مجله دانشکده بهداشت و انستیتو تحقیقات بهداشتی
سال نوزدهم شماره 2 (پیاپی 74، تابستان 1400)

According to the definition proposed by WHO, social health is a health dimension that impacts, or is affected by, the two physical and mental dimensions. Based on the definition given by the Academy of Medical Sciences of Islamic Republic of Iran, social health includes reciprocal qualitative and quantitative behaviors by individuals towards welfare of the society. Pro-social behaviors and an encouraging environment are considered as the two main components of social health promotion. The purpose of this study was to identify pro-social behaviors in the Iranian society.

This was a qualitative study. Data were collected using 1). Literature review based on sources related to Iranian culture and religious advice, as well as published international experiences, and 2). Expert opinions based on focus group discussions on eight specialized disciplines. The data obtained were content analyzed.

Analysis of the data of this study showed twenty pro-social behaviors (possible to be categorized into three domains/areas of social thinking, speech and expression, and behavior):acceptance of diversity and altruism, understanding human rights, not telling lies, cooperation, humbleness, donation/free contribution, being critical, patience and forgiveness, lack of distrust/suspicion, speaking competence, proper balance/equilibrium, sense of responsibility, brotherhood, personal discipline/order, fidelity, trustworthiness, consultation, cultural exchange, self-identity and, finally, respecting the environment.

Behavior change requires applying evidence-based models, e.g., social marketing. It is, thus, suggested that after investigating and surveying pro-social behaviors in the Iranian society, barriers to pro-social behaviors should be investigated and social marketing programs be developed and implemented aiming to help improve these behaviors.

 The health financing system is the process of collecting, pooling and managing financial resources to purchase health services. Sustainable financing of the Iranian health system is crucial for achieving universal health coverage. The purpose of this study was to identify strategies for sustainable financing of the Iranian health system.

 This study was conducted using the scoping review in 2020. The following databases and search engines were searched systematically between 21.03.2002 and 21.09.2020 to find studies related to sustainable financing strategies for the Iranian health system: PubMed, Web of Science, Scopus and Embase, Magiran, Iranmedex and SID databases, and two search engines; i.e., "Google" and "Google scholar”. Finally, 47 studies were selected and analyzed using the MAXQDA software and the framework analysis method.

A total of 40 strategies were identified for strengthening the sustainability of Iranchr('39')s health financing system, which were grouped into three categories: collecting funds, pooling funds and purchasing health services. The most frequently cited strategies for sustainable financing of the Iranian health system were the following: increasing the health share of gross domestics product, expanding tax revenues, pre-payment methods of health financing, strengthening public-private partnership, increasing the efficiency of the health system, reducing health system costs, consolidating insurance funds, eliminating insurance overlaps, value-based health service tariffs, optimizing health services support packages, and fixed payment methods based on  the performance of the health service providers.

The Iranchr('39')s health financing system must be strengthened in such a way as to make it possible to collect, pool and manage sufficient financial resources to be used to purchase health services for the people to ultimately ensure universal health coverage leading to the promotion of the public’s health.

The World Health Organization considers the implementation of the referral system to be a key step in improving the quality of services in health care systems. The purpose of this study was to explain the executive challenges of the electronic referral system in Golestan Province, Iran.

A qualitative study was conducted in Golestan Province, Iran in 2019 with a content analysis approach. The participants were family physicians, specialists, university staff managers, responsible health officers in the Offices of Deputy Ministers of Health, the General Directorate of Health Insurance, Department of Information Technology, Rural Health Network managers, health network managers and patients selected purposefully. Data were collected through semi-structured interviews and analyzed using the content analysis method.

The main challenges of giving appointments to patients included the lack of time of family physicians, the irregular presence of specialists, difficulty in getting an appointment, and reverse referrals. As regards referrals and waiting times, the main challenges were found to be the lack of sufficient admissions following cancellation of the health insurance contract with the private sector, the delay of physicians in attending the health centers, long waiting times to be visited, and writing the feedback by the physicians. In addition, the main challenges of the visits and diagnosis included the short visiting times, the higher quality of the specialistschr('39') visits in the private sector, and the lack of clear guidelines. Finally, the main challenges as regards giving feedback were the reluctance and noncommitment of some specialists to provide feedback, as well as the low quality and lack of usability of the feedbacks given.

Based on the findings of this study, the following actions and measures may help improve the current situation as regards the current referral systems: allocating sustainable resources; allocating financial credits; designing and implementing a reward and punishment system; reforming the queuing system; empowering medical students; and equipping specialists with electronic pens for giving written feedback.

This study aimed to assess the effects of zinc supplementation on the clinical signs of patients with plaque-type psoriasis with skin congestion under 20%.

This randomized double-blinded clinical trial included 44 patients with plaque-type psoriasis with skin congestion under 20% referring to the Imam Reza Hospital in Ardabil, Iran. The patients with low levels of serum zinc and no history of joint congestion were randomly divided into a treatment and a control group. Those in the treatment group received, daily for a month, a 220mg zinc supplement along with Eucerin, a topical ointment, while those in the control group received a placebo and Eucerin for the same period. All the participants were followed up for a period of three months. The severity of itching, erythema, scaling, dispersion, and extent of lesions induration were determined using the Psoriasis Area Severity Index (PASI) before and after the intervention. The data were analyzed using the SPSS software version 26.0, the statistical method being generalized estimation equations (GEE).

There were no significant differences between the two groups as regards demographic and general characteristics (p>0.05); there was no significant difference as regards their initial serum zinc levels either (p>0.05). Based on the  GEE analysis, no significant differences were observed as regards itching severity, erythema, scaling, dispersion, the thickness of lesions’ induration between the two groups over the study period (p>0.05).

Zinc supplementation has no considerable effect on reducing the clinical signs of patients with plaque-type psoriasis and skin congestion under 20%.

Premenstrual Syndrome (PMS) is experiencing some physical and psychological symptoms in the last days of the menstrual cycle; it interferes with educational, social and family functioning, creating problems for the adolescents. The objective of this study was to determinee the effectiveness of a transdiagnostic treatment program on anxiety, depression and stress in female adolescents with premenstrual syndrome and their motherschr('39') quality of life.

This experimental study was conducted on 26 female adolescents with PMS referring to two health centers in Tehran, Iran in 2019. They were divided randomly in 2 groups, namely, an intervention (n=12, attending six 90-minute session per week‎) and a control (n=14) group. Data were gathered using the WHO Quality of Life, Beck depression, the DASS and PMS Screening Tool (PSST) questionnaires initially and after one month. The repeated ANOVA test was used for data analysis using SPSS software version 21; a p-value of <5% was considered to show statistical significance.

As compared to the control group, at the end of the period the intervention group showed a statistically significant decrease in the means of the three variables of depression, anxiety and stress (p <0.05). The decrease significantly improved the quality of life of the mothers.

The findings of this study show that a transdiagnostic treatment program can be an effective method to reduce the psychological problems of adolescent girls and improve the quality of life of their mothers.

Social capital is a social component affecting health outcomes considered to be one of the important factors influencing health inequity in the communities; it is one of the main concerns of health system in the suburbs. This study aimed to determine social capital and its relationships with demographic factors and perceived health status in the suburbs of Mashhad, Iran in 2020.

This was a descriptive-analytical study including 300 residents in the suburbs of Mashhad, Iran selected using the cluster sampling method. The data collection tool was a questionnaire containing demographic and perceived health status questions, as well as the Onyx and Bullen social capital questionnaire. Data were analyzed using the t-test, Pearson correlation test, one-way analysis of variance and multiple linear regression, using SPSS-version 24.

The mean age of the individuals was 34.6± 11 years and their social capital score 53.63± 10.52. Among the eight social capital components, the value of life (57.91± 17.7) and participation in the local community (44.28± 15.28) were found to have the highest and lowest mean scores, respectively. Further analysis of the data showed that sex, education level and perceived health could predict 23% of the changes in the total social capital (p <0.001).

In this study, the level of social capital of the participants was low, but the demographic factors and health status were related to social capital. Therefore, policymakers and social and health planners should design and implement community-based interventions to improve the level of social capital.

The aim of this study was to investigate the effectiveness of emotional working memory education on the ability to control emotions and cognitive emotion regulation in women hurt by infidelity.

This was a pre-test, post-test and follow-up single-blind intervention study. From among the women hurt by infidelity referring to the Social Emergency Department of Sabzevar City, Iran between September and January 2021, a sample of 42 were randomly selected and assigned to either an experimental (n = 21) or a control group (n = 21). They completed 2 questionnaires, namely, an Inhibition of Emotions Questionnaire (27) and a Cognitive Emotion Regulation Questionnaire (29), initially and after the intervention. The education was carried out in 20 sessions using emotional working memory education software (32). The data were analyzed using the repeated measures multivariate analysis of variance.

Analysis of the data showed that emotional working memory education can affect the ability to control emotions and regulate cognitive emotion in women hurt by infidelity.

A complementary treatment strategy for controlling emotions and cognitive emotion regulation in women hurt by infidelity is emotional work-based education. Practical implications of the findings of this study were discussed.

Breast cancer is one of the most common cancers in Iran. The aim of this study was to assess the effectiveness of existential-humanistic therapy in self-acceptance and marital satisfaction in women with breast cancer.

This was a quasi-experimental study with a pre-test, post-test and follow-up design with a control group. The statistical population was the women with breast cancer referring to Shahid-Rahimi Hospital in Khorramabad, Iran in 2020, from among whom two groups (experimental and control) of 15 women each were randomly selected and asked to complete the self-acceptance (USAQ) and marital satisfaction (ENRICH) questionnaires. Then the experimental group attended eight 90-minute intervention sessions. After the intervention, both groups took a post-test and followed up further after two more months. The data were analyzed using the repeated measures ANOVA test.

The repeated measures ANOVA test showed that the interaction between group and time was statistically significant. Therefore, the self-acceptance and marital satisfaction variables increased significantly (F=5/77, P<0/01 and F=13/97, P<0/01, respectively).

According to the results of this study, existential-humanistic therapy has a significant effect on self-acceptance and marital satisfaction in breast cancer patients. It is, therefore, recommended to pay attention, in addition to the physical problems of such patients, also to their psychological problems and, along with pharmacotherapy consider psychotherapy, including existential-humanistic therapy as well.