Shiraz E-Medical Journal
Year:2020 | Volume:21 | Issue:1|Papers Count:8

Context: Subjects with spinal cord injury (SCI) may experience a low quality of life due to struggling with sensory and motor impairments and various underlying illnesses. Objectives: The present study was conducted to investigate the health-related quality of life (HRQoL) of Iranian patients with SCI. Methods: In the present study, a search was done in domestic and international databases including MagIran, Iran Medex, SID, Google Scholar, Web of Science, PubMed, and Scopus using specific keywords (“ Quality of Life” OR “ Health-Related Quality of Life” OR “ Life Style” OR “ QoL” OR “ HRQoL” ) AND (“ Shortform questionnaire 36” OR “ SF-36” ) AND (“ spinal cord injury” OR “ SCI” ) AND “ Iran” , without time limitation. Observational studies evaluating HRQoL in patients with SCI were included. TheHRQOLwas assessed using the 36-item Short Form questionnaire (SF-36). The SF-36 has two main domains of Physical Component summary (PCS), and Mental Component summary (MCS). Based on the heterogeneity of the data, the data were analyzed by fixed and random effects models. Stata 14 was used to analyze the collected data. Results: Eight studies with a sample size of 848 SCI patients were included in the analysis. The mean scores of PCS and MCS of the subjects with SCI were 55. 47% (95% confidence interval [CI]: 42. 50-68. 43) and 67. 91% (95%CI: 59. 18-76. 64), respectively. The findings showed that the highest and the lowest scores of the subscales of HRQoL in both paraplegia and tetraplegia groups were related to physical functioning and social functioning, respectively. Themeanscore of eight subscales of HRQoL(except for social functioning) was higher in paraplegic patients than in those with tetraplegia. Conclusions: Individuals with SCIhadhalf of the total score of the physical dimension of HRQoL. Providing strategies for improving the HRQoL of Iranian people with SCI, especially in the physical aspect, seems necessary.

Background: Estimating the future risk of cardiovascular diseases (CVDs) and conducting primary prevention interventions in the high-risk groups are effective strategies. Objectives: This studywasconducted to evaluate the prevalence of CVDrisk factorsandthe results of CVDrisk assessment inKerman in 2017. Methods: A descriptive cross-sectional study was conducted among 450 middle-aged participants referring to health care centers using the multistage random sampling method. The risk prediction chart developed by the WHO and International Society of Hypertension was used for risk assessment. We used middle-aged population surveillance forms to extract the risk factors of CVDs. The prevalence of different risk factors was reported. Besides, we reported the CVD risk classifications and the prevalence of some risk factors. Results: The prevalence rates of hypertension, diabetes mellitus, and hyperlipidemia were 20. 9%, 9. 6%, and 8. 6%, respectively. Moreover, 64. 1% of the participants were overweight or obese. Abnormal waist circumference was observed in 57. 5% of the participants. The prevalence of smoking was 12. 9%. The prevalence rates of a sedentary lifestyle, inadequate fruit consumption, inadequate vegetable consumption, saturated fat consumption, and high-salt food consumption were 47. 7%, 28. 3%, 40. 7%, 23. 1%, and 25. 3%, respectively. The prevalence rates of low, moderate, and high or very high risks of CVD were 90. 3%, 5. 3%, and 4. 4%, respectively. Conclusions: There was a high prevalence of CVD risk factors in the middle-aged population. Policymakers should design effective interventions for modifying the main risk factors. Risk management is the main step to conduct strategies targeting high-risk groups.

Background: Unintended pregnancies impose a large financial burden on national resources and health. Objectives: This study aimed to determine the risk factors associated with unintended pregnancies in women aged 15 to 45 in Sanandaj, Kurdistan, Iran. Methods: This nested case-control study was conducted in the second half of 2016 (a period of six months) on 800 pregnantwomen aged 15 to 45. Overall 240 subjects were placed in the unintended pregnancy group (case group) and 560 subjects in the intended pregnancy group (control group). The data were analyzed using STATA 12 software. Logistic regression analysis was done to investigate the final effect of the studied variables. Results: In multivariate analysis, the significant relationship was found between unintended pregnancy and some studied variables, including mother’ s age (> 25) (odds ratio (OR): 1. 69; 95% CI: 1. 07-2. 41), child gender in the current pregnancy (female) (OR: 2. 85; 95% CI: 1. 94-4. 17), higher family income (OR: 0. 47; 95% CI: 0. 31-0. 74), a history of unintended pregnancy (OR: 5. 07; 95% CI: 3. 08-8. 55), abortion or curettage history (OR: 2. 78; 95% CI: 1. 47-5. 10), having not good communication with spouse (OR: 9. 09; 95% CI: 2. 73-17. 38), attending family planning classes (OR: 1. 54; 95% CI: 1. 05-2. 29), and higher previous pregnancies (OR: 4. 62; 95% CI: 2. 79-7. 79). Conclusions: Our results showed some preventable factors such as mother’ s age, child gender in the current pregnancy and family income may be related to the unintended pregnancy. Using the study results may help health policymakers in designing interventional programs.

Background: Equitable distribution of health services is the main goal of all countries, but this objective is more closely monitored and planned at the national level. Objectives: The purpose of this study was to investigate the distribution of care providers of mother and child as vulnerable groups at the provincial level in one of the provinces of Iran in 2011-2017. Methods: The Gini coefficient, dissimilarity index, and Gaswirth index were used to assess the distribution of maternal and child care specialists. The time trend of inequality was estimated using regression analysis. The calculations were performed using STATA-14 software. Results: The mean Gini coefficients of pediatricians, gynecologists, and midwives in the study period were 0. 25, 0. 32, and 0. 36, respectively. The mean dissimilarity indices for the mentioned specialists in the study period were 15, 14. 7, and 10. 9, respectively. The mean Gaswirth indices were 0. 99, 0. 78, and 0. 49, respectively. The results of the regression analysis showed that the effect of time on inequalities was not significant. Conclusions: The results of the study showed that there was some inequality in the distribution of human resources related to maternal and child health. Therefore, health policymakers are proposed to design and implement a sustainable policy for the fair distribution of these workforces at the provincial level. Equality of indicators at the national level does not necessarily imply equitable distribution at the county level. Therefore, it is proposed to measure and monitor the indicators at provincial/state levels, as well.

Background: Sexual transmission of HIV/AIDS is a major route for infection and the most effective strategy to control this infection is condom use. Objectives: This study aimed to assess the predictors of condom use among HIV positive patients. Methods: This cross sectional study was a descriptive-analytical study. A total of 121 HIV positive individuals, which included 57 women and 64 men were recruited during five months from a Behavioral Diseases Counseling Center in Karaj. Data were collected by questionnaires including demographic characteristics, drug abuse history, sexual history, depression, and social support. Social support and depression were evaluated by MOS questinnaire and Beck II, respectively. Data analysis was done by SPSS version 19. Results: The mean age of the participants was 36. 6  8 years. About 39% of HIV positive patients in this study used a condom during their last sexual encounter; however, consistent use of condomoccurred in 28. 1% cases in the past three months. Multivariate regression showed that the number of sexual partners’ ( = 0. 16), (P < 0. 01) age ( =-0. 23), (P < 0. 05) number of children ( = 0. 21), (P < 0. 05) and social support ( = 0. 58), (P < 0. 001) were predictors of condom use. Conclusions: Considering the low rate of condom use among HIV-positive patients, it is essential to provide counseling services and gender sensitive interventions to promote safer sex behavior in this context. As social support is a critical variable to predict condom use, it is suggested to be considered to develop effective prevention programs for people living with HIV.

Background: Diabetic Foot Ulcer (DFU) as one of the main complications of diabetes mellitus has serious outcomes such as infection, foot amputation, low quality of life, and premature death. Objectives: This study was conducted to assess the DFU prevalence and its related factors among diabetic patients. Methods: The population of this cross-sectional study included adult diabetic patients in the Diabetes Center of Kerman University of Medical Sciences. The data were recorded in a questionnaire using patients’ medical records, interviews with them, and physical examination. The collected data were imported to SPSS version 22 software and analyzed. Results: Of 400 diabetic patients enrolled in the study, 69% (n = 276) were female. Themean ( SD) of their age was 57. 1 ( 11. 9) years and 72% (n = 288) were younger than 65. The frequency of DFU during the total course of the disease and its annual prevalence were 17. 3% (n = 69) and 11. 8% (n = 49)among diabetic patients, respectively. More than one-third (37. 7%) of the DFU patients and 6. 6% of all the patients were admitted to a hospital due to DFU. Major or minor amputation was performed for 14. 5% (n = 10) of the total DFU patients and 2. 5% of the total patients. Having diabetes-related complications was determined as the strongest predictor of DFU (OR = 7. 016, 95% CI = 2. 67-18. 38), followed by smoking (OR = 3. 80, 95% CI = 2. 06-6. 99) and age over 64 years (OR = 3. 70, 95% CI = 1. 299-10. 568). Conclusions: The frequency of DFU was high among diabetic patients attending the Diabetes Center of Kerman University of Medical Sciences. Also, hospital admission and foot amputation due to DFU had a considerable frequency. Therefore, there is a crucial need to improve the quality of foot care services and emphasize foot self-care as essential components of diabetes self-management at all levels of the health service delivery system to decrease the risk of DFU.

Background: Considering the high prevalence and burden of cardiovascular diseases in Iran and the health expenditures imposed on households, the present study aimed to investigate the catastrophic and impoverishing health expenditures among households having cardiovascular patients. Methods: This descriptive-analytical and cross-sectional study was conducted from March 2017 to September 2017. Data were collected from 385 patientswhoreferred to the three main hospitals providing cardiovascular care in Tehran. Demographic and socioeconomic data, household income, out-of-pocket payments of households having cardiovascular patients were collected via face-toface interviews and based on the expenditure part of theWorld Health Organization’ s Health Survey questionnaire. The occurrence of catastrophic and impoverishing health expenditures due to cardiovascular care was calculated by income deciles. To identify the determinants of catastrophic and impoverishing expenditures, logistic regression was used. Results: In this study, 24. 6% of all households having cardiovascular patients experienced catastrophic health expenditures. Furthermore, the extent of experiencing impoverishing expenditures was 3. 8% among the households. The variables such as education level, type of health insurance, household income, outpatient and inpatient expenditures had a significant relationship with the occurrence of catastrophic health expenditures. Moreover, the type of health insurance, household income, and inpatient expenditures had a significant relationship with the incidence of impoverishing health expenditures. Conclusions: Mechanisms such as the development of financial risk pooling in the cardiovascular care setting, using generic medicines instead of brand names in patients and excluding poor patients’ from payments can be effective for financial empowerment and reduction of the catastrophic and impoverishing health expenditures among cardiovascular patients.

Background: Regarding problems related to quality, justice, effectiveness of health care provided by the Ministry of Health of Islamic Republic of Iran in 2015, the family physician is the main responsible for the health team who provides all the services and medical-healthcare with the assistance of midwives and other staff. Objectives: The purpose of this study was to explain the experiences of urban family physicians in Shiraz, Fars province, Iran. Methods: This study was conducted in 2018 at Shiraz University of Medical Sciences, Shiraz, Iran. Participants in this study were 8 physicians in the urban family physician program with a variety of experiences. The method of this study is qualitative, based on content analysis. Sampling was done purposefully using semi-structured in-depth interviews from participants to reach saturation. Data were analyzed using content analysis with software MAXQDA V. 2007. Data validity was evaluated using criteria such as credibility, dependability, and confirmability. Results: Results were presented in 4 categories: lack of infrastructure, inefficiency of implementation, comprehensive look at the health of the community, and the need for corrective actions along with 17 subcategories. Conclusions: The most important challenges after 8 years of starting a family physician program include the lack of infrastructure, inefficiency of the implementation method, lack of a comprehensive look at the health of the community, and the need for corrective actions in the program. It is the responsibility of health policymakers to address these challenges to improve them. It is recommended that training at all levels of the involved individuals, including theoretical and practical training should be considered.