فهرست مطالب

  • Volume:9 Issue: 2, 2020
  • تاریخ انتشار: 1399/03/17
  • تعداد عناوین: 12
|
  • Hesam Seyedin, Mahnaz Afshari *, Parvaneh Isfahani, Amir Rakhshan, Ebrahim Hasanzadeh, Masood Taherimirghaed Page 1
    Context

    Supplier-induced demand (SID) is one of the challenges of health systems, leading to unbearable expenses, particularly for people.

    Objectives

    The present study aimed to investigate the factors leading to SID in Iran.
    Data Sources: The present study is a comprehensive systematic review focusing on studies of SID up to the end of May 2018 in six English databases, five Persian databases, and two search engines. The exclusion criteria were publications in languages other than Persian and English and publications after May 2018.
    Data Extraction: A data extraction form was used to record authors' names and specifications, year of publication, the city of the study, language, purpose, methodology, data collection method, and factors influencing the induced demand. The risk of bias was assessed using a standard risk of bias tool.

    Results

    We found 514 papers. Eventually, 16 papers met the inclusion criteria, and they were selected for the study. We found 11 papers in the Persian language and five articles in English. The design of 37.5% of the articles was qualitative, 31.25% analytical, 25% descriptive-analytical, and 6.25% descriptive. Factors influencing SID were classified at four levels including meta-level (Ministry of Health and Medical Education (MoHME)), macro-level (universities of Medical Sciences), meso-level (service providers), and micro-level (patients).

    Conclusions

    According to the results of this research, creating SID can lead to serious challenges for health systems, service providers, patients, and insurance organizations. Therefore, health managers and policymakers need to design appropriate strategies such as adopting the evidence-based approach to purchasing services by the insurer and approval of standards and rules to reduce such SID.

    Keywords: Iran, Review [Publication Type], Health Service Needs Demand, Supplier-Induced Demand
  • Deepanshu Naithani, Santosh Kumar Karn* Page 2

    Neurological coordination is essential for performing biological and mechanical activities achieved by the cooperation of biomolecules such as carbohydrates, lipids, and proteins. It plays an important role in energy production, which can be fascinatingly improved by ketone bodies. Ketone bodies are small, water-soluble lipid molecules by shifting the glycolytic phase KBs directly enters into the tricarboxylic acid cycle for ATP synthesis. It leads to the production of much more energy levels than a single molecule of glucose. Therefore, it could have a profound effect on neuro-metabolism as well as bioenergetics of ATP production. These neuro-enhancement properties are useful for epilepsy, Alzheimer's, and several neurocognitive disorders treatment. Interestingly, the cancer cells cannot use it for efficiently energy production results in decreasing cancer cells viability. This review summarized ketone bodies generation, related imperative effects on normal cells, and more importantly its application in various neurological disorders treatment by rising neuronal functions.

    Keywords: Neurons, Ketogenic Diet, Physiology, ATP, Ketones Bodies, Metabolic Function
  • Mahmoud Hajipour, Niloufar Taherpour, Abolfazl Payandeh, Koorosh Etemad, Shahab Rezaeian, Fatemeh Zolfizadeh, Abdolhalim Rajabi, Ali Ghasemi, Tannaz Valadbeigi, Yadollah Mehrabi * Page 3
    Background

    Unintentional and intentional injuries are the most important factors that cause disability and death among children throughout the world, especially in Iran.

    Objectives

    This study aimed to assess injury- and non-injury-related factors associated with under five mortality (U5M) at individual and community levels in Iran.

    Methods

    This population-based case-control study recruited a total of 2,228 mothers in Iran in 2017. Subjects were divided into three groups (428 as the case group, 664 as the control group 1, and 1,136 as the control group 2). Data were extracted from health records of mothers and interviews through a researcher-made checklist in the health center of eight provinces of Iran. The multilevel logistic regression model was used to evaluate risk factors of under-five mortality at individual and community levels. Data were analyzed using R V. 3.5.0 software.

    Results

    Analysis showed gestational age (post-term and pre-term) (OR = 4.20, CI: 3.14 - 5.61 , P < 0.001), pregnancy interval (between 1 to 3 years) (OR = 3.05, CI: 2.15 - 4.13, P < 0.001), history of mother’s diseases (OR = 3.14, CI: 2.41 - 4.10, P < 0.001), living in urban area (OR = 1.51, CI: 1.16 - 1.97, P < 0.01) and worst life events among mothers (OR = 1.91, CI: 1.46 - 2.49, P < 0.001) were risk factors associated with under-five injury-related mortality. Moreover, women’s literacy (OR = 0.72, CI: 0.54 - 0.97, P < 0.05), mothers being housewife (OR = 0.76, CI: 0.61 - 0.93, P < 0.01) were protective factor at the community level (P < 0.05).

    Conclusions

    This study revealed factors related to under-five mortality at individual and community levels, which most of them are preventable. Therefore, child mortality can be controlled by improving family health, mothers’ education, as well as conducting interventions at the community level.

    Keywords: Iran, Injuries, Under-Five Mortality, Non-Injuries, Multilevel Model
  • Ahmad Rahbar, AmirAshkan Nasiripour*, Mahmood Mahmoodi Majdabadi Page 4
    Background

    A knowledge-oriented organizational culture (OC) is the cornerstone of the educational environment and is among the most important factors in knowledge management (KM) among the members of an organization.

    Objectives

    This study aimed at investigating the effect of OC on the implementation of KM in teaching hospitals of Qom province, Iran.

    Methods

    This descriptive-analytical study was carried out on 570 staff of teaching hospitals in 2017. A standard researcher-made instrument was used to collect data. The validity and reliability of the questionnaire were confirmed by the CVR and CVI. The mean values of these items were 0.88 and 0.82, respectively, and Cronbach’s alpha coefficient for all items was found to be 0.97. In addition, convergent and discriminant validities were used to determine its construct validity. Data were analyzed using exploratory factor analysis, confirmatory factor analysis, and structural equation modeling by SPSS and LISREL 8.8.

    Results

    It was found that 66.7% of the participants were female. The mean scores of KM and OC were 3.35 ± 0.816 and 3.12 ± 1.20, respectively. According to the results of exploratory factor analysis, the Kaiser-Meyer-Olkin measure was 0.962 and the Bartlett test result was significant (P < 0.001). The SEM analysis indicated the good fit of the model (χ2/df = 2.12, RMSEA = 0.04, GFI = 0.95, AGFI = 0.93). Moreover, the test results and fit indices showed the significance of trust culture (β = 0.37, t-value = 4.60) and collaboration culture (β = 0.32, t-value = 4.05), whereas learning culture (β = 0.11, t-value = 1.10) was insignificant.

    Conclusions

    Since the mean scores of KM and OC components were moderate, it is suggested that specific programs be implemented in teaching hospitals concerning trust and collaboration culture issues to improve the current culture. Furthermore, the current model proposed a framework for the improvement of KM implementation in teaching hospitals.

    Keywords: Knowledge Management, Teaching Hospital, Organizational Cultures
  • Hakimeh Pourghayoomi, Habibollah Dehghan *, MohammadJavad Tarrahi Page 5
    Background

    Continuous activities in hot environments are a serious threat to people’s health in society, especially in women.

    Objectives

    Therefore, the purpose of this study was to evaluate the effect of an optimized cooling vest to control the women's thermal strain in the hot laboratory conditions.

    Methods

    The cooling vest (1500 g) was designed for women. This study carried out on 20 female students in a climatic chamber (37°C, humidity, 39%) on a treadmill (2 km/h and zero-degree gradient) in two modes, with the cooling vest (6 steps in 10 min) and without the cooling vest (4 stages in 10 min). The measured parameters at certain time points included heart rate, oral temperature, thermal sensation (TS), perceived exertion (PE), as well as physiological and perceptual strain indices (PSI and PeSI). Ultimately, the data were analyzed by SPSS software (Ver. 22), and the paired t-test was used to compare the data at different time points.

    Results

    The statistical analysis showed a significant difference between the mean TS, PE, PeSI, and PSI in the two test modes (P < 0.05). Also, the paired t-test showed no significant difference between the mean heart rate, resting heart rate, and oral temperature in the two test modes (P > 0.05).

    Conclusions

    Considering the positive effects of the designed cooling vest for perceptual and physiological heat strain for women, it can be used as a useful and cost-effective solution in the warm environment to reduce the effects of exposure to heat.

    Keywords: Heat Strain, Cooling Vest, Phase Change Material
  • Sima Baridkazemi, Khalilollah Moeininan, Ali Taghipour, Ayat Rahmani, Hamidreza Nassehinia* Page 6
    Background

    Air pollution is a major social problem, particularly in developing countries, where the rapid expansion of industries, cities, and traffic is the main cause of increased air pollution.

    Objectives

    This ecological study (correlation) has been conducted with the aim of analyzing the correlation between ambient fine particulate matter (PM2.5) amount and the rate of stroke mortality in Mashhad during the years 2014 and 2015.

    Methods

    Data were collected from hospitals, the Monitoring Center of Environmental Pollutants, and the Bureau of Meteorology in Khorasan Razavi Province and were analyzed to evaluate the correlation.

    Results

    The results show that the correlation coefficient between PM2.5 and the rate of stroke mortality in different seasons in 2014 and 2015 are 0.997 and 0.902, respectively. The correlation was stronger in 2014 and is significant at a confidence level of 0.01.

    Conclusions

    According to the results, the annual average concentration of PM2.5 decreased from 29.261 (μg/m3) in 2014 to 25.283 (μg/m3) in 2015, and also, the annual rate of stroke mortality decreased by 4.4% in 2015.

    Keywords: Air Pollution, Mashhad, PM2.5, Stroke Mortality
  • Fatemeh Jabbari, Akbar Eslami *, Jahanbakhsh Mahmoudian Page 7

    Diclofenac (DCF) is among the compounds that are highly resistant to biological degradation processes and have low removal efficiency in wastewater treatment plants. In the current study, DCF removal was examined by using the O3/UV/S2O8 process. All experiments were carried out in a 2-liter lab-scale semi-continuous reactor. DCF concentration was measured by HPLC analytical method. The study began with the optimization of pH, and the effects of other operating parameters, including pH, ozone concentrations, drug, persulfate, and natural organic matter (Humic acid) on the degradation were investigated. The mineralization of diclofenac was also investigated. The results showed the removal efficiency of 89% and a persulfate concentration of 200 mg/L, pH = 6, DCF = 8 mg/L, and reaction periods 30 min in the O3/UV/S2O8 process. Humic acid was selected as a scavenging compound, which decreased the removal DCF rate from 89% to 76%. So, sulfate radical-based technologies show promising results for the removal of these particular pharmaceuticals from the wastewater treatment plant.

    Keywords: Wastewater Treatment, Diclofenac, Advanced Oxidation, Sulfate Radical
  • Hossein Moein *, Gholamreza Nabi Bidhendi, Naser Mehrdadi, Hossein Kamani Page 8
    Background

    Among water pollutants, Natural Organic Matters (NOMs) are highly important for making problems in water treatment plants.

    Objectives

    The main objective of this study was to investigate the efficiency of photocatalytic degradation of humic acid using magnetic nanoparticles (Fe-doped TiO2@Fe3O4) in aqueous solutions.

    Methods

    In the present experiment, Fe-doped TiO2@Fe3O4 nanoparticles were synthesized by the sol-gel method, and SEM, XRD, and DRS analyzes were utilized to characterize the synthesized nanoparticles. The effects of various variables, including pH (3 - 11), initial concentration of humic acid (20 - 80 mg/L), and concentration of nanoparticles (250 - 2000 mg/L) at different reaction times (15 - 60 min) were investigated on the photocatalytic degradation of humic acid.

    Results

    The maximum degradation efficiency of humic acid at pH 3, the initial humic acid concentration of 5 mg/L, nanoparticle dose of 400 mg/L, and reaction time of 60 min using a 15-W bare UV lamp.

    Conclusions

    Due to the high efficiency of photocatalytic degradation, it is proposed to use for the removal of humic acid from water resources.

    Keywords: Humic Acid, Magnetic Nanoparticles, Photocatalyst
  • Afsaneh Bakhtiari, Seyed Jalil Seyedi Andi *, Monireh Parvaneh Page 9
    Background

    Prescription writing is one of the most important stages of medical treatment, and following its principles improves efficiency and effectiveness of treatment. Midwifery students are the group of a medical team who are authorized to prescribe medications. However, clinical evidence suggests that their skills are inadequate in the area.

    Objectives

    Therefore, this study was designed to investigate the effect of a workshop on the prescription writing skills of midwifery students.

    Methods

    This was a quasi-experimental study conducted among 32 senior undergraduate midwifery students. The students were divided into two groups. A two-day workshop was held for each group. Each group was divided into three sub-groups for practical work. The training was provided based on the general principles of prescribing in four parts including superscription, general principles of prescription, standard principles of prescription, and instruction of using medications. Adherence to the principles of prescribing by students was evaluated through a checklist before and after training and four weeks later. Data were analyzed with a general linear model and repeated measures analysis.

    Results

    Patient's name was the most common record in the prescriptions. The mean number of drug items was 3.7 ± 0.04, which decreased to 2 ± 0.03 after the intervention. The name and signature of the prescribed drugs were in less than 15% of the prescriptions, with 85% improvement after the intervention. Moreover, 40.6% of the prescriptions were readable, but in none of them, the reason for visit and diagnosis were mentioned (over 50% increases after training). Form of drug, dose and medication number were listed in 45% of the prescriptions that rose to more than 70% in all the three cases. The most responses on the instruction of using the medication were related to the method of use and drug use intervals. Repeated measures ANOVA showed a significant difference in the mean scores of students' prescriptions after education and four weeks after the workshops in all the four parts of prescription principles (P < 0.001). This significant difference was also observed in all four common diseases in gynecology (P < 0.001).

    Conclusions

    The prescription workshop had a significant positive effect on the knowledge and skills of midwifery students in the field of prescription writing. Therefore, this strategy can be used as a useful approach for the rational use of medicines by midwives. Because of the importance of prescription writing, we suggest including it in the curriculum of midwifery students.

    Keywords: Workshop, Prescription, Midwifery Student
  • Vida Zaroushani *, Farahnaz Khajehnasiri Page 10
    Background

    In electromagnetic shielding topics, the selection of suitable shields is an important subject and the lack of a specific ranking index for choosing protective shields causes problems in decision-making. Thus, this study proposes a quantitative index to rank and select electromagnetic shields in radiofrequency and microwave radiation.

    Objectives

    The objective of this study was to construct a simple quantitative index to rank and select electromagnetic shields in radiofrequency and microwave radiation.

    Methods

    A cross-sectional study was designed. In this study, the construction of the ranking index was carried out in four main stages including stabilizing the concept, analytical structure and variable selection, weighing and combination of variables, and validating the index. In this study, the average, minimum, maximum, and standard deviation of shielding effectiveness were considered the main phenomenon variables. Finally, the ranking index and ranking difference index were created as percentages to rank and select electromagnetic shields.

    Results

    In this study, a quantitative index was made as percentages called "Ranking Index" to rank and select the premier and preferable shield. Moreover, to indicate the difference in the shielding effectiveness of various shields, the "Difference Index" was made as percentages.

    Conclusions

    This study presented a simple quantitative index to rank electromagnetic shields. It could be used as a selection tool in radiation safety management. Moreover, this ranking index had a simple formula that could be calculated easily and quickly in excel software with high accuracy and low cost. In addition, it could be easily incorporated into a user-friendly tool for the ease of application. A case study of electromagnetic nanocomposite shields was conducted to use the Ranking Index, which showed its capability for ranking the shielding performance of studied electromagnetic shields. This index can create similar scientific literature to report the efficacy of electromagnetic shields and the selection of preferred shields in different research studies. It is suggested that future studies examine this quantitative index in other frequency ranges.

    Keywords: Index, Microwave, Classification, Decision Making, Electromagnetic Radiation
  • Aminallah Babouie, Rahim Ostovar*, Parviz Aghaei Borzabad Page 11

    Health is one of the fundamental values and needs of humans. It is an accepted right in international documents such as the Universal Declaration of Human Rights and the statement of the World Health Organization. The present study aimed to design an optimal model for the development of Neighborhood Health centers in Kohgiluyeh and Boyer Ahmad Province, Iran, in 2018 - 2019. The research population included 200 residents and 200 health staff and authorities in the city of Yasuj. The instruments and questionnaires for evaluating and surveying the health centers’ duties, people’s attitudes, and center development strategies were provided by the researcher and confirmed in terms of validity and reliability. The midwifery service (m = 37.4) and mental health service (m = 31.8) had the highest and lowest rates of quality score of service. of service, respectively. The mean (standard deviation) scores of people’s and authorities’ attitudes toward the provision of services in health centers were 4.46 (0.6) and 3.9 (0.8), respectively. The attitude of males, physicians, and nurses had a significant effect on the development strategies of health centers (P < 0.05). To achieve better results, neighborhood health centers should respect the principle of equity and equal access, and pay attention to vulnerable classes such as immigrants and low-income populations.

    Keywords: Development, Health Centers, Pattern Design
  • Mohaddesseh Noura, Mehdi Zanganeh Baygi* Page 12