مجله پیاورد سلامت
سال پانزدهم شماره 3 (امرداد و شهریور 1400)

Sedentary life style increases risk of cardiovascular diseases (CVDs). Physical activity and green tea supplementation can reduce cardiovascular risk factors by improving inflammation and body composition. The aim of study was to determine benefits of 8 weeks of spinning training and green tea supplementation on risk factors cardiovascular and body composition in overweight women.

A total 32 overweight women based on BMI (Body Mass Index) (27.1±1.6) and (24.9±3.6 years) were randomly divided into three groups: Spinning+green tea (n=11), spinning+placebo (n=11) and control (placebo +no training) (n=10). Training groups carried out 8 weeks of spinning training with an intensity of 11-17 Rating of Perceived Exertion (RPE). Blood sampling were obtained 48 h before starting the interventions and then 48 h after last training session. Serum concentration of hs-CRP (high sensitive C-reactive protein) and blood level of fibrinogen were measured. In addition, BMI and BF% (Body fat percent), bioelectrical impedance analysis was performed.

After 8 weeks of interventions only hs-CRP was significantly decreased in spinning+green tea group (P=0.005). In addition, fibrinogen (P=0.001), BF% (P=0.001) and BMI (P=0.001) were significantly decreased in both training groups. Also, there was significant difference of hs-CRP in the training groups (P=0.028). However, no significant difference of fibrinogen and BF% were observed between the training groups. In the case of fibrinogen both spinning+green and spinning+placebo groups had a significant difference with control group (P=0.004), (P=0.014) respectively. Regarding BF% and BMI only a significant difference wera between the spinning+green and control (P=0.006), (P=0.007) respectively.

It seems that spinning training has improved risk factors of cardiovascular and body composition. Indeed, green tea supplementation has increased the effectiveness of spinning training.

Implementation of a program to support physicians’ working long in deprived areas is one of the most important programs of the Health System Transformation Plan in response to the challenge of the shortage of expert staff, particularly physicians. Numerous factors affect the persistence of physicians in different regions, especially in deprived ones. This study aims to explain the experiences of physicians in relation to the challenges of working long in deprived areas.

The present research is a qualitative study that was conducted in 2020 in Tehran, Iran. To achieve information saturation, 16 physicians and specialists were chosen using purposive sampling method. Then, for data collection, semi-structured interviews were used. Moreover, data analysis was performed using Graneheim and Lundman contractual content analysis method, and data management was done with MAXQDA software version 12. Furthermore, Lincoln and Guba reliability criteria were applied to achieve data accuracy and reliability.

Three female and 13 male physicians with a mean work experience of 45.4±7.8 years and an average work experience in deprived areas of 8±6.3 years participated in the study. Six participants were native to the region and the rest were non-native. Twelve participants in the study were the faculty members of the university. When the data were analyzed, 286 initial codes were extracted. The information was divided into four main categories and eleven subcategories. Welfare, motivation, justice and security were the main categories of this study.

Providing individual and social welfare for physicians, and fair treatment in financial payments and educational justice along with establishing security provide the necessary motivation for physicians to stay in a deprived area. Besides by combining several solutions at the same time, the presence of doctors in deprived areas can be guaranteed.

Colorectal adenocarcinoma is one of the common causes of death due to weak response to common therapies. In this study, the effect of citric acid on bioavailability and apoptosis of the human colorectal adenocarcinoma cell line (HT29) was examined. Citric acid is a naturally organic acid that commonly found in citrus and is considered as a physiological inhibitor of enzymes involved in glycolysis pathway to remove cancer cells.

In this study, HT-29 colorectal adenocarcinoma cancer cells were cultured in DMEM medium with 10% bovine serum. The cells were treated in 400, 800 and 1600 μg/ml concentrations of citric acid and incubated at 24, 48 and 72 hours respectively. Cell growth was analyzed by MTS kit and apoptosis was analyzed three times by flow- cytometry using an Annexin V-FITC/PI kit according to the manufacturers protocol.

The results of bioavailability of treated HT-29 cells with different concentrations (400, 800 and 1600 μg/ml) of citric acid, after trinary incubation time (24, 48 and 72 hours) using the MTS assay showed that, bioavailability of HT-29 cell line decreased at all concentrations of citric acid in a time dependent manner. Also, the results of the apoptosis induction in treated HT-29 cell line with different concentrations (400, 800 and 1600 μg/ml) of citric acid, after trinary incubation time (24, 48 and 72 hours) using Annexin V-FITC/PI test showed that the percentage of the early and late apoptosis cells increased with increasing citric acid concentration and incubation time, which increased the percentage of apoptosis compared to the control group is significant in all three times of 24, 48 and 72 hours.

The results indicate that citric acid can reduce the bioavailability of colorectal adenocarcinoma cells by inducing apoptosis pathway.

Low-grade systemic inflammation, sedentary lifestyle, and vitamin D deficiency are considered risk factors for developing non-specific low back pain. The aim of this study was to investigate the effect of selective lumbar stabilization exercises with vitamin D intake on the level of hypersensitive C-reactive protein (hs-CRP) and 25-hydroxy vitamin D levels in women with chronic non-specific low back pain.

In this semi-experimental study with pretest–posttest design, 48 women with chronic low back pain were initially selected by available sampling method and then randomly divided into control, exercise, vitamin D and combined groups. Lumbar stabilization exercises were performed at different levels for 8 weeks. The vitamin D and combined groups received 50,000 IU vitamin D weekly. Data were analyzed using paired t-test, ANOVA and Kruskal-Wallis tests with a significant level of less than 0.05. 

25.64% and 74.26% of the subjects had insufficient levels of vitamin D (20-29 ng/ml) and vitamin D deficiency (less than 20 ng/ml), respectively. 8 weeks of lumbar stabilization exercises, vitamin D consumption, and the combined intervention decreased hs-CRP and increased 25-hydroxyvitamin D. In addition, the combined intervention had a stronger effect on lowering hs-CRP levels compared to the other two interventions. The effect of vitamin D intake and combined intervention on improving vitamin D status was greater compared to lumbar stabilization exercises.

It seems that lumbar stabilization exercises, vitamin D intake, and combined interventions can improve low-grade systemic inflammation in people with low back pain and low vitamin D levels by lowering hs-CRP and positively regulating 25-hydroxyvitamin D, but combined intervention is associated with greater effectiveness in reducing hs-CRP.

In recent years, the family physician plan has been implemented as a main strategy of health system in Iran. Therefore, the necessity to reform organizational structure based on experiences of other countries is felt more than before. The aim of this study was to explore required structures of Family Physician Program to achieve service quality dimensions in Primary Health care through analyzing country experiences.

This study was a systematic review. All relevant databases were searched using appropriate search strategies and keywords (Family Physicians, Primary Health Hare, Quality of Care). To evaluate the quality of selected papers, CASP tool was applied by 4 experts, and their choices were discussed to reach a final decision.

In order to achieve the quality of services in the field of family medicine, based on the findings of this study, eight important executive structures must be considered. These structures are: Organizational and managerial structures, including health system governance, Support  mechanisms and referral system, Systematic communication platform, Electronic health services, Service delivery processes,Insurance structure, Supervisory and control structure including financial control mechanisms, competitive control and quantitative control, Payment structure, quantitative and qualitative development structure of service providers, Quality structure that includes the definition and evaluation of quality and accountability mechanisms as well as incentive mechanisms for service quality, Support structure including insurance support, classified support for specific groups, and finally, the cultural structure in the two areas of culture building of the referral system and strengthening the position of family physicians.

Quality improvement in primary health care requires attention to executive structures. Use of executive experiences of other countries will be useful in achievement of quality health care in family physician system.

Health systems have played an important role in improving and increasing life expectancy. However, there is a large gap between health systems’ potential and their current performance, most of which relate to governance issues. The purpose of this study is to provide a model for improving the governance of the country's health system.

The present study is applied-developmental in terms of purpose. After reviewing the theoretical foundations and previous research, the governance strategies of the health system were identified. Then, using Fuzzy Delphi Method (FDM) and surveying 13 academic and executive experts who were purposefully selected, the research model was designed. Finally, in order to validate the model, 169 managers and specialists of health system departments in Tehran were interviewed with a questionnaire, and the data were analyzed using structural equation modeling (SEM) and SmartPLS software. At this stage, the sampling method was available and the sample size was calculated by Cochran's method.

According to the research findings, in order to promote health governance, 10 main strategies and 58 sub-strategies should be considered. Identified strategies include strategic orientation, optimal financial resource management, stakeholder partnership development, knowledge resource development, administrative health promotion, technical knowledge development, value and ethical orientation, executive and operational platform development, Service delivery capacity management and Balanced and integrated stewardship. Also, the coefficient of determination for the outcome variable is 0.549 and the intensity of the effect of intervening/ facilitating and contextual factors on governance strategies is equal to 0.610 and 0.533, respectively.

The results showed that the governance of the health system is a multifaceted and complex phenomenon and in order to improve it, a set of strategies must be implemented. In addition, it is suggested that according to the issues and threats facing the health system, a roadmap and a long-term plan should be developed in order to move towards the governance model proposed in the present study.

Due to the important role of radiological images for identifying patients with COVID-19, creating a model based on deep learning methods was the main objective of this study.

15,153 available chest images of normal, COVID-19, and pneumonia individuals which were in the Kaggle data repository was used as dataset of this research. Data preprocessing including normalizing images, integrating images and labeling into three categories, train, test and validation was performed. By Python language in the fastAI library based on convolution technique (CNN) and four architectures (ResNet, VGG MobileNet, AlexNet), nine models through transitional learning method were trained to recognize patients from healthy persons. Finally, the performance of these models was evaluated with indicators such as accuracy, sensitivity and specificity, and F-Measure.

Of the nine generated models, the ResNet101 model has the highest ability to distinguish COVID-19 cases from other cases with 95.29% sensitivity. Other applied models showed more than 96% accuracy in correctly diagnosis of various cases in test phase. Finally, the ResNet101 model was able to demonstrate 98.4% accuracy in distinguishing between healthy and infected cases.

The obtained accuracy showed the accurate performance of developed model in detecting COVID-19 cases. Therefore, by implementing an application based on the developed model, physicians can be helped in accurate and early diagnosis of cases. an application based on the developed model, physicians can be helped in accurate and early diagnosis of infected cases.

Large amounts of hospital costs are not reimbursed annually by health insurance as deductions. Therefore, reducing deductions is very important for the hospital. In the study of design and implementation of analytical dashboard of insurance deductions based on medical intelligence business, to improve financial management with the aim of focusing on assessing the level of satisfaction and its applicability has been done.

To design the questionnaire, first 27 questions were prepared through library studies and interviews with members of the hospital board of directors, and the validity and consistency of its items were determined through content validity and Cronbach’s alpha coefficient. Data were analyzed in SPSS software and the results were used to design and implement the dashboard.

The study is of development-applied type. In the first phase, to determine Content Validity Ratio CVI (Content Validity Index), and CVR (Content Validity Ratio) a researcher-made questionnaire was provided to 20 experts. In the second phase, by building a data warehouse in SQL (Structured Query Language), the information of the tables related to the deductions of the hospital HIS system was transferred to it and the operational information of the organization was extracted and converted into DW format and the map information was tested. OLAP (Online Analytical Processing) services were then loaded on the created analytics database. In the last step, Power BI tool was selected and used to create business intelligence mechanisms, display and visualize information. In the third phase, using the QUIS (Questionnaire for User Interface Satisfaction) standard questionnaire, the level of satisfaction and usability of the dashboard was evaluated by 15 experts.

In this study, two questionnaires were used. CVR was measured in all items of the first questionnaire, more than 0.50 and CVI was measured in the upper areas of 0.90 and Cronbach’s alpha coefficient was obtained between 0.8 and 0.9, which indicated a good level. The second questionnaire was to evaluate the level of satisfaction and usability of the dashboard that the average of the total evaluation based on the indicators of the QUIS questionnaire is equal to 85.40. Therefore, the level of satisfaction and usability of the dashboard was “very good” for the evaluators.