مجله دانشکده بهداشت و انستیتو تحقیقات بهداشتی
سال هجدهم شماره 2 (پیاپی 70، تابستان 1399)

It is essential to take action to strengthen the national primary health care (PHC) system. The purpose of this study was to conduct a comprehensive review to find ways to strengthen the PHC system in Iran based on the experiences of different countries.

This was a comprehensive review study. The relevant studies were retrieved using Science Direct, PubMed, Google Scholar, Scopus, Web of Science, Magiran, Iranmedex and SID databases. Inclusion criteria included all the studies that specifically focused on the factors enhancing the PHC system between 1998 and 2017. Finally, 30 articles were selected.

Strategies for strengthening the PHC system were examined from two different angles: factors that facilitate the performance of the health care team, and ways to improve the implementation of PHC. In addition, strategies have been recommended for the following in order to strengthen the PHC system in Iran: trust-based relationships; widespread implementation of the National PHC Program with a focus on personnel training; teaching healthy lifestyle behaviors and drug side-effects; investing in information technology in the health sector in areas such as immunization, child care and prevention of chronic diseases.

Strengthening primary health care requires coordination and inter-sectoral collaboration; involvement and will of a wide range of health and non-health organizations; government support; strengthening of the referral system and the family physician; strengthening the health team; self-care and community participation; a public health-oriented and preventive approach in macro-policies; and, finally,  allocating more resources to the health sector.

“Active ageing” is the process of optimizing opportunities for health, participation and security of the elderly in order to enhance their quality of life. This study aimed to measure the Active Ageing Index (AAI) in Tehran at the individual level and determine its determinants.    

This quantitative cross-sectional study included 590 old people 55 years old and above, selected by randomized cluster sampling and interviewed at their homes in various areas of Tehran. The AAI tool, which includes 4 domains ─ employment, participation, secure/safe life and an empowering environment ─ and 22 indicators was used to measure active ageing. The association between individual characteristics of older people and their AAI scores was determined using the mixed-effect linear regression analysis method, with the STATA software.

The overall AAI score in Tehran was found to be 26.8 out of 100, it being 33.9 and 20.6 for men and women, respectively. Being a women, older, poorer, and living alone or in a large family resulted in significantly lower AAI scores as compared to being a man, younger, richer, living with others, and living in a smaller family.

Iranian older people, particularly women, are experiencing relatively inactive lives. Their AAI scores are particularly low in the third and fourth domains. Considering the high rate of population aging in Iran, providing a safe environment for an active life for the elderly, particularly for the groups found to have a less active life, is a top priority.

Despite rapid diagnostic and therapeutic advances, patients with chronic coronary artery disease (CCAD) should adopt self-care behaviors. This study aimed to determine predictors of perceived health competence among CCAD patients in Tehran, Iran in 2019-2020.

This cross-sectional study was conducted among 700 patients with CCAD referred to Shahid-Rajaie Cardiovascular Center in Tehran selected using the available sampling method. Data were collected using the perceived health competence scale (PHCS), 12-item quality of life scale and Modanloochr('39')s adherence to treatment scale questionnaires. The content validity ratio and content validity index were used to determine validity, and the Cronbachchr('39')s alpha to determine reliability, of the PHCS questionnaire. Data analysis was performed using descriptive statistics, Pearson correlation coefficient, Structural Equation Modeling (SEM), the software being SPSS25.

The multivariate regression analysis showed that perceived health competence had statistically significant direct associations with physical (β = 1.08, p< 0.001) and psychological (β = 0.85, p< 0.001) domains of quality of life, commitment to treatment (β = 0.12, p =0.01), willingness to participate in treatment (β = 0.12, p = 0.05) and uncertainty about implementation (p = 0.1, p‹ 0.001) of adherence to treatment. There was a significant indirect association between age and perceived health competence (β = -0.13, p = 0.03).

Based on the findings, considering a “very good” and a “poor” mean score for adherence and the quality of life among the patients, respectively, adopting strategies for promoting quality of life in both the physical and mental dimensions can lead to improvements in perceived health competence in cardiovascular patients. In addition, it seems that focusing on subscales of “willingness to participate in treatment” might help in improving the patientschr('39') perceived health competence.

One of the dimensions of health is social health. Social health indicates, in a way, the inviolability of the identity aspects of individuals in the community. From among the factors affecting social health, a sense of social security both in its objective and mental dimensions has a particularly significant effect, and also a fundamental impact, on the efficiency of individuals in the society. In this study the relationship between the two variables ─ social security and social health ─ was investigated empirically.

This was a quantitative survey including a sample of 400 residents in Lende City, Kohgiluyeh and Boyer-Ahmad Province, Iran in 1398. Data were collected using questionnaires.

The findings showed that there were statistically significant relationships between the sense of social security and social health in most of their domains (P <0.05). Modeling of structural equations between these two variables also showed that the sense of social security with a regression weight of 0.54 had an effect on social health in a way that this variable alone explained 29% of changes in social health, while gender had no effect in this regard.

On the basis of the findings it can be concluded that the sense of social security has significant effects on social health and efficiency of people in the society. Therefore, if a society can protect the identity components of its citizens in its different ethnic, religious, linguistic and national aspects and increase their level of social tolerance, then it will be possible to create better conditions for promoting the social health of individuals in that society.

Previous research has shown that many factors can affect sportspersons’ quality of life. Sleep deprivation is one of these factors. Based on laboratory evidence, a number of possible mechanisms for the relationship between sleep deprivation and quality of life of sportspersons have been suggested. The aim of this study was to investigate the effect of sleep deprivation on the quality of life of sport science students.

This was an experimental research study. The sample was 20 volunteer male sport science students selected by simple random sampling using a counterbalanced intra-group design. Data on the volunteer students were collected at two time points under controlled conditions in the university dormitory: 1. after twelve hours of fasting and eight hours of sufficient sleep, and 2. after twelve hours of fasting and thirty hours of full lack of sleep. The initial and final quality of life of the subjects were assessed and compared using the World Health Organization Quality of Life Questionnaire (WHOQOL_BREF). Changes in the dependent variable resulting from intervention were analyzed using the dependent t-test at p<0.05 with the SPSS software ver.22.

Analysis of the data showed that 30 hours of sleep deprivation significantly reduced the quality of life scale, perception of physical health, mental health, social relationships, environmental health and the general health of the students (p=0.012).

According to the results of this study, it is concluded that 30 hours of sleep deprivation can bring about a significant change in the quality of life of active male sport science students. Athletes need more sleep than inactive people because of exercise needs that affect the quality and quantity of sleep. Therefore, coaches and athletes are advised to identify the factors that cause sleep deprivation and, based on this, try to prevent athletes from falling asleep during training and competitions, and consequently reduce the negative effect of sleep deprivation on sports performance.

Rheumatoid arthritis is the most common and most important type of arthritis caused by interaction of genetic, immunologic, psychological and social factors and is accompanied by chronic pains. The aim of this study was to investigate the effectiveness of treatment based on acceptance and commitment to the perception of pain and functional disability of women with rheumatoid arthritis in Khorramabad, Iran.

This was a semi-experimental study with a pre- and post-test design with experimental and control groups, the statistical population being all the women with rheumatoid arthritis in Khorramabad, Iran. A sample of 40 women were selected using the available sampling method and randomly assigned to either an experimental (n = 20) or a control (n= 20) group. Under similar circumstances a pre-test was conducted using the pain perception and functional disability questionnaires in both groups. Admission- and commitment-based treatment interventions were then performed in the experimental group in eight 90-minute sessions, but the control group did not receive any intervention. At the end, post-tests were done in both groups.

The multivariate and univariate analysis of covariance showed that the intervention based on acceptance and commitment had a significant effect on reducing the patientschr('39') perception of pain and functional disability (P <0.001).

Based on the results of this study, it can be said that treatment based on acceptance and commitment can reduce the perception of pain and functional disability in women with rheumatoid arthritis. Therefore, along with medical treatment, this type of treatment can be used to reduce the perception of pain and functional disability of such patients.

Individualism is a mental and behavioral tendency that leads to individual autonomy in such a way that the individualchr('39')s goals and desires are more important to him than the goals and desires of others; such a person considers himself responsible for his successes and failures. The main purpose of this study was to determine the relationship between lifestyle and individualism in women in Shiraz, Iran.

This was a cross-sectional correlational study conducted in Shiraz, Iran 2019 on a sample of 564 single women aged 25 to 49 years selected by a combination of appropriate and purposive stratified sampling methods. The data were collected using the horizontal and vertical individualism questionnaire of Triandis et al. and analyzed using the SPSS software version 25 at both the descriptive and analytical levels, the statistical test being the Pearson correlation coefficient test.

The rate of individualism of the respondents was about 69%. Investigating the dimensions of individualism showed that the respondentschr('39') tendency to individualism in the dimension of prioritizing the individual activities of the individuals (78.15%) was higher than those of the other two dimensions. The lifestyle score of the respondents was 63.4%. Based on the Pearson correlation coefficient, there was a significant inverse relationship between the womenchr('39')s lifestyle in Shiraz and their individualism, which means that a better lifestyle can lead to a decrease in the womenchr('39')s individualism.

Based on the findings, there is an inverse relationship between lifestyle and the degree of individualism of women in Shiraz, Iran. Therefore, improving the lifestyle by focusing on the family and paying attention to its supportive dimensions can have a positive effect on reducing the individualism of this group.

Rotavirus is the most common cause of diarrhea in children worldwide. Vaccination of children has a very important effect in reducing diarrheal infection. This study was conducted to determine the safety and effectiveness of a rotavirus vaccine in children.

This study was a systematic review and meta-analysis, the data bases searched being Iranmedex, Nirp, SID, Web of science, Scopus, CRD, Pubmed, Magiran, Cochrane, and Google scholar search engine between 2000 and 2019. The inclusion criteria were children under 5 years of age, interventions with the rotavirus vaccines, Rota Teq or RV1 or RV5 or RRV or RRVTV or Rotarix or RIX-4414, compared with placebo or no vaccine. All the intervention studies were, after evaluating the quality of the methodology, included in the study. The total final effect was estimated by estimating the standard error and the ratio through meta-analysis using a random model method, followed by calculating the vaccine effectiveness. The publication bias of the studies was evaluated using the relevant tests.

A total of 767 related articles were searched by systematic review, followed by studying the full texts of 61 articles and screening 18 based on the consequences resulting from reduced visits, reduced hospitalizations and deaths, and selecting finally six studies. The overall efficiencies of the Rotateq vaccine and Rotarix were estimated, based on the standard error index and the efficacy ratio index, to be 94% and 79%, respectively, and the risk ratio (case group to the control group) was 23.81-41.96.

The findings of this study confirm the high effectiveness of the rotavirus vaccine in reducing rotavirus diarrhea. This means that the economic burden attributable to this disease will be significantly reduced.