Journal of School of Public Health and Institute of Public Health Research

Assessing the effect of educational intervention on some barriers of living with diabetes among type 2 diabetes: Application of BAZNEF Model

Roya Sadeghi

Background and Aim: Overcoming barriers of living with type-2 diabetes mellitus is a challenge in line with empowering patients for a well-managed life. This study was conducted to determine the effect of an educational intervention based on the BASNEF model on the living barriers among type-2 diabetes patients and factors affecting it.

Materials and Methods: This study, conducted in 2014, was a quasi-experimental intervention including a total of 90 type-2 diabetes patients under coverage of South of Tehran Health Centers, randomly divided, after a pre-test, into 2 groups ─ an experimental and a control (comparison) group. Based on the information obtained through the pre-test, a one-month education was imparted at the experimental group in 6 sessions the control group received no education. The educational contents included, based on the BASNEF model constructs, diabetes as a disease and its cardiovascular complications, healthy nutrition, physical activity, methods of self-monitoring blood glucose control, and ways of communication with the health personnel and physicians.

Results: The findings showed significant differences between the mean scores of constructs of the BASNEF model (beliefs, attitudes, subjective norm, enabling factors) and constructs of barriers of living with diabetes (diagnosis, treatment, self-monitoring, communication with health professionals) in both the experimental and control groups before and after the intervention (p<0.0001).

Conclusion: The findings of this study show the necessity of educating type-2 diabetes patients aiming at reducing barriers to living with the disease. The BASNEF model is one of the applicable theories that can be used to this end.

Factors affecting pregnancy, postpartum and neonatal complications in rural areas of Kurdistan Province, Iran

Fahimeh Ramezani Tehrani

Background and Aim: Prenatal and neonatal care provides an opportunity for counseling, resulting in reduction of pregnancy-related and neonatal complications. It is expected that such care would result in promoting the health status of these vulnerable groups and improving the relevant indicators.

Materials and Methods: This was a cross-sectional survey including 668 mothers and 2-month-old children. Data were collected using questionnaires and structured interviews.

Results: On the whole, 35.9%, 21.0% and 5.1% of the mothers reported, at least, one pregnancy, one complication, and one neonatal complication, respectively. Results of the logistic regression model showed that the odds ratio of reporting at least one of the pregnancy complications increased by more than double in women who had a medical history or a high-risk pregnancy, increase decreased by 63% in those who had continuous care during pregnancy, decreased by 40% in those who had received thorough prenatal care, and increased by 0.05% for every unit increase in age. The odds ratio of reporting at least one postpartum complication increased by 70% per unit of in the density of health workers. Moreover, the odds ratio of reporting at least one neonatal complication decreased by 48% in women who had received full neonatal care and by 50% per every unit of increase in the density of health workers.

Conclusion: The findings of this study show the important role of behvarzes (community health workers) in detecting postpartum and neonatal complications, as well as the importance of antenatal care and quality of antenatal care as regards detecting at-risk women and neonates and prevention of pregnancy and antenatal complications.

Assessment of the health system performance of the Pars Energy-Economic Zone

Abbas Vosough Moghaddam

Background and Aim: The Pars Energy-Economic Special Zone, as the energy capital of Iran, needs a healthy productive workforce. In order to be able to promote equitable health indicators of the Zone, it is essential to first obtain information about the situation of the health system in the region.

Material and Methods: This was a cross-sectional qualitative study. Data were collected using an essential public health services (EPHS) performance assessment questionnaire and a researcher-developed questionnaire for strengths, weaknesses, opportunities and threats (SWOT) analysis of the Zone health system. In the next phase, stakeholder analysis was done: the major stakeholders were invited and asked, after explaining the methodology to them, to complete, individually, the EPHS performance assessment and the SWOT analysis questionnaires, followed by grouping and summarizing the results. Finally, content analysis of results of the group discussions was done and the main domainsا extracted.

Results: The EPHS overall average score was 37.8 (out of 100, the standard score). The greatest weakness was allocated to information functioning. Delivering public health services by the district health networks was the most important strength. Further analysis of the data showed that the far external environment in all the subdomains was the major threat to the public health in the zone.

Conclusion: Based on the findings, it can be said that the organizational status of the Zone is in a weak and threat position. One of the root causes is poor functioning of the public health system. It is essential that the Ministry of Petroleum and the Ministry of Health and Medical Education find effective ways for integrated leadership of the public health services in the Zone.

Association between physical activity and body mass index in different melanocortin receptor 4 (MC4R) genotypes

Hamideh Pishva

Background and Aim: Malfunction in the energy homeostasis central system resulting from melanocortin receptor 4 (MC4R) mutations is considered to be an important factor in development of obesity. Although physical activity can weaken the effect of obesity-related genes, very few investigations have been carried out in relation to the MC4R gene. This study was conducted to investigate the association between physical activity and body mass index (BMI) in different MC4R genotypes (rs17782313).

Materials and Methods: A sample of 400 individuals was randomly selected from among subjects participating in the Iranian Multicenter Osteoporosis Study (IMOS). Their weights and heights were measured and their dietary intakes and physical activity data assessed using validated questionnaires. In addition, the different MC4R genotypes (rs17782313) were determined in the subjects by the PCR-RFLP method. Finally, using the adjusted multiple linear regression model, the probable effect of physical activity on BMI in different MC4R polymorphisms (rs17782313) was determined.

Results: Only in individuals with the CT genotype was a statistically significant association (p<0.05) observed between body mass index and physical activity (hr/d and METs-hr/wk).

Conclusions: Physical activity, particularly in heterozygous MC4R polymorphism individuals (rs17782313), can play an effective role in reducing body mass index.

Creating a reserve bank of Plasmodium falciparum and Plasmodium vivax isolates collected from malaria patients for use in studies on the genetic and biological features

Mehdi Nateghpour

Background and Aim: Considering the ongoing national malaria elimination program in Iran, establishing a bank of human Plasmodium genes and proteins can be very useful for research purposes. This study was conducted to collect some of the native isolates of human Plasmodia from endemic areas in the country.

Materials and Methods: A 2ml vein-punctured blood sample was prepared from each confirmed malaria case. The samples were dispensed in EDTA pre-dosed tubes and cryopreserved for further tests. Moreover, relevant Geimsa-stained thick and thin blood smears were kept in a safe place. Tests for genetic indicators of MSP-1 was performed for each of the P. vivax samples with the RFLP-PCR techniques. In addition, an in vivo drug sensitivity test was performed for each P. falciparum case. Collecting and cryopreserving samples will continue.

Results: A total of 131 samples, including 109, 19 and 3 P. vivax, P. falciparum and mixed samples, respectively, were preserved with relevant data such as species, parasitaemia and nationality of the donor. MSP-1 gene classification resulted in three different haplotypes including Hap.1, Hap.2 and Hap.3 with frequencies of 20.6%, 41.2% and 38.2%, respectively. The In vivo drug sensitivity tests on P. facilparum isolates showed that all of the isolates were sensitive to the current drug of choice, namely, a combination of artesunate and fansidar.

Conclusion: This study resulted in the preservation of considerable amounts of P. vivax and P. falciparum samples for further relevant studies and research purposes.

Association between food insecurity and gestational diabetes mellitus: A case- control study

Amir Mansour Alavi Naeini

Background and Aim: Diabetes mellitus is one of the most common medical problems in pregnant women. Nutrition plays an important role in the prevention and control of this disease. Some studies have found a relationship between gestational diabetes mellitus (GDM) and food insecurity. The objective of this study was to investigate the association between food insecurity and GDM.

Material and Methods: : This case-control study included 274 pregnant women (137 GDM cases and 137 healthy controls) selected by convenience sampling. Data on the subjects’ food insecurity, demographic features and physical activity (MET) were collected by interviewing and their heights and weights measured. For the analysis of the data, the Chi-square test, independent sample t-test and multivariate and univariate logistic regression tests were used, the statistical software being SPSS 16.0.

Results: On the whole, 18.2% and 21.9% of the women in the case and control groups suffered from food insecurity, respectively. There were statistically significant differences between the case and control groups with regard to a previous history of pregnancy, a family history of diabetes in the first and second degree relatives, and a history of giving birth to a baby weighing over 4 kgs.

Further analysis of the data showed a family history of diabetes mellitus and a low socio-economic status to be independent risk factors for GDB.

Conclusion: No statistically significant difference was observed between food insecurity of the women and gestational diabetes mellitus in this study. Despite this finding, considering that there are associations between food insecurity and other types of diabetes mellitus, we recommend further studies on this subject to be able to either accept or reject the hypothesis on the association between food insecurity and gestational diabetes mellitus.

Development and psychometric evaluation of an instrument for the care of danger signs in under-5 year-old children based on the Health Belief Model

Mohsen Shamsi

Background and Aim: Currently there is no standardized and validated questionnaire for assessing the care of danger signs in children less than 5 years by the mothers based on behavioral patterns. The aim of this study was to develop and evaluate psychometrically an instrument for assessment of the care of danger signs in children less than 5 years old by the mothers based on the Health Belief Model.

Materials and Methods: This cross-sectional study was carried out on 350 mothers in the City of Arak, Iran. After reviewing the related literature, an instrument was designed and its content validity ratio (CVR), content validity index (CVI) and face validity were measured. To measure the reliability of the scales, the internal consistency method was used. Data analysis was done using the SPSS software.

Results: The scores of the CVI and CVR of the 81 items were found to be 0.79 and 0.62, respectively, the items being classified into seven categories. Based on the Cronbach's alpha, the overall reliability was 0.86. The reliability of the questionnaire for checklists of performance was 0.99, followed by those of perceived benefits (0.90), severity (0.83), perceived barriers (0.68), knowledge (0.66), perceived susceptibility (0.65), self-efficacy (0.63), and cues to action (0.56). Conclusion: The output of this psychometric process study is a valid and reliable instrument for measuring symptoms of risk behaviors in the care of vulnerable children based on the health belief model constructs, which can be used in health sciences research aiming at helping to protect the health of children.

A retrospective study on distribution, frequency and rate of parasitaemia in patients infected with Plasmodium species in Kerman Province, Iran during the period 2009-2010

Mehdi Nateghpour

Background and Aim: Malaria is still one of the major health problems in comparison with any other parasitic disease in Iran with considerable economic and mortality consequences. Sistan-and-Baluchestan, Hormozgan and Kerman are the most affected provinces in the country approximately 96% of the cases are reported from these three provinces. The aim of this study was to determine the frequency, distribution and rate of parasitaemia of human Plasmodium (P.) species in patients infected with malaria parasites in Kerman province.

Materials and Methods: A total of 92,798 peripheral blood smears were collected from suspected malaria patients during the period 2009-10. Thin and thick blood smears were prepared according to the World Health Organization (WHO) standard procedure. Percentage of parasitaemia was determined based on the number of parasites in the positive slides. The Chi-square test was used for data analysis.

Results: A total of 571 samples were found to contain human Plasmodium species, including 523, 44, and 4 cases of P. vivax, P. falciparum and mixed infection, respectively. The results also showed that, as compared with the previous year, the total number of P. vivax cases

decreased in 2010 by 33.96%. The highest level of parasitaemia was observed in one of the patients infected with P. falciparum, with 77240 parasites/µl of blood, and the lowest in a patient infected with P. vivax, with 48 parasites/µl of blood. There were no differences between the positive and negative cases as regards parameters such as nationality, habitat or gender (Chi-square, p<0.05). Furthermore, based on the Mann-Whitney test, there was no significant difference between the mean counts of P. falciparum and P. vivax (p-value = 0.464).

Conclusion: Considering that Iran is in the elimination stage of malaria, patient finding and rapid, timely diagnosis of the disease are very important, particularly cases coming from Pakistan and Afghanistan, helping sustainability of the elimination program.