Payesh
Year:2017 | Volume:16 | Issue:6|Papers Count:9

Objective(s): Food fortification is one of public health strategies to prevent and control anemia and iron deficiency. Flour fortification with iron and folic acid launched in 2001 in Iran. Thus the present meta-analysis conducted to assess the impact of flour fortification on hemoglobin, serum ferritin, anemia, iron deficiency and iron deficiency anemia.Methods: We searched English and Persian databases up to December 2013 to identify relevant studies. Quality assessment was conducted according to the EPOC (Cochrane Effective Practice and Organization of Care) statement. Meta-analysis was carried out using the Comprehensive Meta-Analysis version2 software. Random effects model was used due to the heterogeneity between the studies. Subgroup analysis and sensitivity analysis performed using CMA-2. Begg and Mazumdar’ Rank Correlation Test and Egger’s linear regression were adopted to test the possible publication bias.Results: A total of 42 articles (consisted 80 trials) were included in the study. Meta-analysis of “before-after studies” showed that flour fortification with iron resulted in a significant increase in hemoglobin levels (0.342 g/dl; 95% CI: 0.216 ~ 0.416, p<0.001) and serum ferritin levels (3.997 ng/ml; 95% CI: 1.782 ~ 6.213, p<0.001) and a reduced prevalence of anemia (-0.058; 95% CI: - 0.097 ~ - 0.018, p=0.005) and prevalence of iron deficiency (-0.073; 95% CI: - 0.114 ~ - 0.032, p=0.001) and no effect on iron deficiency anemia. Meta-analysis of “controlled trials” showed that flour fortification with iron resulted in a significant increase in hemoglobin levels (0.313 g/dl; 95% CI: 0.146 ~ 0.480, p<0.001) and serum ferritin levels (8.470 ng/ml; 95% CI: 6.694 ~ 10.246, p<0.001) and a reduced prevalence of anemia (-0.075; 95% CI: - 0.123 ~ - 0.027, p=0.002) and no effect on iron deficiency and iron deficiency anemia. Subgroups analysis indicated that the effectiveness of flour fortification with iron was reported more often in the before and after studies in "low quality" articles than in the controlled trials in "high quality" articles. Meanwhile, the use of NaFeEDTA was the most important factor in the effectiveness of flour fortification with iron.Conclusion: The present meta-analysis provided evidence of the effectiveness of flour fortification with iron for improving hemoglobin and ferritin levels and reducing the risk of anemia. However, evidence of effectiveness for reducing the risk of iron deficiency was limited and there was no effect on iron deficiency anemia. It should be considered that controlled trials have provided more valuable results than before and after studies, and also chemical compound of iron was found to be an important factor in the effectiveness of flour fortification with iron.

Objective(s): The World Health Organization (WHO) estimates that 250 million children under the age of five suffer from vitamin A deficiency and 2.8 to 3 million children under the age of 5 suffer from clinical symptoms of vitamin A deficiency. Since the malnutrition of children is related to their diet, the purpose of this study was to evaluate the status of vitamin A in children aged 1-6 years in Darab city and its relationship with some socioeconomic factors and anthropometric indices using a specific vitamin A questionnaire.Methods: In this cross-sectional study, which was part of a project to determine the prevalence of malnutrition in children under 6 years old in Fars province Fars province, 510 one to six years old children were selected by multi-stage cluster sampling in Darab. Demographic and socio-economic characteristics were evaluated through questionnaires and interviews. Children height and weight were calculated based on Z score. To evaluate the status of receiving vitamin A, the Helen Clare International Center for Dietary Frequency Questionnaire was used. Chi-square test and logistic regression were adjusted for age and sex were used.Results: father's occupation [OR=1.1; CI %95 [0.980-1.46], P=0.05] differed significantly in two groups [no efficient or efficient vitamin A].Contact between Property and income with vitamin A deficiency means no statistic different. [p>0.05]. Mild degrees of malnutrition in children is more common and there is significant difference between under weighting and stunting and wasting parameters with vitamin A deficiency in animal source [p<0.05]. According to HKI questionnaire, this society has no lack of exposure.Conclusion: Vitamin A deficiency is not a matter of health issue in Darab. It rather correlates with deficiency in animal vitamin A intake that might be proxy of poor socioeconomic status.

Objective(s): Food security is defined as the permanent access to sufficient, safe and nutritious food for all people in order to have an active and healthy life. To achieve sustainable food supply, quantification of food security at the household level is necessary. The main aim of this study were (i) quantitative analysis of food security in Marvdasht, Iran and (ii) Estimate the effect of milk, fruits and vegetables consumption on food security.Methods: We carried out a descriptive-survey to analyze food security status. In all 500 rural and urban households were randomly selected. The household food security was assessed by an 18-item Household Food Security questionnaire as recommended by USDA, and the correlation between variables was determined by Spearman test.Results: The results of this study showed that food insecurity in Marvdasht was 73.8 %. The findings also showed that the consumption of milk, fruit and vegetables were low.Conclusion: The study results suggest that food insecurity could be reduced with consumption of milk, fruits and vegetables.

Objective(s): The aim of this study was to assess dimensions and application of outpatient appointment systems.Methods: A systematic review was performed to indicate main factors affecting the performance of outpatient scheduling systems. Relevant articles were extracted from several databases including SID, Google scholar, PubMed, and Magiran using “outpatient”, “appointment”, and “scheduling” as keywords.Results: In all 767 citations were identified. Of these 34 papers were found relevant and included in this review. The review showed that there were four main methods to design and improve the outpatient scheduling systems: Mathematical optimization methods (deterministic and stochastic), Heuristics, Queueing theory, and Simulation method. In addition we found that three groups of factors impacted the performance of outpatient scheduling system. These were factors related to the characteristics of service providing system, factors related to patients, and factors related to clinic approach and policy.Conclusion: Outpatient scheduling systems are important in quality improvement of health care services. It seems that the complexity of designing a scheduling systems increases as quantity and diversity of services increases. Access to right and efficient data is necessary to design an outpatient scheduling system.

Objective(s): People are the major recipients of health services, they deserve their selves to have the choice right and equitable access to healthcare services. Health system is responsible for providing the fair services and choice right to the public. Hence, this study aims to explore the current position of freedom and equity in providing the healthcare services.Methods: This qualitative study was conducted through literature and national documents review and face to face interview with key experts of the health system. All interviews are recorded and transcribed. MAX QDA10 was applied for organizing the concepts. Framework analysis was used for analyzing the concepts.Results: Findings were categorized in two main themes of freedom of choice (with 3 categories including freedom of choice for treatment services, freedom of choice for preventive and hygienic services and freedom of choice for choosing the insurer) and equity (with 2 categories including equity in financial access and equity in physical access). Equity in physical access includes two sub categories: equity in access to preventive and hygiene services and equity in access to specialty and subspecialty services.Conclusion: The freedom of choice and equity are considered in different ways in the health system however, there is a significant gap with the ideal position. It seems that the commitment of health system managers to national documents and learning from the experiences of other countries is essential for proper implementation of freedom of choice and equity at different levels of the health system.

Objective(s): Successful implementation of strategic planning improves performance of organizations and enhances the accountability of employees and managers. This study aimed to examine the success of strategic planning implementation in hospitals in Tehran province, Iran.Methods: This study was performed in 93 hospitals in Tehran in 2016. Data were collected using a valid and reliable questionnaire covering nine dimensions of organizational issues including leadership and management, planning, organizational learning, organizational culture, employee management, customer management, resource management, process management, and organizational performance. The data were analyzed by statistical tests using the SPSS software.Results: Strategic planning implementation was moderately successful in hospitals (score of 2.84 out of 5). The most and least success were observed for planning and employee management dimensions respectively. Process management, organizational culture and customer management constructs had the most effect on the success of strategic plans. Significant statistical correlation was also observed between strategic planning implementation and managers' commitment (p=0.0001, r=0.406), employees’ involvement (p=0.0001, r=0.338), and physicians’ participation (p=0.001, r=0.363).Conclusion: Using an appropriate model of strategic planning, creating participative, collaborative and creative organizational culture, strong management and leadership, providing required resources and training and empowerment of staff are necessary for successful implementation of strategic planning in hospitals.

Objective(s): Cardiovascular diseases are the main cause of death in developed and developing countries. The aim of this study was to investigate the effect of a family-centered empowerment model (FCEM) on quality of life in elderly patients with angina.Methods: This was a randomized trial on a convenient sample of patients 60 years and older with angina hospitalized in cardiology clinics of a teaching hospital in Qazvin, Iran. Patients were randomized to receive intervention or the usual care. The intervention group received a four dimensions program (perceived threat with group discussion method, self-efficacy with problem solving methods, self-esteem with educational partnership and outcome and process evaluations). To collect data we used an specific FCEM instrument, and the Seattle Angina Questionnaire.Results: Following the implementation of the program the intervention in group showed better quality of life in all dimensions compared to their own baseline score and the control group (p<0.001).Conclusion: Family-centered empowerment model in patients with angina have improved their quality of life.

Objective(s): Head lice are well known currently as a global health problem. The prevalence of the disease is higher in girls. and at school age. This study performed to evaluate effect of education about preventive behaviors of pediculosis among mothers on morbidity rate of their daughters to pediculosis capitis in primary schools.Methods: This was a quasi-experimental study in two groups (case and control) carried out in 2016. The study samples were composed of 414 mothers and their daughters studying in elementary schools in Lowshan city (Guilan province, Iran). Simple random sampling method used. We provided the intervention group with group discussion in five sessions. There was no intervention in the mothers of the control group. The rate of students' infection was determined in two stages before and after the intervention and compared in two groups. The data were analyzed using SPSS windows version 16 by chi-square and t-test.Results: The results showed that among 414 daughters, 78 (18.8%) were infected with Pediculus Capitis, 38 (18.4%) were in the case group and 40 (19.2%) were in the control group. After intervention in the case group, the rate of infection of girls decreased from 18.4% to 8.2%, but did not change in the control group. Chi-square test showed a significant difference between mother's education in group discussion and morbidity rate of pediculosis capitis in their daughters after participation (P<0.05).Conclusion: The findings showed that group discussion on preventive behaviors of pediculosis in mothers led to decrease in morbidity in daughters.

Objective(s): Health literacy is the capacity and the ability to access to, and understand, health information to maintain and improve. The current study aimed to investigate the relationship between health literacy and postpartum depression among nulliparous pregnant women who referred to health centers in Karaj, Iran.Methods: A prospective study was carried out on a sample of 348 nulliparous women in third trimester of their pregnancy. They have completed a demographic, a reproductive questionnaire, the Health Literacy Inventory for Adults (HELIA). In addition they have completed the Edinburgh Postnatal Depression Scale (EPDS) as outcome measures at two points in time at baseline and at 8th week after delivery. Logistic regression analysis was performed to assess the relationship between health literacy and depression.Results: The mean health literacy among women was 67.30 (±14.66) indicating that 39.6% of women had limited health literacy. The prevalence of postpartum depression was 21.6%. The results of multivariable logistic regression showed that in addition to depression during pregnancy (OR: 1.21, 95% CI: 1.08-1.37, P=0.001) and type of delivery (OR for cesarean section for medical reasons: 5.58, 95% CI: 2.79-11.16, P<0.001), health literacy score (OR: 0.97, 95% CI: 0.95-0.99, P=0.033) was significantly associated with postpartum depression.Conclusion: The findings suggest that postpartum depression significantly is associated with health literacy in nulliparous women. It seems that promoting health literacy among this population could lead to significant reduction in e postpartum depression.