Publications by authors named "Seyedeh Belin Tavakoly Sany"

23 Publications

  • Page 1 of 1

The Health Literacy Status and Its Role in Interventions in Iran: A Systematic and Meta-Analysis.

Int J Environ Res Public Health 2021 04 17;18(8). Epub 2021 Apr 17.

Department of Health Education and Health Promotion, Faculty of Health, Mashhad University of Medical Sciences, Mashhad 13131-99137, Iran.

There are increasing calls for public health policies to realize the visions of a health literate society and health literacy on a global scale. However, there are still more gaps in what researchers recognize and what steps they should take to improve health literacy (HL) skills. This review aimed to measure the HL status of the Iranian population and the effect size of the underlying association between HL and other health outcomes, and to examine the effectiveness of HL interventions on improving the functional dimension of HL, self-efficacy, and health-promoting behaviors. All full text published articles written in English and Persian language were included from inception until January 2019, but the type of study is not limited. A total of 52 potentially relevant articles with data on 36,523 participants were included in this review. In the population with health conditions, the average HL score was 62.51 (95% CI: 59.95-65.08), while in the patient population, the HL score was 64.04 (95% CI: 60.64-67.45). Health literacy was positively and significantly correlated with self-care behaviors 0.42 (95% CI; 0.35-0.49), self-efficacy 0.35 (95% CI; 0.26-0.43), knowledge 0.50 (95% CI; 0.44-0.55), communication skills 0.33 (95% CI; 0.25-0.41), and health promotion behaviors 0.39 (95% CI; 0.35-0.44). The meta-analyses showed that overall, HL interventions significantly improved HL status, self-efficacy, and health promotion behaviors. Results indicate that HL status was in the range of marginal HL level in the Iranian population. Our finding highlights the beneficial impact of HL intervention on health-promoting behaviors and self-efficacy, particularly in low literacy/socioeconomic status people.
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http://dx.doi.org/10.3390/ijerph18084260DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8073744PMC
April 2021

Impact of an Educational Training on Behavioral Intention for Healthcare Waste Management: Application of Health Action Model.

Int Q Community Health Educ 2021 Feb 25:272684X20982595. Epub 2021 Feb 25.

Department of Public Health, School of Health, Torbat Heydariyeh University of Medical Science, Torbat Heydariyeh, Iran.

Inappropriate healthcare waste management (HCWM) may lead to health hazards through the release of toxic and infectious agents into the environment. This study aimed to assess the appropriateness of a Health Action Model (HAM) operationalized in a training intervention to promote behavioral intent towards HCWM practice among hospital staff. This was a quasi-experimental intervention study of 128 hospital staff attending a training intervention in Sabzevar Hospital, Iran. Four training intervention was carried out using potential constructs of the HAM model to compare the quality of HCWM process and behavioral intent of hospital staff before and after a training session. A questionnaire based on HAM and multiple statistical analyses were used to assess the effectiveness of the training intervention. The average age of the eligible participants was 35.05 ± 9.4 years. A majority of the participant was married (88%), nursing staff (54%) and possessed a bachelor's degree (66%) or diploma (18%). After the intervention, a significant change (p < 0.05) was observed in the intervention group compared to the control group in staff knowledge, attitude, self-efficacy, belief, and motivation. Further, our result showed a significant improvement from 53.6 ± 24.3 to 83.6 ± 11.5 in the behavioral intention toward HCWM practice. This work provides evidence of the effectiveness of the HAM as a guide in which the potential determinates that influence an individual's behavioral intention toward medical waste practice were identified and described. This model help promote behavioral intention at a variety of target audiences and setting in waste management practice.
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http://dx.doi.org/10.1177/0272684X20982595DOI Listing
February 2021

Organizing framework to investigate associations between diabetes knowledge, health literacy, and self-care behaviors in patients with type 2 diabetes based on the extended parallel process model.

J Diabetes Metab Disord 2020 Dec 28;19(2):1283-1292. Epub 2020 Sep 28.

Department of Public Health, School of Health, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran.

Objective: The mechanisms underlying the relations between diabetes self-care behaviors, cognition, and social factors are still equivocal, and it is unclear how diabetes knowledge and health literacy is associated with self-care behaviors. Here, we tested a hypothetical path model linking diabetes self-care behaviors to knowledge, health literacy, and constructs of the extended parallel process model (EPPM) to understand potential predictors that may influence patients' self-care behavior with type 2 diabetes.

Methods: A cross-sectional study was conducted, and 404 patients with type 2 diabetes were recruited from healthcare centers in Khaf, Iran. Diabetes self-care behaviors were indicated by, glucose self-control, foot care, physical activity, medications, smoking, and a healthy diet. The main data collection instruments in this study were the Health Literacy for Iranian Adults questionnaire (HELIA), diabetes knowledge, and self-care behavior based on the EPPM questionnaires.

Results: The results from path modeling indicated that perceived susceptibility, efficacy, self-efficacy, knowledge, and health literacy were significant ( < 0.05) predictors for diabetes self-care behaviors and path model accounted for 32% of the total variance.

Conclusion: Based on the results, key constructs of EPPM, diabetes knowledge, and health-related literacy are empirically supported diabetes self-care behaviors. These factors could apply to health professionals for developing educational intervention programs to facilitate a physically active lifestyle.
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http://dx.doi.org/10.1007/s40200-020-00642-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7843697PMC
December 2020

Psychosocial Determinants of Changes in Dietary Behaviors Among Iranian Women: An Application of the Pender's Health Promotion Model.

Int Q Community Health Educ 2020 Dec 6:272684X20976825. Epub 2020 Dec 6.

Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

Data on how the complex cognitive processes, personal, and social factors influence health promoting behaviors of women are very limited and the results have been inconsistent. Here, we examine how prior behaviors, behavior-specific cognition (perceived benefits/barriers, self efficacy, and activity-related affect), situational and interpersonal factors (social support, modeling, and norms) associated with the level of dietary behaviors in Iranian women. A cross sectional survey of 356 women aged 18-60 years from health care centers in Iran was undertaken from October 2015 to September 2016. Multiple analytical models and Pender's health promotion model (HPM) were implemented to examine the effectiveness of HPM and its potential constructs on PA behaviors. The instruments used were designed using Pender's HPM as a basis. The path model fitted data and accounted for 51% of the variance in dietary behaviors; and prior behavior, perceived self-efficacy, interpersonal influences, and commitment to plan were significantly associated with dietary behavior. We found that constructs from the HPM are empirically improved dietary behavior among the women population. This result provides a suitable source for designing strategies of a nutrition education intervention for improving the frequency and nutrient intake of breakfast consumption among female students.
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http://dx.doi.org/10.1177/0272684X20976825DOI Listing
December 2020

Review of Organizational Health Literacy Practice at Health Care Centers: Outcomes, Barriers and Facilitators.

Int J Environ Res Public Health 2020 10 16;17(20). Epub 2020 Oct 16.

Department of Health Education and Health Promotion, Faculty of Health, Mashhad University of Medical Sciences, 13131-99137 Mashhad, Iran.

The term organizational health literacy (OHL) is a new concept that emerged to address the challenge of predominantly in patients with limited health literacy (HL). There is no consensus on how OHL can improve HL activities and health outcomes in healthcare organizations. In this study, a systematic review of the literature was conducted to understand the evidence for the effectiveness of OHL and its health outcome, and the facilitators and barriers that influence the implementation of OHL. A literature search was done using six databases, the gray literature method and reference hand searches. Thirteen potentially articles with data on 1254 health organizations were included. Eight self-assessment tools and ten OHL attributes have been identified. Eleven quality-improvement characteristics and 15 key barriers were reviewed. Evidence on the effectiveness of HL tools provides best practices and recommendations to enhance OHL capacities. Results indicated that shifting to a comprehensive OHL would likely be a complex process because HL is not usually integrated into the healthcare organization's vision and strategic planning. Further development of OHL requires radical, simultaneous, and multiple changes. Thus, there is a need for the healthcare system to consider HL as an organizational priority, that is, be responsive.
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http://dx.doi.org/10.3390/ijerph17207544DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7589923PMC
October 2020

Health Literacy in Iranian Women: A Systematic Review and Meta-Analysis.

Iran J Public Health 2020 May;49(5):860-874

Social Determinants of Health Research Center, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.

Background: Inadequate health literacy (HL) is associated with poorer health outcomes and worse health care. Up to one-half of Iranian women have difficulty in interpreting medical information, and national HL assessment has been limited in Iran. We have undertaken a systematic review of the literature and used a meta-analysis to examine the situation of HL status in Iranian women, and determine the relationship between HL and self-efficacy, and self-care behaviors.

Methods: Six databases (PubMed, Web of Science, Scopus, Google Scholar, Scientific Information Database) and other non-indexed citations were searched using a variety of keywords regarding HL and Iranian women. The bias risk was decreased by the involvement of two independent reviewers assessing study quality and eligibility of included articles.

Results: The average HL scores were in the range of marginal or limited (63.08; 95% CI, 59.83-66.32) in the Iranian women. The HL score was significantly higher among pregnant women (67.55; 95% CI, 32.54-82.57) and was lower in women with chronic disease (57.79; CI, 48.34-67.24). There was a significant association between HL and self-efficacy and self-care behaviors.

Conclusion: The average level of HL in the period of the review was marginal among Iranian women. The relationship of HL with self-efficacy and self-care behaviors was statistically significant but moderate.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7475634PMC
May 2020

Communication skills training for physicians improves health literacy and medical outcomes among patients with hypertension: a randomized controlled trial.

BMC Health Serv Res 2020 Jan 23;20(1):60. Epub 2020 Jan 23.

Department of Health Education and Health Promotion, Faculty of Health, Mashhad University of Medical Sciences, Mashhad, Iran.

Background: Improving the training of physicians about communication skills and patient health literacy (HL) is a major priority that remains an open question. We aimed to examine the effectiveness of communication skills training for physicians on the hypertension outcomes and the health literacy skills, self-efficacy and medication adherence in patients with uncontrolled blood pressure (BP).

Methods: A randomized, controlled trial method was conducted on 240 hypertensive patients and 35 physicians presenting to healthcare clinics in the Mashhad, Iran, from 2013 to 2014. Using stratified blocking with block sizes of 4 and 6, eligible patients with uncontrolled blood pressure were randomly allocated to the intervention and control groups. Physicians in the intervention group received educational training over 3 sessions of Focus -Group Discussion and 2 workshops. The control group received the routine care. The primary outcome was a reduction in systolic and diastolic BP from baseline to 6 months. The secondary outcome was promoting HL skills in hypertensive patients. Data were analyzed using the regression model and bivariate tests.

Results: After the physician communication training, there was a significant improvement in physicians-patient communication skills, hypertension outcomes, medication adherence, and self-efficacy among the patients being managed by the physicians receiving training, compared to the control group.

Conclusion: The educational intervention leads to better BP control; it may have been sufficient training of physicians change to impact counseling, HL and self-efficacy and adherence. The quality of physician-patient communication is an important modifiable element of medical communication that may influences health outcomes in hypertensive Iranian patients.

Trial Registration: Iranian Registry of Clinical Trials (IRCT), IRCT20160710028863N24. Registered April 4, 2018 [retrospectively registered].
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http://dx.doi.org/10.1186/s12913-020-4901-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6979365PMC
January 2020

The Effectiveness of an Educational Intervention Based on Theories and Models on Diabetes Outcomes: A Systematic Review.

Curr Diabetes Rev 2020 ;16(8):859-868

Social Determinants of Health Research Center, Gonabad University of Medical Sciences, Gonabad, Iran.

Background & Introduction: Patient's self-management behaviors are essential to control diabetes. Studies have demonstrated that health educational interventions can improve some aspects of glycemic control and clinical outcomes, however, it is unclear which education theories underlying these interventions improve effectiveness. In this review of the literature, we aimed to assess the efficacy of health education and promotion theories, or models, to improve self-care and self- management behaviors among patients with type 2 diabetes (T2D). Methods & Results: Eight scientific databases (Web of Science, PubMed, Scopus, Magiran, Google Scholar, Medlib, ProQuest and Scientific Information Database) were searched to identify a published academic article from 2010 to 2019. We included quasi-experimental, clinical trial and randomized clinical trial studies. A total of 26 studies including data from 3879 patients with T2D met the inclusion criteria. We found that the PRECEDE (7/26, 26.92%) and Health Belief Models (7/26, 26.92%) were the most common models used to assess the efficacy of health education and health promotion models. Conclusion: Overall, health promotion and education theories and models have been used as a useful instrument for improving the self-care behaviors and self-management behaviors among patients with T2D.
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http://dx.doi.org/10.2174/1573399816666191223110314DOI Listing
September 2020

Aptamers as potential recognition elements for detection of vitamins and minerals: a systematic and critical review.

Crit Rev Clin Lab Sci 2020 03 2;57(2):126-144. Epub 2019 Nov 2.

Metabolic Syndrome Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Vitamin and mineral deficiencies are prevalent globally, and extensive efforts have been made to assess their status. Most traditional methods are expensive and time-consuming; therefore, developments of rapid, simple, specific, and sensitive methods for the assessment of vitamins and minerals in biological samples are of high importance in research. Aptamers are synthetic nucleic acid single-stranded DNA or RNA that can be synthesized . They can be engineered to be analyte-specific and have been suggested as a substitute for monoclonal antibodies, due to their high sensitivity and affinity. In addition, aptamers can be chemically synthesized and readily modified for use as biosensors. These features make aptamers a promising tool for the detection of biological analytes. In this review, we provide an overview of the potential use of aptamer-based biosensors. Search terms were conducted on several online databases, including Google Scholar, PubMed, Scopus, and Science Direct from January 2000 to August 2019. Eligibility criteria were used and quality evaluation was performed. Following the review of 4349 articles, 39 articles met the inclusion criteria. Aptasensors have recently been developed for the detection of vitamins by using optical methods, with a detection range from 74 pM to 204 pM, and lower limit of detection of 2.4 pM. Both electrochemical and optical methods have been used for detection of minerals, however electrochemical methods show a wider linear range and lower detection limits compared to optical methods with a wide linear range from 0.2 fM to 1.0 mM and limit of detection of 14.7 fM. The current report reviews recent developments in aptamer-based biosensors for detection of vitamins and minerals. Studies have shown that aptasensors' properties are suitable for the quantification of vitamins and minerals with high sensitivity, affinity, and specificity. Nevertheless, the limitations and future directions of aptamers require further research and new technological innovation.
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http://dx.doi.org/10.1080/10408363.2019.1678566DOI Listing
March 2020

Health risk assessments of arsenic and toxic heavy metal exposure in drinking water in northeast Iran.

Environ Health Prev Med 2019 Sep 14;24(1):59. Epub 2019 Sep 14.

Khorasan Razavi Regional Water Authority, Mashhad, Iran.

Background: Arsenic and heavy metals are the main cause of water pollution and impact human health worldwide. Therefore, this study aims to assess the probable health risk (non-carcinogenic and carcinogenic risk) for adults and children that are exposed to arsenic and toxic heavy metals (Pb, Ni, Cr, and Hg) through ingestion and dermal contact with drinking water.

Method: In this study, chemical analysis and testing were conducted on 140 water samples taken from treated drinking water in Mashhad, Iran. The health risk assessments were evaluated using hazard quotient (HQ), hazard index (HI), and lifetime cancer risk (CR).

Results: The results of the HQ values of arsenic and heavy metals for combined pathways were below the safety level (HQ < 1) for adults, while the HI for children were higher than the safety limit in some stations. Likewise, Cr showed the highest average contribution of HI (55 to 71.2%) for adult and children population. The average values of total carcinogenic risk (TCR) through exposure to drinking water for children and adults were 1.33 × 10 and 7.38 × 10, respectively.

Conclusion: Overall, the CR through exposure to drinking water for children and adults was borderline or higher than the safety level of US EPA risk, suggesting the probability of carcinogenic risk for the children and adults to the carcinogenic elements via ingestion and dermal routes. Therefore, appropriate purification improvement programs and control measures should be implemented to protect the health of the residents in this metropolitan city.
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http://dx.doi.org/10.1186/s12199-019-0812-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6745075PMC
September 2019

Factors that influence dietary behavior toward iron and vitamin D consumption based on the theory of planned behavior in Iranian adolescent girls.

Nutr J 2019 02 6;18(1). Epub 2019 Feb 6.

Social Determinants of Health Research Center, Gonabad University of Medical Sciences, Gonabad, Iran.

Background: The impact of iron and vitamin D supplements among adolescent is not well understood. The prevalence of supplement use, and the behavioral intentions of adolescents was studied to better understand the data on supplement intake. We used the theory of Planned Behavior (TPB) to explore the determinants that influence supplement intake, and its potential constructs to examine determinants that influence dietary supplement behavior towards the use of iron and vitamin D supplements amongst a sample of Iranian schoolgirl.

Methods: This was a cross-sectional study of 485 adolescent girls aged 12-17 years. Multiple analytical models including hierarchical regression and structural equation modeling (SEM) were used to examine the association between TPB constructs and adolescent's behavioral intentions to consume dietary supplements.

Results: Based on the results of SEM, constructs of TPB and knowledge were found to predict 74% of the variation in the behavioral intentions of the schoolgirls. SEM indicated that perceived behavioral control (PBC) and knowledge had significant associations with intention behaviors to take nutritional supplements.

Conclusion: TPB and its constructs were used to establish the determinants of iron and vitamin D intake among schoolgirls in Iran. This outcome indicates that efforts to promote behavioral intentions through targeting subjective norms, attitude, and PBC may promote supplement use.
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http://dx.doi.org/10.1186/s12937-019-0433-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6366087PMC
February 2019

Anemia is associated with cognitive impairment in adolescent girls: A cross-sectional survey.

Appl Neuropsychol Child 2020 Apr-Jun;9(2):165-171. Epub 2019 Jan 20.

Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

Anemia is associated with impairment in oxygen transport, affecting an individual's physical and mental wellbeing, and work performance. The aim of this study was to examine the prevalence of anemia and its possible association with serum antibody titers to Hsp27 (as an indicator of cellular stress), cognitive function, measures of emotion, and sleep patterns in adolescent girls. A total of 940 adolescent girls were assessed to evaluate neuropsychological function with validated questionnaires. A complete blood count was determined as part of the assessment of hematological parameters. Serum anti-Hsp27 was measured for each subject. Among the total of 940 participants, 99 girls (10.5%) were anemic [hemoglobin <12(g/dL)]. Serum anti-HSP27 was significantly higher in anemic compared to healthy girls ( < 0.05). There was no significant differences in depression, aggression, insomnia, daytime sleepiness and sleep apnea score between two groups. However, the total cognitive abilities score was significantly lower in the anemic girls (76.8 ± 2.1 vs. 85.7 ± 2.5,  = 0.002). Logistic regression analysis showed that anemic girls were 1.73 times more likely than nonanemic girls to have cognitive impairment (95% confidence interval [CI] = 1.07-2.78;  = 0.025). Anemia was associated with elevated levels of anti-HSP27 and supports the hypothesis that cellular stress may be associated with anemia. Anemia was adversely associated with an assessment of cognitive abilities and was an independent risk factor for cognitive impairment in this group.
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http://dx.doi.org/10.1080/21622965.2018.1550405DOI Listing
December 2020

Relationship between serum high sensitivity C-reactive protein with angiographic severity of coronary artery disease and traditional cardiovascular risk factors.

J Cell Physiol 2019 07 12;234(7):10289-10299. Epub 2018 Dec 12.

Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, University Putra Malaysia, Malaysia.

Serum high-sensitivity C-reactive protein (hs-CRP) is predictive of coronary artery disease (CAD). The aim of this study was to examine the possible association of hs-CRP with presence and severity of CAD and traditional CAD risk factors. This case-control study was carried out on 2,346 individuals from September 2011 to May 2013. Of these 1,187 had evidence of coronary disease, and were subject to coronary angiography, and the remainder were healthy controls (n = 1,159). Characteristics were determined using standard laboratory techniques and serum Hs-CRP levels were estimated using enzyme-linked immunosorbent assay (ELISA) kits, and severity of CAD was assessed according to the score of obstruction in coronary artery. Serum hs-CRP levels were higher in those with severe coronary disease, who had stenosis ≥ 50% stenosis of at least one coronary artery (all p < 0.001 vs. individuals in healthy control), and correlated significantly with the score for coronary artery disease (all p < 0.01). After adjustment for conventional risk factors, regression analysis revealed that smoking habits, fasting blood glucose, total cholesterol, high-density lipoprotein, hs-CRP, blood pressure, anxiety, dietary intake of vitamin E, and cholesterol remained as independent determinants for angiographic severity of CAD. The area under the receiving operating characteristic (ROC) curve for serum hs-CRP was 0.869 (CI 95% 0.721-0.872, p < 0.001). The optimal values for the cut-off point was a serum hs-CRP of 2.78 mg/l (sensitivity 80.20%, specificity 85%) to predict severity of CAD. Increased serum hs-CRP levels are significantly associated with angiographic severity of CAD, suggesting its value as a biomarkers for predicting CAD.
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http://dx.doi.org/10.1002/jcp.27945DOI Listing
July 2019

Health Risk Assessment for Human Exposure to Trace Metals and Arsenic via Consumption of Hen Egg Collected from Largest Poultry Industry in Iran.

Biol Trace Elem Res 2019 Apr 17;188(2):485-493. Epub 2018 Jul 17.

Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

The relative contribution of foodstuffs to intake of heavy metal is still equivocal, and thus, available data are rare. Here, the concentration of ten heavy metals and arsenic were measured in the content of hen egg from five strains of commercial laying hens to evaluate contamination level and potential health risk among local and international consumers in Iran. The estimated daily intake (EDI) of all heavy metals was significantly lower than the provisional tolerable daily intake (PTDI) and respective tolerable daily intake (TDI). The non-carcinogenic and carcinogenic risk values for eating eggs were in the safe range for all consumers, indicating that the no health risk for consumers due to the daily intake of either arsenic or heavy metals. Therefore, intake of heavy metal exposure through the consumption of commercial egg product in Iran is completely safe for both national and international consumers.
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http://dx.doi.org/10.1007/s12011-018-1437-4DOI Listing
April 2019

Serum C-reactive protein in the prediction of cardiovascular diseases: Overview of the latest clinical studies and public health practice.

J Cell Physiol 2018 11 22;233(11):8508-8525. Epub 2018 Jun 22.

Medical Education and Metabolic Medicine Head, Department of Medical Education, Brighton and Sussex Medical School, University of Brighton Falmer Campus, Brighton, UK.

Cardiovascular disease is the most common cause of morbidity and mortality globally. Epidemiological studies using high-sensitivity assays for serum C-reactive protein have shown a consistent association between cardiovascular disease risk and serum C-reactive protein concentrations. C-reactive protein is a biomarker for inflammation, and has been established in clinical practice as an independent risk factor for cardiovascular disease events. There is evidence that serum C-reactive protein is an excellent biomarker of cardiovascular disease and is also an independent and strong predictor of adverse cardiovascular events. Further characterization of the impact and influence of lifestyle exposures and genetic variation on the C-reactive protein response to cardiovascular disease events may have implications for the therapeutic approaches to reduce cardiovascular disease events. This review summarizes the studies that have examined the association between serum C-reactive protein and the risk of cardiovascular disease. We also discuss the impact of independent factors and C-reactive protein genetic polymorphisms on baseline plasma C-reactive protein levels.
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http://dx.doi.org/10.1002/jcp.26791DOI Listing
November 2018

Health providers' communication skills training affects hypertension outcomes.

Med Teach 2018 02 28;40(2):154-163. Epub 2017 Nov 28.

d Brighton and Sussex Medical School , Division of Medical education, Falmer , Brighton, Sussex , UK.

Objective: Hypertension is a common cardiovascular risk factor within the Iranian population, and this may be improved through changes in lifestyle. We aimed at improving hypertension outcomes and health literacy skills among hypertensive patients through communication skills training targeting health providers.

Methods: A randomized controlled trial method was used to enroll 35 health providers and 240 hypertensive patients attending community-based healthcare practices in the Mashhad, Iran. We evaluated the effects of a communication skills intervention for primary care providers compared to usual care controls, on the hypertension outcomes, patient medication adherence, and self-efficacy, assessed at baseline and post-intervention. Bivariate analysis and the regression model were used to assess whether the health provider training improved outcomes.

Results: Majority of participating patients were female (77.3%), less than high school education (80.3%), married (82.3%), and low income (82.3%), with mean age of 37 years. Following the educational intervention, there was a significant improvement (p < 0.05) in patient communication skills, self-efficacy, adherence to medication, and hypertension outcomes in the intervention compared to the control group.

Conclusions: The brief communication skills training for health care providers appear to be an efficient way to improve patient-provider communication skills and hypertension outcome among patients with uncontrolled BP.
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http://dx.doi.org/10.1080/0142159X.2017.1395002DOI Listing
February 2018

The status and characteristics of eutrophication in tropical coastal water.

Environ Sci Process Impacts 2017 Aug;19(8):1086-1103

Department of Health Education and Health Promotion, School of Health, Social Determinants of Health Research Center, Mashhad University of Medical Science Mashhad, Iran.

A set of methodological tools was tested to assess the sensitivity of several ecological and biological indices to eutrophication while at the same time attempting to explore a linkage among pressures, classification assessment and drivers. Industrial discharges, harbor activities, natural interactions and river discharges are the pressures most related to the eutrophication process in tropical coastal water bodies. Among the eutrophication indices used, TRIX and operational indicators overestimated the eutrophication status in the study area, but EI and chl-a seems to be a rather responsive index to reflect the first stage of eutrophication. It is noteworthy that EI and chl-a showed better overall agreement with the ecological quality status (EcoQ) showing that probably it reflects the indirect relation of macrobenthic with water eutrophication in a better way. An ecological boundary of EI and chl-a from moderate to poor may be needed in order to explain the poor status of relatively eutrophic Klang Strait coastal sites.
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http://dx.doi.org/10.1039/c7em00200aDOI Listing
August 2017

Dioxin risk assessment: mechanisms of action and possible toxicity in human health.

Environ Sci Pollut Res Int 2015 Dec 29;22(24):19434-50. Epub 2015 Oct 29.

Advanced Materials Research Group, Institute of Hydrogen Economy, Universiti Teknologi Malaysia, International Campus, 54100, Kuala Lumpur, Malaysia.

Dioxin-like compounds (DLCs) have been classified by the World Health Organization (WHO) as one of the most persistent toxic chemical substances in the environment, and they are associated with several occupational activities and industrial accidents around the world. Since the end of the 1970s, these toxic chemicals have been banned because of their human toxicity potential, long half-life, wide dispersion, and they bioaccumulate in the food web. This review serves as a primer for environmental health professionals to provide guidance on short-term risk assessment of dioxin and to identify key findings for health and exposure assessment based on policies of different agencies. It also presents possible health effects of dioxins, mechanisms of action, toxic equivalency factors (TEFs), and dose-response characterization. Key studies related to toxicity values of dioxin-like compounds and their possible human health risk were identified through PubMed and supplemented with relevant studies characterized by reviewing the reference lists in the review articles and primary literature. Existing data decreases the scope of analyses and models in relevant studies to a manageable size by focusing on the set of important studies related to the perspective of developing toxicity values of DLCs.
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http://dx.doi.org/10.1007/s11356-015-5597-xDOI Listing
December 2015

Integrated ecological risk assessment of dioxin compounds.

Environ Sci Pollut Res Int 2015 Aug 9;22(15):11193-208. Epub 2015 May 9.

Institute of Biological Sciences University of Malaya, 50603, Kuala Lumpur, Malaysia,

Current ecological risk assessment (ERA) schemes focus mainly on bioaccumulation and toxicity of pollutants in individual organisms. Ecological models are tools mainly used to assess ecological risks of pollutants to ecosystems, communities, and populations. Their main advantage is the relatively direct integration of the species sensitivity to organic pollutants, the fate and mechanism of action in the environment of toxicants, and life-history features of the individual organism of concern. To promote scientific consensus on ERA schemes, this review is intended to provide a guideline on short-term ERA involving dioxin chemicals and to identify key findings for exposure assessment based on policies of different agencies. It also presents possible adverse effects of dioxins on ecosystems, toxicity equivalence methodology, environmental fate and transport modeling, and development of stressor-response profiles for dioxin-like chemicals.
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http://dx.doi.org/10.1007/s11356-015-4511-xDOI Listing
August 2015

Human health risk of polycyclic aromatic hydrocarbons from consumption of blood cockle and exposure to contaminated sediments and water along the Klang Strait, Malaysia.

Mar Pollut Bull 2014 Jul 23;84(1-2):268-79. Epub 2014 May 23.

Institute of Biological Sciences, University of Malaya, 50603 Kuala Lumpur, Malaysia.

The concentration of carcinogenic poly aromatic hydrocarbons (c-PAHs) present in water and sediment of Klang Strait as well as in the edible tissue of blood cockle (Anadara granosa) was investigated. The human health risk of c-PAHs was assessed in accordance with the standards of the United States Environmental Protection Agency (US EPA). The cancer risks of c-PAHs to human are expected to occur through the consumption of blood cockles or via gastrointestinal exposure to polluted sediments and water in Kalng Strait. The non-carcinogenic risks that are associated with multiple pathways based on ingestion rate and contact rates with water were higher than the US EPA safe level at almost all stations, but the non-carcinogenic risks for eating blood cockle was below the level of US EPA concern. A high correlation between concentrations of c-PAHs in different matrices showed that the bioaccumulation of c-PAHs by blood cockles could be regarded as a potential health hazard for the consumers.
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http://dx.doi.org/10.1016/j.marpolbul.2014.05.004DOI Listing
July 2014

Polycyclic aromatic hydrocarbons in coastal sediment of klang strait, Malaysia: distribution pattern, risk assessment and sources.

PLoS One 2014 18;9(4):e94907. Epub 2014 Apr 18.

Faculty of Natural Resources and Environment, Ferdowsi University of Mashhad, Mashhad, Iran.

Concentration, source, and ecological risk of polycyclic aromatic hydrocarbons (PAHs) were investigated in 22 stations from surface sediments in the areas of anthropogenic pollution in the Klang Strait (Malaysia). The total PAH level in the Klang Strait sediment was 994.02±918.1 µg/kg dw. The highest concentration was observed in stations near the coastline and mouth of the Klang River. These locations were dominated by high molecular weight PAHs. The results showed both pyrogenic and petrogenic sources are main sources of PAHs. Further analyses indicated that PAHs primarily originated from pyrogenic sources (coal combustion and vehicular emissions), with significant contribution from petroleum inputs. Regarding ecological risk estimation, only station 13 was moderately polluted, the rest of the stations suffered rare or slight adverse biological effects with PAH exposure in surface sediment, suggesting that PAHs are not considered as contaminants of concern in the Klang Strait.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0094907PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3991632PMC
January 2015

Titanium (III) cation selective electrode based on synthesized tris(2pyridyl) methylamine ionophore and its application in water samples.

Sci Rep 2014 Apr 11;4:4664. Epub 2014 Apr 11.

Chemistry Department, Faculty of Science, University Malaya, 50603 Kuala Lumpur, Malaysia.

The introduction of low detection limit ion selective electrodes (ISEs) may well pave the way for the determination of trace targets of cationic compounds. This research focuses on the detection of titanium (III) cation using a new PVC-membrane sensor based on synthesized tris(2pyridyl) methylamine (tpm) ionophore. The application and validation of the proposed sensor was done using potentiometric titration, inductively coupled plasma atomic emission spectrometry (ICP-AES), and atomic absorption spectrometry (AAS). The membrane sensor exhibited a Nernstian response to the titanium (III) cation over a concentration range of 1.0 × 10(-6)-1.0 × 10(-2) M and pH range from 1-2.5. The Nernstian slope, the lower of detection (LOD), and the response time (t95%) of the proposed sensor were 29.17 ± 0.24 mV/dec, 7.9 × 10-7 M, and 20 s, respectively. The direct determination of 4-39 μg/ml of titanium (III) standard solution showed an average recovery of 94.60 and a mean relative standard deviation of 1.8 at 100.0 μg/ml. Finally, the utilization of the electrodes as end-point indicators for potentiometric titration with EDTA solutions for titanium (III) sensor was successfully carried out.
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http://dx.doi.org/10.1038/srep04664DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3983601PMC
April 2014

A review of strategies to monitor water and sediment quality for a sustainability assessment of marine environment.

Environ Sci Pollut Res Int 2014 Jan 19;21(2):813-33. Epub 2013 Oct 19.

Institute of Biological Sciences, University of Malaya, 50603, Kuala Lumpur, Malaysia,

The basic aim of this work is (1) to review and present practically operational requirements for a sustainability assessment of marine environment, such as describing the monitoring process, research approaches, objectives, guidelines, and indicators and (2) to illustrate how physico-chemical and biological indicators can be practically applied, to assess water and sediment quality in marine and coastal environment. These indicators should meet defined criteria for practical usefulness, e.g. they should be simple to understand and apply to managers and scientists with different educational backgrounds. This review aimed to encapsulate that variability, recognizing that meaningful guidance should be flexible enough to accommodate the widely differing characteristics of marine ecosystems.
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http://dx.doi.org/10.1007/s11356-013-2217-5DOI Listing
January 2014