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Leila Zhianfar,1 Haidar Nadrian,2 Mohammad Asghari Jafarabadi,3 Fatemeh Espahbodi,4 Abdolreza Shaghaghi1 1Health Education & Promotion Department, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran; 2Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; 3Epidemiology and Biostatistics Department, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran; 4Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, IranCorrespondence: Abdolreza ShaghaghiHealth Education & Promotion Department, Faculty of Health, Tabriz University of Medical Sciences, Golgasht Ave, Tabriz, P.C 516667411, IranTel +98 41 33376227Email ar.shaghaghi@gmail.comPurpose: A multimodal intervention designed and executed to improve therapeutic regimen adherence and quality of life in a sample of Iranian hemodialysis patients. Its feasibility and impact was assessed post intervention.Patients and Methods: This randomized controlled trial (RCT) study was conducted at two hemodialysis wards of the Shahrvand hospital located in Sari, the capital city of the Mazandaran province, north of Iran. The study sample included patients with end-stage renal disease (ESRD) receiving outpatient hemodialysis treatment. Considering 10% attrition, 70 registered patients were randomly categorized into intervention and control groups. The proposed intervention included playing of relevant educational video tracks, conducting eight cognitive behavioral therapy (CBT) group sessions, and telephone-based peer support. Data were collected applying a set of questionnaires including sociodemographic, Beck Depression Inventory (BDI-SF), Multidimensional Scale of Perceived Social Support (MSPSS), Patient Satisfaction with Nursing Care Quality Questionnaire (PSNCQQ), End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ) and the World Health Organization Quality of Life (WHOQOL-SF) scale. Sociodemographic and clinical data were collected at baseline in both groups and the postintervention assessment was performed in the intervention and nonintervention groups after one month and three months.Results: A significant change in the self-reported depression symptoms (P=0.001), mean social support score (P=0.001), nursing care satisfaction score (P=0.001), quality of life score (P=0.001) and interdialytic weight gain (IDWG) (P=0.001) was observed among the participants in the intervention group compared to the baseline measures. The highest rise in the ESRD-AQ scores within the intervention group was observed after one month of intervention (mean difference=131.88) compared to the baseline values. Same pattern of statistically significant changes in mean scores of the intervention group’s attendants in all subscales of the ESRD-AQ were also ascertained.Conclusion: This interventional study revealed that inaugurating of a feasible low-cost intervention without need to add major logistic or financial inputs into existing health-care systems, especially in resource limited contexts, is achievable. Findings of this study could provide insights into scientific basis of evidence-informed interventions applicable in the realm of health-care delivery.Keywords: hemodialysis patients, intervention, adherence

Leila Zhianfar,1 Haidar Nadrian,2 Abdolreza Shaghaghi1 1Health Education & Promotion Department, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran; 2Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, IranCorrespondence: Abdolreza ShaghaghiHealth Education & Promotion Department, Faculty of Health, Tabriz University of Medical Sciences, Golgasht Ave., Tabriz, IranTel +98 41 33376227Email shaghaghir@tbzmed.ac.irObjective: To systematically retrieve and condense the best possible evidence on the successful interventions that targeted enhancement of therapeutic and lifestyle recommendations adherence in hemodialysis patients (HDPs).Design: An umbrella review of interventional studies.Data Sources: A comprehensive search of the Cochrane Database of Systematic Reviews, Ovid, PubMed, Scopus, EMBASE and Web of science databases to identify relevant publications in 2000– 2018 (June) timeframe.Study Selection: Two reviewers independently applied inclusion criteria to select potential systematic reviews assessing the successful interventions that targeted enhancement of therapeutic and lifestyle recommendations adherence in HDPs. Data were summarized for information about the first author(s)’ names, year of publication, type(s) of the intervention and output variables, main findings and also the applied quality appraisal tools in the retrieved research evidence.Data Extraction: Eligible studies were selected and data were extracted independently by two reviewers. The Joanna Briggs Institute (JBI)’s critical appraisal tool for systematic reviews was used to assess the quality of the identified publications, and discrepancies were resolved by consensus with a third reviewer.Data Synthesis: Thirteen systematic reviews (12 solely systematic reviews and 1 systematic review with meta-analyses) were eligible to be enrolled in the study. The range of interventions that had been reported to boost therapeutic and lifestyle recommendations adherence in HDPs’ included psycho-educational programs, physical activity enhancement initiatives, information technology (IT)-based interventions and aromatherapy. Depression, diet biomarkers and interdialytic weight gain (IDWG) were among the myriad of output variables that had been measured as proxies to assess impacts of the implemented interventions. Psycho-educational interventions were among the prevalent initiatives to boost therapeutic and lifestyle recommendations adherence among the HDPs.Conclusion: This umbrella review revealed that various intervention approaches and strategies can be used for HDPs’ better therapeutic and lifestyle recommendations adherence with considerable methodological heterogeneity. The pinpointed research evidence is also supporting application of multifaceted interventional modalities to reach an improved acquiescence form the patients’ side and their families. Further studies are recommended to address the interactions across various interventions in discordant socio-cultural contexts.Keywords: hemodialysis, intervention, adherence, psychosocial, cognitive, exercise

Background: Patients with end stage renal disease (ESRD) are increasing worldwide. This is especially paramount in low and middle income countries in which ESRD patients are struggling to access specialist services e.g. hemodialysis (HD). Benchmarking analysis of the offered healthcare packages in several countries and comparison of the utilized alternative healthcare models for ESRD patients may be auspicious for institutional capacity-building in the existing healthcare facilities. Main aim of this study was to perform a benchmarking and evidence-informed gap analysis of the ESRD care provision in Iran and recognize the gaps that cause diversification in care quality for ESRD patients that hinder efforts for care quality improvement in the Iranian National Healthcare System., Methods: Dimensions of the Australian Anglicare Southern Queensland Clinical and Care Governance Framework (ASQCGF) were utilized as corner stones of a comprehensive clinical care plan that is essential in responding to HD patients' needs in Iran. An extensive literature search was performed at the next stage to recognize the gold standard core elements. The ascertained components were assigned to the five separate dimensions of the ASQCGF and a preliminary draft (comprehensive package of care for HD patients) was prepared. A checklist was developed at a later stage which was sent to a panel of expert consisting professional healthcare providers in nephrology and hemodialysis wards for their opinions. A gap analysis was conducted to evaluate current care processes of the Iranian HD patients align with the elements of the gold standard framework., Results: The identified deficits were classified in five areas in accord with the elements of ASQCGF as follow: A) supply of resources, medical devices and equipment support B) recruitment and endorsement of clinics and general work force C) infection prevention and controlling procedures D) care effectiveness monitoring and quality improvement E) provision of safe environment for both HD patients and hospitals' staff., Conclusions: The study findings revealed considerable gaps in providing quality HD services to the Iranian HD patients that herald their therapeutic unmet needs and the shift that is needed to narrow down the widening organizational failure which fuels the current disenchantment among the both healthcare providers and HD patients., Competing Interests: Declarations. Ethics approval and consent to participate: This gap analysis process was implemented based on the collected data in one of the stages of a larger study that had been endorsed by the Iranian Registry of Clinical Trials (approval number: IRCT20171213037859N1) and institutional level Medical Ethics Board of Trustees (MEBoT) affiliated to the Tabriz University of Medical Sciences (approval number: IR.TBZMED.REC.1397.425). Since, no human subjects were enrolled in this phase of the study, it was sought exempt from obtaining re-application for ethical approval. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Type 2 diabetes mellitus (T2DM) is one of the most important risk factors for cardiovascular diseases, with a high economic burden on health care systems. Since gender and residency can affect people's lifestyle and health behaviors, this study was conducted to investigate the prevalence of T2DM and its determinants by gender and residency., Methods: A secondary analysis study was conducted on the survey data of the IraPEN (Iran's Package of Essential Non-Communicable Disease) pilot program conducted in 2017 in Naghadeh County, Iran. Data of 3,691 participants aged 30-70 years from rural and urban areas of the County were included into data analysis process. Sociodemographic factors, anthropometric measurements, and cardiovascular risk factors related to T2DM were assessed., Results: The overall prevalence of T2DM within the population was 13.8%, which was significantly higher among women (15.5%) than men (11.8%), and non-significantly higher in urban (14.5%) areas than rural (12.3%) areas. In both genders, age (male: OR 1.01, 95% CI: 1.00-1.03; P = 0.012; female: OR 1.03, 95% CI: 1.02-1.04; P<0.001), blood pressure (male: OR 1.77, 95% CI: 1.13-2.79; P = 0.013; female: OR 2.86, 95% CI: 2.12-3.85; P<0.001), and blood triglycerides (male: OR 1.46, 95% CI: 1.01-2.11; P = 0.04; female: OR 1.34, 95% CI: 1.02-1.77; P = 0.035) had a significant relationship with the chance of developing T2DM. Among women, a significant relationship was found between abdominal obesity (OR 1.68, 95% CI: 1.17-2.40; P = 0.004) and the chance of developing T2DM. Age (rural: OR 1.03, 95% CI: 1.01-1.04; P<0.001; urban: OR 1.02, 95% CI: 1.01-1.04; P<0.001), blood pressure (rural: OR 3.14, 95% CI: 2.0-4.93; P<0.001; urban: OR 2.23, 95% CI: 1.66-3; P<0.001), and abdominal obesity (rural: OR 2.34, 95% CI: 1.41-3.87; P = 0.001; urban: OR 1.46, 95% CI: 1.06-2.01; P = 0.019), in both rural and urban areas, blood cholesterol (OR 1.59, 95% CI: 1.07-2.37; P = 0.02) in rural areas, and blood triglycerides (OR 1.51, 95% CI: 1.16-1.98; P = 0.002) in urban areas were significant predictors of T2DM., Conclusion: Given the higher prevalence of T2DM among females, risk reduction strategies at the community level should be more targeted at women. The higher prevalence of T2DM risk factors among the urban population is a wake-up call for policymakers to pay more attention to the consequences of unhealthy and sedentary lifestyles within urban communities. Future actions should be focused on appropriate timely action plans for the prevention and control of T2DM from early years of life., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Ghassab-Abdollahi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)