Explaining stress coping behaviors in patients with multiple sclerosis based on the PRECEDE model: a qualitative directed content analysis

Background Stress can be regarded as one of the consequences of Multiple Sclerosis (MS) and a factor in exacerbating or recurring the symptoms resulting from the disease. This study aimed to explain the stress coping behaviors in patients with MS based on the PRECEDE model. Methods This study is a qualitative directed content analysis research based on the PRECEDE model. Data were obtained through in-depth semi-structured interviews with 26 patients with MS, who were selected using a purposive sampling and maximum diversity in terms of gender, age, education, marital status, and employment. Data collection continued until the saturation occurred. Simultaneously, collected data were analyzed using a qualitative directed content analysis method. Results Data analysis led to the identification of 11 sub-categories. Of these, 10 sub-categories were assigned to three categories of predisposing factors (awareness, attitude, self-efficacy, and perceived severity), enabling factors (existence of resources, access to resources, skills of using resources, and educational preferences), and reinforcing factors (social support, important others and behavioral consequences). The social comparison category was a new category identified from the analysis of interviews. Conclusions Based on the results, individual, environmental and social factors play a role in the stress of these patients. Designing programs that lead to their empowerment and improvements in the environmental and social conditions can be effective in controlling stress in these patients. Based on the results, planners can adopt the most appropriate strategies to change these determinants, help reduce stress, and promote the psychological standard of living in these patients.

Parents' Behavior Related to Caries Status of Children with Down Syndrome in Surabaya

Background. Down syndrome (DS) is a chromosome disorder due to the presence of all or part of a third copy of chromosome 21 (trisomy 21) caused by a failure in chromosome segregation. Following Riset Kesehatan Dasar (RISKESDAS) in 2013, the number of people with DS in Indonesia increased compared to 2010, with an estimated 924 children with DS in Surabaya. Data regarding caries status in children with DS in Surabaya is limited. Objective. To evaluate parents’ behavior (predisposing, enabling, and reinforcing factors) related to the caries status of children with DS. Methods. This observational analytic cross-sectional study included children aged ≤18 years with DS and parents who were members of the Parents' Association of Children with Down Syndrome (POTADS). Caries status were measured using the DMF-T/def-t score, and parents were asked to fill out a questionnaire. Data were analyzed using Spearman’s correlation test. Result. We included 46 children with DS in this study. The DMF-t / def-t index of children with DS (7.2) was categorized as very high according to WHO. There was a significant relationship between lack of knowledge of parents and caries status in children with DS. Enabling factors and reinforcing factors were not significantly correlated with caries status. Conclusion. Parents' behavior is correlated with the caries status of children with DS. All combination of three factors behavior, including predisposing, enabling and reinforcing, are needed to reduce the number of caries in children with DS.

When Ischemic Heart Failure Complicated with Diabetes Mellitus

Diabetes and heart failure are mutually reinforcing factors. The treatment strategy and prognosis for patients with both diabetes and heart failure are inconclusive. This article reviews the current situation of ischemic heart failure complicated with diabetes, the pathophysiological relationship between diabetes and heart failure, and disease management. Especially, we highlight the latest result from CRISIS (Coronary Revascularization in Patients with Ischemic Heart Failure and Prevention of Sudden Cardiac Death) study, which finds that diabetes associates with greater ejection fraction improvement after revascularization in patients with reduced ejection fraction. This result implies the indication for revascularization in patients with heart failure who present with DM.

Conceptualizing Epistemic Power: The Changing Relationship Between Economic Policy Paradigms and Academic Disciplines

The ways in which epistemic foundations of academic disciplines shape policy paradigms have been an understudied area. We illustrate such dynamics by focusing on paradigm shifts between economics and legal scholarship. Our case study focuses on the evolution of the Finnish corporate tax policy between 1991 and 2014 to illuminate complex policy diffusion through professions. First, in 1993, Finnish corporate tax policy was aligned with the neoclassical ideas of the time in a lawyer-driven process. Second, in the early 2000s, initiatives from the EU and the OECD provided these lawyers a new epistemic source for broadening their argumentation. Third, in the 2010s, the disciplinary base shifted from legal studies to economics, which coincided with administrative reforms emphasizing quantitative impact assessments. These transformations completed the shift from legal scholarship to economics in tax policy design, paving way to the entrance of economic theoretical arguments to tax policy discussions. Our findings highlight five overlapping and mutually reinforcing factors that shape knowledge production in expert groups that influence economic policy: (1) the extent to which politicians rely on expertise; (2) the balance of power between academic disciplines in evidence-based policy-making; (3) the disciplinary base to which the dominant expert groups rely on; (4) the shifts in the epistemological, ontological and methodological mainstream within particular disciplines; and, (5v) the extent to which international organizations are seen as epistemic versus policy-driven authorities.

Design, implementation, and evaluation of a PRECEDE-PROCEED model-based intervention for oral and dental health among primary school students of Rafsanjan city: a mixed method study

Background Oral and dental health has a significant impact on public health as well as the quality of life among individuals and families. This study aims to design, implement, and evaluate an intervention based on the PRECEDE-PROCEED model for oral and dental health among primary school students in Rafsanjan city, Southern Iran. Methods According to the nature of the model and with the focus group discussion and interview methods, in phases 1 to 4 (PRECEDE), predisposing, enabling, and reinforcing factors related to oral health were identified. The training program was designed and consisted of six sessions for students (250 students) with a brushing session, three sessions for parents, and two sessions for teachers. Process evaluation and the effect of the program on behavioral and factors affecting oral health were evaluated (PROCEED). Results In the qualitative section, seven predisposing factors, five enabling factors, and two reinforcing factors were identified. A training program based on the PRECEDE-PROCEED model was found to be effective in increasing the mean scores of the above constructs and the students’ brushing behavior (P < 0.001). Conclusion Based on the model planning phases, the factors affecting the brushing behavior of children aged 6–12 years were identified. The educational program has had a significant effect on improving the scores of predisposing, enabling and reinforcing factors and children’s brushing behavior.

Profitability without Investment

Sustained investment in productive capabilities and fixed-capital formation is a key driver of inclusive and sustainable structural transformation. Both historically and compared to other middle-income countries, South Africa has performed poorly in terms of sustaining domestic-productive investments. This failing has coexisted with the development of a stock market with the second-highest level of capitalization over gross domestic product (GDP) in the world, and high levels of profitability across several economic sectors. This chapter provides new evidence on the specific ways in which financialization of non-financial corporations in South Africa has resulted in low investment performances, focusing on two large, publicly listed corporations operating across different economic sectors between 2000 and 2019. The analysis shows that, despite sector heterogeneities: (1) corporations have increasingly financed operations, capital expenditure, and distributions to shareholders with debt; (2) the US dollar-denominated share of this debt has grown rapidly, exposing corporations to increased exchange and interest rate risk; and (3) distributions to shareholders, driven by dividends rather than share repurchases, have risen markedly. These financialization dynamics are attributed to the distribution of power in the domestic political economy and the subordinate nature of South Africa’s integration with global finance. Driving financialization, these two mutually reinforcing factors have undermined the translation of profits into domestic investment, reducing its capacity to drive structural transformation.

Determinants of self-management behaviors among pulmonary tuberculosis patients: a path analysis

Background Tuberculosis (TB) is one of the top 10 causes of death in the world. Since Directly Observed Therapy (DOT) as a core strategy for the global TB control are not applicable to all types of TB patients, and self-management of TB patients (SMTP) as a patient-centered supervision type is a supplement to DOT and can improve TB case management. However, the factors related to SMTP are complex and need more study. This study aimed at identifying the determinants of SMTP and examining the direct/indirect effects of these determinants. Methods The purposive sampling technique was used to select study sites and participants were recruited from the study sites by the consecutive sampling method. The PRECEDE model was used as the framework to analyze the determinants of SMTP. The responses of TB patients were acquired via a questionnaire survey for data collection. A Pearson correlation analysis was used to define the relationship between the predisposing, enabling, reinforcing factors with SMTP behaviors. A regression-based path analysis was used to determine the action paths of the predisposing, enabling, and reinforcing factors on SMTP behaviors. Results The predisposing (TB knowledge), enabling [health education and healthcare workers (HCWs) support], reinforcing factors (family support) had significant positive correlations with SMTP behaviors (P < 0.05). The predisposing, enabling, reinforcing factors were positively correlated with each other (r = 0.123‒0.918, P < 0.05), except for family support and HCWs support. The predisposing factors (TB knowledge, β = 0.330) and the enabling factors (HCWs support, β = 0.437) had direct effects on SMTP behaviors. The enabling factors (health education and HCWs support) and the reinforcing factors (family support) had indirect effects on SMTP behaviors. Conclusions This study revealed the effects and action path of TB knowledge, health education, HCWs support, and family support on SMTP behaviors via a path analysis. Assessing patient’s needs for SMTP along with promoting effective TB health education and providing firm support from HCWs and family members are potential strategies to promote SMTP behaviors. Graphic abstract

Relationship between serum iron level and febrile convulsion in children

The aim of the present study was to evaluate the relationship between febrile convulsion, serum iron levels and whole blood parameters. This cross-sectional case-control study included patients aged 6 months-6 years-old brought to the department of pediatrics of Kütahya ParkHayat Hospital with febrile convulsions between January 2015 and December 2019. The patients were divided into two groups as: febrile with convulsions (study group; n= 47) and febrile without convulsions (control group; n= 35). Both groups were age and sex-matched. Some blood parameters such as mean serum iron, ferritin, Hb and MCV levels were used to compare the groups. Mean serum iron levels of the study and control groups were 33.7 ± 2.1 μg/dL and 56.3 ± 7.4 μg/dL (p<0.05), and serum ferritin levels were 27.3 ± 6.2 ng/mL and 31.1 ± 2.1 ng/ mL (p>0.05), respectively. Mean hemoglobin levels of the study and control groups were 10.6 ± 1.7 g/dL and 11.1 ± 1.4 g/dL (p <0.05), and mean MCV levels were 71.1 ± 1.2 fL and 73.2 ± 1.1 fL (p>0.05), respectively. In the light of the findings of this study, the low serum iron and ferritin levels may be reinforcing factors for developing febrile convulsion. However, multicentre studies with more patients are needed to reach a precise conclusion.