Journal of Health System Research
Year:2012 | Volume:8 | Issue:5|Papers Count:25

Gastric cancer is the fourth most common cancer and is the second cause of death from cancer. Although the Helicobacter pylori infection is a very important factor in gastric cancer, it is not the only risk factor. The role of nutrition has been studied as the most important environmental risk factors in incidence, control and prevention of gastric cancer. This study aimed to review past researches on the association between several dietary factors and gastric cancer. A literature search in PubMed was done with the use of "Gastric cancer", "Helicobacter pylori", "Fruit and vegetables", "Meat and processed meat", "Salt and salted food", "Green tea", "Black tea" and "Coffee" as keywords. Findings from 36 cross-sectional, ecologic, case-control, cohort, and meta-analysis studies, until 2011, have been taken into account in this review. Findings from the current evidence suggest that the risk of gastric cancer decreases with high intake of fruits and fresh vegetables and possibly with green tea consumption, and increases with the intake of various processed meats, salt and salted foods. There is no clear evidence about the relationship between gastric cancer and various meats, fish, black tea and coffee. Dietary modification to increase intake of fruits and fresh vegetables and to reduce intake of salt and salted foods, represent an effective strategy in control and prevention of gastric cancer.

One of the factors associated to the increase or decrease in breast cancer risk is different dietary patterns of consumption by using different food groups. Therefore, the role of diet has attracted the attention of researchers to the extent that many studies have investigated the role of food groups in the risk of breast cancer. This study aimed to review the current evidence regarding the association of food groups and breast cancer. We searched PubMed for related publications using "dietary fats”, “meat and processed meat", “fruit and vegetable”, “food group”, “dairy” and "carbohydrate" and grains as keywords. We searched for papers that had been published between 2009 and 2011 and were on human subjects. About 400 papers were identified and after the elimination of papers that were unrelated to the subject the 31 relevant studies available for review were examined. Some studies have shown that dietary patterns rich in vegetables, and with less meat and processed food are related to the reduced risk of breast cancer. However, a number of other studies have not attained such results. Certain vegetables and fruits consumption rather than consumption of the whole vegetables group is much more important in reducing the risk of breast cancer. Consumption of processed meat has been consistently reported as a factor in enhancing the risk of breast cancer. The findings of studies on the effects of food consumption patterns’, rich in vegetables with antioxidant components and low in the glycemic index of carbohydrates, association with reduced cancer risk shoed consistency. Therefore, it seems that future investigations should be focused on the association between different dietary patterns and risk of breast cancer in relation to hormonal and genetic factors.

Background: The heavy metals include two types of necessary and unnecessary elements which are significant in eco-toxicology. These elements have high stability and can generate toxicity in the organisms. The aim of this study was to measure the heavy metals concentration in water and sediments of Gorgan Gulf, Iran, as a baseline measure for determination of future trends.Methods: In the winter of 2010, 30 samples (15 from water and 15 from sediments) were drawn from 5 sampling stations (4 stations in Gorgan Gulf and one station in estuary of Gorganroud River). The samples were measured by atomic absorption spectroscope for concentration of zinc (Zn), lead (Pb), chrome (Cr) and cadmium (Cd).Findings: The results obtained from the present study showed a significant difference in concentration of heavy metals in water and sediments sampled from various stations. The highest concentration of heavy metals was detected in water and sediments of Gorgan and Gharasou estuaries (stations 1 and 2) and the lowest concentration was found in Galougah seaside and Khozeini canal (the stations 4 and 5). Among the studied metals, Pb and Zn had the highest amount in water and sediments, respectively. Furthermore, when compared to standard limits in water, Cr, Cd, and Pb had more concentration than standard limits of world health organization. The results from metal concentrations in sediments also showed that metal concentration were lower than global standards.Conclusion: Increase of population and pollution can change the amounts of heavy metals in the study areas, hence their measurement should be considered as a continuous and important approach for future studies.

Background: Social support is as the most effective agent in successfully coping with stressful circumstances. Considering the importance of healthcare at home for the patients with type 2 diabetes, family practice is fundamental to the quality of patient adaptation to problems, and consequences of the disease. The main aim of this study was to evaluate the status of perceived family support and some related factors in patients with type 2 diabetes.Methods: A cross-sectional study was conducted. Random simple sampling method was used. The sample consisted of 113 patients who referred to the Sedigheh Tahereh Research Center. To complete the questionnaire in the days predetermined (randomly), a personal interview was conducted with each of the patients. To evaluate the data analysis of variance, Pearson correlation and repeated measures ANOVA were used.Findings: Of the 113 patients, 106 patients (81 women and 25 men) were entered into the analysis. The one-way ANOVA test showed there was a statistically significant difference in family support across economic levels (F=3.24, P<0.001). Analysis of variance with repeated measures, revealed significant differences between perceived family support aspects of patients' self care behaviors (F=39.31, P<0.001). Results showed that the lowest and highest self-reported scores of perceived support, respectively, were related to drug treatment and general support.Conclusion: The present study showed that patients’ perceived family support in drug treatment and adherence to diet was poor. Because of the importance of these two aspects in the treatment plan for patients, it is essential that family empowerment programs be considered.

Background: Noise is one of the most important environmental problems in industrialized societies and developing countries. According to world health organization report, in European Union countries about 40% of the populations are exposed to road traffic noise with an equivalent sound pressure level of 55 decibels during a day.Methods: The study was conducted by a signal processing software (MATLAB) which is one of the most powerful mathematical software for processing and generating signals. First the signal was produced at the frequencies of 50-500 Hz and 1000-6000 Hz, then it propagated along a duct with dimensions of 20´20´150 cm. These signals were sampled by transferring them with order through the channels with sampling rate of 8000 Hz and sampling time of 10 seconds.Findings: Reduction of amplitude about 0.05 at 500 and 0.15 at 250 frequencies for low frequency noise was observed. At frequencies of 1000, 4000, and 6000 Hz, there was a reduction of 0.02, 0.01, and 0.004 of amplitude, respectively. The figures showed that as the frequency increased the amplitude decreased, while the amplitude of low frequency noise increased.Conclusion: From the figures and the obtained information it can be noted that due to the high power of low frequency noise at ventilation duct, specific effects and unavoidable disorders were caused. However, strengthening low frequency noise in channels and ventilation ducts can be confirmed. Low frequencies noise in the distribution channel, with increase in the length of the channel can reach to its maximum amplitude.

Background: Iron deficiency anemia (IDA) is the most common cause of anemia. It is estimated that about 30% of the world population suffer from it. The highest prevalence of this anemia is in Adolescent girls. Because of its effects on work efficiency, productivity and development trend, prevention is important. The aim of this study was to determine the effect of applying the PRECEDE educational model as a theoretical framework for controlling IDA among grade two guidance school girls.Methods: This quasi-experimental study was done on 130 students who were allocated to case (65) and control (65) groups randomly in 2010-2011. Intervention was done in three 60 minute sessions. The questionnaires were distributed and completed immediately, and three months after educational intervention. A self-administered questionnaire base on the PRECEDE model constructs was the data gathering tool. Data were analyzed by independent Student’s t-test, paired t-test, repeated measure ANOVA, and chi-square statistical tests in SPSS software version 18.Findings: After educational intervention, the mean score of knowledge and attitude (Predisposing factors), using educational resources, organizing educational class, participating in educational programs (Enabling factors), encouraging family and teachers (Reinforcing factors), and iron deficiency anemia preventive behaviors had a significant increase in the case group in comparison with the control group (P =0.00).Conclusion: The present study indicated that an educational intervention program based on the PRECEDE model and main components (Predisposing, Enabling, and Reinforcing factors) have a positive effect in improving iron deficiency anemia preventive behaviors in the study population.

Background: The chemical quality of water used for dialysis fluid is a vital factor in the overall care received by dialysis patients. Therefore, water used for this purpose should be treated with advanced methods before use for dialysis. The objective of this study was to assess the efficiency of reverse osmosis systems to improve water quality used for dialysis fluid.Methods: In this descriptive study, 40 water samples were collected from inlet and outlet of reverse osmosis systems of 5 hemodialysis services of Isfahan hospitals, Iran, during April to August 2011. The samples were analyzed for physicochemical parameters including residual chlorine, chloramines, pH, hardness, Al, F, Cu, Mn, Cd, Cr, Pb, Ni concentration according to the standard methods for examining water and waste water.Findings: The results of this study showed that the reverse osmosis systems significantly reduce the amount of residual chlorine, chloramines, hardness, Na, K, F, NO3, SO4 and Mn, but it could not significantly reduce the amount of Cu, Zn, Cd, Cr, Pb and Al. However, the results also showed that the amount of NO3, hardness, Pb, Cd, Cr and Al in outlet samples of reverse osmosis systems was higher than the value given by association for the advancement of medical instrumentation (AAMI).Conclusion: Reverse osmosis systems could improve the quality of water used for hemodialysis but they do not reduce the level of some contaminant to the recommended values for dialysis fluid. This condition may be unsafe for hemodialysis patients. So a rigorous control of chemical contaminants is necessary in order to ensure that hemodialysis therapy is in a good quality.

Background: Thalassemia is the most common genetic disease in humans and is considered as a growing health problem worldwide. Due to its importance, thalassemia prevention program has considerable importance in Iran. This study aimed to examine the educational needs about thalassemia and related for candidate married couples in Qom, Iran.Methods: This cross sectional study was carried out on 420 marriage candidate who referred to Amir Al Momenin counseling center in Qom. Samples were selected by judgmental and convenient sampling. Data were collected with questionnaires. Statistical analysis of data was performed by SPSS software version 16. P<0.05 was considered significant.Findings: The average age of marriage was 25.35 in men and 20.81 in women. Media was mentioned as the most important source of providing information about thalassemia. In total 20.7% of the subjects had good information, 42.9% had average and 36.4 % of them had weak awareness about the disease. Also in terms of attitude, 15% had good attitude, 61% had moderate and 24% poor attitude towards prevention and the need for marriage counseling. There was no significant difference regarding knowledge and attitudes between men and women (P>0.05).Conclusion: As it was shown in the results, marriage candidates lack efficient information and knowledge about thalassemia, therefore designing multilateral educational interventions is essential.

Background: Students may experience increased pressure and stress especially during late adolescence and early youth (as they enter university). Facing numerous stressors in a period of transition can jeopardize their mental health. Therefore, this study evaluated mental health status and its determinants among students of Ilam University (Ilam, Iran).Methods: This study was conducted on all undergraduate and postgraduate students who had entered Ilam University in 2010. In a total number of 661 students, there were 288 boys and 373 girls. The mental health questionnaire (developed by the Iranian Ministry of Sciences) was used to collect data. This questionnaire included the demographic variables that may affect mental health. We considered a cutoff point of 100 to identify individuals who required psychological measures and psychotherapy. Data was analyzed using Friedman test, correlation coefficients, regression analysis, analysis of variance, and t-test in SPSS16.Findings: Overall, 17% of the evaluated students were at risk. Mental health was significantly related with academic field and interest in the academic field. The highest and lowest ranking means belonged to social anxiety and anxiety, respectively. According to regression analysis, all factors (depression, anxiety, obsession, social anxiety, and sleep disorders) had significant correlations with the students’ total psychopathology scores. Suicidal thoughts had significant relations with total psychopathology scores, self-efficacy, and perfectionism. Self-efficacy was significantly correlated with social support and perfectionism.Conclusion: Our findings highlighted the need for more attention to students’ mental health.

Background: Medication errors are the most common medical errors and are one of the major challenges threatening the health system. This study aimed to determine nurses’ perceived barriers and behaviors to reporting medication errors in 2011.Methods: Using convenience sampling, a total of 403 nurses were selected from teaching hospitals in affiliated to Lorestan University of Medical Sciences (Khorramabad, Iran). Data was gathered via the modified Goldstone Questionnaire which was distributed at the nursing station and collected at the end of the shift. Data was analyzed using chi-square and t tests and analysis of variance in SPSS16.Findings: While 73% of the participants (n=294) were not certain about the cases of medication error, 81.6% (n=329) stated fear of the nursing manager's reaction as the main obstacle to reporting medication errors. Moreover, 38.2% of the nurses (n=154) did not report their medication errors because they were afraid of losing their job. According to the subjects’ ranking, illegible prescriptions and damaged drug labels were the most and least important causes of committing medication errors, respectively. The nurses’ rankings of causes of error were significantly correlated with gender and work experience.Conclusion: Training courses to improve nurses’ knowledge and motivate them to act according to the patient’s benefit along with establishing a proper system of error reporting are essential.

Background: Diabetes has no definite treatment. The most important treatment strategy employed to control diabetes is adherence to self-care behaviors such as special diet, physical activity, blood glucose monitoring, daily foot care, and taking the prescribed medicine. This study aimed to assess rates of adherence to different dimensions of self-care behaviors and evaluate the predicting value of each dimension on glycemic control among type 2 diabetic patients under coverage of the Diabetes Clinic of Qom University of Medical Sciences (Qom, Iran).Methods: This cross-sectional, descriptive, analytic study was conducted on 275 randomized patients. Data was collected using the Summary of Diabetes Self-Care Activities (SDSCA) measure, a cognitive health questionnaire, and Beck Depression Questionnaire. Glycated hemoglobin (HbA1c) test was also performed. Data was analyzed through bivariate correlations and multivariate linear regression in SPSS17.Findings: The final regression model introduced education level, medicine taking behavior, nutrition, physical activity, and blood glucose monitoring as the main predictors. This model accounted for 66% of the variance of HbA1c level as a glycemic control indicator (P<0.001).Conclusion: Various dimensions of self-care behaviors of patients with type 2 diabetes have different impacts on metabolic control. Medicine taking and nutritional dimensions of self-care behaviors have the greatest effect on glycemic control.

Background: Regular physical activity reduces the risk of death and prevents cardiovascular diseases in diabetic patients. Thus, designing behavior change programs is an important factor to increase behavioral skills and enhance self-care among these patients. This study analyzed the effects of an eight-week educational intervention based on the transtheoretical model (TTM) on improving physical activity of type 2 diabetic patients in Hamadan, Iran.Methods: In an interventional study, 50 type 2 diabetic patients (mean age: 50.07±6.64 year old, 88% married) who did not have regular physical activity and were in pre-action stage of the change model were randomly selected and allocated to two groups of intervention and control (n=25 in each group). Data was collected using the TTM questionnaire. In order to improve physical activity, an eight-week educational program was conducted for the intervention group. Routine educations were also planned for the control group by diabetes research center. One month later, the participants refilled the questionnaires and data was analyzed using SPSS16.Findings: There were no significant differences between the intervention and control groups in regular physical activity and TTM constructs before the educational intervention. After the education, physical activity stages of change significantly increased in the intervention group compared to the control group. Mean scores of cognitive and behavioral processes of change and physical activity self-efficacy in the intervention group increased significantly more than the control group. However, increases in decisional balance in the two groups were not significantly different. Moreover, the two groups were not significantly different in terms of self-reevaluation level.Conclusion: According to our findings, educating diabetic patients based on the TTM improves their stages of change and stabilizes regular physical activity behavior. Therefore, management of type 2 diabetes will require educational interventions to improve physical activity based on the behavior-changing theories.

Background: Internet use has grown largely in recent years in Iran. Students are one of the major users of the Internet. This study evaluated the effects of student Internet users’ lifestyle and behaviors.Methods: This cross-sectional study used stratified multistage sampling to select 600 students from universities in Gorgan (Iran) during 2009. Data was collected through a valid and reliable questionnaire and analyzed in SPSS.Findings: Most participants had healthy nutrition and 51.8% did not find the Internet to affect their nutrition status. While 44.4% of the subjects had not exercised during the month prior to the study, 68.4% suggested the Internet to be ineffective on their physical activity status. Moreover, 18.9% reported tiredness and 32.8% reported satisfaction and calmness after using the Internet. About 90% of the students did not respond to questions about the effects of the Internet on their smoking, drug abuse, and unsafe sex status.Conclusion: Intarnet use did not seem to influence the lifestyle of our participants. However, since Iranian students are increasingly using the Internet, more studies in this field are required.

Background: Characteristics of adolescence are being noted to shape and develop the emotional, social and cognitive growth. Emotional state is richer in adolescence. Irritability, depression, anxiety and aggression are observed in adolescents. Assertiveness is a structured intervention approach which is used to improve the effectiveness of social relations. This study was conducted to determine the effectiveness of assertiveness program on depression, anxiety and stress of high school female students.Methods: This study was conducted in 2010-2011 educational year in selected high schools of Isfahan, Iran. 126 students in second year of high schools were randomly selected and participated in this study. The students were divided in two groups of trial (63 students) and control (63 students). The assertiveness program was trained during 8 sessions in the trial group and after 8 weeks posttest was performed in both groups. Data was then analyzed through statistical tests.Findings: Chi-square and Mann -Whitney U showed no significant differences in demographic variables of both groups (P<0.05). Repeated measurement test showed no significant differences in mean score of assertiveness before, immediately after and 2 months after the intervention in the control group, whereas this test showed significant differences in the trial group (P= 0.002). Also the same test showed that there was no significant differences in mean score of anxiety and stress in control group (P>0.05), whereas there was a significant difference in the trial group (P<0.05). Independent sample T test showed no significant differences in mean score of stress before intervention between the two groups, but 2 months after intervention, despite the decrease of mean score of stress, this differences was not significant in trial group (P=0.09).Conclusion: Applying assertiveness program for high school students leads to decrease of student’s depression, anxiety and stress. High school years are one of the most sensitive periods of human life. Based on the safety, affordability, effectiveness and efficiency of these programs, performing these methods is suggested for controlling high school students’ depression, anxiety and stress.

Background: Citizenship education is increasingly considered as an important strategy to empower youths in taking responsibilities and playing their individual and social roles, and to protect them against psychosocial pathologies. The purpose of the present descriptive study was to investigate students’ levels of knowledge, their intention, subjective norms, and attitudes toward the characteristics and skills of citizenship by utilizing the theory of reasoned action.Methods: Three all-girls’ high schools in the 3rd educational district of Shiraz, Iran, in which the three majors of math, science, and human sciences were established, were randomly selected. In the schools, one class of each major was randomly chosen to take part in the study. Overall, 228 students participated in the study. A 62-item self-administered questionnaire, composed of 15 MCQ questions for testing knowledge and 34 questions with Likert-type scale for measuring theory's constructs, was used for collecting the study data. The content validity of the instrument was confirmed by 7 specialists in health education, sociology, and social sciences. A test-retest pilot study showed that the reliability of the questionnaire in terms of the constructs of the study, including knowledge (r=82%), attitude (r=97%), subjective norms (r=94%), and behavioral intention (r=97%) were desirable.Findings: The results of the study showed that the students’ level of knowledge (mean+SD=7.84+1.98) and attitude (75.38+7.44) were relatively low. Moreover, subjective norms (23.24+4.33) and behavioral intention (18.07+3.03) were relatively desirable, but they were below the ideal levels. The analysis of the relationship between the variables of the study revealed that there were significant correlations between attitude and knowledge (P=0.037, r=0.139), attitude and behavioral intention (P=0.003, r=0.199), subjective norms and behavioral intention (P=0.31, r=0.143), and subjective norms and attitude (P=0.008, r=0.174). There were no significant statistical relationships between the demographic variables and the core constructs of the study.Conclusion: Regarding undesirable levels of students' knowledge and attitudes, well-designed citizenship educational programs are recommended. On the other hand, findings of behavioral intention and subjective norms set forth a desirable prognosis that these programs will be effective. Finally, results of this study are in favor of utilizing the theory of reasoned action in both predicting citizenship behavior and planning citizenship education programs in schools.

Background: In the hot weather overweight and obesity are considered as significant risk factors for incidence of cardiac strain in workers. This study is aimed to compare cardiac strain among overweight and normal-weighted workers in hot and humid conditions of the south of Iran.Methods: This cross-sectional study was conducted on 71 workers in the south of Iran in the summer of 2010. The heart rate was measured at rest and during work. Cardiac strain based on working heart rate (WHR), relative cardiac cost (RCC), net cardiac cost (NCC), load relative cardiovascular (CVL) and heart rate reduction were analyzed in 35 normal weight people (BMI<25) and 36 overweight people (BMI. 25) using descriptive statistics and Student’s t-test.Findings: In 42% of workers body mass index was higher than 25. The average temperature in the two groups was not significantly different. The mean WHR in these two groups was 101±20.3 and 112±18.9 respectively (P=0.026). The acceptable limits in NCC, RCC, WHR, and CVL parameters and Brouha index were significantly higher in overweight people than in people with normal weight.Conclusion: Based on the study results, the severity of cardiac strain was higher in overweight workers compared with normal weight workers. Hence, in order to decrease cardiac strain, selecting overweight individuals for these jobs should be avoided. Moreover, some vital interventions for losing weight, such as nutritional education, should be implemented, and they should be encouraged to increase their physical activity.

Background: Improving the dietary intake of different groups and populations is important for improving their health status. Therefore, the aim of this study was to determine the nutrients and food group intake, and dietary habits of female students in Isfahan University of Medical Sciences, Isfahan, Iran.Methods: This descriptive and cross-sectional study was conducted on 289 healthy female university students. They were selected from students of Isfahan University of Medical Sciences by the systematic random cluster sampling method. Usual dietary intake was estimated by a validated semi-quantitative food frequency questionnaire. For assessing the dietary habits a separate questionnaire was used.Findings: Mean age of the participants was 21±7 years. The mean of body mass index (BMI) was 25.9±5.1 kg/m2. The mean of low fat dairy and high fat dairy intake was, respectively, 1.3±0.11 and 1.3±0.16 servings per day. Daily whole grain intake was only 1.0±0.2 servings while refined grain intake was 6.0±1.2 servings per day. The fruit and vegetable intake was 2.2±0.4 and 3.2±1.0 servings per day. Folate, iron, calcium, and fiber intake were lower than the Recommended Dietary Allowances (RDA) amounts (70%, 76%, 90%, and 56% of RDA, respectively). 45% of the population consumed fast foods 2 times a week. 35% used frying oils for cooking most of the time. 52% of the students skipped breakfast.Conclusion: The dietary habits of the study population need to be improved. Paying attention to the intake of micronutrients including folate, iron, dairy products, and dietary fiber in this group is especially important.

Background: The association between shift of work and chronic diseases such as cardiovascular diseases and their related mechanisms has been investigated in several studies. The aim of this study is to investigate the relationship between longitudinal change in total cholesterol as a main CVD risk factor and the shift of work, with controlling of the effect of baseline weight at time of recruitment.Methods: This retrospective cohort study consists of 674 employees of Polyacryl Iran Corporation (PIC) of Isfahan from 1992 to 2009. The relationship between shift of work and cholesterol based on weight status at baseline of recruitment with the effect of confounding factors including age, BMI, pre-employment cholesterol, glucose, triglyceride, urea, work types, education, and marital status was studied. A linear mixed model with skew-elliptical errors was used for analysing the data. Parameter estimation was done using Bayesian approach using WinBUGS statistical software. Bayesian confidence interval was used for testing regression coefficients.Findings: Linear mixed model with skew-normal error was better compared to other models. In this model the relationship between shift of work and cholesterol changes with controlling of confounding factors was significant in those who were not overweight at baseline (β=2.25, P<0.001, 95% CI=0.67, 3.88), but was not significant for those who were overweight at baseline of employment.Conclusion: By increasing of age, the mean rate of cholesterol changes was significantly higher in shift workers who had normal weight at baseline of recruitment compared with shift workers who were overweight at baseline of recruitment. Furthermore, linear mixed model with heavy tailed and skewed error indicate better fitting than the standard linear mixed model.

Background: Nanotechnology, with the help of new tools, has the ability to change food and agricultural industries. It can use these tools for diagnosing of molecular behavior of diseases, rapid disease detection, and increasing the ability of plants to absorb nutrients. This technology has widespread use in various industries and sectors, and agriculture is one of the most important fields that will benefit greatly from using the achievements of nanotechnology. Regarding the importance of the application of this technology in agriculture, this study examined attitudes of Isfahan Agricultural Jihad Organization experts on using this technology in Iran in 2012.Methods: This study is a cross-sectional study using census sampling method on agricultural experts working in the Isfahan Agricultural Jihad Organization. A researcher-made questionnaire was used to collect data, and content validity and reliability of the questionnaire were approved. Data were analyzed using the Spearman correlation coefficient, Mann-Whitney test, Kruskal-Wallis test, and multiple regression analysis by using SPSS software version 19.Findings: Mean age of participants was 36.5 years with an SD of 9.4. There was no significant relationship between age and education level of experts, with their attitude. However, there was a significant inverse relationship between work experience and training on nanotechnology, with the experts’ attitude.Conclusion: From the experts’ viewpoint, with nanotechnology materials with improved properties, lower costs and more durability can be produced. Moreover, nanotechnology is a complementary and base to other technologies and not competing force. Experts had negative views on some cases such as "nanotechnology is a transient and weak technological wave" and "nanotechnology and its applications are largely imaginary and unrealistic".