مجله دانشکده بهداشت و انستیتو تحقیقات بهداشتی
سال شانزدهم شماره 2 (پیاپی 62، تابستان 1397)

Iran's Health Sector Evolution Plan (HSEP) is one of the most important national health reform plans. HSEP has attracted many criticisms. An important criticism is about its service costs. This article reports the results of a project conducted to compare the costs of normal and caesarian section delivery before and after implementation of the HSEP. This was an applied research project using hospital accounting records as data. A total of 120 delivery files (60 normal delivery and 60 caesarian section) were selected randomly from the accounting software of a large hospital in Isfahan before and after May, 2014.The data in each subject’s file ─ paid shares of the hospital, patient and insurance ─ but not hoteling, inpatient and other costs was extracted. The health service providers’ incomes based on the annual tariffs of the services and changes in payments for each service for gynecologist and anesthesiologists were calculated. Data were analyzed using the excel software. The costs of normal delivery and caesarian section after implementation of the National HSEP had increased by 193% and 226%, respectively. In addition, of the treating physicians (gynecologists and anesthesiologists) had also increased by 257% for the normal and by 130% for caesarian section. Changes in the sums of money involved in service delivery indicates shifting of parts of the costs from the patients to the health subsidy and insurance systems. The health System Evolution has not lead to real reductions in the out-of-pocket money paid by the patients. Higher cost of services will imply the need for better cost management. Increased costs of services will be to the benefit of neither patients nor the health system. This would mean that in designing and implementation of the Health Sector Evolution Plan economic aspects should be taken into consideration more carefully

The Internet is a strong and multimedia technology that meets the most basic needs of human beings; however, this new technology can have great negative effects on people's lives. This study aimed to determine the prevalence of Internet addiction and its relationship with quality of sleep and quality of life among students of Zahedan University of Medical Sciences. This descriptive-analytical cross-sectional study was conducted in Zahedan in 2017.The study population included all the students of Zahedan University of Medical Sciences. A sample of 340 students were selected through stratified random sampling. Data were collected using three World Health Organization questionnaires, namely, quality of sleep, Internet addiction and quality of life questionnaires, and analyzed using SPSS (v22), the statistical tests being ANOVA and linear regression test and T-test. Data analysis showed that Internet addiction and the quality of life among the students were mild (43 ± 15) and desirable (78.4± 1.6), respectively. However, the sleep Quality Index for 282 students (82.9%) was not desirable. There were statistically significant associations (p<0.05) between the place of residence on the one hand and Internet addiction, quality of sleep and quality of life on the other. Based on the findings it can be concluded that Internet addiction has a negative effect on the quality of sleep and quality of life of the students. The students need to pay more attention to the use of the Internet. It is also recommended that behavioral and cognitive intervention be designed and implemented aiming at teaching the students proper use of the computer and the Interne

Sleep disorders and insomnia are problems which create many problems for the elderly and imperil their physical and mental health. The present study aimed to investigate the effect of multi-component cognitive-behavioral therapy on insomnia symptoms and sleep parameters in elderly people. The statistical population includes all the elderly people residing in Kahrizak nursing home, Tehran. The sample consisted of 30 elderly people with insomnia selected by purposive sampling and randomly assigned to experimental and control groups.They completed the Athens Insomnia Scale and Sleep Log. The experimental group received the Edinger’s insomnia disorder multi-component cognitive-behavioral therapy in six 90-min sessions; the control group received no intervention. Based on MANCOVA, ANCOVA and Benferoni post hoc, group comparison in the pre-test and follow-up showed that the average scores of insomnia and sleep-onset latency were statistically significantly reduced in the experimental group as compared to the control group, and the total length of sleep was significantly increased (P≤ 0/001). Follow-up did not reveal any significant differences between the experimental and control groups as regards the total time of staying in bed. Based on the findings of this study, it is recommended that psychologists and nurses working in area of elderly use the multi-component cognitive-behavior therapy to improve the sleep quality of the elderly

The purpose of phenylketonuria (PKU) screening is to assess the risk of, and prevent, the disease in the newborns likely inflicted with it. The aim of this study was to investigate why and how PKU screening was decided to be included in the national health agenda, initiated and implemented in Iran. This qualitative study was conducted based on the Kingdon’s framework model in 2015. The participants were thirty-eight policy-makers, managers and researchers selected by purposeful sampling.Data were collected using semi-structured interviews and analyzed using framework analysis. The physical and mental disabilities, medical and maintenance costs and the need for rehabilitation services were examples of the problem stream. In addition, sampling based on the National Congenital Hypothyroidism Program and implementation feasibility at the national level were examples of the policy stream. Finally, pressure by the patients' families, the Scientific Children Association and executive managers were examples of the political will stream. When the three streams occurred simultaneously, health policy-makers agreed to implement the program and then was opened the window of opportunity. Successful implementation of the National Phenylketonuria Screening Program in Iran has been the result of interactions among three streams, namely, nature of the problem, political will and optimal use of policy-makers of the window of opportunity opened

In health promotion, empowerment is a process through which people gain greater control over decisions and actions affecting their health. This study aimed to assess the predictive factors of health care empowerment among women in reproductive age in 2016. This cross-sectional study was conducted on 549women in reproductive age referring to health centers in South Tehran. The participants were recruited through cluster and multi-stratified sampling. Data were collected using the Health Care Empowerment Questionnaire (HCEQ), which has three subscales, namely, degree of control, involvement in interactions and involvement in decision-making. The data were analyzed using the descriptive and analytical tests and multi-regression analysis. Husbands' education level, women's employment, family size, ethnicity, history of chronic diseases and economic status were predictors of degree of control. Husbands' education level (under high school diploma and high school diploma), family size (2-3, 3-4) and moderate economic status (sufficient income) predicted involvement in interactions. In addition, husbands' education (incomplete high school diploma and high school diploma), family size (2-3, 3-4), women's employment and history of chronic diseases predicted involvement in decision-making. The findings indicate that various individual, family and socio-economic conditions of reproductive-age women influence their potential empowerment for receiving health care services. A family-based approach to facilitate receiving reproductive health care seems to be essentia

Lipoprotein disorders are an integral component of type-2 diabetes mellitus (T2DM). Therefore, early diagnosis and treatment of lipid disorders can be beneficial in prevention and treatment of many complications associated with T2DM.The aim of this study wasto determine the effect of docosahexaenoic acid (DHA) supplementation on the serum levels of apolipoproteins (Apos) A1, A2, B48 and C3 in patients withT2DM.

In this 8-week randomized, double-blind, placebo-controlled clinical trial, 44 T2DMpatients were randomly assigned to either an experimental group (n=22, receiving daily 2.4 g DHA) or a placebo group (n = 22, receiving paraffin). The serum levels of AposA1, A2, B48 and C3 were measured in all the patients at the beginning and at the end of the period.

There was a statistically significant increase in the mean serum level of ApoA1 in the DHA group (p = 0.014). In addition, a significant difference was observed in the serum level of ApoC3 after intervention between the DHA and placebo group (p=0.031). There were no significant differences between the two groups as regards the mean changes in serum levels of ApoA1, ApoA2, ApoB48 and ApoC3.

Dietary supplementation with docosahexaenoic acidhasno effects on the serum levels of apolipoproteins in patients with type-2 diabetes

Diabetes mellitus is one of the most prevalent and important health problems in the world.Considering the high prevalence of metabolic syndrome in diabetic patients and the potential effects of its components on HbA1C in these patients, the present study was conducted to determine the effect of metabolic syndrome components on HbA1C in type-2 diabetic patients. This retrospective cohort study was conducted on 157 diabetic patients regularly referring to the Diabetes Control Center in Qazvin City during 2014, where complete data about theirmetabolic syndrome components, as well as HbA1C levels were available. The data were analyzed using multiple linear regression (α=0.05 for statistical significance). Based on the regression model, the effects of age, HDL-C and fasting blood glucose on HbA1C were statistically significant; the effects of other variables were nonsignificant. The R2value for the variables entered for prediction of HbA1C was found to be 0.45 (R2 = 45%). Considering the significant relationship between some components of the metabolic syndrome such as HDL-C and fasting blood glucose on HbA1C in diabetic patients, it is essential to design and implement programs to reduce the level of HbA1C in these patients

The aggregation of misfolded proteins leads to various cellular malfunctions and disorders such as Alzheimer’s disease. The conventional treatments of such diseases often fail due to their inability to cross the blood-brain barrier. The ability of nanoparticles to influence protein folding and aggregation and, as a result, their potential therapeutic effect in diseases involving protein aggregation, sounds promising. The objective of this study was to determine the effect of silver nanoparticles (AgNPs) on the amyloid aggregation of Hen Egg White Lysozyme (HEWL).
Material and Lysozyme was dissolved at 2 mg/mL in a 50 mM glycine buffer (pH 2.5) and incubated at 57 °C while being stirred gently with Teflon magnetic bar; the result was conversion of lysozyme to amyloid. The effect of the particles was assessed using different technics: Thioflavin T (ThT), Congo Red, atomic force microscopy (AFM) and Toxic test (MTT). Data were analyzed using SPSS 16, the statistical test being the independent t-test. Incubation of lysozyme with AgNPs at a concentration of 3-60 mcg/L could inhibit the HEWL fibrillation (p<0.05). Surprisingly, the lowest concentration (3 mcg/L) was found to be the most effective; at this concentration, the lag time (nucleation phase) became longer and the fibrillation phase considerably shortened. In addition, the cytotoxicity of the aggregated amyloids in the cell culture decreased. Based on the findings, it is concluded that silver nanoparticle surfaces can actas nano-chaperones and inhibit HEWL fibrillation; thus, they can potentially be used in the treatment of Alzheimer’s disease