Journal title

fa بررسی میزان آموزش به بیماران دیابتی نوع دو با استفاده از سی دی های آموزشی1 Evaluating the Effect of Using Training CDs on the Patients with Type II Diabetes1 غدد مقطعی (Cross sectional) Cross sectional دیابت شیرین نوع دوکه سابق بر این آن را دیابت شیرین غیروابسته به انسولین (NIDDM) یا دیابت بزرگسالان می‌نامیدند، نوعی <a href="https://fa.wikipedia.org/w/index.php?title=%D8%A7%D8%AE%D8%AA%D9%84%D8%A7%D9%84_%D8%AF%D8%B1_%D8%B3%D9%88%D8%AE%D8%AA_%D9%88_%D8%B3%D8%A7%D8%B2_%D8%A8%D8%AF%D9%86&action=edit&redlink=1" title="اختلال در سوخت و ساز بدن (صفحه وجود ندارد)">اختلال در سوخت و ساز بدن</a> است که با بالا بودن <a href="https://fa.wikipedia.org/w/index.php?title=%DA%AF%D9%84%D9%88%DA%A9%D8%B2_%D8%AE%D9%88%D9%86&action=edit&redlink=1" title="گلوکز خون (صفحه وجود ندارد)">گلوکز خون</a> در شرایط <a href="https://fa.wikipedia.org/w/index.php?title=%D9%85%D9%82%D8%A7%D9%88%D9%85%D8%AA_%D8%AF%D8%B1_%D9%85%D9%82%D8%A7%D8%A8%D9%84_%D8%A7%D9%86%D8%B3%D9%88%D9%84%DB%8C%D9%86&action=edit&redlink=1" title="مقاومت در مقابل انسولین (صفحه وجود ندارد)">مقاومت در مقابل انسولین</a> و کمبود نسبی <a href="https://fa.wikipedia.org/wiki/%D8%A7%D9%86%D8%B3%D9%88%D9%84%DB%8C%D9%86" title="انسولین">انسولین</a> شناسایی می‌شود(1). نشانه‌های کلاسیک این بیماری عبارتند از <a href="https://fa.wikipedia.org/wiki/%D8%A7%D8%B3%D8%AA%D8%B3%D9%82%D8%A7%D8%A1" title="استسقاء">احساس تشنگی مفرط</a>، <a href="https://fa.wikipedia.org/w/index.php?title=%D8%A7%D8%AF%D8%B1%D8%A7%D8%B1_%D8%B2%DB%8C%D8%A7%D8%AF&action=edit&redlink=1" title="ادرار زیاد (صفحه وجود ندارد)">تکرر ادرار</a>، و<a href="https://fa.wikipedia.org/wiki/%D9%BE%D8%B1%D8%AE%D9%88%D8%B1%DB%8C" title="پرخوری">احساس گرسنگی مفرط</a>. ۹۰٪ افراد مبتلا به <a href="https://fa.wikipedia.org/wiki/%D8%AF%DB%8C%D8%A7%D8%A8%D8%AA_%D8%B4%DB%8C%D8%B1%DB%8C%D9%86" title="دیابت شیرین">دیابت</a>به دیابت نوع ۲ دچار هستند و ۱۰۰٪ دیگر به ترتیب مبتلا به <a href="https://fa.wikipedia.org/w/index.php?title=%D8%AF%DB%8C%D8%A7%D8%A8%D8%AA_%D8%B4%DB%8C%D8%B1%DB%8C%D9%86_%D9%86%D9%88%D8%B9_%DB%B1&action=edit&redlink=1" title="دیابت شیرین نوع ۱ (صفحه وجود ندارد)">دیابت شیرین نوع ۱</a> و <a href="https://fa.wikipedia.org/wiki/%D8%AF%DB%8C%D8%A7%D8%A8%D8%AA_%D8%A8%D8%A7%D8%B1%D8%AF%D8%A7%D8%B1%DB%8C" title="دیابت بارداری">دیابت بارداری</a>می‌باشند. گفته می‌شود که <a href="https://fa.wikipedia.org/wiki/%DA%86%D8%A7%D9%82%DB%8C" title="چاقی">چاقی</a> دلیل عمده دیابت نوع ۲۲ در افرادی است که به لحاظ ژنتیکی مستعد ابتلا به این بیماری هستند. از دیگر دلایل آن می‌توان به عدم تحرک، <a href="https://fa.wikipedia.org/wiki/%D9%81%D8%B4%D8%A7%D8%B1_%D8%AE%D9%88%D9%86_%D8%A8%D8%A7%D9%84%D8%A7" title="فشار خون بالا">فشار خون بالا</a>، داشتن HDL خون پایین و یا <a href="https://fa.wikipedia.org/wiki/%D8%AA%D8%B1%DB%8C_%DA%AF%D9%84%DB%8C%D8%B3%DB%8C%D8%B1%DB%8C%D8%AF" title="تری گلیسیرید">تری گلیسیرید</a> بالا اشاره کرد(2-1). در شروع بیماری می‌توان با افزایش <a href="https://fa.wikipedia.org/w/index.php?title=%D8%AD%D8%B1%DA%A9%D8%A7%D8%AA_%D9%88%D8%B1%D8%B2%D8%B4%DB%8C&action=edit&redlink=1" title="حرکات ورزشی (صفحه وجود ندارد)">ورزش</a> و <a href="https://fa.wikipedia.org/w/index.php?title=%D8%B1%DA%98%DB%8C%D9%85_%D8%BA%D8%B0%D8%A7%DB%8C%DB%8C_%D8%AF%DB%8C%D8%A7%D8%A8%D8%AA%DB%8C&action=edit&redlink=1" title="رژیم غذایی دیابتی (صفحه وجود ندارد)">اصلاح رژیم غذایی</a> دیابت نوع 2 را کنترل کرد. نرخ ابتلا به دیابت به طرز قابل توجهی در ۵۰ سال اخیر به موازات چاقی افزایش یافته است. تا سال ۲۰۱۰ تقریباً حدود ۲۸۵  میلیون نفر مبتلا به این بیماری بودند و این درحالیست که تعداد آنها در سال ۱۹۸۵ حدود ۳۰  میلیون نفر بوده است. عوارض ناشی از قند خون بالا می‌تواند شامل <a href="https://fa.wikipedia.org/w/index.php?title=%D8%A8%DB%8C%D9%85%D8%A7%D8%B1%DB%8C_%D9%82%D9%84%D8%A8%DB%8C&action=edit&redlink=1" title="بیماری قلبی (صفحه وجود ندارد)">بیماری قلبی</a>، <a href="https://fa.wikipedia.org/w/index.php?title=%D8%B3%DA%A9%D8%AA%D9%87%E2%80%8C%D9%87%D8%A7&action=edit&redlink=1" title="سکته‌ها (صفحه وجود ندارد)">سکته‌ها</a>، <a href="https://fa.wikipedia.org/w/index.php?title=%D8%B1%DB%8C%D8%AA%DB%8C%D9%86%D9%88%D9%BE%D8%A7%D8%AA%DB%8C_%D8%AF%DB%8C%D8%A7%D8%A8%D8%AA%DB%8C&action=edit&redlink=1" title="ریتینوپاتی دیابتی (صفحه وجود ندارد)">ریتینوپاتی دیابتی</a>که بر بینایی اثر می‌گذارد، <a href="https://fa.wikipedia.org/w/index.php?title=%D9%86%D8%A7%D8%B1%D8%B3%D8%A7%DB%8C%DB%8C_%DA%A9%D9%84%DB%8C%D9%88%DB%8C&action=edit&redlink=1" title="نارسایی کلیوی (صفحه وجود ندارد)">نارسایی کلیوی</a> که در آن فرد ممکن است نیاز به <a href="https://fa.wikipedia.org/wiki/%D8%AF%DB%8C%D8%A7%D9%84%DB%8C%D8%B2" title="دیالیز">دیالیز</a> داشته باشد، و گردش ضعیف خون در دست و پا که ممکن است منجر به <a href="https://fa.wikipedia.org/wiki/%D9%82%D8%B7%D8%B9_%D8%B9%D8%B6%D9%88" title="قطع عضو">قطع عضو</a> شود. عارضه حاد <a href="https://fa.wikipedia.org/wiki/%DA%A9%D8%AA%D9%88%D8%A7%D8%B3%DB%8C%D8%AF%D9%88%D8%B2_%D8%AF%DB%8C%D8%A7%D8%A8%D8%AA%DB%8C" title="کتواسیدوز دیابتی">کتواسیدوزیکی</a> از ویژگی‌های <a href="https://fa.wikipedia.org/w/index.php?title=%D8%AF%DB%8C%D8%A7%D8%A8%D8%AA_%D8%B4%DB%8C%D8%B1%DB%8C%D9%86_%D9%86%D9%88%D8%B9_%DB%B1&action=edit&redlink=1" title="دیابت شیرین نوع ۱ (صفحه وجود ندارد)">نوع ۱دیابت</a> است که شیوع چندانی ندارد(4-3).  دیابت نوع ۲ را می‌توان از طریق تغذیه مناسب و ورزش منظم به تاخیر انداخت یا از بروز آن جلوگیری کرد<a href="https://fa.wikipedia.org/wiki/%D8%AF%DB%8C%D8%A7%D8%A8%D8%AA_%D9%86%D9%88%D8%B9_%DB%B2#cite_note-16">(6-5)</a>. نظارت متمرکز بر <a href="https://fa.wikipedia.org/wiki/%D8%B3%D8%A8%DA%A9_%D8%B2%D9%86%D8%AF%DA%AF%DB%8C" title="سبک زندگی">سبک زندگی</a> می‌تواند خطر ابتلا به این بیماری را به بیشتر از نصف کاهش دهد(7). ورزش کردن بدون توجه به وزن اولیه فرد و کاهش بعدی وزن او فایده مند است<a href="https://fa.wikipedia.org/wiki/%D8%AF%DB%8C%D8%A7%D8%A8%D8%AA_%D9%86%D9%88%D8%B9_%DB%B2#cite_note-18">(9-8)</a>. دیابت یکی از بیماری های شایع در کشورها به شمار می رود و دارای عوارض کوتاه مدت و بلند مدت می باشد و بر روی دیگر سیستم های بدن(مغز، قلب، کلیه) اثرات منفی می گذارد(1). میزان شیوع دیابت در ایران بالاست و از هر 20 ایرانی یک نفر به دیابت مبتلاست اما مشکل اینجاست که بیشتر افراد نمی دانند که بیماراند و همین باعث بروز صدمات جبران ناپذیر می شود With a variety of short-term and long-term com-plications, diabetes is one of the most common diseases in the world and has negative effects on different body systems (e.g., brain, heart, kidneys) (1). The prevalence of diabetes is high in Iran and one per 20 of the Iranian people suffers from diabetes. However, the most important problem is that most people do not know they are sick and this causes irreparable consequences (1). Although diabetes is a common disease, some provisions can be thought to prevent its progress and in some cases prevent its occurrence. One of these cases is training diabetic patients. Training can be done through different ways such as using pamphlets, leaflets, photographs, videos, and training classes about the disease for patients. With regard to the evolution of technology and new instruments, better and more effective methods are implemented for training in the world (2, 3). In this study, patients with diabetes were trained through instructional videos. First, patients with type II diabetes referred to the clinic were identi-fied. Then, the date and time of their next visit to the clinic were arranged. Moreover, the objectives of the study were explained to the participants. The samples were divided into two groups: case and control groups. Initially, the two groups were given a test battery including demographic in-formation (i.e., age, gender, height, weight, mari-tal status, location, and history of disease) and 10 questions on their knowledge and attitudes about diabetes, in which the 5-point Likert-type scale was used (Completely know = 5, Partly know = 4, Not sure = 3, Slightly know = 2, and Do not know = 1). Overall, the total score of the ques-tionnaire was 50 points and it was classified into four categories including the low score category (10- 20 points), the lower-middle score category (21-30 points), the upper-middle score category (31-40 points), and high score category (41-50 points). The sample size based on the following statistical formula was at least 44 patients in each group: Z1 is a 95% confidence interval (i.e., 1/96). Z2 is the power of a test (0/84 for 80% power). S is an estimate of the standard deviation of the health literacy score of the two groups. d is the minimum mean difference between the two groups and shows the difference is significant while S is considered to be 0/6. The questionnaire was completed by the case and control groups. Only the case group was given the training CDs containing information on rec-ognizing diabetes, its causes and complications, diet, physical activities and other methods to con- Taghinejad & Tavan: Evaluating the Effect of Using Training CDs on the Patients … Available at: http://ijph.tums.ac.ir 302 trol diabetes, and required actions at the onset of diabetes. After going to the clinic again, the pa-tients completed the same questionnaire. Fur-thermore, the control group also completed the same questionnaire on their next visit to the clinic. Before the intervention (i.e., the instructional videos), the scores of the two groups were almost similar and close to each other. In terms of classi-fications, scores of the case group were as fol-lows: 68% had low score, 24% received the low-er-middle score, and 8% achieved the upper-middle high score, respectively. In the control group, scores were classified as follows: 65% had low score, 25% received the lower-middle score, and 10% achieved the upper-middle score. Moreover, the mean and standard deviation of the case group was 8.6 ± 21.7 and those of the control group were 8.69 ± 22.3. The scores of both groups had increased after the intervention. Although the control group experienced no train-ing, their scores were higher due to conducting the instructions of the experts. However, their scores were not statistically significant (P-value=0.03). However, the training (with instruc-tional videos) was carried out for the case group and their scores were higher in the next test and statistically significant (P-value = 0.03). After the second visit, the classification of scores of both groups was as follows: in the case group, 34% had low score, 46% received the lower-middle score, and 20% achieved the upper-middle score and in the control group, 25% had low score, 55% received the lower-middle score, and 20% achieved the upper-middle score. The mean and standard deviation of the case and control groups were10.9 ±27.5 and 9.8±.33.8, respectively. However, the striking thing is that the overall information on type II diabetes were presented to the patients, but none of them achieved high scores (41-50 points). One of the reasons is that the patients did not exactly pay attention to the questions while responding or to the instructional videos while watching. Most of the study partici-pants were people over 50 yr and maybe this is one of the reasons that the training was not done efficiently. Finally, if some training for effective prevention or treatment of the disease is conducted through instructional videos, it will bring about better re-sults for patients. Thus, it is necessary for the practitioners to act with sensitivity about this subject for example by preparing appropriate programs and lectures or making some series about diabetes on the national radio and televi-sion broadcasts to grant facts because the intui-tive teaching method might be much more fruit-ful than other training methods. Conflict of Interests The authors declare that there is no conflict of interest. Acknowledgements This study was approved by Ilam University of Medical Sciences. The cooperation and financial assistance of the Research Deputy of Ilam Uni-versity of Medical Sciences is gratefully appreciat-ed. Moreover, we would like to deeply thank the healthcare centers affiliated to Ilam University of Medical Sciences and the chancellors and the hospital security officers of education and treat-ment centers of Shahid Mustafa Khomeini for contributing to data collection procedures دیابت, سی دی, بیمار 0 0 http://newresearch.medilam.ac.ir/browse.php?a_code=A-10-2394-3&slc_lang=fa&sid=1 Hamid Taghinejad حمید تقی نژاد hamid2005mordad@yahoo.com 5819804201 100319475328460027262 Yes Department of Nursing, School of Nursing and Midwifery, Ilam University of Medical sciences, Ilam, Iran گروه آموزشی پرستاری، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی ایلام، ایلام، ایران Ali Sharifi علی شریفی sharifi.ali34@yahoo.com 4539323441 100319475328460027263 No Department of Internal Medicine, School of Medicine, Ilam University of Medical sciences, Ilam, Iran گروه آموزشی داخلی، دانشکده پزشکی، دانشگاه علوم پزشکی ایلام، ایلام، ایران Hamed Tavan حامد توان hamedtavan@gmail.com 5810022855 100319475328460027264 No Ilam University of Medical Sciences, Ilam, Iran دانشگاه علوم پزشکی ایلام، ایلام، ایران