فهرست مطالب

  • Volume:8 Issue: 3, 2019
  • تاریخ انتشار: 1398/06/07
  • تعداد عناوین: 12
|
  • Mahdiyeh Heydari, Mahmood Yousefi, Naser Derakhshani, Rahim Khodayari Zarnaq* Page 1
    Context
    Medical tourism is a relatively new concept with rapidly growing application. It is defined as purposeful travel to receive the health services provided in other countries and is underlain by patient satisfaction as one of the quality indicators that primarily attract medical tourists. The purpose of this study was to systematically review the factors that affect the satisfaction of people who travel to other countries to receive medical treatment. Evidence Acquisition: To identify contributors to the satisfaction of medical tourists, we conducted a systematic review between July 2016 and March 2017. The Preferred Reporting Items for Systematic Reviews and Prizma checklist was used as a guide for the review. The quality of the papers was examined independently by two of the researchers using the Kmet checklist. Further filtering left us with a final sample of 20 studies, which were subjected to content analysis using the input-process-output (IPO) model. The factors identified were then represented in the IPO model. A total of 376 studies were obtained from 9 English and Persian databases using 6 main search keywords. The specific keywords used were “medical tourist,” “health tourist,” “health tourism,” “medical tourism,” “satisfaction,” and “consent.” were searched from the databases of Scopus, Web of Science, Science Direct, ProQuest, Embase, Ovid, magiran and SID.
    Results
    The examination of the studies yielded 137 effective factors that influence the satisfaction of medical tourists. The factors were classified into six categories, namely, services, manpower, information, costs, physical conditions, and health equipment. Among these categories, the service domain encompassed most of the influencing factors.
    Conclusions
    The satisfaction of medical tourists is determined by different factors, among which satisfaction with the provision of services has been of great interest to medical tourists. Specifically, medical tourists evaluate the manner by which health care providers offer services, the quality of care that they receive, and the behavior of hospital staff. The results present implications for destination countries in their efforts to enhance the positive features of their services and address those that negatively affect the satisfaction of medical tourists.
    Keywords: Medical Tourism, Satisfaction, Quality, Systematic Review
  • Kamran Mehrabani Zeinabad, Naeimehossadat Asmarian, Seyyed Mohammad Taghi Ayatollahi * Page 2
    Background
    Information on the pattern and trend of mortality with regards to sex and location gives us a detailed insight into the population health which is an essential component in policy debates to improve the health system.
    Objectives
    The purpose of this study is to explore and compare the mortality pattern in the west and east of Iran.
    Methods
    To assess the spatial patterns, we used disease mapping and spatial dependency with first-order neighborhood structure. Incorporating neighborhood structure with Bayesian method assisted us in using smooth standardized mortality ratios (SMR).
    Results
    Mean overall smooth SMRs in the west and east were 1.005 and 0.998, respectively, and mortality trend in these two regions were approximately smooth. The most favorable conditions were associated with females in the east and females in the west had a higher risk of death.
    Conclusions
    The health system in Iran has been effectively improved and with recent essential health policies, it is expected to see a negative trend in mortality rates in the near future.
    Keywords: Mortality Trend, Disease Mapping, Spatio-Temporal, Iran
  • Ali Khavanin, Reza Arezoomandan*, Hosein Shojaee Farah Abady, Javad Mirnajafizade, Mahdi Abbaszadeh, Somayeh Arezoomandan Page 3
    Background
    In addition to a variety of organic solvents, workers in many industries are also exposed to excessive noise levels.
    Objectives
    The purpose of this study was to evaluate the co-exposure effects of bandpass noise and styrene on working memory, anxiety, and locomotor activity in rats.
    Methods
    Thirty male Wistar albino rats were used. Animals were divided into 4 groups, including the noise exposure group (1), styrene exposure group (750 ppm), simultaneous subacute exposure to noise and styrene group (100 dB, 750 ppm), and the control group. The exposure duration was 6 hours/day, 6 days/week in 3 consecutive weeks. At the end of the exposure, the locomotor activity and working memory were evaluated using open field test and Y-maze test, respectively.
    Results
    The results showed that simultaneous exposure to noise and styrene significantly decreased locomotor activity compared to the control group (P < 0.0001), whereas noise and styrene alone had no significant effect on locomotor activity. Spontaneous alternation in the simultaneous exposure group showed no significant difference compared with the noise and styrene groups. Also, simultaneous exposure to styrene and noise significantly decreased working memory compared to the control group (P < 0.0001).
    Conclusions
    Co-exposure to noise and styrene have significant destructive effects on the brain and behaviors and these harmful effects should be considered in the workplace. However, further human and molecular studies should be conducted to clarify its accurate effects and mechanisms.
    Keywords: Noise, Styrene, Working Memory, Locomotor Activity, Rat
  • Mohsen Askarshahi, Seyed Alireza Afshani, Nahid Ardian*, Mohammad Ali Morowatisharifabad, Seyed Saeed Mazloomy Mahmoodabad, Mohammad Hassan Ehrampoush, Masoomeh Goodarzi Khoigani Page 4
    Background
    One of the most important determinants of behavior is intention. Numerous factors can contribute to the intention to file a divorce petition. One of the successful conceptual frameworks in explaining the effective factors on the intention to divorce is the theory of planned behavior (TPB).
    Objectives
    The current study aimed at identifying the factors affecting the determinants of intention to divorce based on TPB.
    Methods
    The current cross sectional study was conducted on 140 divorce applicants in Yazd, Iran in 2017 selected by random sampling. Data collection tools were a demographic information checklist and a researcher-made questionnaire including 48 items divided into four constructs, i e, attitude, behavioral control, subjective norms, and intention. The questionnaire was developed based on the constructs of the theory of planned behavior (TPB) and validated in a qualitative study. Data analysis was performed with the AMOS software using goodness-of-fit indices (GFI) of the model, as well as SPSS using ANOVA, post-hoc, and independent t tests.
    Results
    The constructs of the TPB significantly indicated the ability to predict the intention to file a divorce petition (R2 =0.58). The findings showed that the attitude variables (β = 0.69), perceived behavioral control (β = 0.16), and subjective norms (β = 0.13) had the highest effect on the structure, respectively. Model fit indices (GFI, comparative-fit-index, normed-fit-index, root mean-square error of approximation, and normed chi-Square) indicated the goodness of model. The mean score of attitude toward divorce was higher in women than in men (P < 0.001).
    Conclusions
    Attitude toward divorce was the most effective factor in intention to file a divorce petition. Given the important role of attitudes in the intention to divorce, further educational interventions in this field are suggested in order to consider influencing constructs according to TPB.
    Keywords: Intention, Divorce, Theory of Planned Behavior
  • Azin Nahvijou, Mohammad Arab, Ahmad Faramarzi*, Seyed Yaser Hashemi, Javad Javan Noughabi Page 5
    Background
    Esophageal carcinoma is regarded as a malignant disease with fatal consequences. In cancers, it was the sixth cause of death in the world, with an estimated 439025 deaths in 2015.
    Objectives
    We conducted a research to evaluate the esophageal carcinoma burden based on the World Health Organization regions, during 2000 to 2015.
    Methods
    Global Burden of Disease (GBD) was used to retrospectively collect the data from 2000 to 2015. The Institute for Health Metrics and Evaluation publishes the data. We utilized disability adjusted life years (DALY), incidence rate and prevalence rate to describe the esophageal cancer burden in the world.
    Results
    In 2015, there were a total of 9854406 DALYs attributed to esophageal cancer where the majority were related the years of life lost (YLL) (9725791), and 128613 of the total were concerned with years lost due to disability (YLD). The highest of DALYs was in the Western Pacific region with 4773660 of the total. The Eastern Mediterranean region, with 516412 DALYs, shows the lowest number.
    Conclusions
    The esophageal carcinoma is still a public health problem in high incidence countries. In all countries, the majority of the DALYs is related to YLL, indicating that prevention and early detection should be taken seriously. The burden of esophageal cancer is different in geographical regions. Therefore, a suitable and specific program in every region and country should be developed. 
    Keywords: Esophageal Neoplasms, World Health Organization, Global Burden of Disease
  • Mostafa Mirzaei Aliabadi, Reza Esmaeili*, Iraj Mohammadfam, Maryam Ashrafi Page 6
    Background
    Pigging operation is one of the maintenance activities that is used to check pipeline functionality in operational conditions using a PIG device and high pressure of liquid/gas, which is potentially hazardous.
    Objectives
    The present study aimed at customizing SPAR-H methodology for the pigging operation using Bayesian networks (BNs). It also aimed at identifying and analyzing human errors in pigging operation in a gas transmission company.
    Methods
    The current article was composed of two main steps. In the first step, the SPAR-H BN model was developed using expertelicited prior probabilities of pigging operation applied to Bayesian network. In this step, CPTs of PSF nodes are constructed using prior probabilities, which are achieved from expert opinion. The CPT of error node is developed using coding process of SPAR-H formula in a simulation node. In the second step, a descriptive study was carried out to estimate the probability of human errors in pigging operation in a gas transmission plant in Iran. First, hierarchical task analysis (HTA) was conducted by walking through the pigging operation and interviews with workers. Next, the SPAR-H BN model was utilized for estimation of human error probability.
    Results
    The developed model was tested on the pigging operation subtasks. In the considered case study, the mean probability of human error was estimated as 0.184. The highest probability of human error was related to “opening the kicker valve for enhancing pressure” subtask.
    Conclusions
    The BNs were helpful to adapt the SPAR-H methodology to the pigging operation using dedicated prior probabilities. Beside that, the probabilities of human error can be updated taking into account the more realistic operational and environmental conditions.
    Keywords: Human Error, Standardized Plant Analysis Risk-Human (SPAR-H), Bayesian Network (BN), Pipeline Inspection Gauges(PIG)
  • Ahmad Raiesi, Seyed Mohammad Hashemi Shahri*, Mohammad Mehdi Gouya, Alireza Ansari Moghaddam, Fariba Shahraki Sanavi, Mahdi Mohammadi, Hasan Okati Aliabad, Seyed Mehdi Tabatabaei, Mehdi Zanganeh, Khadijeh Kalan Farmanfarma Page 7
    Objectives
    Althoughmalaria is in the elimination phase in Iran, cases imported from Afghanistan and Pakistan asmalaria-endemic regions is challenging. Therefore, the present study investigates the experiences of mobile populations about malaria control in Southeastern Iran.
    Methods
    A qualitative study was conducted in October 2015. Participant selection was purposive and criteria-based, and a total of 70 migrants and mobile population were selected from Sistan and Baluchistan province, southeast of Iran. Semi-structured indepth interviews were conducted with all of the participants using ten guide questions based on the concepts of the PEN-3 model to examine the views and experiences of the participants about malaria during their travels. The PEN-3 model emphasizes the culture of preventive behaviors or health-promoting behaviors. Content analysis was used for data analysis.
    Results
    According to the PEN-3 model, the most important cultural impediments were the false beliefs about the usefulness of herbal medicines for the treatment of the disease (negative perception), the wrong attitude of being protected from the disease due to holding certain jobs (negative perception), the belief in destiny and God’s will with respect to the incidence of diseases (negative enabler), and eating native plants for the prevention of the disease (existential nurturer).
    Conclusions
    Malaria prevention program should focus on the cultural characteristics of immigrants for effective interventions to control malaria.
    Keywords: Malaria, Immigrant, Iran, PEN-3 Model, Culture
  • Mahmoud Hajipour, Hamid Reza Tabatabaee, Koorosh Etemad, Hossein Ansari, Alireza Ansari Moghadam, Mehdi Mohammadi, Seyed Mehdi Tabatabaei, Ali Reza Mirahmadizadeh, Mohammad Hassan Lotfi, Shahin Saeidinejat, Maryam Soltani, Tannaz Valadbeigi, Halime Yaghoobi, Abdolhalim Rajabi, Ali Ghasemi, Kambiz Mahdizadeh, Fatemeh Ghasemi, Fatemeh Shahbazi, Negar Piri, Mostafa Enayatrad, Fatemeh Zolfizadeh, Sepideh Mahdavi, Sima Afrashteh, Mostafa Dianati, Seideh Zeinab Almasi* Page 8
    Background
    Stillbirth is an important economic, cultural, and health index that has a higher prevalence in developing countries.
    Objectives
    The present research was conducted to determine the pre-pregnancy risk factors of stillbirth in Iran.
    Methods
    This research is a national population-based case-control study on the risk factors of stillbirth in Iran. A total of 3,085 women presenting to public healthcare centers of ten provinces/cities of Iran entered the study, including 1,459 women who their last pregnancy ended in a stillbirth as the case group and 1,626 women who their last pregnancy ended in a live birth as the control group. Data were collected with a researcher-made questionnaire and were then analyzed by SPSS-19 using the chi-square and the logistic regression tests. P values less than 0.05 were considered statistically significant.
    Results
    The results revealed a relationship between the last pregnancy ending in a stillbirth and a previous history of stillbirth (OR = 2.64, CI: 1.81 - 3.85, P = 0.001), miscarriage (OR = 1.57, CI: 1.21 - 2.03, P = 0.001) irregular menstruation (OR = 1.29, CI: 1.02 - 1.64, P = 0.029), age over 35 (OR = 1.58, CI: 1.17 - 2.14, P = 0.001), low level of education (OR = 3.50, CI: 2.30 - 5.33, P = 0.001), and the use of oral contraceptives.
    Conclusions
    There are several risk factors for stillbirth, including a previous history of stillbirth, miscarriage or irregular menstrual cycle, most of which can be controlled through pre-pregnancy training. Educational interventions are, therefore, required to improve the knowledge of women at childbearing age and preventive measures should be taken to reduce the number of stillbirths in pregnant women.
    Keywords: Stillbirth, Risk Factors, Case-Control, Pregnancy, Miscarriage
  • Aslan Nazari, Iravan Masoudi Asl*, Masoud Abolhallaje, Amir Ashkan Nasiripour, Mohammad Javad Kabi Page 9
    Background
    Social health insurances are created to achieve public coverage in order to access affordable health care services. Therefore, stewardships of health system should intervene to fulfill these objectives.
    Objectives
    The current study aimed at proposing an interaction pattern between health system and insurances in the field of financing.
    Methods
    A mixed-method study was conducted in two phases from 2017 to 2018. A qualitative interview was employed to identify dimensions and requirements of the interactions in Iran. In the second phase, the extracted items and dimensions were reviewed by experts using Delphi technique and focus-group discussions in two rounds. The data were analyzed by SPSS software version 22 using one-sample t-test.
    Results
    In the qualitative section, two aspects of interaction ways and mechanisms were determined and finally six themes were extracted. In the first round of Delphi, out of 43 extracted items, 12 items were omitted and 31 items achieved the agreement limit. All 31 items were approved by the experts in the second round of Delphi (P < 0.05).
    Conclusions
    Employment of interaction concepts in the field of financing requires a thorough examination of the conditions of each country and it is necessary to create the required infrastructures to achieve the desired situation. Interaction mechanisms of stewardship and social health insurances are not clear in Iran; therefore, creating constituency committees of uniformity is suggested.
    Keywords: Health Care Sector, Insurance Coverage, Insurance Pools
  • Zahra Zamanian, Saeed Yousefinejad, Mohammad Javad Khoshnoud, Farideh Golbabaie, Mohammad Reza Zare, Aboutaleb Modaresi, Mohammad Reza Zarei, Abdolrasoul Rahmani* Page 10
    Background
    Trichloroethylene (TCE) is one of the most important environmental contaminants that can introduce both occupational and public health because of its widespread use.
    Objectives
    This study was aimed to investigate effects of inhalation exposure to TCE on serum immunoglobulin and electrolyte levels under controlled laboratory conditions.
    Methods
    Five equal groups (5 animals each) were randomly selected from a total of 25 adult male Sprague-Dawley rats. TCE vapor was generated by dynamic evaporation method in exposure chamber. The animals were exposed to TCE at five different concentration levels (0 ppm as control, 10, 100, 250, and 400 ppm through 8 hours inhalation during a day, for 10 consecutive days.
    Results
    Based on results, IgG, IgM and IgA levels were significantly increased in rats following exposure to various levels of TCE ≥ 100 ppm (P < 0.05). Conversely, TCE exposure significantly caused a decrease in the levels of IgE in the case group with those values compared to control group (P < 0.05). Contrariwise, serum levels of Ca were significantly increased in rats exposed to TCE levels above 250 ppm, the high and very high exposure level (P < 0.05). At a concentration of 100 and 400 ppm, changes were noted in serum P levels (P < 0.05). A moderate positive relationship was found between serum P and the TCE concentration in sub-acute exposure (R2 = 0.66, P < 0.05).
    Conclusions
    In conclusion, sub-acute inhalation exposure to TCE (≥ 100 ppm) is related to the electrolyte and immunoglobulin toxicity in the form of increased Ca, P, IgA, IgG and IgM and decreased Cl, Na and IgE.
    Keywords: Trichloroethylene, Immunoglobulin, Electrolytes, Sub-Acute Exposure, Animal Model
  • Nastaran Keshavarz Mohammadi, Aliakbar Sayyari *, Aliasgar Farshad, Nader Jahanmehr, Sameen Siddiqi, Rahim Taghizadeh, Christopher Dye Page 11
    Problem: The sustainable development goals (SDGs) and their associated targets and indicators provide a global framework for advancing health in development, which must be adapted to the needs of each country. Approach: Building on previous experience with millennium development goals (MDGs), the Islamic Republic of Iran is advancing health under the SDGs by targeting non-communicable diseases, which accounted for 70% of deaths in Iran in 2016, giving particular emphasis to the social, economic and environmental determinants of health. Local Setting: The national population and sub-populations of the Islamic Republic of Iran. Relevant Changes: The interlink ages between the principal health goal (SDG 3) and all other goals are a stimulus to seek benefits for health from multisectoral action, working across the whole of government and within civil society. Iran’s sustainable development agenda embraces health in 12 of 17 SDGs, and aims to track progress using 56 of 230 defined indicators. These take account of the health benefits of reducing poverty, hunger and low literacy, and from healthier strategies for agriculture, education, transport, housing and employment. We present baseline statistics for these indicators, covering the period of 1990 - 2015. Lessons Learnt: Placing health in the context of sustainable development facilitates Iran’s goal of improving prevention alongside treatment, tackling the underlying social, economic and environmental determinants of health by working across the whole of government. The way forward is advocating for shared responsibility for health and evidence-informed participatory decision making mechanisms, strengthening and sharing information databases.
    Keywords: SDG, MDG, Health
  • Tahereh Kamalikhah , Fatemeh Rahmati Najarkolaei *, Nooshin Rouhani Tonekaboni , Leila Sabzmakan , Hassan Okati, Aliabad , Farid Rezaei Moghadam Page 12
    Background
    Individuals suffering from chronic low back pain (CLBP) experience major physical, social, and occupational disruptions. Strong evidence confirms the effectiveness of Alexander technique (AT) training for CLBP.
    Objectives
    The present study applied an integrative model of behavioral prediction (IM) to design AT training for education of teachers with CLBP.
    Methods
    This was a quasi-experimental study conducted on female teachers with non-specific LBP in southern Tehran in 2014. The intervention group consisted of 42 teachers (AT training based on IM) and the control group included 35 teachers (AT training only). The validity and reliability of the 108-item AT questionnaire based on IM constructs were confirmed using content validity (CVR 0.87, CVI 0.96) and Cronbach’s α (0.84). Data were analyzed by Independent and Paired Sample t-test, Mann-Whitney U test, Wilcoxon, and covariance.
    Results
    The results of the study indicated that AT behaviors, skills and abilities, direct and indirect perceived behavioral control, indirect subjective norms, direct and indirect attitude, and perceived risk were higher in the intervention group three months after the intervention (all P values < 0.05). Disability score (P < 0.001), hand to floor test (P = 0.023), and pain frequency (P = 0.022) showed a significantly higher reduction in the intervention group.
    Conclusions
    The IM educational framework coupled with AT training may facilitate applying AT directions and finally, lead to pain reduction in CLBP.
    Keywords: Complementary Treatment, Educational Model, Low Back Pain, Teachers