مجله دانشکده بهداشت و انستیتو تحقیقات بهداشتی
سال نوزدهم شماره 4 (پیاپی 76، زمستان 1400)

Referral system is one of the principles and foundations of primary health care services. One of the most important challenges and problems of the referral system is the lack of knowledge of people and patients of its nature, services and benefits. The purpose of this study was to identify the factors affecting the acceptance of the referral system by patients.

This was a qualitative study conducted in 2021 using the framework (structural) analysis method. The participants were 18 experts in the field of referral system and 14 patients referred to the outpatient and inpatient wards of Imam Khomeini Hospital Complex in Tehran selected by purposive sampling. Data were collected by Semi-structured interviews and analyzed using the MAXQDA.

Factors influencing the acceptance of the referral system by patients were found to be the following: (1). Factors related to the stewardship and governance of the health system (responsibility and accountability, appropriate levels of health services, patient-centered care, and rules and regulations); (2). Factors related to the health services access (financial, physical and cultural); (3). Factors related to service providers (trusting healthcare staff, professional skills of service providers, and their behavioral and communication skills); (4). Factors related to the service delivery process (quality of service delivery, attention to patients' wants and needs, use of technology in service delivery, monitoring service delivery, and service coverage); (5). factors related to the recipients of the services (satisfaction, education, awareness and communication).

Considering the importance and key role of patients in the success of the referral system, health planners and policy makers should pay special attention to the factors identified in this study.

Using a proper method to prioritize and develop a basic health services package is a serious challenge. This study was conducted to design a process for developing and revising a basic health services package in Iran.

A combined study of quantitative and qualitative methods was used in this study. The qualitative part was conducted through holding 25 in-depth individual interviews and two focus group discussions with experts from the Ministry of Health and Medical Education, Program and Budget Organization and insurance organizations, while the quantitative part was a descriptive cross-sectional study including 277 experts using a valid and reliable questionnaire.  Data analysis of the qualitative and quantitative parts was done using a content analysis and the SPSS-23 software, respectively.                                                                                                                             

The process of developing a basic health services package includes 4 steps, namely, explaining the list of services in the basic health services package, extracting the criteria for including services in the service package, prioritizing the criteria for including services in the package, and comparing services with priority criteria. In the prioritization stage, disease burden criteria, target groups and community needs were found to have the highest means and recognized as the most important criteria.

The process designed in this study for developing and revising a basic health services package provides policymakers with the required scientific evidence by emphasizing the introduction and continuity of services that have higher priorities and the elimination of services that have lower priorities.

Occupational injuries are an important human resource management challenge with negative effects on employees and organizations. A knowledge of the prevalence of occupational injuries is the first step in eliminating or reducing them. The aim of this study was to determine the prevalence of occupational injuries among financial employees of hospitals affiliated to Tehran University of Medical Sciences.

This was a cross-sectional questionnaire survey conducted in 2019 in 13 hospitals of Tehran University of Medical Sciences using a valid questionnaire to gather data. A total of 162 questionnaires were randomly distributed among the financial staff of the hospitals, but only 147 subjects completed the questionnaires. Data were analyzed using the SPSS statistical software.

Analysis of the data showed that 52.6% and 50.2% of the financial staff of the hospitals were suffering from physical and mental occupational injuries, respectively. Most of the occupational physical injuries were related to headache, neck pain, back pain and visual impairment, and most of the occupational psychiatric injuries were stress and anxiety. Female and single employees experienced significantly more occupational injuries. Working in a sitting position for a long time, lack of proper equipment operation, lack of safety and health facilities, insufficient training and carelessness of staff were the causes of musculoskeletal injuries.

About half of the hospital financial staff were found to suffer from occupational injuries. Occupational injuries had had direct and indirect costs for the employees and the hospitals. Hospital managers should plan and implement measures to eliminate or reduce occupational injuries at an individual, group, and organizational level.

The objective of this study was to determine the seroepidemiological history of SARS-CoV-2 infection among asymptomatic children in Tehran.

Blood samples of children younger than 14 years old were collected during the period autumn-winter 2020 and spring 2021 and tested for SARS-CoV-2 IgG antibody using the EUROIMMUN ELISA kit. In addition, questionnaires were used to collect demographic and infection status information in the participants. Data were analyzed using the SPSS software.

Out of the 1142 children collected from the children with no COVID-19 symptoms, 33.3% (381/1142) were found to have had a history of SARS-CoV-2. The positive samples in girls and boys were 34.1% and 33.03%, respectively. Analysis of the data showed no statistically significant differences between the infection rate on the one hand and age, family size, underlying diseases, gender or occupations of the family members on the other hand. In addition, the infection rate was significantly lower in autumn 2020 than in winter 2020 and spring 2021.

SARS-CoV-2 infection can occur in children with no clinical symptoms. In addition, the infection rate is in direct correlation with an increase in age of the children.

Cardiovascular diseases (CVD) are the leading cause of death globally, causing annually 17.3 million deaths, more than 75% of these deaths occurring in the low- and middle-income countries. Although extensive studies have been conducted to determine the risk factors for these diseases, limited studies have been performed to investigate these factors using a multilevel analysis method. The aim of this study was to determine the CVD risk factors in the staff of Mashhad University of Medical Sciences using a multilevel analysis approach, as well as compare the application of the conventional and multilevel logistic regressions in doing this according to the hierarchical structure of the data.

This was a case-control study including a total of 1091 randomly selected individuals from among the people in a prospective cohort study, namely, the “PERSIAN Cohort Study in Mashhad University of Medical Sciences”.  The case group included 152 patients with a definite diagnosis of CVD and the control group 939 staff members not suffering at the time from CVD. Data analysis was done using the STATA software. Data analysis (based on frequencies and percentages) was done using one-way and two-level logistic regression analysis at α = 0.05.

Multivariate analysis showed that hypertension, smoking, fasting blood sugar and cholesterol were among the cardiovascular risk factors with a significant relationship with the disease. Based on the two-tier logistic regression model, the odds ratio for CVD in the hypertensive patients was 3.93 times that in individuals with a normal blood pressure with a confidence interval of 2.64-6.28. The risk in smokers was 1.85 (1.11-3.09) times that in nonsmokers. The CVD odds ratio in individuals with a high fasting blood glucose level (undiagnosed/uncontrolled diabetes) was 2.7 (1.18-6.18) times that in those with a normal blood pressure. There were no statistically differences between the case and control groups as regards the other variables ─ body mass index, diabetes (controlled or uncontrolled), or blood triglyceride level.

The findings show that statistical model selection can influence the results of data analysis in a dataset. It should be noted that the results of this study indicate a high prevalence of some cardiovascular risk factors among the staff. Another crucial point in this study is that the level of physical activity of the staff was found to be low, which would result in increased risk of overweight and obesity.

Cardiovascular diseases are the most common cause of death in most countries of the world, hypertension being the most important cause of disability. The aim of this study conducted in 2020-2021 was to determine the effect of educational intervention on the nutritional knowledge, illness perception and dietary adherence in hypertensive middle aged women based on the transtheoretical model (TTM).

This was a quasi-experimental study on middle-aged women (30-59 years old) suffering from hypertension referred to the  health centers and health bases in the 21st district of Tehran in 2020-2021. A total of 164 subjects were randomly assigned to the intervention (n=82) or control (n=82) group by randomized quadruple blocks. A multifaceted questionnaire was completed for both the control and intervention groups and their blood pressure measured. This was followed by  a one-month virtual education for the intervention group in the form of a WhatsApp group and designing and developing fifty-six podcasts and educational clips with a maximum duration of four minutes based on the transtheoretical model constructs. After a lapse of one and six months both groups completed the questionnaire again and their blood pressure was measured. Descriptive statistics and general linear model were used for data analysis using the SPSS version 25 (p<0.05).

Before the intervention the mean age of the subjects was 50.16 years and their systolic and diastolic blood pressures were 1.35 and 1.84 mmHg, respectively, and there were no statistically significantly differences between the two groups as regards contextual variables, constructs of nutritional awareness, disease perception, diet adherence, systolic and diastolic blood pressures and body mass index (as an ananthropometric index) and transtheoretical model constructs. Data one month after the intervention revealed significant differences (p<0/001) between the two groups (p <0/001) as regards the constructs of nutritional awareness, disease perception, self-sufficiency construct of the transtheoretical model and systolic blood pressure. Six months after the intervention significant differences were observed between the two groups as regatds  nutritional awareness constructs, disease perception (p<0.007), diet adherence (p<0.001), stages of change constructs (p<0.001) and self-sufficiency (p<0.001) of the transtheoretical model.

The results of this study show that educational intervention based on the transtheoretical model in middle-aged women with hypertension can increase their nutritional knowledge, illness perception, self-sufficiency, self-adequacy and diet adherence.

Delivering health services to the elderly is one of the most important responsibilities of the health care system of any country. In order to improve the provision of health services to the elderly population under its coverage, the National Social Security Organization conducted this study with the aim of designing, implementing and evaluating a model for providing outpatient health care services to the elderly population under the coverage of its Tehran Province Office. 

This was a sequential-exploratory mixed-method study. The initial model was developed and validated using the integrated review method and the final model using the Delphi technique and group discussions with experts. Then the educational program was developed and implemented for the health team. Assessment of the effectiveness of the program was done using a researcher-made knowledge and attitude questionnaire (pre- and post-test). The model was then implemented in the Khandan-e-Hakim Clinic. The effectiveness of the model implementation was determined based on the qualitative content analysis of the interviews with the elderly and qualitative content analysis of the health team comments.

The outpatient care model of the elderly included an organized clinical process consisting of 6 phases. The mean age of the health team members was 45.7±15.11 years. The difference between the health team satisfaction total scores before and after participating in the educational program was statistically significant (P≤0.05). Further analysis of the data showed, based on the interviews with the elderly, the main categories to be "assessment of cognitive function, mood and behavior", "physical assessment", "appreciation of the health and dignity of the elderly" and "satisfaction of the elderly and their companions". Analysis of the comments of the health team revealed their satisfaction with the implementation of the model.

The introduced model can make possible rapid identification of health problems and timely intervention in the elderly population. This implementation model will help disease prevention and complications at different levels. The findings of this study can help service providers to provide better care and health services for the elderly.

One of the emotions that plays an important role in the health of all people is the emotion of anger which is one of the main emotions. The aim of the present study was to compare the effectiveness of emotion regulation and resilience training mediated by locus of control on anger control in medical students.

This was an experimental study. The statistical population included all medical students randomly divided into three groups of 30 students each by simple and multi-stage cluster sampling. One of the experimental groups received 8 sessions of emotion regulation training and the other 8 sessions of resilience training. Data were collected on all the subjects using the Rotter locus of control and Spielberger's anger and trait questionnaires
and analyzed using repeated-measures and two-factors analysis of variance.

Analysis of the data showed that there was a statistically significant difference between the emotion regulation and resilience training groups as regards anger control. In addition, the differences between the two groups as regards the locus of internal and external control in controlling anger and its subscales were also significant.

Teaching emotion regulation and resilience skills can, like other skills, help greatly students against the challenges of the present era.