Journal of Health System Research
Year:2023 | Volume:19 | Issue:2|Papers Count:10

Background: Due to the increasing number of elderly people in Iran, as well as chronic diseases, such as diabetes, in the elderly, this study was conducted to investigate the relationship between spiritual health and hope with adherence to the medication regimens in the elderly with type 2 diabetes. Methods: This descriptive-analytical study was conducted in the diabetes clinic of 22 Bahman Hospital in Gonabad, Iran. The data were collected using the demographic information form, Herth Hope Index (HHI), Paloutzian and Ellison Spiritual Well Being Scale, and Morisky Medication Adherence Scale (MMAS) by interview method. Data were analyzed using independent t-test, analysis of variance (ANOVA), and Spearman coefficient in SPSS software. Findings: Most of the participants had high spiritual health, high hope, and low adherence to medication regimen. In addition, spiritual health was directly related to treatment adherence (P < 0. 05),however, no relationship was found between hope and treatment adherence (P > 0. 05). Conclusion: High hope in an elderly person cannot be a reason for good adherence to medication regimen, but for appropriate medication adherence, it is necessary for the elderly to have correct and sufficient information about their medication and treatment plan.

Background: In recent years, population growth, lack of rainfall, and increase in urban, industrial, and agricultural activities have caused more use of underground water resources. This will cause many problems for the economy, ecosystem, and human health. Considering the need to investigate and monitor the quality of groundwater, the present research was carried out with the aim of investigating the important chemical parameters of water wells in some cities of Isfahan Province, Iran. Methods: To conduct this research, 181 well water samples were collected from Khansar, Daran, Tiran, Fereydunshahr, Najaf Abad, and Dehaghan cities in Isfahan Province. Then, electrical conductivity (EC), pH, and nitrate concentration were measured. Next, nitrate hazard quotient (HQ) (non-carcinogenic risk of nitrate) was calculated. ArcGIS software was used for mapping the measured features. Findings: The amount of EC, pH, and nitrate varied from 191. 4 to 7624 μ, S/cm, 6. 49 to 8. 20, and 1. 9 to 99. 2 mg/l, respectively. The lowest value of HQ (0. 03) was calculated for the group of men and the highest value (3. 68) was obtained for the group of children. The average value of HQ for men, women, and children was 0. 61, 0. 74, and 1. 40, respectively. Conclusion: All measured pH values were below the national standard of Iran (1053) and the Environmental Protection Organization of Iran. The studied areas had no limit in terms of nitrate concentration for using well water for agriculture. However, in 78. 6% of the study areas where the amount of nitrate was in the range of 22. 1-50 mg/l, there is a possibility of increasing nitrate concentration and making it unsuitable for drinking.

Background: Malnutrition is prevalent among patients undergoing hemodialysis, and a significant number of these people suffer from symptoms of malnutrition. Nevertheless, there are limited data regarding malnutrition based on the anthropometric assessment among these patients in Isfahan, Iran. The purpose of this study was to investigate the prevalence of malnutrition based on anthropometric indicators in patients undergoing hemodialysis in Isfahan City. Methods: The present descriptive multi-center cross-sectional study was conducted on 260 hemodialysis patients in Hojjatieh, Farabi, Zahraye Marzieh, Shariati, and Amin hospitals in Isfahan City in 2021. The weight, height, waist circumference (WC), and mid-arm muscle circumference of the patients who met the inclusion criteria were measured. Cut-off point for malnutrition index was determined based on previous studies conducted in Iran. The independent t-test was used to compare the mean difference of the studied indexes in two groups of men and women. Findings: More than half of male subjects had low body mass index (BMI) (58. 9%) and mid-arm muscle circumference (53%). In addition, the prevalence of low BMI (73. 3%), WC (52%), and mid-arm muscle circumference (73%) was more than 50% among women. Conclusion: A significant percentage of patients included in this study had an unfavorable nutritional status based on the anthropometric assessment. Therefore, regular nutritional assessment and taking necessary actions to prevent or treat malnutrition is necessary in hemodialysis patients.

Background: The purpose of this study was to model a real wastewater treatment plant in operation with GPS-X software. In the following, the verification of the output results of the software was done with the results of the effluent tests of the discussed sewage treatment plant. Then, the rate of return sludge, recycled sludge, and disposed sludge of the wastewater treatment plant was optimized by Modified Ludzack-Ettinger (MLE) method, so that it has the greatest effect on the quality of the effluent, especially chemical oxygen demand (COD) and nitrate (NO3) parameters. Methods: First, using the available data of an operating wastewater treatment plant, the processes of the treatment plant were modeled in the software and the compatibility of the model with the existing treatment plant was checked. After the validation of the software, in order to check the parameters affecting the activated sludge process, including return sludge rate, excess sludge rate, and internal recirculation sludge rate in the treatment of organic matter and nitrogen, COD, NO3, and ammonia parameters were investigated as indicators of pollution. In addition, the MLE process for nitrogen removal was modeled in the software. After performing the modeling by changing the parameters and checking the resulting outputs, the results regarding the effect of increasing the sludge recirculation rate on the COD concentration in the effluent and the effect of increasing and decreasing the internal recirculation rate and the disposal sludge rate on COD removal were examined. In addition, the mutual effect of changes in internal sludge recycling and return sludge and the amount of excess sludge disposal on NO3 removal was shown by different graphs. Findings: In this study, while validating the software, the results of the experiment design showed that the return sludge rate and the internal recirculation rate had mutual effects on each other in the removal of COD and NO3, and in the optimal mode of operation and design, the ratio of 0. 54 for return sludge and one-time internal recycling and ratio of 0. 021 for disposal sludge had the greatest effect on COD and NO3 removal target efficiency and increasing the effluent quality. Conclusion: GPS-X software can be used in the modeling and optimization of wastewater treatment processes.

Background: Childbirth is a completely natural event,however, when the life of the mother or child is in danger, a cesarean section is performed. Due to the lack of awareness of the complications of cesarean section, we are faced with an exponential increase in cesarean,therefore, this research aims to compare the effect of education based on the theory of planned behavior with the routine method on the intention to choose the method of childbirth in women referred to comprehensive health service centers in Mashhad, Iran. Methods: The present study was a field trial that was conducted on 76 pregnant women in 2022. People were selected by two-stage random cluster sampling method and randomly divided into two groups (intervention and control). Data were collected using a demographic and fertility questionnaire and a valid and reliable questionnaire related to the construct of the theory of planned behavior for both intervention and control groups in three stages, before, immediately, and one month after the intervention. The training program for the intervention group was given to people based on the theory of planned behavior in 6 sessions and the control group received routine training. The data were analyzed using Kolmogorov-Smirnov, Mann-Whitney, chi-square, Fisher's exact, and generalized estimation equations (GEE) model statistical tests. Findings: In this study, the two groups were homogeneous in terms of demographic and fertility variables. The results of the GEE model showed that the average score of the variables of awareness, attitude, perceived behavioral control, subjective norm, and behavioral intention immediately and one month after the intervention was significantly higher in the intervention group than in the control group (P < 0. 05). Conclusion: The intervention by the theory of planned behavior has an effect on the choice of natural delivery method,therefore, it is recommended to use these trainings along with pregnancy care in order to reduce caesarean section.

Background: Musculoskeletal disorders related to work are among the most common occupational injuries. Back pain is the most common musculoskeletal disorder among office workers and computer users. The present study was conducted to investigate the effect of 12 weeks of Williams corrective exercises on the reduction of back pain in the health workers of two cities of Selseleh (Aleshtar) and Noorabad, Iran. Methods: The present study was an interventional and cross-sectional study conducted on all the health workers of Selseleh and Noorabad cities, using census and cluster sampling methods during the year 2021. Among the 196 health workers in these two cities, 36 people from Selseleh City and 60 people from Noorabad City who had back pain were identified using the Nordic questionnaire. After homogenization in terms of age, gender, body mass index (BMI), and height, people were divided into two control and intervention groups, and their working posture was evaluated using the Rapid Upper Limb Assessment (RULA) method. After the training class, the health workers in the intervention group were asked to perform Williams partial sit up corrective movements, including stretching the back muscles of the thigh, tilting the pelvis, two knees to the chest, partitioning, circular rings, and quadriceps stretching, for 12 weeks. Finally, the data obtained from the questionnaires were collected and statistically analyzed using SPSS software. Findings: In total, 25 men (37. 4%) and 47 women (65. 3%) participated in the study, and the most significant number of surveyed people (62. 5%) had a diploma. Investigations showed that the RULA score after the intervention was significantly lower in the intervention group than in the control group. Before performing the corrective movements, the score obtained by the RULA method for both the intervention and control groups showed level 2, but after performing the exercises, 13 people (36. 1%) out of 36 people in the intervention group improved and were placed at level 1, and the musculoskeletal complaints of 11 people (30. 6%) also improved. Conclusion: Considering the development of the mechanization of physical jobs, the advancement of technology, and the increase in the use of computers, as well as considering the importance of the health of employees, including health workers, it is necessary to take a step by adopting a suitable and effective strategy in the offices in order to improve and prevent the occurrence of such disorders.

Background: Considering the effects of the coronavirus disease 2019 (COVID-19) epidemic on the level of physical activity, food patterns, and quality of life (QOL) of people in the community, the present study aims to investigate the relationship between the level of physical activity, dietary intake, and body mass index (BMI) with the QOL of people with Down syndrome during the COVID-19 pandemic. Methods: This descriptive-correlational study was conducted in 2021. 384 girls and boys with Down syndrome (mean age 12. 07 ±,3. 48 years and 12. 28 ±,3. 03 years, respectively) were selected by available and targeted sampling method. The research tools included physical activity questionnaire for older children (PAQ-C) and physical activity questionnaire for adolescents (PAQ-A), food frequency questionnaire (FFQ), and 36-item Short Form Survey (SF-36), which were completed by the parents of the samples. Data were analyzed using descriptive and inferential statistics methods (Spearman correlation coefficient and Mann-Whitney U test) in SPSS software. Findings: The average score of physical activity level for boys and girls was 2. 62 ±,0. 93 and 2. 53 ±,0. 95, respectively, which indicates the unfavorable level of physical activity in these people. In the dimension of QOL and based on the eight subscales, it was determined that there was no difference between the dimensions of QOL in girls and boys. Besides, there was no significant relationship between the amount of physical activity of girls and boys with QOL dimensions. Findings related to consumption of macronutrients and QOL dimensions showed that in girls and boys, there was a relationship between protein and fat consumption and physical pain, although this relationship was weak (P < 0. 05). Moreover, in girls and boys, a negative relationship was observed between carbohydrate and fat consumption with vitality, physical performance, and physical limitation (P < 0. 05). According to the results, it was found that in boys and girls, there was a negative and significant relationship between BMI and vitality, physical performance, and physical limitation (P < 0. 05). However, in boys, a significant negative relationship between BMI and mental problems was also observed. This means that by reducing the BMI of girls and boys, the aspects of QOL in them improved (P < 0. 05). Conclusion: The reduction in the intake of carbohydrates and fat macronutrients in girls and boys leads to changes in some aspects of the QOL (increasing vitality, improving physical performance, and reducing physical limitations) due to the epidemic of the COVID-19. It can also be expected that by reducing the BMI, improvement in indicators of vitality, physical performance, and reduction of physical limitations will be achieved.

Background: Family caregivers of patients with neurological and psychiatric disorders are prone to many physical and psychological problems during their care process. There are several ways to reduce the physical and psychological consequences in caregivers. The aim of this study was to investigate the effect of psychological education on the responsibility and mental health of family caregivers of psychiatric patients in Lordegan, Iran. Methods: In this quasi-experimental study, 60 psychiatric caregivers were randomly assigned to two groups of intervention and control. Two questionnaires were used to collect information: Depression, Anxiety, and Stress Scale (DASS) and Caregiver Burden Inventory (CBI). Psychological training intervention in the intervention group was based on a group method and no intervention was performed in the control group. The training program was presented in 8 sessions and the collected data were analyzed using SPSS software. Findings: After the intervention, the mean burden of responsibility and mental health in the intervention group had a significant decrease compared to before the intervention (P < 0. 001),however, after the intervention, the mean burden of responsibility and mental health in the control group was not significantly different than before (P > 0. 05). Conclusion: The results of this study emphasize the usefulness of psychological educational intervention in reducing the burden of responsibility and mental health of family caregivers of psychiatric patients. Therefore, holding training courses in the field of psychology for the caregivers of psychiatric patients can empower caregivers in various psychological dimensions, including reducing the burden of responsibility and increasing mental health.

Background: Melanoma is one of the most commonly diagnosed cancers and the second cause of cancer-related death among people. This disease is the rarest and most malignant type of skin cancer. In advanced conditions, it has the ability to spread to internal organs and can lead to death. In Iran, for several years, significant data about melanoma have been collected either manually or electronically, due to its prevalence and the high costs it leaves on the country's healthcare system, but despite these valuable data, the health system is still unaware of the high potential of data mining in predicting the survival of patients with melanoma. Therefore, the aim of this study was to design an intelligent system to predict the survival of these patients. Methods: This study was practical in terms of nature and descriptive-analytical and retrospective in terms of method. The research population consisted of patients with melanoma cancer from the database of the National Cancer Research Center affiliated to Shahid Beheshti University, located in Tajrish Martyrs Hospital, Tehran, Iran (between 2007 and 2012), who were followed up for 5 years (n = 4118). SPSS and Weka software were used to design the support system for melanoma cancer survival prediction. The final model for predicting melanoma cancer survival was selected based on the evaluation indices of data mining algorithms. Findings: Neural network algorithms, simple Bayes, Bayesian network (BN) and combination of decision tree with simple Bayes, logistic regression, J48, and ID3 were selected as the used models of the country's database. Based on the findings, the neural network performed better with a value of 0. 97 in terms of accuracy and 91. 03 in terms of features. Conclusion: The performance of the neural network in all evaluation indices was statistically higher than other selected algorithms. Therefore, this algorithm was chosen as a support system for predicting melanoma cancer survival.

Background: The purpose of this study was to investigate the effect of green human resource management on organizational sustainability with respect to the mediating role of motivation and service culture of employees of sports organizations in Fars Province, Iran. Methods: This was an applied research in terms of purpose and a descriptive-survey of correlation type in terms of data collection method. The statistical population of the study included the employees of sports organizations in Fars Province (n = 4047). A statistical sample of 395 people was selected using Cochran's method by stratified sampling method. To conduct the research, the standard questionnaires of organizational resources management of Sakhavalkar and Tadani, organizational sustainability of Karkolian et al., Hackman and Oldham motivation, and Danaifar service culture were used. The face and content validity of the questionnaire designed for this study was confirmed by the professors of this field and the reliability was confirmed using Cronbach's alpha for the questionnaires of green resource management, organizational sustainability, motivation, and service culture with values of 0. 86, 0. 78, 0. 85, and 0. 96, respectively. Statistical analysis of data was performed using structural equation modeling (SEM). Findings: Green human resource standards with a path coefficient of 0. 364 had an effect on sustainability. Moreover, the variable of service culture with a path coefficient of 0. 408 had a mediating role in the relationship between green human resources and sustainability, and the variable of motivation did not play a significant role. Conclusion: According to the results, it can be said that the application of green human resource management in the sports sector can be implemented and serious attention should be paid to its various aspects such as service culture and employee motivation to strengthen sports organizations through sustainable development.