Evidence Based Care
Volume:6 Issue: 4, Winter 2017

Tuberculosis is among the top ten causes of mortality across the world and is highly prevalent in Mashhad, Khorasan Razavi, Iran. The adoption of healthy behaviors by patients can prevent the transmission of this disease to other individuals. The Health Promotion Model is one of the models used in the field of behavior change in this regard.
Aim: The aim of the present study was to investigate the relationship between the components of Pender’s Health Promotion Model and self-care behaviors among the smear-positive pulmonary tuberculosis patients in Mashhad.
This correlational study was conducted on 144 smear-positive pulmonary tuberculosis patients, selected from 45 healthcare centers of Mashhad in 2015 using purposive sampling method. The research instruments included Self-Care Behavior Questionnaire, Components of Pender’s Health Promotion Model, and Behavior Observation Checklist. The data were analyzed using Spearman’s rank-order correlation coefficient through the SPSS software version 16.
According to the results of the study, the mean age of the patients was 51.9±21.1 years. The results also showed that the mean of self-care total score was equal to 63.7±7.3. Additionally, the Spearman’s rank-order correlation indicated that self-care behavior was significantly correlated with prior related behavior (P=0.006), perceived barriers (P As the findings of the present study indicated, there was a significant relationship between the self-care behaviors and self-efficacy, perceived barriers, and interpersonal influences in smear-positive tuberculosis patients. Regarding this, considering these strategies in the health promotion model could be of utmost importance in designing effective interventions for the improvement of self-care behaviors among these patients.

Breastfeeding self-efficacy show self-confidence and the ability of mothers to perform breastfeeding and maternal health literacy, ability of women to gain access to, understand, and use information in ways that promote and maintain their health and their children.
Aim: this study was Measuring Associations between self-efficacy breastfeeding and maternal health literacy.
This descriptive study was carried out in Mashhad health center in 2015. 185 pregnant women with first experience were selected randomly. Data were collected through health literacy maternal questionnaire and self-efficacy breastfeeding Fox & Dennis questionnaire and analyzed by descriptive and statistical tests in the SPSS/18.
The mean score of women's self-efficacy breastfeeding and standard deviation were 120.5 and 11.7 respectively and the mean maternal health literacy was 42.7±5.6. The results regression showed that the only variable that significantly associated with breastfeeding self-efficacy was maternal health literacy.
Implications for practice: According to the results of this study, maternal health literacy must be raised to enhance breastfeeding self-efficacy, which could lead to an improvement in maternal breastfeeding in the society.

Given the high prevalence of type II diabetes and its complications, the evidence regarding the beneficial effects of probiotic yogurt on some cardiovascular biomarkers in diabetic patients is worthy of investigation.
Aim: To investigate the effect of probiotic yogurt on blood glucose level and cardiovascular biomarkers in patients with type II diabetes.
This randomized, clinical trial was conducted on 90 patients with type II diabetes who visited the 5 Azar diabetes clinic in Gorgan, Iran, in 2014. The intervention group consumed three 100 g packages of probiotic yogurt per day for four weeks, while the control group used an equal amount of plain yogurt. Dietary intake, as well as anthropometric and biochemical parameters were measured before and after the trial. To analyze the data, independent t-test, paired t-test, and analysis of covariance were performed, using SPSS version 18.
The mean ages of the intervention and control groups were 50.49±10.92 and 50.13±9.20 years, respectively. In the intervention group, paired t-test showed significant differences between mean levels of blood glucose, cholesterol, low-density lipoprotein (LDL), triglycerides, diastolic blood pressure, and glycated hemoglobin before and after four weeks of daily intake of probiotic yogurt (P0.05). At the end of trial, the independent t-test showed a significant difference between the two groups in terms of mean levels of blood glucose, LDL, triglycerides, blood pressure, and glycated hemoglobin (P Consumption of probiotic yogurt showed beneficial effects on blood glucose, glycated hemoglobin, blood pressure, and serum lipid levels in the intervention group. However, it had no significant effect on cholesterol, high-density lipoprotein, and C-reactive protein as compared with the control group. The authors recommend further longitudinal studies to draw a definitive conclusion in this regard. Overall, consumption of probiotic yoghurt can be recommended as an adjunctive therapy for type II diabetic patients.

Background and Despite the high prevalence of chronic obstructive pulmonary disease, There haven,t been definite curative treatment for the disease and focus of treatment has directed towards pulmonary rehabilitation as an effective non-drug treatments. this study were performed to determine the effect of motivational abdominal breathing device on breathing pattern and dyspnea of chronic obstructive pulmonary disease
This study is a clinical trial done in 2015 on 70 patients with chronic obstructive pulmonary disease admitted to Samen alaeme hospital, CHENARAN city. Patients were assigned to two groups of 35 persons, Intervention and control. groups did exercises at home twice a day for two weeks. The dyspnea, respiratory rate and depth of breathing, before, seventh day and after the intervention was measured by spirometry and dyspnea NRS scale. Data analysis was performed by SPSS version 11.5 using t-test, Mann-Whitney and repeated measures analysis.
The results showed that difference in respiratory rate before and after intervention (P=0/78) did not change significantly between two groups. But difference before and after the intervention, depth of breathing and before and after intervention of dyspnea were significantly changed in both groups (P The results of this study showed that motivational abdominal breathing device has a more positive effect than the abdominal breathing normally on respiratory status and thus can be used as effective rehabilitation techniques.

Despite the implementation of new training programs, neglecting individual differences in terms of learning styles can be taken into account as one of the reasons for poor levels of self-care behaviors in patients suffering from diabetes.
Aim: The purpose of the present study was to examine the effect of training according to the learning styles on self-care behaviors among individuals suffering from type 2 diabetes.
This randomized, controlled clinical trial was performed on 69 diabetic patients referring to Parsian Clinic in Mashhad, Iran, who were divided into experimental (comprised of four aural, visual, read-write, and kinesthetic-sensory groups based on the results of the VARK [Visual, Auditory, Read/Write, Kinesthetic] Learning Styles Questionnaire) and control (lecture-based education). Self-care training was also conducted during two sessions each two weeks on four domains of diet, exercise program adherence, blood glucose monitoring, and insulin intake. To analyze the data, independent samples t-test and Mann-Whitney U test were run, using SPSS version 21.
Based on the independent samples t-test, in the experimental and control groups, the total mean scores of self-care behaviors were not significantly different prior to the intervention (135.2±17.6, 129.7±27.6, respectively). However, a statistically significant difference was noted between the experimental and control groups regarding the total mean scores of self-care behaviors (164.1±7.6, 140.5±10.0, respectively; P=0.001).
It was concluded that self-care training based on learning styles could be improved among patients with diabetes. The VARK Learning Styles Questionnaire could be used to facilitate this type of training through providing information about learning and teaching methods as well as using the media appropriate to individuals’ learning styles.

Living with schizophrenic patients and its associated stress and negative psychological burden can bring about different experiences for their families. The provision of stress management training for these families can be helpful in increasing self-confidence and enhancing interpersonal communication in these caregivers, which can improve their mental health status and enhance the quality of patient care.
Aim: Regarding this, the aim of the present study was to investigate the impact of stress management training on positive experiences of the families giving care to patients suffering from schizophrenia.
This randomized controlled clinical trial was conducted on 57 primary caregivers of schizophrenic patients admitted to Ibn Sina Hospital in Mashhad, Iran in 2016. For the purpose of the study, the participants were divided into the control (including 29 individuals) and experimental groups (entailing 28 subjects). Subsequently, a stress management training program was administered on the experimental group within six one-hour sessions. On the other hand, the control group only received educational pamphlets on stress management at the end of the study. Additionally, the standardized Experience of Caregiving Inventory developed by Szmukler et al. was filled out by the caregivers before and three months after the intervention. The data analysis was performed using independent-samples t-test and Mann-Whitney U test through SPSS version 11.5.
The findings of this study revealed that 50% (14 cases) and 69% (20 subjects) of the participants in the experimental and control groups were female, respectively. The results revealed no significant differences in the total scores for positive experiences of the caregivers in the control (61.2±17.3) and experimental groups (62.3±20.7) at the pre-intervention stage (P=0.40). Likewise, no significant difference was observed between the total scores of the control group (64.5±14.3) and experimental group (67.6±12.9) at the post-intervention stage (P=0.40).
Given the findings of the present study and considering that positive experiences are taken into account as parts of high levels of needs and performance among the caregivers, it seems that improving such positive experiences requires specific and complementary interventions.

Hyperbilirubinemia is considered one of the most prevalent problems in newborns. Phototherapy, exchange transfusion, and herbal medicine are common therapeutic approaches for preventing any neurologic damage in infants with neonatal jaundice. However, herbal medicine is less commonly used.
Aim: This study aimed to investigate the effect of bilineaster drop on neonatal hyperbilirubinemia.
This study was a randomized clinical trial conducted on 98 term neonates (aged 2-14 days) with neonatal jaundice admitted to Ghaem Hospital of Mashhad, Iran, during 2015. These newborns were randomly assigned into intervention (phototherapy and bilineaster drop) and control (only phototherapy) groups. Total and direct serum bilirubin levels were measured at the time of admission and then 12, 24, 36, and 48 h after treatment. Data were analyzed using independent t-test and repeated measures ANOVA through Stata software (Version 12).
The mean ages of the newborns at the time of admission were 6.2 ±2.5 and 6.04 ±2.4 days in the intervention and control groups, respectively. The intervention group showed higher reduction in mean duration of hospital stay, readmission rate, and bilirubin levels 12 and 24 h after the intervention, compared to the control group (P>0.001). However, the two groups demonstrated no statistically significant difference 36 h and 48 h after the intervention (P=0.06, P=0.22, respectively). Repeated measures ANOVA indicated that the intervention had no significant effect on the reduction trend of bilirubin levels (P=0.10 [total], P=0.06 [indirect]) in both groups. Nonetheless, bilirubin levels significantly diminished in both groups over time (PImplications for Practice: The results of this study demonstrated that the use of bilineaster drop along with phototherapy could cause a significant decrease in the levels of total and direct bilirubin; however, the intervention had no effect on the downward trend of bilirubin.

Pulmonary arterial hypertension (PAH) is a progressive disease with high morbidity and mortality rates. Research has shown that PAH has a prevalence rate of 10-79% in thalassemia major patients. This cross-sectional study was carried out in 2014 to determine the prevalence and risk factors of PAH in all thalassemia major patients of over 18 years of age in Ilam, Iran. A cardiologist measured systolic pulmonary artery pressure (SPAP) by using Doppler echocardiography. SPAP of higher than 25 mm Hg was defined as PAH criterion. The obtained data was analyzed using SPSS, version 17. Of the 36 studied patients, 17 (47.2%) were male and 19 (52.8%) were female. The mean age of the patients was 26.0±5.6 years. The prevalence of PAH in the thalassemia major patients was estimated to be 47.2% and the mean SPAP was determined to be 26.2±14.6 mm Hg. Among the examined PAH risk factors, only the history of pulmonary disease (0.02) and transfusion (0.03) was found to be significant.