Cultural barriers in the education of cardiovascular disease patients in Iran

BACKGROUND

Cardiovascular diseases are responsible for the highest mortality rate in Iran; however, there is a lack of evidence for cultural factors influencing patient education. Such information is important for the provision of effective patient care.

AIM

To identify key issues relating to cultural factors influencing education of cardiovascular disease patients in Iran.

METHODS

The qualitative research approach was used in this study, with open-ended interviews used to gather data. Eighteen nurses, four cardiovascular specialists, nine patients with cardiovascular disease and four family members were interviewed at two educational hospitals in Tehran. Interviews were taped, transcribed and analysed using constant comparative analysis.

FINDINGS

Participants expressed a range of cultural factors influencing patient education. Five themes emerged from the analysis: (a) patients' lifestyle, (b) beliefs about disease and treatment, (c) concealment of true diagnosis, (d) different opinions regarding the preferred instructor, and (e) ineffective communication.

CONCLUSION

Findings show that cultural beliefs may act as risk factors for, or serve to intensify, cardiovascular disease. Consideration of these factors is essential for the success of patient education programmes.

Effects of a continuous care model on perceived quality of life of spouses of haemodialysis patients

We carried out a semi-experimental study with simple randomized sampling to study the effects of applying a continuous care model on the quality of life of 36 spouses of haemodialysis patients in Hamedan, Islamic Republic of Iran. Participants took part in group discussions and training on the continuous care approach and completed the Perceived Quality Of Life (PQOL) questionnaire before and after the intervention. Mean scores on the physical, social and cognitive dimensions, as well as happiness and total scores significantly increased after the intervention. Applying a continuous care model has positive effects on the caregivers of chronic patients.

The empowerment process in people with diabetes: an Iranian perspective

BACKGROUND

Empowerment and power are well-researched concepts concerning people with chronic diseases. However, few researchers have focused specifically on the process of empowerment in Iranian people with diabetes. Understanding the empowerment process could help health professionals facilitate empowerment.

AIM

To explore the empowerment process in Iranian people with diabetes.

METHOD

A grounded theory research design was used incorporating in-depth interviews to collect the data from men and women aged 21-73 years (n = 16). Data were collected between February and July 2007. Constant comparative analysis was undertaken to identify key categories.

FINDINGS

Participants indicated being embarrassed by the diagnosis, thirsting to learn, living in the shadow of fear, accepting diabetes as reality, managing diabetes and feeling empowered were distinct but interconnected phases in the empowerment process. The empowerment process was influenced by cultural and religious beliefs including the concept of the doctor as holy man, accepting diabetes as God's will, caring for the body because it was God's gift, paying attention to symptomatic disease, and support from peers and family, especially daughters.

CONCLUSION

The empowerment process consists of several distinct but interconnected phases. The findings will help health professionals develop a deeper understanding of how Iranian people with diabetes become empowered.

Barriers to, and facilitators of post-operative pain management in Iranian nursing: a qualitative research study

BACKGROUND

Unrelieved post-operative pain continues to be a major clinical challenge, despite advances in management. Although nurses have embraced a crucial role in pain management, its extent is often limited in Iranian nursing practice.

AIM

To determine Iranian nurses' perceptions of the barriers and facilitators influencing their management of post-operative pain.

METHODS

This study was qualitative with 26 participant nurses. Data were obtained through semi-structured serial interviews and analysed using the content analysis method.

FINDINGS

Several themes emerged to describe the factors that hindered or facilitated post-operative pain management. These were grouped into two main themes: (1) barriers to pain management after surgery with subgroups such as powerlessness, policies and rules of organization, physicians leading practice, time constraints, limited communication, interruption of activities relating to pain, and (2) factors that facilitated post-operative pain management that included the nurse-patient relationship, nurses' responsibility, the physician as a colleague, and nurses' knowledge and skills.

CONCLUSION

Postoperative pain management in Iran is contextually complex, and may be controversial. Participants believed that in this context accurate pain management is difficult for nurses due to the barriers mentioned. Therefore, nurses make decisions and act as a patient comforter for pain after surgery because of the barriers to effective pain management.

Efficacy and long-term immunogenicity of hepatitis B vaccine in haemodialysis patients

BACKGROUND

Hepatitis B vaccine is effective in protection against hepatitis B virus (HBV) infection in haemodialysis (HD) patients, but the antibody response is variable in this population and the persistence of immunity in them remains largely unknown. In this study we aimed to evaluate the efficacy and long-term immunogenicity of hepatitis B vaccine in HD patients.

METHODS

In this study, we initially offered HBV vaccination as double dose, four vaccine series schedule (40 microg injections intramuscularly in the deltoid muscle at 0, 1, 2 and 6 months) to 54 HD patients who were negative for hepatitis B core antibody and did not receive any dose of HBV vaccine previously. Serum levels of hepatitis B surface antibody (anti-HBs) tested 1-2 months after completion of vaccination. Then we follow the patients up to 1 year after primary vaccination to evaluate the persistence of immunity (as indicated by serum levels of anti-HBs higher than or equal to 10 IU/l).

RESULTS

After primary vaccination, 87% of patients developed anti-HBs levels above 10 IU/l. 27.8% and 59.2% of them were weak responders and high responders respectively. 13% of patients were non-responders. After 1-year follow-up, 18.18% of responders had lost their anti-HBs (transient responders). All of them were initially in weak responders group and had lower anti-HBs levels.

CONCLUSION

We found an average percentage of seroconversion after primary HBV vaccination in HD patients. Our study also supported this fact that an antibody titre above 100 IU/l following primary vaccination is necessary to maintain that level of antibody 1 year later.

Normative data and psychometric properties of the parent and teacher versions of the strengths and difficulties questionnaire (SDQ) in an Iranian community sample

BACKGROUND

Strengths and difficulties questionnaire (SDQ) is a widely used instrument for screening mental problems in children and adolescents. The main aim of this study was to evaluate the validity and psychometric properties of this questionnaire in comparison with the children behavior checklist (CBCL) and psychiatric interview.

METHODS

The study was done in two stages. At stage one, 600 children aged between 6 and 12 were evaluated using the parent and teacher versions of SDQ and CBCL. At stage two, 25 children with the scores above the cut point reported by the developer of SDQ and 27 children with the score below this point were selected to be interviewed by a child and adolescent psychiatrist according to Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) classification and by another clinician using the K-SADS-PL (Schedule for Affective Disorders and Schizophrenia for School-Age Children- Present and Lifetime Version) as a semi structured interview.

RESULTS

The mean scores of SDQ subscales found in this study were comparable to what found in other studies in other countries. The cut-off points of SDQ were almost similar to that of other researches. The internal consistency and concurrent validity of this questionnaire was good.

CONCLUSIONS

The current study showed that both parent and teacher versions of SDQ in Persian language can be used as a valid tool in screening the mental problems in children and adolescents.

Smoking initiation among Iranian adolescents: a qualitative study

In response to the need for effective tobacco prevention programmes in the Islamic Republic of Iran, the present study sought to determine the major risk factors for initiation of smoking by adolescents. A content analysis with a qualitative approach was conducted through 22 in-depth interviews, 2 focus groups (4 and 6 participants in each group) and 30 narratives. The following 3 themes emerged from the analysis as risk factors for initiating smoking by adolescents: personal factors, social factors and beliefs about smoking. Based on these findings, it is recommended that prevention activities should be embedded in a comprehensive approach which aims to change the smoking and parenting behaviour of parents and teachers, and at creating non-smoking policies in schools and other places where young people congregate.

An identity-based model for adolescent health in the Islamic Republic of Iran: a qualitative study

We conducted this study on 52 adolescents from Tehran to investigate their perspectives on health. We used the grounded theory approach and the constant comparison analysis method. Identity emerged as a core variable along with the concepts of friendship and relationships, education, family, lack of limitation and community. Identity affects adolescents' health regarding the emerged concepts. Participants believed that psychosocial health-related factors were more important than physical and individual health factors. Therefore, social welfare, healthy family/friendship, and caring for adolescents' individuality are important for healthy adolescence.

Cloud point extraction for the determination of copper, nickel and cobalt ions in environmental samples by flame atomic absorption spectrometry

A cloud point extraction procedure was presented for the preconcentration of copper, nickel and cobalt ions in various samples. After complexation with methyl-2-pyridylketone oxime (MPKO) in basic medium, analyte ions are quantitatively extracted to the phase rich in Triton X-114 following centrifugation. 1.0 mol L(-1) HNO(3) nitric acid in methanol was added to the surfactant-rich phase prior to its analysis by flame atomic absorption spectrometry (FAAS). The adopted concentrations for MPKO, Triton X-114 and HNO(3), bath temperature, centrifuge rate and time were optimized. Detection limits (3 SDb/m) of 1.6, 2.1 and 1.9 ng mL(-1) for Cu(2+), Co(2+) and Ni(2+) along with preconcentration factors of 30 and for these ions and enrichment factor of 65, 58 and 67 for Cu(2+), Ni(2+) and Co(2+), respectively. The high efficiency of cloud point extraction to carry out the determination of analytes in complex matrices was demonstrated. The proposed procedure was applied to the analysis of biological, natural and wastewater, soil and blood samples.

Pre-transplant calcium-phosphate-parathormone homeostasis as a risk factor for early graft dysfunction

While good organ quality and ideal transplant conditions eliminate many of the know factors that compromise initial graft function (IGF), poor early graft function (EGF) still occurs after living donor kidney transplantation (LDKT). Uncontrolled pre-transplant hypercalcemia and hyperparathyroidism are associated with impaired allograft function. Between April 2004 and January 2006, data were collected on 354 LDKT recipients including 252 males and 102 females, to determine risk factors for poor EGF, defined as either delayed or slow graft function (DGF or SGF). Of the 354 recipients, 318 (89%) had IGF, 22 (6.2%) had SGF and 14 (4%) had DGF. Donor female gender (P = 0.04) and duration on dialysis (P = 0.02) were associated with poor EGF. Recipients with DGF had higher serum phosphate (P = 0.07) and calcium x phosphate product ( P = 0.01) than recipients with IGF and SGF. The serum parathormone (PTH) levels were higher in recipients with SGF and DGF although the difference was not statistically significant (P = 0.1). Serum calcium levels did not correlate with the occurrence of poor EGF (P = 0.9). Our study suggests that serum phosphate and calcium x phosphate product serve as risk factors for DGF while serum PTH level may play a role as a risk factor for SGF and DGF.

Inflammation and pruritus in hemodialysis patients

Pruritus is a common problem in dialysis patients. The aim of this study was to determine the cause(s) of pruritus and its relationship with inflammatory proteins. In a cross sectional study, all patients on hemodialysis at the Emam Khomaine and Sina Hospital, Tehran, Iran who did not have any pruritus-producing skin lesions were studied. They were questioned about the occurrence of pruritus during the preceding two weeks. Variables including inflammatory proteins (C-reactive protein, albumin, ferritin, transferrin, fibrinogen), hemoglobin, red blood cell indices, iron, iron binding capacity, transferring saturation, urea, creatinine, calcium, phosphorus, calcium x phosphorus product, alkaline phosphatase and parathormone were determined. Data were analyzed using Anova or Chi-square tests for evaluation of difference between variables. Of the 164 patients studied, 80 (49%) had pruritus. Of these, 45 subjects (23.8%) had severe and 35 (21.3%) mild to moderate pruritus. There were no significant differences between groups with or without pruritus for age, sex, duration on dialysis, dialysis adequacy, cause of renal failure and erythropoetin usage. Mean CRP was 16.6 mg/L; 58.5% of the patients had CRP > 10 mg/L. There was no significant correlation between CRP levels and presence or severity of pruritus. Also, none of the other inflammatory proteins revealed any significant differences. Among the other parameters, only the mean MCV levels were significantly different between the three groups (P < 0.05). Our study suggests that inflammatory proteins do not play any part in hemodialysis associated pruritus.

Infertility among female renal transplant recipients

We studied 122 women with renal allograft transplantation to evaluate their reproductive systems. The patients were recruited from the three main kidney transplant surgery centers in Tehran, from September to October 2005. Fifteen (12%) patients were either in the menopausal stage or had hysterectomies, and the other 33(27%) were unmarried. Of the 76(62%) married women at the reproductive age, 10 (13.1%) had infertility that was defined as the failure of a married woman to conceive after 12 months of frequent intercourse without contraception. Three patients had male factor infertility, three others had ovulatory problems, and four cases were undefined. Only six cases were actively treated by ovulation induction +/- an intrauterine inducer (IUI); two patients became pregnant, while the other four refused infertility treatment. The reasons of unwillingness for infertility treatment included old age (40 years) in one patient, positive HBsAg in one, renal retransplantation in one, and previous clomiphene therapy failure in another. We conclude that the prevalence of infertility among female renal transplant recipients is the same as the general population, and the causes are mostly treatable. However, many are less motivated to be treated for this problem.