Journal of Health System Research
Year:2011 | Volume:7 | Issue:3|Papers Count:16

Background: Some studies have shown significant changes in quality of life due to menopausal status. A large number of factors, including psycho-social factors, have been found to be associated with quality of life. The aim of this study was to investigate factors affecting quality of life among postmenopausal women in Isfahan, Iran, based on behavioral analysis phase of PRECEDE model.Methods: This cross-sectional study was conducted through stratified sampling among 200 healthy postmenopausal women in Isfahan. Data were collected by two validated and reliable questionnaires (one for assessing quality of life and one for assessing the factors based on behavioral analysis phase of PRECEDE model). Inferential and descriptive statistics were used in SPSS18 to analyze the data.Findings: The mean age of respondents was 55.74±4.77 and the mean age at which menopause had occurred was 50.20±3.56. While illiterate participants constituted 30.5% of the studied population, 5% were highly educated.81 percent of women were married and 90 percent were housewives. The majority of women were married (81%) and housewives (90%). Pearson correlation test indicated positive significant relationships between quality of life and attitude toward menopause, perceived self-efficacy, and enabling and reinforcing factors. However, there was no significant relationship between quality of life and knowledge about menopause. Finally, quality of life was significantly associated with age, education level, employment and marital status.Conclusion: We believe that health care providers should provide women with information about menopause and help them create support groups to adopt positive attitudes and healthy behaviors.

Background: Hemodialysis patients' health depends on adherence to treatment recommendations. Nonadherence to treatment is directly associated with worse clinical outcomes. This study was designed to determine the association of between treatment adherence behaviors among maintenance hemodialysis patients and depression, perceived social support, self efficacy, and patient's interaction with medical service providers based on social cognitive theory.Methods: This cross-sectional study used proportional random sampling to select 160 maintenance hemodialysis patients in Isfahan, Iran. Data was gathered by Beck depression questionnaire, multidimensional scale of perceived social support (MSPSS), strategies used by patients to promote health (SUPPH) questionnaire, patient reactions assessment questionnaire, and the end-stage renal disease adherence questionnaire. The data were analyzed using descriptive and correlation statistics.Findings: Our findings showed that 60.06% of the participants were male. Their average age was 51.95±15.04 and mean of total scores of treatment adherence behaviors was 861.48±201.64 (range: 0-1200). There was not any significant relationship between the studied factors treatment adherence behaviors. However, behavioral sub-scales were significantly related with the studied factors (P<0.05).Furthermore, all factors had significant relationships with scores of perception about the importance of behaviors (P<0.001). Demographics, including age, sex, and marital status, were also related with treatment adherence behavior scale and sub-scale (P<0.05).Conclusion: Based on the results, social-psychological factors affect treatment adherence behaviors as a mediator of perceptions. Therefore, they have to be considered in future theory-based interventions and studies.

Background: The rapid growth of various forms of computer games makes children and adolescents spend a lot of their leisure time playing them. This phenomenon has direct and indirect effects on different aspects of quality of life including psychological and physical status and social relationships. This study examined the relationship between quality of life and computer games in adolescents aging 12-15 in the city of Borkhar, Iran.Methods: In this cross-sectional study, 444 male and female students in junior high and first grade of high school in Borkhar were selected by 2-stage, cluster, stratified sampling. Data was collected by world health organization quality of Life–BREF questionnaire and a second questionnaire including demographics and personal information on how the subjects spent their leisure time, and when, where, and how long they played computer games. To calculate body mass index (BMI), weight and height were measured in a sample group of students. Data were analyzed by Pearson correlation, Spearman correlation, chi-square, and independent t tests, as well as analysis of covariance.Findings: The mean score of overall quality of life of students was 67.11±13.34. The results showed significant relations between the age the subjects started playing games and the overall quality of life scores and its 4 areas (range r=-0.13 to -0.18). There were also significant relations between income levels and facilities and the overall quality of life scores and its 4 areas (P<0.001). Average score of overall quality of life in computer games users was 68.27±13.03 while it was 64.81±13.69 among those who did not play games and the difference was significant (P=0.01). There were significant differences in environmental and mental health between the two groups (P<0.05). There were no significant relations between BMI and the number of hours of computer games were played and the type of computer games.Conclusion: Playing computer games for a short time under parental supervision can have positive effects on quality of life of adolescents. However, spending long hours playing computer games may have negative long term effects.

Background: Development of oil and gas resources involves serious process hazards which put these industries among the most hazardous industries. Therefore, preventive approaches through risk identification and evaluation using new techniques such as layers of protection analysis (LOPA) are receiving vast attention these days. The present study aimed to analyze probable major accidents in sour water reduction unit of gas refineries. It also tried to investigate the adequacy of safeguard layers in the system and provide suggestions to promote the level of safety using dependent and independent (active and reactive) protection layers where recommended safety measures did not seem sufficient.Methods: This descriptive study used LOPA to analyze the consequences of unacceptable risks to determine the risk situation after applying layers of control and protection. It also suggested protective layers as corrective actions for high-risk areas. Finally, in necessary cases, a safety integrity code was developed.Findings: Based on the determined role of available protective layers in controlling the potential risks, the further protective layers were recommended as a way to reduce risk to acceptable levels. In addition, the safety integrity level required by some equipments was determined in necessary cases.Conclusion: This study revealed that the effectiveness of available protective layers was not adequate in some. Therefore, additional protective layers are required to improve the preventive potential of process safety systems.

Background: Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. It is one of the most common infectious diseases largely resulted from patients' lifestyles. The purpose of the present study was to investigate factors related with adopting healthy behaviors by patients with tuberculosis based on health belief model.Methods: The present cross-sectional study was performed on 196 patients with tuberculosis. Data was collected using a 47-item self-designed questionnaire. Cronbach's alpha was used to assess the reliability of the questionnaire and it was calculated as 73.9. Pearson test was used to study the correlation between independent variables and adopting healthy behaviors.Findings: The mean score of adopting healthy behaviors by patients was 87.52±13.8. Pearson correlation test indicated statistically significant relations between adopting healthy behaviors and scores of knowledge (P<0.001, r=0.536), perceived susceptibility (P<0.001, r=0.36), perceived benefits (P<0.001, r=0.347), and perceived barriers (P=0.046, r=0.143).Conclusion: Direct relationship exists between adopting healthy behaviors and scores of knowledge, perceived susceptibility, and perceived benefits. Although the results of this study can be the basis of educational interventions, any generalization should be performed cautiously.

Background: Colorectal cancer is one of the most important and most common cancers and the second leading cause of cancer deaths worldwide. Every year, nearly one million new cases of colorectal cancer are recognized around the world and nearly half of them lose their lives due to the disease. According to statistics about the shocking incidence and mortality rates of colorectal cancer, secondary prevention of this type of cancer is important. Research has shown 90% of early diagnosed patients to be curable.Among the colorectal cancer screening tests, the fecal occult blood test (FOBT) is preferred because of its convenience and low cost. However, due to various reasons, people are not willing to do this screening test. The goal of this study was to assess the factors that affect participating in colorectal cancer screening programs in the moderate risk population, based on health belief model structures.Methods: A cross-sectional survey of 196 individuals more than 50 years old was conducted in Isfahan.Ninty-eight individuals of the target group were randomly selected from laboratories when they referred to do FOBT (Group A). Cluster sampling was used to collect data from the other 98 individuals (Group B) who were home interviewed. A questionnaire based on health belief model was used to assess the factors associated with performing FOBT. The data collected were analyzed using descriptive and inferential statistics.Findings: The mean score of knowledge in the first and second groups were 48.5±11.7 and 36.5±19.3, respectively. Individuals in the first group were more likely to be married, had more years of schooling and better financial status. There were significant relationships between knowledge (P<0.001), perceived susceptibility (P<0.001), perceived severity (P<0.001), perceived barriers (P<0.001), and self-efficacy (P<0.001) in the two groups. However, there was no significant association between perceived benefits in the two groups. Subjects that had FOBT in the past year in each group reported better scores of HBM.Conclusion: According to this study, it seems that there is an urgent need to pay more attention to colorectal cancer and its prevention through screening. A better understanding of factors affecting FOBT can be a useful step to reduce rate of death and costs, and also to improve community health outcomes.

Background: Perchloroethylene (PCE) is a chlorinated aliphatic hydrocarbon which has been widely used in some industries. Industrial wastewaters polluted with PCE must be treated because of its possible carcinogenic effects. Since an Anaerobic Migrating Blanket Reactor (AMBR) has never been used in PCE biodegradation, this study aimed to determine its ability to biodegrade PCE with higher concentrations than those previously studied.Methods: A laboratory scale AMBR, with a total volume of 10 liters and four compartments for biodegradation of PCE in synthetic substrate, was used. The reactor was seeded with anaerobic digested sewage sludge. Then, the performance of the reactor was evaluated during 4 phases through which PCE loading rate increased from 3.75 to 75 mg/L.d. Hydraulic retention time (HRT) was fixed at 32 hours.Findings: Optimum 98% COD removal efficiency through organic loading of COD was obtained as 3.1g/L.d. Optimum 99.8% PCE removal efficiency was observed at a loading rate equal to 37.5 mg/L.d.Average COD and PCE removal efficiency for the whole active period of the reactor were 91.4 and 99.5%, respectively.Conclusion: According to our results, a full-scale AMBR can be used as a simple, efficient, and reliable method for treatment of PCE in real polluted industrial wastewater.

Background: Since no evidence has been found regarding the effects of the dietary approaches to stop hypertension (DASH) on cardiovascular risk factors among type 2 diabetic patients, this study was conducted to investigate the possible effects.Methods: A randomized crossover clinical trial was undertaken on 31 type 2 diabetic patients. The study lasted for 8 weeks. The participants were randomly selected to go on a control diet or DASH diet.Findings: After following the DASH eating pattern, body weight (P=0.007) and waist circumference (P=0.002) were reduced significantly. Fasting blood glucose levels and A1C decreased after adoption of the DASH diet (-29.4±6.3 mg/dl, P=0.04 and -1.7±0.1%, P=0.04, respectively). After the DASH diet, the mean change of HDL cholesterol levels was increased (4.3±0.9 mg/dl, P=0.001) and LDL cholesterol was reduced (-17.2±3.5 mg/dl, P=0.02). Additionally, DASH had beneficial effects on systolic (-13.6±3.5 vs. -3.1±2.7 mmHg, P=0.02) and diastolic blood pressure (-9.5±2.6 vs. -0.7±3.3 mmHg, P=0.04).Conclusion: Among diabetic patients, the DASH diet had beneficial effects on cardiovascular risk factors.

Background: Family can play an important role in improving an individual's mental health through the provision of close and positive relations (social capital). The present study aimed to analyze the effects of family social capital on youth mental health in Isfahan, Iran during 2009.Methods: In this survey, a stratified sample of 384 males and famales aged 15-19 were studied utilizing an 80-item questionnaire. The 28-item general mental health questionnaire provided by the world health organization (Cronbach's alpha=0.88) was used to measure mental health. Other questions assessed family social capital in six categories including participation, trust, solidarity, economic support, emotional support, and family supervision and control (Cronbach's alpha=0.90). To analyze the data regarding dependent and independent variables correlation coefficient, the coefficient of determination, analysis of variance, and t-test were used. Amos 18 was utilized to construct the structural equation model.Findings: The findings showed that family social capital [such as participation in decision making (R2=0.116, trust (R2=0.255), solidarity (R2=0.192), economic support (R2=0.201), emotional support (R2=0.184), family supervision (R2=0.116)] significantly promoted individuals' mental health (a=0.63). The results also indicated that higher socioeconomic status of the family had a significant positive effect on youth mental health. However, variables like age, sex and level of education had no significant relations with mental health.Conclusion: It has been shown that family social capital variables have a significant effect on the health of children. So it is in cumbent on familes to try to provide such relations in the family since other studios have shown a positive relationship between mental health and school achievements of students.

Background: Delivery is a spontaneous mechanism without the need for intervention to save lives but in cases where the mother or baby is at risk, performing cesarean section will help save the mother and/or the baby. Unfortunately, today the prevalence of cesarean in most developed countries is over 50 percent, while the World Health Organization has emphasized that cesarean section should be performed only based on the indication. In this study we assessed the causes and factors influencing choice of delivery method.Methods: In this cohort study 396 primiparous pregnant women were studied during their last trimester.The subjects were selected from pregnant women referring to health centers in Ardabil, Iran through dual stage sampling. A questionnaire consisted of 54 questions, designed in six parts, was used to collect data.The validity and reliability of the questionnaire was confirmed. In order to analyze the data statistical software SPSS15 was used to perform chi-square and paired t-test.The mean age of mothers was 21.8. 3.2 years and the majority of them (34.6) were high school graduates. They were mostly housewives.Findings: The majority of friends, husbands and mothers of pregnant women had suggested vaginal delivery to terminate pregnancy. Although 70.7% of mothers claimed that they would probably or definitely have normal vaginal delivery with labor, at the end of pregnancy, cesarean section was chosen as the most popular method for delivery (58.6%). The most effective factor in decision making was physician's suggestion (36.6%). Women's attitude towards cesarean significantly decreased after the surgery (P<0.05).Conclusion: Social factors and motivations, particularly from physicians and health personnel, have a significant impact on health-related behaviors. Therefore, promoting pregnant women's knowledge and attitude towards vaginal delivery would motivate them.

Background: Superficial and cutaneous fungal infections can be transmitted through using covered swimming pools. This study was conducted in order to assess the dermatophyte fungi, pH and residual chlorine levels in covered pools of Yazd, Iran in 2009.Methods: In the current descriptive cross-sectional study, carpet sampling was used to collect 100 samples from different areas of 4 randomly selected covered swimming pools in Yazd. Mycosel agar plates were cultured in order to separate and identify dermatophytic fungal species. The pH and residual chlorine levels of the water were also measured in this study.Findings: Seven out of 100 samples had positive culture of pathogenic dermatophyte fungi. Dressing rooms, sauna and foot-bath parts were contaminated. Anthropophilic Trichophyton mentagrophytes (6 cases) and Epidermophyton floccosum (1 case) were isolated especially in summer. Water pH ranged from 7.8 to 8.2 and residual chlorine levels varied from 0.4 to 0.7 mg/l.Conclusion: Since anthropophilic dermatophytes were identified in the studied swimming pools, pathogenic fungi can be transmitted from swimmers to the environment of the pool. Therefore, paying attention to personal hygiene by swimmers, preventing the entrance of infected people, and maintaining good sanitation conditions in the water and environment of the swimming pools are necessary.

Background: Noise is one of the most harmful agents in the workplace and it has an important role in disturbing the physiological balance of the body. Research shows that the main problem of workers in the workplace is noise pollution. In addition to adverse effects of noise on auditory system, as a stressor it may cause hypertension, cardiovascular disease, anxiety and impaired secretion of hormones, especially cortisol. The purpose of this study was assessment of sound effect on urinary cortisol levels in workers.Methods: This is an experimental and analytical prospective study. The population was Sepahan Layeh factory workers in Iran. Twenty cases were selected among healthy male morning-shift workers without any hearing loss. Urine samples were collected three times a day (9 am, 11.30 am, and 3 pm) for two days.During the first day, workers did not use any hearing protection device, but on the second day they were asked to use earmuffs. Urinary cortisol levels were measured by RIA system and urinary. Creatinine was measured by an auto analyzer system (JAFFE method).Findings: The mean urinary cortisol levels on the first and second days were 0.105 mg/mg creatinine 0.076 mg/mg creatinine, respectively. The mean urinary cortisol at 9 am, 11.30 am, 3 pm on the first day of the study were 0.142, 0.119, and 0.052, respectively. These levels and in the were 0.103, 0.086 and 0.041 on the second day.Conclusion: Paired t-test results showed significant differences between the mean urinary cortisol levels in the two days of study, as well as at different times during the same day (P<0.05). In this study, no modifications were made except noise reduction in the second day. The results show that a significant decrease in cortisol level and consequently stress reaction occurred due to noise reduction of about 29.3 dB (by using earmuffs). Thus, the results of this study indicate that using hearing protection devices such as earmuffs is beneficial in reducing adverse effects of noise on chronic increment of cortisol levels.