over 18 years. Given the objective of the study, the data were collected using semi-structured interviews. The participants were selected using purposive sampling and the sampling procedure continued until data saturation as the point when no new information is observed in the data. Accordingly, the data were saturated after interviewing 15 participants. The data were analyzed using Colaizzi’s seven-step method. Results: The analysis of the data revealed four main themes including ambivalent attachment to the mother, feelings of constant fear and worry, a sense of constant care for the mother, and a cold and emotionless relationship with the child. Conclusion: The present study suggested that schizophrenia is a disorder that affects the mother-child relationship, and does the term “schizophrenic mothers” need to be reconsidered? However, the result of this research has been done according to the nature and cultural context of Iranian society. © The Author(s) 2021
Global prevalence of Trichomonas vaginalis among female sex workers: a systematic review and meta-analysis
Get PDFAbstract
Trichomoniasis is a sexually transmitted infection (STI), caused by the protozoan parasite, Trichomonas vaginalis. Female sex workers are intensely affected by the infection, since they have frequent direct physical contact. The current systematic review andmeta-analysis represents the global prevalence of T. vaginalis in female sex workers. Five databases (Science Direct, Scopus, PubMed,Web of Science, and Google Scholar) were explored for literatures that published from July 1985 to June 2020. Totally, 85 studies (54,515 participants) from 46 countries met the inclusion criteria. The global pooled prevalence of T. vaginalis was 16% (95% CI 13–19%). The estimated pooled prevalence based on methods including wet mount, culture, and molecular techniques was 15% (95% CI 12–19%),16% (95% CI 10–24%), and 22% (95% CI 13–32%), respectively. Moreover, the infection was most prevalent at the mean age of 30–36 (20%, 95% CI 11–30%). Regarding the World Health Organization (WHO) regions, the highest pooled prevalence was estimated to be in the African region (23%, 95% CI 7–46%). In addition, we indicated that countries with low-income level have the highest pooled prevalence (23%, 95% CI 14–34%). Our results revealed that the worldwide prevalence of T. vaginalis was significant in female sex workers. Therefore, considering a precise strategy such as a health education program with regard to safe intercourse is needed to increase knowledge and prevent T. vaginalis infection in sex workers.
Keywords Trichomoniasis . Worldwide epidemiology . Female sex workers . Sexually transmitted disease
Prevalence of Strongyloides stercoralis in the immunocompetent and immunocompromised individuals in Iran: a systematic review and meta-analysis
Get PDFStrongyloidiasis is a neglected tropical disease mostly distributed in tropical and subtropical regions. The current study evaluated the prevalence of Strongyloides stercoralis in immunocompetent and immunodeficient patients in Iran. The available online literature published from June 1994 to October 2020 was obtained from multiple English databases (PubMed, Science Direct, Scopus, Web of Science and Google Scholar) and four Persian databases (Magiran, Iran Medex, Iran Doc and SID). All statistical analyseswere performed using R software (version 3.6) meta-package and p-values <0.05 were considered significant. From1051 articles, 74 studies (248 656 individuals) met the inclusion criteria. The pooled prevalence of S. stercoralis was 2% (95% confidence interval [CI] 1 to 3) and 4% (95% CI 1 to 8) in immunocompetent and immunodeficient patients, respectively. In immunodeficient cases, the pooled prevalence of studies utilizing serology, culture and microscopic methods was 10% (95% CI 2 to 23), 1% (95% CI 0 to 6) and 1% (95% CI 0 to 1), respectively. In immunocompetent cases, the pooled prevalence of studies utilizing microscopic, culture and molecular methods was 2% (95% CI 1 to 3), 2% (95% CI 1 to 4) and 2% (95% CI 0 to 6), respectively.We propose an appropriate screening and control program along with comprehensive research regarding the frequency of strongyloidiasis in the country.
Keywords: Iran, neglected tropical disease, soil-transmitted helminth, Strongyloides stercoralis, systematic revie
Effects of Placenta Location in Pregnancy Outcomes of Placenta Accreta Spectrum (PAS): A Retrospective Cohort Study
Get PDFObjective: Placenta Accreta Spectrum (PAS) affects approximately one in a thousand deliveries. Very few
studies evaluated PAS risk factors based on their location. In this study, we have investigated the effects
of placenta location on placental adhesion-related complications, its risk factors, and outcomes.
Materials and methods: We performed a retrospective cohort study of pathology-confirmed cases of PAS
from patients with peripartum hysterectomy, at a large educational hospital in Qazvin, Iran, from 2009 to
2019. Placenta location was found by ultrasound reports and intraoperative evaluation. We measured
demographic features, basic characteristics, maternal and neonatal outcomes based on placental
location including anterior, posterior, and lateral in Placenta Accreta Spectrum. Chi-square, t-test, and
one-way ANOVA were used to examine the relation of complications, risk factors, and outcomes in PAS.
Results: A review of 70 cases showed the distribution of placenta location as follows: 57% anterior, 27%
posterior, and 16% lateral. The mean gestational age at delivery was 35 (33-39) weeks. In 78.6% (n=55)
of the patients, an association with placenta previa and in 94/2% (n=66) of cases a history of cesarean
section was found, however, it was not significantly correlated with placenta location (p=0.082). We found
that surgery duration was significantly longer in patients with lateral PAS (155±38, vs 129.35±33.8 and
133.15±31.5 for anterior and posterior placenta respectively, p=0.09). Patients with lateral PAS also bled
more than the remaining two groups (2836 ml for lateral PAS vs 2002 and 1847 for anterior and posterior
placenta respectively, p=0.022). Moreover, women with a history of uterine surgery were more likely to
have posterior PAS compared to those with anterior and lateral PAS (p=0.035).
Conclusion: Differences in complications, risk factors, and outcomes of PAS based on placenta location
may lead to improved diagnosis and decreased morbidity in women.
Keywords: Hysterectomy; Maternal Mortality; Placenta Accreta; Postpartum Hemorrhage; Placenta Previ
بررسی استرس، ترس و کیفیت زندگی اعضای خانواده پرستاران شاغل در بخش های کووید 19 بیمارستان های آموزشی دانشگاه علوم پزشکی قزوین
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Application of Theory of Planned Behavior to Predict the Factors Affecting the Substance Abuse Treatment Continuity
Get PDFIntroduction: The high rate of relapse after addiction withdrawal indicates inadequacy of detoxification courses and ignoring the role of psychosocial variables as critical component of successful treatment protocols. The aim of the present study was to apply the theory of planned behavior (TPB) to determine the effective factor related to the substance abuse treatment continuity in the in-treatment clients referring to drug-stop clinics of Masal city.
Methods: With a simple random sampling method, 195 in-treatment clients referring to drug-stop clinics of Masal city participated in a cross-sectional study. Data were collected by demographic information questionnaire, TPB-related scales, substance abuse screening questionnaire (TCU) and treatment continuity questionnaire. Chi-Squared test, independent t-test, one-way analysis of variance (ANOVA), Pearson correlation coefficient and path analysis were used to analyze the data.
Results: The finding of the two models revealed that the strongest correlation coefficients were found between intention with constructs such as attitude, perceived behavioral control (PBC), and treatment continuity, as well as between treatment continuity and attitude (P < 0.05). Also, attitudes (β = 0.51, P < 0.05) and PBC (β = 0.33, P<0.05) had the greatest effect on intention to treatment continuation. Moreover, attitudes and subjective norms significantly mediated the relationship between the history of substance abuse and the intention to treatment continuation (P < 0.05). Finally, TPB constructs described 52% and 31% variance of intention and treatment continuity, respectively (P < 0.05).
Conclusions: The findings confirmed the usefulness of TPB to determine the factors influencing the substance abuse treatment continuity. So, design of TPB-based behavioral-cognitive interventions is recommended to improve substance abuse treatment continuity
Lipoid congenital adrenal hyperplasia with cholestatic jaundice
Get PDFBACKGROUND AND OBJECTIVE: Lipoid congenital adrenal hyperplasia (LCAH) is the most severe form of adrenal hyperplasia and mutations in the StAR gene are the most common cause of the disease. Adrenal insufficiency and cholestasis are reported in few patients. The aim of this study was to report the results of treatment of two sisters with lipoid CAH and cholestatic jaundice. CASE REPORTS: Here, we present two sisters at the age of 30 and 60 days with conjugated hyperbilirubinemia and elevated liver enzymes and adrenal insufficiency. They had a 46,XY karyotype with external female genitalia without uterus and ovaries. LCAH was detected through electrolyte abnormalities, increased ACTH, decreased levels of cortisol and sex hormones and was confirmed by determination of exome sequencing and Sanger sequencing. In these patients, a homozygous mutation (c.653C>T) in exon 6 of STAR gene was identified. The patients were treated with 10 mg of hydrocortisone IV every 8 hours for 3 days; oral hydrocortisone was then administered at a dose of 2.5 mg every 8 hours and 0.2 mg fludrocortisone daily. One month after the therapy, levels of bilirubin and liver enzymes of these patients became normal. The first patient died 7 months after her mother stopped giving the drugs to the child. The other patient is now 9 years old. She is in good clinical condition as her treatment goes on. CONCLUSION: Considering the reported cases, adrenal lipoid hyperplasia should be considered as a rare cause of cholestasis with adrenal insufficiency in patients. © 2021, Babol University of Medical Sciences. All rights reserved.
Author keywords
Adrenal Insufficiency; Karyotype; Lipoid CAH; Neonatal Cholestasi
