Journal of Health System Research
Year:2020 | Volume:16 | Issue:2|Papers Count:10

Background: People with limited health literacy show a low level of health promoting behaviors. This study is performed aiming to determine relationship between health literacy status and health promoting behaviors among female high school students in Tehran, Iran, in 2018. Methods: This descriptive-analytic study was conducted on 370 people using cluster sampling method. Data were collected through demographic and background questionnaires, Health Literacy Measure for Adolescents (HELMA), and Health Promoting Lifestyle Profile II (HPLP-II) and analyzed using descriptive and analytical tests in SPSS software. Findings: The mean scores of health promotion behaviors and health literacy were 57. 54 ± 11. 24 (moderate) and 59. 92 ± 12. 87 (inadequate), respectively. The highest mean scores of health promotion behavior and health literacy dimensions were stress control (65. 55) and perception (74. 15) and the lowest mean scores were health responsibility (50. 18) and calculation (43. 69), respectively. There was a direct and significant relationship between health literacy and health promotion behaviors (r = 0. 43, P < 0. 001) with the study of magazines and the interest in health issues. However, the relationship between the use of the Internet and the evaluation of the health status with these dimensions was inverse and significant. There was an inverse relationship between the health promoting behaviors with educational stage (r =-0. 35, P < 0. 001) and age (r =-0. 31, P < 0. 001), and a significant relationship with the field of study (r = 0. 30, P < 0. 001). Conclusion: According to the study results, it is necessary to develop curriculum for promoting these behaviors and increase the health literacy in cyberspace.

Background: The aim of this study is to investigate the effect of Acceptance and Commitment Therapy (ACT) on cognitive fatigue in female patients with multiple sclerosis (MS). Methods: This was a quasi-experimental study with a pre-test and post-test design and three months of follow up performed on three groups of therapy, placebo, and waiting list. Thus, among the female patients with MS referred to the MS Society of Ahwaz, Iran, 41 patients were chosen with the convenience sampling method and divided into therapy (n = 13), placebo (n = 13), and waiting list (n = 14) by random sampling. Findings: All patients completed the Modified Impact of Fatigue Scale (MFIS) in the pretest and posttest stages and after the three-month follow-up period. The results of the mixed analysis of variance (ANOVA) showed that the interaction between time and therapy can reduce the cognitive fatigue in patients with MS (F = 3. 53, P = 0. 014, effect size = 0. 16, statistical power = 0. 84) and this reduction will remain and until the follow-up. Conclusion: According to fatigue as a main and pervasive complaint of this group, the results of this study can be used as an appropriate method to reduce cognitive fatigue in patients with MS.

Background: This study is conducted with the aim of determining the effectiveness of spiritual-based existential therapy and positive existential therapy on resiliency of elderly women. Methods: The present study was a quasi-experimental study with three groups and two stages of pre-test and post-test with control group. The statistical population of the study included all elderly women referred to comprehensive health service centers in Isfahan, Iran. The sample consisted of 36 persons who were selected based on the inclusion criteria among the elderly women referred to the mentioned centers and were randomly assigned into two experimental and one control group (n = 12 each). The study instrument included Connor-Davidson Resilience Scale (CD-RISC) that was completed in pretest and posttest phases by the three groups. The collected data were analyzed using analysis of covariance (ANCOVA) through SPSS software. Findings: The ANCOVA results revealed that there was a significant difference between spiritual-based existential therapy and control group in resiliency (P < 0. 001). Due to the differences in the mean values of the three groups, Bonferroni post hoc test showed that there was no significant difference between spiritual-based existential therapy and positive existential therapy and between positive existential therapy and control group (P > 0. 050). Conclusion: Spiritual-based existential therapy is an effective treatment to increase resiliency in elderly women. Elderly women, by participating in group sessions of spiritual-based existential therapy, gain higher resilience against adverse effects of the elderly stage.

Background: One of the essential factors in regulating the excitement of irritable children is mothers’ parenting style which is effective in self-controlling of these children; therefore, the purpose of this study is to develop a parental model based on the attachment theory of children with disruptive mood dysregulation disorder (DMDD). Methods: This study was conducted using directed content analysis method with deductive classification system; and purposeful sampling continued with data saturation approach. Attachment texts were analyzed for parental characteristics. First, the concepts associated with parenting were identified and then the extracted concepts were classified based on the main components of attachment theory. Finally, the validity and reliability of parental patterns were investigated and confirmed. Findings: In this template, a matrix was drawn and then classification was carried out in two levels; level one containing the main attachment components, and level two containing 71 codes based on level one. Thus, the parenting model was considered with six main components of behavioral, affective, cognitive, psychic, kinesthetictactile, and physical security. Conclusion: The proposed parenting model, which includes behavioral, emotional, cognitive, psychological, kinetic-tactile, and physical safety components, can be used along with other treatments available for children with mood disorders.

Background: Breast milk contains organic nutrients necessary for the growth and development of infants and children. Since various factors are effective in the early discontinuation of breast milk, the accurate identification of these factors in various cultural contexts can play an important role in providing, maintaining, and promoting the health of children. Thus, the present study was conducted to determine the causes of breast milk discontinuation and use of artificial milk in children aged 0-18 months in Isfahan, Iran. Methods: This was a cross-sectional descriptive analytical study with the study population including 600 mothers with 18-month old children in 20 centers and health centers in Isfahan City. Data were collected using questionnaires and interview with mothers. Findings: The most important reasons for discontinuation of breastfeeding were mothers' lack of breast milk, infant’ s unwillingness to breastfeed, mother’ s disease or specific drug use, childhood diseases, maternal occupation, and early onset of supplementary foods. The most important reasons for using synthetic milk from the viewpoint of mothers were lack of breast milk, child crying and restlessness, and the recommendation by a pediatrician. Conclusion: The main reason for early breastfeeding and the use of artificial milk is the inadequacy of breast milk. It seems that educational interventions are essential considering the importance, benefits, nutrition manner, the way to resolve breast-feeding problems, and the adequacy of milk in the child.

Background: The presence of antibiotics in water resources is known as a serious threat to human and ecosystem health due to the creation of persistency in microorganisms. Therefore, the aim of this study is to determine the efficiency of potassium ferrate with ultrasound waves (Fe(VI)-US) for the removal of ciprofloxacin. Methods: This was an experimental study conducted to evaluate the effect of potassium ferrate alone and with ultrasound for the removal of ciprofloxacin. Moreover, the effective parameters, including contact time (5-10 minutes), initial concentration of antibiotic (10 and 15 mg. l-1), pH (4-9), and potassium ferrate concentration (15-150 mg. l-1) were investigated under different frequency (30-70 kHz) in a reactor for the removal of ciprofloxacin. The remained ciprofloxacin concentration in the solution was determined by high performance liquid chromatography (HPLC) with an ultraviolet (UV) detector at 280 nm and reverse phase column C18. Findings: The removal rate of ciprofloxacin by potassium ferrate was obtained as 65-78%. The efficiency of ciprofloxacin removal increased by 5-8% through the application of potassium ferrate with ultrasound waves (Fe(VI)-US). Moreover, the highest removal efficiency was 86% for the initial antibiotic concentration 10 mg. l-1, potassium ferrate concentration 150 mg. l-1, pH = 5, and frequency 60 kHz. Conclusion: The results of this study showed that potassium ferrate with ultrasound can be effectively used for the removal of ciprofloxacin in aquatic solutions.

Background: Polyethylene Terephthalate (PET) is a polymeric resin of polyester group used in the manufacture of beverage bottles. Migration of PET ingredients such as acetaldehyde to the content of bottles has adverse effects on consumers’ health. The purpose of the present study is to measure acetaldehyde in bottles of water. Methods: A total of 36 bottles of water stored in PET from 12 commercial brands (6 brands from each mineral and drinking water) were collected from retail stage in Isfahan, Iran. Measurement of acetaldehyde was performed using gas chromatography-mass spectrometry (GC-MS). The results were compared with the limit defined in standard of European Community in SPSS software using t-test. Findings: Acetaldehyde was found in 26 samples with the frequency of 72%. The average of this compound was 22. 18 ± 6. 79 and 6. 36 ± 4. 53 parts per billion (ppb) in mineral and drinking water, respectively. Acetaldehyde observed more in mineral water compared to drinking water samples. The amount of acetaldehyde was less than the limit defined in standard of European Community in all samples. Conclusion: According to the comparison of the measured values for acetaldehyde in mineral and drinking water in the present study with standard limit of European Community, it is recommended to perform the studies for risk assessment of different compounds migrated from bottles to their content and their effects on health.

Background: Schools of health sciences play an important role in public health by training the workforce and the development of scientific work. However, several factors can threaten the position and status of these centers and disrupt their interactions with executive-industrial environments. Since no comprehensive study has been conducted on the barriers facing the schools of health sciences, this study is conducted with the objective to identify the concerns of the schools of health sciences for interaction with executive-industrial environments. Methods: In this study, the conversation flow of 20 specialists and heads of the schools of health sciences of Iranian type 1 universities was filmed at Isfahan University of Medical Sciences, Isfahan, Iran in summer 2018; the conversations were handwritten and then typed word for word; they were then analyzed by content analysis method. Findings: As a result of data analysis, the related factors were classified into two main categories: 1) challenges and needs of interaction with health deputies, 2) challenges and needs of interaction with industry, which the latter itself included four categories. Conclusion: For the first time, the present study achieved some important results on the categorization of a set of challenges and needs related to the interactions with the health deputy office, as well as the interactions with the office of industrial relationships as the barriers to the operations of the universities and the operational environments. Therefore, the above results can be used as a guideline for designing comprehensive programs to remove barriers to communication and interaction at the schools of health sciences with their offices of health deputy and industrial relationships.

Background: Most previous studies have not referred to the implications of using electronic health record systems. So the purpose of the present study is to investigate the realization of the consequences of using the Integrated Health System (SIB) from users' point of view in Isfahan, Iran. Methods: This was a descriptive cross-sectional study with the statistical population including all users of SIB located in Isfahan primary healthcare centers. The sample consisted of 320 users according to Morgan table. A questionnaire was arranged in five dimensions including problem solving, decision rationalization, horizontal integration, vertical integration, and customer service. After examining the validity and reliability of the questionnaire, the data were analyzed by single sample t-test in SPSS software. Findings: The findings showed that although the implementation and use of SIB contributed to improving the integrity and coordination of horizontal (t = 2. 30, P < 0. 050) and vertical (t = 1. 96, P < 0. 050) communications as well as customer service (t = 8. 31, P < 0. 001), it had no significant role in problem solving (t = 0. 68, P > 0. 050) and decision rationalization (t = 1. 05, P > 0. 050). Conclusion: Problem solving and decision rationalization have been the main objectives of SIB; nevertheless, users evaluated them as main weaknesses of the system. So paying attention to the needs of different users is recommended to its stakeholders.

Background: Healthcare decisions should be based on evidence generally provided by randomized controlled trials (RCTs) comparing two or more interventions for a condition that affects the target population. Methods: When more than one study is available, meta-analysis can be used to combine several intervention effects and obtain an overall estimate of that effect size in the target population. However, for most clinical conditions, there are more than two effective interventions. In such cases, it is not possible to perform multiple pairwise meta-analysis. Additionally, direct clinical trials may not be designed and implemented for all interventions. Findings: Network meta-analysis (NMA) is a method for comparing multiple interventions simultaneously in a single study using a combination of direct and indirect evidence in a network of RCTs the results of which enable us to rank all the interventions in a coherent way. Conclusion: The present study was designed to provide a basic explanation of the benefits of producing a direct and indirect evidence-based network, reviewing key assumptions in NMA, and explaining the stages of performing NMA. In addition, by using an example to evaluate the cardiac toxicity of different interventions to treat HER-2 positive breast cancer, the implementation and production steps of the meta-analysis network were presented.