فهرست مطالب

Health Promotion Perspectives - Volume:9 Issue:3, 2019
  • Volume:9 Issue:3, 2019
  • تاریخ انتشار: 1398/05/27
  • تعداد عناوین: 12
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  • Vijay Kumar Chattu *, Sebastian Kevany Pages 161-163
    The concept of health security involves the intersection of several fields and disciplines and is an inherently political and sensitive area. It is also a relatively a new field of study and practice which lacks a precise definition - though numerous disciplines and areas like foreign policy, national interests, trade interests, health security, disaster relief, and human rights contribute to the concept. The purpose of this paper is to highlight the need for, health diplomacy in improving health security. For example, it is not unusual for developing country societies to build their health security measures by restricting travel and movement of those emanating from affected areas. When extreme health security measures threaten cordial and cooperative relations between nations, the issue of protection of one country’s population may lead to the risk of international conflict. As the World Health Organization (WHO) stated in 2007 that‘functioning health systems are the bedrock of health security,’ it is crucial that partners with sound financial and technical capacities benefit developing countries through their assistance and sharing information. This paper explores how health diplomacy holds great promise to address the needs of global health security through binding or nonbinding instruments, enforced by global governance mechanisms.
    Keywords: Health diplomacy, Healthsecurity, Global health, Ebola, Health policy, Global healthgovernance
  • Nazli Namazi *, Neil R. Brett, Nick Bellissimo, Bagher Larijani, Javad Heshmati, Leila Azadbakht Pages 164-173
    Background
    Seafood is the main source of long-chain n-3 polyunsaturated fatty acids (n-3PUFAs) with beneficial health effects; however, findings on the association between the consumption of different types of seafood and type 2 diabetes mellitus (T2DM) are conflicting. Our objective was to perform a systematic review and meta-analysis examining the relationship between different types of fish/seafood and the risk of T2DM in adult populations.
    Methods
    A systematic search of PubMed/Medline, Scopus, and Web of Science (ISI) databases was performed for cohort studies, published in English, before 1 September 2017. Multivariate adjusted relative risk (RR) estimates with 95% confidence intervals (CIs) for each category of seafood were pooled to examine the association.
    Results
    Comparing the highest vs. lowest fatty fish intake categories indicated that there was a significant inverse association between the consumption of fatty fish and onset of T2DM (RR:0.89; 95 % CI: 0.82, 0.98; I2: 0%, P=0.54). However, after performing sensitivity analysis, we found that eliminating one study resulted in a non-significant association (RR: 0.93; 95 % CI:0.80, 1.09). There were no significant associations between lean fish (RR: 1.03; 95% CI: 0.87,1.22, I2: 51.0%, P=0.08), seafood other than fish (RR: 0.95; 95% CI: 0.83, 1.10, I2: 71.2%,P=0.002), fish products (RR: 0.96; 95% CI: 0.82, 1.13, I2:0%, P=0.62), and fried fish (RR: 1.02;95% CI: 0.83, 1.26, I2:71.2%, P=0.06) and T2DM risk.
    Conclusion
    The risk of T2DM was not associated with the intake of lean fish, seafood other than fish, and fish products. However, due to the low robustness of findings regarding protective roles of oily fish, more longitudinal studies are needed to clarify this association.
    Keywords: Seafood, Diabetes mellitus, Type 2, Fatty acids, Metaanalysis
  • Vijay Kumar Chattu *, Andy W Knight Pages 174-180
    Background
    The Caribbean region, with a population of around 17 million, has the highest burden of chronic noncommunicable diseases (NCDs) in the region of the Americas. It is estimated that diabetes and hypertension has an economic impact of around 5%-8% of the gross domestic product of the region. The purpose of this study was to explore and understand how global health diplomacy contributed to the evolution of a collective Caribbean regional summit declaration to address the epidemic of NCDs.
    Methods
    A systematic review was conducted, and all the major databases such as MEDLINE, PubMed, EMBASE, Scopus, Web of Science, EBSCO, Global Health database and other available policy documents from various sources were screened. All articles available from 1910-2018were extracted. From the total of 3223 titles, after filtering, the search narrowed down to 28full texts that are included in this study. Policy documents and articles related to NCDs, global health diplomacy, and the Port of Spain Declaration (POSD) were the focused themes.
    Results
    The Caribbean region showed significant commitment to the prevention and control of NCDs through its united voice and commitment since 2001. The successful rounds of negotiations for regional health have led to the formulation of the 15- point multisectoralPOSD "Uniting to Stop the Epidemic of Chronic NCDs." This was the first Summit in the world where the Heads of Government focused on prevention and control of NCDs with a clear road map for policy implementation, collaboration, and collective action. This regional summit declaration gained global attention and resulted in the United Nations Political Declaration on the Prevention and Control of NCDs and as WHO Global Action Plan for the Prevention and control of NCDs 2013-2020.
    Conclusion
    There is enormous scope for this evolving area of Global Health Diplomacy in addressing the future challenges of health security.
    Keywords: Global health, Diplomacy, Non-communicable Diseases, Epidemics, Caribbean region, Disease prevention
  • Hamid Reza Shaamekhi, Mohammad Asghari Jafarabadi, Mahasti Alizadeh * Pages 181-190
    Background
    Self-medication is the choice and use of medications by people to treat a self diagnosed illness or symptom. The aim of this study was to search the relationship between a number of socio-demographic conditions and self-medication in the population covered by health complexes in Tabriz, Iran.
    Methods
    This study was a cross-sectional descriptive-analytic study and was carried out on the population covered by health complexes in Tabriz. Participants were recruited by a multi-stage sampling method. A total of 1000 participants were included in the study. Data collection was done using a researcher-created questionnaire. Data were analyzed using chi-square test and logistic regression.
    Results
    The incidence of self-medication was 70.9% for participants who reported illness in the last month. The chance of self-medication was higher in young (P=0.007) and middleaged (P=0.012) groups, and housewives (P=0.048); and was lower among participants who were not literate (P=0.047). There was no significant relationship between gender and self medication (P=0.553). The high cost of visits was mentioned as a reason for self-medication. The most frequently mentioned drugs used in self-medication were analgesics, cold medicines, and antibiotics, respectively. More frequent reasons for self-medication were the previous experience of the disease, the assumption that the ailment was not important, and the high cost of visits, respectively.
    Conclusion
    The prevalence of self-medication in this study was high. Considering the results, education in the community, financial support, and monitoring the delivery of drugs can play an important role in improving the pattern of drug use.
    Keywords: Cause, Drug, Demographic, Self-medication
  • Gholam Abbas Shirali, Leila Nematpour * Pages 191-197
    Background
    Resilience engineering (RE) is a new approach to upgrade safety management systems. Due to its novelty in the field of safety, RE seems to be promising in providing good indicators to assess priorities in organizational strengths/weaknesses while planning to promote safety within organizations. Several methods have been recently developed to evaluate REperformance. The current study is an attempt to quantify and determine the priorities of REdimensions in a steel industry using analytic network process (ANP).
    Methods
    In this cross-sectional study, 489 male workers of a steel industry participated. Forthis purpose, the RE questionnaire was distributed among workers and, then, super decisions software (version 3.2) was used to analyze the data.
    Results
    The results indicated that there was a sufficient level of RE in the organization where top management commitment with normalized weight 0.1781 and awareness-opacity with normalized weight 0.1483 were ranked as the first and last priorities of the organization, respectively.
    Conclusion
    The results of this study showed that the top management system, with the adoption of safety policies, has been able to improve the performance of RE in the organization. Managers should consider appropriate measures to improve the RE situation.
    Keywords: Analysis network process, Safety management systems, Resilience engineering, Superdecisions software
  • Javier F. Boyas *, Tatiana Villarreal, Otálora, Luis R. Alvarez, Hernandez, Mariam Fatehi Pages 198-206
    Background
    Guided by an ecological systems theory (EST) framework, the purpose of the present study was to investigate how multiple micro, mezzo, and macro factors influence the suicidality continuum from suicidal ideation to suicide attempt among Latinx LGB (lesbian, gay, and bisexual) youth living in the United States.
    Methods
    Data for this cross sectional-study included 451 participants who self-identified as Latinx LGB on the 2017-National Youth Risk Behavioral Survey. The analysis explored micro, mezzo, and macro-level factors’ association with three suicidality outcomes (ideation, planning, and attempt) at the bivariate and multivariate level. Since the outcome variables were dichotomized, univariate logistic regressions and backward elimination logistic regressions were used.
    Results
    The most commonly reported suicidal behavior was ideation (n = 173; 40%), followed by planning (n = 150; 34%), and then attempt (n = 64; 21%). Findings from the backward elimination logistic regression on suicidal ideation suggest the best set of independent variables are being bullied at school (odds ratio [OR] = 2.81; CI: 1.61–4.89), experiencing sexual assault(OR = 2.32; CI: 1.32–4.07), experiencing depressive symptoms (OR = 1.99; CI: 1.07– 3.69),being cannabis use (OR = 1.76; CI: 1.08–2.89), and being female (OR = 1.72; CI: 1.01–2.93).For suicide planning the model suggested, experiencing depressive symptoms (OR = 3.21; CI:1.74–5.91), cannabis use (OR = 2.46; CI: 1.49–4.07), being bullied at school (OR = 2.04; CI:1.17–3.58), and experiencing sexual assault (OR = 1.88; CI: 1.07–3.31) exhibited the strongest relationships. Suicide attempt was significantly associated with cannabis use (OR = 3.12; CI:1.60–6.08), experiencing depression (OR= 2.89; CI: 1.30–6.43), experiencing sexual assault(OR = 2.77; CI: 1.34–5.71), and being bullied at school (OR = 2.34; CI: 1.12–4.91).
    Conclusion
    Given the findings of this study, it is essential that tailored suicide prevention efforts be established that uniquely address the intersections of race/ethnicity and sexual orientation and how this intersection influences micro, mezzo, and macro factors associated with suicide ideation, planning, and attempt among Latinx LGB adolescents.
    Keywords: Suicide, Latinos, LGB Persons, Adolescence
  • Jalal Poorolajal, Jamal Ahmadpoor *, Younes Mohammadi, Ali Reza Soltanian, Seyedeh Zahra Asghari, EhsanMazloumi Pages 207-213
    Background
    Despite the growing epidemic of problematic Internet use (PIU), little information is available on PIU and related factors in Iran.
    Methods
    This cross-sectional study was conducted on 4261 university students among 13universities throughout the country in 2017. The data collection tool included demographic characteristics, the status of using the Internet, social media, computer games, tobacco, alcohol, and illicit drugs, suicide ideation and attempt, and unprotected sex. PIU was measured using the15-item PIU questionnaire. The status of general health was evaluated using the 28-item general health questionnaire (GHQ) questionnaire. The simple and multiple logistic regression analysis were used to measure the crude and adjusted associations between various factors and PIU.
    Results
    Of 4261 university students, 55.9% were female, 13.5% were smokers, 4.9% were drug abusers, 7.9% were alcohol abusers, 7.8% had unprotected sex in the past year, 7.4%had suicidal ideation in the past month, 1.7% had attempted suicide in the past year, and27.3% suffered from PIU. Only 61.1% had normal health. In contrast, 30.9%, 7.2%, and 0.8%had mild, moderate, and severe general health problems, respectively. There were significant relationships between PIU and age group 20-24 vs. <20 years (odds ratio [OR]=1.39; 95% CI:1.06, 1.82), single vs, married (OR=2.57; 95% CI: 1.85, 3.57), suicidal attempt (OR=2.77;95% CI: 1.47, 5.19), using online games (OR=1.31; 95% CI: 1.07, 1.60), and poor general health (OR=12.14; 95% CI: 4.53, 32.54).
    Conclusion
    Nearly one-third of medical sciences students suffered from PIU. This unhealthy behavior was associated with poor general health and elevated risk of suicidal behaviors. This health-threatening behavior provides an early warning signal that deserves special attention, otherwise, it may threaten both college students’ health and function.
    Keywords: Internet, Video games, Social media, Mental health, Students, Suicide
  • Tahereh Eteraf, Oskouei, Saeid Abdollahpour, Moslem Najafi, Vahideh Zarea Gavgani * Pages 214-222
    Background
    Drug package inserts (PIs) are the most accessible source of information for users and are designed to aid the safe use of medicines and avert adverse events. This study measured the conformity of PIs with the health communications standards of Iran’s Food and drug Administration (FDA).
    Methods
    This descriptive cross-sectional study evaluated 92 PIs related to 22 best-selling neurological and psychiatric drugs in Iran based on criteria approved by Iran’s FDA. Six categories of criteria were considered in evaluating the extent of conformity: I) writing and formatting, II) references, III) drug description, IV) warnings and precautions, V) interactions, and VI) side effects. Each PI was scored based on observation of standards; data was analyzed using Microsoft Excel pivot tables.
    Results
    In total, 2929 items from 92 PIs were evaluated, of which 37 (40.2%) were related to antidepressants, 31 (33.7%) to sedatives and hypnotics, and 24 (26%) to anticonvulsant drugs. The PI content was insufficient in various aspects of conformity with standards in each category. Among the six categories, the best match was found in warnings and precautions with 667items (72.5%), followed by writing and formatting with 663 (69.1%). The lowest conformity was found in the reference category with 194 (26.4%) items.
    Conclusion
    The PIs of Iranian neurological drugs do not fully meet Iran’s FDA standards. It is strongly recommended that smart PIs be developed using mobile apps to overcome this problem.
    Keywords: Health communication, Package inserts, Drug product, Drug labeling, Neurologic, Psychiatric, Medication
  • Martin Hushie * Pages 223-232
    Background
    There is an increasing prevalence of type 2 diabetes (T2D) globally and countries in Sub Sahara Africa, such as Ghana are contending with the epidemic. The main objective ofthis study was to explore the barriers and facilitators of T2D self-care as perceived by patients and health providers (HPs) in Ghana.
    Methods
    A maximum variation sample of 33 adult patients with a range of demographic features, diabetic conditions and self-care regimens and 3 providers were purposely selected from thespecialist diabetes clinic of a private hospital in Accra, Ghana. Data were collected using in depth interviews, which were recorded and transcribed; and non-participant observational fieldnotes-that were analyzed thematically through directed content analysis.
    Results
    The findings reveal that T2D adult patients face many inter-related challenges to diabetes self-care, than enabling factors that fell into four major domains:1) the counselling process and context (patients missing follow-up appointments, unacceptance of diagnosis); 2)recommended food and diet regimens (changing habitual diets, dislike and confusion about recommended diets); 3) social aspects (social functions interfering with dietary regimens, family members diverting patient from dietary goals) and 4) fears (non-disclosure to family member/pretense of being well).
    Conclusion
    Integrated self-management interventions are needed to address these barriers, including tailoring dietary education to patients’ specific needs, guiding patients on how tomanage diet during social occasions and among family members; and as well, providing mental health support. Future research should focus on T2D self-care behaviours and practices outside the clinic, including home, work and shopping environments.
    Keywords: Type 2 diabetes mellitus, Diet, Self-care, Ghana, Healthpromotion, Health education, Social support
  • Reza Kazemi, Negar Alighanbari, Zahra Zamanian * Pages 233-240
    Background
    Previous studies have reported impaired performance, sleepiness and sleep deprivation among night workers. The purpose of this study was to investigate the effect of color screen Light Filtering software on cognitive performance, alertness and sleep quality among night shift operators of a medical emergency operations center.
    Methods
    This field trial interventional study was carried out among 30 nightshift operators of shiraz emergency control center. The baseline assessments were carried out under the existing computer screen light conditions in the week preceding the installation of f.lux software. The same measurements were repeated again 4 weeks after installing the software. The cognitive performance of the participants was measured using continuous performance test (CPT) and n-back, while their sleep quality was assessed through Pietersburg Sleep Quality Index (PSQI). Further, to assess their subjective and objective alertness, Stanford sleepiness index and go/nogo test were used, respectively.
    Results
    The results of this study showed that Screen Light Filtering software significantly increased subjective (P<0.001) and objective alertness (P<0.05). Additionally, the performance of the working memory (P=0.008) and sleep quality (P=0.008) improved significantly after the intervention.
    Conclusion
    The results revealed that using Screen Light Filtering software is an effective and low-cost method to improve sleep quality and cognitive performance since it filters the short wavelength part of the spectrum and helps body adaptation.
    Keywords: Cognitive function, Night shiftwork, Sleepiness, Sleep
  • Hassan Eini Zinab, Naser Kalantari, Alireza Ostadrahimi, Jafar Sadegh Tabrizi, Samira Pourmoradian * Pages 241-247
    Background
    Identifying and prioritizing the most appropriate policies for enhancing nutritional habits are vital for the prevention and control of non-communicable diseases (NCDs). This study was conducted to prioritize the nutritional policies in Iran.
    Methods
    A cross-sectional survey applying the two-round Delphi technique was used to prioritize policy options in preventing the burden of NCDs. In the first round, the experts in health and nutrition policy were asked to prioritize 21 policy options on a 5-point Likert scale. After analyzing the first-round questionnaire, the highest mean and lowest dispersion index were calculated as an indicator of high-priority options. In the second round, the policy options suggested by the participants were added to the second-round questionnaire. Finally, the questionnaires were sent to all the participants in case they desired to change their opinions.
    Results
    The expert achieved consensus on "principles of healthy eating" courses in the curriculum of students as a high-priority policy option. In this regard, "promoting community education and customizing healthy food choice" was the next high priority policy option. On the other hand, the lowest policy priority option was "sending free/low-price healthy drinks at home". The three high priority policy categories were reformulating the content of food, enhancing the consumers’ knowledge, and food labeling, respectively.
    Conclusion
    Our findings showed that reformulation, food promotion, and food labeling had the highest priorities for preventing NCDs in Iran. Although food provision policies were cost effective in developing countries such as Iran, it is essential to provide sub-structures for the reformulation of food products.
    Keywords: Nutritional policy, NCDs, Iran
  • Hossein Akbari, Mohsen Roshanpajouh, Keramat Nourijelyani, Mohammad, Ali Mansournia, AfarinRahimi, Movaghar *, Kamran Yazdani Pages 248-254
    Background
    The current study aimed at determining the pattern of drug dependence and its related factors in mid-term residential treatment centers (MTRCs).
    Methods
    The current cross-sectional study was conducted on all drug dependent people residing in MTRCs of Tehran, Iran, who were voluntarily seeking treatment from April to August, 2018. Required data were collected through face-to-face interviews. Drug dependence was categorized into four groups: soft opioids, hard opioids, methamphetamine, and combination of hard opioids and methamphetamine. The association of potential risk factors with drug dependence was measured using chi-square test and multinomial logistic regression.
    Results
    Out of 1868 participants in the current study, 97% were male. Mean age (SD) of the participants was 38.1 (9.9). The different types of drug dependence were hard opioids (43.0%),soft opioids (29.5%), methamphetamine (15.4%), and a combination of hard opioids and methamphetamine (12.1%). The prevalence of injecting drug use was 2.7%. In comparison with the reference group (soft opioids), being un-married and unemployment, significantly increased the risk of using the three groups of drugs (odds ratios [ORs]: 1.5-3.34, P values: <0.001-0.033).Age ≥30 years at the initiation of drug use, and using current drug for more than 10 years, significantly increased the risk of using hard opioids and a combination of hard opioids and methamphetamine (ORs: 1.65-2.31, P values: <0.001-0.030). Age ≥50 years significantly decreased the risk of using the three groups of drugs (ORs: 0.21-0.43, P≤0.001).
    Conclusion
    Different pattern of drug dependence found in MTRCs, they were mostly hard opioid users, lower injecting drug use and higher mean of age.