نشریه سلامت اجتماعی
سال هفتم شماره 4 (پاییز 1399)

Reliable and up-to-date data are essential for proper and timely decisions. However, most accessible data are limited to specific locations and subjects, which do not present the big picture. Besides, data might be manipulated to serve a group of people's political and economic interests. Although the World Health Organization has been developed to act impartially as an international organization, they fail to ignore the supreme authorities' impact. Therefore, they confine to republishing the official reports of the member governments. However, policy-makers in healthcare not only depend on comprehensive and reliable data but also need to figure out the relations between the indicators of health and their determinants . Accordingly, Hans Rosling, a Swedish physician, developed a comprehensive and practical tool named the Gapminder. Rosling, who was previously a member of the Doctors without Borders, provided healthcare services in Ghana when he realized this gap in the health data accessibility. Hence, he developed the Gapminder in cooperation with his son and daughter-in-law. This software has provided awareness about health indicators and the relations with their determinants in a global perspective. Thus, Gapminder creates an updated and fact-based perception of global health for users . This editorial is written to gain readers' attention to the article entitled "Global Indicators of Health: Changes and New Facts," published in this issue. We are looking forward to publishing more articles in this subject area in future issues.

Global indicators of health are changing continuously among various societies, whereas an accurate awareness of these changes and related factors has not been developed yet. One of the major causes of this lack of awareness is insufficient and inaccurate transferring of statistic data. The objective of this study was reporting the changes occurred in global indicators of health and explaining the new facts using the Gapminder tool.

In this study, visual and graphical tools of Gapminder were used. Gapminder is a non-profit organization that acquires data from reliable databases and demonstrates them on diagrams on its website and application. It includes 498 public health and socio-economic indicators which are derived and updated from international institutions including World Bank, World Health Organization, the United Nations and the Global Burden of Diseases study. Gapminder provides various tools for the users. The diagrams demonstrated in this study are derived from the 2018 offline version of Gapminder and necessary alterations have been made.

In 1965, there were two peaks in the diagram of the distribution of world population based on their income. Most of the populations of the Asian countries were distributed in the low-income section of the diagram, whereas most of the populations of the European and American countries were distributed in the high-income section of the diagram. However, in 2018, there is only one peak in the middle of this diagram. This diagram in 2018 indicates that most of the world populations, regardless of their countries, live in the middle section of the diagram. Therefore, it could be concluded that in each country, there are people living in each level of the all four levels of income. The novel classification, classifies the world population based on their daily income to four levels: people with daily income of less than two dollars, two to eight dollars, eight to 32 dollars and more than 32 dollars.

The changing trend of the mentioned indicators of health is stablished. However, since nowadays the major source of awareness is media, biases of the mass media have created inaccurate awareness among people. Therefore, novel methods and tools are required to transfer accurate data about health indicators to researchers, policy makers, investors, and other members of societies. Accordingly, Gapminder has been developed to assist the observation and interpretation of global indicators of health changes. The Gapminder foundation and its software have enabled statistical data to be demonstrated more attractively and comprehensively. However, inventing and applying novel methods and tools for transferring data is not the last step in increasing public awareness regarding to changes of the health indicators. Thus, the next step would be driving a paradigm shift in mentation among people in order to adopt evidence and fact based view about the world around them.

Global health reports are valuable sources in all health areas for policymakers. The aim of our study was to review the global reports published within ten years, focusing on the situation and functions of Iran health system.

The study reviewed global health reports. In our study and with a systematic approach, we attempted to find and review all the main published reports from 2008 to 2018, using appropriate search strategies. At first, we assessed how these reports are published and who are the main participants. Then, the importance of the area and approach of the report was assessed. The indicators at international and national levels from the aspect of both the process and outcomes were the fundamental part of our analysis. Finally, special experiences from Iran were extracted from each global report.

Sixteen global reports in the areas of non-communicable disease, communicable diseases, mental health, and injuries were selected and indicators related to the world and Iran was extracted.

Assessment of the global reports demonstrated that the situation of Iran's health system in the areas of controlling the non-communicable diseases, maternal health, and water safety was favorable. However, the situation in the areas of unintentional injuries and happiness was unfavorable. The situation in the field of mental health and violence prevention was intermediate

Critical thinking has always been at the forefront of the global education system as purposeful thinking.This study aimed to investigate critical thinking as one of the mental health dimensions in elementary textbooks in the form of a quantitative and qualitative content analysis.

This study was a descriptive research and the methods of library and content analysis were used. The study sample included all primary school textbooks in the academic year 2017-2018. The main source of determination of the components of mental health was the comprehensive curriculum of health education in schools from preschool to the end of highschool, which was revised according to the opinion of eight experts in the field of mental health. Data collection method, identification, analysis and counting the components of each of the analysis unit text, image and activity were based on the list of analysis content. For quantitative analysis of the data, descriptive statitsics, frequency calculation was used.

Among the components of critical thinking, the ability to analyze information and experiences, and unbiased judgments, had the highest and lowest frequencies, respectively. The highest frequency of critical thinking components was found in the sixth grade textbooks and the least frequency was in the third grade. Based on the form of presentation, the highest frequency of critical thinking material was in form of excersices and the least was among materials in the form of image. In addition, the most attention has been drawn to the knowledge-based materails while skill-based materails had received no attention.

It can be concluded that little attention has been paid to critical thinking in primary school textbooks, and the main focus of the presentation is in the knowledge axis while the skill axis has received improper attention

Divorce is a process that begins with experiencing the emotional crisis among couples and ends with the attempt to solve the conflict by entering a new position with new roles and lifestyle. The purpose of the present study was to compare the early maladaptive schemas in four groups of before, during, after divorce, and normal couples in Tehran during 2016-2017.

The present study was a causal-comparative study. The statistical population consisted of all couples before, during, after divorce, and normal couples who were referred to the family courts of Tehran in 2016-2017. Using a convinience sampling method, 30 participants in each group were selected. Data were collected by Early Maladaptive Schemas questionnaire and multivariate analysis of variance was used to analyze the data by SPSS-22.

The mean (SD) age in the group before divorce was 33.1 (4.3), during divorce 31.6 (5.4), after divorce 35.8 (5.9), and the normal group 34.7 (5.2). The mean (SD) score of exclusion and cessation component was 36.3 (2.8) (P<0.001) and self-reliance and impaired function 15.8 (2.2) (P<0.04) in the group before divorce which was higher than other groups. In addition, the mean (SD) score of other orientation was 12.1 (2.1) (P<0.03) and hypervigilance and inhibition 9.4 (1.9) (P<0.002) in the normal group which was significantly lower than the other groups, but the components of the constraint components had no significant difference in the four groups before, during, after divorce, and normal couples.

The study showed that couples before, during, and after divorce have the most maladaptive schemata compared to normal couples

Despite the establishment of various institutions and organizations in the realization of women's rights and education, and despite the considerable costs, women are suffering from the problems of economic and cultural poverty. Therefore, the Welfare Organization decided to alleviate their problems with the national microfinance program. The purpose of this study was to explain the goals, service model, challenges, and future path of this national program in the Welfare Organization.

A qualitative study was conducted in 2016. Participants included managers and experts of Welfare organization in 31 provinces of the country, 21 members of public mediators and collaborative and stakeholder organizations, and five senior managers of social deputy in the Welfare Organization. Data were collected using document analysis and interviews with experts and analyzed by the content analysis method.

The national microfinance program was implemented with the aim of expanding the family economy, utilization of villagers with unsecured bank loans and empowering them, and promoting employment, micro-businesses, and enhancing the savings and banking skills of the target group. The unfamiliarity of external stakeholders, the troubled banking system, the short-term outlook, and the inflexibility of managers and the transfer of duties to the private sector were identified as program challenges. The executive strategies include increasing financial support from self-help groups, reducing interest rates on loans paid by the Agricultural Bank, opening an account in the name of the group, repaying loans in installments, increasing awareness of the legality of the program, increasing the percentage of local executives' fees and creating an entrepreneurial spirit.

Despite the services provided in the microfinance program, it faces challenges at the government and external stakeholders and banking laws. To improve the current status, implementation of suggested solutions along with revision and modification of related processes is necessary.

Safety is one of the principles of patient care and is a vital component of quality management. The first goal of a health care organization is preventing injuries during treatment, and thus preventing endangering patient safety. Thus, the objective of this study was to investigate the safety culture among the primary health centers in Karaj.

This descriptive cross-sectional study was performed with participation of 164 health care providers, who worked in 20 Karaj health centers that were selected via simple random selection from 41 primary health centers in 2017-2018. A modified version of the Hospital Survey on Patient Safety Culture and a demographic questionnaire were used. Central and dispersion statistics were used for data description via SPSS software version 21.

The mean (SD) total score of positive patient safety culture was 64.7 (9.9), minimum score was 36.4 and maximum score was 89.2. Among the dimensions of patient safety culture, the highest scores were related to the within-unit teamwork dimension with mean (SD) of 80.3 (17.1) and head of center support for patient safety with mean (SD) of 76.1 (16.6) and the lowest score was for the non-punitive response to error dimension with mean (SD) of 33.3 (18.8). As many as 99 (63.1%) health care providers rated their workplace in this regard as excellent and very good, 48 (30.6%) considered it acceptable and 10 (6.3%) reported inadequate and poor workplace safety.

The study indicated that the scores of patient safety culture among health care providers have increased in all its dimensions except for teamwork across units of health care, compared to the previous study. Among the dimensions of patient safety culture, the highest score was related to the within-unit teamwork and head of center support for patient safety, and the lowest score was to the non-punitive response to error

Medical malpractice in Iran is a common and increasing phenomenon, the characteristics of which change over time. Therefore, it is useful and necessary to describe this phenomenon and update the data about it. The purpose of this study was to describe medical malpractice complaints and socio-demographic characteristics of patients and physicians involved in medical malpractice cases in Tehran.

This descriptive cross-sectional study was performed by reviewing medical malpractice cases in Tehran Medical System Dispute Resolution Council. The study was conducted by census method and 484 medical malpractice files were studied. Data were analyzed by SPSS software version 24 and using descriptive statistics including frequency, percentage, mean and standard deviation.

In 298 (61.5%) cases of medical malpractice cases, the patient was referred to a physician for cosmetic procedures, and in 169 (35%) cases, patients were referred to a physician for treating a medical problem. The highest number of cases resulted in medical malpractice, 139 (37.6%), were in private clinics. Public clinics, 4 (1.1%), had the lowest frequency. Most patients were aged 31-42 years, 159(43.3%), married and 219 (59.8%), with Bachelor's degree 145 (39.2%), and low socioeconomic status 137(37%). 206 (55.7%) of the complainant patients were employed, and others were unemployed or economically inactive. The mean (SD) physicians' age was 49.6 (9.6) years. 392 (81%) physicians were male, and 92 (19%) were female. 148 (30.5%) physicians had 20 years of work experience, and 291 (60.1%) were specialists.

Most of the patients were female, married, with a Bachelor's degree and from low socioeconomic status. Most physicians were specialists, with over twenty years of work experience.

The benefits of psychological activities are as significant as physical activities during leisure time. The aim of this study was to determine and recognize the roles of leisure time and the effect of psychological factors among adolescents and young people.

This descriptive-analytical study was conducted via the fuzzy Delphi method to determine and identify the variables involved in the research. The statistical population included all adolescents aged 13 to 21 years in Tehran province, among whom 305 people were selected by multi-stage cluster sampling. Data collection tools included standard questionnaires including meaning in life, generalized anxiety disorder, emotional intelligence, openness to experience, Meta-Emotion, physical health, need for Recreation, happiness, and volunteer work, and researcher-made questionnaires including recognition of personal interests, Calmness, and flourishing of talent. Data were analyzed by SmartPLS software using the structural equation method.

Psychological factors with mean (SD) 2.1 (0.2) improved leisure functions with mean (SD) 2.7 (0.4), P <0.01. Variables of psychological factors including anxiety with mean (SD) 1.2 (0.6), Meta-Emotion 3.1 (0.4), openness to experience 1.9 (0.4), emotional intelligence 2.6 (0.6), meaning of life 3.5 (0.8) and recognition of personal interests 0.4 (0.3) and leisure functions including relaxation with mean (SD) 1.0 (0.4), voluntary work 3.3 (0.8), health 4.5 (1.0), happiness 1.0 (0.4), talent flourishing 1.3 (0.5), and entertainment 3.4 (0.6), with indicators They have a significant relationship in the pattern, P<0.01. Also, considering the GOF=0.40, the overall fit level of the model was excellent.

The study showed that psychological factors improved the roles of leisure time

Emotions play a significant role in the learning and achievements of students. The objective of this study was to determine the relationship between achievement goal orientation and cognitive emotion regulation strategies with positive and negative academic achievement emotions among students of Payame Noor University of West Azarbaijan Province in the academic year 2019-2020.

This correlational study was conducted with participation of 391 undergraduate students (264 women and 105 men) of Payame Noor University of West Azarbaijan Province, who were studying in the first semester of the academic year 2019-2020, and were selected via cluster sampling method. Questionnaires of goal orientation and cognitive emotion regulation strategies and achievement emotions were used to collect data. Pearson correlation coefficient test was used to calculate the relationship between the variables and step-by-step regression test were used to examine the effect of predictor variables on the criterion variable. SPSS software version 24 was used to analyze data.

The goal orientation of the tendency orientation with the average (SD) 16.9 (4), the goal orientation of the avoidance function 16.6 (4.2), the goal orientation of the orientation function 17.1 (4), and compatible cognitive emotion regulation styles 59.2 (12.7), were positively associated with the score of positive achievement emotion 102.3 (20.6), P<0.001. They were negatively associated with negative progress emotion score 105.7 (29.9), P< 001. The score of incompatible cognitive emotion regulation styles with mean (SD) 41.1 (9.1) was positively associated with the negative achievement emotions 105.7 (29.9). Goal orientation of tendency dominance, compatible cognitive emotion regulation styles, and orientation function orientation explained 31.6% of the variable variance of students' positive achievement emotions. Also, the components of goal orientation of tendency dominance, incompatible cognitive emotion regulation styles and compatible cognitive emotion regulation styles explained 20% of the variance of variable of students' negative achievement emotions.

The score of positive achievement emotions of students was positively and negative achievement emotions was negatively associated with the score of components of goal orientation including goal orientation of tendency dominance, goal orientation of avoidance performance and goal orientation of orientation performance. Also, the compatible cognitive emotion regulation styles were positively associated with the positive achievement emotions and negatively associated with negative achievement emotions. Negative achievement emotions were positively associated with incompatible cognitive emotion regulation styles.

Diabetes can have significant psychological effects on health and delay the disease's recovery. Therefore, the aim of this study was to test and compare the causal relationship between the health control center and health-related quality of life mediated by diabetic distress in patients with type 1 and type 2 diabetes.

This study was conducted with the participation of 371 patients with type 1 and type 2 diabetes who were referred to endocrinologists in Bushehr in 2019, and were selected by convenience sampling method. Data were collected via Health-related Quality of Life, Psychiatric Distress of Diabetic Patients, and Health Control Center questionnaires. Data were analyzed via the path analysis method using AMOS software version 22.

In the group with type 1 diabetes, with increasing of health control center related to influential people with a mean (SD) of 28.1 (3.2) and increasing the internal health control center with a mean (SD) of 23.1 (3.1), health-related quality of life increases with a mean (SD) of 40.1 (7.1) (P<0.001). However, with the increase of the health control center related to chance with a mean (SD) of 24.00 (8.7), the quality of life-related to health decreases (P<0.001). Also, with the increase of the health control center related to influential people and the internal health control center, diabetic distress decreases with a mean (SD) of 2.8 (0.9) (P<0.001). Diabetic distress increases as the chance related health control center increases (P<0.001). Also, with increasing diabetic distress, the quality of life-related to health decreases (P<0.001). In the group of type 2 diabetes, with increasing the health control center related to influential people with a mean (SD) of 26.3 (4.3) and increasing the internal health control center with a mean (SD) of 25.1 (7.1), health-related quality of life increases with a mean (SD) of 43.2 (12.1) (P<0.001). However, with increasing the health control center related to chance with a mean (SD) of 20.3 (6.6), the quality of life-related to health decreases (P<0.001). Also, with the increase of the health control center related to influential people and the internal health control center, diabetic distress decreases with a mean (SD) of 2.6 (0.8) (P<0.001). Diabetic distress increases as the chance related health control center increases (P<0.001). Also, with increasing diabetic distress, the quality of life-related to health decreases (P<0.001).

The study showed that the health control center had a significant correlation between chance and related people with health-related quality of life. Internal Health Control Center, in addition to having a direct impact on the quality of life, also reduces the quality of life in both groups of patients with type 1 and type 2 diabetes by reducing the anxiety of diabetes.

Obesity is a known risk factor for cardiovascular diseases; however, weight loss and decreasing body mass index (BMI) are difficult for many patients with coronary heart disease. The purpose of this study was to determine the effectiveness of acceptance-based behavior therapy on BMI among patients with premature coronary heart disease.

This study was conducted in the summer of 2018 and was of quasi-experimental design with control group, pre-test, post-test, and a follow-up period after 3 months. The statistical population included all male patients with premature coronary heart disease who were younger than 50 years old and were referred to Shahid Rajaee hospital in Tonekabon, among whom 24 were selected via convenience sampling method and divided into two intervention and control groups. The intervention group received treatment-based behavioral therapy for eight weekly sessions while the control group did not receive any intervention. BMI was calculated in the pre-test, post-test and follow-up for each participant.Data were analyzed via SPSS software version 22.

In the experimental group, the mean (SD) BMI decreased from 32.2 (3.4) before the intervention to 31.5 (3.1) after the intervention (P<0.01). In the control group, the mean (SD) BMI decreased from 32.6 (3.5) before the intervention to 32.5 (3.4) after the intervention; however, the decrease was not statistically significant. In addition, in the follow-up phase of the experimental group, the mean (SD) BMI decreased from 31.5 (3.1) in post-test to 30.4 (2.8) in the follow-up (P<0.001). In the control group, the mean (SD) BMI decreased from 32.5 (3.4) in post-test to 32.4 (3.4) in the follow-up; however, this decrease was not statistically significant.

It could be concluded that acceptance-based behavioral therapy lead to a decrease in BMI among premature coronary heart disease patients.