Iranian Journal of

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Background & Objectives: For those with a chronic illness, suffering may result not only from physical limitations, but also from the psychosocial consequences of having a chronic condition. Therefore, simply measuring physical health is not enough anymore. It is necessary to evaluate quality of life as an important clinical outcome in these patients. We conducted the present study to measure quality of life (QoL) in multiple sclerosis (MS) patients and its predictors in comparison with the general population in Tehran, using a generic and overall QoL instrument, the WHOQOL-BREF (World Health Organization Quality of Life-BREIF). This questionnaire comprises four domains including physical health, mental health, social relationships, and environmental health. For each domain, scores range from 4 to 20, higher scores corresponding to a more favorable QOL.
Methods: This study was of cross-sectional type and involved 145 selected systematically patients registered in the Iranian Multiple Sclerosis Society. The WHOQOL-Questionnaire was filled in for these patients through telephone interviews. The results were compared with quality of life scores from the general population obtained from a population-based study in Tehran. Multiple regression was used for data analysis.
Results: The response rate was 97% 73.8% of participants were female, the mean age of participants was 36.5 (SD = 10.4) years, and the mean years of their formal education was 12.5 (SD=3.6). Mean scores for physical health, psychological health, social relationship and environmental health were 11.5 (SD=3.2), 11.8 (SD=3.2), 12.7 (SD=3.1), and 11.5 (SD=2.7), respectively. In comparison with the general population, the patients' scores in all domains were significantly lower than in the general population. Severity of disease and education level had a relationship with domain scores in regression analysis.
Conclusions: The WHOQOL-BREF questionnaire can discriminate between these patients’ quality of life and that of the general population and show the effect of disease severity and demographic variables on quality of life. Therefore the questionnaire can be used in this group of patients, although it may be necessary to add some specific questions to make the tool more sensitive in evaluating quality of life from a clinical perspective. Educational interventions are recommended to improve quality of life in this group of patients.

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Background & Objectives: Today, the quality of life study has an important role in health care especially in chronic diseases, in clinical judgment and in medical resources supplying. Malignancies have a clinical and health importance in the world and Iran. Breast cancer has first order among women’s malignancies. Now, survival rate for this cancer is long. However Breast cancer has several complications that affected patient’s life. It is necessary that we studying the quality of life and related factors among this patients.
Methods: We conducted a cross-sectional study on 119 breast cancer patients that admitted and treated in chemotherapy ward of Namazi hospital in Shiraz.We used QLQ-C30 & QLQ-BR23 to assessment quality of life in these patients. We used univariate nonparametric tests and multiple linear regression model to identify associations between dependent variables and the quality of life and it’s different scales.All calculation performed by using SPSS.V.13.
Results: Mean age of patients was 48.27±11.42 with quality of life total score 64.92±24.28. Univariate analysis showed that occupation,duration of disease,grade of tumor,physical,emotional and cognitive functioning, also, symptoms such as fatigue,pain, nausea and vomiting , insomnia , constipation and financial difficulties, perspective were associated to quality of life. (P< 0.05). But in multivariate analysis, only occupation, menopause status, dyspnea , grade of tumor and financial difficulties perspective were related to quality of life (p<0.05).
Conclusions: With this finding, It is recommended that financial supports, also early detection are necessary for improvement of quality of life in these patients

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Background and objectives: The scattered state of villages both from their geographic aspect and the distance between residential units within a single village has made the task of supply, distribution and monitoring the quality of water a difficult one. Ideas of experienced people in the field of rural water quality control, has been obtained to reach gain a view on existing difficulties in supplying safe water to villages and the ways to overcome them.
Methods: Using a three-iteration Delphi procedure, consensus was built and measured among eleven managers and experts of rural water quality control. Given the large number of opinions and views ,the problems were discussed and were given priority according to the alphabetical order of the names of the participants.
 Results: The difficulties were summarized as of being, the main source of water supply, economic, human resources , facilities, cultural and extra organization issues.
Conclusion: The cooperation rate was 100% in this study and most of the problems were concerning no credible financial support in supplying of costs for the maintenance facilities, upkeep of networks and the incorrect choice made in selecting of the water resource. We can overcome to these problems by implementing reforms, teaching, retraining, constant supervision and efficient management of the working staff , supervision of special operations projects including mending of breaks in pipelines and thus could lead to a more efficient distribution to the villages on time.

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ackground & Objectives: In fact, economic growth, income inequality and health are integrated issues. Economic growth along with increasing income lead to individuals' health promotion and public health and has a positive impact on it, but if there is inappropriate policy to redistribute of these resources, it would have reverse effects. The purpose of this study was to examine the relationship between economic growth and ecological income inequality indices with health in Iran from 1978 to 2006.
Methods: An ecological study was designed and relevant data were gathered from the statistics center of Iran and Iran Central Bank. Results: The correlation between Gini coefficient and health indices was statistically significant (P<0.01). The association between economic growth and mortality rate of children under five years index (P<0.01) and with life expectancy (P<0.05) were statistically significant as well.
Conclusions: Economic development and decreasing income inequality should be considered as important determinant factors to have better health in Iranian society.

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Background and Objectives: Measuring the quality of life is one of the important indicators in evaluating health. The chronic disease is a one of the main cause of reduction in quality of life. The aim of this study was to assess the quality of life and its influential factors in 15-64 years old people in Kurdistan province, Iran.
Methods: In this cross-sectional study EUROHIS-QOL 8-item questionnaire was employed. Data was analyzed by SPSS statistical package.
Results: After adjusting the possible confounders, the mean score of quality of life was less in smoker 1.41 score versus non-smoker, in women 1.52 score versus men, in hypertension patients 1.41 score versus non-hypertension. The mean score of quality of life was reduced 0.05 per each year.
Conclusions: It is recommended to implement some interventions to manage properly current chronic diseases in order to increase the quality of life. It also seems that EUROHIS-QOL (8-item) is a suitable tool to measure the QOL in Iranian culture.

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Background & Objectives: Non-Communicable disease (NCD) is a main group of diseases which are responsible for a large proportion of the Global Burden of Disease around the world. Although disparities in the NCDs' risk factors can affect the goals of health for all, less attention has been paid so far on this topic. In this study, we investigated socio-economic inequality in the NCDs’ risk factors and evaluated the causes affecting on this inequality in Shahroud, Iran.
Methods: Conducting this survey, we used surveillance data for NCD of 1000 individuals who lived in Shahroud district during 2005. We determine a socio-economic variable which explained social and economic status of the people using Principal Component Analysis. We then evaluated each NCD risk factors at different levels of the socio-economic variable and calculated concentration index for the risk factors. The causes of the inequality were described by decomposition analysis of the concentration indices.
Results: Concentration indices for hypertension, smoking, insufficient physical activity, and unhealthy diet were -0.141, -0.191, -0.046 and -0.091, respectively. Differences of concentration curves of the risk factors from the line of equality were significant but not for diabetes, obesity and high blood cholestrol. Age, being a government employee, being unmarried, living in rural area and low economic status were the most important factors which influence on these inequalities.
Conclusion: Inequality in some NCD risk factors was significant in Shahroud district. More investigations with larger sample size and more appropriate variables to measure socioeconomic status are recommended.

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Background & Objectives: To assess vision related quality of life and determinants in patients afflicted with chronic eye disease.
Methods: In this analytical cross-sectional study, consecutive sampling was performed at Noor Eye Hospital between 2008 and 2009. A valid and standard 39-item visual functioning questionnaire (National Eye Institute visual functioning questionnaire, NEI-VFQ 39) was completed. The questionnaire consists of 11 domains related to vision and one domain about general health. The total score range from zero (0) to 100, where a higher score reflects better vision related quality of life. The independent t-test, pearson correlation coefficient as well as simple and multiple linear regression models were employed for statistical analysis.
Results: The mean overall score in patient and control groups were 54.5 [95% confidence interval (CI) 57.3 - 71.8] and 96.0 [95% CI: 88.2-103.9], respectively. Patients with cataracts had the highest score (64.6 95%CI: 57.3 - 71.8) and those with visual acuity of 20/70 or worse showed lowest scores (41.9 95%CI: 30.7 - 53.1). Age (P=0.006) and education level (0.001) were associated with quality of life score.
Conclusion: Based on our study findings, it could be concluded that low vision patients with a visual acuity of 20/70 or worse hardly received half of the total scores. Diabetic retinopathy, age related macular degeneration, glaucoma, and cataract stand in ascending rank order. The relatively lower scores as compared to results from other countries warrant further research into the causes of such differences.

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Background & Objectives: Aging and elderly population growth has been increased in Iran. Quality of life of older persons is important as a consideration in medical decisions and as a clinical outcome measure. Health related quality of life (HRQoL) is not well understood in this group therefore we designed this study to determine the quality of life among elderly populations of Tehran, Iran.
Methods: This cross-sectional study was conducted on a random sample of elderly people selected from the elderly centers in Tehran. The Iranian version of short-form Health survey (SF-36) and perceived social support questionnaires were employed as standard tools.
Results: Overall, 400 elderly people with the mean age of 64.07(SD =4.49) took part in this study. Of all participants, 298 individuals were women. The mean score of PCS (Physical Component summery) and MCS (Mental Component Summery) were 64.62 (SD= 12.68) and 63.35 (SD=4/7) respectively. The results of this study revealed that women compared to men had significantly higher scores in different dimensions of health related quality of life as physical function, social function, body pain and general health. Additionally, participants with lower body mass indexes, higher education level, married elderly, healthy aged participants and richer ones had higher scores of health related quality of life.
Conclusion: According to this study, there was correlation between mean PCS and social support as well as MCS and social support. Quality of life in female, individuals with higher education and socioeconomic status were higher than male, persons with lower education and socioeconomic status.

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Background & Objectives: Sleep quality is an important factor in student life and affects in their learning process. Sleep problems are related to increased health concerns, irritability, depression, fatigue, attention and concentration difficulties, along with poor academic performance. The aim of this paper is to conduct a survey based on a questionnaire that would characterize the quality of sleep in students living in dormitories of Tehran University of Medical Sciences (TUMS).
Methods: We conducted a cross-sectional study using the stratified random sampling approach on 277 students residing in dormitories in Tehran. A demographic questionnaire and Pittsburgh Sleep Quality Index (PSQI) were used for data collection.
Results: Mean (CI) of PSQI in students was 8.57 (8.10- 9.04). Using the cut-off score of 6 for the PSQI global score, 73.3% (68.1%-78.5%) of students were described as poor sleeper. Female students had a worse quality of sleep compared to male. The mean duration of sleep in students was 5:15´± 105´ (hours). This was significantly higher in male students than female students. There were no significant relationships between demographic variables such as age, academic level, marital status and family income with and quality of sleep.
Conclusion: This study showed that poor sleep quality is prevalent among students living in dormitories of TUMS. Therefore it is necessary to provide effective educational interventions for this group in order to improve the quality of sleep.

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Background & Objectives: The aim of this study was to identify the quality of life (QOL) measures commonly used to assess disabled people compared to healthy individuals.
Methods: A cross-sectional study was conducted in 1000 disabled and healthy individuals aged between 15 to 75 years old during 2009 year. These groups were selected by random sampling method multistage cluster sampling from Crescent Comprehensive Rehabilitation Center located in Tehran. WHO's Quality of Life (WHOQOL-100) questionnaire was used to measure quality of life.
Results: The Mean age were 35.9±12.9 and 35.1±12.7 years amongst disabled and non disabled groups, respectively. There was a significant difference between two groups in terms of somatic health and independence of quality of life (P<0.001), in which the mean score in both domains were high in healthy individuals. No significant difference was observed between two groups in other scopes.
Conclusion: Findings of this study highlighted the lower quality of life in disabled people in Tehran, Therefore this group should be targeted for any relevant intervention in order to improve their care.

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Background and Objectives: Inequity in health is a universal term which used for showing current differences, variations and inequalities of people in access to health. But inequality in health refers to some inequities which seems are unfair or caused by some errors and biases. The current study aimed to describe some of the common health related inequity measures to be useful for the inequity researchers and other interested health coworkers.
Methods: The calculation, advantage and disadvantage of most common health-inequity indexes including slope index of inequity, relative index of inequality, Theil’s Index, mean log deviation, index of disparity, Gini coefficient, weighted utilization social welfare function, absolute and relative concentration index were assessed. Inequity size of these measures was calculated by using the health care utilization survey data.
Results: Average of health care utilization in in-need subjects was 66.4%. This indicator was in the first to fifth quintiles equal to 57.6%, 63.4%, 71.6%, 69.5% and 75.3%, respectively. Relative concentration index and Gini coefficient was calculated as 0.053 and 0.0062, respectively.
Conclusion: Inequity in health care utilization in Markazi province differs based on the types of inequity measures. Selection of the inequity indexes dependent to the objective and the scale of under study variable. Among discussed indexes, concentration index determine the more accurate and also show the gradient of inequity. Therefore it can be used as the best index.

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Background & Objectives: Relationship between jobs and different aspects of health, including quality of life has been considered by researchers however the employment aim has risen in Iranian women in Iran but there is little known about the quality of life in this group, therefore the aim of this study was to investigate the relationship between employment and quality of life of women in the city of Zabol. Methods: This cross-sectional study was carried out during 2009-2010 in Zabol, Iran. The sample consisted of 420 women selected randomly from health care centers. Health-related quality of life was assessed using the SF-36 and classified using k-means clustering method. The relationship between the independent variables with the quality of life was assessed by multinomial logistic regression. Results: The mean age of participants was 30.46 ± 8.75 years. Quality of life indicated as low (35.4%), medium (33.7%) and high classes (30.9%), respectively. The results indicated that employed women were more likely than housewives to hadhigher quality of life. An increase age, significantly reduced respectively five and four percent of chance to had moderate and high level of quality of life. Conclusion: More than half of women had medium and low quality of life. Increasing age was associated with decreased quality of life, but employment was an independent predictor for higher quality of life.

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Background & Objectives: Randomized controlled trials are the most reliable type of study to be able to compare different interventions in scientific research. The introduction of bias into the design and conduct of randomized controlled trials can seriously affect the accuracy of the results and led to the results be invalid. The aim of this study was to assess the bias in randomized controlled trials published in Iranian nursing and midwifery journals.
 Methods: We searched all published articles in eight professional nursing and midwifery Iranian journals in 2010. Risk of bias in RCTs was assessed using of Cochrane group risk of bias standard tool by two reviewers independently.
Results: After reviewing the eight journals, 68 randomized controlled trials were retrieved. The majority of studies had unclear or high risk of bias. Random sequence generation in 22%, concealment allocation in 4.5%, blinding in 22%, incomplete outcome data in the 35.3%, selective outcome reporting in 51.5%, and other bias in 36.7% of the studies were in low risk of bias.
 Conclusion: A large proportion of the studies had high or unclear risk of bias. It was considerable that none reporting bias led to uncertainty reader from study quality. Bias might significantly affect the internal validity of the studies results therefore in interpretation of the findings of these studies caution should be taken.

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Background & Objectives: Nowadays, human values for example quality of life has important place to be considered as health index along with other measurements like morbidity and mortality indexes. This study intended to compare the quality of life for residents living in apartment’s flats more than 15 years with residents living in non-apartment housing in Shiraz.
Methods: The World Health Organization Quality of Life (WHOQOL_BREF) standard questionnaire was completed by participants. This population was chosen by a multi-stage sampling method in Shiraz city. Type of living accommodation, physical, psychological, social, and environmental health factors were adjusted in the linear model.
 Results: The mean score of health aspects in people who lived in apartment vs non apartment living were: physical 13.57 and 16.41, psychological 10.71and 14.87, social 8.57and 13.84 and in environmental 13.59 and 10.18 respectively, however after adjustment for gender, education, marital status, age, job, family size, income, type of disease (chronic, acute, chronic- acute), possession of house and area of house, changed to 14.41 for physical and 15.61, psychological 12.6 and 14.47, social 8.74 and 13.72 and environmental 15.42 and 9.23 (P<0.0001).
Conclusion: The results of this study show that the health of apartment-living residents even after adjustment of some other influencing factors, in major of domains was less than non apartment-living residents which indicating this issue should be considered in urban-living health.

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Background & Objectives: The world population is growing old. The rising proportion of the elderly is creating new health care challenges in the current century. This study aimed to determine the quality of life and the associated factors in the elderly population of Azerbaijan district in the city of Tehran, Iran.

Methods: This cross-sectional study was conducted on 287 elderly persons aged 60 and older. Participants were selected through systemic random sampling. The WHOQOL-BREF questionnaire, the Activities of Daily Living (ADL) questionnaire, and a questionnaire for demographic characteristics were used for data collection. Each domain was given a score between 0 to100 based on the WHO manual. The final variables were determined in a multivariate linear regression model using SPSS16.

Results: The mean score of the 4 domains of quality of life (physical, psychological, environmental, and social health) of the elderly population living in Azerbaijan district was 58.41, 53.13, 59.53, and 42.82, respectively.

Conclusion: A variety of correlates affect the quality of life of the elderly. Recognizing and considering these factors are important for planning more effective programs for the elderly and empowering them.

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Background & Objectives: Due to the increasing tendency to measure the quality of life in recent years and the extensive quality of life questionnaires, it is important to determine the appropriate method of analyzing data derived from these studies. The aim of the present study was to introduce ordinal logistic regression models as an appropriate method for analyzing the data of quality of life.

Methods: The data was derived from a cross-sectional study on quality of life survey of 938 students. For data analysis, two binary logistic regression models and ordinal logistic regression models were used and the results of these models were compared.

Results: The results of goodness of fit showed that all three models were fitted well. Based on the ordinal logistic regression models, the three variables out of the explanatory variables were statistically associated with the response while based on the binary logistic regression model, after combining two categories of response variable, only two variables were significant. Therefore, combining the categories of the response variable should be avoided as much as possible because it may lead to data loss due to ignoring some of the response categories.

Conclusion: It is concluded that to analyze quality of life data, due to the nature of the response variable, ordinal logistic regression models are recommended considering the fewer parameter estimates and easier interpretation of the results

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  Background & Objectives: Households governed by women have become an important phenomenon worldwide in the second half of the twentieth century. The study of female-headed households shows that this vulnerable social group faces many financial, physical, mental, and emotional problems and experiences stress and anxiety more than men-headed households. This study aimed to determine the quality of life in these households supported by District 9 of Tehran Municipality.

  Methods: This cross- sectional study was performed on female-headed households supported by District 9 of Tehran municipality during 14 months. Data collection tools included a demographic questionnaire, the Iranian version of World Health Organization Quality of Life (WHOQOL-BREF-BREF). The data was analyzed using SPSS software version 16 and descriptive- analytic tests such as mean, standard deviation, and a multiple regression analysis. The significance level in this study was considered α < 5% .

  Results : The mean age of the participants was 50.8 ± 13.8 years, and the majority of the female-headed households were unemployed (71.1 %). The findings in the four domains of quality of life showed that the domains of environment health and social relation received the lowest (9.87) and the highest (12.61) score, respectively. Using multiple regression models, it was shown that the only variables that affected the overall quality of life were age (P< 0.013) and current disease (P< 0.001).

  Conclusion : Findings demonstrated that the authorities should consider planning for effective interventions to improve the quality of life in this vulnerable group of society.

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Background and Objectives: The main question that arises in ‘Quality of Life’ (QOL) studies is how people assess this phenomenon and what factors affect it. Using these answers, we can better analyze the findings of QOL studies in our country.

Methods: In this content analysis, we carried out semi-structured interviews, and applied maximum variation opportunistic sampling in terms of gender, age, education, ethnicity, and economic status. First, we asked the participants to answer the question on QOL by thinking aloud. Then, they were asked to discuss the factors that affected their choice a posteriori. Finally, the inductive qualitative analysis was done and the mental model of the participants was extracted.

Results: We extracted five main categories and 33 themes. These categories included physical factors, psychological factors, socioeconomic factors, family issues, and environmental factors. Physical health, expectations, satisfaction, community engagement, financial problems, environmental pollution, leisure and recreation, family environment, family relationships and the role of the wife were the most important factors affecting the QOL in the participants’ opinions.

Conclusion: In addition to the health status, family issues such as the family environment and financial problems affected the QOL. Moreover, the participants believed environmental health was an integral part of QOL.

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Background and Objectives: One of the issues affecting the health sector is the presence of regional inequalities. The purpose of this study was to evaluate the trend of inequality in the distribution of human resources and health facilities in the health sector of Iran.
 
Methods: In this study, inequality in the distribution of human resources and health facilities in the health sector was assessed using the Gini coefficient in 2006, 2011, and 2015. The variables included human resources (6 indicators) and health facilities (10 indicators). Data were collected from the Statistical Center of Iran and the Statistics and Information Technology office of the Ministry of Health. For a Gini coefficient less than 0.35, 0.35-0.5, 0.5-0.6, more than 0.6 indicated relatively balanced inequality, relatively unequal inequality, high inequality, and very high inequality, respectively.
 
Results: The maximum Gini coefficient belonged to radiographic centers (0.61) and the minimum was Behvarz (0.23). In human resources indicators, inequality decreased over the study years from 0.57 to 0.27. However, inequality showed a slight increase in Behvarzes from 0.24 to 0.26. Among the facilities indicators, the Gini coefficient of urban health centers, health care facilities, beds, and radiology centers decreased from 0.45 to 0.31, whereas other indicators had an increasing trend from 0.24 to 0.59. In the private sector, there was a high inequality (0.5 to 0.61).
 
Conclusion: Eliminating inequalities in the distribution of health sector resources can help to improve justice in health outcomes. Therefore, policymakers should be pay more attention to eliminating inequalities.

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Background and Objectives: Universal health coverage will have a problem in achieving it’s goals if it doesn’t consider the quality. This study aimed to Background and Objectives: Universal health coverage cannot achieve it’s goals if it doesn’t consider the quality. This study wants to assess the quality of health services in Iran, identify existing challenges and provide solutions.
 
Methods: This study was a mixed qualitative and review study. In the first stage, the national main indicators of the quality of services were reviewed. Then, the orientation of the available upstream documents on the quality of services was explained. The most important challenges, trends, and recommendations of health quality improvement were extracted via interviews.
 
Results: Proper observation of the Iran health care quality requires appropriate framework and indicators. Upstream documents strongly emphasized on the government's responsibility to play a key role as stewardship and that the health system should provide the necessary structural, procedural, and consequential requirements besides determining appropriate model. Quality management programs had obstacles in some aspects like the performance of managers and human resources, structural/communicational requirements, education, payment system, culture, use of quality management indicators and models, financial, information, and equipment resources, laws and regulations, and supervision.
 
Conclusion: Improving the quality of health services in Iran requires strategies in organizing, resource generation, payment, laws and regulations, and behavior of policy makers and planners. Quality tools should be used without haste and should pay attention changes in the nature of diseases, expectations of stakeholders, and increased global attention to this issue in designing related plans.